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January 2023, Volume 73, Issue 0

Letter to the Editor

The uncertainty of Cholera epidemic

Zubia Afzal  ( Department of Medicine, King Edward Medical University, Lahore, Pakistan. )
Abdul Rehman Gull  ( Department of Medicine, King Edward Medical University, Lahore, Pakistan. )

DOI: 10.47391/JPMA.6960210


Madam, Pakistan is facing the worst cholera outbreak in the last few years in one of the leading cities, Karachi, however government denies the existence of an epidemic. Cholera, an acute infection of the small intestine is caused by the bacterium Vibrio cholera. It causes acute watery diarrhoea within 12 hours to 5 days of ingestion of contaminated food or water. Most people are asymptomatic but play an important role in the spread of the disease by shedding bacteria in their faeces. If left untreated, severe dehydration can lead to shock, renal failure and death.

Cholera has been declared an endemic disease in Pakistan but reporting of actual diagnosed cases still remains an issue.1 Poor sanitation and lack of hygienic practices can contribute towards increased cases. The recent outbreak of cholera in Sindh especially Karachi is the result of lack of proper healthcare measures, as it had been predicted in a recent study on occurrence of cholera infection in the country.2 The director of the National Institute of Child, Professor Dr Nasir Saleem revealed to the media that at least 10-15 cases are diagnosed as cholera among 100 children coming to hospital daily. Diagnosed cases of cholera can be treated properly with fluid replacement and antibiotics reducing the severity of disease.3

Doctor Faisal Mahmood, an infectious disease expert, has also confirmed the enormity of the recent outbreak. A total of 618 suspected cases of Cholera have been reported in mid March 2022 in Sindh by National Institute of Health (NIH) in its weekly bulletin of Integrated Disease Surveillance and Response. The 'Ogawa' strain has been implicated for this outbreak which has shown varied resistance to different antibiotics in past years, making treatment complicated.4

Despite these confirmations from the health department, Government officials have been denying the outbreak. They concede to 129 confirmed cases of cholera in last 4 months in Karachi, however, do not consider them enough to call it an outbreak. This paradoxical conclusion has led healthcare workers to emphasize that the government needs to acknowledge the outbreak for proper management and prevention. Global Task Force on Cholera Control (GTFCC) launched the country-led strategy 'Ending Cholera: A Global Roadmap to 2030' for cholera control in 2018.5 If our country fails to execute one of its most important strategy to detect and respond to cholera outbreaks quickly, how will we ever decrease cholera morbidity and mortality?


Submission completion date: 23-05-2022


Acceptance date: 08-09-2022


Disclaimer: None to declare


Conflict of Interest: None to declare


Funding Disclosure: None to declare




1.      Naseer M, Jamali T. Epidemiology, determinants and dynamics of cholera in Pakistan: gaps and prospects for future research. J Coll Physicians Surg Pak. 2014;24:855.

2.      Zohra T, Ikram A, Salman M, Amir A, Saeed A, Ashraf Z, et al. Wastewater based environmental surveillance of toxigenic Vibrio cholerae in Pakistan. Plos One. 2021; 16:e0257414.

3.      Bhatti MW. No awareness in public as City Faces 'Worst Cholera outbreak in recent years'. The News International. [Online] [Cited 2022 July 23]. Available from: URL:

4.      Hasaan A, Shanker B, Qazi A, Zaman A, Kapoor A, Kumar N. The frequency of vibrio cholera 01 EL TOR (Inaba And Ogawa) and its Resistance Pattern in Karachi. J Muhammad Med Coll. 2020; 11:21-6.

5.      Legros D. Global cholera epidemiology: opportunities to reduce the burden of cholera by 2030. J Infect Dis. 2018; 218:S137-40. doi: 10.1093/infdis/jiy486

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