Medicine

Greece, Iran, Iraq, Jordan, Kuwait, Lebanon, Morocco. Pakistan, Saudi Arabia, Sudan. Syrian Arab Republic. Turkey. USSR, United Arab Republic, Yemen, Yugoslavia. The Conference first expressed its deep concern over the steady westward progress of cholera and noted that, although the current pandemic seemed less virulent than those of the past. its presence in the Eastern Mediterranean region required sharp vigilance and great efforts to prevent its further spread. Practically all lives can now be saved by the prompt application of modern treatment, as the Conference stressed. If proper measures are applied quickly. there is no need for undue alarm. or for irrational action as was customary in the past. when the appearance of cholera meant a national disaster. great suffering and misery. This highlights the danger of failing to recognize and report an outbreak in its earliest stages. New features of the current pandemic include the fantastic increase in speed and volume of travel todayincluding tourism, pilgrimages and mass movement of nomads, migrants and seasonal labourers. There is also the difficulty of detecting mild cases and carrier states in healthy persons. The WHO Conference in Ankara established principles to be followed in the control of cholera and stressed the need for: (i) strengthening of health services, so that cholera control can be carried out without serious interruption of the normal life of the country; (11) immediate improvement of sanitation and health education of the general public; (iii) concentrated efforts to clean out infected areas where the disease has been known to exist for centuries as well as those now in the process of being established; (iv) correct application of the International Sanitary Regulations, with avoidance of excessive and ineffective measures. The Conference recognized that "early and reliable reporting of quarantinable diseases, including cholera, is a legal and moral obligation of each State. It enables countries concerned as well as the World Health Organization to undertake protective measures in good time for the benefit of all". Conclusions and recommendations reached by the Conference were considered to be of great practical importance for the prevention of cholera. They deal in particular with the need for: (a) investigation and surveillance of all enteric and diarrhreal diseases; (b) training of medical, paramedical and laboratory staff to this end; (c) development of modern rehydration and other treatment facilities which are of paramount importance in the prevention of death (without treatment as many as one-third of all cases are fatal, but with prompt and adequate action. mortality drops to less than 1%); (d) improvement of sanitation and food control, and construction of sanitation facilities to keep pace with social and industrial development and increased tourism and trade; (e) health education of the public to avoid creation of panic and to enlist their active participation in cholera control through personal and domestic hygiene. The Conference emphasized the importance of international cooperation in the prevention and control of cholera and invited all countries to join the efforts of the governments already involved and of the World Health Organization. To this effect. countries were invited to make donations to the WHO Cholera Vaccine Bank and to the WHO Spe.cial Account for Cholera Control. The Conference expressed its hope that countries would explore possibilities and opportunities for mutual assistance in various aspects of cholera prevention and control. As a footnote to this conference It is interesting to learn that the present. or seventh, pandemic (six occurred between 1817 and 1899) started in 1961. when cholera broke out of Sulawesi, or Celebes Island. in Indonesia and swept through the Far East gaining ground every year. It has now been reported from most parts of Asia. extending from the Philippines in the east to Iran and Iraq in the west and from Korea in the north to West Irian in the south-east. The cholera strain responsible for this latest epidemic, the El Tor vibrio, had first been considered as different from the classical strains of cholera and less dangerous. 'I'he issue was settled in 1962 by a WHO Scientific Group, which stated that the disease caused by the El Tor vibrio was indistinguishable from that caused by the vibrio of classical cholera, and that El Tor infection must be regarded as essentially identical with classical cholera and treated as such. The present pandemic is caused in most cases by the El Tor strain, which has supplanted the classical strains even in India. but not in East Pakistan. In some areas both types are found. The most important characteristic of the present pandemic is that countries previously free from the disease have become invaded, and there is evidence that new endemic foci have been established.