The stuff in poop that kills: Vibrio cholerae

Within the first hour of arriving in Dhaka, Bangladesh, I passed a man with his pants down urinating into the flooded waters that pooled around us. Mistaking a floating bag for a rock, I stepped and sank deep into the plastic bag. The field researchers whipped around with horror and amusement on their faces. I stared down at my legs submerged in the brown water and watched a piece of feces bubble and bump against my calf.  I couldn't have asked for a warmer welcome into the discipline of cholera and diarrheal diseases.  

Vibrio cholerae, a gram-negative bacterium, affects over 1.4 billion people globally and kills hundreds of thousands of people each year. For several years I worked as a research coordinator for a NIH funded study on cholera prevention. My team set out to produce a sustainable behavior-based program called CHoBI-7, to prevent the spread of cholera among household contacts.

Simple interventions like a providing a hand washing station, teaching when there are hand washing opportunities with pictures, and teaching when and why to boil water, were among some of the tools we provided. Our dream was to save lives, millions at a time.

Our findings demonstrated that our Cholera Hospital Based Intervention for 7 Days (CHoBI7) was effective in significantly reducing symptomatic cholera infections 6 months post-intervention. The next step is to scale-up the program so a greater proportion of the country as well as other countries can benefit from CHoBI7.

In the United States, we take our water quality, sanitation, and hygiene for granted. I challenge you to think on when you first learned about hand washing or when you first trusted that your drinking water isn’t contaminated with your neighbor’s urine and feces. Will you get rice-water diarrhea today? Maybe not, but someone across the globe will. Next time you do the dishes, think about all the clean water you let rush down the drain, think about your drain and how it's connected to a pipe that goes somewhere. And as you stare at that clean water you're wasting, know that you've done this ... just because you can.

George, C. M., Jung, D. S., Saif-Ur-Rahman, K. M., Monira, S., Sack, D. A., Rashid, M. U., ... & Winch, P. J. (2016). Sustained uptake of a hospital-based handwashing with soap and water treatment intervention (cholera-hospital-based intervention for 7 Days [CHoBI7]): a randomized controlled trial. The American journal of tropical medicine and hygiene, 94(2), 428-436.