CHOLERA IN GOMA, JULY 1994

In 1994, between July 14 and July 20, around one million of Rwandan re fugees fled to the North Kivu region of Zaire, In spite of the existen ce of favorable conditions for cholera, it was necessary to wait until the laboratories isolated the first strain of cholera, on July 20 and 21, before the international community took action in one of the most important outbreaks of cholera known. The total number of cases of ch olera was 36 471, of which half occurred between July 21 and July 27, reaching a peak on July 26. The average overall mortality was 28 per 1 0 000 in the second half of July, and 5 per 1O 000 in the first half o f August. 85 percent cent of the deaths are associated with diarrhea a nd 60 percent of these deaths with diarrhea are caused by cholera, the other being caused by dysentery. From July 24 to September 17, the Bi oforce laboratory (French army) carried out 396 coprocultures: it isol ated 78 strains of cholera (Vibrio cholerae 01, biotype El Tor, seroty pe Ogawa, resisting at 0129, without indole), and 77 strains of shigel la (Shigella dysenteriae type 1). There were several causes of this ou tbreak, among which the most important was the lack of water: during t he first week, the average available of water was been evaluated at 20 0 ml per day per person; the other causes of this outbreak were the im possibility, to dig latrines, the lack of hygiene, the level of health and the promiscuity among the refugees. One of the modalities to limi t this outbreak of cholera would probably have been to anticipate the subsequent cases and deaths by a massive international response adapte d to this risk, as soon the Rwandan refugees began to flood in Goma.