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Ministry confirms cases of cholera

THE Ministry of Health has reported that more than 100 Cambodians have tested positive for cholera since November, reversing its initial refusal to confirm the presence of the disease and simultaneously defending its handling of the outbreak.

Speaking at a joint press conference held with the World Health Organisation (WHO) on Friday, Minister of Health Mam Bunheng said there had been 128 confirmed cholera cases and one death. About 65 percent of the cases involved children under the age of 15, and the single recorded fatality was an 82-year-old man from Takeo province who died after contracting cholera in January, he said.

Dr Nima Asgari, a public health official at the WHO, on Sunday noted that the nation has only four hospitals, all in Phnom Penh, with the correct laboratory facilities required to test for cholera, adding that it would be “almost impossible to estimate the actual number of cases of cholera” nationwide.

Prior to Friday, ministry officials had not released any information about cholera cases, drawing criticism from officials at Kantha Bopha Children’s Hospital in Phnom Penh, who said they had been forwarding information on cases of cholera to the government since mid-November.

Though doctors at the hospital last week accused the government of not doing enough to publicise the outbreak, Mam Bunheng said his ministry had tried to balance the need to be forthcoming and the need to avoid sowing “panic”.

“We have not hidden any cases,” he said, pointing out that cholera cases had been reported in “three or four” Khmer-language newspapers. He said the ministry had refrained from making more publicising information about the cases so as to avoid encouraging people to seek unnecessary treatment and potentially overwhelm medical facilities.

“We may cause panic among people, and they will rush to hospitals to get treated,” he said.

He said the ministry had taken immediate action after the first case was confirmed, visiting provinces in which potential cases had been reported to educate residents about the importance of frequent hand-washing, covering toilets and boiling drinking water. He also said the ministry had distributed oral rehydration salts, intravenous fluids and chlorine for disinfecting water.

Mam Bunheng said an uptick in diarrhoea cases was common during the dry season.

“An increase in diarrhoea is not unusual at this time of year in Cambodia, when water levels are low and people may be tempted to use unprotected water sources,” Mam Bunheng said.

“I hope the press will inform people about preventions rather than making them panic.”

Dr Sok Touch, director of the Health Ministry’s Communicable Diseases Control Department, echoed that sentiment, saying: “This [press conference] is not to declare an emergency but to provide an update about cholera cases.”

Treatment
As they have throughout the past week, government and WHO officials argued that, when it comes to treatment, there is little difference between cholera and other forms of acute watery diarrhoea.

“We want to consider cholera as just another kind of diarrhoea,” Sok Touch said. He added that it was important for people to practice good hygiene to protect themselves from all forms of diarrhoea, not just cholera.

Asgari reiterated that most cholera cases can be treated with oral rehydration, and that only 10 to 20 percent of cases become severe enough to require hospitalisation.

He disputed the argument put forth by Kantha Bopha doctors last week that all suspected cases of cholera should be treated with antibiotics.
“Antibiotics should be used for only severe cases of acute watery diarrhea,” Asgari said, adding that indiscriminate use of antibiotics could eventually render them less effective.

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