Preventive inoculation against<unk>  in 1966 The World Health Organization (WHO) recommends focusing on prevention, preparedness, and response to combat the spread of<unk> . They also stress the importance of an effective surveillance system. Governments can play a role in all of these areas. Water, sanitation and hygiene Although<unk>  may be life-threatening, prevention of the disease is normally straightforward if proper sanitation practices are followed. In developed countries, due to nearly universal advanced water treatment and sanitation practices present there,<unk>  is rare. For example, the last major outbreak of<unk>  in the United States occurred in 1910–1911.<unk>  is mainly a risk in developing countries in those areas where access to WASH (water, sanitation and hygiene) infrastructure is still inadequate. Effective sanitation practices, if instituted and adhered to in time, are usually sufficient to stop an epidemic. There are several points along the<unk>  transmission path at which its spread may be halted: * Sterilization: Proper disposal and treatment of all materials that may have come into contact with<unk>  victims' feces (e.g., clothing, bedding, etc.) are essential. These should be sanitized by washing in hot water, using chlorine bleach if possible. Hands that touch<unk>  patients or their clothing, bedding, etc., should be thoroughly cleaned and disinfected with chlorinated water or other effective antimicrobial agents. * Sewage and fecal sludge management: In<unk> -affected areas, sewage and fecal sludge need to be treated and managed carefully in order to stop the spread of this disease via human excreta. Provision of sanitation and hygiene is an important preventative measure. Open defecation, release of untreated sewage, or dumping of fecal sludge from pit latrines or septic tanks into the environment need to be prevented. In many<unk>  affected zones, there is a low degree of sewage treatment. Therefore, the implementation of dry toilets that do not contribute to water pollution, as they do not flush with water, may be an interesting alternative to flush toilets. * Sources: Warnings about possible<unk>  contamination should be posted around contaminated water sources with directions on how to decontaminate the water (boiling, chlorination etc.) for possible use. * Water purification: All water used for drinking, washing, or cooking should be sterilized by either boiling, chlorination, ozone water treatment, ultraviolet light sterilization (e.g., by solar water disinfection), or antimicrobial filtration in any area where<unk>  may be present. Chlorination and boiling are often the least expensive and most effective means of halting transmission. Cloth filters or sari filtration, though very basic, have significantly reduced the occurrence of<unk>  when used in poor villages in Bangladesh that rely on untreated surface water. Better antimicrobial filters, like those present in advanced individual water treatment hiking kits, are most effective. Public health education and adherence to appropriate sanitation practices are of primary importance to help prevent and control transmission of<unk>  and other diseases. Handwashing with soap or ash after using a toilet and before handling food or eating is also recommended for<unk>  prevention by WHO Africa. File:Unsafe disposal of faecal sludge or sewage in Haiti (6458176073).Dumping of sewage or fecal sludge from a UN camp into a lake in the surroundings of Port-au-Prince is thought to have contributed to the spread of<unk>  after the Haiti earthquake in 2010, killing thousands. File:A SOIL EkoLakay toilet customer. (15921409131).Example of a urine-diverting dry toilet in a<unk> -affected area in Haiti. This type of toilet stops transmission of disease via the fecal-oral route due to water pollution. File:Cholera hospital in Dhaka.Cholera hospital in Dhaka, showing typical<unk>  beds". Surveillance A modelling approach using satellite data can enhance our ability to develop<unk>  risk maps in several regions of the globe. Surveillance and prompt reporting allow for containing<unk>  epidemics rapidly.<unk>  exists as a seasonal disease in many endemic countries, occurring annually mostly during rainy seasons. Surveillance systems can provide early alerts to outbreaks, therefore leading to coordinated response and assist in preparation of preparedness plans. Efficient surveillance systems can also improve the risk assessment for potential<unk>  outbreaks. Understanding the seasonality and location of outbreaks provides guidance for improving<unk>  control activities for the most vulnerable. For prevention to be effective, it is important that cases be reported to national health authorities. Vaccination Euvichol-plus oral vaccine for<unk>  Spanish physician Jaume Ferran i Clua developed a<unk>  inoculation in 1885, the first to immunize humans against a bacterial disease. However, his vaccine and inoculation was rather controversial and was rejected by his peers and several investigation commissions. Russian-Jewish bacteriologist Waldemar Haffkine successfully developed the first human<unk>  vaccine in July 1892. He conducted a massive inoculation program in British India. A number of safe and effective oral vaccines for<unk>  are available. The World Health Organization (WHO) has three prequalified oral<unk>  vaccines (OCVs): Dukoral, Sanchol, and Euvichol. Dukoral, an orally administered, inactivated whole cell vaccine, has an overall efficacy of about 52% during the first year after being given and 62% in the second year, with minimal side effects. It is available in over 60 countries. However, it is not currently recommended by the Centers for Disease Control and Prevention (CDC) for most people traveling from the United States to endemic countries. The vaccine that the US Food and Drug Administration (FDA) recommends, Vaxchora, is an oral attenuated live vaccine, that is effective as a single dose. One injectable vaccine was found to be effective for two to three years. The protective efficacy was 28% lower in children less than five years old. However, , it has limited availability. Work is under way to investigate the role of mass vaccination. The WHO recommends immunization of high-risk groups, such as children and people with HIV, in countries where this disease is endemic. If people are immunized broadly, herd immunity results, with a decrease in the amount of contamination in the environment. WHO recommends that oral<unk>  vaccination be considered in areas where the disease is endemic (with seasonal peaks), as part of the response to outbreaks, or in a humanitarian crisis during which the risk of<unk>  is high. Oral<unk>  Vaccine (OCV) has been recognized as an adjunct tool for prevention and control of<unk> . The World Health Organization (WHO) has prequalified three bivalent<unk>  vaccines—Dukoral (SBL Vaccines), containing a non-toxic B-subunit of<unk>  toxin and providing protection against V.<unk> e O1; and two vaccines developed using the same transfer of technology—ShanChol (Shantha Biotec) and Euvichol (EuBiologics Co.), which have bivalent O1 and O139 oral killed<unk>  vaccines. Oral<unk>  vaccination could be deployed in a diverse range of situations from<unk> -endemic areas and locations of humanitarian crises, but no clear consensus exists. Sari filtration Women at a village pond in Matlab, Bangladesh washing utensils and vegetables. The woman on the right is putting a sari filter onto a water-collecting pot (or kalash) to filter water for drinking.|240px Developed for use in Bangladesh, the "sari filter" is a simple and cost-effective appropriate technology method for reducing the contamination of drinking water. Used sari cloth is preferable but other types of used cloth can be used with some effect, though the effectiveness will vary significantly. Used cloth is more effective than new cloth, as the repeated washing reduces the space between the fibers. Water collected in this way has a greatly reduced pathogen count—though it will not necessarily be perfectly safe, it is an improvement for poor people with limited options. In Bangladesh this practice was found to decrease rates of<unk>  by nearly half. It involves folding a sari four to eight times. Between uses the cloth should be rinsed in clean water and dried in the sun to kill any bacteria on it. A nylon cloth appears to work as well but is not as affordable.
Cholera
Travelers' diarrhea
Dysentery
Polymeal
Miliary fever
Malaria
Jamaican vomiting sickness
Milk sickness