The nation of Zimbabwe which had experienced a massive cholera outbreak that started in August 2008 is going through two additional infectious disease outbreaks in 2010.

Though the cholera epidemic has tapered down, there have still been nearly 150 cases with five deaths since late 2009. This is however a dramatic decrease from the 37,000 cases and nearly 2,000 deaths from the same time frame a year earlier.

The dilapidated and broken sanitation system and water infrastructure that caused the last outbreak is still in the same state of disrepair and health officials fear another possible large outbreak during the rainy season.

Cholera is an acute bacterial intestinal disease characterized by sudden onset, profuse watery stools (given the appearance as rice water stools because of flecks of mucus in water) due to a very potent enterotoxin. The enterotoxin leads to an extreme loss of fluid and electrolytes in the production of diarrhea. It has been noted that an untreated patient can lose his bodyweight in fluids in hours resulting in shock and death.

It is caused by the bacterium, Vibrio cholerae. Serogroups O1 and O139 are the types associated with the epidemiological characteristics of cholera (outbreaks).

The bacteria are acquired through ingestion of contaminated water or food through a number of mechanisms. Water is usually contaminated by the feces of infected individuals. Drinking water can be contaminated at the source, during transport or during storage at home. Food can get contaminated by soiled hands, during preparation or while eating.

In addition to the cholera situation, the country is also facing a measles outbreak which began in September 2009. Since that time there have been over 1800 cases and 75 deaths.

There is a Measles Task Force headed from the Zimbabwe health ministry and the World Health Organization (WHO) there to determine risk and determine vaccination needs.

Measles or rubeola, is an acute highly communicable viral disease that is characterized by Koplik spots in the cheek or tongue very early in the disease. A couple of days later a red blotchy rash appears first on the face, and then spreads, lasting 4-7 days. Other symptoms include fever, cough and red watery eyes. The patient may be contagious from four days prior to the rash appearance to four days after rash appearance.

The disease is more severe in infants and adults. Complications from measles which is reported in up to 20% of people infected include; seizures, pneumonia, deafness and encephalitis.

And to make a bad situation worse, it has been reported that 24 children have contracted schistosomiasis from after playing in contaminated water at a nearby reservoir.

Schistosomiasis is an acute or chronic disease, produced by parasites called Schistosoma. It is not a single disease, but a disease complex initiated by several different species of schistosomes. The three most important human species are Schistosoma mansoni, S. haematobium and S. japonicum.

The schistosomes are found in fresh water. This water gets contaminated by infected people working in the rice field, fisherman in the lake or children playing who indiscriminately defecate or urinate in the water.

The free-swimming stage (cercariae) of the parasite is capable of penetrating the unbroken skin of the human host.

This shows what a combination of poverty, poor sanitation, poor health care, and bad infrastructure does to the public health of a nation…infectious diseases can really take hold under such conditions.