Amid an outbreak of cholera in the Kathmandu Valley, the Ministry of Health and Population has been considering launching a vaccination drive to contain the spread of the infectious disease.

If not controlled immediately, infection could continue for months, and vaccination could be an effective means to prevent the spread, officials said.

Dr Chuman Lal Das, director at the Epidemiology and Disease Control Division, said a request has been made with the International Vaccine Institute and the World Health Organisation for vaccine doses. “The International Vaccine Institute told us that they cannot provide the vaccine doses. We have been waiting for a response from the UN health body,” he said.

At least 23 people from various places in the Valley and Makwanpur district have tested positive for Vibrio cholera 01 Ogawa serotype as of Thursday.

With cases of infection of the deadly disease reported from various places of the Valley, public health experts estimate that the deadly pathogens might have already spread in several other places of the Capital. Given that, it has been challenging to run ring vaccination against cholera.

Cases of cholera have been reported from Bagbazar, Dillibazar, Balaju, Balkhu, Sanepa, Kapan, Naikap, Kageshwori Manohara, Bhaktapur, and Jaisidewal in the Valley.

“Huge resources will be needed to administer the oral vaccine to people residing in the Valley,” said Das, director of the division.

Cholera is a highly infectious disease that causes severe diarrhoea and vomiting, which leads to dehydration and even death within a few hours if left untreated.

Public health experts say that number of cases could be just the tip of the iceberg, as only around 10 percent of the infected people with cholera develop severe symptoms such as watery diarrhoea and vomiting.

Due to poor sanitation and hygiene conditions, Nepal is highly vulnerable to water-borne diseases, including diarrhoea, dysentery, typhoid, hepatitis, and cholera, with thousands of people getting infected with them every year.

According to the Health Ministry’s data from the last fiscal year, for every 1,000 children under five years of age, 349 suffered from diarrhoeal diseases.

Doctors say contaminated water and food are the main catalysts for the spread of cholera in the Kathmandu Valley.

A study carried out by the Health Ministry following the outbreak of cholera this year showed that nearly 70 percent of drinking water samples in Kathmandu Valley have been found to have been contaminated with E coli and faecal coliform.

Escherichia coli, or E. coli, is bacteria that normally live in the intestines of people and animals. Most types of E. coli are harmless and even help keep the digestive tract healthy. But some strains can cause diarrhoea when one eats or drinks contaminated food and water.

Water contaminated with microbes found in human faeces is not safe to drink, doctors say.

“It will be good if we can vaccinate the entire population residing in the disease-hit areas,” said Dr Prabhat Adhikari, an infectious disease expert. “If that is not possible, then we can select vulnerable groups—people in the immediate circle of the infected person and those residing in the immediate area of the outbreak.”

In October last year, a cholera outbreak in several local units of Kapilvastu killed at least six, including three minors—boys aged seven and two, and a girl aged five—and a 45-year-old man.

Following the outbreak, the Health Ministry had launched a mass vaccination drive against the disease after all its attempts to curb the infection failed.

The World Health Organisation says cholera is a global threat to public health and an indicator of inequality and a lack of social development.

The current outbreak of cholera is blamed on contaminated water with the increase in rainfall and disruption in garbage collection in Kathmandu Valley. Several other factors, including the condition of water supply pipes, water storage, and pollution in water sources, affect the quality of water supplied to households, officials said.

The Kathmandu Upatyaka Khanepani Limited (KUKL) still uses the old pipeline laid decades ago in core city areas. Since there are leakages in the old pipelines, there is a high risk of sewage mixing with drinking water. Although the KUKL chlorinates the water before supplying it to households, it is still prone to contamination due to the leaking pipes.

Doctors warn that the chances of disease outbreaks not only of cholera but also dysentery, typhoid, hepatitis A, and E, among others, are high due to poor hygiene and contaminated water.

The World Health Organisation says that a multifaceted approach is key to controlling cholera and reducing deaths.

Doctors say launching awareness drives against water-borne diseases and ensuring safe drinking water are the only ways to save people from dying of water-borne diseases, including cholera.

A combination of careful survey, ensuring safe drinking water, maintaining sanitation and hygiene, social mobilisation, and treatment is required to contain the spread of the infection, according to doctors.

Along with trying to launch vaccination against cholera, the authorities concerned should also focus on safe drinking water and sanitation, Adhikari said. “People themselves should take precautions and stay safe,” he said. “Only use boiled water in the household whatever the source of the water may be.”