At least three diarrheal patients— one from Kalimati in Kathmandu Metropolitan City, one from Tokha Municipality, and another from Gwarko of Lalitpur district—have tested positive for cholera.

Officials at the Health Office Kathmandu said that the National Public Health Laboratory, which carried out testing on stool samples of diarrheal patients, confirmed cholera infection on Monday evening.

“Reports from the laboratory confirmed cholera outbreaks in additional three places in the Valley, including two areas in Kathmandu,” said Dr Arjun Sapkota, chief of Health Office Kathmandu. “Earlier rapid diagnostic tests too had shown cholera infection in those patients.”

With these additional cases, the total number of diarrheal patients testing positive for cholera across the country has reached 16 within a week.

Last week, cholera outbreaks were reported in Godawari Municipality of Lalitpur district and Dhangadhi Sub-metropolitan City of Kailali district.

At least 13 people—seven in Godawari Municipality and six in Dhangadhi Sub-metropolis tested positive for cholera, according to officials at the Epidemiology and Disease Control Division.

Cholera is a highly infectious disease that causes severe diarrhoea and vomiting, which in turn results in dehydration and can lead to death within a few hours if left untreated. The World Health Organisation says cholera is a global threat to public health and an indicator of inequality and a lack of social development.

Health officials said that the Vibrio cholera 01 Ogawa serotype has been confirmed in the stool sample of an infected patient. Health officials concede that the outbreak of the deadly disease in several places at once shows that the cholera has spread to multiple locations of the Valley.

According to Officials at the Health Office Kathmandu, the infected patients have been admitted at the Sukraraj Tropical and Infectious Disease Hospital and Chabahil-based Helping Hands Community Hospital.

Following news of the suspected cholera outbreak, the Epidemiology and Disease Control Division, along with Health Office Kathmandu and the local units, which are responsible for responding to the disease outbreaks, scrambled to contain the spread of the infection.

“Contaminated water is the main culprit behind the cholera outbreaks in Lalitpur and Kailali,” said Dr Yadu Chandra Ghimire, director at the division. “Various programmes including water and sanitation initiatives, and awareness campaigns, are being organised in the affected areas.”

The Kathmandu Valley often witnesses cholera outbreaks during the monsoon season, with hundreds of people suffering from diarrheal infections that continue for months. Public health experts say that due to poor sanitation and hygiene conditions, the country as a whole is highly vulnerable to water-borne illnesses including diarrhoea, dysentery, typhoid, hepatitis, and cholera, with thousands of people getting infected every year.

This year too, major hospitals in Kathmandu Valley have been grappling with a surge in cases of water-borne diseases including severe diarrhoea.

“Fifteen to 20 diarrheal patients have been seeking care in our emergency department every day,” said Dr Ravi Shakya, director at the Patan Hospital.

In 2022, a total of 77 cases of cholera were confirmed in the Valley. Last year, health authorities administered an oral cholera vaccine in wards 11, 12, and 13 of the Kathmandu Metropolitan City, which were highly affected by the outbreak.

Public health experts said that sheer negligence from parts of authorities concerned is responsible for ongoing outbreak of diarrheal disease including deadly cholera.

Health authorities in most local units had stopped testing of drinking water just before the start of the monsoon season citing lack of funds, although deadly microbes such as faecal coliform and E coli were frequently detected in drinking water samples.

Faecal coliform and E coli, both microscopic organisms, are found in human faeces. According to doctors, their presence of faecal coliform and E coli in drinking water means it is contaminated with sewage.

“Ensuring water quality is a regular job and basic duty of the relevant agency,” said Dr Sher Bahadur Pun, chief of Clinical Research Unit at the Sukraraj Hospital. “Such essential services should not be halted under any conditions.”

Doctors say bottled water is widely used by households and offices in Kathmandu Valley and is generally considered safe, but water quality of several companies have been found questionable. Presence of dangerous microbes in bottled water every year, which means not all jar water brands are safe to drink without treatment.

Doctors have asked authorities to launch awareness drives against water-borne diseases and ensure safe drinking water to prevent deaths from illnesses like cholera.

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

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