Health authorities are considering ring vaccination in the cholera-hit ward 5 of Chhinnamasta Rural Municipality and surrounding areas in Saptari district after a month-long outbreak killed three people and infected 98 others.

Though a final decision on vaccination has not yet been taken, officials say infections have not stopped completely and the potentially deadly disease has spread to new areas instead.

“People are still getting infected with diarrheal ailments in the cholera hit areas,” said Dr Abhiyan Gautam, chief of Immunisation Section at the Family Welfare Division under the Department of Health Services. “Although no decision has been taken to vaccinate the vulnerable population in the disease-hit areas, it seems that without vaccination it will be difficult to contain the outbreak.”

Two children and an elderly man died from the cholera outbreak nearly a month ago. Officials in the disease-hit rural municipality said 13 diarrhoeal patients tested positive for cholera in rapid diagnostic tests carried out in the village, and laboratory tests of stool samples from five patients confirmed Vibrio cholerae 01 Ogawa serotype.

Three new diarrheal patients were hospitalised on Saturday.

“People are still falling ill even after weeks of efforts to containment efforts,” Bidyananda Chaudhary, chairman of the rural municipality, told the Post over the phone from Saptari. “The disease has now spread to another Dalit settlement.”

Chaudhary said he visited Kathmandu and submitted a memorandum to the Minister for Health and Population Sudha Gautam requesting federal support to contain the outbreak.

“Doctors as well as experts we consulted have said that without vaccination, it will be difficult to contain the spread.”

Officials said that water and sanitation conditions in the affected Dalit settlements of Musahar and Paswan suffer from extremely poor water and sanitation conditions, and added that changing hygiene practices in the area cannot happen overnight.

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

In Bara and Parsa districts, at least four people have died of cholera and over 1,800 others have been hospitalised since the first week of August.

Authorities resorted to anti-cholera vaccination after all their efforts failed to control the spread of infection. Over one million people from Parsa and some areas of Bara were administered the anti-cholera vaccine.

Officials said everyone above one year of age in all municipalities of Parsa district and six adjoining municipalities in Bara district—the areas hardest hit by the outbreak—were administered the oral cholera vaccine immediately after the Dashai holidays last month.

Public health experts say the Birgunj outbreak is the largest since the Jajarkot epidemic in 2009. They say the Birgunj outbreak exposes critical gaps in the government’s preparedness and response system, and water and sanitation conditions.

Nepal often witnesses outbreaks of water- and food-borne diseases, including cholera, during the monsoon season as floodwaters contaminate most of the drinking water sources.

Last year, at least 95 cholera cases were confirmed in Kathmandu, Lalitpur, Jajarkot, Pyuthan, Makawanpur, Rolpa, Sindhupalchok, Achham, and Rautahat districts. The health ministry previously administered cholera vaccine to people from the affected areas of Kapilvastu, Rautahat, and Kathmandu a few years ago to halt the spread.

Poor sanitation and hygiene make the country highly vulnerable to waterborne diseases, including diarrhoea, dysentery, typhoid, hepatitis, and cholera, especially in the monsoon season, according to doctors.

They say the risk of waterborne diseases will not decrease until the water and sanitation conditions improve, and people get safe drinking water. Several other factors, including storage conditions, supply pipes, and pollution of water sources, also determine the quality of water supplied to households.

The World Health Organisation says cholera is a global threat to public health, and a multifaceted approach is the key to controlling the disease and reducing deaths.