After efforts to contain the spread of cholera, which broke out in Birgunj last month and spilled over to adjoining local units and districts, the Ministry of Health and Population is gearing up to administer cholera vaccine to vulnerable populations.

Officials say that preparations are underway to administer the oral cholera vaccine to all eligible people in the disease hit areas and to other highly vulnerable populations.

“Had the recent events in the country not disrupted our work, we might have made much progress on vaccination by now,” said Dr Bikash Devkota, secretary for the health ministry. “Now preparations are still un derway to administer the cholera vaccine.”

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. The National Public Health Laboratory, which carried out testing on stool samples of the infected people, confirmed that Vibrio cholerae o1 Ogawa serotype is responsible for the outbreak.

So far, at least four people have died and over 1,300 others hospitalised. Health officials working in the disease-hit areas say a dozen people are getting infected with the potentially fatal disease every day and that the disease is still out of control despite their efforts.

“Around a dozen patients from the cholera-hit areas have been seeking treatment every day at our hospital,” Dr Chuman Lal Das, medical superintendent at the Birgunj-based Narayani Hospital, told the Post over the phone from Birgunj. “The spread of the disease has slowed compared to the last month but is still continuing. We have also been informed that preparations for vaccination are underway.”

Officials say destruction of the federal health ministry in Kathmandu and other health offices, and an environment of fear caused by protests delayed vaccination plans. They said the Global Alliance for Vaccine and Immunisation, Global Task Force on Cholera Control, International Federation of Red Cross and Red Crescent Societies, the World Health Organisation and the United Nations Children’s Fund have all agreed to support vaccine delivery and immunisation.

“We have done our part and are ready to begin the campaign as soon as the vaccine arrives,” said Dr Abhiyan Gautam, chief of the Immunisation Section at the Family Welfare Division under the Department of Health Services. “Over 1.8 million people from affected areas of Parsa and Bara districts will be inoculated.”

Alongside preparations for mass vaccination, several measures including door-to-door awareness campaigns and the distribution of educational materials have been launched in the affected areas, according to officials. Several teams of federal, provincial and local health workers, and the WHO are all working on the ground to help contain the outbreak.

Public health experts say the Birgunj outbreak is the largest since the Jajarkot epidemic in 2009. Sixteen years ago, the far-western district of Jajarkot saw a major cholera outbreak that killed several and infected hundreds.

Experts say that the Birgunj outbreak exposes critical gaps in the government’s preparedness and response system, and water and sanitation conditions.

Experts are particularly alarmed by both the severity of the outbreak and the deaths it has caused.

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 administered cholera vaccines to people from affected areas of Kapilvastu, Rautahat, and Kathmandu a few years ago to contain the further spread of the disease.

Experts say poor sanitation and hygiene make the country highly vulnerable to waterborne diseases, including diarrhoea, dysentery, typhoid, hepatitis, and cholera, especially in the monsoon season.

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 impact 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 key to controlling the disease and reducing deaths.