Cholera on the March

Few diseases are more feared than cholera, which in past centuries has decimated whole populations. Cholera is endemic to many Asian nations, where sanitation is poor and water supplies are contaminated. But the disease also maintains a tenuous toehold in the West. Last week it was frightening Italy, where the death toll had risen to at least 21, and threatening other European countries as well.

Their concern is well founded, because the effects of cholera can be catastrophic. The disease is caused by comma-shaped bacteria that thrive in contaminated water supplies. The bugs do even better in the human intestine.

There they multiply rapidly, triggering vomiting and devastating diarrhea that can drain off as much as 25% of the body's fluid in hours, depleting it of essential salts and causing dehydration, kidney failure and circulatory collapse.

Treatment involves intensive replacement of lost fluids and infusions of salts to restore the body's water and chemical balance. It is almost always effective. But without prompt medical attention, 50% of cholera's victims die.

The current outbreak began late last month in Naples, where it afflicted 94 victims and killed at least ten. Cases of cholera cropped up in the Adriatic port of Bari. The disease erupted in Rome, and finally leaped the Tyrrhenian Sea to Sardinia. By week's end, cases had been reported in Florence and as far north as Bologna and Milan.

Health Ministry officials blamed the outbreak (at week's end it had not yet reached epidemic proportions) not on contaminated drinking water, but on shellfish. Most of the victims, they explained, had eaten mussels, which were apparently taken from polluted waters around Italy and in North Africa. To prevent the disease from spreading any further, officials banned the sale and importation of shellfish throughout Italy and ordered large mussel beds in the Bay of Naples destroyed.

No Vaccine. In an effort to calm the jumpy public, officials ordered that streets and storefronts in Rome and Naples be washed down with disinfectant --a strategy designed largely to provide psychological, not medical, relief. Vaccination centers, staffed in part by medics from the U.S. Sixth Fleet, managed to immunize at least 85% of Naples' 1,278,000 people against the disease.

But the program failed to reassure many Italians. In Torre del Greco, a city of 83,000 on the Bay of Naples, some 500 people who could not be immunized because the vaccine supply ran out marched on the municipal building and had to be dispersed by police.

Fearing the spread of the disease, health officials in several countries began demanding that travelers returning from Italy show certificates of immunization against cholera. That action apparently is not enough to halt the march of the disease. Scattered cases have already been reported in Sweden, Britain, France and West Germany. The majority of those stricken in Northern European countries have not even been to Italy. Most appeared to have picked up the disease in North Africa.

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