Woods Institute for the Environment, Stanford University, Stanford, CA 94305, United States.
Woods Institute for the Environment, Stanford University, Stanford, CA 94305, United States.
Vaccine. 2020 Feb 29;38 Suppl 1:A110-A117. doi: 10.1016/j.vaccine.2019.07.084. Epub 2019 Aug 2.
Cholera has been eliminated as a public health problem in high-income countries that have implemented sanitation system separating the community's fecal waste from their drinking water and food supply. These expensive, highly-engineered systems, first developed in London over 150 years ago, have not reached low-income high-risk communities across Asia. Barriers to their implementation in communities at highest risk for cholera include the high capital and operating costs for this technological approach, limited capacity and perverse incentives of local governments, and a decreasing availability of water. Interim solutions including household level water treatment, constructing latrines and handwashing promotion have only marginally reduced the risk of cholera and other fecally transmitted diseases. Increased research to develop and policy flexibility to implement a new generation of solutions that are designed specifically to address the physical, financial and political constraints of low-income communities offers the best prospect for reducing the burden of cholera across Asia.
在高收入国家，通过建立卫生系统将社区的粪便废物与饮用水和食物供应隔离开来，霍乱已被消除，不再成为公共卫生问题。这些昂贵的、高度工程化的系统早在 150 多年前就在伦敦首次开发，但尚未在亚洲的低收入高风险社区得到普及。在霍乱风险最高的社区实施这些系统存在障碍，包括这种技术方法的高资本和运营成本、地方政府能力有限和激励机制不当，以及水资源日益减少。包括家庭层面水处理、建造厕所和推广洗手在内的临时解决方案，仅略微降低了霍乱和其他粪便传播疾病的风险。增加研究以开发专门针对低收入社区的物理、财务和政治限制的新一代解决方案，并制定实施政策的灵活性，为减少亚洲地区霍乱负担提供了最佳前景。
