County Girds to Act Should Cholera Strike : Health: Epidemic has spread quickly north from South American. Health authorities say migrant camps in county are especially vulnerable.

San Diego-area health officers are testing sewage and alerting doctors asthey brace for the arrival of cholera in an epidemic that has leapfrogged north through the Americas and struck a new nation each month since it was first spotted in Peru during January.

Federal and local health officials stress that a major outbreak of cholera is not expected to hit the United States. But poor areas in border states--particularly colonias in Texas and migrant camps in San Diego County, might be vulnerable to the disease, they say.

Cholera, known as a disease of the poor, flourishes in areas lacking adequate water, sewage systems and sanitary food storage. The life-threatening disease, which is easily treated, is transmitted by bacteria in contaminated water or food.

“For John Q. Public who lives in a house, the risk is very, very minimal,” said Dr. Donald G. Ramras, deputy director of the San Diego County Department of Health Services. “Except travelers (in cholera-stricken countries) must be careful.”

Health experts worry about cholera infesting the many North County camps of migrant workers. An estimated 3,000 to 20,000 migrants have little access to treated water or sanitation.

“We’ve been telling the country that we don’t think there will be a lot of cholera in the United States. We’re talking about people in Nebraska,” said Dr. David L. Swerdlow, a medical epidemiologist with the Centers for Disease Control who came to San Diego several months ago to work with the health department. “There are pockets in the U.S. where there could be cholera, I don’t think there’s any doubt about that.”

Fifteen U.S. cases of the epidemic-related strain of cholera have cropped up so far, according to the CDC. These cases involved Americans who traveled to Latin America or ate tainted crab that had been cooked in Ecuador and smuggled into the United States. So far, there have been no cases on the West Coast.

As a cholera specialist, Swerdlow has tracked the disease, traveling last year to the small islands of Micronesia in the Pacific and Malawi in Africa. This past February, he went to Peru, where the disease has stricken 256,343, infected 52% of the population, and killed 2,453.

In San Diego, he is working with local health officials, bolstering the county’s defense against cholera and setting up early-warning systems so experts will know if--and when--the disease strikes.

The county has sent out notices to local physicians. The health department also has contacted the major laboratories and hospitals, making sure they know the procedures for testing for cholera. And its workers are going to migrant camps, informing the inhabitants about the disease and its symptoms.

“The conditions of the camps are worse than Peru,” Swerdlow said. “There are camps that don’t have access to latrines or water--that’s perfect for cholera. There’s no real housing. If the conditions are worse than Peru, where 52% had cholera, there’s no reason to think that it couldn’t happen here, too.”

Advocates for migrant workers say they fear that the specter of cholera will only increase existing tensions between North County homeowners and workers who live in makeshift shacks just yards away.

“It’ll be a pretext for getting rid of the camps,” said Claudia Smith, regional counsel for the California Rural Legal Assistance. “I’m worried that this will create some type of hysteria; people are really inclined already to believe that the men in the camps are disease-ridden. And that is just not true.”

But Swerdlow hopes his efforts to combat the disease will not provide ammunition to angry landowners. His intent, he says, is to set up a system to monitor and treat the county’s most vulnerable population.

Swerdlow and his colleagues are trying to win the trust of the migrant workers, some of whom have immigrated illegally and distrust outsiders. Last month, health care workers made special arrangements with men chosen from five camps. Each man reports to a visiting health care worker weekly, informing him of any illnesses to strike the camp. With this system, which the health workers hope to expand, Swerdlow believes the county can better monitor conditions in the camps.

Earlier this month, health officials began a weekly ritual of testing sewage from Point Loma and Tijuana. The sewage test, they say, will serve as a signal should the disease arrive. “If we find it in the sewage, that’s a pretty good indication that there’s a source in the community,” said Christopher R. Peter, chief of the county’s public health laboratory.

In New Orleans, health officials using the same test two decades ago were able to detect the presence of cholera in a neighborhood, then trace the infected individual.

Peter hopes to expand testing to include taking samples from North County as well as the eastern part of Tijuana. “We don’t want to wait until we have all kinds of cases before we do something,” he said.

There have been 65 cases of cholera in the United States since 1973, but those cases involved a strain known to be prevalent along the Gulf of Mexico, in Louisiana and Texas, the CDC said.

Today, officials are looking for Vibrio cholerae , ( Vibrio is Greek for “comma”) an organism that got its name because of its comma shape. This strain of cholera has struck 23 countries in 2 1/2 years, said Dr. Allen Reis, a CDC medical epidemiologist who specializes in enteric diseases.

The epidemic reached Peru in January, moving next to Ecuador and Colombia, in its surge through the Americas.

“It’s impressive that it can move as fast as it does,” Reis said. “That keeps us on our toes, wondering where it’s going to be next. And it reminds us that areas need to be prepared for it, even if it isn’t next door.”

Last month, Reis headed up a team that started in San Diego and traveled along the border through Texas to identify the most vulnerable pockets.

Although a vaccine against cholera exists, the CDC does not recommend it because it is ineffective and carries side effects. Reis and others emphasize that cholera can easily be treated with rehydration therapy and sometimes antibiotics. But untreated, the disease kills half of those it strikes.

Not all individuals infected with cholera get sick. In fact, about 75% of those infected will have no symptoms and can remain infected for seven to 10 days. Those who do get sick will suffer diarrhea, vomiting, cramps, and dehydration. The dehydration can be so extreme that a cholera victim can lose more than 10% of his body weight, the CDC says.

Because the cholera bacteria can live independently of human beings, experts don’t believe the disease will be eradicated.

“I fully expect we will see the spread of cholera through many more countries,” said Dr. David Sack, associate professor of international health at Johns Hopkins University and director of the International Travel Clinic. “I don’t think it’s going to be gone, I think it’s going to be here for many, many years to come.”

Individuals traveling to countries where cholera is present are advised by the CDC to:

* Avoid raw or undercooked seafood, including ceviche.

* Avoid raw food, including vegetable salads, and food from street vendors.

* Drink boiled or carbonated bottled water. Don’t drink beverages with ice that uses unboiled water.

* Eat only foods that are cooked and hot, or fruits you peel.

* Follow the CDC’ general rule: “Boil it, cook it, peel it, or forget it.”

Cholera Epidemic MEXICO CASES: 806 GUATEMALA CASES: 115 DEATHS: 2 EL SALVADOR CASES: 43 DEATHS: 1 PANAMA CASES: 2 ECUADOR CASES: 36,859 DEATHS: 581 PERU CASES: 256,343 DEATHS: 2,453 CHILE CASES: 41 DEATHS: 2 COLOMBIA CASES: 5,605 DEATHS: 119 BRAZIL CASES: 124 DEATHS: 1 BOLIVIA CASES: 20 DEATHS: 2 FIRST CHOLERA CASES REPORTED PERU: JANUARY ECUADOR: FEBRUARY COLOMBIA: MARCH CHILE: APRIL BRAZIL: MAY MEXICO: JUNE GUATEMALA: JULY EL SALVADOR AND BOLIVIA: AUGUST PANAMA: SEPTEMBER Source: Center for Disease Control as of Sept. 10