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Reporting and treating cholera: Soon, there could be an app for that

8424972981_35858721c7_zIn the aftermath of the 7.0 magnitude earthquake that shook Haiti in January 2010, clean water for drinking and hygiene was scarce. This set the stage for the largest cholera outbreak in recent history, killing an estimated 6,631 people. Now that a devastating 7.8 magnitude earthquake has hit Nepal, a similar situation may be in the works. Eric Jorge Nelson, MD, PhD, a pediatrician and cholera expert, is working to change this scenario with a smartphone app that he and his team are developing for use in places at high-risk for cholera outbreaks.

Although disasters and cholera often go hand in hand, the disease is also a perennial problem in places like Bangladesh and Nepal, where monsoons routinely overflow sewers and contaminate water supplies, Nelson explained. In areas such as these, about 2.8 million cases of cholera occur each year.

Time is of the essence when reporting and treating cholera. "The time it takes from when a person ingests the bacterium [Vibrio cholerae], becomes sick with diarrhea, and dies can be less than 24 hours," Nelson told me during a recent conversation. If untreated, as many as half of the people with cholera can die, but the mortality rate drops to less than one percent if treated in time.

Therein lies the rub, Nelson explained. Many cholera-stricken areas have limited access to electricity and the tools that disease experts and doctors need to rapidly report and respond to a cholera outbreak. "The reporting mechanisms are often six-weeks delayed," Nelson said. "We need a way to help hospitals; they need an ongoing system to provide real-time data."

To address this problem, Nelson and his colleagues are creating a smartphone app with the aid of a $1.25-million Early Independence Award from the National Institutes of Health. Their first goal is to develop and deliver the app to doctors working in hospitals in Bangladesh, where cholera is common.

The app is a series of four pages that prompt the doctor to collect data that helps them report, diagnose and treat patients with cholera. It also contains a checklist of "danger signs" that doctors may fail to notice; this list reminds him or her to look for other illnesses that could mask or mimic cholera.

Perhaps the best feature of the app is that it's fast. "If English is your first language, you can get through the app in roughly 60 seconds. If English is your second language, it takes about two minutes," Nelson told me.

Nelson and his colleagues will start testing the app in hospitals in Bangladesh later this year. Once the app is perfected, they'll develop a streamlined version that can be used in areas at risk of a cholera outbreak, like the site of Nepal's recent earthquake. Being able to report cholera cases in a disaster area in real time could help disease experts make decisions, such as where to ship cholera medication and who should receive cholera vaccines.

"Epidemiologists and physicians have different needs," Nelson said. "As an epidemiologist you count the events of cholera and report it to the stakeholder to get action. I'm a doctor, and physicians function differently; they have the patient in front of them and they need help as well." He hopes that with this app, one phone will address the needs of the patient, physician and epidemiologist.

Editor's note: Nelson and his Stanford colleague, Jason Andrews, MD, are seeking emergency support to implement the platform in post-earthquake Nepal. 

Previously: A sanitation solution: Stanford students introduce dry toilets in HaitiTracking sales of over-the-counter medicines to predict disease outbreaks and Using social media to fight cholera
Image by: Abir Abdullah/ADB

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