Human plague in Southern Africa during the period 1965-1969

A Thesis Submitted to the Faculty of Medicine, University of the Witwatersrand, in Partial Fulfilment of the Requirements for the Degree of Doctor of Medicine Johannesburg 197

The Recent Cholera Outbreak in the South Mrican Gold Mining Industry

A large-scale cholera surveillance programme was introduced in South Africa in November 1973 as a result of the progressive southward spread of cholera in Africa. Moore's technique for the isolation of Salmonella paratyphi was modified for cholera detection. The method proved to be very sensitive and it was possible to detect Vibrio cholerae in main sewer lines after its casual and transient introduction by an unidentified carrier. Transmission occurred in the acc!im<:tisation centre, probably through the drinking of water contaminated after it had been drawn from the tap. Faecal contamination of the environment was demonstrated, and V. cho/erae was isolated from the floor, onto which it had been disseminated from the perianal region by means of profuse perspiration. Perpetuation of cholera was probably aided by a faecally contaminated air-humidifying water reservoir, the water of which experimentally allows survival and multiplication of V. cholerae for a week and longer. Prophylactic treatment of selected high-risk groups of people was administered in the form of doxycycline, which appeared to result in rapid termination of the epidemic. Mass vaccination of all mine personnel (20 000) was carried out to reduce the incidence of clinical cholera and the bacterial load