ORS DISTRIBUTION AND REDUCTION OF CHOLERA DEATHS 1

Widespread Distribution of ORS and the Reduction of Cholera Mortality Rates

Meg Fulton

Department of Biology, Harvard Summer School

BIOS S-62: Infectious Diseases, Pandemics, and Social Injustice

Dr. Donald Goldmann

Vibrio cholerae is toxic due to its lipopolysaccharide, an endotoxin that generates

inflammation that, in severe cases, can lead to a septic reaction. This toxin has the effect of

causing severe diarrhea and consequent dehydration that can quickly become life-threatening

without treatment. The mechanism begins with the bacteria's pili allowing it to attach to

epithelial cells in the small intestine. The toxin then takes over the function of these cells,

allowing it to penetrate and set off a chain reaction that leads to the excretion of chloride. As one

subunit of the toxin binds to receptors (primarily GM1 ganglioside receptors) on the epithelium

of the small intestine, this allows the other subunit to enter the cell and bind to G proteins,

attaching ADP and keeping the proteins in a state of activation. This leads to a continuous

stimulation of adenylate cyclase and consequently a constant production of messenger molecules

called cAMP which has the effect of opening chloride channels, causing chloride to be secreted

into the intestines in large quantities. This then triggers the osmotic loss of sodium and water

from cells through the cystic fibrosis transmembrane conductance regulator (CFTR). Frequent

and high-volume water-based diarrhea results, causing significant and potentially catastrophic

loss of hydration.
ORS DISTRIBUTION AND REDUCTION OF CHOLERA DEATHS 2

Oral rehydration solution (ORS) works by replacing the electrolytes lost in the watery

stool caused by cholera. The primary ingredients are water, glucose, and sodium; the glucose is

necessary because it allows the sodium to be properly absorbed since glucose mediates

electrolyte transfer across the intestinal lumen (Glass, Stoll, 2018). It is effective in greatly

reducing cholera's death rate in most settings, even those low in medical resources, because of its

ease of administration; unlike an IV, giving ORS does not require medical experience and is

often given by family members of the sick.

Widespread use of ORS in resource-poor locations such as Bangladesh has been

accomplished by global efforts (by NGOs, etc.) to educate communities about the treatment's

effectiveness and how to administer it. The discovery that ORS can easily be made at home with

just sugar and salt led to an even greater increase in its availability; in Bangladesh, a campaign

followed in which health workers were recruited to travel to people's homes to teach them how to

make the solution. Pre-packaged solution was (and still is) also widely distributed during cholera

outbreaks.
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References

Glass, R. I., MD, PhD, & Stoll, B. J., MD. (2018). Oral Rehydration Therapy for Diarrheal

Diseases: A 50-Year Perspective. JAMA. https://doi.org/10.1001/jama.2018.10963