Bracing for El Tor

In the Soviet Union, medical authorities have clamped tight restrictions on travel to busy southern resort cities. In Israel, health teams are making daily checks of water pipelines, wells and reservoirs and summarily closing restaurants that fall short of tough new standards of hygiene. Paris hospitals have begun rationing vaccine, and medical officers at French airports are reminding pilots of inbound airliners to report by radio any unusual gastrointestinal disorders among passengers and crews so that medical teams can meet the plane.

Soviet Seamen. Europe and Africa were bracing last week for the arrival from Asia Minor of Vibrio cholerae, a comma-shaped bacillus that is the cause of the first serious outbreak of cholera in several years. So far, more than 3,000 cases, including at least 100 resulting in death, have been reported in a dozen countries along an arc that stretches from Dubai on the Persian Gulf to Accra on the west coast of Africa.

The epidemic is the latest flare-up of a hardy strain of cholera known as El Tor (named for the Egyptian quarantine station where it was first identified). The strain originated more than 30 years ago in the highlands of Indonesia's Celebes Islands. In recent years the disease has spread north to the Korean peninsula and west along the Southeast Asian mainland. After passing through India, Pakistan and Afghanistan, it became a raging epidemic in Iran and Iraq by 1965. There the disease seemed to mark time--at least until a month or so ago, when it resumed its westward march.

Health officials are still uncertain how the epidemic got its start. The first confirmed outbreak occurred a month ago in the Soviet port of Astrakhan on the Caspian Sea, where 352 cases have been reported. At about the same time, El Tor also cropped up in Egypt. After that, the disease spread rapidly, partly as an unhappy dividend from the Middle East conflict. Soviet sailors returning from Egyptian ports may have carried El Tor to the Soviet Black Sea ports of Odessa and Kerch, where 101 cases have been reported. More recently, the disease has cropped up in Jordan, Iraq and Syria. Israel has reported 33 cases, Lebanon 30 and Libya 28. A Togolese businessman died of cholera in Ghana last week, and medical authorities in Kenya have isolated a suspected cholera victim who arrived in Nairobi on a flight from Rome. El Tor is expected to show up in Western Europe any day now. The outbreak has not yet approached the Middle East epidemic of 1965-66, which ravaged Iran and Iraq and eventually killed some 14,000 persons.

Suppressing Sickness. Typically, the disease is contracted from food or drinking water contaminated by human excrement or vomit. After a short incubation period of often only one day, victims are seized with attacks of diarrhea so devastating that within hours they are seriously dehydrated, losing almost as much as their own body weight in fluids. In extreme cases, the kidneys and other vital organs cease to function. Even so, death results in only an estimated 15% of El Tor cases. With proper treatment, which involves administering antibiotics and large amounts of distilled water and salts, the death rate can be cut to as low as 1%. Cholera immunizations are at best about 70% effective against the disease.

Perhaps the most disturbing aspect of the current epidemic is the refusal of many governments to face up to the presence of the disease within their borders. By treaty, members of the Geneva-based World Health Organization are required to report even suspected cholera cases within 24 hours. Nonetheless, Teheran and Cairo continue to dismiss reports of cholera in their countries as "summer diarrhea." WHO consultants who visited Guinea last week discovered at least 2,000 cases of cholera, including 60 deaths, in and around the capital of Conakry. The country's left-leaning government, eager not to spoil Guinea's popularity among vacationers from Scandinavia and other European countries, denounced the WHO findings as "malevolent" and withdrew from the organization. It blamed the reports on its enemies, above all the ''imperialists." The denials failed to impress Air Afrique or even the Soviet airline, Aeroflot. Both suspended flights to the disease-ridden capital.

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