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Cholera -- Worldwide, 1989

As of April 30, 1990, 48,403 cholera cases worldwide were reported to the World Health Organization (WHO) (Table 1), compared with 44,083 in 1988. The number of countries reporting the disease increased from 30 in 1988 to 35 in 1989. Two countries--Sao Tome and Principe and Yugoslavia--reported indigenous cases of cholera for the first time during the present pandemic. As in previous years, there was strong evidence that cholera occurred in several countries that failed to report the disease. Africa

In Africa, 35,606 cases were reported by 16 countries in 1989, compared with 23,186 cases reported by 12 countries in 1988. A particularly large outbreak, with more severe cases than in previous years, began in Malawi in October 1989; Ogawa was the predominant serotype of Vibrio cholerae 01, whereas the Inaba serotype had been responsible for past epidemics. Cholera was reported for the first time in 1989 by Sao Tome and Principe, where 3953 cases occurred. The epidemic in Angola continued despite seasonal fluctuations, and the total number of cases increased during 1988. Although substantial reductions in cases were reported by Rwanda and the United Republic of Tanzania, cholera appeared again in Mozambique, Niger, and Zambia, which had not reported cases in 1988. Asia

In Asia, a total of 12,785 cases were reported by 12 countries, compared with 20,872 cases in 11 countries in 1988. A large outbreak was reported by Peoples Republic of China during May-September 1989 in Xinjiang Autonomous Region, where an epidemic had occurred in the same season in 1988; the source for both years was a contaminated water supply. In Japan, most cases occurred as foodborne outbreaks that were rapidly controlled and did not result in secondary spread (1). Cases also appeared in Kuwait, Macao, Myanmar, and Nepal, which did not report cases in 1988. Europe

In Europe, 11 cases, mostly imported, were reported by six countries in 1989, compared with 14 cases reported by four countries in 1988. The two indigenous cases reported by Yugoslavia were associated with a waterborne epidemic during August-September caused primarily by Shigella sonnei; further spread of cholera was prevented by strict control measures. Adapted from the Weekly Epidemiological Record 1990;65:141-2. Enteric Diseases Br, Div of Bacterial Diseases, Center for Infectious Diseases, CDC.

Editorial Note

Editorial Note: Subsaharan Africa reported nearly three quarters of the world's cholera cases in 1989. Increasing experience in treating cholera and widespread use of oral rehydration have helped reduce the case-fatality rate. However, prevention of the disease has been difficult. Recent investigations of cholera in Africa (1,2) have shown that the modes and vehicles of transmission vary from place to place and have identified simple and practical ways to prevent transmission. The findings emphasize the need for epidemiologic investigation of epidemic and endemic cholera to determine how the disease is transmitted in each locale and to design practical area-specific control measures.

References

  1. Tauxe RV, Holmberg SD, Dodin A, Wells JG, Blake PA. Epidemic cholera in Mali: high mortality and multiple routes of transmission in a famine area. Epidemiol Infect 1988;100:279-89.

  2. St. Louis ME, Porter JD, Helal A, et al. Epidemic cholera in West Africa: the role of food handling and high-risk foods. Am J Epidemiol 1990;131:710-28.



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