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Recommended Measures for Cholera Surveillance and Rapid Surveillance Information Dissemination for Latin America and the Caribbean

Case definitions. Two categories should be used in case definitions in areas with epidemic cholera: clinical and laboratory-confirmed. A clinical case should be defined as acute, watery diarrhea in a person aged greater than or equal to 5 years; a laboratory-confirmed case, as culture-confirmed Vibrio cholerae O1 infection in a person with diarrhea.

Report forms. Lengthy surveillance forms should not be used. Basic data (e.g., age, sex, address, date of onset or treatment, hospitalization, and outcome) can be collected using short forms and kept for analysis at the local level.

Laboratory confirmation of cases. Cultures should be performed for clinical cholera cases in a cholera-threatened area. After cholera has become established in an area, stool cultures should be performed at a reduced frequency (e.g., 10 cultures per month) to confirm the continuing presence of V. cholerae O1 and to monitor antimicrobial resistance.

Surveillance during an evolving epidemic. In areas threatened by cholera, acute dehydrating diarrhea in persons aged greater than or equal to 5 years should be investigated and cultured. When small numbers of cases are being confirmed, only laboratory-confirmed cases should be reported. When the number of laboratory-confirmed cases increases, the clinical case definition should be used for reporting, and culturing should be used only on a limited basis to confirm the continuing presence of cholera. As the number of cholera cases decreases, the definition for clinical cases should be used for at least 1 year to detect seasonal recurrences of the epidemic. To determine routes of cholera transmission and the potential for prevention, case-control investigations should be conducted at outbreak sites.

Analysis and communication of surveillance data. Surveillance data (e.g., numbers of cases, hospitalizations, and deaths) should be transmitted weekly to the central level and analyzed in a timely manner. Summary reports should be disseminated regularly to all components of and levels within the surveillance system and to the Pan American Health Organization.

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