The Epidemiology of Cholera

Since the first pandemic of cholera in 1817 spread through the Middle East to Europe, cholera has been among the most feared of the classic epidemic diseases.1 Cholera was highly virulent, decimating entire communities within weeks of its introduction. The disease had a high case-fatality ratio that approached 50% in some areas and spread relentlessly in worldwide pandemics from endemic foci in Asia to the Middle East, Europe, East Africa, and the Americas. While cholera epidemics have been extensively described and studied, epidemiologic understanding of the transmission of V. cholerae 01 is still too inadequate to permit effective control measures that would contain the disease and prevent its emergence and spread.2 Proper and timely rehydration therapy can reduce mortality to less than 1%, and antibiotic treatment can decrease shedding of vibrios, but neither of these treatment measures has significantly altered the spread of disease.