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
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.
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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