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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