Cholera should be considered as a risk for travellers returning to industrialized countries

Abstract

Cholera is an acute infection of the intestine, caused by a toxin producing strain of Vibrio cholerae, resulting in profuse watery diarrhoea. Without adequate treatment cholera can lead to shock and death within a few hours. Several pandemics have spread from the Ganges delta through Asia, Europe and the Americas in the 19th century. The seventh pandemic by Vibrio cholera serogroup 01 Biotype El Tor is now in progress and has been affecting countries in Africa, Asia and South America. Another type, Vibrio cholerae serogroup O139, have emerged in India and Bangladesh in 1992 and have been reported to been spread to other south east Asian countries, but even in these countries the O1 type still dominates. In 2003 111,575 cholera cases and 1894 cholera deaths were reported to the WHO from 45 countries. However, WHO considers that due to fear of trade sanctions and damage to tourism only 5–10% of the cholera cases are reported. Obviously cholera is a great problem in countries with poor sanitation, poor standards of food and water, and where wars have created large groups of refugees. For example, during the refugee crisis in Goma, Zaire in 1994 an estimated 58,000–80,000