Abstract
Cholera, an acute diarrheal infection has become a major global threat. Vibrio cholerae the causative agent of cholera has been responsible for six previous pandemics since 1817 that spanned four continents and Australia with the seventh pandemic ongoing since 1961. Two serogroups of V. cholerae O1 and O139 have the ability to secrete the enterotoxin with potential to cause epidemics. The prior six pandemics were caused by the classical biotype of the O1 serogroup. However, the emergence of the El Tor biotype and subsequent variants of El Tor with classical traits are the main isolates in the seventh pandemic.Cholera outbreaks have increased among vulnerable communities affected by war, earthquakes, conflicts and famines. Annually, 2.9 million cases of cholera occur globally in 69 endemic countries with 95,000 deaths. Early detection followed by prompt fluid and electrolyte replacement can reduce the case fatality ratio significantly. Improvements in water systems, sanitation and hygiene have effectively eliminated the transmission of cholera in high-income countries and reduced transmission in some developing nations. However, an estimated 1.8 billion are still at risk for cholera due to lack of potable water, inadequate sanitation and hygiene. Interventions focusing on hygiene in conjunction with proper disposal and treatment of sewage and provision of safe drinking water are likely to be effective in preventing the recurrence of cholera. Lastly, the use of current oral vaccines in endemic settings in combination with WASH interventions may be an effective approach to prevent and reduce the spread of cholera infection.
Highlights
Cholera, caused by Vibrio cholerae, is an acute watery diarrheal illness that has become a major global health threat
There have been many V. cholerae epidemics. One such epidemic occurred in the Ganges Delta in the 1800s, spread beyond Asia as the first recorded pandemic in 1817 to include most of Africa, Europe, and Australia
The large-scale outbreaks that occurred over the course of seven documented pandemics were mostly caused by V. cholerae serogroup O1 classical biotype with the exception of one major outbreak in 1992 across Asia that saw the emergence of the O139 serogroup
Summary
Cholera, caused by Vibrio cholerae, is an acute watery diarrheal illness that has become a major global health threat. The large-scale outbreaks that occurred over the course of seven documented pandemics were mostly caused by V. cholerae serogroup O1 classical biotype with the exception of one major outbreak in 1992 across Asia that saw the emergence of the O139 serogroup. During the start of the current seventh pandemic in 1961, the El Tor biotype emerged and spread in most parts of Asia, swept west in the 1970s including Africa, the Middle East and the former USSR before arriving in Latin America in the early 1990s, most recently causing outbreaks in Hispaniola in 2010 [2]. In 1961, the El Tor biotype, which was not previously implicated in epidemics, emerged from Sulawesi, Indonesia causing the seventh cholera pandemic. Dehydration resulting in death can occur within 6-12 hours after the onset of symptoms especially with absence of or delayed rehydration therapy. 1990’s and became more common and concerning due to several resistance mechanisms including plasmid mediation and macrolide resistant proteins [24]
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