Overview
While many view cholera simply as a disease of the past it is still very much prevalent in many countries today, particularly ones with poor sanitation systems and access to clean water. The current (seventh) pandemic started in South Asia in 1961 and all current cases can be linked back to this single origin.
Statistics
What does Cholera look like today?
Researchers have estimated that each year there are 1.3 to 4.0 million cases of cholera, and 21 000 to 143 000 deaths worldwide due to cholera. During 2022, 472 697 cases and 2349 deaths were reported to WHO from 44 countries. The WHO country-led strategy aims to reduce cholera deaths by 90% and to eliminate cholera in as many as 20 countries by 2030.
Vaccines
Can we be protected?
Currently there are 3 WHO pre-qualified oral cholera vaccines (OCV): Dukoral®, Shanchol™, and Euvichol-Plus®. All 3 vaccines require 2 doses for full protection. Oral cholera vaccines should be used with improvements in water and sanitation to control cholera outbreaks and prevent disease in endemic areas where infection is common. None of the vaccines provide long lasting immunity so on a regular basis in non endemic areas vaccination is not recommended. The WHO does currently have a stockpile of vaccines to be used and distributed during outbreaks and in highly endemic areas known as hotspots.
Only one live oral cholera vaccine (vaxchora) is available in the US for people traveling to endemic areas, but is not required or regularly administered other than by request.
Haiti
Why is Haiti brought up when talking about Cholera?
On October 20, 2010, the first outbreak of cholera ever confirmed in Haiti was recognized 10 months after the catastrophic earthquake that killed over 200,000 people and displaced over 1 million. The devastating outbreak caused over 820,000 cases and nearly 10,000 deaths. More than 7% of the population became infected. The Haiti epidemic started in 2010 due to UN Peacekeepers bringing over cholera from Nepal. This was at its time the most devastating outbreak
From a peak of over 352,000 suspected cholera cases in 2011 and over 4,000 suspected cholera deaths in 2010, only 720 suspected cholera cases and 3 cholera deaths were reported in 2019. This represented a greater than 99% decrease in cases from 2011 to 2019. Sadly, after 3 years of no reported cases, a cholera outbreak was reported in October 2022. As of November 7, 2022, there were over 600 confirmed cholera cases and over 6,500 suspected cases in the greater Port-au-Prince area.
Improving water and sanitation infrastructure, strengthening surveillance of cholera, and the use of oral cholera vaccine are key to managing and stopping the current outbreak and preventing cholera spread overall in Haiti.
Travel
What should I do when visiting an endemic area?
Cholera is not commonly endemic to the US. Cases do however occasionally occur from being brought back from an endemic country or from undercooked or raw shellfish from the Gulf of Mexico.
When traveling to a foreign country, be aware of whether cholera cases have recently occurred in an area you plan to visit. When visiting an endemic area, it is recommended to drink only bottled, boiled, or chemically treated water and bottled or canned beverages, and avoid ice cubes.Travelers should only eat foods that are packaged or that are freshly cooked and served hot. Avoid raw or undercooked meats and seafood, or raw or undercooked fruits and vegetables unless they are peeled. Visit a doctor or travel clinic to talk about vaccination if you will be traveling to or living in one of these areas.