201659 Epidemic cholera in sub-Saharan Africa: A preventable tragedy

Wednesday, November 11, 2009: 8:50 AM

Nicholas Gaffga, MD, MPH , Epidemiologic Studies Branch, Centers for Disease Control and Prevention, Atlanta, GA
Robert Tauxe, MD, MPH , Enteric Diseases Epidemiology Branch, Centers for Disease Control and Prevention, Atlanta, GA
Eric D. Mintz, MD, MPH , Enteric Diseases Epidemiology Branch, Centers for Disease Control and Prevention, Atlanta, GA
Epidemic cholera was eliminated from industrialized countries over a century ago, but remains a major cause of morbidity and mortality, and a marker for unsafe drinking water and sanitation, in developing countries. Death from cholera is preventable through oral, or in severe cases, intravenous rehydration. The cholera case-fatality rate therefore reflects access to basic health care. We reviewed World Health Organization (WHO) data on cholera cases and deaths reported between 1960 and 2008. In the 1960's, at the beginning of the 7th cholera pandemic, cholera had an exclusively Asian focus. In 1970, the pandemic reached sub-Saharan Africa, where it has remained entrenched. In 1991, it reached Latin America, resulting in nearly 1 million reported cases from the region within 3 years. In contrast to its persistence in Africa, cholera was largely eliminated from Latin America within a decade. In 2007, 34 (81%) of 42 countries that reported indigenous cases of cholera to WHO were in sub-Saharan Africa. The reported incidence of cholera in sub-Saharan Africa in 2007 (222 cases/million population) was 77 times higher than that in Asia (2.9 cases/million population) and the cholera case fatality rate in sub-Saharan Africa (2.4%) was 7 times higher than in Asia (0.33%); no cholera cases were reported from Latin America. The numbers of cholera cases and deaths in Africa are key indicators of global efforts to reach the Millennium Development Goals for water, sanitation, and child survival, and of the effectiveness of development aid to the region.

Learning Objectives:
This presentation will describe the epidemiology of cholera in Africa; identify the factors that contribute to cholera transmission, persistence, and mortality in the African context; and highlight practical

Keywords: Drinking Water Quality, International Health

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have worked on cholera epidemiology, management, and prevention for 18 years, and on cholera prevention in Africa for over a decade. I have published many articles on this subject, including manuscripts in the Lancet, JAMA, and most recently in the New England Journal of Medicine (March 12, 2009).
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.