Epidemic cholera in sub-Saharan Africa: A preventable tragedy

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.