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REVIEW OF REPORTED CHOLERA OUTBREAKS WORLDWIDE, 1995–2005

The global temporal and spatial distribution of cholera is underappreciated, given the lack of surveillance in endemic areas and economic disincentives to report outbreaks. To judge the use of specific novel interventions such as vaccines or anti-secretory agents, we compiled a database and analyzed cholera reports from the Program for Monitoring Emerging Diseases from 1995 to 2005. Of the 632 reports meeting the search criteria, 66% originated in Sub-Saharan Africa, followed by 16.8% from Southeast Asia. Reported outbreaks in Africa tended to be larger in size. The most common risk factors were water source contamination, heavy rainfall and flooding, and population dislocation. While cholera reporting is sub-optimal, this review provides a detailed sub-national quantification of cholera, identifies foci of endemicity in Africa, and describes risk factors by region. We highlight the need for more extensive outbreak reporting to justify investments in new interventions.

Received April 20, 2006. Accepted for publication July 10, 2006.

Acknowledgments: Cecile Viboud, John Sentz, and Wladimir Alonso contributed to adaptation of the figures. Robert Tauxe and Eric Mintz provided commentary on an earlier presentation.

Financial support: Funding for this study was provided by the National Insitutes of Health Fogarty International Center and the Bill & Melinda Gates Foundation through a grant entitled Novel Methodology to Quantitate Geospatial/Temporal Distribution of Diarrhea Disease and Evaluate Prevention.

^* Address correspondence to Mark A. Miller, Division of International Epidemiology and Population Studies, Fogarty International Center, National Institutes of Health, 16 Center Drive, Bethesda, MD 20892. E-mail: millermark{at}nih.gov

Authors’ addresses: Louise Kelly-Hope, David Griffith, and Mark Miller, Division of International Epidemiology and Population Studies, Fogarty International Center, National Institutes of Health, 16 Center Drive, Bethesda, MD 20892, Telephone: 301-496-0815, Fax: 301-496-8496, E-mail: millermark{at}nih.gov.

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