title: The true burden and risk of cholera: implications for prevention and control.
abstract: Cholera is a substantial health burden on the developing world and is endemic in Africa, Asia, South America, and Central America. The exact scale of the problem is uncertain because of limitations in existing surveillance systems, differences in reporting procedures, and failure to report cholera to WHO; official figures are likely to greatly underestimate the true prevalence of the disease. We have identified, through extensive literature searches, additional outbreaks of cholera to those reported to WHO, many of which originated from the Indian subcontinent and southeast Asia. Such underestimation of cholera can have important implications for decisions on provision of health interventions for indigenous populations, and on risk assessments for travellers. Furthermore, until recently, it has not been possible to implement public-health interventions in low-income countries to eliminate disease, and the prevention of cholera in travellers has been limited to restrictive guidelines. However, a vaccine against cholera is now available that has proven efficacy and tolerability in mass vaccination campaigns in low-income countries, and among travellers.
authors.affiliation: Academic Centre for Travel Medicine and Vaccines, WHO Collaborating Centre for Travel Medicine, Royal Free and University College Medical School, London, UK. j.zuckerman@medsch.ucl.ac.uk
authors.forename: Jane N
authors.initials: JN
authors.lastname: Zuckerman
authors.forename: Lars
authors.initials: L
authors.lastname: Rombo
authors.forename: Alain
authors.initials: A
authors.lastname: Fisch
mesh_terms: D001210:Asia, Southeastern / Q000453:epidemiology; D002771:Cholera / Q000453:epidemiology / Q000517:prevention & control*; D022121:Cholera Vaccines; D018563:Disease Notification; D004196:Disease Outbreaks; D019353:Endemic Diseases; D006801:Humans; D007194:India / Q000453:epidemiology; D032541:Mass Vaccination; D018571:Sentinel Surveillance; D014944:World Health Organization
chemical_list: D022121:Cholera Vaccines