Re-emergence of Cholera in the Americas: Risks, Susceptibility, and Ecology.
BACKGROUND
The re-emergence of cholera in Haiti has established a new reservoir for the seventh cholera pandemic which threatens to spread to other countries in the Americas.


METHODS
Statistics from this new epidemic are compared to the 1991 Peru epidemic, which demonstrated the speed and complexity with which this disease can spread from country to country. Environmental factors implicated in the spread of Vibrio cholerae such as ocean currents and temperatures, as well as biotic factors from zooplankton to waterfowl pose a risk for many countries in the Americas.


RESULTS
The movement of people and goods from Hispaniola are mostly destined for North America, but occur to some degree throughout the Americas. These modes of transmission, and the probability of uncontrolled community spread beyond Hispaniola, however, are completely dependent upon risk factors within these countries such as water quality and availability of sanitation. Although North America has excellent coverage of these deterrents to the spread of infectious gastrointestinal diseases, many countries throughout Latin America and the Caribbean lack these basic services and infrastructures.


CONCLUSIONS
In order to curb the immediate spread of cholera in Hispaniola, treatment availability should be expanded to all parts of the island and phase II epidemic management initiatives must be developed.
Department of Global Health, University of South Florida, Florida, USA.
Mathieu Jp
MJ
Poirier
Ricardo
R
Izurieta
Sharad S
SS
Malavade
Michael D
MD
McDonald