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Chapter 19 : The Epidemiology of Cholera in Africa

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Abstract:

This chapter traces the epidemic in Africa, describes epidemiologic investigations that determined prevalent modes of transmission, and discusses efforts to control the epidemic and prevent deaths. During the 20th century, cases of cholera were mostly limited to areas in Asia and the Indian subcontinent where cholera is endemic. Between 1972 and 1991, cholera spread throughout much of the remainder of Africa. Both foodborne and waterborne transmission of cholera have been documented in Africa. Seafood, implicated as a vehicle of cholera transmission in other parts of the world, was associated with illness in Guinea-Bissau in 1987. The survival of O1, biotype E1 Tor, in the types of water storage containers used in Africa has been studied. Management of cholera case treatment was evaluated during an outbreak among Mozambican refugees in Malawi in 1990. The rapidity with which resistant isolates could become prevalent was demonstrated in 1977 in Tanzania. A strategy for the control and prevention of cholera in Africa was set forth in a declaration presented at the Forty-fifth World Health Assembly. Since cholera has become endemic throughout much of Africa, local and foreign governments and relief organizations must coordinate their efforts to prevent unnecessary loss of life throughout that continent.

Citation: Swerdlow D, Isaäcson M. 1994. The Epidemiology of Cholera in Africa, p 297-307. In Wachsmuth I, Blake P, Olsvik Ø (ed), and Cholera. ASM Press, Washington, DC. doi: 10.1128/9781555818364.ch19

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Figure 1

Emergence of cholera in Africa. Routes of transmission, as well as the date of emergence (month/year), are shown. Reprinted from reference with permission.

Citation: Swerdlow D, Isaäcson M. 1994. The Epidemiology of Cholera in Africa, p 297-307. In Wachsmuth I, Blake P, Olsvik Ø (ed), and Cholera. ASM Press, Washington, DC. doi: 10.1128/9781555818364.ch19
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Image of Figure 2
Figure 2

Countries in Africa reporting cholera from 1961 to 1991 (World Health Organization, May 1993).

Citation: Swerdlow D, Isaäcson M. 1994. The Epidemiology of Cholera in Africa, p 297-307. In Wachsmuth I, Blake P, Olsvik Ø (ed), and Cholera. ASM Press, Washington, DC. doi: 10.1128/9781555818364.ch19
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Image of Figure 3
Figure 3

Cholera in Africa. The number of cases and number of countries reporting cases from 1970 to 1992 are shown. Reprinted from reference with permission.

Citation: Swerdlow D, Isaäcson M. 1994. The Epidemiology of Cholera in Africa, p 297-307. In Wachsmuth I, Blake P, Olsvik Ø (ed), and Cholera. ASM Press, Washington, DC. doi: 10.1128/9781555818364.ch19
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Image of Figure 4
Figure 4

Cholera in Africa. The number of deaths and case fatality rate, by year, from 1970 to 1992 are shown (World Health Organization, May 1993).

Citation: Swerdlow D, Isaäcson M. 1994. The Epidemiology of Cholera in Africa, p 297-307. In Wachsmuth I, Blake P, Olsvik Ø (ed), and Cholera. ASM Press, Washington, DC. doi: 10.1128/9781555818364.ch19
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Figure 5

A strategy for the control and prevention of cholera in Africa. Reprinted from reference with permission.

Citation: Swerdlow D, Isaäcson M. 1994. The Epidemiology of Cholera in Africa, p 297-307. In Wachsmuth I, Blake P, Olsvik Ø (ed), and Cholera. ASM Press, Washington, DC. doi: 10.1128/9781555818364.ch19
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