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Chapter 21 : The Latin American Epidemic

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Abstract:

The cholera epidemic in Latin America entered its third year in early 1993. Before 1980, only three Latin American countries had national programs for promoting rehydration treatment of diarrheal illness. The low mortality figures may reflect relatively thorough case counting in countries like Peru, Ecuador, and Colombia, but they also indicate the growing experience and skill of the Latin American medical community in treating cholera. Development of an effective and inexpensive vaccine would be an important advance, and several experimental vaccines are being tested in Latin American populations. The general success of treatment for cholera means that the Latin American medical system is now more skilled in treating any dehydrating diarrhea and that the populace is more confident about the benefit of such treatment. Cholera will remain a risk where people live below a sanitary threshold, without safe water and food, sewage disposal, or elementary hygiene. The epidemic is a metaphor for underdevelopment, a marker for many diseases that are transmitted by contaminated food and bad water. The scope of the epidemic extends beyond health and clinical medicine to include the fisheries, agriculture, shipping, and tourist industries of many nations.

Citation: Tauxe R, Seminario L, Tapia R, Libel M. 1994. The Latin American Epidemic, p 321-344. In Wachsmuth I, Blake P, Olsvik Ø (ed), and Cholera. ASM Press, Washington, DC. doi: 10.1128/9781555818364.ch21

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Figures

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Figure 1

Numbers of reported cases of cholera by day of presentation in four departments of Peru, January 23 to March 31, 1991. Data are taken from OGE, Lima, Peru.

Citation: Tauxe R, Seminario L, Tapia R, Libel M. 1994. The Latin American Epidemic, p 321-344. In Wachsmuth I, Blake P, Olsvik Ø (ed), and Cholera. ASM Press, Washington, DC. doi: 10.1128/9781555818364.ch21
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Figure 2

(A) Reported weekly incidence of cholera by physiographic region in Peru from January 1, 1991, to December 31, 1992. Peru has three regions: the dry coastal plains, the Andean mountain chain, and the Amazon jungle. (B) Reported weekly CFRs by region in Peru from January 1, 1991, to December 31, 1992. Data are taken from OGE, Lima, Peru.

Citation: Tauxe R, Seminario L, Tapia R, Libel M. 1994. The Latin American Epidemic, p 321-344. In Wachsmuth I, Blake P, Olsvik Ø (ed), and Cholera. ASM Press, Washington, DC. doi: 10.1128/9781555818364.ch21
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Figure 3

Geographic extent of the Latin American epidemic over time. Lines represent the advancing front of the epidemic at different dates. By March 1993, all Latin American countries except Uruguay had reported cholera, and no cases had been reported from the Caribbean.

Citation: Tauxe R, Seminario L, Tapia R, Libel M. 1994. The Latin American Epidemic, p 321-344. In Wachsmuth I, Blake P, Olsvik Ø (ed), and Cholera. ASM Press, Washington, DC. doi: 10.1128/9781555818364.ch21
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Figure 4

Numbers of reported cases of cholera by week (Peru, Guatemala) or by month (Mexico) from January 1991 through early 1993. In each country, incidence peaks in the summer and fall. Since Peru is south of the equator, the warm seasonal peaks occur in January through March. Data were obtained from the Pan American Health Organization.

Citation: Tauxe R, Seminario L, Tapia R, Libel M. 1994. The Latin American Epidemic, p 321-344. In Wachsmuth I, Blake P, Olsvik Ø (ed), and Cholera. ASM Press, Washington, DC. doi: 10.1128/9781555818364.ch21
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Figure 5

Reported incidence of cholera by state in Mexico, 1991 and 1992.

Citation: Tauxe R, Seminario L, Tapia R, Libel M. 1994. The Latin American Epidemic, p 321-344. In Wachsmuth I, Blake P, Olsvik Ø (ed), and Cholera. ASM Press, Washington, DC. doi: 10.1128/9781555818364.ch21
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References

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Tables

Generic image for table
Table 1

Cholera cases and deaths by country as reported January 1, 1991, through June 10, 1993, to the Pan American Health Organization, with date of first report

Citation: Tauxe R, Seminario L, Tapia R, Libel M. 1994. The Latin American Epidemic, p 321-344. In Wachsmuth I, Blake P, Olsvik Ø (ed), and Cholera. ASM Press, Washington, DC. doi: 10.1128/9781555818364.ch21
Generic image for table
Table 2

Reported cases and incidence of cholera by age and sex, Mexico, 1991

Citation: Tauxe R, Seminario L, Tapia R, Libel M. 1994. The Latin American Epidemic, p 321-344. In Wachsmuth I, Blake P, Olsvik Ø (ed), and Cholera. ASM Press, Washington, DC. doi: 10.1128/9781555818364.ch21
Generic image for table
Table 3

Risk factors for cholera identified in six collaborative case-control investigations in Latin America, 1991 to 1992

Citation: Tauxe R, Seminario L, Tapia R, Libel M. 1994. The Latin American Epidemic, p 321-344. In Wachsmuth I, Blake P, Olsvik Ø (ed), and Cholera. ASM Press, Washington, DC. doi: 10.1128/9781555818364.ch21

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