Chapter 18 : Historical Perspectives on Pandemic Cholera

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This chapter provides an overview of the history of cholera to set the scene for understanding the epidemiology and surveillance of cholera since 1970. Accounts of the spread of pandemic cholera in the 19th century are largely summaries of apparent transfer from place to place by steamship. Before 1961, the El Tor biotype of O1 was known to cause cases and outbreaks of cholera-like disease, but it was not generally considered to have epidemic potential. It may be reasonable to consider the first six cholera pandemics as a single continuing pandemic, even though there is no bacteriologic proof that O1 of the classical biotype caused the first four pandemics as well as the fifth and sixth. First, the divisions between the six pandemics are indistinct, and it is not clear that they were separated by cholera-free intervals. Second, there is recent evidence that O1 can persist indefinitely as a free-living organism in some natural environments; pandemics 2 through 6 may have stemmed from organisms persisting in the environment in many countries as well as from small foci of human disease. Third, the seventh pandemic, caused by a different biotype, has persisted for 33 years, longer than any of the previous pandemics; it had explosive expansions in 1970 and 1991 that might have been considered new pandemics according to methods used to describe the first six pandemics. Finally, there may now be an eighth pandemic caused by of a different O group.

Citation: Blake P. 1994. Historical Perspectives on Pandemic Cholera, p 293-295. In Wachsmuth I, Blake P, Olsvik Ø (ed), and Cholera. ASM Press, Washington, DC. doi: 10.1128/9781555818364.ch18
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