The Cholera Pandemic, Still with Us after Half a Century: Time to Rethink

The recent outbreaks of cholera in Haiti, Pakistan, and Zimbabwe suggest that our current global action plans against cholera are failing. This issue contains two important articles that will help inform our discussions on ways to respond to the global cholera situation. Cholera is a severely dehydrating illness caused by Vibrio cholerae, a Gram-negative organism. V. cholerae exists in environmental aquatic reservoirs, and, as a result, cholera is not an eradicable disease, but it is controllable. Humanity has recognized seven cholera pandemics since 1817, all originating in Asia. The most recent pandemic began in 1961 in Indonesia, making it at half a century the longest cholera pandemic on record. As opposed to burning out after 5–20 years as all previous pandemics have done, this pandemic, if anything, seems to be picking up speed. Cholera outbreaks are occurring with increasing frequency and severity, as demonstrated by the recent major outbreaks in Nigeria, Angola, Pakistan, Vietnam, Zimbabwe, and now Haiti. This is on top of all the endemic infections that largely go “unnoticed”. In fact, cholera is now endemic in approximately 50 countries worldwide, and V. cholerae infects 3–5 million individuals each year, killing approximately 100,000, only a minority of whom die in outbreaks that garner media attention.