Cholera in the Americas

UNTIL recently, cholera has been rare in the Americas. However, epidemic cholera appeared in Peru in January 1991 and spread rapidly through Latin America. In the first year of this epidemic, 17 cases of cholera that were associated with travel to Latin America were reported in the United States. More cases are likely to be seen. Although no spread from these imported cases has occurred, it is possible that some areas of the United States with poor sanitary conditions may be at risk for limited continued transmission of cholera. This article reviews the methods for recognition, diagnosis, and treatment of cholera. HISTORICAL BACKGROUND Six pandemics of cholera spread throughout the world before the 20th century, including three successive waves of epidemic cholera that affected the United States in the 19th century until the "sanitary revolution" brought the modernization of water and sewage systems.1The current seventh pandemic began in