Cholera in the 1990s.

Two strains of Vibrio cholerae are currently significant in cholera: a remnant from the sixth pandemic (1899-1923) still present in South Asia and the seventh pandemic strain which emerged in 1961. The 1990s were marked by spread of the seventh pandemic to South America in 1991 and appearance of an O139 form of the seventh pandemic strain in 1992 (or possibly 1991), which in 1993 predominated in some areas but then declined. Molecular analysis showed that the sixth and the seventh pandemic clones are related, but have a different TCP pathogenicity island and possibly different CTX phages, suggesting independent derivation from related environmental strains. Upsurges of the seventh pandemic were accompanied by increased genetic variation enabling the relationships between strains to be studied, but the basis for variation in pathogenicity is not known. There is clearly a risk of new forms arising and a strategy for speedy development of vaccines needs to be established.