Gaffga Nicholas H, Tauxe Robert V, Mintz Eric D
Division of Foodborne, Mycotic, and Enteric Diseases, National Center for Zoonotic, Vectorborne, and Enteric Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
Am J Trop Med Hyg. 2007 Oct;77(4):705-13.
Cholera was largely eliminated from industrialized countries by water and sewage treatment over a century ago. Today it remains a significant cause of morbidity and mortality in developing countries, where it is a marker for inadequate drinking water and sanitation infrastructure. Death from cholera can be prevented through simple treatment-oral, or in severe cases, intravenous rehydration. The cholera case-fatality rate therefore reflects access to basic health care. We reviewed World Health Organization (WHO) data on cholera cases and deaths reported between 1960 and 2005. In the 1960s, at the beginning of the seventh and current cholera pandemic, cholera had an exclusively Asian focus. In 1970, the pandemic reached sub-Saharan Africa, where it has remained entrenched. In 1991, the seventh pandemic reached Latin America, resulting in nearly 1 million reported cases from the region within 3 years. In contrast to the persisting situation in Africa, cholera was largely eliminated from Latin America within a decade. In 2005, 31 (78%) of the 40 countries that reported indigenous cases of cholera to WHO were in sub-Saharan Africa. The reported incidence of indigenous cholera in sub-Saharan Africa in 2005 (166 cases/million population) was 95 times higher than the reported incidence in Asia (1.74 cases/million population) and 16,600 times higher than the reported incidence in Latin America (0.01 cases/million population). In that same year, the cholera case fatality rate in sub-Saharan Africa (1.8%) was 3 times higher than that in Asia (0.6%); no cholera deaths were reported in Latin America. The persistence or control of cholera in Africa will be a key indicator of global efforts to reach the Millennium Development Goals and of recent commitments by leaders of the G-8 countries to increase development aid to the region.
一个多世纪前，霍乱在工业化国家因水和污水处理措施而基本消除。如今，霍乱仍是发展中国家发病和死亡的一个重要原因，在这些国家，它是饮用水和卫生基础设施不足的一个标志。霍乱导致的死亡可以通过简单的治疗——口服补液，或在严重情况下进行静脉补液来预防。因此，霍乱病死率反映了获得基本医疗保健的情况。我们回顾了世界卫生组织（WHO）关于1960年至2005年期间报告的霍乱病例和死亡的数据。在20世纪60年代，即第七次也是当前霍乱大流行开始时，霍乱仅在亚洲流行。1970年，该大流行蔓延到撒哈拉以南非洲，并在那里持续存在。1991年，第七次大流行蔓延到拉丁美洲，在3年内该地区报告了近100万例病例。与非洲持续存在的情况形成对比的是，霍乱在十年内基本从拉丁美洲消除。2005年，向WHO报告本土霍乱病例的40个国家中有31个（78%）在撒哈拉以南非洲。2005年撒哈拉以南非洲报告的本土霍乱发病率（每百万人口166例）比亚洲报告的发病率（每百万人口1.74例）高95倍，比拉丁美洲报告的发病率（每百万人口0.01例）高16600倍。同年，撒哈拉以南非洲的霍乱病死率（1.8%）比亚洲（0.6%）高3倍；拉丁美洲没有报告霍乱死亡病例。霍乱在非洲的持续存在或得到控制，将是全球实现千年发展目标努力以及八国集团领导人近期承诺增加对该地区发展援助的关键指标。
