Cholera in 1994. Part I.

In 1994, Vibrio cholerae O1 biotype El Tor, the agent responsible for the seventh cholera pandemic which began in 1961, continued to spread in all regions of the world (Map 1). In all, 384,403 cholera cases were officially reported to WHO in 1994 (a 2% increase over 1993), reversing the downward trend which started in 1992. A total of 10,692 deaths were reported in 1994, increasing the reported global case-fatality ratio (CFR) to 2.8% from 1.8% in 1993. Cholera cases were notified from 94 countries/areas, the highest number ever reporting in one year. (Table 1 and Fig. 1). The year was marked by the dramatic cholera outbreak that devastated the Rwandan refugee camps in Goma, Zaire in July. Major outbreaks also affected Afghanistan, Brazil, Guinea, Guinea-Bissau and Somalia. Africa reported a rise in the number of cholera cases, and was the continent accounting for the largest proportion of all reported cases. The incidence of cholera cases in the Americas continued to fall and reported CFR was the lowest recorded since the disease reached Latin America in 1991. Asia reported a 17% increase in cholera cases compared with 1993. Europe, which usually reports only imported cases, registered a significant increase in the number of indigenous cholera cases. Oceania reported 6 cases, 5 of which were imported, and no deaths (Figs. 2 and 3). The new V. cholerae strain O139 (Bengal) has affected 10 countries in Asia since it was first detected in India at