Cholera in 1993. Part I.

In 1993, the seventh pandemic of Vibrio cholerae O1 biotype El Tor, which began in Indonesia in 1961 and reached South and Central America in 1991, continued in all regions of the world (Map 1): a total of 376,845 cases and 6,781 deaths were reported from 78 countries, with a global case-fatality ratio (CFR) of 1.8%. This represents an 18% reduction in the number of reported cases and a 16% reduction in the number of reported deaths compared with 1992. The number of countries reporting cholera is the highest ever recorded in any one year (Table 1, and Fig. 1). A total of 209,192 cases and 2,438 deaths were reported from the Americas, a 41% reduction in the number of cases and a 1.5% increase in the number of deaths from 1992. Africa reported 76,713 cases and 2,532 deaths, a 16% reduction in the number of cases and a 52% reduction in the number of deaths from 1992. Asia reported 90,862 cases and 1,809 deaths, a five-and-a-half-fold increase in both the number of cases and deaths (Figs. 2 and 3). Europe reported 73 cases (the majority imported) and 2 deaths, a four-fold increase in the number of cases. Five imported cases were reported by Australia in the Oceania region. Of particular importance during 1993 was the emergence of epidemic cholera produced by a non-O1 cholera serogroup. V. Cholerae O139 (Bengal) was first identified in 1992 as the causative organism of large outbreaks in India and in 1993 was isolated in 7 countries in Asia. Imported cases have been reported from 5 other countries.(ABSTRACT TRUNCATED AT 250 WORDS)