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EPIDEMIOLOGIA: coleramandell2015

Clinical descriptions of cholerali!e illness e"ist in ancient #ans!rit te"ts$ and cholera has li!el%&een endemic to the Gan'es delta re'ions for cent(ries$ if not lon'er) #e*en cholera pandemicsha*e &een recorded since 1+1,) All of the pandemics are tho('ht to ha*e ori'inated in Asia$partic(larl% from the Indian s(&continent) -he El -or O1 V. cholerae strain ca(sin' the on'oin'

se*enth pandemic is e*ol*in') Pol%morphisms in the 'enome of the pandemic strain ha*e &eenreported to ha*e arisen in the .a% of .en'al and then to ha*e independentl% spread to othercontinents)25 All se*en pandemics /ere li!el% ca(sed &% V. cholerae O1$ &(t in 12$ V. choleraeO1 emer'ed in India and .an'ladesh to &ecome the rst nonO1 sero'ro(p to 'i*e rise toepidemic cholera) Altho('h V. cholerae O1 initiall% ca(sed lar'e cholera o(t&rea!s$ at present$this sero'ro(p onl% ca(ses a small fraction of cholera cases in Asia3 f(rthermore$ V. choleraeO1 has not spread o(tside of Asia) 4oriontal 'ene e"chan'e appears to e"plain the molec(larori'ins of V. cholerae O13 the 'enome of this no*el V. cholerae sero'ro(p is essentiall%identical to that of El -or O1 V. cholerae$ e"cept that the 'enes encodin' O1 anti'en &ios%nthesisha*e &een replaced &% 'enes encodin' the O1 Oanti'en)26Cholera had &een a&sent from the Americas for nearl% a cent(r% (ntil 11$ /hen a lar'eo(t&rea! &e'an in Per( and rapidl% spread thro('ho(t m(ch of #o(th and Central America)D(rin' the ens(in' decade$ more than one million cases /ere reported) -he so(rce of the El -orO1 strain that 'a*e rise to this epidemic is not certain3 it has &een proposed that contaminatedship &allast /ater /as the so(rce$ &(t this idea has &een 7(estioned)2, Cholera did not reach theCari&&ean d(rin' this o(t&rea!) 4o/e*er$ in Octo&er 2010$ a se*ere cholera epidemic &e'an in4aiti on the Cari&&ean island of 4ispaniola$ 8(st 10 months after a de*astatin' earth7(a!e hadcompromised that nation9s alread% ten(o(s infrastr(ct(res for sanitation and /ater) In the 2%ears after the onset of the epidemic$ more than 600$000 cases and ,00 deaths /ere recordedin 4aiti$ and at least 6)1; of the pop(lation had &een infected

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