PAHO Declares Central America Free of Cholera

Nicaraguan workers clean a water well contaminated during Hurricane Mitch in 1998. Such efforts prevented any major outbreaks of cholera. ©PAHO Nicaragua

The Pan American Health Organization (PAHO) has declared Central America a cholera-free zone, following a successful five-year multinational effort to rid the region of the disease.

The achievement was marked on Dec. 5, 2003, the fifth anniversary of the 1998 Costa del Sol Declaration, in which the region's ministers of health pledged to work together to prevent cholera outbreaks in the aftermath of Hurricane Mitch.

Hurricane Mitch in 1998 threatened to unleash cholera outbreaks throughout the region, reversing the health progress achieved in recent years. To prevent this, the region's health ministers met in El Salvador in December 1998 and signed the Costa del Sol Declaration, which proved to be a pivotal tool in the fight against cholera.

With PAHO support, the countries worked to replace and expand potable water and sewerage services, efforts that over time prevented cholera from becoming a serious threat. Despite the extensive damaged caused by Mitch, there were fewer cholera cases reported in Central America in 1998 than in 1994.

El Salvador's minister of health, Herbert Betancourt, appeared for the Dec. 5 announcement at PAHO's country office in San Salvador. PAHO Director Mirta Roses Periago sent a video message for the event, in which she noted that Central America was proof that multinational efforts can lead to important public health successes.

Cholera was absent from the Western Hemisphere during all but the last decade of the 20th century. The disease reemerged in Peru in 1991 and within a year had spread to 400,000 people in 14 countries.

However, the region responded well to cholera's reemergence. Although the disease claimed 4,093 lives in 1991, by 2000 the number of cholera deaths was down to 40 and by 2001, deaths were down to zero.

Panama reported its last case of cholera in 1994; Costa Rica, in 1997; Belize, in 1999; El Salvador and Nicaragua, in 2000; and Honduras, in 2001. The last recorded case of cholera in the isthmus was in Guatemala in March 2002.

In late 2003, two developments appeared to threaten Central America’s cholera-free status. Guatemala's Department of Epidemiology reported an outbreak in its journal, but the report was later termed erroneous. In early December, a suspected case was reported in Tipitapa, Nicaragua, but both PAHO and Nicaragua's Ministry of Health discarded the report after an investigation.

Cholera is caused by the bacterium Vibrio cholerae and is usually spread through water. It causes severe diarrhea and often leads to death from dehydration.