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Epidemiological Bulletin
      Vol. 18, No. 1
 March 1997  


CHOLERA SITUATION IN THE AMERICAS, 1996

Introduction

In 1996, 17 countries in the Hemisphere reported a total of 24,642 cases and 350 deaths from Vibrio cholerae 01 (Figure 1). Compared to the 86,646 cases and 890 deaths reported in 1995, there was a 72% reduction in cases and a 60% reduction in deaths from the disease in 1996. The distribution of cases by country is illustrated in Figure 1. In 1996, the number of cases reported continued the downward trend observed since 1991 (Table 1 - Figure 2).


Table 1
Reported Cholera Cases, Deaths, and Cumulative Incidence Rates
by Country, Region of the Americas, 1991-1996*

Country




 Date of Most
Recent Update

 Cases
(Deaths)
1991


 Cases
(Deaths)
1992


 Cases
(Deaths)
1993


 Cases
(Deaths)
1994


 Cases
(Deaths)
1995


 Cases
(Deaths)
1996


 Cumulative Cases
(Deaths)
1991-1996

 Cumulative
Incidence
(per 100,000 Population)***
1991-1996
South America
Argentina
 

Bolivia
 

Brazil****
 

Chile
 

Colombia
 

Ecuador
 

F. Guiana
 

Guyana
 

Paraguay
 

Peru
 

Surinam
 

Venezuela
 

 2/15/97
 

2/22/97
 

2/15/97
 

1/28/96
 

12/29/96
 

12/29/96
 

2/13/93
 

12/29/96
 

4/1/96
 

12/29/96
 

12/29/96
 

2/22/97
 

 0
 

206
(12)

2,103
(33)

41
(2)

16,800
(291)

46,284
(697)

1
(0)

0
 

0
 

322,562
(2,909)

0
 

13
(2)

 553
(15)

22,260
(383)

37,572
(462)

73
(1)

13,287
(170)

31,870
(208)

16
(0)

556
(8)

0
 

210,836
(727)

12
(1)

2,842
(68)

 2,080
(24)

10,134
(254)

153,109
(670)

32
(0)

609
(11)

6,883
(72)

2
(0)

66
(2)

3
(0)

71,448
(575)

0
 

409
(10)

 889
(15)

2,710
(46)

119,722
(542)

1
(0)

996
(14)

1,785
(16)

**
 

0
 

0
 

23,887
(199)

0
 

0
 

 188
(1)

3,136
(86)

15,915
(96)

0
 

1,922
(35)

2,160
(23)

**
 

0
 

0
 

22,397
(171)

0
 

0
 

 474
(5)

2,847
(68)

4,634
(23)

1
(0)

4,428
(70)

1059
(12)

**
 

0
 

4
(0)

4,518
(21)

0
 

268
(9)

 4,184
(60)

41,293
(849)

333,055
(1,826)

148
(3)

38,042
(591)

90,041
(1,028)

19
(0)

622
(10)

7
(0)

655,648
(4,602)

12
(1)

3,532
(89)

 12
 

556
 

205
 

1
 

108
 

785
 

13
 

74
 

0.14
 

2,757
 

3
 

16
 
North/Central America
Belize
 

C. Rica
 

El Salv.
 

Guatemala
 

Honduras
 

Mexico
 

Nicaragua
 

Panama
 

Un. States
 

 2/1/97
 

8/4/96
 

12/29/96
 

2/22/97
 

1/25/97
 

2/15/97
 

2/15/97
 

2/22/97
 

12/29/96
 

 0
 

0
 

947
(34)

3,664
(50)

17
(0)

2,690
(34)

1
(0)

1,178
(29)

26
(0)

 159
(4)

12
(0)

8,106
(45)

15,861
(227)

407
(103)

8,162
(99)

3,067
(46)

2,416
(49)

102
(1)

 135
(3)

14
(0)

6,573
(14)

30,821
(306)

4,013
(102)

10,712
(193)

6,631
(220)

42
(4)

18
(0)

 6
(1)

37
(0)

11,739
(40)

16,779
(156)

5,049
(102)

4,059
(56)

7,881
(134)

0
 

34
(0)

 19
(0)

24
(0)

2,923
(5)

7,970
(95)

4,717
(77)

16,430
(137)

8,825
(164)

0
 

20
(0)

 26
(0)

19
(0)

182
(2)

1,568
(14)

708
(14)

1,088
(5)

2,813
(107)

0
 

5
(0)

 345
(8)

106
(0)

30,470
(140)

76,663
(848)

14,911
(398)

43,141
(524)

29,218
(671)

3,636
(82)

205
(1)

 159
 

3
 

528
 

721
 

263
 

46
 

648
 

138
 

0.08
 
Total Cases
(Death)
Incidents		   396,533
(4,093)
89		 358,169
(2,617)
81		 303,734
(2,460)
68		 195,574
(1,321)
44		 86,646
(890)
19		 24,642
(350)
5		 1,365,298
(11,371)
 		 305
 
 

* Data should be considered provisional and subject to revision
** No reports received
*** Total comulative incidence 1991-1996 does not include the United States
**** Notified cases include clinical and confirmed cases.

In 1996, Brazil, Peru and Colombia (countries that share borders) had the greatest number of cases: 4,634, 4,518, and 4,428, respectively, Nicaragua, with significantly fewer cases (2,813), reported the greatest number of deaths (107). In the past three years, French Guiana, Guyana, Suriname, and Panama have been cholera-free, and the disease has not spread to the Caribbean countries and Canada.

In 1996 the average case-fatality rate for cholera in Latin America (deaths/cases) was around 1.4%.

Based on the epidemiological reports received from 4 January to 22 February 1997 (epidemiological week 8), eight countries in the Hemisphere reported 2,755 cases and 34 deaths from cholera. During 1996-1997, four counties in the region have witnessed a significant re-emergence of the disease. The following is a brief description of the current situation in each country.

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Argentina

During the first five months of 1996, Argentina experienced an epidemic of cholera that peaked in February and was concentrated mainly in Salta Province. The epidemic was responsible for 422 cases and 5 deaths, with the last case reported on 25 May. During October (epidemiological week 4) another outbreak of the disease was reported raising the cumulative total for the year to 474 cases, or 2.5 times the total number of cases reported in 1995 (188 cases). The epidemic continued in 1997 peaking during epidemiological week 3. As of 15 February 1997, Argentina reported 405 cases, the majority of them (95%) along the Bolivian border with Salta and Jujuy.

The National Commission for the Prevention and Control of Cholera in Argentina has been responsible for programming and coordinating joint activities in border areas. It is also in charge of information exchange and analysis, promoting meeting of the local border commissions and defining the strategies for prevention and control in populations at risk. The Commission has also been engaged in supervision and has actively collaborated in work related to case management, laboratory diagnosis, the training of heath workers, food control, and the construction of the basic sanitation works in high-risk areas.

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Bolivia

In 1996, Bolivia reported a total of 2,847 cases and 68 deaths. Since October 1996, the country has been experiencing its sixth cholera outbreak which is likely to persist until April or May 1997. The municipalities most affected are Tarija, Beni Chuquisaca, Santa Cruz, and Cochabamba. Yacuiba, on the border with Argentina, has been declared and emergency zone. Between 29 December and 16 January 1997, Tarija reported 482 cases and 1 death, Street sales of food and beverages have been suspended in the municipality due to the suspicion that his practice is responsible for the outbreak. As of epidemiological week 8, the cumulative total for cholera cases in 1997 was 946 and 7 deaths, with a marked decline beginning in week 3.

A team of professionals from the National Health Secretariat was formed to conduct joint activities that will make it possible to control the outbreak and improve epidemiological surveillance in the country. Support at the operational level has been provided in the following areas: clinical and maintenance of a chorine generator. Bolivia is collaborating with Argentine authorities in the preparation of project for PAHO/WHO technical cooperation.

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Colombia

In 1996, Colombia was struck by a cholera epidemic that chiefly affected the Atlantic Coast and the mid-Magdalena region; endemic behavior persisted in the Pacific Coast area, and outbreaks and isolated cases occurred in the Amazon and Andean regions. Along the Venezuelan border, there were no cases reported in the Departments of Arauca, Vichada, and Guainia; however, the Departments of Guajira, César, and Norte de Santander were affected. In 1996, the Department of Guajira accounted for 32% of the cases and 54% of the deaths from cholera in Colombia. The drought, the migration of salt miners (June), and the lack of drinking water and critical excreta disposal, were the main causes of the epidemic in that department. Colombia reported a total of 4,428 cases and 70 deaths in 1996 - a 130% increase in cholera cases over 1995 (Figure 3).

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Venezuela

In September 1996, after a two-year hiatus, cholera was reported in Venezuela in the municipality of Páez in the State of Zulia. This outbreak was associated with the consumption of raw seafood and initially involved 9 people. In 1996, during epidemiological week 51, the epidemic reached the Federal District causing 16 reported cases. In all, the epidemic (weeks 39-52) was responsible for 254 cases and 8 deaths, or 95% of the total cases reported by Venezuela for that year. As of epidemiological week 8, 1997, 323 cases and 14 deaths have been reported with a significant decline beginning in week 3.

Source: Communicable Diseases Program, Division of Disease Prevention and Control, (HCT, HCP) PAHO.

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