Cholera outbreaks and pandemics
Encyclopedia
It is estimated that cholera
Cholera
Cholera is an infection of the small intestine that is caused by the bacterium Vibrio cholerae. The main symptoms are profuse watery diarrhea and vomiting. Transmission occurs primarily by drinking or eating water or food that has been contaminated by the diarrhea of an infected person or the feces...

 affects 3-5 million people worldwide, and causes 100,000-130,000 deaths a year as of 2010. This occurs mainly in the developing world. In the early 1980s, death rates are believed to have been greater than 3 million a year. It is difficult to calculate exact numbers of cases, as many go unreported due to concerns that an outbreak may have a negative impact on the tourism of a country. Cholera remains both epidemic
Epidemic
In epidemiology, an epidemic , occurs when new cases of a certain disease, in a given human population, and during a given period, substantially exceed what is expected based on recent experience...

 and endemic in many areas of the world.

It is estimated that cholera
Cholera
Cholera is an infection of the small intestine that is caused by the bacterium Vibrio cholerae. The main symptoms are profuse watery diarrhea and vomiting. Transmission occurs primarily by drinking or eating water or food that has been contaminated by the diarrhea of an infected person or the feces...

 affects 3-5 million people worldwide, and causes 100,000-130,000 deaths a year as of 2010. This occurs mainly in the developing world. In the early 1980s, death rates are believed to have been greater than 3 million a year. It is difficult to calculate exact numbers of cases, as many go unreported due to concerns that an outbreak may have a negative impact on the tourism of a country. Cholera remains both epidemic
Epidemic
In epidemiology, an epidemic , occurs when new cases of a certain disease, in a given human population, and during a given period, substantially exceed what is expected based on recent experience...

 and endemic in many areas of the world.

It is estimated that cholera
Cholera
Cholera is an infection of the small intestine that is caused by the bacterium Vibrio cholerae. The main symptoms are profuse watery diarrhea and vomiting. Transmission occurs primarily by drinking or eating water or food that has been contaminated by the diarrhea of an infected person or the feces...

 affects 3-5 million people worldwide, and causes 100,000-130,000 deaths a year as of 2010. This occurs mainly in the developing world. In the early 1980s, death rates are believed to have been greater than 3 million a year. It is difficult to calculate exact numbers of cases, as many go unreported due to concerns that an outbreak may have a negative impact on the tourism of a country. Cholera remains both epidemic
Epidemic
In epidemiology, an epidemic , occurs when new cases of a certain disease, in a given human population, and during a given period, substantially exceed what is expected based on recent experience...

 and endemic in many areas of the world.

Although much is known about the mechanisms behind the spread of cholera, this has not led to a full understanding of what makes cholera outbreaks happen some places and not others. Lack of treatment of human feces
Feces
Feces, faeces, or fæces is a waste product from an animal's digestive tract expelled through the anus or cloaca during defecation.-Etymology:...

 and lack of treatment of drinking water greatly facilitate its spread, but bodies of water can serve as a reservoir
Natural reservoir
Natural reservoir or nidus, refers to the long-term host of the pathogen of an infectious disease. It is often the case that hosts do not get the disease carried by the pathogen or it is carried as a subclinical infection and so asymptomatic and non-lethal...

, and seafood shipped long distances can spread the disease. Cholera was not known in the Americas for most of the 20th century, but it reappeared towards the end of that century and seems likely to persist.

Deaths in India
Indian subcontinent
The Indian subcontinent, also Indian Subcontinent, Indo-Pak Subcontinent or South Asian Subcontinent is a region of the Asian continent on the Indian tectonic plate from the Hindu Kush or Hindu Koh, Himalayas and including the Kuen Lun and Karakoram ranges, forming a land mass which extends...

 between 1817 and 1860 are estimated to have exceeded 15 million people. Another 23 million died between 1865 and 1917. Russian
Russian Empire
The Russian Empire was a state that existed from 1721 until the Russian Revolution of 1917. It was the successor to the Tsardom of Russia and the predecessor of the Soviet Union...

 deaths during a similar time period exceeded 2 million.

First

  • 1816-1826 - The first cholera pandemic
    First cholera pandemic
    The first cholera pandemic, also known as the first Asiatic cholera pandemic or Asiatic cholera, lasted from 1817 to 1824. While cholera had spread across India many times previously, this outbreak went further; it reached as far as China and the Caspian Sea before receding...

    , though previously restricted, began in Bengal
    Bengal
    Bengal is a historical and geographical region in the northeast region of the Indian Subcontinent at the apex of the Bay of Bengal. Today, it is mainly divided between the sovereign land of People's Republic of Bangladesh and the Indian state of West Bengal, although some regions of the previous...

    , and then spread across India
    India
    India , officially the Republic of India , is a country in South Asia. It is the seventh-largest country by geographical area, the second-most populous country with over 1.2 billion people, and the most populous democracy in the world...

     by 1820. Ten thousand British troops, and many times this number of Indians, died during this pandemic. The cholera outbreak extended as far as China
    China
    Chinese civilization may refer to:* China for more general discussion of the country.* Chinese culture* Greater China, the transnational community of ethnic Chinese.* History of China* Sinosphere, the area historically affected by Chinese culture...

    , Indonesia
    Indonesia
    Indonesia , officially the Republic of Indonesia , is a country in Southeast Asia and Oceania. Indonesia is an archipelago comprising approximately 13,000 islands. It has 33 provinces with over 238 million people, and is the world's fourth most populous country. Indonesia is a republic, with an...

     (where more than 100,000 people succumbed on the island of Java
    Java
    Java is an island of Indonesia. With a population of 135 million , it is the world's most populous island, and one of the most densely populated regions in the world. It is home to 60% of Indonesia's population. The Indonesian capital city, Jakarta, is in west Java...

     alone) and the Caspian Sea
    Caspian Sea
    The Caspian Sea is the largest enclosed body of water on Earth by area, variously classed as the world's largest lake or a full-fledged sea. The sea has a surface area of and a volume of...

    , before receding.

Second

  • 1829-1851 - A second cholera pandemic
    Second cholera pandemic
    The second cholera pandemic also known as the Asiatic Cholera Pandemic was a Cholera pandemic from 1829-1849.-History:This pandemic began, like the first, with outbreaks along the Ganges River delta. From there the disease spread along trade routes to cover most of India. By 1828 the disease had...

    reached Russia (see Cholera Riots
    Cholera Riots
    - Cholera Riots in Russia :The Cholera Riots were the riots of the urban population, peasants and soldiers in Russia in 1830-1831 during the cholera outbreak....

    ), Hungary
    Hungary
    Hungary , officially the Republic of Hungary , is a landlocked country in Central Europe. It is situated in the Carpathian Basin and is bordered by Slovakia to the north, Ukraine and Romania to the east, Serbia and Croatia to the south, Slovenia to the southwest and Austria to the west. The...

     (about 100,000 deaths) and Germany
    Germany
    Germany , officially the Federal Republic of Germany , is a federal parliamentary republic in Europe. The country consists of 16 states while the capital and largest city is Berlin. Germany covers an area of 357,021 km2 and has a largely temperate seasonal climate...

     in 1831, London
    London
    London is the capital city of :England and the :United Kingdom, the largest metropolitan area in the United Kingdom, and the largest urban zone in the European Union by most measures. Located on the River Thames, London has been a major settlement for two millennia, its history going back to its...

     (more than 55,000 people died in the United Kingdom
    United Kingdom of Great Britain and Ireland
    The United Kingdom of Great Britain and Ireland was the formal name of the United Kingdom during the period when what is now the Republic of Ireland formed a part of it....

    ) and Paris
    Paris
    Paris is the capital and largest city in France, situated on the river Seine, in northern France, at the heart of the Île-de-France region...

     in 1832. In London, the disease claimed 6,536 victims and came to be known as "King Cholera"; in Paris, 20,000 succumbed (out of a population of 650,000), with about 100,000 deaths in all of France
    France
    The French Republic , The French Republic , The French Republic , (commonly known as France , is a unitary semi-presidential republic in Western Europe with several overseas territories and islands located on other continents and in the Indian, Pacific, and Atlantic oceans. Metropolitan France...

    . The epidemic reached Quebec, Ontario and New York
    New York
    New York is a state in the Northeastern region of the United States. It is the nation's third most populous state. New York is bordered by New Jersey and Pennsylvania to the south, and by Connecticut, Massachusetts and Vermont to the east...

     in the same year, and the Pacific coast of North America by 1834. In the center of the country, it spread through the cities linked by the rivers and steamboat traffic. The 1831 cholera epidemic killed 150,000 people in Egypt
    Egypt
    Egypt , officially the Arab Republic of Egypt, Arabic: , is a country mainly in North Africa, with the Sinai Peninsula forming a land bridge in Southwest Asia. Egypt is thus a transcontinental country, and a major power in Africa, the Mediterranean Basin, the Middle East and the Muslim world...

    .

In 1846, cholera struck Mecca
Mecca
Mecca is a city in the Hijaz and the capital of Makkah province in Saudi Arabia. The city is located inland from Jeddah in a narrow valley at a height of above sea level...

, killing over 15,000 people. A two-year outbreak began in England and Wales
England and Wales
England and Wales is a jurisdiction within the United Kingdom. It consists of England and Wales, two of the four countries of the United Kingdom...

 in 1848, and claimed 52,000 lives.

1849 - A second major outbreak occurred in Paris. In London, it was the worst outbreak in the city's history, claiming 14,137 lives, over twice as many as the 1832 outbreak. Cholera hit Ireland
Ireland
Ireland is an island to the northwest of continental Europe. It is the third-largest island in Europe and the twentieth-largest island on Earth...

 in 1849 and killed many of the Irish Famine survivors, already weakened by starvation and fever. In 1849, cholera claimed 5,308 lives in the port city of Liverpool
Liverpool
Liverpool is a city and metropolitan borough of Merseyside, England, along the eastern side of the Mersey Estuary. It was founded as a borough in 1207 and was granted city status in 1880...

, England
England
England is a country that is part of the United Kingdom. It shares land borders with Scotland to the north and Wales to the west; the Irish Sea is to the north west, the Celtic Sea to the south west, with the North Sea to the east and the English Channel to the south separating it from continental...

, and 1,834 in Hull
Kingston upon Hull
Kingston upon Hull , usually referred to as Hull, is a city and unitary authority area in the ceremonial county of the East Riding of Yorkshire, England. It stands on the River Hull at its junction with the Humber estuary, 25 miles inland from the North Sea. Hull has a resident population of...

, England. An outbreak in North America took the life of former U.S. President
President of the United States
The President of the United States of America is the head of state and head of government of the United States. The president leads the executive branch of the federal government and is the commander-in-chief of the United States Armed Forces....

 James K. Polk
James K. Polk
James Knox Polk was the 11th President of the United States . Polk was born in Mecklenburg County, North Carolina. He later lived in and represented Tennessee. A Democrat, Polk served as the 17th Speaker of the House of Representatives and the 12th Governor of Tennessee...

. Cholera, believed spread from ship(s) from England, spread throughout the Mississippi river system
Mississippi River
The Mississippi River is the largest river system in North America. Flowing entirely in the United States, this river rises in western Minnesota and meanders slowly southwards for to the Mississippi River Delta at the Gulf of Mexico. With its many tributaries, the Mississippi's watershed drains...

, killing over 4,500 in St. Louis and over 3,000 in New Orleans as well as thousands in New York
New York
New York is a state in the Northeastern region of the United States. It is the nation's third most populous state. New York is bordered by New Jersey and Pennsylvania to the south, and by Connecticut, Massachusetts and Vermont to the east...

. It claimed 200,000 victims in Mexico
Mexico
The United Mexican States , commonly known as Mexico , is a federal constitutional republic in North America. It is bordered on the north by the United States; on the south and west by the Pacific Ocean; on the southeast by Guatemala, Belize, and the Caribbean Sea; and on the east by the Gulf of...

.
In 1849, cholera was spread along the California
California Trail
The California Trail was an emigrant trail of about across the western half of the North American continent from Missouri River towns to what is now the state of California...

, Mormon
Mormon Trail
The Mormon Trail or Mormon Pioneer Trail is the 1,300 mile route that members of The Church of Jesus Christ of Latter-day Saints traveled from 1846 to 1868...

 and Oregon Trail
Oregon Trail
The Oregon Trail is a historic east-west wagon route that connected the Missouri River to valleys in Oregon and locations in between.After 1840 steam-powered riverboats and steamboats traversing up and down the Ohio, Mississippi and Missouri rivers sped settlement and development in the flat...

s as 6,000 to 12,000 are believed to have died on their way to the California Gold Rush
California Gold Rush
The California Gold Rush began on January 24, 1848, when gold was found by James W. Marshall at Sutter's Mill in Coloma, California. The first to hear confirmed information of the gold rush were the people in Oregon, the Sandwich Islands , and Latin America, who were the first to start flocking to...

, Utah
Utah
Utah is a state in the Western United States. It was the 45th state to join the Union, on January 4, 1896. Approximately 80% of Utah's 2,763,885 people live along the Wasatch Front, centering on Salt Lake City. This leaves vast expanses of the state nearly uninhabited, making the population the...

 and Oregon
Oregon
Oregon is a state in the Pacific Northwest region of the United States. It is located on the Pacific coast, with Washington to the north, California to the south, Nevada on the southeast and Idaho to the east. The Columbia and Snake rivers delineate much of Oregon's northern and eastern...

 in the cholera years of 1849-1855. It is believed more than 150,000 Americans died during the two pandemics between 1832 and 1849.

During this pandemic the beliefs behind the reason for cholera differed. In France cholera was assumed to somehow be connected to the poor community or the environment. Russia thought of this disease as contagious and America put the blame of cholera on recent immigrants, specifically the Irish. Lastly, some of the British thought that the reason might be due to divine intervention.:

Third

  • 1852-1860 - The third cholera pandemic
    Third cholera pandemic
    The third cholera pandemic was an outbreak of cholera that occurred from 1852-1860, and mainly affected Russia, with over a million deaths. In 1853-1854, London's epidemic claimed over 10,000 lives with 23,000 deaths for all of Britain.-External links:*...

    mainly affected Russia, with over one million deaths. In 1852, cholera spread east to Indonesia, and later invaded China
    China
    Chinese civilization may refer to:* China for more general discussion of the country.* Chinese culture* Greater China, the transnational community of ethnic Chinese.* History of China* Sinosphere, the area historically affected by Chinese culture...

     and Japan in 1854. The Philippines
    Philippines
    The Philippines , officially known as the Republic of the Philippines , is a country in Southeast Asia in the western Pacific Ocean. To its north across the Luzon Strait lies Taiwan. West across the South China Sea sits Vietnam...

     were infected in 1858 and Korea
    Korea
    Korea ) is an East Asian geographic region that is currently divided into two separate sovereign states — North Korea and South Korea. Located on the Korean Peninsula, Korea is bordered by the People's Republic of China to the northwest, Russia to the northeast, and is separated from Japan to the...

     in 1859. In 1859, an outbreak in Bengal again led to the transmission of the disease to Iran
    Iran
    Iran , officially the Islamic Republic of Iran , is a country in Southern and Western Asia. The name "Iran" has been in use natively since the Sassanian era and came into use internationally in 1935, before which the country was known to the Western world as Persia...

    , Iraq
    Iraq
    Iraq ; officially the Republic of Iraq is a country in Western Asia spanning most of the northwestern end of the Zagros mountain range, the eastern part of the Syrian Desert and the northern part of the Arabian Desert....

    , Arabia and Russia. There were at least seven major outbreaks of cholera in Japan
    Japan
    Japan is an island nation in East Asia. Located in the Pacific Ocean, it lies to the east of the Sea of Japan, China, North Korea, South Korea and Russia, stretching from the Sea of Okhotsk in the north to the East China Sea and Taiwan in the south...

     between 1858 and 1902. The Ansei
    Ansei
    was a after Kaei and before Man'en. This period spanned the years from November 1854 through March 1860. The reigning emperor was .- Change of era :...

     outbreak of 1858-60, for example, is believed to have killed between 100,000 and 200,000 people in Tokyo
    Tokyo
    , ; officially , is one of the 47 prefectures of Japan. Tokyo is the capital of Japan, the center of the Greater Tokyo Area, and the largest metropolitan area of Japan. It is the seat of the Japanese government and the Imperial Palace, and the home of the Japanese Imperial Family...

     alone.
1854 - An outbreak of cholera in Chicago
Chicago
Chicago is the largest city in the US state of Illinois. With nearly 2.7 million residents, it is the most populous city in the Midwestern United States and the third most populous in the US, after New York City and Los Angeles...

 took the lives of 5.5% of the population (about 3,500 people). In 1853-4, London's epidemic claimed 10,738 lives. The Soho
Soho
Soho is an area of the City of Westminster and part of the West End of London. Long established as an entertainment district, for much of the 20th century Soho had a reputation for sex shops as well as night life and film industry. Since the early 1980s, the area has undergone considerable...

 outbreak in London ended after removal of the handle of the Broad Street pump by a committee instigated to action by John Snow
John Snow (physician)
John Snow was an English physician and a leader in the adoption of anaesthesia and medical hygiene. He is considered to be one of the fathers of epidemiology, because of his work in tracing the source of a cholera outbreak in Soho, England, in 1854.-Early life and education:Snow was born 15 March...

. His study proved contaminated water was the main agent spreading cholera, although he did not identify the contaminant. It would take many years for this message to be believed and acted upon. Throughout Spain
Spain
Spain , officially the Kingdom of Spain languages]] under the European Charter for Regional or Minority Languages. In each of these, Spain's official name is as follows:;;;;;;), is a country and member state of the European Union located in southwestern Europe on the Iberian Peninsula...

, cholera caused more than 236,000 deaths in 1854–55. In 1854 and 1855, it entered Venezuela; Brazil also suffered in 1855.

During the third pandemic, Tunisia, who had not been affected by the two previous pandemics thought the reason for cholera was the Europeans. They blamed the sanitation of the Europeans who had previously had the disease and were in their country. Also, the United States now assumed that cholera was somehow associated with African Americans :

Fourth

  • 1863-1875 - The fourth cholera pandemic
    Fourth cholera pandemic
    The fourth cholera pandemic was the fourth major pandemic of cholera that spread from 1863 to 1879. It began in the Bengal region, and Indian Muslim pilgrims visiting Mecca spread the disease through the Middle East.-External links:*...

    spread mostly in Europe and Africa
    Africa
    Africa is the world's second largest and second most populous continent, after Asia. At about 30.2 million km² including adjacent islands, it covers 6% of the Earth's total surface area and 20.4% of the total land area...

    . At least 30,000 of the 90,000 Mecca
    Mecca
    Mecca is a city in the Hijaz and the capital of Makkah province in Saudi Arabia. The city is located inland from Jeddah in a narrow valley at a height of above sea level...

     pilgrims fell victim to the disease. Cholera ravaged Africa in 1865. Traveling southeastward, cholera reached Zanzibar
    Zanzibar
    Zanzibar ,Persian: زنگبار, from suffix bār: "coast" and Zangi: "bruin" ; is a semi-autonomous part of Tanzania, in East Africa. It comprises the Zanzibar Archipelago in the Indian Ocean, off the coast of the mainland, and consists of numerous small islands and two large ones: Unguja , and Pemba...

    , where 70,000 people are reported to have died in 1869–70. Cholera claimed 90,000 lives in Russia in 1866. The epidemic of cholera that spread with the Austro-Prussian War
    Austro-Prussian War
    The Austro-Prussian War was a war fought in 1866 between the German Confederation under the leadership of the Austrian Empire and its German allies on one side and the Kingdom of Prussia with its German allies and Italy on the...

     (1866) is estimated to have taken 165,000 lives in the Austrian Empire
    Austrian Empire
    The Austrian Empire was a modern era successor empire, which was centered on what is today's Austria and which officially lasted from 1804 to 1867. It was followed by the Empire of Austria-Hungary, whose proclamation was a diplomatic move that elevated Hungary's status within the Austrian Empire...

    . Hungary and Belgium
    Belgium
    Belgium , officially the Kingdom of Belgium, is a federal state in Western Europe. It is a founding member of the European Union and hosts the EU's headquarters, and those of several other major international organisations such as NATO.Belgium is also a member of, or affiliated to, many...

     both lost 30,000 people, and in the Netherlands
    Netherlands
    The Netherlands is a constituent country of the Kingdom of the Netherlands, located mainly in North-West Europe and with several islands in the Caribbean. Mainland Netherlands borders the North Sea to the north and west, Belgium to the south, and Germany to the east, and shares maritime borders...

    , 20,000 perished. In 1867, Italy
    Italy
    Italy , officially the Italian Republic languages]] under the European Charter for Regional or Minority Languages. In each of these, Italy's official name is as follows:;;;;;;;;), is a unitary parliamentary republic in South-Central Europe. To the north it borders France, Switzerland, Austria and...

     lost 113,000 lives. That same year, cholera traveled to Algeria
    Algeria
    Algeria , officially the People's Democratic Republic of Algeria , also formally referred to as the Democratic and Popular Republic of Algeria, is a country in the Maghreb region of Northwest Africa with Algiers as its capital.In terms of land area, it is the largest country in Africa and the Arab...

     and killed 80,000.


Outbreaks in North America in 1866 - 1873 killed some 50,000 Americans.
In London, a localized epidemic in the East End claimed 5,596 lives, just as London was completing its major sewage and water treatment systems; the East End section was not quite complete. William Farr
William Farr
William Farr was a nineteenth-century British epidemiologist, regarded as one of the founders of medical statistics.-Early life:He was born in Kenley, Shropshire, England to poor parents...

, using the work of John Snow, et al., as to contaminated drinking water being the likely source of the disease, relatively quickly identified the East London Water Company as the source of the contaminated water. Quick action prevented further deaths. Also, a minor outbreak occurred at Ystalyfera
Ystalyfera
Ystalyfera is a former industrial village in the upper Swansea Valley, on the River Tawe, about north-east of Swansea. It is an electoral ward and a community in the unitary authority of Neath Port Talbot, Wales, comprising a resident population of just over 3,000 people, approximately 60% of whom...

 in South Wales, caused by the local water works using contaminated canal water; it was mainly its workers and their families who suffered, and 119 died. In the same year, more than 21,000 people died in Amsterdam, The Netherlands. In the 1870s, cholera spread in the U.S. as an epidemic from New Orleans along the Mississippi River and related ports of tributaries, with thousands dying.

Fifth

  • 1881-1896 - The fifth cholera pandemic
    Fifth cholera pandemic
    The fifth cholera pandemic was the fifth major outbreak of cholera that occurred in the years 1881-1896 starting in India. The 1892 outbreak in Hamburg, Germany was the only major European outbreak; about 8,600 people died in Hamburg. Although generally held responsible for the virulence of the...

    , according to Dr A. J. Wall, the 1883-1887 part of the epidemic cost 250,000 lives in Europe and at least 50,000 in Americas. Cholera claimed 267,890 lives in Russia (1892); 120,000 in Spain
    Spain
    Spain , officially the Kingdom of Spain languages]] under the European Charter for Regional or Minority Languages. In each of these, Spain's official name is as follows:;;;;;;), is a country and member state of the European Union located in southwestern Europe on the Iberian Peninsula...

    ; 90,000 in Japan
    Japan
    Japan is an island nation in East Asia. Located in the Pacific Ocean, it lies to the east of the Sea of Japan, China, North Korea, South Korea and Russia, stretching from the Sea of Okhotsk in the north to the East China Sea and Taiwan in the south...

     and over 60,000 in Persia
    Iran
    Iran , officially the Islamic Republic of Iran , is a country in Southern and Western Asia. The name "Iran" has been in use natively since the Sassanian era and came into use internationally in 1935, before which the country was known to the Western world as Persia...

    . In Egypt
    Egypt
    Egypt , officially the Arab Republic of Egypt, Arabic: , is a country mainly in North Africa, with the Sinai Peninsula forming a land bridge in Southwest Asia. Egypt is thus a transcontinental country, and a major power in Africa, the Mediterranean Basin, the Middle East and the Muslim world...

    , cholera claimed more than 58,000 lives. The 1892 outbreak in Hamburg
    Hamburg
    -History:The first historic name for the city was, according to Claudius Ptolemy's reports, Treva.But the city takes its modern name, Hamburg, from the first permanent building on the site, a castle whose construction was ordered by the Emperor Charlemagne in AD 808...

     killed 8,600 people. Although the city government was generally held responsible for the virulence of the epidemic, it went largely unchanged. This was the last serious European cholera outbreak, as cities improved their sanitation and water systems.

Sixth

  • 1899-1923 - The sixth cholera pandemic
    Sixth cholera pandemic
    The sixth cholera pandemic was a major outbreak of cholera from the years 1899 to 1923. It killed more than 800,000 in India then erupted in the Middle East, northern Africa, Russia and Eastern Europe....

    had little effect in Europe because of advances in public health, but major Russian cities (more than 500,000 people dying of cholera during the first quarter of the 20th century) and the Ottoman Empire
    Ottoman Empire
    The Ottoman EmpireIt was usually referred to as the "Ottoman Empire", the "Turkish Empire", the "Ottoman Caliphate" or more commonly "Turkey" by its contemporaries...

     were particularly hard hit by cholera deaths. The 1902-1904 cholera epidemic claimed 200,000 lives in the Philippines
    Philippines
    The Philippines , officially known as the Republic of the Philippines , is a country in Southeast Asia in the western Pacific Ocean. To its north across the Luzon Strait lies Taiwan. West across the South China Sea sits Vietnam...

    . Twenty-seven epidemics were recorded during pilgrimages to Mecca
    Mecca
    Mecca is a city in the Hijaz and the capital of Makkah province in Saudi Arabia. The city is located inland from Jeddah in a narrow valley at a height of above sea level...

     from the 19th century to 1930, and more than 20,000 pilgrims died of cholera during the 1907–08 hajj
    Hajj
    The Hajj is the pilgrimage to Mecca, Saudi Arabia. It is one of the largest pilgrimages in the world, and is the fifth pillar of Islam, a religious duty that must be carried out at least once in their lifetime by every able-bodied Muslim who can afford to do so...

    . The sixth pandemic killed more than 800,000 in India
    India
    India , officially the Republic of India , is a country in South Asia. It is the seventh-largest country by geographical area, the second-most populous country with over 1.2 billion people, and the most populous democracy in the world...

    . The last outbreak in the United States was in 1910-1911, when the steamship Moltke brought infected people from Naples to New York City. Vigilant health authorities isolated the infected on Swinburne Island
    Swinburne Island
    Swinburne Island is the smaller of two artificial islands located in the Lower New York Bay east of South Beach, Staten Island.-History:The island was created in 1860. Along with Hoffman Island, it was used to quarantine immigrants to the United States in the early 20th century who were found to be...

    . Eleven people died, including a health care worker on the island.
In this time period cholera greatly started to be associated with outsiders and this could be seen time and time again. The Italians blamed the Jews and gypsies, the British who were in India accused the “dirty natives”, and the Americans saw the problem coming from the Philippines.

Seventh

  • 1961–1975 - The seventh cholera pandemic
    Seventh cholera pandemic
    The seventh cholera pandemic was the seventh major outbreak of cholera and occurred from the years 1961 to the 1970s and has continued to the present. The outbreak began in Indonesia, called El Tor after the strain, and reached Bangladesh in 1963, India in 1964, and the USSR in 1966. From North...

    began in Indonesia
    Indonesia
    Indonesia , officially the Republic of Indonesia , is a country in Southeast Asia and Oceania. Indonesia is an archipelago comprising approximately 13,000 islands. It has 33 provinces with over 238 million people, and is the world's fourth most populous country. Indonesia is a republic, with an...

    , called El Tor
    El Tor
    El Tor is the name given to a particular strain of the bacterium Vibrio cholerae, the causative agent of cholera. Also known as V. cholera biotype eltor, it has been the dominant strain in the seventh global pandemic. It is distinguished from the classic strain at a genetic level, although both are...

     after the strain, and reached East Pakistan
    East Pakistan
    East Pakistan was a provincial state of Pakistan established in 14 August 1947. The provincial state existed until its declaration of independence on 26 March 1971 as the independent nation of Bangladesh. Pakistan recognized the new nation on 16 December 1971. East Pakistan was created from Bengal...

     (now Bangladesh
    Bangladesh
    Bangladesh , officially the People's Republic of Bangladesh is a sovereign state located in South Asia. It is bordered by India on all sides except for a small border with Burma to the far southeast and by the Bay of Bengal to the south...

    ) in 1963, India in 1964, and the USSR in 1966. From North Africa
    North Africa
    North Africa or Northern Africa is the northernmost region of the African continent, linked by the Sahara to Sub-Saharan Africa. Geopolitically, the United Nations definition of Northern Africa includes eight countries or territories; Algeria, Egypt, Libya, Morocco, South Sudan, Sudan, Tunisia, and...

    , it spread into Italy by 1973. In the late 1970s, there were small outbreaks in Japan and in the South Pacific. There were also many reports of a cholera outbreak near Baku
    Baku
    Baku , sometimes spelled as Baki or Bakou, is the capital and largest city of Azerbaijan, as well as the largest city on the Caspian Sea and of the Caucasus region. It is located on the southern shore of the Absheron Peninsula, which projects into the Caspian Sea. The city consists of two principal...

     in 1972, but information about it was suppressed in the USSR.

Notable recent outbreaks

  • 2011: Besides the ongoing cholera outbreak in Haiti and spilling over to Dominican Republic, there are outbreaks in Nigeria and Democratic Republic of Congo, in addition, Somalia
    Somalia
    Somalia , officially the Somali Republic and formerly known as the Somali Democratic Republic under Socialist rule, is a country located in the Horn of Africa. Since the outbreak of the Somali Civil War in 1991 there has been no central government control over most of the country's territory...

     is experiencing a double hit of cholera outbreak and famine.

  • In January 2011, about 411 Venezuelan citizens were invited to a wedding ceremony to be held in The Dominican Republic, by the time they returned to Caracas and other Venezuelan cities, some of these people, all of whom had consumed a particular dish of raw fish cooked in lemon juice, (Ceviche), were suffering from the symptoms of Cholera. By January 28, almost 111 cases had been confirmed by the Venezuelan Health Authorities, who as a safety measure quickly instituted an 800 number for patients who were in doubt as to whether or not they too were infected. Internationally, this small outbreak prompted Venezuela's western neighbor, Colombia, to secure its border against probable transmission and immigration of the disease. Also, Dominican authorities started a nationwide study to determine the cause of the outbreak within their shores, as well as warning the public of the imminent danger associated to the consumption of raw fish and shellfish. As of January 29, 2011, none of the cases in Venezuela proved fatal, but 2 of them degraded to a life-threatening state and the patients had to be hospitalized. The fact that most of the people infected were members of the upper class probably helped in speeding up the detection and containment of the outbreak, since most of them had a way to circumvent Venezuela's deteriorated public health facilities, and had access to private clinics and hospitals.

  • November 2010 - It was reported the cholera outbreak that began in Haiti the previous month had spread into the Dominican Republic. Nepalese UN soldiers have been blamed for acting as carriers and passing it on through poorly maintained septic systems. However, Asian cholera strains have been spread around the world already e.g. by ballast water of ships; Vibrio cholera bacteria can survive between outbreaks in brackish warm water as it recently has been discovered, and movement of unresistant refugees near this is the likely cause.,. It was also reported the cholera outbreak has reached Florida from a woman who had visited Haiti. Cholera has occurred in Southern USA in recent years without causing major epidemics.

  • October 2010 - In late October a cholera outbreak was reported in Haiti
    Haiti
    Haiti , officially the Republic of Haiti , is a Caribbean country. It occupies the western, smaller portion of the island of Hispaniola, in the Greater Antillean archipelago, which it shares with the Dominican Republic. Ayiti was the indigenous Taíno or Amerindian name for the island...

    , and as of November 16 the Haitian Health Ministry reported the number of dead to be 1,034, with hospitalizations for cholera symptoms totaling over 16,700. It is feared that the epidemic could accelerate due to standing water left by a recent hurricane and the fact that over one-tenth of the population remain living in close quarters in tents in refugee camps without adequate sanitation since the Haiti earthquake
    2010 Haiti earthquake
    The 2010 Haiti earthquake was a catastrophic magnitude 7.0 Mw earthquake, with an epicentre near the town of Léogâne, approximately west of Port-au-Prince, Haiti's capital. The earthquake occurred at 16:53 local time on Tuesday, 12 January 2010.By 24 January, at least 52 aftershocks...

     in January.

  • August 2010 - Nigeria
    Nigeria
    Nigeria , officially the Federal Republic of Nigeria, is a federal constitutional republic comprising 36 states and its Federal Capital Territory, Abuja. The country is located in West Africa and shares land borders with the Republic of Benin in the west, Chad and Cameroon in the east, and Niger in...

     is reaching epidemic proportions after wide spread confirmation of the Cholera outbreaks in 12 of its 36 states. 6400 cases have been reported with 352 reported deaths. The health ministry blamed the outbreak on heavy seasonal rainfall and poor sanitation.

  • January 2009 - The Mpumalanga province of South Africa
    South Africa
    The Republic of South Africa is a country in southern Africa. Located at the southern tip of Africa, it is divided into nine provinces, with of coastline on the Atlantic and Indian oceans...

     has confirmed over 381 new cases of Cholera, bringing the total number of cases treated since November 2008 to 2276. 19 people have died in the province since the outbreak.

  • August 2008 - April 2009: In the 2008 Zimbabwean cholera outbreak, which is still continuing, an estimated 96,591 people in the country
    Zimbabwe
    Zimbabwe is a landlocked country located in the southern part of the African continent, between the Zambezi and Limpopo rivers. It is bordered by South Africa to the south, Botswana to the southwest, Zambia and a tip of Namibia to the northwest and Mozambique to the east. Zimbabwe has three...

     have been infected with cholera and, by 16 April 2009, 4,201 deaths had been reported. According to the World Health Organization
    World Health Organization
    The World Health Organization is a specialized agency of the United Nations that acts as a coordinating authority on international public health. Established on 7 April 1948, with headquarters in Geneva, Switzerland, the agency inherited the mandate and resources of its predecessor, the Health...

    , during the week of 22–28 March 2009, the "Crude Case Fatality Ratio (CFR)" had dropped from 4.2% to 3.7%. The daily updates for the period 29 March 2009 to 7 April 2009, list 1748 cases and 64 fatalities, giving a weekly CFR of 3.66% (see table above); however, those for the period 8 April to 16 April list 1375 new cases and 62 deaths (and a resulting CFR of 4.5%). The CFR had remained above 4.7% for most of January and early February 2009.

  • November 2008 - Doctors Without Borders reported an outbreak in a refugee camp in the Democratic Republic of the Congo
    Democratic Republic of the Congo
    The Democratic Republic of the Congo is a state located in Central Africa. It is the second largest country in Africa by area and the eleventh largest in the world...

    's eastern provincial capital of Goma
    Goma
    Goma is a city in the eastern Democratic Republic of the Congo, on the northern shore of Lake Kivu, next to the Rwandan city of Gisenyi. The lake and the two cities are in the western branch of the Great Rift Valley, and Goma lies only 13 to 18 km due south of the crater of the active...

    . Some 45 cases were reportedly treated between November 7 and 9.


  • August - October 2008 - As of 29 October 2008, a total of 644 laboratory-confirmed cholera cases, including eight deaths, had been verified in Iraq
    Iraq
    Iraq ; officially the Republic of Iraq is a country in Western Asia spanning most of the northwestern end of the Zagros mountain range, the eastern part of the Syrian Desert and the northern part of the Arabian Desert....

    .

  • March - April 2008 - 2,490 people from 20 provinces throughout Vietnam
    Vietnam
    Vietnam – sometimes spelled Viet Nam , officially the Socialist Republic of Vietnam – is the easternmost country on the Indochina Peninsula in Southeast Asia. It is bordered by China to the north, Laos to the northwest, Cambodia to the southwest, and the South China Sea –...

     have been hospitalized with acute diarrhea. Of those hospitalized, 377 patients tested positive for cholera.

  • August 2007 - The cholera epidemic started in Orissa
    Orissa
    Orissa , officially Odisha since Nov 2011, is a state of India, located on the east coast of India, by the Bay of Bengal. It is the modern name of the ancient nation of Kalinga, which was invaded by the Maurya Emperor Ashoka in 261 BC. The modern state of Orissa was established on 1 April...

    , India
    India
    India , officially the Republic of India , is a country in South Asia. It is the seventh-largest country by geographical area, the second-most populous country with over 1.2 billion people, and the most populous democracy in the world...

    . The outbreak has affected Rayagada, Koraput and Kalahandi districts, where more than 2,000 people have been admitted to hospitals.

  • July - December 2007 - A lack of clean drinking water in Iraq
    Iraq
    Iraq ; officially the Republic of Iraq is a country in Western Asia spanning most of the northwestern end of the Zagros mountain range, the eastern part of the Syrian Desert and the northern part of the Arabian Desert....

     has led to an outbreak
    2007 Iraq cholera outbreak
    A lack of clean drinking water in Iraq in 2007 led to an outbreak of cholera. A total of 181 people were infected, with 10 deaths reported.According to Dr...

     of cholera. As of 2 December 2007, the UN had reported 22 deaths and 4,569 laboratory-confirmed cases.

  • In 2000, some 140,000 cholera cases were officially notified to WHO. Africa
    Africa
    Africa is the world's second largest and second most populous continent, after Asia. At about 30.2 million km² including adjacent islands, it covers 6% of the Earth's total surface area and 20.4% of the total land area...

     accounted for 87% of these cases.

  • January 1991 to September 1994 - Outbreak in South America
    South America
    South America is a continent situated in the Western Hemisphere, mostly in the Southern Hemisphere, with a relatively small portion in the Northern Hemisphere. The continent is also considered a subcontinent of the Americas. It is bordered on the west by the Pacific Ocean and on the north and east...

    , apparently initiated when a ship discharged ballast water
    Sailing ballast
    Ballast is used in sailboats to provide moment to resist the lateral forces on the sail. Insufficiently ballasted boats will tend to tip, or heel, excessively in high winds. Too much heel may result in the boat capsizing. If a sailing vessel should need to voyage without cargo then ballast of...

    . Beginning in Peru
    Peru
    Peru , officially the Republic of Peru , is a country in western South America. It is bordered on the north by Ecuador and Colombia, on the east by Brazil, on the southeast by Bolivia, on the south by Chile, and on the west by the Pacific Ocean....

    , there were 1.04 million identified cases and almost 10,000 deaths. The causative agent was an O1, El Tor strain, with small differences from the seventh pandemic strain. In 1992 a new strain appeared in Asia, a non-O1, nonagglutinable vibrio (NAG) named O139 Bengal. It was first identified in Tamil Nadu
    Tamil Nadu
    Tamil Nadu is one of the 28 states of India. Its capital and largest city is Chennai. Tamil Nadu lies in the southernmost part of the Indian Peninsula and is bordered by the union territory of Pondicherry, and the states of Kerala, Karnataka, and Andhra Pradesh...

    , India and for a while displaced El Tor in southern Asia before decreasing in prevalence from 1995 to around 10% of all cases. It is considered to be an intermediate between El Tor and the classic strain and occurs in a new serogroup. There is evidence of the emergence of wide-spectrum resistance to drugs such as trimethoprim
    Trimethoprim
    Trimethoprim is a bacteriostatic antibiotic mainly used in the prophylaxis and treatment of urinary tract infections.It belongs to the class of chemotherapeutic agents known as dihydrofolate reductase inhibitors...

    , sulfamethoxazole
    Sulfamethoxazole
    Sulfamethoxazole is a sulfonamide bacteriostatic antibiotic.It is most often used as part of a synergistic combination with trimethoprim in a 5:1 ratio in co-trimoxazole , also known under trade names such as Bactrim, Septrin, or Septra; in Eastern Europe it is marketed as Biseptol...

     and streptomycin
    Streptomycin
    Streptomycin is an antibiotic drug, the first of a class of drugs called aminoglycosides to be discovered, and was the first antibiotic remedy for tuberculosis. It is derived from the actinobacterium Streptomyces griseus. Streptomycin is a bactericidal antibiotic. Streptomycin cannot be given...

    .

False reports

A persistent myth states 90,000 people died in Chicago of cholera and typhoid fever
Typhoid fever
Typhoid fever, also known as Typhoid, is a common worldwide bacterial disease, transmitted by the ingestion of food or water contaminated with the feces of an infected person, which contain the bacterium Salmonella enterica, serovar Typhi...

 in 1885, but this story has no factual basis. In 1885, there was a torrential rainstorm that flushed the Chicago River
Chicago River
The Chicago River is a system of rivers and canals with a combined length of that runs through the city of the same name, including its center . Though not especially long, the river is notable for being the reason why Chicago became an important location, as the link between the Great Lakes and...

 and its attendant pollutants into Lake Michigan
Lake Michigan
Lake Michigan is one of the five Great Lakes of North America and the only one located entirely within the United States. It is the second largest of the Great Lakes by volume and the third largest by surface area, after Lake Superior and Lake Huron...

far enough that the city's water supply was contaminated. However, because cholera was not present in the city, there were no cholera-related deaths. Nevertheless, the incident caused the city to become more serious about its sewage treatment.
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