Cholera, Travel, and Infection Control

Extract

Recent outbreaks of cholera in South America and a handful of imported cases in the United States have transformed the disease from a third-world curiosity to an important issue for our daily American newspapers. Although cholera often is considered one of the classic plagues of humankind, we now know that the disease can be contained with modern sanitation and that, with proper hydration, mortality rates are less than 1%. The role of epidemiologists and infection control practitioners should be to provide information, reassure the public, and prevent harmful attempts at infection control based on “cholera hysteria.”

It is surprising to realize that cholera is a relative newcomer to the global pestilence scene. In fact, pandemics were not reported before the 18th century..’ As cholera spread from Asia to Europe, panic outran the disease and was exacerbated by futile attempts to limit the epidemic. Cholera victims were placed in strict quarantine, and their houses were burned. In some instances, military troops encircled towns or fortified borders in a vain attempt to confine the disease. Public officials would deny that cholera had invaded their cities until the graveyards were filled with indisputable evidence. In the early 1800s, during the height of the epidemic in the United States, 1,000 people died daily in Philadelphia, Pennsylvania, alone.² Virtually all those deaths could have been prevented with proper rehydration and replacement of electrolytes.