PAN AMERICAN HEALTH ORGANIZATION
Regional Office for the Americas of the
WORLD HEALTH ORGANIZATION

Washington, 19 April 1996 -- Cholera continues to spread in Latin America, with over 1.3 million cases and 11,339 deaths reported since the epidemic began in Peru in January 1991, the Pan American Health Organization reported today.

"Now, as the epidemic enters its sixth year in the hemisphere, cholera has become established in a number of countries, serving as a stark reminder of deficiencies in water quality, sanitation, and hygiene that will continue to challenge governments and health agencies into the next century," the report said.

In 1995, 85,802 cases of cholera and 847 deaths were reported from 14 countries, a decrease from the 195,574 cases and 1,321 deaths reported in 1994, according to the data compiled by the Division of Disease Prevention and Control of PAHO.

Although total reports of cholera cases declined in 1995, four countries reported more cholera cases in 1995 than in 1994. These were Colombia, with 1,922 cases and 35 deaths in 1995; Ecuador, with 2,160 cases and 23 deaths; Mexico, with 16,430 cases and 137 deaths; and Nicaragua, which reported 8,825 cases and 164 deaths in 1995.

The report noted that cholera is under-reported, and "cholera surveillance figures represent only a small fraction of the actual number of people infected." In addition, year-to-year trends may be distorted by changes in cholera case definitions or reporting policies.

Countries reporting cholera cases in 1995 included: Peru, 22,397 cases and 171 deaths; Mexico, with 16,430 cases and 137 deaths; Brazil, with 15,915 cases and 95 deaths; Nicaragua, with 8,825 cases and 164 deaths; Guatemala, with 7,970 cases and 85 deaths; Honduras, with 4,717 cases and 77 deaths; El Salvador, with 2,923 cases and 5 deaths; Bolivia, with 2,293 cases and 54 deaths; Ecuador, with 2,160 cases and 23 deaths; Colombia, with 1,922 cases and 35 deaths; Argentina, with 188 cases and 1 death; Costa Rica, with 24 cases and no deaths; Belize, with 19 cases and no deaths; and the U.S.A., with 19 cases and no deaths. Chile, Guyana, Panama, Paraguay, Suriname, and Venezuela reported no cases.

The report called for improvement in detection of cholera in Latin America, noting that, "Despite declining annual cholera incidence rates in most countries, cases continue to be reported, and are increasing in some areas. Improved cholera surveillance measures will help enhance understanding of the disease and contribute to controlling its spread."

CHOLERA IN THE AMERICAS
SUMMARY OF REPORTED CASES, DEATHS, AND CUMULATIVE INCIDENCE
RATES BY COUNTRY, 1991-1995*

Country	Date of Most Recent Update	Cases (Deaths) 1991	Cases (Deaths) 1992	Cases (Deaths) 1993	Cases (Deaths) 1994	Cases (Deaths) 1995	Cumulative Cases (Deaths)	Cumulative Incidence* per 100,000 persons
SOUTH AMERICA								-
Argentina	03 Dec 95	0	553 (15)	2,080 (24)	889 (15)	188 (1)	3,710 (55)	11
Bolivia	30 Nov 95	206 (12)	22,260 (383)	10,134 (254)	2,710 (46)	2,293 (54)	37,603 (749)	507
Brazil	31 Dec 95	2,103 (33)	37,572 (462)	153,109 (670)	119,722 (542)	15,915 (85)	328,421 (1,792)	203
Chile	31 Dec 95	41 (2)	73 (1)	32 (0)	1 (0)	0	147 (3)	1
Colombia	27 Nov 95	16,800 (291)	13,287 (170)	609 (11)	996 (14)	1,922 (35)	33,614 (521)	96
Ecuador	22 Dec 95	46,284 (697)	31,870 (208)	6,883 (72)	1,785 (16)	2,160 (23)	88,982 (1,016)	776
French Guiana	13 Feb 93	1 (0)	16 (0)	2 (0)	**	**	19 (0)	13
Guyana	29 July 95	0	556 (8)	66 (2)	0	0	622 (10)	74
Paraguay	27 Dec 95	0	0	3 (0)	0	0	3 (0)	0.06
Peru	16 Dec 95	322,562 (2,909)	210,836 (727)	71,448 (575)	23,887 (199)	22,397 (171)	651,130 (4,581)	2738
Suriname	25 July 95	0	12 (1)	0	0	0	12 (1)	3
Venezuela	30 Dec 95	13 (2)	2,842 (68)	409 (10)	0	0	3,264 (80)	15
NORTH/ CENTRAL AMERICA								-
Belize	30 Dec 95	0	159 (4)	135 (3)	6 (1)	19 (0)	319 (8)	148
Costa Rica	04 Nov 95	0	12(0)	14 (0)	37 (0)	24 (0)	87 (0)	3
El Salvador	31 Dec 95	947 (34)	8,106 (45)	6,573 (14)	11,739 (40)	2,923 (5)	30,288 (138)	525
Guatemala	02 Dec 95	3,664 (50)	15,861 (227)	30,821 (306)	16,779 (156)	7,970 (95)	75,095 (834)	707
Honduras	27 Dec 95	17 (0)	407 (103)	4,013 (102)	5,049 (102)	4,717 (77)	14,203 (384)	251
Mexico	30 Dec 95	2,690 (34)	8,162 (99)	10,712 (193)	4,059 (56)	16,430 (137)	42,053 (519)	46
Nicaragua	04 Dec 95	1 (0)	3,067 (46)	6,631 (220)	7,881 (134)	8,825 (164)	26,405 (564)	596
Panama	30 Dec 95	1,178 (29)	2,416 (49)	42 (4)	0	0	3,636 (82)	138
USA	30 Dec 95	26 (0)	102 (1)	18 (0)	34 (0)	19 (0)	199 (1)	0.07
Total Cases (Deaths) Cumulative Incidence		396,533 (4,093) 89	358,169 (2,617) 81	303,734 (2,460) 68	195,574 (1,321) 44	85,802 (847) 19	1,339,812 (11,338)	302

*This data should be considered provisional and subject to revision.
**No reports received.