Medical expert of the article
New publications
Cholera - Epidemiology
Last reviewed: 06.07.2025
All iLive content is medically reviewed or fact checked to ensure as much factual accuracy as possible.
We have strict sourcing guidelines and only link to reputable media sites, academic research institutions and, whenever possible, medically peer reviewed studies. Note that the numbers in parentheses ([1], [2], etc.) are clickable links to these studies.
If you feel that any of our content is inaccurate, out-of-date, or otherwise questionable, please select it and press Ctrl + Enter.
The source of the cholera pathogen is a person (patient and vibrio carrier). Patients with latent and mild forms of the disease who maintain social activity are especially dangerous.
The mechanism of transmission of the infection is feco-oral. The routes of transmission are water, alimentary, contact-household. The water route is of decisive importance for the rapid epidemic and pandemic spread of cholera. At the same time, not only drinking water, but also using it for household needs (washing vegetables, fruits, etc.), swimming in an infected body of water, as well as eating fish, crayfish, shrimp, oysters caught there and not heat-treated, can lead to cholera infection.
Susceptibility to cholera is universal. In endemic areas, children under 5 years of age are predominantly affected, with the exception of infants who receive IgA antibodies against cholera with their mother's milk. When a cholera outbreak develops in a non-endemic region, all age groups are equally susceptible to the disease. Factors that contribute to an increased risk of the disease include: a high infectious dose of the pathogen, concomitant conditions associated with hypochlorhydria (malnutrition, atrophic gastritis, including that caused by Helicobacter pylon infection, gastrectomy, taking drugs that reduce the acidity of gastric juice), and insufficiency of local immunity. For unknown reasons, more severe forms of the disease caused by biovar E1 Tor are recorded in individuals with blood group 0 (I).
The developing immunity is short-lived (up to 1 year), type- and species-specific, and local immunity has protective value.
After an illness, antimicrobial and antitoxic immunity is developed, which lasts from 1 to 3 years.
The epidemic process is characterized by acute explosive outbreaks, group diseases and individual imported cases. Due to extensive transport links, cholera is systematically brought into the territory of countries free of it. Six cholera pandemics have been described. The seventh pandemic, caused by the El Tor vibrio, is currently ongoing.
Classical cholera is common in India, Bangladesh, Pakistan, El Tor cholera is common in Indonesia, Thailand and other countries of Southeast Asia. In Russia, mostly imported cases are registered. Over the past 20 years, more than 100 cases of importation have been recorded in seven regions of the country. The main reason for this is tourism (85%). Cases of cholera have been recorded among foreign citizens. The most severe cholera epidemic was in Dagestan in 1994, where 2,359 cases were registered. The infection was brought in by pilgrims performing the Hajj to Saudi Arabia.
As with all intestinal infections, cholera in countries with a temperate climate is characterized by a summer-autumn seasonality.
[