Brief History: Cholera Outbreaks

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People suffering from the symptoms of cholera lay on the floor at a hospital run by the Haitian government where Doctors Without Borders is treating people October 27, 2010 in St. Marc, Haiti. Haiti, one of the poorest nations in the Western Hemisphere, has been further unsettled by an outbreak of cholera which has so far killed nearly 300 people as of Tuesday.

During the final week of October, earthquake-ravaged Haiti scrambled to contain a sudden outbreak of cholera that threatened to turn into a full-scale epidemic. Once a global malady, the intestinal bacterium--which is transmitted through feces-contaminated water or food and has a 50% mortality rate when left untreated--is now found almost solely in the world's most impoverished regions. There, especially in the wake of disaster, it often serves as a cruel second calamity.

While cholera has existed since antiquity (Hippocrates wrote of the disease), it didn't spread across continents until 1817, when infected travelers carried it from India along trade routes and into modern-day Burma, Sri Lanka and Indonesia. In the 1830s, a second pandemic reached as far as the U.S., killing 5,000 New Orleans residents in one year alone. An 1866 New York City epidemic led to the creation of the city's board of health, the first in the U.S. Thanks to improved sanitation and modern medicine, the disease was eradicated from many parts of the world by the 1920s. Today cholera victims who are treated with an oral or intravenous solution of fluids--to replace those violently expelled by cholera's main symptom, diarrhea--have a 99% rate of survival.

These days, the scourge often comes hand in hand with cataclysms both natural (hurricanes, earthquakes) and man-made (war). Iraq suffered cholera outbreaks after the first Persian Gulf War in 1991 and again in 2003. In 1994 cholera swept through Rwandan refugee camps in the Democratic Republic of Congo, killing 23,800 within a month. So far, the 1.3 million earthquake survivors living in tents in the Haitian capital, Port-au-Prince, have been largely spared the disease. But it lingers nonetheless, the latest sign of just how far from recovery the fragile Caribbean country remains.