Marine ecosystems and cholera

Historically, most of the major epidemics or outbreaks of cholera around the world have originated in coastal regions. The most dramatic of recent outbreaks of cholera occurred in India and Bangladesh in 1991, followed by an outbreak of cholera after almost a century without cholera in South America in 1991. Both of these recent epidemics were reported first in the coastal regions of India and Peru, respectively. Cholera epidemics are seasonal, occurring during the spring and fall months. Outbreaks of cholera in noncholera epidemic areas have been ascribed to travel and shipping activities, but there is compelling evidence that V cholerae always is present in the aquatic environment and proliferates under nonepidemic conditions while attached to, or associated with, eucaryotic organisms. It is hypothesized that climate directly influences the incidence and geographic distribution of the cholera bacterium.