1. June 2003 PAHO/WHO Cholera (Region of the Americas, 1991-2002)

2. June 2003 PAHO/WHO Initial epidemic: January 1991 August 1991 February 1992 March 1993 Cholera Epidemic in the Americas

3. June 2003 PAHO/WHO Reported Cases of Cholera (Region of the Americas, 1991-2002) 24 534 57,312

4. June 2003 PAHO/WHO Number of Cholera Cases in Central America 13 1

5. June 2003 PAHO/WHO Factors Favoring Eradication  Fragility of the organism.  Large dose required for infection (10 6 ), lack of person-to-person transmission.  Short incubation period.  Probable impact of non-specific control measures.  Public motivated.

6. June 2003 PAHO/WHO Factors Impeding Eradication  Persistence of V. cholerae in the aquatic environment.  Increase in population density.  Non-existence of an adequate vaccine, limited protection from natural immune system.  Failure of other traditional public-health measures (chemoprophylaxis, quarantine, trade embargos).  Development of an effective treatment.  Flexibility and variety of V. cholerae toxigenic strains.

7. June 2003 PAHO/WHO Incidence of Cholera by Gross National Product (per capita GNP)

8. June 2003 PAHO/WHO Prevention and Control Strategies  Epidemiological surveillance.  Environmental sanitation.  Food safety.  Social communication and health/sanitary education.