Transmission
Usually via contaminated water but also shellfish and food.

Affected areas
During 1996 cholera cases reported to WHO continued to decline in the Americas but increased in Africa. There also appears to have been a decrease in Asia by about 30%. The predominent serotype is still 01 biotype El Tor. However in all these areas the disease remains common especially in those living in poor conditions. The 0139 serotype which was causing concern from 1992 does not appear to have spread or been the start of a pandemic with only India reporting isolated cases in 1996. (WER 1997:72,229-236). Cholera infected areas currently reported to WHO are listed at the end of this record.

Recommendations for vaccination
This vaccine is now rarely used and only if precautions against food and especially water borne infections are going to be impossible to achieve. Cholera vaccine gives only partial and shortlived protection.

Cholera Vaccination Certificates
No country officially requires cholera certificates as a condition of entry.
However sometimes travellers, usually seafarers, request cholera vaccine and/or certificates because of company policies which may not be up to date.
Also immigration authorities occassionally ask for cholera certificates but reports of this 'illegal' practice are usually only from remote border crossings (not major airports). The aim may be to obtain money from travellers who do not comply. When this occurs it should be reported to WHO who can report the incident to the appropriate national authorities.

Notes
Cholera Infected Areas (WHO/WER 74.4 29/January 1999) Other countries, especially those with poor hygiene, may also have cholera which is not reported.
AFRICA: Angola, Benin, Burkina Faso, Burundi, Cameroon, Cape Verde, Central African Republic, Chad, Comores, Congo, Cote D'Ivoire, Dem.Rep.of Congo, Djibouti, Ghana, Guinea, Guinea Bissau, Kenya, Liberia, Malawi, Mali, Mauritania, Mozambique, Niger, Nigeria, Rwanda, Sao Tome and Principe, Senegal, Sierre-Leone, Somalia, Swaziland, Tanzania, Togo, Uganda, Zambia, Zimbabwe.
ASIA: Afghanistan, Bhutan, Cambodia, China, India, Iran, Laos, Malaysia, Mongolia, Myanmar, Nepal, Philippines, Sri Lanka, Vietnam.
AMERICAS: Argentina, Belize, Bolivia, Brazil, Chile, Colombia, Costa Rica, Ecuador, El Salvador, French Guiana, Guatemala, Guyana, Honduras, Mexico, Nicaragua, Panama, Peru, Suriname, Venezuela.
EUROPE: Nil