Seven cholera pandemics have happened over the past 200 years, with the first one starting in India in 1817. The seventh cholera pandemic is still ongoing today and began in 1961, as reported by the World Health Organization in a factsheet from March 2022. Many major local cholera outbreaks have also been recorded, such as an outbreak in South America from 1991 to 1994 and a more recent outbreak in Yemen from 2016 to 2021.

Scientists know how cholera spreads, but they still do not fully understand why outbreaks occur in some places and not others. Untreated human waste and untreated drinking water help the disease spread easily. Water sources have been found to act as a reservoir for the bacteria, and seafood transported over long distances can carry the disease to new areas.

Between 1816 and 1923, the first six cholera pandemics happened one after another without stopping. Increased trade, movement of people, and religious pilgrimages helped spread the disease. In the late 1800s, important discoveries were made: the first cholera vaccine by Pasteur, identification of the Vibrio cholerae bacterium by Filippo Pacini and Robert Koch. After many years without a pandemic, the seventh cholera pandemic began in 1961. It decreased in the 1970s but continued in smaller outbreaks. Cholera outbreaks still happen in many developing countries today. Epidemics often occur after wars, natural disasters, or when people live in crowded places with poor sanitation, as these conditions allow Vibrio cholerae to contaminate water and food supplies.

In India, more than 15 million people died during the first three pandemics between 1817 and 1860. Another 23 million people died between 1865 and 1917 during the next three pandemics. In the Russian Empire during a similar time period, more than 2 million people died from cholera.

Pandemics

The first cholera pandemic began in the Bengal region of India, near Calcutta (now Kolkata), from 1817 to 1824. The disease spread from India to Southeast Asia, the Middle East, Europe, and Eastern Africa through trade routes. The second pandemic occurred from 1826 to 1837 and affected North America and Europe because of improvements in transportation, global trade, and increased human movement, including soldiers. The third pandemic started in 1846, lasted until 1860, and reached North Africa and South America, including Brazil for the first time. The fourth pandemic lasted from 1863 to 1875 and spread from India to Naples and Spain, and to the United States in 1873. The fifth pandemic occurred from 1881 to 1896 and began in India, spreading to Europe, Asia, and South America. The sixth pandemic started in India in 1899 and lasted until 1923. These outbreaks were less deadly because people learned more about the cholera bacteria. Egypt, the Arabian Peninsula, Persia, India, and the Philippines were most affected during these epidemics, while other areas, such as Germany in 1892 and Naples from 1910 to 1911, also had serious outbreaks. The seventh pandemic began in 1961 in Indonesia and was caused by a new strain of the bacteria, called El Tor, which still exists in developing countries as of 2019.

Cholera was not common in the Americas most of the 20th century after it appeared in New York City in the early 1900s. It returned to the Caribbean near the end of the century and may continue to occur.

The first cholera pandemic started in Bengal and spread across India by 1820. Hundreds of thousands of Indians and 10,000 British soldiers died during this outbreak. The disease reached China, Indonesia (where over 100,000 people died on the island of Java alone), and the Caspian Sea in Europe before it declined. In 1821, it is estimated that up to 100,000 people died in Korea.

The second pandemic reached Russia, Hungary (with about 100,000 deaths), and Germany in 1831. It killed 130,000 people in Egypt that year. In 1832, it spread to London and the United Kingdom (where more than 55,000 people died) and Paris. In London, 6,536 people died, and the disease was called "King Cholera." In Paris, 20,000 people died (out of a population of 650,000), and total deaths in France reached 100,000. In 1833, a cholera outbreak killed many members of the Pomo, a Native American tribe in California. The disease spread to Quebec, Ontario, Nova Scotia, and New York in 1833, and reached the Pacific coast of North America by 1834. In the central United States, it spread through cities connected by rivers and steamboat traffic.

In Washington, D.C., Michael Shiner, an enslaved worker at the Washington Navy Yard, wrote, "The time cholera broke out in about June and July, August and September 1832, it raged in the city of Washington, and every day they were twelve or thirteen carried out to their graves a day." By late July 1832, cholera had spread to Virginia. On August 7, 1832, Commodore Lewis Warrington told the Secretary of the Navy, Levi Woodbury, that cholera was at the Gosport Navy Yard, "Between noon of that day [August 1] and the morning of Friday [August 3], when all work on board the USS Fairchild stopped, several deaths by cholera occurred and fifteen or sixteen cases (of less severity) were reported."

During this time, the cause of cholera was unknown, and the disease had a very serious outcome. Cholera affected Mexico in 1833 and 1850, leading officials to quarantine some groups and disinfect buildings, especially in large cities. However, the outbreaks still caused many deaths.

In response to the second pandemic, the Ottoman Empire and Egypt improved their quarantine systems, following models used in the western Mediterranean. In 1831, Egypt created the Egyptian Quarantine Board and built its first modern lazaretto (a facility for isolating sick people) in Alexandria in 1833. In 1831, the Ottoman government established the first permanent quarantine complex in Istanbul. In 1838, the Ottoman government formed the Supreme Council of Health, which managed 59 quarantines. While these measures were not effective against cholera, they helped protect the two countries from bubonic plague.

At this time, scientists had different ideas about what caused cholera. In France, doctors believed the disease was linked to poverty or poor living conditions. Russians thought it was contagious but did not know how it spread. In the United States, people believed cholera came from recent immigrants, especially the Irish, who were thought to have brought the disease from British ports. Some British people thought the disease might be caused by divine punishment.

The third cholera pandemic had a major impact on Russia, with over one million deaths. In 1846, more than 15,000 people died of cholera in Mecca. A two-year outbreak began in England and Wales in 1848, killing 52,000 people.

In 1849, another major outbreak occurred in France. In London, it was the worst outbreak in the city's history, killing 1

Other outbreaks

Vibrio cholerae is a very strong type of bacteria that causes many disease outbreaks over the past 300 years. Most of these outbreaks stop on their own after reaching their highest point, without needing help from people. One important factor that affects how these outbreaks spread is a process called phage predation. This happens when certain viruses (called lytic phages) attack and kill the bacteria. For this to work, the phages must recognize the bacteria’s surface receptors. Bacteria can avoid being attacked by changing their surface receptors, which stops the phages from attaching to them. In V. cholerae, this change happens because of a process called quorum sensing (QS), which is influenced by the number of bacteria present. Stool samples from infected people show that bacteria interact with each other during later stages of infection. QS is controlled by two special molecules called AI-2 and CAI-1. These molecules affect how well phages can attack V. cholerae.

A study found that AI-2 and CAI-1 reduce the activity of ten genes that help create a part of the bacteria’s surface called the O-antigen. This part is often used by phages as a way to attach to the bacteria. When the O-antigen is not made, the bacteria become more resistant to phage attacks. This means that losing the ability to make the receptor makes it harder for phages to control or eliminate V. cholerae. This knowledge is important for developing treatments that use phages to fight bacterial infections. Future treatments might include substances that block quorum sensing, called "quorum quenchers," to reduce phage resistance.

Outbreaks and Statistics:
– 1991–1994: A cholera outbreak in South America began when a Chinese ship released ballast water. It started in Peru, with over 1 million cases and nearly 10,000 deaths. The bacteria was an O1 strain, similar to the seventh pandemic strain.
– 1992: A new strain, O139 Bengal, appeared in India. It spread in parts of Asia but became less common after 1995. Scientists warn that some cholera bacteria now resist drugs like trimethoprim, sulfamethoxazole, and streptomycin.
– 1994: An outbreak in Goma, Democratic Republic of Congo, killed 12,000 people by August. At the worst, 3,000 people died daily from cholera.
– United States: A V. cholerae strain (O1) has been found in Louisiana and Texas. It may spread through seafood shipments. No major outbreaks have occurred in the U.S. due to good sanitation.
– 2000: About 140,000 cholera cases were reported globally, with 87% in African countries.
– 2007: A lack of clean water in Iraq caused a cholera outbreak with 4,569 cases and 22 deaths.
– 2007–2008: Cholera outbreaks occurred in India, Vietnam, and Iraq. In Vietnam, 2,490 people were hospitalized, with 377 testing positive for cholera.
– 2008–2009: A major cholera outbreak in Zimbabwe infected 96,591 people and caused 4,201 deaths. The death rate dropped slightly by early 2009.
– 2010: Nigeria reported 6,400 cholera cases and 352 deaths. Heavy rain and poor sanitation were blamed.
– 2010–2016: A major cholera outbreak began in Haiti after a UN peacekeeping camp was linked to the disease. By 2016, over 790,000 people were infected, and more than 9,000 died. The UN admitted responsibility and pledged $400 million to help, but only $10 million was raised by 2017.
– 2011: A cholera outbreak in Venezuela began after travelers from the Dominican Republic returned home. Over 100 cases were confirmed in Venezuela.

Note: All statistics and details are based on the original text and have not been altered.

False reports

A common but untrue story claims that 90,000 people died in Chicago from cholera and typhoid fever in 1885. However, this story is not supported by facts. In 1885, heavy rain caused the Chicago River and its pollutants to flow into Lake Michigan, contaminating the city's water supply. At that time, cholera was not present in Chicago, so no deaths from cholera occurred. Because of the pollution, the city made changes to improve how it handled sewage to prevent similar problems in the future.

In popular culture

Cholera is a disease that today mainly affects people living in poor conditions and areas with little access to clean water. Unlike tuberculosis, which was often shown in stories and art as a disease linked to artists or people in certain social groups, cholera is rarely romanticized because of its painful symptoms, such as severe diarrhea, spitting out large amounts of liquid, and strong muscle spasms that may continue even after death. Because of this, cholera is not often shown in popular culture.

• In 1831, German composer Fanny Hensel wrote a musical piece to mark the end of the second cholera outbreak in Berlin. The piece was first performed in December at a celebration for her father, Abraham Mendelssohn Bartholdy, whose sister died during the outbreak. The work was published after Hensel's death in 1986 as Oratorium nach Bildern der Bibel, but she referred to it as her "Cholerakantate" and "Choleramusik" in her writings.

• The 1889 novel Mastro-don Gesualdo by Giovanni Verga describes a cholera outbreak on the island of Sicily but does not show the suffering of those affected.

• In Thomas Mann's novella Death in Venice, published in 1912 as Der Tod in Venedig, the disease is portrayed as a symbol of the final decline of the character Gustav von Aschenbach. This differs from the real effects of cholera, as the character in the story dies peacefully on a beach. The 1971 film adaptation by Luchino Visconti also avoids showing the disease's severe symptoms. The novella was later adapted into an opera by Benjamin Britten in 1973 and a ballet by John Neumeier in 2003.

• In W. Somerset Maugham's novel The Painted Veil (1925), a British couple's marriage is explored during a cholera outbreak in China. The 2006 film adaptation, starring Edward Norton and Naomi Watts, showed the physical effects of the disease. Earlier versions from 1934 and 1957 did not show these effects.

• In Gabriel García Márquez's 1985 novel Love in the Time of Cholera, the disease is a background element rather than a central focus. The novel was adapted into a film in 2007 by Mike Newell.

• The 1995 film The Horseman on the Roof (Le Hussard sur Le toit) by Jean-Paul Rappeneau is about a cholera outbreak in southern France.

• The 1997 American television film Contagious is about people dying in Los Angeles from a cholera outbreak.

• In the 2021 American sitcom Ghosts, a group of ghosts who died from cholera live in the basement of Woodstone Mansion.