Recent developments in cholera

Cholera continues to be an important public health problem among many poorer communities in Africa, Asia and South America, despite the bacteriology and epidemiology of the disease having been described over a century ago. Molecular techniques have enabled current researchers to gain new insights into pathogenicity, into the relationships between environmental and clinical strains, and into new strategies for vaccine development. The description of non-culturable 'dormant' strains in the environment and the effect of environmental factors on toxin gene regulation provide valuable clues to the ecology of the disease. Disease management continues to be based on urgent and appropriate rehydration, and recent community studies emphasize the need for effective local health services to provide this if case fatality rates are to remain low. While antimicrobial agents may play a role in case management and prophylaxis, the increasing prevalence of antimicrobial resistance must be addressed. New vaccine candidates, based on a molecular understanding of pathogenicity, provide scope for improved strategies for disease prevention, though the appropriate public health context for their use has not been determined. This review summarizes activities in these fields of cholera research and considers the continuing global problem of the disease.