Epidemiology of cholera in travellers, and conclusions for vaccination recommendations

All cases of cholera imported to Europe and North America between 1975 and 1981 were reviewed to assess the danger of cholera for visitors to endemic areas. Data were obtained from the health authorities of the respective countries. From a total of 129 cases notified to the World Health Organisation detailed reports were obtained on 117 patients. Of these, 66 (56%) were immigrants, refugees, from endemic areas, or foreign workers returning from leave in their native countries. Only 51 (44%) were citizens of countries in Europe or North America. The incidence per journey for foreign travellers visiting Africa or Asia was about 1 in 500 000. Stay in hospital was always short, and fewer than 2% of patients died. In view of the minimal risk and lack of reliability of cholera vaccination, such protection is not indicated for ordinary tourists visiting developing countries.