Risk of Cholera Among Western and Japanese Travelers

Background: There has been concern about an increased risk of cholera in travelers to Latin America since the spread of the pandemic to this part of the world. Additionally, before this study the continuous high incidence of imported cholera to Japan had so far not been analyzed. Methods: A retrospective analysis of cases notified in 1991 to national surveillance centers in industrialized countries and to the World Health Organization was carried out. Denominator data were obtained by the World Tourism Organization. Results: The reported rate of imported cholera in European and North American travelers visiting endemic areas remains in the range of 0,2 per 100,000, as was observed 10 years ago. This rate is, however, is manyfold higher in Japanese travelers, with a highest value of 13,0 per 100,000 reported in those returning from Indonesia, usually Bali. No secondary outbreaks were observed in those countries to which cholera was imported. Conclusions: It is assumed that the higher rates in Japanese travelers are mainly due to more intensive surveillance. On Bali and elsewhere, further studies are needed to determine both the role of V. cholerae as a cause of traveler's diarrhea in tourists and to re-evaluate the need for cholera vaccination at specific high-risk destinations.