Cholera Incidence and El Niño–Related Higher Ambient Temperature

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Abstract
To the Editor: Since the 1991 epidemic, cholera continues to be an important health problem in Peru. More than 260,000 cases were reported in Lima alone by the end of 1993, when the epidemic was brought under control. Recent investigations suggest the existence of an environmental aquatic reservoir for Vibrio cholerae O1.1-5 Furthermore, cholera seasonality in endemic areas suggests possible long-term survival of V cholerae in the environment. Therefore, extreme weather phenomena like the 1997-1998 El Niño may facilitate the growth of V cholerae in the environment, which may in turn trigger the onset of a cholera outbreak. We have previously suggested probing sewage water for the presence of V cholerae as an environmental surveillance measure against future cholera outbreaks.5