During the first week of February this year, the South African health authorities reported two cases of cholera in people returning from Malawi. Since then, four more infections have been notified to the NICD. The third case was a household contact of the index patients, two infections have been acquired locally, and the origin of one case remains under investigation. This event highlights the ongoing risk that cholera may pose for travellers, and the community.
Cholera is an acute, secretory diarrhoeal disease caused by toxigenic strains of the Gram-negative bacterium Vibrio cholerae. Improved sanitation and access to safe water have largely eliminated indigenous cholera in high-income countries. However, cholera remains endemic in many middle and lower-income countries where both sporadic and 1 epidemic infections can occur. Upwards of four million cases of cholera are estimated to occur each year with approximately 150 000 deaths. The World Health Organization (WHO) estimates that officially-reported cases may 2 significantly under-represent the true number of infections . Cholera remains prevalent in many parts of Africa, Central America and Asia (Figure 1, below). The recent detection of two locally acquired cases is of great concern as South Africa has been regarded as being cholera-free.