ABSTRACT
INTRODUCTION Cholera remains an important global health challenge. It is the most severe of all diarrheal diseases and the archetype for the large group of infectious diarrheas caused by noninvasive bacteria that produce one or more enterotoxins. Collectively, these ‘‘enterotoxic enteropathies’’ (1) account for a substantial proportion of all infection-related diarrheas in the world. Although not as prevalent as enterotoxigenic Escherichia coli (ETEC), cholera is notable for the striking rapidity with which it can lead to severe dehydration, shock, and death after onset of symptoms and for causing explosive outbreaks. Although accurate numbers are difficult to obtain, in part because of surveillance difficulties but also for fear of economic and social consequences, cholera is estimated to account for at least 3 to 5 million cases and 120,000 to 200,000 deaths annually among adults as well children (2).
