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39-572: At-Tur itself appears to have been founded in the 13th century near the site of the ancient Raythou (medieval Raya ). The El tor strain of cholera was discovered there in 1905. It was a quarantine camp for Muslim pilgrims returning from Hajj (the Islamic pilgrimage to Mecca). Known for its springs, the city is an important tourist destination in the South Sinai Governorate along with Sharm El Sheikh and Saint Catherine . The Raithu desert

78-459: A community near Kwangtung, a fishing area. The second case was from a boat-dwelling population located between Kwangtung and Hong Kong. Hong Kong had 72 cases with 15 deaths (20.8% mortality). By February 1, 1962, 4,107 people were infected with cholera, with 897 deaths (21.8% mortality). By September, despite a massive vaccination campaign, cholera had rapidly moved through the Philippines , where

117-808: A high cholera fatality rate of 16% by 1962. 25 countries were infected by the end of 1971 and, between 1972 and 1991, cholera spread throughout much of the remainder of Africa. An international campaign began in 1970, including the research laboratory in Dhaka , Bangladesh; the Southeast Asia Treaty Organisation (SEATO), the United Kingdom, Australia, and various American agencies. Human volunteers took part in an NIH -sponsored series of tests to develop an effective cholera vaccine. At this time, new outbreaks of cholera were occurring in Egypt, South Korea, and

156-542: A mass, and the armada stayed for a few days preparing to sail and attack Suez. El Tor was captured by Israel during the Six-Day War of 1967. It was returned to Egypt, along with the rest of the Sinai Peninsula, following the 1979 Egypt–Israel peace treaty. Its climate is classified by Köppen-Geiger system as hot desert (BWh). El Tor El Tor is a particular strain of the bacterium Vibrio cholerae ,

195-468: A single species V. cholerae : however, Hugh believed the differing features between the two could be of epidemiological importance, so El Tor vibrios were further classified as V. cholerae biotype eltor (serogroup O1). El Tor was identified again in an outbreak in 1937 but the pandemic did not arise until 1961 in Sulawesi . El Tor spread through Asia ( Bangladesh in 1963, India in 1964) and then into

234-517: A sink and source during the pandemic spread of cholera throughout the 1960s and 1970s. The suggestion that the pandemic spread of cholera may have been augmented by Chinese cases, in addition to China being identified as an origin for bordering countries, contrasts with the view that the pandemic began in Indonesia. The El Tor cholera outbreak was first reported in Java , a seaside community near Kendal which

273-506: A two-dose cholera vaccine. During the 2010–2017 cholera outbreak in Haiti, those who received the two doses of the vaccine were 76% less likely to become sick. This protection lasted 4 years. The clinical severity of the El Tor biotype causing pandemic cholera in 1962, also resulted in modern research assessing administration of antimicrobials in the initial phase of an outbreak. This was tested in

312-441: Is closely linked to inadequate access to clean water and sanitation facilities and hence, people at risk largely live in slums and poor communities. The 7th pandemic is traced to early 1961 and is ongoing. The evolution of the classical cholera strain known from the first six pandemics was revealed through genetic analysis . The first observation of the new lineage came from a laboratory in El Tor, Egypt , in 1897. By this time,

351-488: Is diagnosed through a stool test or rectal swab, and today treatment takes the form of an oral rehydration solution (ORS). The ORS uses equimolar concentrations of sodium and glucose to maximise sodium uptake in the small intestine , and carefully replaces fluid losses. In severe cases, the rapid loss of bodily fluids leads to dehydration and patients are at risk of shock . This requires administration of intravenous fluids and antibiotics . The transmission of cholera

390-523: Is relatively mild, or at least rarely fatal, and patients are asymptomatic for about a week. El Tor is able to survive in the body longer than classical cholera vibrios. This characteristic allows carriers to infect a greater population of people. In fact, V. cholerae biotype eltor can be isolated from water sources in the absence of an outbreak of cases. In extreme cases, persons can become long-term carriers; for example, Cholera Dolores, who tested vibrio positive nine years after her primary infection. El Tor

429-583: Is situated around El Tor, between Saint Catherine and the Red Sea . It is part of the Archdiocese of Mount Sinai and Raithu of the Eastern Orthodox Patriarchate of Jerusalem . The " Martyrs of Raithu " were 43 anchorites (early Christian hermits) murdered by bedouins (desert dwellers) during the reign of Emperor Diocletian (284-305CE). Christian monks fleeing persecutions had been present since

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468-460: Is the seventh major outbreak of cholera beginning in 1961 and continuing to the present. Cholera has become endemic in many countries. In 2017, WHO announced a global strategy aiming to end the pandemic by 2030. This pandemic is based on the strain called El Tor ; it started in Indonesia in 1961 and spread to East Pakistan (now Bangladesh ), by 1963. It went to India in 1964, and into

507-678: Is transmitted by the fecal-oral route. This route is the consequence of infected persons defecating near a water source, and uninfected persons consuming contaminated water. In addition, the bacteria can be transmitted by consuming uncooked food fertilized with human feces . Treatment of a cholera infection consists of replenishing lost fluid and electrolytes by intravenous or oral solutions, and by antibiotics . El Tor outbreaks can be prevented by better standards of sanitation, filtering and boiling water, thoroughly cooking seafood, and washing vegetables and fruits before consumption. 1961%E2%80%931975 cholera pandemic The seventh cholera pandemic

546-618: The Pasteur Institute of Iran produced 9.5 million cholera vaccines to protect the population of the eastern regions of Iran. In 1966 Iraq reported its first case. The cholera strain reached the Middle East and Africa in 1970 and spread rapidly. It is thought that a traveler returning from Asia or the Middle East introduced the disease into Africa. The Arabian Peninsula, Syria and Jordan became infected, followed by Guinea in August 1970. Cholera

585-687: The Soviet Union by 1966. In July 1970, there was an outbreak in Odessa (now Ukraine) and in 1972 there were reports of outbreaks in Baku , but the Soviet Union suppressed this information. Cholera reached Italy in 1973 from North Africa . Japan and the South Pacific saw a few outbreaks by the late 1970s. In 1971, the number of cases reported worldwide was 155,000. But in 1991, it reached 570,000. The spread of

624-494: The immune response . Subsequently, these advances have resulted in the development of experimental cholera vaccines derived from non-living and attenuated live strains. By 2017 the FDA had approved a single-dose, live, oral cholera vaccine called Vaxchora for adults aged 18–64 who are travelling to an area of active cholera transmission. A study in Haiti has shown lasting protection from

663-480: The 1970s with tetracycline but was found not to be useful due to resistance against this antibiotic . Questions have been raised alluding to newer drugs, and whether the administration of these will be more useful than such previous attempts. The ongoing seventh pandemic has affirmed that cholera is still prevalent in society and can cause high mortality. In 1992 the Global Task Force on Cholera Control (GTFCC)

702-539: The 20th century, the Ottoman government established six medical stations along the coast of the Sinai Peninsula to cater to pilgrims returning from Mecca. One of them was in El Tor (A' Tur as it is called today). Sick passengers were dropped off in one of the stations for treatment. In 1905, Felix Gotschlich, a German physician at the El Tor station identified vibrios in stool specimen of two pilgrims returning from Mecca . Though

741-558: The 3rd century, and the Raithu monastery (or Rutho) was commissioned in the 6th century by Byzantine emperor Justinian . The latter was proposed as a UNESCO World Heritage site on November 1, 1994, in the Cultural category. Theodore of Raithu was champion of neo-Chalcedonism in the early 7th century. En route to Suez with the objective to seek and destroy the Ottoman fleet, a Portuguese Armada

780-560: The El Tor strain, where it gained new genes that likely increased transmissibility. Cholera spread overseas in 1961, indicating a pandemic strain. Many studies point to Indonesia as the source of the seventh cholera pandemic; however, research has indicated that outbreaks in China between 1960 and 1990 were associated with the same sub-lineages. These strains spread globally from the Bay of Bengal on multiple occasions. China has been classified as both

819-519: The Middle East, Africa and Europe. From North Africa it spread into Italy by 1973. The extent of the pandemic has been due to the relative mildness (lower expression level) of El Tor, the disease has many more asymptomatic carriers than is usual, outnumbering active cases by up to 50:1. The outbreaks during this time frame are believed to be due to the rapid development of transportation and communication on an international level, as well as decreased sanitation levels in areas with increasing populations. In

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858-418: The Soviet Union. The 1964 invention of use of oral rehydration salts (ORS) to treat cholera was endorsed by WHO in the 1980s. This practice of replacing fluids and electrolytes is estimated to have saved the lives of 40 million individuals infected with cholera. As a result of the success of ORS treatment, the past 30 years have seen changes to cholera response that centred on treating affected individuals in

897-624: The bacteria, which produced soluble hemolysin, were more related to non-cholera vibrios; therefore, referred to all hemolytic vibrios as El Tor vibrios. In the early 1930s, A. Shousha, A. Gardner and K. Venkatraman, all researchers, suggested that only hemolytic vibrios agglutinated with anti-cholera serum should be referred to as El Tor vibrios. In 1959, R. Pollitzer designated El Tor as its own species V. eltor separate from V. cholerae , but six years later, in 1965, R. Hugh discovered that V. cholerae and V. eltor were similar in 30 positive and 20 negative characteristics. Thus, they were classified as

936-455: The causative agent of cholera . Also known as V. cholerae biotype eltor, it has been the dominant strain in the seventh global cholera pandemic . It is distinguished from the classic strain at a genetic level, although both are in the serogroup O1 and both contain Inaba, Ogawa and Hikojima serotypes . It is also distinguished from classic biotypes by the production of hemolysins. At the turn of

975-524: The classical biotype that caused the first six cholera pandemics. Previously, health workers who were against the administration of the cholera vaccine based their opinion on the view that always limited resources should be directed at immediate rehydration and improved practices, and longer-term investment to provide safe water and improved sanitation. Such practices as appropriately cooking food before consumption, using sterilised water, following general personal hygiene, and sanitising environments, decrease

1014-416: The disease spread. Cholera is caused by eating food or drinking water that is contaminated with the bacteria V. cholerae . It affects both children and adults, causing severe watery diarrhea with dehydration . But, as noted, the El Tor strain has persisted for decades to the present, causing repeated epidemics in varied locations, with 570,000 cases in 1991 alone. WHO and other authorities believe that

1053-503: The disease was helped by modern transportation and mass migrations. Mortality rates, however, dropped markedly as governments began modern curative and preventive measures. The usual mortality rate of 50% dropped to 10% by the 1980s and less than 3% by the 1990s. In 1991, the strain made a comeback in Latin America . It began in Peru, where it killed roughly 10,000 people. Research has traced

1092-625: The late 1970s there were small outbreaks in Japan and in the South Pacific. Molecular evidence, that is, a specific pulsed-field gel electrophoresis profile, suggests that the distinct genotype of El Tor strain which appeared in Calcutta in 1993, may have spread to Africa. In the country of Guinea-Bissau, it was responsible for an epidemic that began in October 1994 and continued into 1996. An El Tor infection

1131-1345: The number of infected people reached 15,000 by March 1962, with 2,005 deaths. In the Philippines alone, mortality reached 1,682 in 1962. It was reintroduced into British Borneo , supposedly by an asymptomatic traveller from Jolo Island . Outbreaks subsequently occurred in Cambodia , Thailand , Singapore and India . In 1963, WHO declared that cholera remained the number-one killer in diseases subject to international quarantine , having been reported in Taiwan , Pakistan , Afghanistan , Iran , Southern Russia , Iraq , Korea , Burma, Cambodia , South Vietnam , Malaysia , Singapore , Nepal , Thailand , Uzbekistan and Hong Kong . The mid-60s saw cholera infiltrate Southeast Asia, with outbreaks in Chittagong , Bangladesh, Cambodia, Thailand and Malaysia, and India in 1964. The El Tor strain moved further westward, invading South Asia in 1965, including Pakistan , Nepal , Afghanistan , Iran and part of Uzbek SSR . Iran, which had been free from cholera since 1939, reported 2,704 cases by mid-October. When these outbreaks occurred in Iran,

1170-450: The origin of the strain to the seventh cholera pandemic. Researchers initially suspected the strain came to Latin America through Asia from contaminated water, but samples from Latin America and samples from Africa were found to be identical. This rapid transmission of the pathogen around the globe in the 20th century can be attributed chiefly to the major hub, the Bay of Bengal , from where

1209-485: The pilgrims failed to show ante or post mortem evidence of cholera, the vibrios isolated agglutinated with the anti-cholera serum. He did not think it was cholera, since it was hemolytic for human and animal red cells, while the true Vibrio cholerae is not. At that time, there was no cholera epidemic in Mecca or at the El Tor station, and the two pilgrims died from other causes. Later in 1905, Kraus and Pribram found that

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1248-562: The seventh pandemic continues. Cholera is an acute diarrhoeal infection caused by the ingestion of food or water contaminated with the bacterium Vibrio cholerae . Most commonly the contamination of food or water occurs via faecal matter , and the infection is spread through the faecal-oral route . Cholera has also been found to be caused by eating raw shellfish . Symptoms of the disease appear between 12 hours and 5 days of infection; however, only 10% of infected people show severe symptoms of watery diarrhoea, vomiting and leg cramps. Cholera

1287-459: The short term, and attempting to provide safe water and improved hygiene in the long term. The cholera pandemic beginning in 1962 is identified through the ‘El Tor’ biotype, and considerable research has been undertaken into this specific strain of cholera. The El Tor biotype has been demonstrated to have increased resistance to the environment. This has heightened the risk of unknowing transmission from asymptomatic carriage in humans, as opposed to

1326-436: The spread of cholera. In the 21st century, cholera control activities have typically still been focused on emergency responses to outbreaks, with limited attention to the underlying causes that can prevent recurrence. But, the development of new and improved cholera vaccines has allowed this practice of emergency responses to be revised. In addition, recent research has advanced understanding of cholera, its transmission and

1365-511: The ‘El Tor’ strain differed from its relatives by 30%. It originated in South-Asia , then transitioned to its non-pathogenic form in the Middle East in 1900. Sometime between 1903 and 1908, the El Tor strain picked up DNA that triggered its ability to cause disease in humans. Hence, it had mutated into the El Tor pandemic strain. Makassar, South Sulawesi was the source of a 1960 outbreak of

1404-655: Was first thought to have spread along waterways along the coast and into the interior along the rivers . In November 1970 infected individuals seemed to travel by modernised rapid transport. This allowed cholera to extend 1,000 km, when it appeared in Mopti, Mali . Subsequently, customary large gatherings of people facilitated the outward radiation of cholera. From 1970 to 1971, Sierra Leone, Liberia, Côte d'Ivoire, Ghana, Togo, Benin, Nigeria and southern Cameroon, experienced outbreaks. The west-African outbreak of cholera during 1970–1971 infected more than 400,000 persons. Africa had

1443-461: Was organized to coordinate activities and support countries after a severe cholera outbreak in Peru. Today it consists of more than 30 collaborating institutions, including NGOs, academic institutions, and UN agencies supporting affected countries. In 2017 they convened a high-level meeting with officials from cholera-affected countries, donors, and technical partners to announce their strategy “The Global Roadmap to 2030”, an initiative to end cholera as

1482-505: Was sent in 1541 to Red Sea. After several days sailing, the commander Estevão da Gama gives the order to direct a surprise attack. The troops were able to disembark and the defenders came out to the shore but were pushed to the city not managing to close the city doors. The Portuguese as the city fell, were ready to loot, but two Priests came to the Commander, and appeal to him avoiding the destruction. Several soldiers were armed Knights after

1521-706: Was visited by travellers from Makassar in May 1961. Shortly after, Semarang and Djakarta became infected in June. The disease was carried into Kuching , Sarawak when boats from Celebes participated in a regatta in Kuching; the first cholera cases appeared on 1 July. This outbreak lasted two weeks, infecting 582 persons with 79 deaths (17% mortality). By August, the outbreak had reached Kalimantan and Macau (13 patients and six deaths). The first case in Hong Kong appeared on 15 August in

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