Control and Distribution
The infection is spread solely by infected humans, whose excreta may contaminate drinking water and food. This is not the direct contact that Contagionists in earlier generations expected from experience with readily transmittable infections such as smallpox.
Thus communicability was a highly controversial matter until its bacterial etiology was established. With this in mind one can state that the appearance and spread of cholera in a community or country depend first on the appearance of a person, either ill or well, who is discharging the cholera vibrio from his or her intestinal tract, and second on the state of hygiene, water supply, and sewage disposal in promoting or impeding the transmission of the bacterium to a potential victim. In endemic areas such as the Ganges Delta, a water table hardly below the surface of the ground has posed almost insurmountable problems. In the past, unsatisfactory sanitary facilities have been necessary conditions for cholera outbreaks in Europe and the Americas. Indeed, the history of the control of cholera is the history of improved sanitation.Current distribution of epidemic cholera is largely limited to areas in the Indian continent and the tropical Far East, where it persists and occasionally breaks out in low-lying wet areas of contaminated water supply and sewage disposal. Since the Second World War, it has made sporadic forays into the Middle East and Far East, often associated with social disruption. In the early 1970s, cholera appeared briefly in Europe, with outbreaks in Mediterranean ports especially Naples (over 30 deaths), Barcelona, and the Atlantic port of Lisbon with over 2,000 cases. Some cases were carried by rapid transportation to the north, but resulted in no further extension of the disease. One small area of persistent infection appears to be the lower bayou country outside of New Orleans, the origin of these recurring cases.