The high rate of deaths from cholera is a reflection of the levels of poverty, mass migration and inadequate access to health care in some areas. In 1991, the death rate in Africa is far higher than that in South America, even though the number of reported cases is much lower; risk of death in Africa was worsened by factors including lack of access to life-saving oral rehydration salts, and delayed or incorrect management of cholera cases. WHO estimates that, with proper treatment, the death rate from cholera should not exceed 1%. In 1991, WHO reported that the El Tor cholera epidemic in Latin America has already claimed 1,500 lives. For the first time in several years, two cases of cholera occurred in Russia in 1993, with 17 reported in Russia as a whole. A new strain of cholera [V cholerae non-01], called Bengal cholera, invaded Bengal in 1993, causing 107,297 cases of diarrhoea and 1473 deaths. Incidence of cholera is reported to be on the rise in the South Pacific region, possibily related to climate change.
Over 90% of cholera cases are mild and difficult to distinguish clinically from other types of acute diarrhoea, which kill an estimated 3.2 million children under the age of five each year. Although in newly-affected areas, many adults are among those struck by cholera, in the highly endemic areas, cholera is mainly a disease of children, whilst infants under one year of age being breast-fed are rarely affected.
In 1994, 61,960 cases of cholera resulting in 4,389 deaths were reported in Angola, the Democratic Republic of the Congo, Malawi, Mozambique and Tanzania (WHO 1995).
In 2002, an outbreak of severely dehydrating, watery diarrhea from the West Bengal province of India was been linked with the appearance of Vibrio cholera strains that are resistant to furazolidine, the drug of choice for cholera in developing countries.