S Grady, Tulane Univ, New Orleans. However, surveillance data are incomplete in many countries, and the number of cases and deaths may be substantially underestimated. Improving cholera surveillance and developing a coordinated response for epidemic cholera are high public health priorities in Africa. Determination of the routes of cholera transmission is important in developing effective prevention measures. Boiling water is effective but consumes scarce fuel wood and is difficult to sustain.
Chlorination is the most widely used method for purifying municipal water supplies.
Cholera also has been transmitted by the foodborne route in Africa. Because V. cholerae O1 is rapidly inactivated at acid pH levels, recipes that acidify food can be protective. The findings in Zimbabwe that mahewu was protective suggest that it was less likely to transmit foodborne cholera than other foods available in the community. The demonstrated safety of some traditional foods suggests prevention measures that can be recommended and implemented immediately and have particular relevance where fermented gruels are used as traditional weaning foods for young children. Efforts to control cholera epidemics in Africa and elsewhere by mass chemoprophylaxis, vaccination campaigns, roadblocks, and broad embargoes on commodities have been ineffective and have diverted scarce resources away from the critical activities of providing treatment and improving the safety of water and food supplies.