<unk>  affects an estimated 2.8 million people worldwide, and causes approximately 95,000 deaths a year (uncertainty range: 21,000-143,000) . This occurs mainly in the developing world. In the early 1980s, death rates are believed to have been greater than three million a year. It is difficult to calculate exact numbers of cases, as many go unreported due to concerns that an outbreak may have a negative impact on the tourism of a country.<unk>  remains both epidemic and endemic in many areas of the world. In October 2016, an outbreak of<unk>  began in war-ravaged Yemen. WHO called it "the worst<unk>  outbreak in the world". Recent major outbreaks are the 2010s Haiti<unk>  outbreak and the 2016–2021 Yemen<unk>  outbreak. In 2019, 93% of the reported 923,037<unk>  cases were from Yemen (with 1911 deaths reported). Between September 2019 and September 2020, a global total of over 450,000 cases and over 900 deaths was reported; however these numbers suffer from over-reporting from countries that report suspected cases (and not laboratory confirmed cases) as well as under-reporting from countries that do not report official cases (such as Bangladesh, India and Philippines). Although much is known about the mechanisms behind the spread of<unk> , this has not led to a full understanding of what makes<unk>  outbreaks happen in some places and not others. Lack of treatment of human feces and lack of treatment of drinking water greatly facilitate its spread, but bodies of water can serve as a reservoir, and seafood shipped long distances can spread the disease.<unk>  was not known in the Americas for most of the 20th century, but it reappeared towards the end of that century. After the end of the 2010s Haiti<unk>  outbreak, there have not been any<unk>  cases in the Americas since February 2019. the disease is endemic in Africa and some areas of Asia (Bangladesh, India and Yemen).<unk>  is not endemic in Europe, all reported cases had a travel history to endemic areas. History of outbreaks 2008–2009<unk>  outbreak in sub-Saharan Africa showing the statistics as of 12 February 2009 The word<unk>  is from<unk>  from χολή kholē "bile".<unk>  likely has its origins in the Indian subcontinent as evidenced by its prevalence in the region for centuries. The disease appears in the European literature as early as 1642, from the Dutch physician Jakob de Bondt's description it in his De Medicina Indorum. (The "Indorum" of the title refers to the East Indies. He also gave first European descriptions of other diseases.) Early outbreaks in the Indian subcontinent are believed to have been the result of poor living conditions as well as the presence of pools of still water, both of which provide ideal conditions for<unk>  to thrive. The disease first spread by trade routes (land and sea) to Russia in 1817, later to the rest of Europe, and from Europe to North America and the rest of the world, (hence the name "Asiatic<unk> "). Seven<unk>  pandemics have occurred in the past 200 years, with the seventh pandemic originating in Indonesia in 1961. The first<unk>  pandemic occurred in the Bengal region of India, near Calcutta starting in 1817 through 1824. The disease dispersed from India to Southeast Asia, the Middle East, Europe, and Eastern Africa. The movement of British Army and Navy ships and personnel is believed to have contributed to the range of the pandemic, since the ships carried people with the disease to the shores of the Indian Ocean, from Africa to Indonesia, and north to China and Japan. The second pandemic lasted from 1826 to 1837 and particularly affected North America and Europe due to the result of advancements in transportation and global trade, and increased human migration, including soldiers. The third pandemic erupted in 1846, persisted until 1860, extended to North Africa, and reached South America, for the first time specifically affecting Brazil. The fourth pandemic lasted from 1863 to 1875 spread from India to Naples and Spain. The fifth pandemic was from 1881–1896 and started in India and spread to Europe, Asia, and South America. The sixth pandemic started 1899–1923. These epidemics were less fatal due to a greater understanding of the<unk>  bacteria. Egypt, the Arabian peninsula, Persia, India, and the Philippines were hit hardest during these epidemics, while other areas, like Germany in 1892 (primarily the city of Hamburg where more than 8.600 people died) and Naples from 1910–1911, also experienced severe outbreaks. The seventh pandemic originated in 1961 in Indonesia and is marked by the emergence of a new strain, nicknamed El Tor, which still persists () in developing countries.<unk>  became widespread in the 19th century. Since then it has killed tens of millions of people. In Russia alone, between 1847 and 1851, more than one million people perished of the disease. It killed 150,000 Americans during the second pandemic. Between 1900 and 1920, perhaps eight million people died of<unk>  in India.<unk>  became the first reportable disease in the United States due to the significant effects it had on health. John Snow, in England, was the first to identify the importance of contaminated water as its cause in 1854.<unk>  is now no longer considered a pressing health threat in Europe and North America due to filtering and chlorination of water supplies, but still heavily affects populations in developing countries. In the past, vessels flew a yellow quarantine flag if any crew members or passengers were suffering from<unk> . No one aboard a vessel flying a yellow flag would be allowed ashore for an extended period, typically 30 to 40 days. Historically many different claimed remedies have existed in folklore. Many of the older remedies were based on the miasma theory. Some believed that abdominal chilling made one more susceptible and flannel and<unk>  belts were routine in army kits. In the 1854–1855 outbreak in Naples homeopathic camphor was used according to Hahnemann. T. J. Ritter's "Mother's Remedies" book lists tomato syrup as a home remedy from northern America. Elecampane was recommended in the United Kingdom according to William Thomas Fernie. The first effective human vaccine was developed in 1885, and the first effective antibiotic was developed in 1948.<unk>  cases are much less frequent in developed countries where governments have helped to establish water sanitation practices and effective medical treatments. The United States, for example, used to have a severe<unk>  problem similar to those in some developing countries. There were three large<unk>  outbreaks in the 1800s, which can be attributed to Vibrio<unk> es spread through interior waterways like the Erie Canal and routes along the Eastern Seaboard. The island of Manhattan in New York City touched the Atlantic Ocean, where<unk>  collected just off the coast. At this time, New York City did not have as effective a sanitation system as it does today, so<unk>  was able to spread.<unk>  morbus is a historical term that was used to refer to gastroenteritis rather than specifically<unk> . File:Cholera.Drawing of Death bringing<unk> , in Le Petit Journal (1912). File:Pedro II of Brazil and ministers of state.Emperor Pedro II of Brazil visiting people with<unk>  in 1855. File:Cholera 395.1.Hand bill from the New York City Board of Health, 1832—the outdated public health advice demonstrates the lack of understanding of the disease and its actual causative factors. Research Robert Koch (third from the right) on a<unk>  research expedition in Egypt in 1884, one year after he identified V.<unk> e How to avoid the<unk>  leaflet; Aberystwyth; August 1849 One of the major contributions to fighting<unk>  was made by the physician and pioneer medical scientist John Snow (1813–1858), who in 1854 found a link between<unk>  and contaminated drinking water. Dr. Snow proposed a microbial origin for epidemic<unk>  in 1849. In his major "state of the art" review of 1855, he proposed a substantially complete and correct model for the cause of the disease. In two pioneering epidemiological field studies, he was able to demonstrate human sewage contamination was the most probable disease vector in two major epidemics in London in 1854. His model was not immediately accepted, but it was seen to be the more plausible, as medical microbiology developed over the next 30 years or so. For his work on<unk> , John Snow is often regarded as the "Father of Epidemiology". The bacterium was isolated in 1854 by Italian anatomist Filippo Pacini, but its exact nature and his results were not widely known. In the same year, the Catalan Joaquim Balcells i Pascual discovered the bacterium and in 1856 probably António Augusto da Costa Simões and José Ferreira de Macedo Pinto, two Portuguese men, did the same. Cities in developed nations made massive investment in clean water supply and well-separated sewage treatment infrastructures between the mid-1850s and the 1900s. This eliminated the threat of<unk>  epidemics from the major developed cities in the world. In 1883, Robert Koch identified V.<unk> e with a microscope as the bacillus causing the disease. Hemendra
Cholera
Travelers' diarrhea
Dysentery
Polymeal
Miliary fever
Malaria
Jamaican vomiting sickness
Milk sickness