A defining feature of the epidemiology of cholera viewed from a global perspective is that, because of its pandemic nature, the disease ebbs and flows across vast geographic distances over time. The Ganges delta is the ancestral home of cholera, where it has persisted in the past in interpandemic periods as "Asiatic cholera." As the seventh pandemic of
El Tor cholera has progressively disseminated since the early 1960s from its origin on the island of Sulawesi in Indonesia, it has become endemic in many areas where it first appeared in epidemic form. Thus, cholera is now endemic in the Philippines; in several countries in Southeast Asia; in multiple countries in sub-Sahara Africa; and (during the 1990s) in Peru, Ecuador, and a number of other Latin American countries.
Typically, when cholera newly invades an immunologically naive population, the highest incidence is observed in young adult males. However, as the disease becomes increasingly endemic, the incidence increases in women and children; eventually, the peak incidence is found in young children.
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