Environmental health conditions and cholera vulnerability in Latin America and the Caribbean.

Epidemic cholera reached South America in January 1991 and later spread to Central America and the United States. It afflicted 312,000 people and claimed 3200 lives. Since cholera had not been in Latin America for almost 70 years, health authorities allowed environmental health barriers to cholera collapse. For example, the Governments of the Region agreed in 1961 to abide by the Charter of Punta del Este to provide water and sewerage to 70% of the urban population and 50% f the rural population by 1971. They did not achieve their goals for the rural population. In fact, at the end of 1988, water was piped to 79% of the urban households and an additional 11% of the urban population had access to a public water source. Sewerage services served 49% of the urban population and, with other methods of excreta disposal, 80% of the population had adequate excreta disposal. On the other hand, only 55% of rural inhabitants had access to either piped water or public standpipes. Further sanitary excreta disposal services only covered 32%. Besides the water quality of existing water supply systems was poor. Since feces of infected people have as many as 1 billion Vibrio cholerae and , in some of Vibrio, up to 80% of carriers exhibit only mild symptoms or no symptoms at all, it is easy to understand how cholera took hold in Latin America. Researchers identified the points of contamination responsible for the cholera outbreak in Piura and Trujillo, Peru to be wells, distribution systems, and house. Annual population growth in Latin America at 2.6% poses specific problems to providing enough water and sanitation services to all in need, especially those in marginal areas around the cities (who will make up 40% of the population by 2000).