Risk assessment: Outbreak of cholera in Cuba, potential risk for European travellers, 12 July 2012

Risk assessment

This rapid risk assessment assesses the potential risk for European travellers to Cuba after an outbreak of cholera in the Granma Province of the country. As of 12 July 2012, 85 cases of Vibrio cholera were confirmed by the Cuban Ministry of Health. ECDC concludes that should the outbreak stay contained within the Granma Province, the risk to European travellers remains low, yet if the outbreak spreads beyond this region, the risk should be reassessed.

Executive summary

For the first time in almost 150 years, Cuba is reporting an outbreak of cholera. As of 12 July 2012, 85 cases of Vibrio cholerae were confirmed by the Cuban Ministry of Health. Based on the available information at this stage, the outbreak appears to be mainly localised in the Granma province, in south-western Cuba, mostly in Manzanillo City. Despite control measures having been put in place by the Cuban health authorities, further cases within Cuba cannot be excluded at this stage.

ECDC has completed a rapid risk assessment to consider the risk for EU travellers travelling to Cuba to be infected with Vibrio cholerae. ECDC’s analysis is that the overall risk to European travellers to Cuba is low. Should the outbreak not spread beyond the Granma province, the risk of infection for European tourists visiting Cuba is negligible. If the outbreak spreads to other provinces, the risk of infection for European tourists should be reassessed. However, with appropriate precautionary measures, the overall risk of infection remains low, as is the risk for further spread of the infection upon return to Europe.

Visitors to Cuba should seek information the preventative measures they can take against cholera prior to travelling. Clinicians should keep the possibility of cholera in mind for travellers returning from Cuba who show clinical signs suggestive of this disease.

In 2010, there were approximately 810 000 European tourists, mostly from Italy, Spain, and Germany visiting Cuba. Around 58% of these tourists were visiting Cuba during the European winter months.

Globally, approximately 2.8 million cholera cases occur annually in endemic countries with nearly 91 000 deaths. In non endemic countries, the number of cases is estimated at 87 000 with 2 500 deaths. The major burden of cholera is located in southern Asia and Africa.