El Tor

History

At the turn of the 20th century, the Ottoman government established six medical stations along the coast of the Sinai Peninsula to cater to pilgrims returning from Mecca. One of them was in El Tor (A' Tur as it is called today). Sick passengers were dropped off in one of the stations for treatment. In 1905, Felix Gotschlich, a German physician at the El Tor station identified vibrios in stool specimen of two pilgrims returning from Mecca. Though the pilgrims failed to show ante or post mortem evidence of cholera, the vibrios isolated agglutinated with the anti-cholera serum. He did not think it was cholera, since it was hemolytic for human and animal red cells, while the true Vibrio cholerae is not. At that time, there was no cholera epidemic in Mecca or at the El Tor station, and the two pilgrims died from other causes.

Later in 1905, Kraus and Pribram found that the bacteria, which produced soluble hemolysin, were more related to non-cholera vibrios; therefore, referred to all hemolytic vibrios as El Tor vibrios. In the early 1930s, A. Shousha, A. Gardner and K. Venkatraman, all researchers, suggested that only hemolytic vibrios agglutinated with anti-cholera serum should be referred to as El Tor vibrios. In 1959, R. Pollitzer designated El Tor as its own species V. eltor separate from V. cholerae, but six years later, in 1965, R. Hugh discovered that V. cholerae and V. eltor were similar in 30 positive and 20 negative characteristics. Thus, they were classified as a single species V. cholerae: however, Hugh believed the differing features between the two could be of epidemiological importance, so El Tor vibrios were further classified as V. cholerae biotype eltor (serogroup O1).

El Tor was identified again in an outbreak in 1937 but the pandemic did not arise until 1961 in Sulawesi. El Tor spread through Asia (Bangladesh in 1963, India in 1964) and then into the Middle East, Africa and Europe. From North Africa it spread into Italy by 1973. The extent of the pandemic has been due to the relative mildness (lower expression level) of El Tor, the disease has many more asymptomatic carriers than is usual, outnumbering active cases by up to 50:1. The outbreaks during this time frame are believed to be due to the rapid development of transportation and communication on an international level, as well as decreased sanitation levels in areas with increasing populations. In the late 1970s there were small outbreaks in Japan and in the South Pacific.

Molecular evidence, that is, a specific pulsed-field gel electrophoresis profile, suggests that the distinct genotype of El Tor strain which appeared in Calcutta in 1993, may have spread to Africa. In the country of Guinea-Bissau, it was responsible for an epidemic that began in October 1994 and continued into 1996.