of contaminated canal water in local water works caused a minor outbreak at ystalyfera in south wales. workers associated with the company and their families were most affected, and 119 died. in 1867, italy lost 113,000 lives; and 80,000 died of the disease in algeria. outbreaks in north america in the 1870s killed some 50,000 americans as cholera spread from new orleans to other ports along the mississippi river and its tributaries. none of the cities had adequate sanitation systems, and cholera spread through the water supply and contact. fifth, 1881–1896 main article: 1881–1896 cholera pandemic 1892 cholera outbreak in hamburg, hospital ward the fifth cholera pandemic - according to dr a. j. wall, the 1883–1887 part of the epidemic cost 250,000 lives in europe and at least 50,000 in the americas. cholera claimed 267,890 lives in russia (1892); 120,000 in spain; 90,000 in japan, and over 60,000 in persia. in egypt, cholera claimed more than 58,000 lives. the 1892 outbreak in hamburg killed 8,600 people. although the city government was generally held responsible for the virulence of the epidemic, it was not changed. this was the last serious european cholera outbreak, as cities improved their sanitation and water systems. sixth, 1899–1923 the sixth cholera pandemic, which was due to the classical strain of o1, had little effect in western europe because of advances in sanitation and public health, but major russian cities and the ottoman empire particularly suffered a high rate of cholera deaths. more than 500,000 people died of cholera in russia from 1900 to 1925, which was a time of extreme social disruption because of revolution and warfare. the 1902–1904 cholera epidemic claimed 200,000 lives in the philippines, including their revolutionary hero and first prime minister apolinario mabini. cholera broke out 27 times during the hajj at mecca from the 19th century to 1930. the sixth pandemic killed more than 800,000 in india. the last outbreak of cholera in the united states was in 1910–1911, when the steamship moltke brought infected people from naples to new york city. vigilant health authorities isolated the infected in quarantine on swinburne island. eleven people died, including a health care worker at the hospital on the island. in 1913, the romanian army, while invading bulgaria during the second balkan war, suffered a cholera outbreak that resulted in 1,600 deaths. during the outbreak, due to cholera frequently being spread by immigrants and tourists, the disease became associated with either outsiders or marginalized groups in societies. in italy, some blamed jews and romani, while in british india numerous anglo-indians ascribed the spread of cholera to hindu pilgrims, and in the united states many accused filipino immigrants of introducing the disease. seventh, 1961–? main article: 7th cholera pandemic (1961-?) as of march 2022, the world health organization (who) continues to define this outbreak as a current pandemic, noting that cholera has become endemic in many countries. in 2017, who announced a global strategy aimed at this pandemic with the goal of reducing cholera deaths by 90% by 2030. the seventh cholera pandemic began in indonesia, called el tor after the strain, and reached east pakistan (now bangladesh) in 1963, india in 1964, and the soviet union in 1966. from south america, it spread into italy by 1973. in the late 1970s, there were small outbreaks in japan and in the south pacific. there was an outbreak in odessa in july 1970, and there were also many reports of a cholera outbreak near baku in 1972, but information about it was suppressed in the soviet union. in 1970, a cholera outbreak struck the sağmalcılar district of istanbul, then an impoverished slum, claiming more than 50 lives. because this incident was notorious, the district was renamed as bayrampaşa. also in august 1970, a few cases were reported in jerusalem. other outbreaks vibrio cholerae has shown to be a very potent pathogenic bacterium causing many pandemics and epidemics over the past three centuries. however, most outbreaks are known to be self-limiting, meaning they come to an end after peaking, without human intervention. one of the mechanisms significantly determining the course of epidemics is phage predation. this process is strongly dependent on successful recognition of the bacteria by lytic phages, in which cell surface receptors play a crucial role. bacteria can reduce their susceptibility by changing their surface receptors and preventing phage adsorption. in the case of v. cholerae, the changed receptor gene expression is due to an alteration in cell-density during its infection cycle, a process called quorum sensing (qs). the stool samples collected from patients contain clumps of bacterial cells, demonstrating the occurrence of cell-cell interaction in the latter stage of the infection cycle. qs is strongly regulated by two auto-inducer molecules, ai-2 and cai-1. evidently, these molecules will have a significant effect on the success of phage predation in v. cholerae infections. a previous study has unravelled the mode of action of auto-inducers on preventing predation on the level of phage entry. the study has shown that the aforementioned auto-inducers downregulate the ten biosynthetic genes of the surface o-antigen, which is primarily used as a phage receptor for vibriophages. this mechanism results in an increased phage resistance. it can be stated that the loss of the ability to produce the receptor, reduces the possibility of a phage-dependent limitation or even elimination of v. cholerae. this should be kept in mind when developing a treatment for enteric bacterial infections with phages as an intervention tool. future approaches may include additional quorum regulators that operate as “quorum quenchers” to reduce quorum-mediated phage resistance. 1990s january 1991 – september 1994: outbreak in south america, apparently initiated when a chinese ship discharged ballast water. beginning in peru, there were 1.04 million identified cases and almost 10,000 deaths. the causative agent was an o1, el tor strain, with small differences from the seventh pandemic strain. in 1992 a new strain appeared in asia, a non-o1, nonagglutinable vibrio (nag), which was named o139 bengal. it was first identified in tamil nadu, india, and for a while displaced el tor in southern asia. it decreased in prevalence from 1995 to around 10 percent of all cases. it is considered to be an intermediate between el tor and the classic strain, and occurs in a new serogroup. scientists warn of evidence of wide-spectrum resistance by cholera bacteria to drugs such as trimethoprim, sulfamethoxazole and streptomycin. an outbreak in goma, democratic republic of congo in july 1994 claimed 12,000 lives by mid-august. during the worst period, it is estimated that as many as 3,000 people were dying per day from cholera. a persistent strain of gulf coast cholera, 01, has been found in the brackish waters of marshes in louisiana and texas in the united states. it could possibly be transmitted by shipments of seafood from those areas to other parts of the country. medical personnel were advised to think of cholera when assessing symptoms for people who had not been traveling. there have been occurrences of this cholera in the south but no major outbreaks because of good sanitation and warning systems. there were more cases in two years from the latin american epidemic, the el tor strain, than in 20 years from the gulf coast strain. 2000s in 2000, some 140,000 cholera cases were officially reported to who. countries in africa accounted for 87 percent of these cases. july–december 2007: a lack of clean drinking water in iraq led to an outbreak of cholera. as of 2 december 2007, the un had reported 22 deaths and 4,569 laboratory-confirmed cases. august 2007: the cholera epidemic started in orissa, india. the outbreak affected rayagada, koraput and kalahandi districts, where more than 2,000 people were admitted to hospitals. march–april 2008: 2,490 people from 20 provinces throughout vietnam were hospitalized with acute diarrhea. of those hospitalized, 377 patients tested positive for cholera. august–october 2008: as of 29 october 2008, a total of 644 laboratory-confirmed cholera cases, including eight deaths, had been verified in iraq. november 2008: médecins sans frontières reported an outbreak of cholera in a refugee camp in the democratic republic of the congo's eastern provincial capital of goma. some 45 cases were reportedly treated between november 7 and 9. by 12 february 2009, the number of cases of infection by cholera in sub-saharan africa had reached 128,548 and the number of fatalities, 4,053. january 2009: the mpumalanga province of south africa confirmed over 381 new cases of cholera, bringing the total number of cases treated since november 2008 to 2276. nineteen people died in the province since the outbreak. august 2008 – april 2009: in the 2008 zimbabwean cholera outbreak, which continued into 2009, an estimated 96,591 people in the country were infected with cholera and, by 16 april 2009, 4,201 deaths had been reported. according to the world health organization, during the week of 22–28 march 2009, the "crude case fatality ratio (cfr)" had dropped from 4.2% to 3.7%. the daily updates for the period 29 march 2009 to 7 april 2009, list 1748 cases and 64 fatalities, giving a weekly cfr of 3.66% (see table above). those for the period 8 april to 16 april list 1375 new cases and 62 deaths (and a resulting cfr of 4.5%). the cfr had remained above 4.7% for most of january and early february 2009. 2010s august 2010: cholera in nigeria was reaching epidemic proportions after widespread confirmation of the disease outbreaks in 12 of its 36 states. 6400 cases were reported with 352 reported deaths. the health ministry blamed the outbreak on heavy seasonal rainfall and poor sanitation. october 2010 – present, haiti and dominican republic: late in october 2010, an outbreak was reported in haiti. as of november 16, the haitian health ministry reported the number of dead to be 1,034, with hospitalizations for cholera symptoms totaling over 16,700. the outbreak was blamed on a camp of nepalese united nations peacekeepers; this was disputed, but since acknowledged by the united nations. the outbreak started on the upper artibonite river; people first contracted the disease by taking water from this river. in addition, some scientists think the hurricane and weather conditions in haiti worsened the consequences of the outbreak, and damaged sanitation systems, allowing it to spread. by november 2010, the disease had spread into the neighboring dominican republic. as of august 2016, the epidemic has officially sickened at least 790,000 people and killed more than 9,000 in haiti. the real burden is probably much higher. in the neighboring dominican republic, there have been at least 32,000 suspected cases and 500 related deaths. in haiti, the outbreak was worsened by hurricane matthew, which hit the southern portion of haiti in fall 2016. the un has acknowledged its role in the epidemic. in august 2016, the un pledged to fight the disease and provide assistance for victims through a $400 million fund; but, as of april 2017, member states had contributed a meagre $10 million of the $400 million pledged. in january 2011, about 411 venezuelan citizens attended a wedding in the dominican republic, where they ate ceviche (raw fish cured in lemon juice) at the celebration. by the time they returned to caracas and other venezuelan cities, some of these travelers were suffering from symptoms of cholera. by january 28, almost 111 cases had been confirmed by the venezuelan health authorities, who quickly set up an 800 number for people to call who wondered whether they were infected. internationally, colombia secured its eastern border against immigrants and probable transmission of the disease. dominican officials started a nationwide study to determine the cause of the outbreak, and warned residents of the imminent danger associated with the consumption of raw fish and shellfish. as of january 29, 2011, none of the cases in venezuela proved fatal, but two patients were hospitalized. since the victims had quickly sought help, the outbreak was detected and contained. 2011: nigeria and democratic republic of congo have had outbreaks; the latter has suffered years of disruption from warfare. somalia has suffered a double hit of cholera and famine, associated with the refugee camps, limited sanitation, and severe drought, causing famine and lowered resistance. cholera outbreak in 2011 and 2012 in multiple african nations, in all regions except north africa; among the affected nations, ghana has led an intense campaign