In 2015, 172,454 cases and 1,304 deaths of<unk>  were reported to WHO worldwide. Outbreaks continued to affect several countries. 
Overall, 41% of cases were reported from Africa, 37% from Asia, and 21% from the Americas. In the early 1980s, mortality rates are believed to exceeded 3 million deaths a year. It is difficult to calculate exact numbers of cases, as many go unreported due to concerns that an outbreak may have a negative impact on the tourism of a country.<unk>  remains both epidemic and endemic in many areas of the world.
Although much is known about the mechanisms behind the spread of<unk> , this has not led to a full understanding of what makes<unk>  outbreaks happen some places but not others. Lack of adequate treatment of human feces and/or drinking water greatly facilitates the spread of<unk> . Bodies of water can serve as a reservoir of the disease. Seafood shipped over long distances can also spread the disease. Cases of<unk>  were not observed in the Americas for most of the 20th century, thought the disease reappeared towards the end of that century and seems likely to persist.
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