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.

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.

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.

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.

[2] El Tor outbreaks can be prevented by better standards of sanitation, filtering and boiling water,[4] thoroughly cooking seafood, and washing vegetables and fruits before consumption.