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The fourth cholera pandemic of the 19th century began in the Ganges Delta of the Bengal region and traveled with Muslim pilgrims to Mecca. In its first year, the epidemic claimed 30,000 of 90,000 pilgrims. Cholera spread throughout the Middle East and was carried to the Russian Empire, Europe, Africa, and North America, in each case spreading via travelers from port cities and along inland waterways.
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