South America Endemicity EpidemicEndemic in all regions except southern South AmericaEndemic Climate driversAbundance of coastal V. cholerae: northwestern South America: SST, Plankton (low confidence)Temperature, precipitation, droughtNorthern South America: temperature (low confidence) northern and southeastern South America: Tmax, Tmin, humidity (low confidence) Direction of ChangeArea of coastline suitable for outbreak: no change (low confidence)Increasing due to urbanisation and decreased vector control programmes, not strongly linked to climateHigher elevation regions: Increase (low confidence) Europe Endemicity Not endemic Southern Europe: focal outbreaks Not endemic Climate driversNo evidence for disease incidence Abundance of coastal V. cholerae: northern Europe: SST, Plankton (medium confidence) Direction of ChangeArea of coastline suitable for outbreak: increase (low confidence)Mediterranean regions of southern Europe: outbreaks (low confidence)No change North America Endemicity Not endemicPartially endemic in southern North AmericaNot endemic Climate driversNo evidence for disease incidence Abundance of coastal V. cholerae: eastern North America: SST (low confidence due to limited evidence)Winter Tmin (low confidence) Direction of ChangeArea of coastline suitable for outbreak: increase (low confidence)Declining No change Small Islands Endemicity EpidemicEndemic on many small islands in the TropicsEndemic on many small islands in the Tropics Climate driversDisease incidence: Caribbean: SST, LST, rainfall (low to medium confidence)Caribbean: SPI, Tmin (low confidence) Direction of ChangeArea of coastline suitable for outbreak: Caribbean and Pacific small islands: Decrease (low confidence)Increasing