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An epidemic of cholera due to Vibrio cholerae biotype El Tor occurred in 1977 on Tarawa in the Gilbert Islands. No cholera epidemic had occurred there previously and special problems were encountered in both the diagnosis and clinical management. The clinical features of the 585 hospital admissions on Tarawa during the first 64 days of the epidemic were recorded. Eight hospital deaths occurred in this period. A marked increase in cholera among malnourished Gilbertese children was noted. Simplified regimes for management were devised for the circumstances including schemes for oral and intravenous rehydration. Coconut water was used extensively in oral rehydration. Paramedical personnel were used effectively during the epidemic. Prophylactic tetracycline was used in household contacts of patients and was effective in reducing subsequent illness.