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Sample records for cholera epidemic years

  1. Recurrent epidemic cholera with high mortality in Cameroon: persistent challenges 40 years into the seventh pandemic.

    PubMed

    Cartwright, E J; Patel, M K; Mbopi-Keou, F X; Ayers, T; Haenke, B; Wagenaar, B H; Mintz, E; Quick, R

    2013-10-01

    Cameroon has experienced recurrent cholera epidemics with high mortality rates. In September 2009, epidemic cholera was detected in the Far North region of Cameroon and the reported case-fatality rate was 12%. We conducted village-, healthcare facility- and community-level surveys to investigate reasons for excess cholera mortality. Results of this investigation suggest that cholera patients who died were less likely to seek care, receive rehydration therapy and antibiotics at a healthcare facility, and tended to live further from healthcare facilities. Furthermore, use of oral rehydration salts at home was very low in both decedents and survivors. Despite the many challenges inherent to delivering care in Cameroon, practical measures could be taken to reduce cholera mortality in this region, including the timely provision of treatment supplies, training of healthcare workers, establishment of rehydration centres, and promotion of household water treatment and enhanced handwashing with soap.

  2. Epidemic cholera spreads like wildfire.

    PubMed

    Roy, Manojit; Zinck, Richard D; Bouma, Menno J; Pascual, Mercedes

    2014-01-15

    Cholera is on the rise globally, especially epidemic cholera which is characterized by intermittent and unpredictable outbreaks that punctuate periods of regional disease fade-out. These epidemic dynamics remain however poorly understood. Here we examine records for epidemic cholera over both contemporary and historical timelines, from Africa (1990-2006) and former British India (1882-1939). We find that the frequency distribution of outbreak size is fat-tailed, scaling approximately as a power-law. This pattern which shows strong parallels with wildfires is incompatible with existing cholera models developed for endemic regions, as it implies a fundamental role for stochastic transmission and local depletion of susceptible hosts. Application of a recently developed forest-fire model indicates that epidemic cholera dynamics are located above a critical phase transition and propagate in similar ways to aggressive wildfires. These findings have implications for the effectiveness of control measures and the mechanisms that ultimately limit the size of outbreaks.

  3. Epidemic cholera spreads like wildfire

    NASA Astrophysics Data System (ADS)

    Roy, Manojit; Zinck, Richard D.; Bouma, Menno J.; Pascual, Mercedes

    2014-01-01

    Cholera is on the rise globally, especially epidemic cholera which is characterized by intermittent and unpredictable outbreaks that punctuate periods of regional disease fade-out. These epidemic dynamics remain however poorly understood. Here we examine records for epidemic cholera over both contemporary and historical timelines, from Africa (1990-2006) and former British India (1882-1939). We find that the frequency distribution of outbreak size is fat-tailed, scaling approximately as a power-law. This pattern which shows strong parallels with wildfires is incompatible with existing cholera models developed for endemic regions, as it implies a fundamental role for stochastic transmission and local depletion of susceptible hosts. Application of a recently developed forest-fire model indicates that epidemic cholera dynamics are located above a critical phase transition and propagate in similar ways to aggressive wildfires. These findings have implications for the effectiveness of control measures and the mechanisms that ultimately limit the size of outbreaks.

  4. Prediction of epidemic cholera due to Vibrio cholerae O1 in children younger than 10 years using climate data in Bangladesh.

    PubMed

    Matsuda, F; Ishimura, S; Wagatsuma, Y; Higashi, T; Hayashi, T; Faruque, A S G; Sack, D A; Nishibuchi, M

    2008-01-01

    To determine if a prediction of epidemic cholera using climate data can be made, we performed autoregression analysis using the data recorded in Dhaka City, Bangladesh over a 20-year period (1983-2002) comparing the number of children aged <10 years who were infected with Vibrio cholerae O1 to the maximum and minimum temperatures and rainfall. We formulated a simple autoregression model that predicts the monthly number of patients using earlier climate variables. The monthly number of patients predicted by this model agreed well with the actual monthly number of patients where the Pearson's correlation coefficient was 0.95. Arbitrarily defined, 39.4% of the predicted numbers during the study period were within 0.8-1.2 times the observed numbers. This prediction model uses the climate data recorded 2-4 months before. Therefore, our approach may be a good basis for establishing a practical early warning system for epidemic cholera.

  5. Environmental Factors Influencing Epidemic Cholera

    PubMed Central

    Jutla, Antarpreet; Whitcombe, Elizabeth; Hasan, Nur; Haley, Bradd; Akanda, Ali; Huq, Anwar; Alam, Munir; Sack, R. Bradley; Colwell, Rita

    2013-01-01

    Cholera outbreak following the earthquake of 2010 in Haiti has reaffirmed that the disease is a major public health threat. Vibrio cholerae is autochthonous to aquatic environment, hence, it cannot be eradicated but hydroclimatology-based prediction and prevention is an achievable goal. Using data from the 1800s, we describe uniqueness in seasonality and mechanism of occurrence of cholera in the epidemic regions of Asia and Latin America. Epidemic regions are located near regional rivers and are characterized by sporadic outbreaks, which are likely to be initiated during episodes of prevailing warm air temperature with low river flows, creating favorable environmental conditions for growth of cholera bacteria. Heavy rainfall, through inundation or breakdown of sanitary infrastructure, accelerates interaction between contaminated water and human activities, resulting in an epidemic. This causal mechanism is markedly different from endemic cholera where tidal intrusion of seawater carrying bacteria from estuary to inland regions, results in outbreaks. PMID:23897993

  6. Environmental factors influencing epidemic cholera.

    PubMed

    Jutla, Antarpreet; Whitcombe, Elizabeth; Hasan, Nur; Haley, Bradd; Akanda, Ali; Huq, Anwar; Alam, Munir; Sack, R Bradley; Colwell, Rita

    2013-09-01

    Cholera outbreak following the earthquake of 2010 in Haiti has reaffirmed that the disease is a major public health threat. Vibrio cholerae is autochthonous to aquatic environment, hence, it cannot be eradicated but hydroclimatology-based prediction and prevention is an achievable goal. Using data from the 1800s, we describe uniqueness in seasonality and mechanism of occurrence of cholera in the epidemic regions of Asia and Latin America. Epidemic regions are located near regional rivers and are characterized by sporadic outbreaks, which are likely to be initiated during episodes of prevailing warm air temperature with low river flows, creating favorable environmental conditions for growth of cholera bacteria. Heavy rainfall, through inundation or breakdown of sanitary infrastructure, accelerates interaction between contaminated water and human activities, resulting in an epidemic. This causal mechanism is markedly different from endemic cholera where tidal intrusion of seawater carrying bacteria from estuary to inland regions, results in outbreaks.

  7. Molecular analyses of Vibrio cholerae O1 clinical strains, including new nontoxigenic variants isolated in Mexico during the Cholera epidemic years between 1991 and 2000.

    PubMed

    Lizárraga-Partida, Marcial Leonardo; Quilici, Marie-Laure

    2009-05-01

    We studied the evolution of Vibrio cholerae O1 during the 1991 to 2000 cholera epidemic in Mexico by biochemical, serological, and molecular characterization of strains collected during this period. Strains were divided into toxigenic and nontoxigenic groups according to the presence or absence of genes encoding cholera toxin. As previously reported, we characterized two populations among toxigenic strains, which were present from the first year of the epidemic. BglI rRNA analysis revealed that these strains had ribotype profiles, denoted M5 and M6 in our study, that were identical to those previously designated Koblavi B5 or Popovic 5 and Popovic 6a or Tamayo B21a, respectively. Ribotype M5 was isolated between 1991 and 1993. This ribotype had a low level of genetic variation as detected by pulsed-field gel electrophoresis (PFGE). Ribotype M6 persisted from 1991 to 2000. However, PFGE profiles suggested that two epidemiologically unrelated strains coexisted within this single ribotype from 1995 until the end of the epidemic. We identified three new BglI ribotypes, Mx1, Mx2, and Mx3, from nontoxigenic V. cholerae O1 strains isolated between 1998 and 2000; one of them grouped strains positive for the toxin-coregulated pilus island. They differed from nontoxigenic clones isolated in Latin America and on the U.S. Gulf Coast and are probably autochthonous Mexican V. cholerae O1 variants. Most of these new variants were isolated from states surrounding the Gulf of Mexico, where the highest incidence of cholera in the country was recorded. Thus, the Mexican Gulf Coast, like the U.S. Gulf Coast, may act as an environmental reservoir of V. cholerae O1.

  8. Understanding the cholera epidemic, Haiti.

    PubMed

    Piarroux, Renaud; Barrais, Robert; Faucher, Benoit; Haus, Rachel; Piarroux, Martine; Gaudart, Jean; Magloire, Roc; Raoult, Didier

    2011-07-01

    After onset of a cholera epidemic in Haiti in mid-October 2010, a team of researchers from France and Haiti implemented field investigations and built a database of daily cases to facilitate identification of communes most affected. Several models were used to identify spatiotemporal clusters, assess relative risk associated with the epidemic's spread, and investigate causes of its rapid expansion in Artibonite Department. Spatiotemporal analyses highlighted 5 significant clusters (p<0.001): 1 near Mirebalais (October 16-19) next to a United Nations camp with deficient sanitation, 1 along the Artibonite River (October 20-28), and 3 caused by the centrifugal epidemic spread during November. The regression model indicated that cholera more severely affected communes in the coastal plain (risk ratio 4.91) along the Artibonite River downstream of Mirebalais (risk ratio 4.60). Our findings strongly suggest that contamination of the Artibonite and 1 of its tributaries downstream from a military camp triggered the epidemic.

  9. Stochastic dynamics of cholera epidemics.

    PubMed

    Azaele, Sandro; Maritan, Amos; Bertuzzo, Enrico; Rodriguez-Iturbe, Ignacio; Rinaldo, Andrea

    2010-05-01

    We describe the predictions of an analytically tractable stochastic model for cholera epidemics following a single initial outbreak. The exact model relies on a set of assumptions that may restrict the generality of the approach and yet provides a realm of powerful tools and results. Without resorting to the depletion of susceptible individuals, as usually assumed in deterministic susceptible-infected-recovered models, we show that a simple stochastic equation for the number of ill individuals provides a mechanism for the decay of the epidemics occurring on the typical time scale of seasonality. The model is shown to provide a reasonably accurate description of the empirical data of the 2000/2001 cholera epidemic which took place in the Kwa Zulu-Natal Province, South Africa, with possibly notable epidemiological implications.

  10. Stochastic dynamics of cholera epidemics

    NASA Astrophysics Data System (ADS)

    Azaele, Sandro; Maritan, Amos; Bertuzzo, Enrico; Rodriguez-Iturbe, Ignacio; Rinaldo, Andrea

    2010-05-01

    We describe the predictions of an analytically tractable stochastic model for cholera epidemics following a single initial outbreak. The exact model relies on a set of assumptions that may restrict the generality of the approach and yet provides a realm of powerful tools and results. Without resorting to the depletion of susceptible individuals, as usually assumed in deterministic susceptible-infected-recovered models, we show that a simple stochastic equation for the number of ill individuals provides a mechanism for the decay of the epidemics occurring on the typical time scale of seasonality. The model is shown to provide a reasonably accurate description of the empirical data of the 2000/2001 cholera epidemic which took place in the Kwa Zulu-Natal Province, South Africa, with possibly notable epidemiological implications.

  11. [Djibouti, history of 2 epidemics of cholera: 1993-1994].

    PubMed

    Morillon, M; De Pina, J J; Husser, J A; Baudet, J M; Bertherat, E; Martet, G

    1998-01-01

    When two cholera epidemics broke out in Djibouti, respectively in 1993 and 1994, Bioforce was obliged to intervene. The first time, three goals were pursued: setting up a rehydration centre in a tent, organizing epidemiological surveillance and training local personnel in treatment and diagnosis techniques. The next year, the epidemic followed serious flooding. The epidemiological analysis showed that cholera had become endemic in the poor neighbourhoods of the town and that epidemic break-outs were favoured by contaminated surface water and disturbances in the distribution of drinking water. The epidemic of 1997, likewise following flooding, only confirmed this point of view.

  12. Nepalese origin of cholera epidemic in Haiti.

    PubMed

    Frerichs, R R; Keim, P S; Barrais, R; Piarroux, R

    2012-06-01

    Cholera appeared in Haiti in October 2010 for the first time in recorded history. The causative agent was quickly identified by the Haitian National Public Health Laboratory and the United States Centers for Disease Control and Prevention as Vibrio cholerae serogroup O1, serotype Ogawa, biotype El Tor. Since then, >500 000 government-acknowledged cholera cases and >7000 deaths have occurred, the largest cholera epidemic in the world, with the real death toll probably much higher. Questions of origin have been widely debated with some attributing the onset of the epidemic to climatic factors and others to human transmission. None of the evidence on origin supports climatic factors. Instead, recent epidemiological and molecular-genetic evidence point to the United Nations peacekeeping troops from Nepal as the source of cholera to Haiti, following their troop rotation in early October 2010. Such findings have important policy implications for shaping future international relief efforts.

  13. Pursuing Justice in Haiti's Cholera Epidemic.

    PubMed

    Weinmeyer, Richard

    2016-07-01

    In 2010, the nation of Haiti was leveled by a shattering earthquake that killed thousands and devastated its already fragile infrastructure. During relief efforts to aid Haiti's suffering population, the United Nations sent troops to Haiti to assist the rebuilding of country's most basic services. But those troops unknowingly carried with them the bacteria that cause cholera, and through the UN's negligent actions, it triggered a horrifying cholera epidemic that continues to harm the Haitian people. Those injured by the cholera epidemic have sought relief in the US federal court system to obtain justice for those killed or sickened by the cholera outbreak. The UN has declared legal immunity for causing the epidemic, yet the litigation on this matter is ongoing.

  14. Mortality Rates during Cholera Epidemic, Haiti, 2010–2011

    PubMed Central

    Rondy, Marc; Boncy, Jacques; Munger, André; Mekaoui, Helmi; Rymshaw, Ellen; Page, Anne-Laure; Toure, Brahima; Degail, Marie Amelie; Nicolas, Sarala; Grandesso, Francesco; Ginsbourger, Maud; Polonsky, Jonathan; Alberti, Kathryn P.; Terzian, Mego; Olson, David; Porten, Klaudia; Ciglenecki, Iza

    2016-01-01

    The 2010 cholera epidemic in Haiti was one of the largest cholera epidemics ever recorded. To estimate the magnitude of the death toll during the first wave of the epidemic, we retrospectively conducted surveys at 4 sites in the northern part of Haiti. Overall, 70,903 participants were included; at all sites, the crude mortality rates (19.1–35.4 deaths/1,000 person-years) were higher than the expected baseline mortality rate for Haiti (9 deaths/1,000 person-years). This finding represents an excess of 3,406 deaths (2.9-fold increase) for the 4.4% of the Haiti population covered by these surveys, suggesting a substantially higher cholera mortality rate than previously reported. PMID:26886511

  15. Mortality Rates during Cholera Epidemic, Haiti, 2010-2011.

    PubMed

    Luquero, Francisco J; Rondy, Marc; Boncy, Jacques; Munger, André; Mekaoui, Helmi; Rymshaw, Ellen; Page, Anne-Laure; Toure, Brahima; Degail, Marie Amelie; Nicolas, Sarala; Grandesso, Francesco; Ginsbourger, Maud; Polonsky, Jonathan; Alberti, Kathryn P; Terzian, Mego; Olson, David; Porten, Klaudia; Ciglenecki, Iza

    2016-03-01

    The 2010 cholera epidemic in Haiti was one of the largest cholera epidemics ever recorded. To estimate the magnitude of the death toll during the first wave of the epidemic, we retrospectively conducted surveys at 4 sites in the northern part of Haiti. Overall, 70,903 participants were included; at all sites, the crude mortality rates (19.1-35.4 deaths/1,000 person-years) were higher than the expected baseline mortality rate for Haiti (9 deaths/1,000 person-years). This finding represents an excess of 3,406 deaths (2.9-fold increase) for the 4.4% of the Haiti population covered by these surveys, suggesting a substantially higher cholera mortality rate than previously reported.

  16. The role of immunity and seasonality in cholera epidemics.

    PubMed

    Sanches, Rosângela P; Ferreira, Claudia P; Kraenkel, Roberto A

    2011-12-01

    This paper presents a mathematical model for cholera epidemics which comprises seasonality, loss of host immunity, and control mechanisms acting to reduce cholera transmission. A collection of data related to cholera disease allows us to show that outbreaks in endemic areas are subject to a resonant behavior, since the intrinsic oscillation period of the disease (∼1 year) is synchronized with the annual contact rate variation. Moreover, we argue that the short period of the host immunity may be associated to secondary peaks of incidence observed in some regions (a bimodal pattern). Finally, we explore some possible mechanisms of cholera control, and analyze their efficiency. We conclude that, besides mass vaccination--which may be impracticable--improvements in sanitation system and food/personal hygiene are the most effective ways to prevent an epidemic.

  17. Relationship between Distinct African Cholera Epidemics Revealed via MLVA Haplotyping of 337 Vibrio cholerae Isolates

    PubMed Central

    Moore, Sandra; Miwanda, Berthe; Sadji, Adodo Yao; Thefenne, Hélène; Jeddi, Fakhri; Rebaudet, Stanislas; de Boeck, Hilde; Bidjada, Bawimodom; Depina, Jean-Jacques; Bompangue, Didier; Abedi, Aaron Aruna; Koivogui, Lamine; Keita, Sakoba; Garnotel, Eric; Plisnier, Pierre-Denis; Ruimy, Raymond; Thomson, Nicholas; Muyembe, Jean-Jacques; Piarroux, Renaud

    2015-01-01

    Background Since cholera appeared in Africa during the 1970s, cases have been reported on the continent every year. In Sub-Saharan Africa, cholera outbreaks primarily cluster at certain hotspots including the African Great Lakes Region and West Africa. Methodology/Principal Findings In this study, we applied MLVA (Multi-Locus Variable Number Tandem Repeat Analysis) typing of 337 Vibrio cholerae isolates from recent cholera epidemics in the Democratic Republic of the Congo (DRC), Zambia, Guinea and Togo. We aimed to assess the relationship between outbreaks. Applying this method, we identified 89 unique MLVA haplotypes across our isolate collection. MLVA typing revealed the short-term divergence and microevolution of these Vibrio cholerae populations to provide insight into the dynamics of cholera outbreaks in each country. Our analyses also revealed strong geographical clustering. Isolates from the African Great Lakes Region (DRC and Zambia) formed a closely related group, while West African isolates (Togo and Guinea) constituted a separate cluster. At a country-level scale our analyses revealed several distinct MLVA groups, most notably DRC 2011/2012, DRC 2009, Zambia 2012 and Guinea 2012. We also found that certain MLVA types collected in the DRC persisted in the country for several years, occasionally giving rise to expansive epidemics. Finally, we found that the six environmental isolates in our panel were unrelated to the epidemic isolates. Conclusions/Significance To effectively combat the disease, it is critical to understand the mechanisms of cholera emergence and diffusion in a region-specific manner. Overall, these findings demonstrate the relationship between distinct epidemics in West Africa and the African Great Lakes Region. This study also highlights the importance of monitoring and analyzing Vibrio cholerae isolates. PMID:26110870

  18. Epidemic cholera in Latin America: spread and routes of transmission.

    PubMed

    Guthmann, J P

    1995-12-01

    In the most recent epidemic of cholera in Latin America, nearly a million cases were reported and almost 9000 people died between January 1991 and December 1993. The epidemic spread rapidly from country to country, affecting in three years all the countries of Latin America except Uruguay and the Caribbean. Case-control studies carried out in Peru showed a significant association between drinking water and risk of disease. Cholera was associated with the consumption of unwashed fruit and vegetables, with eating food from street vendors and with contaminated crabmeat transported in travellers' luggage. This article documents the spread of the epidemic and its routes of transmission and discusses whether the introduction of the epidemic to Peru and its subsequent spread throughout the continent could have been prevented.

  19. Cholera in United States associated with epidemic in Hispaniola.

    PubMed

    Newton, Anna E; Heiman, Katherine E; Schmitz, Ann; Török, Tom; Apostolou, Andria; Hanson, Heather; Gounder, Prabhu; Bohm, Susan; Kurkjian, Katie; Parsons, Michele; Talkington, Deborah; Stroika, Steven; Madoff, Lawrence C; Elson, Franny; Sweat, David; Cantu, Venessa; Akwari, Okey; Mahon, Barbara E; Mintz, Eric D

    2011-11-01

    Cholera is rare in the United States (annual average 6 cases). Since epidemic cholera began in Hispaniola in 2010, a total of 23 cholera cases caused by toxigenic Vibrio cholerae O1 have been confirmed in the United States. Twenty-two case-patients reported travel to Hispaniola and 1 reported consumption of seafood from Haiti.

  20. On the probability of extinction of the Haiti cholera epidemic

    NASA Astrophysics Data System (ADS)

    Bertuzzo, Enrico; Finger, Flavio; Mari, Lorenzo; Gatto, Marino; Rinaldo, Andrea

    2014-05-01

    Nearly 3 years after its appearance in Haiti, cholera has already exacted more than 8,200 deaths and 670,000 reported cases and it is feared to become endemic. However, no clear evidence of a stable environmental reservoir of pathogenic Vibrio cholerae, the infective agent of the disease, has emerged so far, suggesting that the transmission cycle of the disease is being maintained by bacteria freshly shed by infected individuals. Thus in principle cholera could possibly be eradicated from Haiti. Here, we develop a framework for the estimation of the probability of extinction of the epidemic based on current epidemiological dynamics and health-care practice. Cholera spreading is modelled by an individual-based spatially-explicit stochastic model that accounts for the dynamics of susceptible, infected and recovered individuals hosted in different local communities connected through hydrologic and human mobility networks. Our results indicate that the probability that the epidemic goes extinct before the end of 2016 is of the order of 1%. This low probability of extinction highlights the need for more targeted and effective interventions to possibly stop cholera in Haiti.

  1. Widespread epidemic cholera caused by a restricted subset of Vibrio cholerae clones.

    PubMed

    Moore, S; Thomson, N; Mutreja, A; Piarroux, R

    2014-05-01

    Since 1817, seven cholera pandemics have plagued humankind. As the causative agent, Vibrio cholerae, is autochthonous in the aquatic ecosystem and some studies have revealed links between outbreaks and fluctuations in climatic and aquatic conditions, it has been widely assumed that cholera epidemics are triggered by environmental factors that promote the growth of local bacterial reservoirs. However, mounting epidemiological findings and genome sequence analysis of clinical isolates have indicated that epidemics are largely unassociated with most of the V. cholerae strains in aquatic ecosystems. Instead, only a specific subset of V. cholerae El Tor 'types' appears to be responsible for current epidemics. A recent report examining the evolution of a variety of V. cholerae strains indicates that the current pandemic is monophyletic and originated from a single ancestral clone that has spread globally in successive waves. In this review, we examine the clonal nature of the disease, with the example of the recent history of cholera in the Americas. Epidemiological data and genome sequence-based analysis of V. cholerae isolates demonstrate that the cholera epidemics of the 1990s in South America were triggered by the importation of a pathogenic V. cholerae strain that gradually spread throughout the region until local outbreaks ceased in 2001. Latin America remained almost unaffected by the disease until a new toxigenic V. cholerae clone was imported into Haiti in 2010. Overall, cholera appears to be largely caused by a subset of specific V. cholerae clones rather than by the vast diversity of V. cholerae strains in the environment.

  2. Cholera: a continuous epidemic in Africa.

    PubMed

    Naidoo, A; Patric, K

    2002-06-01

    Cholera continues to plague many parts of the world, but has largely been concentrated in Africa, which contributes more than 80% of the total cases worldwide. Natural disasters, like the 2000 floods in Mozambique and the volcanic eruption in the Democratic Republic of the Congo in 2002, generally lead to new outbreaks of the disease. The refugee problem in many countries throughout the world also causes potential threats for disease outbreaks. Case fatality rates are high, and we are not anywhere near curbing new cholera epidemics, especially in Africa. It is thus imperative to renew discussions about the nature of this deadly disease, its treatment, measures for prevention and control, modes of transmission, its physical, social and economic impact, and potential solutions.

  3. On the space-time evolution of a cholera epidemic

    NASA Astrophysics Data System (ADS)

    Bertuzzo, E.; Azaele, S.; Maritan, A.; Gatto, M.; Rodriguez-Iturbe, I.; Rinaldo, A.

    2008-01-01

    We study how river networks, acting as environmental corridors for pathogens, affect the spreading of cholera epidemics. Specifically, we compare epidemiological data from the real world with the space-time evolution of infected individuals predicted by a theoretical scheme based on reactive transport of infective agents through a biased network portraying actual river pathways. The data pertain to a cholera outbreak in South Africa which started in 2000 and affected in particular the KwaZulu-Natal province. The epidemic lasted for 2 years and involved about 140,000 confirmed cholera cases. Hydrological and demographic data have also been carefully considered. The theoretical tools relate to recent advances in hydrochory, migration fronts, and infection spreading and are novel in that nodal reactions describe the dynamics of cholera. Transport through network links provides the coupling of the nodal dynamics of infected people, who are assumed to reside at the nodes. This proves a realistic scheme. We argue that the theoretical scheme is remarkably capable of predicting actual outbreaks and, indeed, that network structures play a controlling role in the actual, rather anisotropic propagation of infections, in analogy to spreading of species or to migration processes that also use rivers as ecological corridors.

  4. Spatially explicit modelling of cholera epidemics

    NASA Astrophysics Data System (ADS)

    Finger, F.; Bertuzzo, E.; Mari, L.; Knox, A. C.; Gatto, M.; Rinaldo, A.

    2013-12-01

    Epidemiological models can provide crucial understanding about the dynamics of infectious diseases. Possible applications range from real-time forecasting and allocation of health care resources to testing alternative intervention mechanisms such as vaccines, antibiotics or the improvement of sanitary conditions. We apply a spatially explicit model to the cholera epidemic that struck Haiti in October 2010 and is still ongoing. The dynamics of susceptibles as well as symptomatic and asymptomatic infectives are modelled at the scale of local human communities. Dissemination of Vibrio cholerae through hydrological transport and human mobility along the road network is explicitly taken into account, as well as the effect of rainfall as a driver of increasing disease incidence. The model is calibrated using a dataset of reported cholera cases. We further model the long term impact of several types of interventions on the disease dynamics by varying parameters appropriately. Key epidemiological mechanisms and parameters which affect the efficiency of treatments such as antibiotics are identified. Our results lead to conclusions about the influence of different intervention strategies on the overall epidemiological dynamics.

  5. Epidemic cholera among refugees in Malawi, Africa: treatment and transmission.

    PubMed Central

    Swerdlow, D. L.; Malenga, G.; Begkoyian, G.; Nyangulu, D.; Toole, M.; Waldman, R. J.; Puhr, D. N.; Tauxe, R. V.

    1997-01-01

    Between 23 August and 15 December 1990 an epidemic of cholera affected Mozambican refugees in Malawi causing 1931 cases (attack rate = 2.4%); 86% of patients had arrived in Malawi < 3 months before illness onset. There were 68 deaths (case-fatality rate = 3.5%); most deaths (63%) occurred within 24 h of hospital admission which may have indicated delayed presentation to health facilities and inadequate early rehydration. Mortality was higher in children < 4 years old and febrile deaths may have been associated with prolonged i.v. use. Significant risk factors for illness (P < 0.05) in two case-control studies included drinking river water (odds ratio [OR] = 3.0); placing hands into stored household drinking water (OR = 6.0); and among those without adequate firewood to reheat food, eating leftover cooked peas (OR = 8.0). Toxigenic V. cholerae O1, serotype Inaba, was isolated from patients and stored household water. The rapidity with which newly arrived refugees became infected precluded effective use of a cholera vaccine to prevent cases unless vaccination had occurred immediately upon camp arrival. Improved access to treatment and care of paediatric patients, and increased use of oral rehydration therapy, could decrease mortality. Preventing future cholera outbreaks in Africa will depend on interrupting both waterborne and foodborne transmission of this pathogen. PMID:9207730

  6. Cholera.

    PubMed Central

    Kaper, J B; Morris, J G; Levine, M M

    1995-01-01

    Despite more than a century of study, cholera still presents challenges and surprises to us. Throughout most of the 20th century, cholera was caused by Vibrio cholerae of the O1 serogroup and the disease was largely confined to Asia and Africa. However, the last decade of the 20th century has witnessed two major developments in the history of this disease. In 1991, a massive outbreak of cholera started in South America, the one continent previously untouched by cholera in this century. In 1992, an apparently new pandemic caused by a previously unknown serogroup of V. cholerae (O139) began in India and Bangladesh. The O139 epidemic has been occurring in populations assumed to be largely immune to V. cholerae O1 and has rapidly spread to many countries including the United States. In this review, we discuss all aspects of cholera, including the clinical microbiology, epidemiology, pathogenesis, and clinical features of the disease. Special attention will be paid to the extraordinary advances that have been made in recent years in unravelling the molecular pathogenesis of this infection and in the development of new generations of vaccines to prevent it. PMID:7704895

  7. [Cholera epidemics on Reunion Island during the 19th century].

    PubMed

    Gaüzère, B-A; Aubry, P

    2012-01-01

    The first cholera outbreak on Bourbon Island (now Reunion Island) was recorded in January 1820. The disease was imported from Mauritius Island aboard the steamer Pivert. The epidemic began on Mauritius in November 1819 after the English frigate, La Topaze, called from Calcutta, India. Dr. François Vinson demonstrated the transmissibility of cholera during this epidemic. Drastic sanitary measures spared Reunion from the two epidemics on Mauritius Island, in 1854 and 1856. The second outbreak of cholera on Reunion Island was recorded on March 6, 1859. The disease was introduced from East Africa by the steamer Mascareignes, which carried indentured servants. The captain (d'Agnel) et the supercargo (Menon) of the steamer claimed to the doctor who boarded the ship before landing that no passengers or crew had had cholera, in flagrant contradiction to the autopsy report issued by Navy surgeon Alfred Vaillant, who had concluded that cholera was present when the vessel left the African coast. This report was withheld from the boarding physician. Cholera spread quickly on the island and affected the poorest people, especially freed slaves, most severely. Dr. Petit, the chief Navy Physician and Director of the Health Department, obtained a confession by Menon about the fraudulent statements. On January 24, 1860, a trial for public health endangerment began on Reunion Island; it ended on February 1 with a not-guilty verdict, based largely on the testimony of several island doctors that cholera was not contagious.

  8. Real-time modelling used for outbreak management during a cholera epidemic, Haiti, 2010-2011.

    PubMed

    Abrams, J Y; Copeland, J R; Tauxe, R V; Date, K A; Belay, E D; Mody, R K; Mintz, E D

    2013-06-01

    The emergence of epidemic cholera in post-earthquake Haiti portended a public health disaster of uncertain magnitude. In order to coordinate relief efforts in an environment with limited healthcare infrastructure and stretched resources, timely and realistic projections of the extent of the cholera outbreak were crucial. Projections were shared with Government and partner organizations beginning 5 days after the first reported case and were updated using progressively more advanced methods as more surveillance data became available. The first projection estimated that 105 000 cholera cases would occur in the first year. Subsequent projections using different methods estimated up to 652 000 cases and 163 000-247 000 hospitalizations during the first year. Current surveillance data show these projections to have provided reasonable approximations of the observed epidemic. Providing the real-time projections allowed Haitian ministries and external aid organizations to better plan and implement response measures during the evolving epidemic.

  9. A generalized cholera model and epidemic-endemic analysis.

    PubMed

    Wang, Jin; Liao, Shu

    2012-01-01

    The transmission of cholera involves both human-to-human and environment-to-human pathways that complicate its dynamics. In this paper, we present a new and unified deterministic model that incorporates a general incidence rate and a general formulation of the pathogen concentration to analyse the dynamics of cholera. Particularly, this work unifies many existing cholera models proposed by different authors. We conduct equilibrium analysis to carefully study the complex epidemic and endemic behaviour of the disease. Our results show that despite the incorporation of the environmental component, there exists a forward transcritical bifurcation at R (0)=1 for the combined human-environment epidemiological model under biologically reasonable conditions.

  10. Human Mobility Patterns and Cholera Epidemics: a Spatially Explicit Modeling Approach

    NASA Astrophysics Data System (ADS)

    Mari, L.; Bertuzzo, E.; Righetto, L.; Casagrandi, R.; Gatto, M.; Rodriguez-Iturbe, I.; Rinaldo, A.

    2010-12-01

    Cholera is an acute enteric disease caused by the ingestion of water or food contaminated by the bacterium Vibrio cholerae. Although most infected individuals do not develop severe symptoms, their stool may contain huge quantities of V.~cholerae cells. Therefore, while traveling or commuting, asymptomatic carriers can be responsible for the long-range dissemination of the disease. As a consequence, human mobility is an alternative and efficient driver for the spread of cholera, whose primary propagation pathway is hydrological transport through river networks. We present a multi-layer network model that accounts for the interplay between epidemiological dynamics, hydrological transport and long-distance dissemination of V.~cholerae due to human movement. In particular, building on top of state-of-the-art spatially explicit models for cholera spread through surface waters, we describe human movement and its effects on the propagation of the disease by means of a gravity-model approach borrowed from transportation theory. Gravity-like contact processes have been widely used in epidemiology, because they can satisfactorily depict human movement when data on actual mobility patterns are not available. We test our model against epidemiological data recorded during the cholera outbreak occurred in the KwaZulu-Natal province of South Africa during years 2000--2001. We show that human mobility does actually play an important role in the formation of the spatiotemporal patterns of cholera epidemics. In particular, long-range human movement may determine inter-catchment dissemination of V.~cholerae cells, thus in turn explaining the emergence of epidemic patterns that cannot be produced by hydrological transport alone. We also show that particular attention has to be devoted to study how heterogeneously distributed drinking water supplies and sanitation conditions may affect cholera transmission.

  11. Deciphering the Origin of the 2012 Cholera Epidemic in Guinea by Integrating Epidemiological and Molecular Analyses

    PubMed Central

    Rebaudet, Stanislas; Mengel, Martin A.; Koivogui, Lamine; Moore, Sandra; Mutreja, Ankur; Kande, Yacouba; Yattara, Ousmane; Sarr Keita, Véronique; Njanpop-Lafourcade, Berthe-Marie; Fournier, Pierre-Edouard; Garnotel, Eric; Keita, Sakoba; Piarroux, Renaud

    2014-01-01

    Cholera is typically considered endemic in West Africa, especially in the Republic of Guinea. However, a three-year lull period was observed from 2009 to 2011, before a new epidemic struck the country in 2012, which was officially responsible for 7,350 suspected cases and 133 deaths. To determine whether cholera re-emerged from the aquatic environment or was rather imported due to human migration, a comprehensive epidemiological and molecular survey was conducted. A spatiotemporal analysis of the national case databases established Kaback Island, located off the southern coast of Guinea, as the initial focus of the epidemic in early February. According to the field investigations, the index case was found to be a fisherman who had recently arrived from a coastal district of neighboring Sierra Leone, where a cholera outbreak had recently occurred. MLVA-based genotype mapping of 38 clinical Vibrio cholerae O1 El Tor isolates sampled throughout the epidemic demonstrated a progressive genetic diversification of the strains from a single genotype isolated on Kaback Island in February, which correlated with spatial epidemic spread. Whole-genome sequencing characterized this strain as an “atypical” El Tor variant. Furthermore, genome-wide SNP-based phylogeny analysis grouped the Guinean strain into a new clade of the third wave of the seventh pandemic, distinct from previously analyzed African strains and directly related to a Bangladeshi isolate. Overall, these results highly suggest that the Guinean 2012 epidemic was caused by a V. cholerae clone that was likely imported from Sierra Leone by an infected individual. These results indicate the importance of promoting the cross-border identification and surveillance of mobile and vulnerable populations, including fishermen, to prevent, detect and control future epidemics in the region. Comprehensive epidemiological investigations should be expanded to better understand cholera dynamics and improve disease control

  12. Deciphering the origin of the 2012 cholera epidemic in Guinea by integrating epidemiological and molecular analyses.

    PubMed

    Rebaudet, Stanislas; Mengel, Martin A; Koivogui, Lamine; Moore, Sandra; Mutreja, Ankur; Kande, Yacouba; Yattara, Ousmane; Sarr Keita, Véronique; Njanpop-Lafourcade, Berthe-Marie; Fournier, Pierre-Edouard; Garnotel, Eric; Keita, Sakoba; Piarroux, Renaud

    2014-06-01

    Cholera is typically considered endemic in West Africa, especially in the Republic of Guinea. However, a three-year lull period was observed from 2009 to 2011, before a new epidemic struck the country in 2012, which was officially responsible for 7,350 suspected cases and 133 deaths. To determine whether cholera re-emerged from the aquatic environment or was rather imported due to human migration, a comprehensive epidemiological and molecular survey was conducted. A spatiotemporal analysis of the national case databases established Kaback Island, located off the southern coast of Guinea, as the initial focus of the epidemic in early February. According to the field investigations, the index case was found to be a fisherman who had recently arrived from a coastal district of neighboring Sierra Leone, where a cholera outbreak had recently occurred. MLVA-based genotype mapping of 38 clinical Vibrio cholerae O1 El Tor isolates sampled throughout the epidemic demonstrated a progressive genetic diversification of the strains from a single genotype isolated on Kaback Island in February, which correlated with spatial epidemic spread. Whole-genome sequencing characterized this strain as an "atypical" El Tor variant. Furthermore, genome-wide SNP-based phylogeny analysis grouped the Guinean strain into a new clade of the third wave of the seventh pandemic, distinct from previously analyzed African strains and directly related to a Bangladeshi isolate. Overall, these results highly suggest that the Guinean 2012 epidemic was caused by a V. cholerae clone that was likely imported from Sierra Leone by an infected individual. These results indicate the importance of promoting the cross-border identification and surveillance of mobile and vulnerable populations, including fishermen, to prevent, detect and control future epidemics in the region. Comprehensive epidemiological investigations should be expanded to better understand cholera dynamics and improve disease control

  13. Rainfall mediations in the spreading of epidemic cholera

    NASA Astrophysics Data System (ADS)

    Righetto, L.; Bertuzzo, E.; Mari, L.; Schild, E.; Casagrandi, R.; Gatto, M.; Rodriguez-Iturbe, I.; Rinaldo, A.

    2013-10-01

    Following the empirical evidence of a clear correlation between rainfall events and cholera resurgence that was observed in particular during the recent outbreak in Haiti, a spatially explicit model of epidemic cholera is re-examined. Specifically, we test a multivariate Poisson rainfall generator, with parameters varying in space and time, as a driver of enhanced disease transmission. The relevance of the issue relates to the key insight that predictive mathematical models may provide into the course of an ongoing cholera epidemic aiding emergency management (say, in allocating life-saving supplies or health care staff) or in evaluating alternative management strategies. Our model consists of a set of dynamical equations (SIRB-like i.e. subdivided into the compartments of Susceptible, Infected and Recovered individuals, and including a balance of Bacterial concentrations in the water reservoir) describing a connected network of human communities where the infection results from the exposure to excess concentrations of pathogens in the water. These, in turn, are driven by rainfall washout of open-air defecation sites or cesspool overflows, hydrologic transport through waterways and by mobility of susceptible and infected individuals. We perform an a posteriori analysis (from the beginning of the epidemic in October 2010 until December 2011) to test the model reliability in predicting cholera cases and in testing control measures, involving vaccination and sanitation campaigns, for the ongoing epidemic. Even though predicting reliably the timing of the epidemic resurgence proves difficult due to rainfall inter-annual variability, we find that the model can reasonably quantify the total number of reported infection cases in the selected time-span. We then run a multi-seasonal prediction of the course of the epidemic until December 2015, to investigate conditions for further resurgences and endemicity of cholera in the region with a view to policies which may bring to

  14. Cholera epidemics in 2010: respective roles of environment, strain changes, and human-driven dissemination.

    PubMed

    Piarroux, R; Faucher, B

    2012-03-01

    The cholera burden has grown strikingly during the past 4 years, and has spread to countries previously spared by this disease. The current spread has proved especially violent, as illustrated by the recent deadly epidemics around the Lake Chad Basin, in East Africa, and in Haiti. This onset of severe cholera epidemics is part of the overall dynamic of the current seventh cholera pandemic, composed of successive epidemic waves. The current wave is attributable to new atypical El Tor strains, which spread from the Bay of Bengal to Papua in the east, Africa, and the Caribbean Sea in the west, and caused hundreds of thousands of cases and thousands of deaths during each of the last 4 years. The particular severity of the resulting epidemics is partially attributable to the specific characteristics of the atypical El Tor strain involved. Besides the abilty of El Tor to spread easily, this strain is associated with more severe clinical findings, because of elevated levels of toxin secretion resulting from a genetic content originating from classical strains. Conversely, recent studies of these deadly outbreaks raised hope by illustrating their relationship with human-borne dissemination rather than with the resurgence of environmental strains. As human-borne dissemination can be more easily targeted than ubiquitous environmental contamination, accurate and comprehensive epidemiological studies are essential to better understand the dynamics of the disease and to optimize future cholera responses.

  15. Seroepidemiologic survey of epidemic cholera in Haiti to assess spectrum of illness and risk factors for severe disease.

    PubMed

    Jackson, Brendan R; Talkington, Deborah F; Pruckler, James M; Fouché, M D Bernadette; Lafosse, Elsie; Nygren, Benjamin; Gómez, Gerardo A; Dahourou, Georges A; Archer, W Roodly; Payne, Amanda B; Hooper, W Craig; Tappero, Jordan W; Derado, Gordana; Magloire, Roc; Gerner-Smidt, Peter; Freeman, Nicole; Boncy, Jacques; Mintz, Eric D

    2013-10-01

    To assess the spectrum of illness from toxigenic Vibrio cholerae O1 and risk factors for severe cholera in Haiti, we conducted a cross-sectional survey in a rural commune with more than 21,000 residents. During March 22-April 6, 2011, we interviewed 2,622 residents ≥ 2 years of age and tested serum specimens from 2,527 (96%) participants for vibriocidal and antibodies against cholera toxin; 18% of participants reported a cholera diagnosis, 39% had vibriocidal titers ≥ 320, and 64% had vibriocidal titers ≥ 80, suggesting widespread infection. Among seropositive participants (vibriocidal titers ≥ 320), 74.5% reported no diarrhea and 9.0% had severe cholera (reported receiving intravenous fluids and overnight hospitalization). This high burden of severe cholera is likely explained by the lack of pre-existing immunity in this population, although the virulence of the atypical El Tor strain causing the epidemic and other factors might also play a role.

  16. Regional-scale climate-variability synchrony of cholera epidemics in West Africa

    PubMed Central

    Constantin de Magny, Guillaume; Guégan, Jean-François; Petit, Michel; Cazelles, Bernard

    2007-01-01

    Background The relationship between cholera and climate was explored in Africa, the continent with the most reported cases, by analyzing monthly 20-year cholera time series for five coastal adjoining West African countries: Côte d'Ivoire, Ghana, Togo, Benin and Nigeria. Methods We used wavelet analyses and derived methods because these are useful mathematical tools to provide information on the evolution of the periodic component over time and allow quantification of non-stationary associations between time series. Results The temporal variability of cholera incidence exhibits an interannual component, and a significant synchrony in cholera epidemics is highlighted at the end of the 1980's. This observed synchrony across countries, even if transient through time, is also coherent with both the local variability of rainfall and the global climate variability quantified by the Indian Oscillation Index. Conclusion Results of this study suggest that large and regional scale climate variability influence both the temporal dynamics and the spatial synchrony of cholera epidemics in human populations in the Gulf of Guinea, as has been described for two other tropical regions of the world, western South America and Bangladesh. PMID:17371602

  17. An epidemic model for the future progression of the current Haiti cholera epidemic

    NASA Astrophysics Data System (ADS)

    Bertuzzo, E.; Mari, L.; Righetto, L.; Casagrandi, R.; Gatto, M.; Rodriguez-Iturbe, I.; Rinaldo, A.

    2012-04-01

    As a major cholera epidemic progresses in Haiti, and the figures of the infection, up to December 2011, climb to 522,000 cases and 7,000 deaths, the development of general models to track and predict the evolution of the outbreak, so as to guide the allocation of medical supplies and staff, is gaining notable urgency. We propose here a spatially explicit epidemic model that accounts for the dynamics of susceptible and infected individuals as well as the redistribution of Vibrio cholera, the causative agent of the disease, among different human communities. In particular, we model two spreading pathways: the advection of pathogens through hydrologic connections and the dissemination due to human mobility described by means of a gravity-like model. To this end the country has been divided into hydrologic units based on drainage directions derived from a digital terrain model. Moreover the population of each unit has been estimated from census data downscaled to 1 km x 1 km resolution via remotely sensed geomorphological information (LandScan project). The model directly accounts for the role of rainfall patterns in driving the seasonality of cholera outbreaks. The two main outbreaks in fact occurred during the rainy seasons (October and May) when extensive floodings severely worsened the sanitation conditions and, in turn, raised the risk of infection. The model capability to reproduce the spatiotemporal features of the epidemic up to date grants robustness to the foreseen future development. To this end, we generate realistic scenario of future precipitation in order to forecast possible epidemic paths up to the end of the 2013. In this context, the duration of acquired immunity, a hotly debated topic in the scientific community, emerges as a controlling factor for progression of the epidemic in the near future. The framework presented here can straightforwardly be used to evaluate the effectiveness of alternative intervention strategies like mass vaccinations

  18. Sociomedical indicators in the cholera epidemic in Ferrara of 1855.

    PubMed

    Scapoli, Chiara; Guidi, Enrica; Angelini, Lauretta; Stefanati, Armando; Gregorio, Pasquale

    2003-01-01

    The historical report on the cholera epidemic of 1855, conserved in Ferrara City's archives allowed us to verify the probable relation between the environment and epidemic in a broad sense, using log-linear analysis and multiple logistic regression. Two thousand and thirty-three cases were analyzed and the quantitative/qualitative variables available from the report were analyzed in relationship with mortality and morbidity rates, considered as response variables. From the analysis of the quantitative variables, it emerges that the variables having a significant influence on the morbidity/mortality rates are the number of individuals and the average number of inhabitants per house. From the analysis of the qualitative variables, it emerges that all the descriptive variables of the state of the streets and houses express a strong association with mortality and morbidity. With the present analysis, data available--a detailed 'street by street' morbidity and mortality recording from cholera in 1855 in Ferrara--were analyzed with modern means and the overall picture that emerge is that in the better kept houses in the better parts of the town had less cholera morbidity and especially mortality.

  19. Epidemic cholera in Guatemala, 1993: transmission of a newly introduced epidemic strain by street vendors.

    PubMed Central

    Koo, D.; Aragon, A.; Moscoso, V.; Gudiel, M.; Bietti, L.; Carrillo, N.; Chojoj, J.; Gordillo, B.; Cano, F.; Cameron, D. N.; Wells, J. G.; Bean, N. H.; Tauxe, R. V.

    1996-01-01

    Epidemic cholera reached Guatemala in July 1991. By mid-1993, Guatemala ranked third in the hemisphere in reported cases of cholera. We conducted a case-control study with two age-, sex-, and neighbourhood-matched controls per patient in periurban Guatemala City. Twenty-six patients hospitalized for cholera and 52 controls were enrolled. Seven (47%) of 15 stool cultures obtained after admission yielded toxigenic Vibrio cholerae O1. All seven were resistant to furazolidone, sulfisoxazole, and streptomycin, and differed substantially by pulsed-field gel electrophoresis from the Latin American epidemic strain dominant in the hemisphere since 1991. In univariate analysis, illness was associated with consumption of left-over rice (odds ratio [OR] = 7.0, 95% confidence interval [CI] = 1.4-36), flavored ices (-helados') (OR = 3.6, CI = 1.1 - 12), and street-vended non-carbonated beverages (OR = 3.8, CI = 1.2-12) and food items (OR = 11.0, CI = 2.3-54). Street-vended food items remained significantly associated with illness in multivariate analysis (OR = 6.5, CI = 1.4-31). Illness was not associated with drinking municipal tap water. Maintaining water safety is important, but slowing the epidemic in Guatemala City and elsewhere may also require improvement in street vendor food handling and hygiene. PMID:8620902

  20. Epidemic cholera in a crowded urban environment, Port-au-Prince, Haiti.

    PubMed

    Dunkle, Stacie E; Mba-Jonas, Adamma; Loharikar, Anagha; Fouché, Bernadette; Peck, Mireille; Ayers, Tracy; Archer, W Roodly; De Rochars, Valery M Beau; Bender, Thomas; Moffett, Daphne B; Tappero, Jordan W; Dahourou, George; Roels, Thierry; Quick, Robert

    2011-11-01

    We conducted a case-control study to investigate factors associated with epidemic cholera. Water treatment and handwashing may have been protective, highlighting the need for personal hygiene for cholera prevention in contaminated urban environments. We also found a diverse diet, a possible proxy for improved nutrition, was protective against cholera.

  1. [The 1853-1856 cholera epidemic in the Portuguese press].

    PubMed

    Almeida, Maria Antónia Pires de

    2011-12-01

    The article examines science and technology communication aimed at a non-specialized audience, using the general press as the main source in this endeavor to capture an image of the popularization of science in Portugal. Based on the fact that the nineteenth-century press was overtly concerned with garnering an audience and spreading knowledge, the study uses news, articles, and advertisements about the 1853-1856 cholera epidemic to assess the era's scientific knowledge (especially about prevention and treatment) and how this information was conveyed to society and used by it.

  2. On Spatially Explicit Models of Epidemic and Endemic Cholera: The Haiti and Lake Kivu Case Studies.

    NASA Astrophysics Data System (ADS)

    Rinaldo, A.; Bertuzzo, E.; Mari, L.; Finger, F.; Casagrandi, R.; Gatto, M.; Rodriguez-Iturbe, I.

    2014-12-01

    The first part of the Lecture deals with the predictive ability of mechanistic models for the Haitian cholera epidemic. Predictive models of epidemic cholera need to resolve at suitable aggregation levels spatial data pertaining to local communities, epidemiological records, hydrologic drivers, waterways, patterns of human mobility and proxies of exposure rates. A formal model comparison framework provides a quantitative assessment of the explanatory and predictive abilities of various model settings with different spatial aggregation levels. Intensive computations and objective model comparisons show that parsimonious spatially explicit models accounting for spatial connections have superior explanatory power than spatially disconnected ones for short-to intermediate calibration windows. In general, spatially connected models show better predictive ability than disconnected ones. We suggest limits and validity of the various approaches and discuss the pathway towards the development of case-specific predictive tools in the context of emergency management. The second part deals with approaches suitable to describe patterns of endemic cholera. Cholera outbreaks have been reported in the Democratic Republic of the Congo since the 1970s. Here we employ a spatially explicit, inhomogeneous Markov chain model to describe cholera incidence in eight health zones on the shore of lake Kivu. Remotely sensed datasets of chlorophyll a concentration in the lake, precipitation and indices of global climate anomalies are used as environmental drivers in addition to baseline seasonality. The effect of human mobility is also modelled mechanistically. We test several models on a multi-year dataset of reported cholera cases. Fourteen models, accounting for different environmental drivers, are selected in calibration. Among these, the one accounting for seasonality, El Nino Southern Oscillation, precipitation and human mobility outperforms the others in cross-validation.

  3. [On the epidemic of cholera and its prevention and control by the railway authorities in 1932].

    PubMed

    Huang, H P; Song, M H

    2016-01-28

    In 1932, the epidemic of cholera in China was serious, spreading to all provinces nationwide, causing heavy casualties. In order to prevent cholera epidemics spread along the railway line, the National Government Ministry of Railways and the local railway administration had taken all countermeasures, including the promulgation of epidemic prevention laws and regulations, quarantine, isolated check-up, disinfection, vaccination and even interruption of traffic. The measures of railway authorities had achieved a certain success. In August 1932, cholera epidemic began to subside gradually.

  4. Lessons learned during public health response to cholera epidemic in Haiti and the Dominican Republic.

    PubMed

    Tappero, Jordan W; Tauxe, Robert V

    2011-11-01

    After epidemic cholera emerged in Haiti in October 2010, the disease spread rapidly in a country devastated by an earthquake earlier that year, in a population with a high proportion of infant deaths, poor nutrition, and frequent infectious diseases such as HIV infection, tuberculosis, and malaria. Many nations, multinational agencies, and nongovernmental organizations rapidly mobilized to assist Haiti. The US government provided emergency response through the Office of Foreign Disaster Assistance of the US Agency for International Development and the Centers for Disease Control and Prevention. This report summarizes the participation by the Centers and its partners. The efforts needed to reduce the spread of the epidemic and prevent deaths highlight the need for safe drinking water and basic medical care in such difficult circumstances and the need for rebuilding water, sanitation, and public health systems to prevent future epidemics.

  5. Cost-effectiveness of oral cholera vaccine in a stable refugee population at risk for epidemic cholera and in a population with endemic cholera.

    PubMed Central

    Murray, J.; McFarland, D. A.; Waldman, R. J.

    1998-01-01

    Recent large epidemics of cholera with high incidence and associated mortality among refugees have raised the question of whether oral cholera vaccines should be considered as an additional preventive measure in high-risk populations. The potential impact of oral cholera vaccines on populations prone to seasonal endemic cholera has also been questioned. This article reviews the potential cost-effectiveness of B-subunit, killed whole-cell (BS-WC) oral cholera vaccine in a stable refugee population and in a population with endemic cholera. In the population at risk for endemic cholera, mass vaccination with BS-WC vaccine is the least cost-effective intervention compared with the provision of safe drinking-water and sanitation or with treatment of the disease. In a refugee population at risk for epidemic disease, the cost-effectiveness of vaccination is similar to that of providing safe drinking-water and sanitation alone, though less cost-effective than treatment alone or treatment combined with the provision of water and sanitation. The implications of these data for public health decision-makers and programme managers are discussed. There is a need for better information on the feasibility and costs of administering oral cholera vaccine in refugee populations and populations with endemic cholera. PMID:9803585

  6. Genome-Wide Study of the Defective Sucrose Fermenter Strain of Vibrio cholerae from the Latin American Cholera Epidemic

    PubMed Central

    Garza, Daniel Rios; Thompson, Cristiane C.; Loureiro, Edvaldo Carlos Brito; Dutilh, Bas E.; Inada, Davi Toshio; Junior, Edivaldo Costa Sousa; Cardoso, Jedson Ferreira; Nunes, Márcio Roberto T.; de Lima, Clayton Pereira Silva; Silvestre, Rodrigo Vellasco Duarte; Nunes, Keley Nascimento Barbosa; Santos, Elisabeth C. O.; Edwards, Robert A.; Vicente, Ana Carolina P.; de Sá Morais, Lena Lillian Canto

    2012-01-01

    The 7th cholera pandemic reached Latin America in 1991, spreading from Peru to virtually all Latin American countries. During the late epidemic period, a strain that failed to ferment sucrose dominated cholera outbreaks in the Northern Brazilian Amazon region. In order to understand the genomic characteristics and the determinants of this altered sucrose fermenting phenotype, the genome of the strain IEC224 was sequenced. This paper reports a broad genomic study of this strain, showing its correlation with the major epidemic lineage. The potentially mobile genomic regions are shown to possess GC content deviation, and harbor the main V. cholera virulence genes. A novel bioinformatic approach was applied in order to identify the putative functions of hypothetical proteins, and was compared with the automatic annotation by RAST. The genome of a large bacteriophage was found to be integrated to the IEC224's alanine aminopeptidase gene. The presence of this phage is shown to be a common characteristic of the El Tor strains from the Latin American epidemic, as well as its putative ancestor from Angola. The defective sucrose fermenting phenotype is shown to be due to a single nucleotide insertion in the V. cholerae sucrose-specific transportation gene. This frame-shift mutation truncated a membrane protein, altering its structural pore-like conformation. Further, the identification of a common bacteriophage reinforces both the monophyletic and African-Origin hypotheses for the main causative agent of the 1991 Latin America cholera epidemics. PMID:22662140

  7. Genome-wide study of the defective sucrose fermenter strain of Vibrio cholerae from the Latin American cholera epidemic.

    PubMed

    Garza, Daniel Rios; Thompson, Cristiane C; Loureiro, Edvaldo Carlos Brito; Dutilh, Bas E; Inada, Davi Toshio; Junior, Edivaldo Costa Sousa; Cardoso, Jedson Ferreira; Nunes, Márcio Roberto T; de Lima, Clayton Pereira Silva; Silvestre, Rodrigo Vellasco Duarte; Nunes, Keley Nascimento Barbosa; Santos, Elisabeth C O; Edwards, Robert A; Vicente, Ana Carolina P; de Sá Morais, Lena Lillian Canto

    2012-01-01

    The 7th cholera pandemic reached Latin America in 1991, spreading from Peru to virtually all Latin American countries. During the late epidemic period, a strain that failed to ferment sucrose dominated cholera outbreaks in the Northern Brazilian Amazon region. In order to understand the genomic characteristics and the determinants of this altered sucrose fermenting phenotype, the genome of the strain IEC224 was sequenced. This paper reports a broad genomic study of this strain, showing its correlation with the major epidemic lineage. The potentially mobile genomic regions are shown to possess GC content deviation, and harbor the main V. cholera virulence genes. A novel bioinformatic approach was applied in order to identify the putative functions of hypothetical proteins, and was compared with the automatic annotation by RAST. The genome of a large bacteriophage was found to be integrated to the IEC224's alanine aminopeptidase gene. The presence of this phage is shown to be a common characteristic of the El Tor strains from the Latin American epidemic, as well as its putative ancestor from Angola. The defective sucrose fermenting phenotype is shown to be due to a single nucleotide insertion in the V. cholerae sucrose-specific transportation gene. This frame-shift mutation truncated a membrane protein, altering its structural pore-like conformation. Further, the identification of a common bacteriophage reinforces both the monophyletic and African-Origin hypotheses for the main causative agent of the 1991 Latin America cholera epidemics.

  8. Survivability and molecular variation in Vibrio cholerae from epidemic sites in China.

    PubMed

    Li, X Q; Wang, M; Deng, Z A; Shen, J C; Zhang, X Q; Liu, Y F; Cai, Y S; Wu, X W; DI, B

    2015-01-01

    The survival behaviour of Vibrio cholerae in cholera epidemics, together with its attributes of virulence-associated genes and molecular fingerprints, are significant for managing cholera epidemics. Here, we selected five strains representative of V. cholerae O1 and O139 involved in cholera events, examined their survival capacity in large volumes of water sampled from epidemic sites of a 2005 cholera outbreak, and determined virulence-associated genes and molecular subtype changes of the surviving isolates recovered. The five strains exhibited different survival capacities varying from 17 to 38 days. The virulence-associated genes of the surviving isolates remained unchanged, while their pulsotypes underwent slight variation. In particular, one waterway-isolated strain maintained virulence-associated genes and evolved to share the same pulsotype as patient strains, highlighting its role in the cholera outbreak. The strong survival capacity and molecular attributes of V. cholerae might account for its persistence in environmental waters and the long duration of the cholera outbreak, allowing effective control measures.

  9. Optimal allocation of the limited oral cholera vaccine supply between endemic and epidemic settings

    PubMed Central

    Moore, Sean M.; Lessler, Justin

    2015-01-01

    The World Health Organization (WHO) recently established a global stockpile of oral cholera vaccine (OCV) to be preferentially used in epidemic response (reactive campaigns) with any vaccine remaining after 1 year allocated to endemic settings. Hence, the number of cholera cases or deaths prevented in an endemic setting represents the minimum utility of these doses, and the optimal risk-averse response to any reactive vaccination request (i.e. the minimax strategy) is one that allocates the remaining doses between the requested epidemic response and endemic use in order to ensure that at least this minimum utility is achieved. Using mathematical models, we find that the best minimax strategy is to allocate the majority of doses to reactive campaigns, unless the request came late in the targeted epidemic. As vaccine supplies dwindle, the case for reactive use of the remaining doses grows stronger. Our analysis provides a lower bound for the amount of OCV to keep in reserve when responding to any request. These results provide a strategic context for the fulfilment of requests to the stockpile, and define allocation strategies that minimize the number of OCV doses that are allocated to suboptimal situations. PMID:26423441

  10. Optimal allocation of the limited oral cholera vaccine supply between endemic and epidemic settings.

    PubMed

    Moore, Sean M; Lessler, Justin

    2015-10-06

    The World Health Organization (WHO) recently established a global stockpile of oral cholera vaccine (OCV) to be preferentially used in epidemic response (reactive campaigns) with any vaccine remaining after 1 year allocated to endemic settings. Hence, the number of cholera cases or deaths prevented in an endemic setting represents the minimum utility of these doses, and the optimal risk-averse response to any reactive vaccination request (i.e. the minimax strategy) is one that allocates the remaining doses between the requested epidemic response and endemic use in order to ensure that at least this minimum utility is achieved. Using mathematical models, we find that the best minimax strategy is to allocate the majority of doses to reactive campaigns, unless the request came late in the targeted epidemic. As vaccine supplies dwindle, the case for reactive use of the remaining doses grows stronger. Our analysis provides a lower bound for the amount of OCV to keep in reserve when responding to any request. These results provide a strategic context for the fulfilment of requests to the stockpile, and define allocation strategies that minimize the number of OCV doses that are allocated to suboptimal situations.

  11. Hurricanes, climate change and the cholera epidemic in Puerto Rico of 1855-1856.

    PubMed

    Christenson, Bernard

    2008-01-01

    Hurricanes and global climate changes may affect the environmental factors of cholera dynamics in warm coastal areas, vulnerable to seasonal or sporadic outbreaks. The cholera epidemic of Puerto Rico in 1855-1856 had a profound effect on the Puerto Rican society; but it was not influenced by any climatic events, such as preceding hurricanes or storms based on past documentary sources. Particularly, the environmental non-toxigenic strains of Vibrio Cholerae in Puerto Rican water sources can maintain their pathogenic potential for sporadic or erratic toxigenic cholera outbreaks--if a "perfect storm" ever occurs.

  12. Worldwide Occurrence of Integrative Conjugative Element Encoding Multidrug Resistance Determinants in Epidemic Vibrio cholerae O1

    PubMed Central

    Marin, Michel A.; Fonseca, Erica L.; Andrade, Bruno N.; Cabral, Adriana C.; Vicente, Ana Carolina P.

    2014-01-01

    In the last decades, there has been an increase of cholera epidemics caused by multidrug resistant strains. Particularly, the integrative and conjugative element (ICE) seems to play a major role in the emergence of multidrug resistant Vibrio cholerae. This study fully characterized, by whole genome sequencing, new ICEs carried by multidrug resistant V. cholerae O1 strains from Nigeria (2010) (ICEVchNig1) and Nepal (1994) (ICEVchNep1). The gene content and gene order of these two ICEs are the same, and identical to ICEVchInd5, ICEVchBan5 and ICEVchHai1 previously identified in multidrug resistant V. cholerae O1. This ICE is characterized by dfrA1, sul2, strAB and floR antimicrobial resistance genes, and by unique gene content in HS4 and HS5 ICE regions. Screening for ICEs, in publicly available V. cholerae genomes, revealed the occurrence and widespread distribution of this ICE among V. cholerae O1. Metagenomic analysis found segments of this ICE in marine environments far from the direct influence of the cholera epidemic. Therefore, this study revealed the epidemiology of a spatio-temporal prevalent ICE in V. cholerae O1. Its occurrence and dispersion in V. cholerae O1 strains from different continents throughout more than two decades can be indicative of its role in the fitness of the current pandemic lineage. PMID:25265418

  13. [DETERMINATION OF TYPES OF EPIDEMIC MANIFESTATIONS OF CHOLERA IN REGIONS OF THE CRIMEA FEDERAL DISTRICT (REPUBLIC OF CRIMEA)].

    PubMed

    Onischenko, G G; Popova, A Yu; Moskvitina, E A; Penkovskaya, N A; Listopad, S A; Titova, S V; Kruglikov, V D

    2015-01-01

    The aim of the study was determination of the type of epidemic manifestations of cholera in the Republic of Crimea based on evaluation of epidemic manifestations of cholera risk of introduction and spread of the infection. It was concluded, that, based on the cholera outbreaks, that had taken place, contamination of surface water bodies (fresh and sea) and sewage by Vibrio cholerae O1 ctxA+ and Vibrio cholerae O1 ctXA- potential epidemic danger of introduction of the infection by various types of international transport, population migration, the presence of epidemiologic risk in realization of water pathway of transmission of cholera causative agent and several other social conditions, the Republic of Crimea remains in the group of territories of type I by epidemic manifestations of cholera.

  14. Analysis of cholera epidemics with bacterial growth and spatial movement.

    PubMed

    Wang, Xueying; Wang, Jin

    2015-01-01

    In this work, we propose novel epidemic models (named, susceptible-infected-recovered-susceptible-bacteria) for cholera dynamics by incorporating a general formulation of bacteria growth and spatial variation. In the first part, a generalized ordinary differential equation (ODE) model is presented and it is found that bacterial growth contributes to the increase in the basic reproduction number, [Formula: see text]. With the derived basic reproduction number, we analyse the local and global dynamics of the model. Particularly, we give a rigorous proof on the endemic global stability by employing the geometric approach. In the second part, we extend the ODE model to a partial differential equation (PDE) model with the inclusion of diffusion to capture the movement of human hosts and bacteria in a heterogeneous environment. The disease threshold of this PDE model is studied again by using the basic reproduction number. The results on the threshold dynamics of the ODE and PDE models are compared, and verified through numerical simulation. Additionally, our analysis shows that incorporating diffusive spatial spread does not produce a Turing instability when [Formula: see text] associated with the ODE model is less than the unity.

  15. Cholera epidemic associated with raw vegetables--Lusaka, Zambia, 2003-2004.

    PubMed

    2004-09-03

    Zambia experienced widespread cholera epidemics in 1991 (13,154 cases), 1992 (11,659), and 1999 (11,327). In response to the large outbreak in 1999, the Zambian Ministry of Health (ZMOH) urged use of in-home chlorination with the locally produced solution, Clorin, and the practice increased substantially Clorin had been introduced in Zambia in 1998 as part of the Safe Water System (SWS), a point-of-use water disinfection and safe-water storage strategy launched by the Society for Family Health, in partnership with ZMOH, the U.S. Agency for International Development, and CDC. Although no outbreaks were reported during 2000-2002, cholera remained endemic. Epidemic cholera returned to Zambia in November 2003, when cases of toxigenic Vibrio cholerae O1, serotype Ogawa, biotype El Tor were confirmed in the capital city, Lusaka. During November 28, 2003-January 4, 2004, an estimated 2,529 cholera cases and 128 cholera deaths (case-fatality rate [CFR] = 5.1%) occurred in Lusaka. In February 2004, the Lusaka District Health Management Team (LDHMT) invited CDC to assist in an investigation of the epidemic. This report summarizes the results of that investigation, which implicated foodborne transmission via raw vegetables and demonstrated a protective role for hand washing with soap. The results underscore the importance of hygiene, clean water, and sanitary food handling for cholera prevention.

  16. Research Spotlight: Model suggests path to ending the ongoing Haitian cholera epidemic

    NASA Astrophysics Data System (ADS)

    Schultz, Colin

    2011-05-01

    Since early November 2010 a deadly cholera epidemic has been spreading across the Caribbean nation of Haiti, killing thousands of people and infecting hundreds of thousands. While infection rates are being actively monitored, health organizations have been left without a clear understanding of exactly how the disease has spread across Haiti. Cholera can spread through exposure to contaminated water, and the disease travels over long distances if an infected individual moves around the country. Using representations of these two predominant dispersion mechanisms, along with information on the size of the susceptible population, the number of infected individuals, and the aquatic concentration of the cholera-causing bacteria for more than 500 communities, Bertuzzo et al. designed a model that was able to accurately reproduce the progression of the Haitian cholera epidemic. (Geophysical Research Letters, doi:10.1029/2011GL046823, 2011)

  17. Slave mortality during the cholera epidemic in Rio de Janeiro (1855-1856): a preliminary analysis.

    PubMed

    Kodama, Kaori; Pimenta, Tânia Salgado; Bastos, Francisco Inácio; Bellido, Jaime Gregorio

    2012-12-01

    The article offers a preliminary analysis of the sociodemographic profile of deaths recorded during the first cholera epidemic in Rio de Janeiro, based on data gathered from death records at Santa Casa de Misericórdia Hospital. After cholera appeared in the country in 1855, Brazilian medical reports indicated a social bias, with slaves and the free poor suffering high mortality. From a historical perspective, however, little research has been done on the epidemic and its dynamics. The recovery of original data on cholera and the analysis of cholera mortality rates help us to better understand aspects of the slave universe in the urban zone of Rio de Janeiro in the period following the end of the slave trade.

  18. CHOLERA FORCING” The Myth of the Good Epidemic and the Coming of Good Water

    PubMed Central

    2009-01-01

    It has been frequently claimed that cholera epidemics, both in the 19th century and today, were and can be the key stimulus for procurement of safe water and sanitation, an idea that I call “cholera forcing.” “Technology forcing” refers to imposition of exogenous factors that suddenly make possible achievements that had not seemed so; cholera has been seen in this light. I argue that this view oversimplifies and underrepresents the importance of industrialization in securing water supplies. Careful study of the financial, political, and administrative foundations of such changes will be more fruitful. PMID:19820212

  19. [Historical report: first isolation of Vibrio cholera serogroup O1 biovar El Tor serovar Inaba during the cholerae epidemic in Peru ‑ 1991].

    PubMed

    Bravo Cruz, Nora; Guillén, Alfredo

    2011-03-01

    20 years ago, a new diarrheal disease was introduced in Peru and the Enteropathogens Reference Laboratory of the Instituto Nacional de Salud had an outstanding role in the isolation and rapid and timely identification of Vibrio cholerae. Cholera had not been seen before, but during the last week of January 1991 an outbreak of acute diarrhea was detected, presenting intense dehydration and some deaths. The epidemic affected, in the beginning, many locations of the peruvian coast. Some working teams of the General Office of Epidemiology and of the Instituto Nacional de Salud obtained fecal samples from patients with acute diarrhea coming from the cities of Chancay, Chimbote, Piura and some hospitals in Lima. The collected samples were transported on Cary and Blair media and processed in the National Reference Laboratory of Enteropathogens (LANARE) of the Instituto Nacional de Salud. Vibrio cholerae serogroup 01 biovar El Tor serovar Inaba was isolated from all the samples, it was sensible to tetracyclines and other antibiotics. This research confirmed the first outbreak of cholera in Peru.

  20. OmpU as a biomarker for rapid discrimination between toxigenic and epidemic Vibrio cholerae O1/O139 and non-epidemic Vibrio cholerae in a modified MALDI-TOF MS assay

    PubMed Central

    2014-01-01

    Background Cholera is an acute diarrheal disease caused by Vibrio cholerae. Outbreaks are caused by a genetically homogenous group of strains from serogroup O1 or O139 that are able to produce the cholera toxin. Rapid detection and identification of these epidemic strains is essential for an effective response to cholera outbreaks. Results The use of ferulic acid as a matrix in a new MALDI-TOF MS assay increased the measurable mass range of existing MALDI-TOF MS protocols for bacterial identification. The assay enabled rapid discrimination between epidemic V. cholerae O1/O139 strains and other less pathogenic V. cholerae strains. OmpU, an outer membrane protein whose amino acid sequence is highly conserved among epidemic strains of V. cholerae, appeared as a discriminatory marker in the novel MALDI-TOF MS assay. Conclusions The extended mass range of MALDI-TOF MS measurements obtained by using ferulic acid improved the screening for biomarkers in complex protein mixtures. Differences in the mass of abundant homologous proteins due to variation in amino acid sequences can rapidly be examined in multiple samples. Here, a rapid MALDI-TOF MS assay was developed that could discriminate between epidemic O1/O139 strains and other less pathogenic V. cholerae strains based on differences in mass of the OmpU protein. It appeared that the amino acid sequence of OmpU from epidemic V. cholerae O1/O139 strains is unique and highly conserved. PMID:24943244

  1. A rivalry of foulness: official and unofficial investigations of the London cholera epidemic of 1854.

    PubMed Central

    Paneth, N; Vinten-Johansen, P; Brody, H; Rip, M

    1998-01-01

    Contemporaneous with John Snow's famous study of the 1854 London cholera epidemic were 2 other investigations: a local study of the Broad Street outbreak and an investigation of the entire epidemic, undertaken by England's General Board of Health. More than a quarter-century prior to Koch's description of Vibrio comma, a Board of Health investigator saw microscopic "vibriones" in the rice-water stools of cholera patients that, in his later life, he concluded had been cholera bacilli. Although this finding was potential evidence for Snow's view that cholera was due to a contagious and probably live agent transmitted in the water supply, the Board of Health rejected Snow's conclusions. The Board of Health amassed a huge amount of information which it interpreted as supportive of its conclusion that the epidemic was attributable not so much to water as to air. Snow, by contrast, systematically tested his hypothesis that cholera was water-borne by exploring evidence that at first glance ran contrary to his expectations. Snow's success provides support for using a hypothetico-deductive approach in epidemiology, based on tightly focused hypotheses strongly grounded in pathophysiology. Images FIGURE 1 FIGURE 2 FIGURE 3 FIGURE 4 FIGURE 5 PMID:9772861

  2. Modelling cholera epidemics: the role of waterways, human mobility and sanitation.

    PubMed

    Mari, L; Bertuzzo, E; Righetto, L; Casagrandi, R; Gatto, M; Rodriguez-Iturbe, I; Rinaldo, A

    2012-02-07

    We investigate the role of human mobility as a driver for long-range spreading of cholera infections, which primarily propagate through hydrologically controlled ecological corridors. Our aim is to build a spatially explicit model of a disease epidemic, which is relevant to both social and scientific issues. We present a two-layer network model that accounts for the interplay between epidemiological dynamics, hydrological transport and long-distance dissemination of the pathogen Vibrio cholerae owing to host movement, described here by means of a gravity-model approach. We test our model against epidemiological data recorded during the extensive cholera outbreak occurred in the KwaZulu-Natal province of South Africa during 2000-2001. We show that long-range human movement is fundamental in quantifying otherwise unexplained inter-catchment transport of V. cholerae, thus playing a key role in the formation of regional patterns of cholera epidemics. We also show quantitatively how heterogeneously distributed drinking water supplies and sanitation conditions may affect large-scale cholera transmission, and analyse the effects of different sanitation policies.

  3. Vaccination strategies for epidemic cholera in Haiti with implications for the developing world.

    PubMed

    Chao, Dennis L; Halloran, M Elizabeth; Longini, Ira M

    2011-04-26

    In October 2010, a virulent South Asian strain of El Tor cholera began to spread in Haiti. Interventions have included treatment of cases and improved sanitation. Use of cholera vaccines would likely have further reduced morbidity and mortality, but such vaccines are in short supply and little is known about effective vaccination strategies for epidemic cholera. We use a mathematical cholera transmission model to assess different vaccination strategies. With limited vaccine quantities, concentrating vaccine in high-risk areas is always most efficient. We show that targeting one million doses of vaccine to areas with high exposure to Vibrio cholerae, enough for two doses for 5% of the population, would reduce the number of cases by 11%. The same strategy with enough vaccine for 30% of the population with modest hygienic improvement could reduce cases by 55% and save 3,320 lives. For epidemic cholera, we recommend a large mobile stockpile of enough vaccine to cover 30% of a country's population to be reactively targeted to populations at high risk of exposure.

  4. Climate, Water, and Human Health: Large Scale Hydroclimatic Controls in Forecasting Cholera Epidemics

    NASA Astrophysics Data System (ADS)

    Akanda, A. S.; Jutla, A. S.; Islam, S.

    2009-12-01

    Despite ravaging the continents through seven global pandemics in past centuries, the seasonal and interannual variability of cholera outbreaks remain a mystery. Previous studies have focused on the role of various environmental and climatic factors, but provided little or no predictive capability. Recent findings suggest a more prominent role of large scale hydroclimatic extremes - droughts and floods - and attempt to explain the seasonality and the unique dual cholera peaks in the Bengal Delta region of South Asia. We investigate the seasonal and interannual nature of cholera epidemiology in three geographically distinct locations within the region to identify the larger scale hydroclimatic controls that can set the ecological and environmental ‘stage’ for outbreaks and have significant memory on a seasonal scale. Here we show that two distinctly different, pre and post monsoon, cholera transmission mechanisms related to large scale climatic controls prevail in the region. An implication of our findings is that extreme climatic events such as prolonged droughts, record floods, and major cyclones may cause major disruption in the ecosystem and trigger large epidemics. We postulate that a quantitative understanding of the large-scale hydroclimatic controls and dominant processes with significant system memory will form the basis for forecasting such epidemic outbreaks. A multivariate regression method using these predictor variables to develop probabilistic forecasts of cholera outbreaks will be explored. Forecasts from such a system with a seasonal lead-time are likely to have measurable impact on early cholera detection and prevention efforts in endemic regions.

  5. Epidemic cholera in Ecuador: multidrug-resistance and transmission by water and seafood

    PubMed Central

    Weber, J. T.; Mintz, E. D.; Cañizares, R.; Semiglia, A.; Gomez, I.; Sempértegui, R.; Dávila, A.; Greene, K. D.; Puhr, N. D.; Cameron, D. N.; Tenover, F. C.; Barrett, T. J.; Bean, N. H.; Ivey, C.; Tauxe, R. V.; Blake, P. A.

    1994-01-01

    To determine risk factors for cholera in an epidemic-disease area in South America, a case—control investigation was performed in Guayaquil, Ecuador, in July 1991. Residents > 5 years old who were hospitalized for treatment of acute, watery diarrhoea and two matched controls for each were interviewed regarding sources of water and food, and eating, drinking, and hygienic habits. Interviewers inspected homes of case-patients and controls to document water treatment, food-handling, and hygienic practices. Faecal specimens and shellfish were cultured for Vibrio cholerae O 1. Isolates were tested for susceptibility to a variety of antimicrobial agents. Drinking unboiled water (odds ratio [OR] = 4·0, confidence interval [CI] = 1·8—7·5), drinking a beverage from a street vendor (OR = 2·8, CI = 1·3—5·9), eating raw seafood (OR = 3·4, CI = 1·4—11·5), and eating cooked crab (OR = 5·1, CI = 1·4—19·2) were associated with illness. Always boiling drinking water at home (OR = 0·5, CI = 0·2—0·9) was protective against illness. The presence of soap in either the kitchen (OR = 0·3, CI = 0·2—0·8) or bathroom (OR = 0·4, CI = 0·2—0·9) at home was also protective. V. cholerae O 1 was recovered from a pooled sample of a bivalve mollusc and from 68% of stool samples from case-patients. Thirty-six percent of the isolates from stool specimens were resistant to multiple antimicrobial agents. Specific prevention measures may prevent transmission through these vehicles in the future. The appearance of antimicrobial resistance suggests the need for changes in current methods of prevention and treatment. PMID:8119348

  6. [Epidemic Cholera and American Reform Movements in the 19th Century].

    PubMed

    Kim, Seohyung

    2015-12-01

    The 19th century was the age of great reform in American history. After constructing of the canal and railroads, the industrialization began and American society changed so rapidly. In this period, there were so many social crisis and American people tried to solve these problems within the several reform movements. These reform movements were the driving forces to control cholera during the 19th century. Cholera was the endemic disease in Bengal, India, but after the 19th century it had spread globally by the development of trade networks. The 1832 cholera in the United States was the first epidemic cholera in American history. The mortality of cholera was so high, but it was very hard to find out the cause of this fatal infectious disease. So, different social discourses happened to control epidemic cholera in the 19th century, these can be understood within the similar context of American reform movements during this period. Board of Health in New York States made a new public health act to control cholera in 1832, it was ineffective. Some people insisted that the cause of this infectious disease was the corruption of the United States. They emphasized unjust and immoral system in American society. Moral reform expanded to Nativism, because lots of Irish immigrants were the victims of cholera. So, epidemic cholera was the opportunity to spread the desire for moral reform. To control cholera in 1849, the sanitary reform in Britain had affected. The fact that it was so important to improve and maintain the water quality for the control and prevention of disease spread, the sanitary reform happened. There were two different sphere of the sanitary reform. The former was the private reform to improve sewer or privy, the latter was the public reform to build sewage facilities. The 1849 cholera had an important meaning, because the social discourse, which had emphasized the sanitation of people or home expanded to the public sphere. When cholera broke out in 1866 again

  7. Molecular epidemiologic analysis of Vibrio cholerae O1 isolated during the 1997-8 cholera epidemic in southern Thailand.

    PubMed Central

    Kondo, S.; Kongmuang, U.; Kalnauwakul, S.; Matsumoto, C.; Chen, C. H.; Nishibuchi, M.

    2001-01-01

    An unusually high incidence of Vibrio cholerae O1 infection was observed in southern Thailand between late December 1997 and March 1998. Fifty-seven V. cholerae O1 strains were isolated in five provinces during this epidemic and were examined. They were El Tor Ogawa strains exhibiting similar antibiograms. All strains were resistant to tetracycline, which had not been reported in Thailand since 1993. The ribotypes. hybridization patterns with ctx and zot gene probes, arbitrarily primed PCR profiles, and pulsed-field gel electrophoresis profiles of the representative strains were compared with the clinical strains isolated from patients in India and Bangladesh in 1997 and 1998 and from international travellers originating from various Asian countries during the 1992-8 period. All southern Thailand strains and the 1998 international traveller strain of Thai origin showed indistinguishable genetic fingerprinting patterns that were distinct from those of other test strains. The results suggest that a tetracycline-resistant clone newly emerged in late December 1997 caused the large epidemic in southern Thailand and that the variants with a slightly different antibiogram appeared during the course of the spreading epidemic. PMID:11561977

  8. Geographical structures and the cholera epidemic in modern Japan: Fukushima prefecture in 1882 and 1895

    PubMed Central

    Kuo, Chun-Lin; Fukui, Hiromichi

    2007-01-01

    Background Disease diffusion patterns can provide clues for understanding geographical change. Fukushima, a rural prefecture in northeast Japan, was chosen for a case study of the late nineteenth century cholera epidemic that occurred in that country. Two volumes of Cholera Ryu-ko Kiji (Cholera Epidemic Report), published by the prefectural government in 1882 and 1895, provide valuable records for analyzing and modelling diffusion. Text descriptions and numerical evidence culled from the reports were incorporated into a temporal-spatial study framework using geographic information system (GIS) and geo-statistical techniques. Results Changes in diffusion patterns between 1882 and 1895 reflect improvements in the Fukushima transportation system and growth in social-economic networks. The data reveal different diffusion systems in separate regions in which residents of Fukushima and neighboring prefectures interacted. Our model also shows that an area in the prefecture's northern interior was dominated by a mix of diffusion processes (contagious and hierarchical), that the southern coastal region was affected by a contagious process, and that other infected areas experienced relocation diffusion. Conclusion In addition to enhancing our understanding of epidemics, the spatial-temporal patterns of cholera diffusion offer opportunities for studying regional change in modern Japan. By highlighting the dynamics of regional reorganization, our findings can be used to better understand the formation of an urban hierarchy in late nineteenth century Japan. PMID:17603906

  9. [Five years of cholera surveillance in Ivory Coast during social and political crisis, 2001 to 2005].

    PubMed

    Ekra, K D; Attoh-Touré, H; Bénié, B V J; Coulibaly, D; Koutouan, M G; Aka, L N; Dagnan, S N; Coulibaly, A; Douba, A; Tiembré, I; Odéhouri-Koudou, P; Tagliante-Saracino, J

    2009-05-01

    For an efficient struggle against infectious diseases with epidemic potential, the Cdte d'Ivoire set up a precocious alert system in 2001 with a main objective: to detect epidemics of cholera, measles, yellow fever and meningitis and to provide necessary information for their control and their prevention. During the 2001 to 2005 period, the country was marked by military and political crisis which occurred in 2002; the country had to face up to a reappearance of cholera. How did it evolve in such a context? The question was to describe the performances of the system and the evolution of cholera from weekly data collected by the centers of epidemiological monitoring in health districts. The cases and declared deaths were compiled and the indicators of morbidity and mortality were then studied according to time site and individual features on the period of 2001 to 2005. From 2001 to 2005, 11,874 cases were notified with 564 deaths and a lethal rate of 4.7%. In 2001, from the initial source of infection, the civil jail, the epidemic of cholera disseminated itself through visitors in the whole city of Abidjan where 3250 cases were notified. Out of city, 20 outbreaks have been declared with a total of 3010 cases. The yearly highest impact, 37 living cases/100,000 inhabitants recorded in 2001, decreased regularly until 2005 with 0.2 living cases/100,000. After 2002, outbreaks were located mainly in the half south of the country which welcomed displaced populations from the north, preferably in transition or settling zones near the front line. The lethal rate in Abidjan (2.3%) was less important than that of other health districts (8.6%). The lethal rate globally increased as the impact decreased. Vibrio cholerae was responsible for the epidemics. The group of 15 years old and over was the most affected (12.69 living cases/100,000) whereas the highest lethal rate appeared in the group under 5 years old (6.6%). The reappearance and constant cholera epidemics in Côte d

  10. The 2008 cholera epidemic in Zimbabwe: experience of the icddr,b team in the field.

    PubMed

    Ahmed, Sirajuddin; Bardhan, Pradip Kumar; Iqbal, Anwarul; Mazumder, Ramendra Nath; Khan, Azharul Islam; Islam, M Sirajul; Siddique, Abul Kasem; Cravioto, Alejandro

    2011-10-01

    During August 2008-June 2009, an estimated 95,531 suspected cases of cholera and 4,282 deaths due to cholera were reported during the 2008 cholera outbreak in Zimbabwe. Despite the efforts by local and international organizations supported by the Zimbabwean Ministry of Health and Child Welfare in the establishment of cholera treatment centres throughout the country, the case-fatality rate (CFR) was much higher than expected. Over two-thirds of the deaths occurred in areas without access to treatment facilities, with the highest CFRs (>5%) reported from Masvingo, Manicaland, Mashonaland West, Mashonaland East, Midland, and Matabeleland North provinces. Some factors attributing to this high CFR included inappropriate cholera case management with inadequate use of oral rehydration therapy, inappropriate use of antibiotics, and a shortage of experienced healthcare professionals. The breakdown of both potable water and sanitation systems and the widespread contamination of available drinking-water sources were also considered responsible for the rapid and widespread distribution of the epidemic throughout the country. Training of healthcare professionals on appropriate cholera case management and implementation of recommended strategies to reduce the environmental contamination of drinking-water sources could have contributed to the progressive reduction in number of cases and deaths as observed at the end of February 2009.

  11. A spatially explicit model for the future progression of the current Haiti cholera epidemic

    NASA Astrophysics Data System (ADS)

    Bertuzzo, E.; Mari, L.; Righetto, L.; Gatto, M.; Casagrandi, R.; Rodriguez-Iturbe, I.; Rinaldo, A.

    2011-12-01

    As a major cholera epidemic progresses in Haiti, and the figures of the infection, up to July 2011, climb to 385,000 cases and 5,800 deaths, the development of general models to track and predict the evolution of the outbreak, so as to guide the allocation of medical supplies and staff, is gaining notable urgency. We propose here a spatially explicit epidemic model that accounts for the dynamics of susceptible and infected individuals as well as the redistribution of textit{Vibrio cholera}, the causative agent of the disease, among different human communities. In particular, we model two spreading pathways: the advection of pathogens through hydrologic connections and the dissemination due to human mobility described by means of a gravity-like model. To this end the country has been divided into hydrologic units based on drainage directions derived from a digital terrain model. Moreover the population of each unit has been estimated from census data downscaled to 1 km x 1 km resolution via remotely sensed geomorphological information (LandScan texttrademark project). The model directly account for the role of rainfall patterns in driving the seasonality of cholera outbreaks. The two main outbreaks in fact occurred during the rainy seasons (October and May) when extensive floodings severely worsened the sanitation conditions and, in turn, raised the risk of infection. The model capability to reproduce the spatiotemporal features of the epidemic up to date grants robustness to the foreseen future development. In this context, the duration of acquired immunity, a hotly debated topic in the scientific community, emerges as a controlling factor for progression of the epidemic in the near future. The framework presented here can straightforwardly be used to evaluate the effectiveness of alternative intervention strategies like mass vaccinations, clean water supply and educational campaigns, thus emerging as an essential component of the control of future cholera

  12. International dissemination of epidemic Vibrio cholerae by cargo ship ballast and other nonpotable waters.

    PubMed

    McCarthy, S A; Khambaty, F M

    1994-07-01

    In 1991 and 1992, toxigenic Vibrio cholerae O1, serotype Inaba, biotype El Tor, was recovered from nonpotable (ballast, bilge, and sewage) water from five cargo ships docked in ports of the U.S. Gulf of Mexico. Four of these ships had taken on ballast water in cholera-infected countries; the fifth took on ballast in a noninfected country. Isolates examined by pulsed-field gel electrophoresis were indistinguishable from the Latin American epidemic strain, C6707; however, they differed significantly from the endemic Gulf Coast strain (VRL 1984), the sixth-pandemic strain (569-B), and a V. cholerae non-O1 strain isolated from a ship arriving from a foreign port. On the basis of our findings, the Food and Drug Administration recommended that the U.S. Coast Guard issue an advisory to shipping agents and captains requesting that ballast waters be exchanged on the high seas before entry of ships into U.S. ports.

  13. Deciphering the origins and tracking the evolution of cholera epidemics with whole-genome-based molecular epidemiology.

    PubMed

    Grad, Yonatan H; Waldor, Matthew K

    2013-09-10

    The devastating Haitian cholera outbreak that began in October 2010 is the first known cholera epidemic in this island nation. Epidemiological and genomic data have provided strong evidence that United Nations security forces from Nepal introduced toxigenic Vibrio cholerae O1, the cause of epidemic cholera, to Haiti shortly before the outbreak arose. However, some have contended that indigenous V. cholerae contributed to the outbreak. In a recent paper (mBio 4:e00398-13, 2013), L. S. Katz et al. explored the nature and rate of changes in this ancient pathogen's genome during an outbreak, based on whole-genome sequencing of 23 Haitian V. cholerae clinical isolates obtained over a 20-month period. Notably, they detected point mutations, deletions, and inversions but found no insertion of horizontally transmitted DNA, arguing strongly against the idea that autochthonous V. cholerae donated DNA to the outbreak strain. Furthermore, they found that Haitian epidemic V. cholerae isolates were virtually untransformable. Comparative genomic analyses revealed that the Haitian isolates were nearly identical to isolates from Nepal and that the Nepalese-Haitian isolates were distinguishable from isolates circulating elsewhere in the world. Reconstruction of the phylogeny of the Haitian isolates was consistent with a single introduction of V. cholerae to Haiti sometime between late July and late October 2010, dates remarkably concordant with epidemiological observations. In aggregate, this paper provides additional compelling evidence that the V. cholerae strain responsible for the Haitian cholera epidemic came from Nepal and illustrates the power of whole-genome-based analyses for epidemiology, pathogen evolution, and forensics.

  14. On the predictive ability of mechanistic models for the Haitian cholera epidemic

    PubMed Central

    Mari, Lorenzo; Bertuzzo, Enrico; Finger, Flavio; Casagrandi, Renato; Gatto, Marino; Rinaldo, Andrea

    2015-01-01

    Predictive models of epidemic cholera need to resolve at suitable aggregation levels spatial data pertaining to local communities, epidemiological records, hydrologic drivers, waterways, patterns of human mobility and proxies of exposure rates. We address the above issue in a formal model comparison framework and provide a quantitative assessment of the explanatory and predictive abilities of various model settings with different spatial aggregation levels and coupling mechanisms. Reference is made to records of the recent Haiti cholera epidemics. Our intensive computations and objective model comparisons show that spatially explicit models accounting for spatial connections have better explanatory power than spatially disconnected ones for short-to-intermediate calibration windows, while parsimonious, spatially disconnected models perform better with long training sets. On average, spatially connected models show better predictive ability than disconnected ones. We suggest limits and validity of the various approaches and discuss the pathway towards the development of case-specific predictive tools in the context of emergency management. PMID:25631563

  15. On the predictive ability of mechanistic models for the Haitian cholera epidemic.

    PubMed

    Mari, Lorenzo; Bertuzzo, Enrico; Finger, Flavio; Casagrandi, Renato; Gatto, Marino; Rinaldo, Andrea

    2015-03-06

    Predictive models of epidemic cholera need to resolve at suitable aggregation levels spatial data pertaining to local communities, epidemiological records, hydrologic drivers, waterways, patterns of human mobility and proxies of exposure rates. We address the above issue in a formal model comparison framework and provide a quantitative assessment of the explanatory and predictive abilities of various model settings with different spatial aggregation levels and coupling mechanisms. Reference is made to records of the recent Haiti cholera epidemics. Our intensive computations and objective model comparisons show that spatially explicit models accounting for spatial connections have better explanatory power than spatially disconnected ones for short-to-intermediate calibration windows, while parsimonious, spatially disconnected models perform better with long training sets. On average, spatially connected models show better predictive ability than disconnected ones. We suggest limits and validity of the various approaches and discuss the pathway towards the development of case-specific predictive tools in the context of emergency management.

  16. Phenotypic Analysis Reveals that the 2010 Haiti Cholera Epidemic Is Linked to a Hypervirulent Strain

    PubMed Central

    Jones, Christopher J.; Wong, Jennifer; Queen, Jessica; Agarwal, Shivani; Yildiz, Fitnat H.

    2016-01-01

    Vibrio cholerae O1 El Tor strains have been responsible for pandemic cholera since 1961. These strains have evolved over time, spreading globally in three separate waves. Wave 3 is caused by altered El Tor (AET) variant strains, which include the strain with the signature ctxB7 allele that was introduced in 2010 into Haiti, where it caused a devastating epidemic. In this study, we used phenotypic analysis to compare an early isolate from the Haiti epidemic to wave 1 El Tor isolates commonly used for research. It is demonstrated that the Haiti isolate has increased production of cholera toxin (CT) and hemolysin, increased motility, and a reduced ability to form biofilms. This strain also outcompetes common wave 1 El Tor isolates for colonization of infant mice, indicating that it has increased virulence. Monitoring of CT production and motility in additional wave 3 isolates revealed that this phenotypic variation likely evolved over time rather than in a single genetic event. Analysis of available whole-genome sequences and phylogenetic analyses suggested that increased virulence arose from positive selection for mutations found in known and putative regulatory genes, including hns and vieA, diguanylate cyclase genes, and genes belonging to the lysR and gntR regulatory families. Overall, the studies presented here revealed that V. cholerae virulence potential can evolve and that the currently prevalent wave 3 AET strains are both phenotypically distinct from and more virulent than many El Tor isolates. PMID:27297393

  17. Phenotypic Analysis Reveals that the 2010 Haiti Cholera Epidemic Is Linked to a Hypervirulent Strain.

    PubMed

    Satchell, Karla J F; Jones, Christopher J; Wong, Jennifer; Queen, Jessica; Agarwal, Shivani; Yildiz, Fitnat H

    2016-09-01

    Vibrio cholerae O1 El Tor strains have been responsible for pandemic cholera since 1961. These strains have evolved over time, spreading globally in three separate waves. Wave 3 is caused by altered El Tor (AET) variant strains, which include the strain with the signature ctxB7 allele that was introduced in 2010 into Haiti, where it caused a devastating epidemic. In this study, we used phenotypic analysis to compare an early isolate from the Haiti epidemic to wave 1 El Tor isolates commonly used for research. It is demonstrated that the Haiti isolate has increased production of cholera toxin (CT) and hemolysin, increased motility, and a reduced ability to form biofilms. This strain also outcompetes common wave 1 El Tor isolates for colonization of infant mice, indicating that it has increased virulence. Monitoring of CT production and motility in additional wave 3 isolates revealed that this phenotypic variation likely evolved over time rather than in a single genetic event. Analysis of available whole-genome sequences and phylogenetic analyses suggested that increased virulence arose from positive selection for mutations found in known and putative regulatory genes, including hns and vieA, diguanylate cyclase genes, and genes belonging to the lysR and gntR regulatory families. Overall, the studies presented here revealed that V. cholerae virulence potential can evolve and that the currently prevalent wave 3 AET strains are both phenotypically distinct from and more virulent than many El Tor isolates.

  18. Unique Clones of Vibrio cholerae O1 El Tor with Haitian Type ctxB Allele Implicated in the Recent Cholera Epidemics from Nigeria, Africa

    PubMed Central

    Pazhani, Gururaja Perumal; Abiodun, Iwalokun Bamidele; Afolabi, Oluwadun; Kolawole, Olukoya Daniel; Mukhopadhyay, Asish K.; Ramamurthy, Thanadarayan

    2016-01-01

    Background and Objectives The antimicrobial susceptibility patterns and genetic characteristics of Vibrio cholerae O1, which is responsible for several cholera epidemics in Nigeria, are not reported in detail since 2007. In this study, we screened V. cholerae O1 El Tor biotype isolates from cholera cases and water samples from different states to investigate their phenotypic and genetic attributes with special reference to their clonality. Results All the V. cholerae O1 biotype El Tor isolates isolated during 2007–2013 were susceptible to fluoroquinolones and tetracycline, the drugs currently used in the treatment of cholera cases in Nigeria. Emergence of CT genotype 7 (Haitian type of ctxB allele) was predominantly seen among Ogawa serotype and the CT genotype 1 (classical ctxB allele) was mostly found in Inaba serotype. Overall, V. cholerae O1 from clinical and water samples were found to be closely related as determined by the pulsed-field gel electrophoresis. V. cholerae isolates from Abia, Kano and Bauchi were found to be genetically distinct from the other states of Nigeria. Conclusion Fecal contamination of the water sources may be the possible source of the cholera infection. Combined prevalence of Haitian and classical ctxB alleles were detected in Ogawa and Inaba serotypes, respectively. This study further demonstrated that V. cholerae O1 with the ctxB has been emerged similar to the isolates reported in Haiti. Our findings suggest that the use of fluoroquinolones or tetracycline/doxycycline may help in the effective management of acute cholera in the affected Nigerian states. In addition, strengthening the existing surveillance in the hospitals of all the states and supply of clean drinking water may control cholera outbreaks in the future. PMID:27479360

  19. [Preventive measures taken in Adrianople during the 1893-1894 cholera epidemic, as reflected in a local newspaper].

    PubMed

    Gökçe, N

    2001-01-01

    Cholera is derived from the Latin words colos (large intestine) and reo (to flow) and means flowing of the liquids through the stomach and the intestines. The first cholera epidemic was experienced in India and spread out to other countries. Although it had been known for ages, it was not recognized until the 16th century. Seven serious cholera epidemics have broken out in the world since the 19th century. In spite of all precautions taken by the Ottoman government, the sixth world cholera epidemic that started in Asia in 1891 and caused the loss of 40 thousand people, reached Istanbul in 1893. Later, it spread to Iznik, Salonika and Anatolia. Just as it appeared in Europe, precautions started to be taken in Adrianople. At first, special care was taken for city hygiene and a commission was formed to inspect the cleanliness of the city. Many brochures and articles were published on the protection against the illness, in order to inform the citizens of the cholera epidemic. Preachers spoke of cholera in their sermons. To protect Adrianople against the epidemic, entrance into and exit out of the city were patrolled and passengers coming from Europe or Istanbul to Adrianople were kept waiting for three days at the quarantines built in Cisri Mustafa Pasha and Catalca.

  20. [The cholera epidemics and the development of public health in Meiji Japan. 1. Modernity, cholera, and health thought].

    PubMed

    Chemouilli, Philippe

    2004-01-01

    We present here the beginnings of public health politics in Meiji Japan (1868-1912). Due to a two century isolation of Japan, public health concepts developed in the West from the end of the 18th century were foreign in premodern Japan. Due to its isolation, Japan was also relatively preserved from some acute infectious diseases such as cholera. In this paper, we investigate the role of cholera epidemics in the emergence of public health concepts in the peculiar context of Meiji Japan. We show that chronic diseases such as tuberculosis and leprosy were neglected for a long time and that the Meiji government set priority on acute infectious diseases that were considered as long as they disturbed public order. Nevertheless, some physicians and government officials considered issues of welfare and poverty. We also review some emerging concepts of social medicine. We try to show, that in Japan as well as in Western nations, public health politics were not exempt of contradictions and paradoxes and a permanent tension existed between coercitive policies and conceptions of welfare and rights to health.

  1. Bessel and the cholera epidemic in Königsberg in 1831 (German Title: Bessel und die Cholera-Epidemie 1831 in Königsberg )

    NASA Astrophysics Data System (ADS)

    Fürst, Dietmar

    When, in 1831, cholera broke out in large parts of Germany, it also claimed numerous victims in Königsberg. Bessel, although not infected, was drawn together with his observatory into the events by actions that served to control the epidemic. The report of events allows a glimpse into Bessel's life in Königsberg and into his personality.

  2. Traveling wave solutions for epidemic cholera model with disease-related death.

    PubMed

    Zhang, Tianran; Gou, Qingming

    2014-01-01

    Based on Codeço's cholera model (2001), an epidemic cholera model that incorporates the pathogen diffusion and disease-related death is proposed. The formula for minimal wave speed c (∗) is given. To prove the existence of traveling wave solutions, an invariant cone is constructed by upper and lower solutions and Schauder's fixed point theorem is applied. The nonexistence of traveling wave solutions is proved by two-sided Laplace transform. However, to apply two-sided Laplace transform, the prior estimate of exponential decrease of traveling wave solutions is needed. For this aim, a new method is proposed, which can be applied to reaction-diffusion systems consisting of more than three equations.

  3. Evidence of a dominant lineage of Vibrio cholerae-specific lytic bacteriophages shed by cholera patients over a 10-year period in Dhaka, Bangladesh.

    PubMed

    Seed, Kimberley D; Bodi, Kip L; Kropinski, Andrew M; Ackermann, Hans-Wolfgang; Calderwood, Stephen B; Qadri, Firdausi; Camilli, Andrew

    2011-01-01

    Lytic bacteriophages are hypothesized to contribute to the seasonality and duration of cholera epidemics in Bangladesh. However, the bacteriophages contributing to this phenomenon have yet to be characterized at a molecular genetic level. In this study, we isolated and sequenced the genomes of 15 bacteriophages from stool samples from cholera patients spanning a 10-year surveillance period in Dhaka, Bangladesh. Our results indicate that a single novel bacteriophage type, designated ICP1 (for the International Centre for Diarrhoeal Disease Research, Bangladesh cholera phage 1) is present in all stool samples from cholera patients, while two other bacteriophage types, one novel (ICP2) and one T7-like (ICP3), are transient. ICP1 is a member of the Myoviridae family and has a 126-kilobase genome comprising 230 open reading frames. Comparative sequence analysis of ICP1 and related isolates from this time period indicates a high level of genetic conservation. The ubiquitous presence of ICP1 in cholera patients and the finding that the O1 antigen of lipopolysaccharide (LPS) serves as the ICP1 receptor suggest that ICP1 is extremely well adapted to predation of human-pathogenic V. cholerae O1.

  4. Modern Cholera in the Americas: An Opportunistic Societal Infection

    PubMed Central

    Lee, Patrick T.

    2013-01-01

    In the Americas, the only two cholera epidemics of the past century have occurred in the past 25 years. Lessons from the 1991 Peruvian cholera epidemic can help to focus and refine the response to the current Haitian epidemic. After three years of acute epidemic response, we have an opportunity to refocus on the chronic conditions that make societies vulnerable to cholera. More importantly, even as international attention wanes in the aftermath of the earthquake and acute epidemic, we are faced with a need for continued and coordinated investment in improving Haiti’s structural defenses against cholera, in particular access to improved water and sanitation. PMID:24028256

  5. Modern cholera in the Americas: an opportunistic societal infection.

    PubMed

    Cerda, Rodrigo; Lee, Patrick T

    2013-11-01

    In the Americas, the only two cholera epidemics of the past century have occurred in the past 25 years. Lessons from the 1991 Peruvian cholera epidemic can help to focus and refine the response to the current Haitian epidemic. After three years of acute epidemic response, we have an opportunity to refocus on the chronic conditions that make societies vulnerable to cholera. More importantly, even as international attention wanes in the aftermath of the earthquake and acute epidemic, we are faced with a need for continued and coordinated investment in improving Haiti's structural defenses against cholera, in particular access to improved water and sanitation.

  6. Diarrheal illness among US residents providing medical services in Haiti during the cholera epidemic, 2010 to 2011.

    PubMed

    Schilling, Katharine A; Cartwright, Emily J; Stamper, John; Locke, Michael; Esposito, Douglas H; Balaban, Victor; Mintz, Eric

    2014-01-01

    Although nosocomial transmission of cholera is rare, two US healthcare workers (HCW) became ill with cholera after providing medical services during the Haiti cholera epidemic. To assess the incidence of diarrheal illness and explore preventive health behaviors practiced by US residents who provided medical services in Haiti, we conducted a cross-sectional, anonymous, web-based survey. We e-mailed 896 participants from 50 US-based, health-focused non-governmental organizations (NGOs), of whom 381 (43%) completed the survey. Fifty-six percent of respondents (n = 215) reported providing some care for patients with cholera. Diarrhea was reported by 31 (8%) respondents. One person was diagnosed with cholera by serologic testing. NGOs responding to international emergencies should ensure ample access to basic hygiene supplies and should promote their use to reduce the incidence of diarrheal illness among HCW working overseas.

  7. [The cholera epidemics in Córdoba as seen through the press: the supply of preservatives and cures during the 1867-1868 epidemic].

    PubMed

    Carbonetti, Adrián; Rodríguez, María Laura; Noelia, Rimonda; Martina, Yamila

    2007-01-01

    Disease is always represented a moment of crisis for individuals and societies. When death brought by disease hangs heavy over societies, they are lead to develop strategies to prevent and cure it. Epidemics, especially cholera epidemics, have had a strong impact on Argentine society, especially on Cordoba residents, because the first cholera outbreak was highly devastating in both demographic and social terms. In this article we analyze the supply of products that were advertised in the press during the first epidemic, which broke out in 1867-68. Our basic hypothesis is that the products available developed a widespread trade that was not the object of commercial transactions common to those social grouping during periods in which there were no epidemics. When they took place, those products were directed towards more affluent groups.

  8. The Portuguese Cholera morbus epidemic of 1853-56 as seen by the press.

    PubMed

    de Almeida, Maria Antónia Pires

    2012-03-20

    This is a study of how scientific knowledge reached common citizens in nineteenth-century Portugal, using newspapers as the main source. Despite the population's limited access to written material, each leading newspaper might be read by 30 000 people a day in Lisbon. This made newspapers the most widely available vehicle for the diffusion of the latest scientific information to the general public. With a cholera morbus epidemic affecting the second largest Portuguese town and all the northern regions, as well as the Algarve, reports on the course of the epidemic were considered essential. The author bases her study on a database of news about the disease in 1855 and 1856, especially with regard to prevention and treatment.

  9. On Spatially Explicit Models of Cholera Epidemics: Hydrologic controls, environmental drivers, human-mediated transmissions (Invited)

    NASA Astrophysics Data System (ADS)

    Rinaldo, A.; Bertuzzo, E.; Mari, L.; Righetto, L.; Gatto, M.; Casagrandi, R.; Rodriguez-Iturbe, I.

    2010-12-01

    A recently proposed model for cholera epidemics is examined. The model accounts for local communities of susceptibles and infectives in a spatially explicit arrangement of nodes linked by networks having different topologies. The vehicle of infection (Vibrio cholerae) is transported through the network links which are thought of as hydrological connections among susceptible communities. The mathematical tools used are borrowed from general schemes of reactive transport on river networks acting as the environmental matrix for the circulation and mixing of water-borne pathogens. The results of a large-scale application to the Kwa Zulu (Natal) epidemics of 2001-2002 will be discussed. Useful theoretical results derived in the spatially-explicit context will also be reviewed (like e.g. the exact derivation of the speed of propagation for traveling fronts of epidemics on regular lattices endowed with uniform population density). Network effects will be discussed. The analysis of the limit case of uniformly distributed population density proves instrumental in establishing the overall conditions for the relevance of spatially explicit models. To that extent, it is shown that the ratio between spreading and disease outbreak timescales proves the crucial parameter. The relevance of our results lies in the major differences potentially arising between the predictions of spatially explicit models and traditional compartmental models of the SIR-like type. Our results suggest that in many cases of real-life epidemiological interest timescales of disease dynamics may trigger outbreaks that significantly depart from the predictions of compartmental models. Finally, a view on further developments includes: hydrologically improved aquatic reservoir models for pathogens; human mobility patterns affecting disease propagation; double-peak emergence and seasonality in the spatially explicit epidemic context.

  10. International dissemination of epidemic Vibrio cholerae by cargo ship ballast and other nonpotable waters.

    PubMed Central

    McCarthy, S A; Khambaty, F M

    1994-01-01

    In 1991 and 1992, toxigenic Vibrio cholerae O1, serotype Inaba, biotype El Tor, was recovered from nonpotable (ballast, bilge, and sewage) water from five cargo ships docked in ports of the U.S. Gulf of Mexico. Four of these ships had taken on ballast water in cholera-infected countries; the fifth took on ballast in a noninfected country. Isolates examined by pulsed-field gel electrophoresis were indistinguishable from the Latin American epidemic strain, C6707; however, they differed significantly from the endemic Gulf Coast strain (VRL 1984), the sixth-pandemic strain (569-B), and a V. cholerae non-O1 strain isolated from a ship arriving from a foreign port. On the basis of our findings, the Food and Drug Administration recommended that the U.S. Coast Guard issue an advisory to shipping agents and captains requesting that ballast waters be exchanged on the high seas before entry of ships into U.S. ports. Images PMID:8074532

  11. Cholera

    MedlinePlus

    ... Cholera occurs in places with a lack of water treatment or sewage treatment, or crowding, war, and famine. Common locations for cholera include: Africa Some parts of Asia India Bangladesh Mexico South and Central America

  12. Haiti's progress in achieving its 10-year plan to eliminate cholera: hidden sickness cannot be cured.

    PubMed

    Koski-Karell, Victoria; Farmer, Paul E; Isaac, Benito; Campa, Elizabeth M; Viaud, Loune; Namphy, Paul C; Ternier, Ralph; Ivers, Louise C

    2016-01-01

    Since the beginning of the cholera epidemic in Haiti 5 years ago, the prevalence of this deadly water-borne disease has fallen far below the initial rates registered during its explosive outset. However, cholera continues to cause extensive suffering and needless deaths across the country, particularly among the poor. The urgent need to eliminate transmission of cholera persists: compared to the same period in 2014, the first 4 months of 2015 saw three times the number of cholera cases. Drawing upon epidemiology, clinical work (and clinical knowledge), policy, ecology, and political economy, and informed by ethnographic data collected in a rural area of Haiti called Bocozel, this paper evaluates the progress of the nation's 10-year Plan for the Elimination of Cholera. Bocozel is a rice-producing region where most people live in extreme poverty. The irrigation network is decrepit, the land is prone to environmental shocks, fertilizer is not affordable, and the government's capacity to assist farmers is undermined by resource constraints. When peasants do have rice to sell, the price of domestically grown rice is twice that of US-imported rice. Canal water is not only used to irrigate thousands of acres of rice paddies and sustain livestock, but also to bathe, wash, and play, while water from wells, hand pumps, and the river is used for drinking, cooking, and bathing. Only one out of the three government-sponsored water treatment stations in the research area is still functional and utilized by those who can afford it. Latrines are scarce and often shared by up to 30 people; open defecation remains common. Structural vulnerabilities cut across all sectors - not just water, sanitation, health care, and education, but agriculture, environment, (global and local) commerce, transportation, and governance as well. These are among the hidden sicknesses that impede Haiti and its partners' capacity to eliminate cholera.

  13. Evidence for a clonally different origin of the two cholera epidemics of 2001-2002 and 1980-1987 in South Africa.

    PubMed

    Keddy, Karen H; Nadan, Sandrama; Govind, Chetna; Sturm, A Willem

    2007-12-01

    Vibrio cholerae O1 serotype Ogawa and serotype Inaba isolates from the cholera epidemic that occurred in 2001 and 2002 in South Africa were compared with isolates of V. cholerae O1 serotype Inaba from the epidemic that occurred between 1980 and 1987. PFGE using NotI digestion was used to compare stored isolates received during the 1980s epidemic with those received during the epidemic in 2001/2002. A selected number of these isolates were then sequenced to compare the sequence of the wbeT gene in the V. cholerae O1 Ogawa strains of 2001/2002 with that in the V. cholerae O1 Inaba strains of the 1980s and 2001/2002. Isolates from the recent epidemic were shown to be related, irrespective of serotype, and had comparable banding patterns on PFGE, using NotI. They were distinctly different from those from the previous epidemic. Sequencing of the wbeT gene showed that the gene was highly conserved between the two epidemics. A single deletional mutation of an adenine residue was observed in the V. cholerae serotype Inaba isolates from the 2001/2002 epidemic, resulting in the serotype switch between the V. cholerae O1 strains from the recent epidemic. The distinct differences in PFGE patterns among isolates from the first and second epidemics exclude the possibility that the Inaba strain from the 1980s became dormant in the environment and mutated to serotype Ogawa, causing the 2001/2002 epidemic, despite the apparent consistency in the site of mutation in the Inaba serotypes between the two epidemics.

  14. Cholera.

    PubMed

    Parsi, V K.

    2001-05-01

    Cholera, an infectious disease caused by Vibrio cholerae, is primarily transmitted by ingestion of contaminated food or water. In severe cases, cholera may lead to severe dehydration, metabolic acidosis, and ultimately, hypovolemic shock and death. The diagnosis is confirmed by identification of V. cholerae in a stool specimen. Treatment should be started immediately by rapid replacement of fluid and electrolytes. Antibiotics such as tetracycline and doxycycline shorten the duration of illness but do not significantly affect overall mortality. Cholera can be prevented by limiting spread, survival, and growth of the organism. The current parenteral cholera vaccine is not recommended by the Public Health Service or the World Health Organization because of its limited protection. A number of oral vaccines are currently being tested in clinical trials.

  15. [Epidemics in the news in Portugal: cholera, plague, typhus, influenza and smallpox, 1854-1918].

    PubMed

    de Almeida, Maria Antónia Pires

    2014-01-01

    In severe health crisis like those of 1854-1856, 1899 and 1918, especially in Porto, where cholera morbus, the bubonic plague, typhus fever, pneumonic influenza and smallpox killed high percentages of the population, the images of the epidemics in the press enable us to identify the scientific knowledge in a country considered peripheral, but which had studies and personnel specialized at the most advanced levels for the time. A database of 6,700 news items and announcements reveals the medical and pharmaceutical knowledge of the second half of the nineteenth and early twentieth centuries, the way it was transmitted and disclosed to the public and the solutions offered by the health authorities. Hygiene was consistently highlighted in the news and announcements.

  16. [A giant field of death: medical and scientific controversies about the cholera morbus epidemic of 1855].

    PubMed

    Santos, Luciana Dos

    2016-01-01

    The article examines the cholera morbus epidemic that afflicted the province of Pernambuco, Brazil, in 1855, focusing on the medical and scientific controversies about how the disease spread, which split medical opinion into two camps: contagion and infection. Documents and reports produced by the Society of Medicine of Pernambuco and the General Public Health Board were analyzed, based on which it was possible to describe the official medical and sanitation program, involving engineers, scientists, and physicians, designed to plan a salubrious city - a model of civilization that combined redeveloping the urban space and disseminating new habits amongst the local people. It is essentially an exercise in observing a science and a society as they take shape.

  17. Historical Parallels, Ebola Virus Disease and Cholera: Understanding Community Distrust and Social Violence with Epidemics

    PubMed Central

    Cohn, Samuel; Kutalek, Ruth

    2016-01-01

    In the three West African countries most affected by the recent Ebola virus disease (EVD) outbreak, resistance to public health measures contributed to the startling speed and persistence of this epidemic in the region. But how do we explain this resistance, and how have people in these communities understood their actions? By comparing these recent events to historical precedents during Cholera outbreaks in Europe in the 19th century we show that these events have not been new to history or unique to Africa. Community resistance must be analysed in context and go beyond simple single-variable determinants. Knowledge and respect of the cultures and beliefs of the afflicted is essential for dealing with threatening disease outbreaks and their potential social violence. PMID:26865987

  18. Cholera.

    PubMed

    Lippi, Donatella; Gotuzzo, Eduardo; Caini, Saverio

    2016-08-01

    Cholera is an acute disease of the gastrointestinal tract caused by Vibrio cholerae. Cholera was localized in Asia until 1817, when a first pandemic spread from India to several other regions of the world. After this appearance, six additional major pandemics occurred during the 19th and 20th centuries, the latest of which originated in Indonesia in the 1960s and is still ongoing. In 1854, a cholera outbreak in Soho, London, was investigated by the English physician John Snow (1813 to 1858). He described the time course of the outbreak, managed to understand its routes of transmission, and suggested effective measures to stop its spread, giving rise to modern infectious disease epidemiology. The germ responsible for cholera was discovered twice: first by the Italian physician Filippo Pacini during an outbreak in Florence, Italy, in 1854, and then independently by Robert Koch in India in 1883, thus favoring the germ theory over the miasma theory of disease. Unlike many other infectious diseases, such as plague, smallpox, and poliomyelitis, cholera persists as a huge public health problem worldwide, even though there are effective methods for its prevention and treatment. The main reasons for its persistence are socioeconomic rather than purely biological; cholera flourishes where there are unsatisfactory hygienic conditions and where a breakdown of already fragile sanitation and health infrastructure occurs because of natural disasters or humanitarian crises.

  19. Update on progress in selected public health programs after the 2010 earthquake and cholera epidemic--Haiti, 2014.

    PubMed

    Domercant, J Wysler; Guillaume, Florence D; Marston, Barbara J; Lowrance, David W

    2015-02-20

    On January 12, 2010, an earthquake devastated Haiti's infrastructure, killing an estimated 230,000 persons and displacing more than 1.5 million. Ten months later, Haiti experienced the beginning of the largest cholera epidemic ever reported in a single country. Immediately after the earthquake and at the start of the cholera epidemic, health priorities in Haiti included improvement of surveillance and laboratory capacity for addressing public health threats in the general population and targeted surveillance and provision of improved water and sanitation in camps for internally displaced persons. As part of a multi-sector, post-earthquake response in collaboration with the Government of Haiti and others, CDC focused on supporting the recovery, expansion, or establishment of several key health programs. This update reports progress in selected health programs, services, and systems in Haiti as of the end of 2014.

  20. [Defense, attack, and street fighting. The role of medicine and military illustrated the example of the cholera epidemics in Prussia].

    PubMed

    Briese, O

    1997-01-01

    This article intends to illustrate the introduction of military rhetoric into medical discourse during the cholera epidemic of 1831/32 in Europe. Even before the era of bacteriology, illness and epidemics were considered to be the military enemies of mankind. Beginning with the rise of the military in early modern times, the language of medical discourses oriented itself on the influential military institutions. Sickness appeared as a warring aggressor. Since the time of the plague at the very latest, military connotations were commonplace in Europe, and this tendency became stronger during the conflicts of the 19th century. In this vein, during the inner crises of Germany at the end of this century, cholera was, at least in the descriptive rhetoric, understood as an inner, destructive, and anarchic enemy.

  1. Cholera

    MedlinePlus

    ... sometimes antibiotics. Anyone who thinks they may have cholera should seek medical attention immediately. Dehydration can be rapid so fluid replacement is essential. Centers for Disease Control and Prevention

  2. Cholera ante portas – The re-emergence of cholera in Kinshasa after a ten-year hiatus

    PubMed Central

    Bompangue, Didier; Vesenbeckh, Silvan Manuel; Giraudoux, Patrick; Castro, Marcia; Muyembe, Jean-Jacques; Kebela Ilunga, Benoît; Murray, Megan

    2012-01-01

    Background: Cholera is an endemic disease in certain well-defined areas in the east of the Democratic Republic of Congo (DRC). The west of the country, including the mega-city Kinshasa, has been free of cases since mid 2001 when the last outbreak ended. Methods and Findings: We used routinely collected passive surveillance data to construct epidemic curves of the cholera cases and map the spatio-temporal progress of the disease during the first 47 weeks of 2011. We compared the spatial distribution of disease spread to that which occurred in the last cholera epidemic in Kinshasa between 1996 and 2001. To better understand previous determinants of cholera spread in this region, we conducted a correlation analysis to assess the impact of rainfall on weekly health zone cholera case counts between December 1998 and March 2001 and a Generalized Linear Model (GLM) regression analysis to identify factors that have been associated with the most vulnerable health zones within Kinshasa between October 1998 and June 1999. In February 2011, cholera reemerged in a region surrounding Kisangani and gradually spread westwards following the course of the Congo River to Kinshasa, home to 10 million people. Ten sampled isolates were confirmed to be Vibrio cholerae O1, biotype El Tor, serotype Inaba, resistant to trimethoprim-sulfa, furazolidone, nalidixic acid, sulfisoxaole, and streptomycin, and intermediate resistant to Chloramphenicol. An analysis of a previous outbreak in Kinshasa shows that rainfall was correlated with case counts and that health zone population densities as well as fishing and trade activities were predictors of case counts. Conclusion: Cholera is particularly difficult to tackle in the DRC. Given the duration of the rainy season and increased riverine traffic from the eastern provinces in late 2011, we expect further increases in cholera in the coming months and especially within the mega-city Kinshasa. We urge all partners involved in the response to remain

  3. Climate and cholera in KwaZulu-Natal, South Africa: the role of environmental factors and implications for epidemic preparedness.

    PubMed

    Mendelsohn, Joshua; Dawson, Terry

    2008-03-01

    A cholera epidemic that took place in KwaZulu-Natal, South Africa (2000-2001) was employed to investigate the impact of climatic and environmental drivers on cholera dynamics. Precipitation (PRE), sea surface temperature (SST) and chlorophyll-a (CHL-a) data acquired from publicly available satellite and ground measurements were analysed together with disease incidence in an effort to assess the environmental contribution to the outbreak. SST (r(2)=0.749, lag=0 months) and PRE (r(2)=0.744, lag=2 months) showed strong associations with incidence. CHL-a showed a moderately strong (r(2)=0.656, lag=6 months) association with incidence while sea surface height (SSH) demonstrated a weak relationship with incidence (r(2)=0.326, lag=5 months). Our analysis tentatively supports a coastal transmission hypothesis, heavily influenced by localized PRE extremes. The role of SSH is likely attenuated by local coastal topography. Future work should clarify the mechanism linking coastal cholera reservoirs and the regional climate system to outbreaks in this region. Finally, we discuss benefits of further research in this area using extended remotely sensed and epidemiological datasets towards the development of early-warning systems and enhanced epidemic preparedness.

  4. Cholera epidemic associated with consumption of unsafe drinking water and street-vended water--Eastern Freetown, Sierra Leone, 2012.

    PubMed

    Nguyen, Von D; Sreenivasan, Nandini; Lam, Eugene; Ayers, Tracy; Kargbo, David; Dafae, Foday; Jambai, Amara; Alemu, Wondimagegnehu; Kamara, Abdul; Islam, M Sirajul; Stroika, Steven; Bopp, Cheryl; Quick, Robert; Mintz, Eric D; Brunkard, Joan M

    2014-03-01

    During 2012, Sierra Leone experienced a cholera epidemic with 22,815 reported cases and 296 deaths. We conducted a matched case-control study to assess risk factors, enrolling 49 cases and 98 controls. Stool specimens were analyzed by culture, polymerase chain reaction (PCR), and pulsed-field gel electrophoresis (PFGE). Conditional logistic regression found that consuming unsafe water (matched odds ratio [mOR]: 3.4; 95% confidence interval [CI]: 1.1, 11.0), street-vended water (mOR: 9.4; 95% CI: 2.0, 43.7), and crab (mOR: 3.3; 95% CI: 1.03, 10.6) were significant risk factors for cholera infection. Of 30 stool specimens, 13 (43%) showed PCR evidence of toxigenic Vibrio cholerae O1. Six specimens yielded isolates of V. cholerae O1, El Tor; PFGE identified a pattern previously observed in seven countries. We recommended ensuring the quality of improved water sources, promoting household chlorination, and educating street vendors on water handling practices.

  5. Implementation of an alert and response system in Haiti during the early stage of the response to the cholera epidemic.

    PubMed

    Santa-Olalla, Patricia; Gayer, Michelle; Magloire, Roc; Barrais, Robert; Valenciano, Marta; Aramburu, Carmen; Poncelet, Jean Luc; Gustavo Alonso, Juan Carlos; Van Alphen, Dana; Heuschen, Florence; Andraghetti, Roberta; Lee, Robert; Drury, Patrick; Aldighieri, Sylvain

    2013-10-01

    The start of the cholera epidemic in Haiti quickly highlighted the necessity of the implementation of an Alert and Response (A&R) System to complement the existing national surveillance system. The national system had been able to detect and confirm the outbreak etiology but required external support to monitor the spread of cholera and coordinate response, because much of the information produced was insufficiently timely for real-time monitoring and directing of a rapid, targeted response. The A&R System was designed by the Pan American Health Organization/World Health Organization in collaboration with the Haiti Ministry of Health, and it was based on a network of partners, including any institution, structure, or individual that could identify, verify, and respond to alerts. The defined objectives were to (1) save lives through early detection and treatment of cases and (2) control the spread through early intervention at the community level. The operational structure could be broken down into three principle categories: (1) alert (early warning), (2) verification and assessment of the information, and (3) efficient and timely response in coordination with partners to avoid duplication. Information generated by the A&R System was analyzed and interpreted, and the qualitative information was critical in qualifying the epidemic and defining vulnerable areas, particularly because the national surveillance system reported incomplete data for more than one department. The A&R System detected a number of alerts unrelated to cholera and facilitated rapid access to that information. The sensitivity of the system and its ability to react quickly was shown in May of 2011, when an abnormal increase in alerts coming from several communes in the Sud-Est Department in epidemiological weeks (EWs) 17 and 18 were noted and disseminated network-wide and response activities were implemented. The national cholera surveillance system did not register the increase until EWs 21 and

  6. Implementation of an Alert and Response System in Haiti during the Early Stage of the Response to the Cholera Epidemic

    PubMed Central

    Santa-Olalla, Patricia; Gayer, Michelle; Magloire, Roc; Barrais, Robert; Valenciano, Marta; Aramburu, Carmen; Poncelet, Jean Luc; Gustavo Alonso, Juan Carlos; Van Alphen, Dana; Heuschen, Florence; Andraghetti, Roberta; Lee, Robert; Drury, Patrick; Aldighieri, Sylvain

    2013-01-01

    The start of the cholera epidemic in Haiti quickly highlighted the necessity of the implementation of an Alert and Response (A&R) System to complement the existing national surveillance system. The national system had been able to detect and confirm the outbreak etiology but required external support to monitor the spread of cholera and coordinate response, because much of the information produced was insufficiently timely for real-time monitoring and directing of a rapid, targeted response. The A&R System was designed by the Pan American Health Organization/World Health Organization in collaboration with the Haiti Ministry of Health, and it was based on a network of partners, including any institution, structure, or individual that could identify, verify, and respond to alerts. The defined objectives were to (1) save lives through early detection and treatment of cases and (2) control the spread through early intervention at the community level. The operational structure could be broken down into three principle categories: (1) alert (early warning), (2) verification and assessment of the information, and (3) efficient and timely response in coordination with partners to avoid duplication. Information generated by the A&R System was analyzed and interpreted, and the qualitative information was critical in qualifying the epidemic and defining vulnerable areas, particularly because the national surveillance system reported incomplete data for more than one department. The A&R System detected a number of alerts unrelated to cholera and facilitated rapid access to that information. The sensitivity of the system and its ability to react quickly was shown in May of 2011, when an abnormal increase in alerts coming from several communes in the Sud-Est Department in epidemiological weeks (EWs) 17 and 18 were noted and disseminated network-wide and response activities were implemented. The national cholera surveillance system did not register the increase until EWs 21 and

  7. Haiti’s progress in achieving its 10-year plan to eliminate cholera: hidden sickness cannot be cured

    PubMed Central

    Koski-Karell, Victoria; Farmer, Paul E; Isaac, Benito; Campa, Elizabeth M; Viaud, Loune; Namphy, Paul C; Ternier, Ralph; Ivers, Louise C

    2016-01-01

    Since the beginning of the cholera epidemic in Haiti 5 years ago, the prevalence of this deadly water-borne disease has fallen far below the initial rates registered during its explosive outset. However, cholera continues to cause extensive suffering and needless deaths across the country, particularly among the poor. The urgent need to eliminate transmission of cholera persists: compared to the same period in 2014, the first 4 months of 2015 saw three times the number of cholera cases. Drawing upon epidemiology, clinical work (and clinical knowledge), policy, ecology, and political economy, and informed by ethnographic data collected in a rural area of Haiti called Bocozel, this paper evaluates the progress of the nation’s 10-year Plan for the Elimination of Cholera. Bocozel is a rice-producing region where most people live in extreme poverty. The irrigation network is decrepit, the land is prone to environmental shocks, fertilizer is not affordable, and the government’s capacity to assist farmers is undermined by resource constraints. When peasants do have rice to sell, the price of domestically grown rice is twice that of US-imported rice. Canal water is not only used to irrigate thousands of acres of rice paddies and sustain livestock, but also to bathe, wash, and play, while water from wells, hand pumps, and the river is used for drinking, cooking, and bathing. Only one out of the three government-sponsored water treatment stations in the research area is still functional and utilized by those who can afford it. Latrines are scarce and often shared by up to 30 people; open defecation remains common. Structural vulnerabilities cut across all sectors – not just water, sanitation, health care, and education, but agriculture, environment, (global and local) commerce, transportation, and governance as well. These are among the hidden sicknesses that impede Haiti and its partners’ capacity to eliminate cholera. PMID:27307774

  8. Rainfall-driven epidemic cholera: hydrologic controls on water-borne disease and multi-season projections

    NASA Astrophysics Data System (ADS)

    Righetto, L.; Bertuzzo, E.; Mari, L.; Casagrandi, R.; Gatto, M.; Rodriguez-Iturbe, I.; Rinaldo, A.

    2012-12-01

    Following the acknowledgement of a clear correlation between rainfall events and cholera resurgence, that was observed in Haiti starting from May 2011, we use a multi-variate Poisson generator to produce rainfall inputs, with which we force spatially explicit models of cholera spreading. Our models consist of ODE systems of equations, describing a network of human communities (divided in Susceptible, Infected and Recovered individuals) connected by river transport of pathogens and human mobility. We perform an a posteriori analysis -- from the beginning of the epidemic until December 2011 -- to assess the model reliability in predicting cholera cases and in testing control measures -- involving vaccination and sanitation campaigns. We then run a multi-seasonal prediction of the course of the epidemic until December 2015, to investigate further resurgences of cholera in the region and to evaluate, again, the effect of policies which may bring to the eradication of the disease in Haiti. We conclude that mathematical models may represent a key information tool for policy makers, as a way to preliminarly assess the possible future course of an epidemic and to test intervention policies to be deployed. Effect of intervention policies on the predicted course of the epidemic between 28/05-31/12/2011 (blue lines: simulations with the observed rainfall pattern; red lines/shaded range: median/25th-75th percentile range of simulations with generated rainfall). A) Effect of a reduction of the 20% of the contact rate , applied in one month starting from the 1st of June (dashed blue/red lines) or the 1st of July (dotted blue/red lines). B) A) Effect of a vaccination of 4 million individuals, implemented in one month starting from the 1st of June (dashed blue/red lines) or the 1st of July (dotted blue/red lines). C) Number of new cases in the period 28/05-31/12/2011 as a function of the reduction of the contact rate . D) Number of new cases in the period 28/05-31/12/2011 as a

  9. Cholera Transmission in Ouest Department of Haiti: Dynamic Modeling and the Future of the Epidemic

    PubMed Central

    Kirpich, Alexander; Weppelmann, Thomas A.; Yang, Yang; Ali, Afsar; Morris, J. Glenn; Longini, Ira M.

    2015-01-01

    In the current study, a comprehensive, data driven, mathematical model for cholera transmission in Haiti is presented. Along with the inclusion of short cycle human-to-human transmission and long cycle human-to-environment and environment-to-human transmission, this novel dynamic model incorporates both the reported cholera incidence and remote sensing data from the Ouest Department of Haiti between 2010 to 2014. The model has separate compartments for infectious individuals that include different levels of infectivity to reflect the distribution of symptomatic and asymptomatic cases in the population. The environmental compartment, which serves as a source of exposure to toxigenic V. cholerae, is also modeled separately based on the biology of causative bacterium, the shedding of V. cholerae O1 by humans into the environment, as well as the effects of precipitation and water temperature on the concentration and survival of V. cholerae in aquatic reservoirs. Although the number of reported cholera cases has declined compared to the initial outbreak in 2010, the increase in the number of susceptible population members and the presence of toxigenic V. cholerae in the environment estimated by the model indicate that without further improvements to drinking water and sanitation infrastructures, intermittent cholera outbreaks are likely to continue in Haiti. PMID:26488620

  10. Cholera Transmission in Ouest Department of Haiti: Dynamic Modeling and the Future of the Epidemic.

    PubMed

    Kirpich, Alexander; Weppelmann, Thomas A; Yang, Yang; Ali, Afsar; Morris, J Glenn; Longini, Ira M

    2015-01-01

    In the current study, a comprehensive, data driven, mathematical model for cholera transmission in Haiti is presented. Along with the inclusion of short cycle human-to-human transmission and long cycle human-to-environment and environment-to-human transmission, this novel dynamic model incorporates both the reported cholera incidence and remote sensing data from the Ouest Department of Haiti between 2010 to 2014. The model has separate compartments for infectious individuals that include different levels of infectivity to reflect the distribution of symptomatic and asymptomatic cases in the population. The environmental compartment, which serves as a source of exposure to toxigenic V. cholerae, is also modeled separately based on the biology of causative bacterium, the shedding of V. cholerae O1 by humans into the environment, as well as the effects of precipitation and water temperature on the concentration and survival of V. cholerae in aquatic reservoirs. Although the number of reported cholera cases has declined compared to the initial outbreak in 2010, the increase in the number of susceptible population members and the presence of toxigenic V. cholerae in the environment estimated by the model indicate that without further improvements to drinking water and sanitation infrastructures, intermittent cholera outbreaks are likely to continue in Haiti.

  11. Cholera outbreaks in India.

    PubMed

    Ramamurthy, Thandavarayan; Sharma, Naresh C

    2014-01-01

    Cholera is a global health problem as several thousands of cases and deaths occur each year. The unique epidemiologic attribute of the disease is its propensity to occur as outbreaks that may flare-up into epidemics, if not controlled. The causative bacterial pathogen Vibrio cholerae prevails in the environment and infects humans whenever there is a breakdown in the public health component. The Indian subcontinent is vulnerable to this disease due its vast coastlines with areas of poor sanitation, unsafe drinking water, and overcrowding. Recently, it was shown that climatic conditions also play a major role in the persistence and spread of cholera. Constant change in the biotypes and serotypes of V. cholerae are also important aspects that changes virulence and survival of the pathogen. Such continuous changes increase the infection ability of the pathogen affecting the susceptible population including the children. The short-term carrier status of V. cholerae has been studied well at community level and this facet significantly contributes to the recurrence of cholera. Several molecular tools recognized altering clonality of V. cholerae in relation with the advent of a serogroup or serotype. Rapid identification systems were formulated for the timely detection of the pathogen so as to identify and control the outbreak and institute proper treatment of the patients. The antimicrobials used in the past are no longer useful in the treatment of cholera as V. cholerae has acquired several mechanisms for multiple antimicrobial resistance. This upsurge in antimicrobial resistance directly influences the management of the disease. This chapter provides an overview of cholera prevalence in India, possible sources of infection, and molecular epidemiology along with antimicrobial resistance of V. cholerae.

  12. [Antibiotic sensitivity to epidemic strains of Vibrio cholerae and Shigella dysenteriae 1 isolated in Rwandan refugee camps in Zaire].

    PubMed

    Cavallo, J D; Niel, L; Talarmin, A; Dubrous, P

    1995-01-01

    Multiresistance or epidemic enteric bacteria to antibiotics greatly complicates treatment, and in some cases prophylaxis, of severe invasive gastroenteritis. During the summer of 1994, two epidemics of diarrhea, one due to Vibrio cholerae and the other to Shigella dysenteriae 1 isolated from the Goma and Bukavu camps was determined by measurement of the Agar Minimal Inhibitory Concentration. Multiresistance to tetracyclins, aminopenicillins, trimethoprimsulfamethoxazole, and nifuroxazide was observed. After intensive treatment mutant forms of both bacteria resistant to nalidixic acid rapidly appeared. Only fluoroquinolones remained active on these mutant strains, but the availability of this agent in Africa is restricted due to cost. The most effective way of preventing resistance is to limit the spread of enteric infections by health education and improvement of hygiene. This can be difficult during wartime.

  13. The controversial experiments on the intravenous administration of drugs (and air!) during the cholera epidemic of 1867 in Italy.

    PubMed

    Cascella, Marco

    2015-12-01

    Cholera ravaged many American and European cities in the nineteenth century. Likewise, Italy was struck by six epidemics since the morbus first appeared in 1835-1837. After the International Sanitary Conferences held in Paris in 1851, there was a decrease of the cases due to consolidation of the city in terms of public and private health. Nevertheless, due to the lack of alternative and innovative remedies, the mortality remained unchanged, affecting more than 60 percent of patients. The city of Brescia in Northern Italy was severely hit by the epidemic of 1867. Not being able to implement effective therapeutic strategies, the administration of drugs like quinine and strychnine was proposed to be done intravenously. The results of intravenous injections were ominous, and all the patients died of "‘sudden death"’. Although the academic authorities forbade further experiments, some physicians carried on a long trial using test animals and mental patients as ‘"guinea pigs"’.

  14. God's punishment or bad strategy: anti-epidemic measures in the lower Neretva basin at the time of cholera in 1886.

    PubMed

    Wokaunn, Mario; Fatović-Ferencić, Stella; Jurić, Ivan; Bekić, Marijo

    2012-09-01

    The epidemic of cholera that took place in the Neretva basin in 1886 was part of the fifth pandemic wave that was spreading throughout Europe. Based on the death records, vital statistics and the newspaper articles from that period, in this paper we present the emergence and the course this epidemic. In the context of analysis and experience of the epidemic of cholera in the lower Neretva basin, the newspaper articles have been recognized as a sensitive register of the changes of behavioural patterns, the way of speaking, the mechanisms of reacting and adjusting to the spreading epidemic, but also the resistance to it. It is based on this material that we can make conclusions about the relationship between the individual and the collective in the time of danger, as well as about the particularities of historical events that have been left out in other sources. Two potential paths for cholera to enter the area of the lower Neretva basin have been identified: one from the sea and the other from land, via the neighbouring country of Bosnia and Herzegovina. Quarantine measures had been taken in order to prevent the onslaught of the epidemic, a sanitary cordon was organized, disinfection of the land was carried out and a cholera hospital organized in Metković. However, despite the undertaken measures, an inefficiency of the government organs was obvious, because their actions mainly applied to formal fulfilment of anti-epidemic measures and they quite easily handed over individual initiatives to physicians. The analysis of strategies concerning the application of anti-epidemic measures in the past can be useful for learning more about the multilayered nature of social mechanisms in the time of epidemics, which makes it convincing and valuable even in the present day.

  15. Notes from the Field: Chlorination Strategies for Drinking Water During a Cholera Epidemic - Tanzania, 2016.

    PubMed

    Wang, Alice; Hardy, Colleen; Rajasingham, Anangu; Martinsen, Andrea; Templin, Lindsay; Kamwaga, Stanislaus; Sebunya, Kiwe; Jhuthi, Brenda; Habtu, Michael; Kiberiti, Stephen; Massa, Khalid; Quick, Rob; Mulungu, Jane; Eidex, Rachel; Handzel, Thomas

    2016-10-21

    Since August 2015, the Ministry of Health, Community Development, Gender, Elderly and Children (MoHCDGEC) of Tanzania has been leading the response to a widespread cholera outbreak. As of June 9, 2016, cholera had affected 23 of 25 regions in Tanzania, with 21,750 cumulative cases and 341 deaths reported (Ally Nyanga, MoHCDGEC Emergency Operations Center, personal communication, June 2016). Approximately one fourth of all cases occurred in the Dar es Salaam region on the east coast. Regions surrounding Lake Victoria, in the north, also reported high case counts, including Mwanza with 9% (Ally Nyanga, MoHCDGEC Emergency Operations Center, personal communication, June 2016). Since the start of the outbreak, MoHCDGEC and the Ministry of Water (MOW) have collaborated with the Tanzania Red Cross Society, United Nations Children's Fund (UNICEF), World Health Organization (WHO), and CDC to enhance the water, sanitation, and hygiene (WASH) response to prevent the further spread of cholera.

  16. Class 1 Integron-Borne, Multiple-Antibiotic Resistance Encoded by a 150-Kilobase Conjugative Plasmid in Epidemic Vibrio cholerae O1 Strains Isolated in Guinea-Bissau

    PubMed Central

    Dalsgaard, Anders; Forslund, Anita; Petersen, Andreas; Brown, Derek J.; Dias, Francisco; Monteiro, Serifo; Mølbak, Kåre; Aaby, Peter; Rodrigues, Amabelia; Sandström, Anita

    2000-01-01

    In the 1996–1997 cholera epidemic in Guinea-Bissau, surveillance for antimicrobial resistance showed the emergence of a multidrug-resistant strain of Vibrio cholerae O1 during the course of the epidemic. The strain was resistant to ampicillin, erythromycin, tetracycline, furazolidone, aminoglycosides, trimethoprim, and sulfamethoxazole. Concomitant with the emergence of this strain, we observed a resurgence in the number of registered cholera cases as well as an increase in the case fatality rate from 1.0% before the emergence of the multiple-drug-resistant strain to 5.3% after the emergence of the strain. Our study shows that the strain contained a 150-kb conjugative multiple-antibiotic resistance plasmid with class 1 integron-borne gene cassettes encoding resistance to trimethoprim (dhfrXII) and aminoglycosides [ant(3")-1a]). The finding of transferable resistance to almost all of the antibiotics commonly used to treat cholera is of great public health concern. Studies should be carried out to determine to what extent the strain or its resistance genes have been spread to other areas where cholera is endemic. PMID:11015401

  17. [The cholera epidemics and the development of public health in Meiji Japan. 2. Strength and weakness of public health politics].

    PubMed

    Chemouilli, Philippe

    2004-02-01

    We present here the beginnings of public health politics in Meiji Japan (1868-1912). Due to a two century isolation of Japan, public health concepts developed in the West from the end of the 18th century were foreign in premodern Japan. Due to its isolation, Japan was also relatively preserved from some acute infectious diseases such as cholera. In this paper, we investigate the role of cholera epidemics in the emergence of public health concepts in the peculiar context of Meiji Japan. We show that chronic diseases such as tuberculosis and leprosy were neglected for a long time and that the Meiji government set priority on acute infectious diseases that were considered as long as they disturbed public order. Nevertheless, some physicians and government officials considered issues of welfare and poverty. We also review some emerging concepts of social medicine. We try to show that in Japan as well as in western nations public health politics were not exempt of contradictions and paradoxes and a permanent tension existed between coercitive policies and conceptions of welfare and rights to health.

  18. Cholera outbreaks in Africa.

    PubMed

    Mengel, Martin A; Delrieu, Isabelle; Heyerdahl, Leonard; Gessner, Bradford D

    2014-01-01

    During the current seventh cholera pandemic, Africa bore the major brunt of global disease burden. More than 40 years after its resurgence in Africa in 1970, cholera remains a grave public health problem, characterized by large disease burden, frequent outbreaks, persistent endemicity, and high CFRs, particularly in the region of the central African Great Lakes which might act as reservoirs for cholera. There, cases occur year round with a rise in incidence during the rainy season. Elsewhere in sub-Saharan Africa, cholera occurs mostly in outbreaks of varying size with a constant threat of widespread epidemics. Between 1970 and 2011, African countries reported 3,221,050 suspected cholera cases to the World Health Organization, representing 46 % of all cases reported globally. Excluding the Haitian epidemic, sub-Saharan Africa accounted for 86 % of reported cases and 99 % of deaths worldwide in 2011. The number of cholera cases is possibly much higher than what is reported to the WHO due to the variation in modalities, completeness, and case definition of national cholera data. One source on country specific incidence rates for Africa, adjusting for underreporting, estimates 1,341,080 cases and 160,930 deaths (52.6 % of 2,548,227 estimated cases and 79.6 % of 209,216 estimated deaths worldwide). Another estimates 1,411,453 cases and 53,632 deaths per year, respectively (50 % of 2,836,669 estimated cases and 58.6 % of 91,490 estimated deaths worldwide). Within Africa, half of all cases between 1970 and 2011 were notified from only seven countries: Angola, Democratic Republic of the Congo, Mozambique, Nigeria, Somalia, Tanzania, and South Africa. In contrast to a global trend of decreasing case fatality ratios (CFRs), CFRs have remained stable in Africa at approximately 2 %. Early propagation of cholera outbreaks depends largely on the extent of individual bacterial shedding, host and organism characteristics, the likelihood of people coming into contact with

  19. Population and Genetic Study of Vibrio cholerae from the Amazon Environment Confirms that the WASA-1 Prophage Is the Main Marker of the Epidemic Strain that Circulated in the Region

    PubMed Central

    Morais, Lena Líllian Canto de Sá; Garza, Daniel Rios; Loureiro, Edvaldo Carlos Brito; Vale, Elivam Rodrigues; Santos, Denise Suéllem Amorim de Sousa; Corrêa, Vanessa Cavaleiro; Sousa, Nayara Rufino; Gurjão, Tereza Cristina Monteiro; Santos, Elisabeth Conceição de Oliveira; Vieira, Verônica Viana; da Fonseca, Erica Lourenço; Vicente, Ana Carolina Paulo

    2013-01-01

    Vibrio cholerae is a natural inhabitant of many aquatic environments in the world. Biotypes harboring similar virulence-related gene clusters are the causative agents of epidemic cholera, but the majority of strains are harmless to humans. Since 1971, environmental surveillance for potentially pathogenic V. cholerae has resulted in the isolation of many strains from the Brazilian Amazon aquatic ecosystem. Most of these strains are from the non-O1/non-O139 serogroups (NAGs), but toxigenic O1 strains were isolated during the Latin America cholera epidemic in the region (1991-1996). A collection of environmental V. cholerae strains from the Brazilian Amazon belonging to pre-epidemic (1977-1990), epidemic (1991-1996), and post-epidemic (1996-2007) periods in the region, was analyzed. The presence of genes related to virulence within the species and the genetic relationship among the strains were studied. These variables and the information available concerning the strains were used to build a Bayesian multivariate dependency model to distinguish the importance of each variable in determining the others. Some genes related to the epidemic strains were found in environmental NAGs during and after the epidemic. Significant diversity among the virulence-related gene content was observed among O1 strains isolated from the environment during the epidemic period, but not from clinical isolates, which were analyzed as controls. Despite this diversity, these strains exhibited similar PFGE profiles. PFGE profiles were significant while separating potentially epidemic clones from indigenous strains. No significant correlation with isolation source, place or period was observed. The presence of the WASA-1 prophage significantly correlated with serogroups, PFGE profiles, and the presence of virulence-related genes. This study provides a broad characterization of the environmental V. cholerae population from the Amazon, and also highlights the importance of identifying precisely

  20. Population and genetic study of Vibrio cholerae from the amazon environment confirms that the WASA-1 prophage is the main marker of the epidemic strain that circulated in the region.

    PubMed

    Morais, Lena Líllian Canto de Sá; Garza, Daniel Rios; Loureiro, Edvaldo Carlos Brito; Vale, Elivam Rodrigues; Santos, Denise Suéllem Amorim de Sousa; Corrêa, Vanessa Cavaleiro; Sousa, Nayara Rufino; Gurjão, Tereza Cristina Monteiro; Santos, Elisabeth Conceição de Oliveira; Vieira, Verônica Viana; da Fonseca, Erica Lourenço; Vicente, Ana Carolina Paulo

    2013-01-01

    Vibrio cholerae is a natural inhabitant of many aquatic environments in the world. Biotypes harboring similar virulence-related gene clusters are the causative agents of epidemic cholera, but the majority of strains are harmless to humans. Since 1971, environmental surveillance for potentially pathogenic V. cholerae has resulted in the isolation of many strains from the Brazilian Amazon aquatic ecosystem. Most of these strains are from the non-O1/non-O139 serogroups (NAGs), but toxigenic O1 strains were isolated during the Latin America cholera epidemic in the region (1991-1996). A collection of environmental V. cholerae strains from the Brazilian Amazon belonging to pre-epidemic (1977-1990), epidemic (1991-1996), and post-epidemic (1996-2007) periods in the region, was analyzed. The presence of genes related to virulence within the species and the genetic relationship among the strains were studied. These variables and the information available concerning the strains were used to build a Bayesian multivariate dependency model to distinguish the importance of each variable in determining the others. Some genes related to the epidemic strains were found in environmental NAGs during and after the epidemic. Significant diversity among the virulence-related gene content was observed among O1 strains isolated from the environment during the epidemic period, but not from clinical isolates, which were analyzed as controls. Despite this diversity, these strains exhibited similar PFGE profiles. PFGE profiles were significant while separating potentially epidemic clones from indigenous strains. No significant correlation with isolation source, place or period was observed. The presence of the WASA-1 prophage significantly correlated with serogroups, PFGE profiles, and the presence of virulence-related genes. This study provides a broad characterization of the environmental V. cholerae population from the Amazon, and also highlights the importance of identifying precisely

  1. Environmental surveillance for toxigenic Vibrio cholerae in surface waters of Haiti.

    PubMed

    Kahler, Amy M; Haley, Bradd J; Chen, Arlene; Mull, Bonnie J; Tarr, Cheryl L; Turnsek, Maryann; Katz, Lee S; Humphrys, Michael S; Derado, Gordana; Freeman, Nicole; Boncy, Jacques; Colwell, Rita R; Huq, Anwar; Hill, Vincent R

    2015-01-01

    Epidemic cholera was reported in Haiti in 2010, with no information available on the occurrence or geographic distribution of toxigenic Vibrio cholerae in Haitian waters. In a series of field visits conducted in Haiti between 2011 and 2013, water and plankton samples were collected at 19 sites. Vibrio cholerae was detected using culture, polymerase chain reaction, and direct viable count methods (DFA-DVC). Cholera toxin genes were detected by polymerase chain reaction in broth enrichments of samples collected in all visits except March 2012. Toxigenic V. cholerae was isolated from river water in 2011 and 2013. Whole genome sequencing revealed that these isolates were a match to the outbreak strain. The DFA-DVC tests were positive for V. cholerae O1 in plankton samples collected from multiple sites. Results of this survey show that toxigenic V. cholerae could be recovered from surface waters in Haiti more than 2 years after the onset of the epidemic.

  2. Access to safe water in rural Artibonite, Haiti 16 months after the onset of the cholera epidemic.

    PubMed

    Patrick, Molly; Berendes, David; Murphy, Jennifer; Bertrand, Fabienne; Husain, Farah; Handzel, Thomas

    2013-10-01

    Haiti has the lowest improved water and sanitation coverage in the Western Hemisphere and is suffering from the largest cholera epidemic on record. In May of 2012, an assessment was conducted in rural areas of the Artibonite Department to describe the type and quality of water sources and determine knowledge, access, and use of household water treatment products to inform future programs. It was conducted after emergency response was scaled back but before longer-term water, sanitation, and hygiene activities were initiated. The household survey and source water quality analysis documented low access to safe water, with only 42.3% of households using an improved drinking water source. One-half (50.9%) of the improved water sources tested positive for Escherichia coli. Of households with water to test, 12.7% had positive chlorine residual. The assessment reinforces the identified need for major investments in safe water and sanitation infrastructure and the importance of household water treatment to improve access to safe water in the near term.

  3. Cholera outbreak--southern Sudan, 2007.

    PubMed

    2009-04-10

    Vibrio cholerae causes cholera, an acute infectious diarrheal disease that can result in death without appropriate therapy, depending on the severity of the disease. War, poverty, inadequate sanitation, and large numbers of refugees and internally displaced persons (IDPs) are major precursors to cholera outbreaks. In 2005, Southern Sudan ended its 22-year civil war with North Sudan; as a result, IDPs and refugees are returning to the south. During April--June 2007, investigators from the Southern Sudan Field Epidemiology and Laboratory Training Program (SS-FELTP) and CDC investigated a cholera outbreak in the town of Juba, Southern Sudan. This report summarizes the results of that investigation, which found that 3,157 persons were diagnosed with suspected cholera during January--June 2007, with 74 deaths resulting from the disease. An environmental investigation revealed suboptimal hygiene practices and a lack of water and sanitation infrastructure in Juba. A case-control study indicated that persons less likely to have cholera were more likely to have consumed hot meals containing meat during the outbreak. Contaminated food or water were not identified as possible sources of the cholera outbreak in Juba. However, this might be attributed to limitations of the study, including small sample size. Cholera can reach epidemic proportions if adequate control measures are not implemented early. Mass media campaigns are important for current and new residents in Juba to understand the importance of proper food handling, clean water, and optimal hygiene practices to prevent the spread of cholera.

  4. Cholera studies*

    PubMed Central

    Pollitzer, R.

    1957-01-01

    The first section of this study deals with areas where cholera is endemic and with the conditions normally favouring endemicity. Turning next to epidemics, the author discusses their origin and types, climatic influences on them, their periodicity and the possibility of forecasting them, the role played in them by different serological races of V. cholerae, and the causes of their decline. In a section on the factors governing the local spread of cholera, he considers contact and water-borne infection; the role of contaminated food and drink, of fomites, of flies, and of carriers; and the incidence according to sex, age, race, and occupation. The last part deals with factors governing the spread of cholera over longer distances, and includes discussion of the effect of movements of individuals and groups and of assemblies of the population on pilgrimages or at religious festivals. PMID:13472431

  5. Spreading of Cholera through Surface Water

    NASA Astrophysics Data System (ADS)

    Bertuzzo, E.; Casagrandi, R.; Gatto, M.; Rodriguez-Iturbe, I.; Rinaldo, A.

    2009-12-01

    Cholera epidemics are still a major public health concern to date in many areas of the world. In order to understand and forecast cholera outbreaks, one of the most important factors is the role played by the environmental matrix in which the disease spreads. We study how river networks, acting as environmental corridors for pathogens, affect the spreading of cholera epidemics. The environmental matrix in which the disease spreads is constituted by different human communities and their hydrologic interconnections. Each community is characterized by its spatial position, population size, water resources availability and hygiene conditions. By implementing a spatially explicit cholera model we seek the effects on epidemic dynamics of: i) the topology and metrics of the pathogens pathways that connect different communities; ii) the spatial distribution of the population size; and iii) the spatial distributions and quality of surface water resources and public health conditions, and how they vary with population size. The model has been applied to study the space-time evolution of a well documented cholera epidemic occurred in the KwaZulu-Natal province of South Africa. The epidemic lasted for two years and involved about 140,000 confirmed cholera cases. The model does well in reproducing the distribution of the cholera cases during the two outbreaks as well as their spatial spreading. We further extend the model by deriving the speed of propagation of traveling fronts in the case of uniformly distributed systems for different topologies: one and two dimensional lattices and river networks. The derivation of the spreading celerity proves instrumental in establishing the overall conditions for the relevance of spatially explicit models. The conditions are sought by comparison between spreading and disease timescales. Consider a cholera epidemic that starts from a point and spreads throughout a finite size system, it is possible to identify two different timescales: i

  6. Epidemiology, determinants and dynamics of cholera in Pakistan: gaps and prospects for future research.

    PubMed

    Naseer, Maliha; Jamali, Tanzil

    2014-11-01

    Cholera is one of the notifiable endemic diseases in Pakistan, but the reporting of cholera cases is still unsatisfactory. Most of the diagnosed cases are never reported to the relevant authorities. In the year 1993 - 2005, the country did not report any single case of cholera to the WHO. The objectives of this review were to understand the epidemiology and to identify the possible determinants of cholera infection in Pakistan. Medscape, Medline, PakMedinet and PubMed, was searched, using key words, epidemiology and determinants of cholera infection in Pakistan during 1995 - 2010. Morbidity and mortality due to cholera infection during 1995 - 2010, without any language restriction. Out of 27 articles published between 1995 - 2010, 17 articles were included in the review. Vibrio cholerae O139 identified as a major cause of infection in older age group, while O1 biotype of cholera as a predominant cause of cholera among young individuals. Mainly reported determinants of cholera in Pakistan include poor sanitation and hygiene practices, increased population density in urban areas, leading to rapid and unplanned urbanization of the major cities and climate change due to increased environmental pollution in Pakistan are plausible factors for endemicity of cholera in Pakistan. Cholera reporting as a notifiable disease to the relevant departments and timely action can prevent the risk of outbreaks. There is a need to identify specific behavioral and environmental determinants responsible for outbreaks and epidemics of cholera in Pakistan which can help to design appropriate preventive and control interventions.

  7. Cholera: Environmental Reservoirs and Impact on Disease Transmission

    PubMed Central

    ALMAGRO-MORENO, SALVADOR; TAYLOR, RONALD K.

    2015-01-01

    Vibrio cholerae is widely known to be the etiological agent of the life-threatening diarrheal disease cholera. Cholera remains a major scourge in many developing countries, infecting hundreds of thousands every year. Remarkably, V. cholerae is a natural inhabitant of brackish riverine, estuarine, and coastal waters, and only a subset of strains are known to be pathogenic to humans. Recent studies have begun to uncover a very complex network of relationships between V. cholerae and other sea dwellers, and the mechanisms associated with the occurrence of seasonal epidemics in regions where cholera is endemic are beginning to be elucidated. Many of the factors required for the organism’s survival and persistence in its natural environment have been revealed, as well as the ubiquitous presence of horizontal gene transfer in the emergence of pathogenic strains of V. cholerae. In this article, we will focus on the environmental stage of pathogenic V. cholerae and the interactions of the microorganism with other inhabitants of aquatic environments. We will discuss the impact that its environmental reservoirs have on disease transmission and the distinction between reservoirs of V. cholerae and the vectors that establish cholera as a zoonosis. PMID:25674360

  8. Cholera Outbreak in Grande Comore: 1998–1999

    PubMed Central

    Troeger, Christopher; Gaudart, Jean; Truillet, Romain; Sallah, Kankoe; Chao, Dennis L.; Piarroux, Renaud

    2016-01-01

    In 1998, a cholera epidemic in east Africa reached the Comoros Islands, an archipelago in the Mozambique Channel that had not reported a cholera case for more than 20 years. In just a little over 1 year (between January 1998 and March 1999), Grande Comore, the largest island in the Union of the Comoros, reported 7,851 cases of cholera, about 3% of the population. Using case reports and field observations during the medical response, we describe the epidemiology of the 1998–1999 cholera epidemic in Grande Comore. Outbreaks of infectious diseases on islands provide a unique opportunity to study transmission dynamics in a nearly closed population, and they may serve as stepping-stones for human pathogens to cross unpopulated expanses of ocean. PMID:26572869

  9. Cholera outbreaks in the classical biotype era.

    PubMed

    Siddique, A K; Cash, Richard

    2014-01-01

    In the Indian subcontinent description of a disease resembling cholera has been mentioned in Sushruta Samita, estimated to have been written between ~400 and 500 BC. It is however not clear whether the disease known today as cholera caused by Vibrio cholerae Vibrio cholerae O1 is the evolutionary progression of the ancient disease. The modern history of cholera began in 1817 when an explosive epidemic broke out in the Ganges River Delta region of Bengal. This was the first of the seven recorded cholera pandemics cholera pandemics that affected nearly the entire world and caused hundreds of thousands of deaths. The bacterium responsible for this human disease was first recognised during the fifth pandemic and was named V. cholerae which was grouped as O1, and was further differentiated into Classical and El Tor biotypes. It is now known that the fifth and the sixth pandemics were caused by the V. cholerae O1 of the Classical biotype Classical biotype and the seventh by the El Tor biotype El Tor biotype . The El Tor biotype of V. cholerae, which originated in Indonesia Indonesia and shortly thereafter began to spread in the early 1960s. Within the span of 50 years the El Tor biotype had invaded nearly the entire world, completely displacing the Classical biotype from all the countries except Bangladesh. What prompted the earlier pandemics to begin is not clearly understood, nor do we know how and why they ended. The success of the seventh pandemic clone over the pre-existing sixth pandemic strain remains largely an unsolved mystery. Why classical biotype eventually disappeared from the world remains to be explained. For nearly three decades (1963-1991) during the Seventh cholera pandemic seventh pandemic, cholera in Bangladesh has recorded a unique history of co-existence of Classical and El Tor biotypes of V. cholerae O1 as epidemic and endemic strain. This long co-existence has provided us with great opportunity to improve our understanding of the disease itself

  10. Cholera in coastal Africa: a systematic review of its heterogeneous environmental determinants.

    PubMed

    Rebaudet, Stanislas; Sudre, Bertrand; Faucher, Benoît; Piarroux, Renaud

    2013-11-01

    According to the "cholera paradigm," epidemiology of this prototypical waterborne disease is considered to be driven directly by climate-induced variations in coastal aquatic reservoirs of Vibrio cholerae. This systematic review on environmental determinants of cholera in coastal Africa shows that instead coastal epidemics constitute a minor part of the continental cholera burden. Most of coastal cholera foci are located near estuaries, lagoons, mangrove forests, and on islands. Yet outbreaks often originate in coastal cities, where cholera is more likely to be imported from distant areas. Cholera outbreaks also may intensify in densely populated slum quarters before spreading to adjacent regions. Frequent seasonality of cholera incidence appears driven by the rainfall-induced contamination of unprotected water sources through latrine overflow and sewage, as well as by the periodicity of human activities like fishing or traveling. Lulls in transmission periods of several years are repeatedly recorded even in high-risk coastal areas. To date, environmental studies have failed to demonstrate a perennial aquatic reservoir of toxigenic V. cholerae around the continent. Finally, applicability of the cholera paradigm therefore appears questionable in Africa, although available data remain limited. Thorough surveys with microbiological analyses of water samples and prospective genotyping of environmental and clinical strains of V. cholerae are needed to understand determinants of cholera in coastal Africa and better target prevention and control measures.

  11. Predictability of Vibrio cholerae in Chesapeake Bay

    PubMed Central

    Louis, Valérie R.; Russek-Cohen, Estelle; Choopun, Nipa; Rivera, Irma N. G.; Gangle, Brian; Jiang, Sunny C.; Rubin, Andrea; Patz, Jonathan A.; Huq, Anwar; Colwell, Rita R.

    2003-01-01

    Vibrio cholerae is autochthonous to natural waters and can pose a health risk when it is consumed via untreated water or contaminated shellfish. The correlation between the occurrence of V. cholerae in Chesapeake Bay and environmental factors was investigated over a 3-year period. Water and plankton samples were collected monthly from five shore sampling sites in northern Chesapeake Bay (January 1998 to February 2000) and from research cruise stations on a north-south transect (summers of 1999 and 2000). Enrichment was used to detect culturable V. cholerae, and 21.1% (n = 427) of the samples were positive. As determined by serology tests, the isolates, did not belong to serogroup O1 or O139 associated with cholera epidemics. A direct fluorescent-antibody assay was used to detect V. cholerae O1, and 23.8% (n = 412) of the samples were positive. V. cholerae was more frequently detected during the warmer months and in northern Chesapeake Bay, where the salinity is lower. Statistical models successfully predicted the presence of V. cholerae as a function of water temperature and salinity. Temperatures above 19°C and salinities between 2 and 14 ppt yielded at least a fourfold increase in the number of detectable V. cholerae. The results suggest that salinity variation in Chesapeake Bay or other parameters associated with Susquehanna River inflow contribute to the variability in the occurrence of V. cholerae and that salinity is a useful indicator. Under scenarios of global climate change, increased climate variability, accompanied by higher stream flow rates and warmer temperatures, could favor conditions that increase the occurrence of V. cholerae in Chesapeake Bay. PMID:12732548

  12. [The determinants of the low case fatality rate of the cholera epidemic in the Littoral department of Benin in 2008].

    PubMed

    Gbary, Akpa Raphaël; Sossou, Roch Aristide; Dossou, Jean-Paul; Mongbo, Virginie; Massougbodji, Achille

    2011-01-01

    The 2008 cholera outbreak in Benin was characterized by a low case fatality rate (0.39 p.100) in the Littoral department, where 502 cases were recorded between July and December. The aim of this study was to identify the key factors associated with the low case fatality rate within the department. The cross-sectional, descriptive and analytical study conducted as part of this research used 404 patient records, focus group discussions with ten former patients, in-depth interviews with 8 health authorities involved in the response and structured face-to-face interviews with 12 health personnel involved in the treatment of patients. The data were analyzed using qualitative and quantitative content analysis based on EPIINFO 3.3.2 and EXCEL 2007 software. The results from several sources were cross-checked through triangulation. The mean age of patients was 23.72 ± 14.8 years. 39.35% patients were admitted with severe dehydration. Oral rehydration, intravenous rehydration and antibiotic therapy were given to 99.5%, 85% and 97.77% of patients, respectively. Only one hospital death was noted. The low case fatality rate was mainly due to the following factors: the high quality of care provided in a center with qualified personnel and available and free of charge treatment kits, protocols based on massive rehydration and appropriate hygiene measures, and patient compliance with the treatment plan. The response was also characterized by good coordination, wide mass and local health promotion, and selective antibiotic prophylaxis, which contributed significantly to reducing the spread of the infection.

  13. [Cholera and war].

    PubMed

    Ganin, V S

    2009-09-01

    During last centures wars were the main account of spread of cholera. It is caused by movement of great mass of troops and peaceful populace, acute fall of living circumstances, decline of sanitarium conditions of population aggregates, difficultness or impossibility of effectuating of contra-epidemic measures. Cholera casualty was multifold bigger, the weapon casualty in fighting armies. The article presents data of cholera epidemics, were in fighting armies of different states. During the XXth century fight casualty began to overpass the disease casualty. It is caused by grand increasing of damage effects of measures of war, organized using of prophylaxis measures and success in treatment of infectious diseases. The article presents data about cholera falling ill during the Great Patriotic War and about system of contro-epidemic barrier on fronts and rear of state.

  14. Predictive modeling of cholera using GRACE and TRMM satellite data

    NASA Astrophysics Data System (ADS)

    Jutla, A.; Akanda, A. S. S.; Colwell, R. R.

    2015-12-01

    Cholera outbreaks can be classified in three forms- epidemic (sudden or seasonal outbreaks), endemic (recurrence and persistence of the disease for several consecutive years) and mixed-mode endemic (combination of certain epidemic and endemic conditions) with significant spatial and temporal heterogeneity. Endemic cholera is related to floods and droughts in regions where water and sanitation infrastructure are inadequate or insufficient. With more than a decade of terrestrial water storage (TWS) data obtained from Gravity Recovery and Climate Experiment (GRACE), understanding dynamics of river discharge is now feasible. We explored lead-lag relationships between TWS in the Ganges-Brahmaputra-Meghna (GBM) basin and endemic cholera in Bangladesh. Since bimodal seasonal peaks in cholera in Bangladesh occur during the spring and autumn season, two separate models, between TWS and disease time series (2002 to 2010) were developed. TWS, hence water availability, showed an asymmetrical, strong association with spring (τ=-0.53; p<0.001) and autumn (τ=0.45; p<0.001) cholera prevalence up to five to six months in advance. One unit (cm of water) decrease in water availability in the basin increased odds of above normal cholera by 24% [confidence interval (CI) 20-31%; p<0.05] in the spring season, while an increase in regional water by one unit, through floods, increased odds of above average cholera in the autumn by 29% [CI:22-33%; p<0.05]. Epidemic cholera is related with warm temperatures and heavy rainfall. Using TRMM data for several locations in Asia and Africa, probability of cholera increases 18% [CI:15-23%; p<0.05] after heavy precipitation resulted in a societal conditions where access to safe water and sanitation was disrupted. Results from mechanistic modeling framework using systems approach that include satellite based hydroclimatic information with tradition disease transmission models will also be presented.

  15. Thirty years of the human immunodeficiency virus epidemic and beyond

    PubMed Central

    Younai, Fariba S

    2013-01-01

    After more than 30 years of battling a global epidemic, the prospect of eliminating human immunodeficiency virus (HIV) as the most challenging infectious disease of the modern era is within our reach. Major scientific discoveries about the virus responsible for this immunodeficiency disease state, including its pathogenesis, transmission patterns and clinical course, have led to the development of potent antiretroviral drugs that offer great hopes in HIV treatment and prevention. Although these agents and many others still in development and testing are capable of effectively suppressing viral replication and survival, the medical management of HIV infection at the individual and the population levels remains challenging. Timely initiation of antiretroviral drugs, adherence to the appropriate therapeutic regimens, effective use of these agents in the pre and post-exposure prophylaxis contexts, treatment of comorbid conditions and addressing social and psychological factors involved in the care of individuals continue to be important considerations. PMID:24136672

  16. Strategy, demand, management, and costs of an international cholera vaccine stockpile.

    PubMed

    Maskery, Brian; DeRoeck, Denise; Levin, Ann; Kim, Young Eun; Wierzba, Thomas F; Clemens, John D

    2013-11-01

    In this article, we review the feasibility of mass vaccination against cholera and estimate the global population at risk for epidemic cholera. We then examine the cost of establishing and managing a cholera vaccine stockpile and summarize published mathematical models of the estimated impact of reactive vaccination campaigns developed for the current Haitian outbreak and a recent outbreak in Zimbabwe. On the basis of these evaluations, we recommend a stockpile that starts at 2 million doses, with an estimated annual cost of $5.5-$13.9 million in 2013, and grows to 10 million doses per year by 2017, with an annual cost of $27-$51 million. We believe that the stockpile can enhance efforts to mitigate future cholera outbreaks by guaranteeing the availability of cholera vaccines and, through use of the stockpile, by revealing knowledge about the efficient use of cholera vaccines during and after crises.

  17. Characterization of Vibrio cholerae Strains Isolated from the Nigerian Cholera Outbreak in 2010.

    PubMed

    Dupke, Susann; Akinsinde, Kehinde A; Grunow, Roland; Iwalokun, Bamidele A; Olukoya, Daniel K; Oluwadun, Afolabi; Velavan, Thirumalaisamy P; Jacob, Daniela

    2016-10-01

    We examined clinical samples from Nigerian patients with acute watery diarrhea for Vibrio cholerae during the 2010 cholera outbreak. A total of 109 suspected isolates were characterized, but only 57 V. cholerae strains could be confirmed using multiplex real-time PCR as well as rpoB sequencing and typed as V. cholerae O:1 Ogawa biotype El Tor. This finding highlighted the need for accurate diagnosis of cholera in epidemic countries to implement life-saving interventions.

  18. Characterization of Vibrio cholerae Strains Isolated from the Nigerian Cholera Outbreak in 2010

    PubMed Central

    Dupke, Susann; Akinsinde, Kehinde A.; Grunow, Roland; Iwalokun, Bamidele A.; Olukoya, Daniel K.; Oluwadun, Afolabi; Velavan, Thirumalaisamy P.

    2016-01-01

    We examined clinical samples from Nigerian patients with acute watery diarrhea for Vibrio cholerae during the 2010 cholera outbreak. A total of 109 suspected isolates were characterized, but only 57 V. cholerae strains could be confirmed using multiplex real-time PCR as well as rpoB sequencing and typed as V. cholerae O:1 Ogawa biotype El Tor. This finding highlighted the need for accurate diagnosis of cholera in epidemic countries to implement life-saving interventions. PMID:27487957

  19. Cholera Treatment

    MedlinePlus

    ... The CDC Cancel Submit Search The CDC Cholera - Vibrio cholerae infection Note: Javascript is disabled or is not ... Infection & Risk Factors Non-O1 and Non-O139 Vibrio cholerae Infections Diagnosis and Detection Laboratory Testing for Cholera ...

  20. Molecular Epidemiology and Antibiotic Susceptibility of Vibrio cholerae Associated with a Large Cholera Outbreak in Ghana in 2014

    PubMed Central

    Eibach, Daniel; Herrera-León, Silvia; Gil, Horacio; Hogan, Benedikt; Ehlkes, Lutz; Adjabeng, Michael; Kreuels, Benno; Nagel, Michael; Opare, David; Fobil, Julius N; May, Jürgen

    2016-01-01

    Background Ghana is affected by regular cholera epidemics and an annual average of 3,066 cases since 2000. In 2014, Ghana experienced one of its largest cholera outbreaks within a decade with more than 20,000 notified infections. In order to attribute this rise in cases to a newly emerging strain or to multiple simultaneous outbreaks involving multi-clonal strains, outbreak isolates were characterized, subtyped and compared to previous epidemics in 2011 and 2012. Methodology/Principal Findings Serotypes, biotypes, antibiotic susceptibilities were determined for 92 Vibrio cholerae isolates collected in 2011, 2012 and 2014 from Southern Ghana. For a subgroup of 45 isolates pulsed-field gel electrophoresis, multilocus sequence typing and multilocus-variable tandem repeat analysis (MLVA) were performed. Eighty-nine isolates (97%) were identified as ctxB (classical type) positive V. cholerae O1 biotype El Tor and three (3%) isolates were cholera toxin negative non-O1/non-O139 V. cholerae. Among the selected isolates only sulfamethoxazole/trimethoprim resistance was detectable in 2011, while 95% of all 2014 isolates showed resistance towards sulfamethoxazole/trimethoprim, ampicillin and reduced susceptibility to ciprofloxacin. MLVA achieved the highest subtype discrimination, revealing 22 genotypes with one major outbreak cluster in each of the three outbreak years. Apart from those clusters genetically distant genotypes circulate during each annual epidemic. Conclusions/Significance This analysis suggests different endemic reservoirs of V. cholerae in Ghana with distinct annual outbreak clusters accompanied by the occurrence of genetically distant genotypes. Preventive measures for cholera transmission should focus on aquatic reservoirs. Rapidly emerging multidrug resistance must be monitored closely. PMID:27232338

  1. Resurgence of cholera in Hong Kong.

    PubMed Central

    Lee, S. H.; Lai, S. T.; Lai, J. Y.; Leung, N. K.

    1996-01-01

    Cholera is one of the three diseases subject to the International Health Regulations. After a period of over 30 years, the seventh pandemic of cholera, which started in South East Asia in 1961, still shows no sign of a decline. On the contrary, it has increased its severity and invaded many other countries in Africa and Latin America. In the last two years, there has been a recrudescence of the disease in South East Asia and Western Pacific Regions. The discovery of a new strain of Vibrio cholerae 0139 in these regions is causing concern in view of its potential to cause major epidemics and higher mortality. Hong Kong had two intensive outbreaks of cholera in the last two years. The cause of these outbreaks was not clear, but adverse environmental conditions and increasing pollution of coastal waters have been implicated. The spread of cholera knows no geographical boundaries. There is a need for intensified efforts among health authorities in the affected areas to prevent the international spread of the disease. PMID:8760949

  2. Climatic, socio-economic, and health factors affecting human vulnerability to cholera in the Lake Victoria basin, East Africa.

    PubMed

    Olago, Daniel; Marshall, Michael; Wandiga, Shem O; Opondo, Maggie; Yanda, Pius Z; Kanalawe, Richard; Githeko, Andrew K; Downs, Tim; Opere, Alfred; Kavumvuli, Robert; Kirumira, Edward; Ogallo, Laban; Mugambi, Paul; Apindi, Eugene; Githui, Faith; Kathuri, James; Olaka, Lydia; Sigalla, Rehema; Nanyunja, Robinah; Baguma, Timothy; Achola, Pius

    2007-06-01

    Cholera epidemics have a recorded history in the eastern Africa region dating to 1836. Cholera is now endemic in the Lake Victoria basin, a region with one of the poorest and fastest growing populations in the world. Analyses of precipitation, temperatures, and hydrological characteristics of selected stations in the Lake Victoria basin show that cholera epidemics are closely associated with El Niño years. Similarly, sustained temperatures high above normal (T(max)) in two consecutive seasons, followed by a slight cooling in the second season, trigger an outbreak of a cholera epidemic. The health and socioeconomic systems that the lake basin communities rely upon are not robust enough to cope with cholera outbreaks, thus rendering them vulnerable to the impact of climate variability and change. Collectively, this report argues that communities living around the Lake Victoria basin are vulnerable to climate-induced cholera that is aggravated by the low socioeconomic status and lack of an adequate health care system. In assessing the communities' adaptive capacity, the report concludes that persistent levels of poverty have made these communities vulnerable to cholera epidemics.

  3. The politics of underdevelopment: metered to death-how a water experiment caused riots and a cholera epidemic.

    PubMed

    Pauw, Jacques

    2003-01-01

    Water privatization programs in South Africa, part of a government policy aimed at making people pay for the full cost of running water ("total cost recovery"), was developed by private water companies and the World Bank to finance improved water supplies and build the country's economy. Instead the programs are causing more misery than development. Millions of poor people have had their water supply cut off because of inability to pay, forcing them to get their water from polluted rivers and lakes and leading to South Africa's worst cholera outbreak--which the government paid millions of dollars to control. Residents in some townships are rebelling, and many of the private multinational water companies are reassessing their involvement in South Africa.

  4. Journals of the plague years: documenting the history of the AIDS epidemic in the United States.

    PubMed Central

    Markel, H

    2001-01-01

    This commentary discusses several journalistic, literary, and historical accounts of the AIDS epidemic as it has unfolded in the United States over the past 2 decades. By examining the different ways that different types of storytellers chronicle the political, social, public health, medical, and economic aspects of epidemic disease, this essay will demonstrate why the AIDS epidemic has been of such intense interest not only to physicians and public health experts but also to journalists, novelists, playwrights, memoirists, and historians. AIDS is a particularly fascinating example of society's broad concern with epidemics because it both is a global pandemic and, in recent years, has become a chronic disease. PMID:11441724

  5. The role of socioeconomic status in longitudinal trends of cholera in Matlab, Bangladesh, 1993-2007.

    PubMed

    Root, Elisabeth Dowling; Rodd, Joshua; Yunus, Mohammad; Emch, Michael

    2013-01-01

    There has been little evidence of a decline in the global burden of cholera in recent years as the number of cholera cases reported to WHO continues to rise. Cholera remains a global threat to public health and a key indicator of lack of socioeconomic development. Overall socioeconomic development is the ultimate solution for control of cholera as evidenced in developed countries. However, most research has focused on cross-county comparisons so that the role of individual- or small area-level socioeconomic status (SES) in cholera dynamics has not been carefully studied. Reported cases of cholera in Matlab, Bangladesh have fluctuated greatly over time and epidemic outbreaks of cholera continue, most recently with the introduction of a new serotype into the region. The wealth of longitudinal data on the population of Matlab provides a unique opportunity to explore the impact of socioeconomic status and other demographic characteristics on the long-term temporal dynamics of cholera in the region. In this population-based study we examine which factors impact the initial number of cholera cases in a bari at the beginning of the 0139 epidemic and the factors impacting the number of cases over time. Cholera data were derived from the ICDDR,B health records and linked to socioeconomic and geographic data collected as part of the Matlab Health and Demographic Surveillance System. Longitudinal zero-inflated Poisson (ZIP) multilevel regression models are used to examine the impact of environmental and socio-demographic factors on cholera counts across baris. Results indicate that baris with a high socioeconomic status had lower initial rates of cholera at the beginning of the 0139 epidemic (γ(01) = -0.147, p = 0.041) and a higher probability of reporting no cholera cases (α(01) = 0.156, p = 0.061). Populations in baris characterized by low SES are more likely to experience higher cholera morbidity at the beginning of an epidemic than populations in high

  6. Cholera: a great global concern.

    PubMed

    Mandal, Shyamapada; Mandal, Manisha Deb; Pal, Nishith Kumar

    2011-07-01

    Cholera, caused by the infection of toxigenic Vibrio cholerae (V. cholerae) to humans, is a life threatening diarrheal disease with epidemic and pandemic potential. The V. cholerae, both O1 and O139 serogroups, produce a potent enterotoxin (cholera toxin) responsible for the lethal symptoms of the disease. The O1 serogroup has two biotypes (phenotypes), classical and El Tor; each of which has two major serotypes (based on antigenic responses), Ogawa and Inaba and the extremely rare Hikojima. V. cholerae O1 strains interconvert and switch between the Ogawa and Inaba serotypes. Fluid and electrolyte replacement is the mainstay of treatment of cholera patients; the severe cases require antibiotic treatment to reduce the duration of illness and replacement of fluid intake. The antibiotic therapy currently has faced difficulties due to the rapid emergence and spread of multidrug resistant V. cholerae causing several outbreaks in the globe. Currently, cholera has been becoming endemic in an increasing number of geographical areas, reflecting a failure in implementation of control measures. However, the current safe oral vaccines lower the number of resistant infections and could thus represent an effective intervention measure to control antibiotic resistance in cholera. Overall, the priorities for cholera control remain public health interventions through improved drinking water, sanitation, surveillance and access to health care facilities, and further development of safe, effective and appropriate vaccines. Thus, this review describes the facts and phenomena related to the disease cholera, which is still a great threat mainly to the developing countries, and hence a grave global concern too.

  7. Cholera in Zimbabwe: Developing an Educational Response to a Health Crisis

    ERIC Educational Resources Information Center

    Mandikonza, Caleb; Musindo, Beatrice; Taylor, Jim

    2011-01-01

    In February 2009, the World Health Organization (WHO) reported that the cholera epidemic in Zimbabwe had claimed 3,300 lives and infected 66,000 people--greater than the toll of that disease in the whole of Africa in most years. How is it possible that a disease such as cholera can have such a devastating effect in modern times? How should one…

  8. Factors Associated with Fatal Outcomes Following Cholera-Like Syndrome in Far North Region of Cameroon: A Community-Based Survey.

    PubMed

    Djouma, Fabrice N; Ateudjieu, Jerome; Ram, Malathi; Debes, Amanda K; Sack, David A

    2016-12-07

    This study demonstrates that most cholera deaths in this region of Cameroon occur out of hospital. This is a region which is prone to cholera, and interventions are needed to improve access to emergency medical care, especially during cholera outbreaks. Cameroon has experienced 14 cholera epidemics during the last 20 years, and these have had high case fatality rates. This study attempted to assess the effect of delays in seeking care and the locations of care as possible risk factors for cholera mortality. The study used data from a community-based survey regarding the circumstances of 97 fatal cases and 197 control (nonfatal) cases following a cholera-like syndrome in villages with cholera-like diseases during cholera outbreaks in Cameroon during 2009-2011. Deaths occurred in one of four environments: the community, in a temporary community treatment center (TCTC), in transit to a treatment center, or in a hospital (39%, 32%, 5%, and 24%, respectively). Using a case-control analysis, factors associated with deaths included the nonuse of a cholera treatment center, receiving health care in a TCTC instead of a hospital, and greater than 4 hours delay between the onset of symptoms and the decision to go to a treatment center (odds ratios of 17.1 [confidence interval (CI): 7.0-41.8], 2.5 [CI: 1.2-5.0], and 2.2 [CI: 1.0-4.6], respectively). During cholera epidemics, a higher proportion of deaths are still occurring in communities. The nonuse and delays in deciding to go a treatment center, and treatment at TCTC rather than a hospital were risk factors for death among patients with cholera-like syndrome in Cameroon. Informing people on community management of cholera-like syndrome and improving care in all health facilities are needed to reduce deaths during cholera epidemics.

  9. Genetic Studies of Vibrio cholerae in South West Cameroon—A Phylogenetic Analysis of Isolates from the 2010-2011 Epidemic

    PubMed Central

    Ngwa, Moise C.; Masalla, Thomas; Esemu, Seraphine; Fumoloh, Foche Francis; Kracalik, Ian; Cella, Eleonora; Alam, Meer Taifur; Akoachere, Jane-Francis; Liang, Song; Salemi, Marco; Morris, J. Glenn; Ali, Afsar; Ndip, Lucy M.

    2016-01-01

    Introduction: During the cholera outbreak from 2010 to 2011 in Cameroon, 33,192 cases with 1,440 deaths (case fatality ratio 4.34%) were reported to the World Health Organization. Of these, the South West Region reported 3,120 clinical cases. This region is in the Equatorial Monsoon climatic subzone of Cameroon, close to the coast, raising questions as to whether cases were linked with development of environmental reservoirs. Methods: In an investigation conducted by the Laboratory for Emerging Infectious Diseases, University of Buea, toxigenic V. cholerae O1 were isolated from diarrheal stool samples from 18 patients, with ages ranging from <3 to 70 years. Coordinates for clinical centers at which cases were identified were obtained using a handheld GPS, and were mapped using ArcGIS. Antibiotic susceptibility testing was performed using the Kirby ‘Bauer agar disc diffusion method. The full genomes of these strains were sequenced with the Illumina MiSeq platform. De novo assembly of cholera genomes and multiple sequence alignment were carried out using the bioinformatics pipeline developed in the Emerging Pathogens Institute laboratory at the University of Florida. Results/Discussion: Genetic comparisons showed that isolates were closely related, with pairwise p-distances ranging from 2.25 to 14.52 10-5 nt substitutions per site, and no statistically significant correlation between the pairwise genetic distances and the geographic distances among sampling locations. Indeed, the phylogeny of the Cameroonian strains displays the typical star-like topology and intermixing of strains from different locations that are characteristic of an exponential outbreak localized around a relatively restricted area with occasional spillover to other parts of the country, likely mediated by direct human contact and human movement. Findings highlight the utility of whole genome sequencing and phylogenetic analysis in understanding transmission patterns at the local level. PMID

  10. Cholera studies*

    PubMed Central

    Swaroop, S.; Pollitzer, R.

    1955-01-01

    In this study, figures relating to cholera deaths occurring in individual countries, from 1900 to 1952, are recorded as well as the incidence of the disease from 1923 up to the present time. The mode of spread of cholera from its endemic home in India to outside countries is described in relation to favourable seasons, main routes followed by the infection, and the role played by large religious gatherings. The incidence of the disease in the various seaports infected within recent years is discussed. PMID:14364186

  11. Cholera in the Americas.

    PubMed

    1991-01-01

    The cholera epidemic 1st hit South America in January 1991 in the coastal town of Chancay, Peru. In 2 weeks, it spread over 2000 km of the Pacific coast. By the end of the 1st month, it had already reached the mountains and tropical forests. By August 1991, cholera cases were reported in order of appearances in Ecuador, Colombia, Chile, Brazil, the US, Mexico, Guatemala, Bolivia, and El Salvador. Health authorities still do not know how it was introduced into South America. The case fatality rate has remained at a low of 1%, probably due to the prompt actions of health authorities in informing the public of the epidemic and what preventive cautions should be taken. This epidemic is part of the 7th pandemic which originated in Celebes, Indonesia in 1961. Cholera can spread relatively unchecked in Latin America because sewage in urban areas is not treated even though they do have sewage collection systems. The untreated wastewater enters rivers and the ocean. Consumption of raw seafood is not unusual and has been responsible for cholera infection in some cases. In fact, many countries placed import restrictions on marine products from Peru following the outbreak at a loss of $US10-$US40 million. Municipal sewage treatment facilities, especially stabilization ponds, would prevent the spread of cholera and other pathogens. In rural areas, pit latrines located away from wells can effectively dispose of human wastes. Most water supplies in Latin America are not disinfected. Disinfection drinking water with adequate levels of chlorine would effectively destroy V. cholera. If this is not possible, boiling the water for 2-3 minutes would destroy the pathogen. Any cases of cholera must be reported to PAHO. PAHO has responded to the outbreak by forming a Cholera Task Force and arranged transport of oral rehydration salts, intravenous fluids, antibiotics, and other essential medical supplies.

  12. Characterization of environmental Vibrio cholerae serogroups O1 and O139 in the Pearl River Estuary, China.

    PubMed

    Li, Xiujun; Wang, Duochun; Li, Baisheng; Zhou, Haijian; Liang, Song; Ke, Changwen; Deng, Xiaoling; Kan, Biao; Morris, J Glenn; Cao, Wuchun

    2016-02-01

    Toxigenic isolates of Vibrio cholerae serogroups O1 and O139 from aquatic reservoirs are a key source for recurrent epidemics of cholera in human populations. However, we do not have an optimal understanding of the microbiology of the strains within these reservoirs, particularly outside of the time periods when there are active cholera cases in the surrounding community. The main objective of the present study was to identify and characterize V. cholerae O1 and O139 in the Pearl River Estuary at a time when active disease was not being identified, despite prior occurrence of epidemic cholera in the region. Water samples were collected at 24 sites in the research area at monthly intervals between 2007 and 2010, and screened for the presence of V. cholerae O1 and O139. All isolates were screened for the presence of ctxAB, ompW, toxR, and tcpA genes. Multilocus variable number tandem repeat analysis (MLVA) was used to assess possible relationships among strains. The results show that Vibrio cholerae O1 or O139 was isolated, on average, from 6.7% of the sites screened at each time point. All V. cholerae O1 and O139 isolates were ctxAB negative, and 37% were positive for tcpA. Isolation was most common in the oldest, most urbanized district compared with other districts, and was associated with lower pH. Despite year-to-year variability in isolation rates, there was no evidence of seasonality. MLVA of 27 selected isolates showed evidence of high genetic diversity, with no evidence of clustering by year or geographic location. In this region where cholera has been epidemic in the past, there is evidence of environmental persistence of V. cholerae O1 and O139 strains. However, environmental strains were consistently nontoxigenic, with a high level of genetic diversity; their role as current or future agents of human disease remains uncertain.

  13. Cholera in a developing megacity; Karachi, Pakistan.

    PubMed Central

    Sheikh, A.; Khan, A.; Malik, T.; Fisher-Hoch, S. P.

    1997-01-01

    Despite rapid urbanization and increasing affluence in Karachi, cases of cholera are frequent. We analysed computerized isolation data from the AKUH Clinical Microbiology Laboratory, Karachi, from 1990-6 to examine microbiological, temporal and demographic trends in Vibrio cholerae infections. During this period 888 strains of V. cholerae (566 V. cholerae serogroup O1, and 204 V. cholerae serogroup O139) were isolated from specimens from 886 patients; 214/464 were adult inpatients, and 250/464 paediatric inpatients, the remaining 422 outpatients. Isolations peaked between June and August. Overlapping epidemics occurred in 1993 and 1994 of serogroup O1 (May to August), and serogroup O139 (August to October). All ages and social and economic strata were affected. Forty-four percent of all isolates were from children under the age of 5 years. The mean age of all patients with serogroup O1 infections was 19.6 years (+/-0.9) compared with 367 (+/-1.7) for serogroup O139 infections (P < 0.0001, t test). More than a quarter (27%) of all serogroup O1 isolates were from babies under 2 years of age. One patient had a serogroup O1 infection followed by a serogroup O139 infection 1 year later. Another patient was infected with serogroup O1 strains 5 years apart. Emergence of resistant strains was observed, but by 1996 serogroup O139 had disappeared. An aquatic organism, cholera nevertheless continues to take its toll in this city of 11 million situated in a desert. PMID:9440430

  14. A five-year study on the epidemiological approaches to cholera in Iran

    PubMed Central

    Mafi, Moharam; Goya, Mohammad Mahdi; Hajia, Massoud

    2016-01-01

    Background: Cholera is considered a key indicator of social development but still is reported in various cities of Iran. The present study aimed to analyze the available information regarding cholera outbreaks since 2010 in Iran. Methods: All cases reported to the Center for Disease Control and Prevention of Ministry of Health and Education who had been confirmed as cholera cases by the Health Reference Laboratory, were entered into this study since 2010. A specific spreadsheet was designed to ensure the safe keeping of the patient records. Results: A total of 1522 patients were clinically diagnosed as cholera with laboratory confirmation over the study period. Cholera was detected in 26 Provinces and 115 cities during this period. Mean age of the patients was 35.1±17, both the Inaba and Ogawa strains were isolated. The highest mortality and the morbidity rate was 1.98% in 2013. The most cholera prevalent provinces in order of frequency were Baluchistan, Alborz, Gilan, Golestan and Qom, as well as Tehran. Inaba serotype was the most common cause of mortality and morbidity in 2013. Conclusion: These findings indicate significant outbreaks of cholera in some of the provinces of Iran and warrant appropriate treatment and preventive measures. PMID:27757199

  15. Cholera: assessing the risk to travellers and identifying methods of protection.

    PubMed

    Steffen, Robert; Acar, Jacques; Walker, Eric; Zuckerman, Jane

    2003-05-01

    This review is based on the findings of a consultation meeting involving consultants in travel medicine and focusing on the risks of cholera to the traveller. Cholera is a severe diarrhoeal disease transmitted via the faeco-oral route and commonly associated with poor sanitation. Between the years of 1995 and 2001, the WHO reported 1829 cases of cholera in developed countries, the majority of which were imported. However, it is believed that this figure reflects less than 10% of the true incidence of cholera due to milder cases being unrecognised, as well as significant underreporting. Travellers to epidemic countries may be at increased risk of contracting cholera if they ingest contaminated food or water. It has been estimated that there are 0.2 cases of cholera per 100,000 European and North American travellers, though there is some evidence that this rate is higher. Oral vaccines are a necessary and welcome advance as, in addition to preventing illness, they can minimise the possibility of transmission of cholera to disease-free regions. The morbidity from cholera can range from asymptomatic or oligosymptomatic infection to disruption of holiday and business plans, or even severe toxicity and dehydration. If untreated, severe illnesses can be fatal, although fatalities have not been reported among travellers for many years.

  16. Analyzing transmission dynamics of cholera with public health interventions.

    PubMed

    Posny, Drew; Wang, Jin; Mukandavire, Zindoga; Modnak, Chairat

    2015-06-01

    Cholera continues to be a serious public health concern in developing countries and the global increase in the number of reported outbreaks suggests that activities to control the diseases and surveillance programs to identify or predict the occurrence of the next outbreaks are not adequate. These outbreaks have increased in frequency, severity, duration and endemicity in recent years. Mathematical models for infectious diseases play a critical role in predicting and understanding disease mechanisms, and have long provided basic insights in the possible ways to control infectious diseases. In this paper, we present a new deterministic cholera epidemiological model with three types of control measures incorporated into a cholera epidemic setting: treatment, vaccination and sanitation. Essential dynamical properties of the model with constant intervention controls which include local and global stabilities for the equilibria are carefully analyzed. Further, using optimal control techniques, we perform a study to investigate cost-effective solutions for time-dependent public health interventions in order to curb disease transmission in epidemic settings. Our results show that the basic reproductive number (R0) remains the model's epidemic threshold despite the inclusion of a package of cholera interventions. For time-dependent controls, the results suggest that these interventions closely interplay with each other, and the costs of controls directly affect the length and strength of each control in an optimal strategy.

  17. [Cholera in 1831. Challenges for science and the federal government].

    PubMed

    Stamm-Kuhlmann, T

    1989-01-01

    The peak of the first great cholera pandemic in 1831 fomented the controversy among contagionists and non-contagionists. In the following year the public debate centered around the correct interpretation of the recent experiences with cholera. The central government of the bureaucratic-absolutist monarchy in Prussia adhered to a firmly contagionist interpretation of the disease and reacted accordingly. Local authorities in Königsberg and Berlin and the bourgeoisie in the merchant city of Danzig, however, stressed the destructive consequences of the cordon system. They considered the results of an interruption in trade and industry to be worse than the damage inflicted by the epidemic. The summer of 1831 demonstrated that cholera could not be stopped by the cordons, but the King's medical advisors nevertheless remained contagionists. Non-contagionists put forward several hypotheses to explain the origin and the spreading of cholera, mainly "miasma" theory and the Hippocratic paradigm of "epidemic constitution". The correlation between poverty and disease, however, was widely noticed. Physicians in the city of Bremen pointed to the necessity of sanitary precautions to be taken in cholera-free periods. On the other hand, many "honest" citizens believed that individuals with a "dissolute" conduct of life were more at risk to contract cholera than others. Instead of costly sanitary policies, the well-to-do classes preferred to identify the defense against cholera with the segregation of unwelcome elements of society. The article is based on hitherto unpublished sources from the former Prussian State Archives at Merseburg, GDR, and the State Archive of the Hanseatic City of Bremen.

  18. Sustained Local Diversity of Vibrio cholerae O1 Biotypes in a Previously Cholera-Free Country

    PubMed Central

    2016-01-01

    ABSTRACT Although the current cholera pandemic can trace its origin to a specific time and place, many variants of Vibrio cholerae have caused this disease over the last 50 years. The relative clinical importance and geographical distribution of these variants have changed with time, but most remain in circulation. Some countries, such as Mexico and Haiti, had escaped the current pandemic, until large epidemics struck them in 1991 and 2010, respectively. Cholera has been endemic in these countries ever since. A recent retrospective study in mBio presents the results of more than 3 decades of V. cholerae monitoring from environmental and clinical sources in Mexico (S. Y. Choi et al., mBio 7:e02160-15, 2016, http://dx.doi.org/10.1128/mBio.02160-15). It reveals that multiple V. cholerae variants, including classical strains from the previous pandemic, as well as completely novel biotypes, have been circulating in Mexico. This discovery has important implications for the epidemiology and evolution of V. cholerae. PMID:27143391

  19. Understanding impacts of climatic extremes on diarrheal disease epidemics: Insights from mechanistic disease propagation models

    NASA Astrophysics Data System (ADS)

    Jutla, A.; Akanda, A. S.; Colwell, R. R.

    2013-12-01

    An epidemic outbreak of diarrheal diseases (primarily cholera) in Haiti in 2010 is a reminder that our understanding on disease triggers, transmission and spreading mechanisms is incomplete. Cholera can occur in two forms - epidemic (defined as sudden outbreak in a historically disease free region) and endemic (recurrence and persistence of the disease for several consecutive years). Examples of countries with epidemic cholera include Pakistan (2008), Congo (2008), and most recently Haiti (2010). A significant difference between endemic and epidemic regions is the mortality rate, i.e., 1% or lower in an endemic regions versus 3-7% during recent epidemic outbreaks. A fundamentally transformational approach - a warning system with several months prediction lead time - is needed to prevent disease outbreak and minimize its impact on population. Lack of information on spatial and temporal variability of disease incidence as well as transmission in human population continues to be significant challenge in the development of early-warning systems for cholera. Using satellite data on regional hydroclimatic processes, water and sanitation infrastructure indices, and biological pathogen growth information, here we present a Simple, Mechanistic, Adaptive, Remote sensing based Regional Transmission or SMART model to (i) identify regions of potential cholera outbreaks and (ii) quantify mechanism of spread of the disease in previously disease free region. Our results indicate that epidemic regions are located near regional rivers and are characterized by sporadic outbreaks, which are likely to be initiated during episodes of prevailing warm air temperature with low river flows, creating favorable environmental conditions for the growth of cholera bacteria. Heavy rainfall, through inundation or breakdown of sanitary infrastructure, accelerates interaction between contaminated water and human activities, resulting in an epidemic. We discuss the above findings in light of

  20. The seventh pandemic of cholera in the USSR, 1961-89.

    PubMed Central

    Narkevich, M. I.; Onischenko, G. G.; Lomov, J. M.; Moskvitina, E. A.; Podosinnikova, L. S.; Medinsky, G. M.

    1993-01-01

    Over the period 1961-89 a total of 1,713,057 cases of cholera were reported to WHO from 117 countries in all continents. The course of the epidemic fell into three periods: in period I (1961 to 1969), 24 countries (predominantly in Asia) reported about 419,968 cholera cases; in period II (1970 to 1977), 73 countries from Asia, Africa, Europe, and the Americas reported 706,261 cases; and in period III (1978 to 1989), 83 countries reported 586,828 cases. The global epidemic was at its most severe in 1967-74. Subsequently morbidity declined and up to 1989 had remained high and stable, with 44,000-52,000 cases per annum. In the USSR 10,723 cholera cases and carriers were reported between 1965 and 1989 from 11 republics (but not Latvia, Lithuania, Estonia, or Armenia). In 1965 and 1970-74 large-scale outbreaks of imported cholera were characteristic of the epidemic in the USSR. Thereafter morbidity declined, and sporadic cases were reported along with environmental, predominantly nontoxigenic strains of cholera vibrio. Most of the outbreaks in the 1970s were waterborne, and virulent strains containing the vct-gene were isolated from samples of water. Large-scale outbreaks continued that were associated with seafood and dairy produce that were contaminated with cholera vibrio. Clinical cases of cholera as well as a considerable number of carriers of avirulent nontoxigenic strains were reported. The epidemiological situation in the USSR is unstable, with cases of cholera and virulent strains from surface water being reported every year.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:8490982

  1. Vibrio cholerae in the environment.

    PubMed

    Soomro, Abdul Lateef; Junejo, Nasreen

    2004-08-01

    The emergence of cholera has been a significant public health problem around the world and battle to completely control this deadly disease continues. Prevalence of Vibrio cholerae (V. cholerae) microorganisms in the environment was considered as the most important factor in this regard. Soil, fresh water, sea water, aquatic plants, animals and some birds have been made target for search if they were providing reserve shelter to the causative agent during inter epidemic periods. Multiple environmental factors have been considered to have the aetiological relationship as no single source is found to host the microorganisms in an inter-epidemic period. We have attempted to review the literature from different parts of the world; encompassing experimental and isolation studies of pathogenic and non-pathogenic strains of V. cholerae in the environment. The non-pathogenic strains were also included due to converting behavior of the agents in the changing environmental scenario to pathogenic forms.

  2. Multiple Antibiotic Resistance of Vibrio cholerae Serogroup O139 in China from 1993 to 2009

    PubMed Central

    Wang, Ruibai; Lou, Jing; Zhang, Lijuan; Li, Jie; Bi, Zhenqiang; Kan, Biao

    2012-01-01

    Regarded as an emerging diarrheal micropathogen, Vibrio cholerae serogroup O139 was first identified in 1992 and has become an important cause of cholera epidemics over the last two decades. O139 strains have been continually isolated since O139 cholera appeared in China in 1993, from sporadic cases and dispersed foodborne outbreaks, which are the common epidemic types of O139 cholera in China. Antibiotic resistance profiles of these epidemic strains are required for development of clinical treatments, epidemiological studies and disease control. In this study, a comprehensive investigation of the antibiotic resistance of V. cholerae O139 strains isolated in China from 1993 to 2009 was conducted. The initial O139 isolates were resistant to streptomycin, trimethoprim-sulfamethoxazole and polymyxin B only, while multidrug resistance increased suddenly and became common in strains isolated after 1998. Different resistance profiles were observed in the isolates from different years. In contrast, most V. cholerae O1 strains isolated in the same period were much less resistant to these antibiotics and no obvious multidrug resistance patterns were detected. Most of the non-toxigenic strains isolated from the environment and seafood were resistant to four antibiotics or fewer, although a few multidrug resistant strains were also identified. These toxigenic O139 strains exhibited a high prevalence of the class I integron and the SXT element, which were rare in the non-toxigenic strains. Molecular subtyping of O139 strains showed highly diverse pulsed-field gel electrophoresis patterns, which may correspond to the epidemic state of sporadic cases and small-scale outbreaks and complex resistance patterns. Severe multidrug resistance, even resistance transfers based on mobile antibiotic resistance elements, increases the probability of O139 cholera as a threat to public health. Therefore, continual epidemiological and antibiotic sensitivity surveillance should focus on the

  3. Multiple antibiotic resistance of Vibrio cholerae serogroup O139 in China from 1993 to 2009.

    PubMed

    Yu, Li; Zhou, Yanyan; Wang, Ruibai; Lou, Jing; Zhang, Lijuan; Li, Jie; Bi, Zhenqiang; Kan, Biao

    2012-01-01

    Regarded as an emerging diarrheal micropathogen, Vibrio cholerae serogroup O139 was first identified in 1992 and has become an important cause of cholera epidemics over the last two decades. O139 strains have been continually isolated since O139 cholera appeared in China in 1993, from sporadic cases and dispersed foodborne outbreaks, which are the common epidemic types of O139 cholera in China. Antibiotic resistance profiles of these epidemic strains are required for development of clinical treatments, epidemiological studies and disease control. In this study, a comprehensive investigation of the antibiotic resistance of V. cholerae O139 strains isolated in China from 1993 to 2009 was conducted. The initial O139 isolates were resistant to streptomycin, trimethoprim-sulfamethoxazole and polymyxin B only, while multidrug resistance increased suddenly and became common in strains isolated after 1998. Different resistance profiles were observed in the isolates from different years. In contrast, most V. cholerae O1 strains isolated in the same period were much less resistant to these antibiotics and no obvious multidrug resistance patterns were detected. Most of the non-toxigenic strains isolated from the environment and seafood were resistant to four antibiotics or fewer, although a few multidrug resistant strains were also identified. These toxigenic O139 strains exhibited a high prevalence of the class I integron and the SXT element, which were rare in the non-toxigenic strains. Molecular subtyping of O139 strains showed highly diverse pulsed-field gel electrophoresis patterns, which may correspond to the epidemic state of sporadic cases and small-scale outbreaks and complex resistance patterns. Severe multidrug resistance, even resistance transfers based on mobile antibiotic resistance elements, increases the probability of O139 cholera as a threat to public health. Therefore, continual epidemiological and antibiotic sensitivity surveillance should focus on the

  4. Critical analysis of compositions and protective efficacies of oral killed cholera vaccines.

    PubMed

    Kabir, Shahjahan

    2014-09-01

    Two cholera vaccines, sold as Shanchol and Dukoral, are currently available. This review presents a critical analysis of the protective efficacies of these vaccines. Children under 5 years of age are very vulnerable to cholera and account for the highest incidence of cholera cases and more than half of the resulting deaths. Both Shanchol and Dukoral are two-spaced-dose oral vaccines comprising large numbers of killed cholera bacteria. The former contains Vibrio cholerae O1 and O139 cells, and the latter contains V. cholerae O1 cells with the recombinant B subunit of cholera toxin. In a field trial in Kolkata (India), Shanchol, the preferred vaccine, protected 45% of the test subjects in all of the age groups and only 17% of the children under 5 years of age during the first year of surveillance. In a field trial in Peru, two spaced doses of Dukoral offered negative protection in children under 5 years of age and little protection (15%) in vaccinees over 6 years of age during the first year of surveillance. Little is known about Dukoral's long-term protective efficacy. Both of these vaccines have questionable compositions, using V. cholerae O1 strains isolated in 1947 that have been inactivated by heat and formalin treatments that may denature protein. Immunological studies revealed Dukoral's reduced and short-lived efficacy, as measured by several immunological endpoints. Various factors, such as the necessity for multiple doses, poor protection of children under 5 years of age, the requirement of a cold supply chain, production costs, and complex logistics of vaccine delivery, greatly reduce the suitability of either of these vaccines for endemic or epidemic cholera control in resource-poor settings.

  5. Avian Cholera, a Threat to the Viability of an Arctic Seabird Colony?

    PubMed Central

    Descamps, Sébastien; Jenouvrier, Stéphanie; Gilchrist, H. Grant; Forbes, Mark R.

    2012-01-01

    Evidence that infectious diseases cause wildlife population extirpation or extinction remains anecdotal and it is unclear whether the impacts of a pathogen at the individual level can scale up to population level so drastically. Here, we quantify the response of a Common eider colony to emerging epidemics of avian cholera, one of the most important infectious diseases affecting wild waterfowl. We show that avian cholera has the potential to drive colony extinction, even over a very short period. Extinction depends on disease severity (the impact of the disease on adult female survival) and disease frequency (the number of annual epidemics per decade). In case of epidemics of high severity (i.e., causing >30% mortality of breeding females), more than one outbreak per decade will be unsustainable for the colony and will likely lead to extinction within the next century; more than four outbreaks per decade will drive extinction to within 20 years. Such severity and frequency of avian cholera are already observed, and avian cholera might thus represent a significant threat to viability of breeding populations. However, this will depend on the mechanisms underlying avian cholera transmission, maintenance, and spread, which are currently only poorly known. PMID:22355304

  6. Enterotoxigenic Escherichia coli and Vibrio cholerae diarrhea, Bangladesh, 2004.

    PubMed

    Qadri, Firdausi; Khan, Ashraful I; Faruque, Abu Syed G; Begum, Yasmin Ara; Chowdhury, Fahima; Nair, Gopinath B; Salam, Mohammed A; Sack, David A; Svennerholm, Ann-Mari

    2005-07-01

    Flooding in Dhaka in July 2004 caused epidemics of diarrhea. Enterotoxigenic Escherichia coli (ETEC) was almost as prevalent as Vibrio cholerae O1 in diarrheal stools. ETEC that produced heat-stable enterotoxin alone was most prevalent, and 78% of strains had colonization factors. Like V. cholerae O1, ETEC can cause epidemic diarrhea.

  7. Invasive Vibrio cholerae Infection Following Burn Injury

    DTIC Science & Technology

    2008-06-01

    as asymptomatic col- onization, otitis , gastroenteritis, soft-tissue infection, sepsis, or even cerebritis. In contrast, epidemic V. cholerae (O-1 or...cholerae grows well on common blood agar, with decreased bacterial over- growth on selective media , such as TCBS agar. As noted in our case (Figure 1), it...is possible for both epidemic and nonepidemic strains to have a “rugose” phenotype on nonselective media , and usually a smooth phenotype on TCBS.11

  8. Fish as Hosts of Vibrio cholerae

    PubMed Central

    Halpern, Malka; Izhaki, Ido

    2017-01-01

    Vibrio cholerae, the causative agent of pandemic cholera, is abundant in marine and freshwater environments. Copepods and chironomids are natural reservoirs of this species. However, the ways V. cholerae is globally disseminated are as yet unknown. Here we review the scientific literature that provides evidence for the possibility that some fish species may be reservoirs and vectors of V. cholerae. So far, V. cholerae has been isolated from 30 fish species (22 freshwater; 9 marine). V. cholerae O1 was reported in a few cases. In most cases V. cholerae was isolated from fish intestines, but it has also been detected in gills, skin, kidney, liver and brain tissue. In most cases the fish were healthy but in some, they were diseased. Nevertheless, Koch postulates were not applied to prove that V. cholerae and not another agent was the cause of the disease in the fish. Evidence from the literature correlates raw fish consumption or fish handling to a few cholera cases or cholera epidemics. Thus, we can conclude that V. cholerae inhabits some marine and freshwater fish species. It is possible that fish may protect the bacteria in unfavorable habitats while the bacteria may assist the fish to digest its food. Also, fish may disseminate the bacteria in the aquatic environment and may transfer it to waterbirds that consume them. Thus, fish are reservoirs of V. cholerae and may play a role in its global dissemination. PMID:28293221

  9. Active surveillance of the aquatic environment for potential prediction, prevention and spread of water borne disease: the cholera paradigm

    NASA Astrophysics Data System (ADS)

    Huq, A.; Colwell, R.

    2011-12-01

    Based on results of ecological and epidemiological studies, occurrence and spread of certain diseases are more fully understood. Cholera is a major waterborne disease, that is relatively easily treatable and clearly preventable, yet tens of thousands die each year worldwide. A dose dependent disease, the infectious dose can vary from 103-106, depending on health status of the victim. Historically, cholera has been shown to spread from person to person. Furthermore, the disease is caused predominantly via ingestion of contaminated water and most of the outbreaks that have been recorded worldwide originated in a coastal region. Using appropriate detection methods, Vibrio cholerae can be isolated from samples collected from ponds, rivers, estuaries, and coastal waters globally. The populations of V. cholerae may vary in numbers during different seasons of the year. It is important to have a clear understanding of the distribution of the causative agent in the environment as such information can assist public health officials in taking action to prevent outbreaks of cholera. Thus an effective monitoring program is critical, particularly in light of climate change with temperature extremes more likely to be occurring. Based on a predictive model and results of ground truth data, temperature has been found to be a factor in the increase of V. cholerae in the environment. Correlation was observed with occurrence of cholera and both temperature and salinity. More recent research indicates additional factors need to be considered in predicting cholera epidemics, including the hydrology and disease dynamics.

  10. Sanitation in the time of cholera.

    PubMed

    Misch, A

    1991-01-01

    Cholera, identified by violent diarrhea, cramps, vomiting, and dehydration, is spreading through Peru into Colombia, Ecuador, Child, and Brazil. Water contaminated with Vibrio cholerae is used for washing food and/or drinking thereby transmitting the disease. PAHO estimates 6 million people in South America may get cholera within the next 3 years. This cholera epidemic is the result of unsanitary conditions in which the urban poor in South America live. In fact, in Lima, Peru, 40% of the people do not have potable, piped water available. These individuals fetch their water from far away taps and private vendors both of which are not necessarily safe. In addition, 40% do not have access to a sewage system. Further, 80% of sick people in developing countries have a water related illness, be it transmitted by contaminated water or by insects and snails that reproduce in the water. Diarrhea is the most deadly of these conditions. Indeed every year 10-20 million children die from the effects of diarrhea which include malnutrition, dehydration, and shock. Yet 940 million people in developing countries have no access to safe water and 1.7 billion do not have a sanitary means of disposing of human wastes, despite the fact that the UN decreed the 1980s the International Drinking Water Supply and Sanitation Decade. Nevertheless UNICEF efforts did bring communal taps, odorless latrines, and/or pour flush toilets to 1.2 billion people. These types of sanitation costs $20-25/person whereas conventional sewers cost $350/person. Low technology supplied water averages $30/person compared to $200/person for piped water. Peru has spent $43 million on emergency medical care for cholera victims which could have provided low cost clean water and sanitation for almost 800,000 poor.

  11. Environmental Monitoring of Endemic Cholera

    NASA Astrophysics Data System (ADS)

    ElNemr, W.; Jutla, A. S.; Constantin de Magny, G.; Hasan, N. A.; Islam, M.; Sack, R.; Huq, A.; Hashem, F.; Colwell, R.

    2012-12-01

    Cholera remains a major public health threat. Since Vibrio cholerae, the causative agent of the disease, is autochthonous to riverine, estuarine, and coastal waters, it is unlikely the bacteria can be eradicated from its natural habitat. Prediction of disease, in conjunction with preventive vaccination can reduce the prevalence rate of a disease. Understanding the influence of environmental parameters on growth and proliferation of bacteria is an essential first step in developing prediction methods for outbreaks. Large scale geophysical variables, such as SST and coastal chlorophyll, are often associated with conditions favoring growth of V. cholerae. However, local environmental factors, meaning biological activity in ponds from where the bulk of populations in endemic regions derive water for daily usage, are either neglected or oversimplified. Using data collected from several sites in two geographically distinct locations in South Asia, we have identified critical local environmental factors associated with cholera outbreak. Of 18 environmental variables monitored for water sources in Mathbaria (a coastal site near the Bay of Bengal) and Bakergonj (an inland site) of Bangladesh, water depth and chlorophyll were found to be important factors associated with initiation of cholera outbreaks. Cholera in coastal regions appears to be related to intrusion. However, monsoonal flooding creates conditions for cholera epidemics in inland regions. This may be one of the first attempts to relate in-situ environmental observations with cholera. We anticipate that it will be useful for further development of prediction models in the resource constrained regions.

  12. Hydroclimatological Controls of Endemic and Non-endemic Cholera of the 20th Century

    NASA Astrophysics Data System (ADS)

    Jutla, A. S.; Whitcombe, E.; Colwell, R.

    2012-12-01

    Cholera remains a major public health threat for the developing countries. Since the causative agent, Vibrio cholerae, is autochthonous to aquatic environment, it is not possible to eradicate the agent of the disease. Hydroclimatology based prediction and prevention strategies can be implemented in disease susceptible regions for reducing incidence rates. However, the precise role of hydrological and climatological processes, which will further aid in development of suitable prediction models, in creating spatial and temporal environmental conditions favorable for disease outbreak has not been adequately quantified. Here, we show distinction between seasonality and occurrence of cholera in epidemic and non-endemic regions. Using historical cholera mortality data, from the late 1800s for 27 locations in the Indian subcontinent, we show that non-endemic regions are generally located close to regional river systems but away from the coasts and are characterized by single sporadic outbreak in a given year. Increase in air temperature during the low river flow season increases evaporation, leading to an optimal salinity and pH required for bacterial growth. Thereafter, monsoonal rainfall, leads to interactions of contaminated river waters via human activity resulting in cholera epidemics. Endemic regions are located close to coasts where cholera outbreak occurs twice (spring and fall) in a year. Spring outbreak is generally associated with intrusion of bacterial seawater to inland whereas the fall peak is correlated with widespread flooding and cross-contamination of water resources via increased precipitation. This may be one of the first studies to hydroclimatologically quantitatively the seasonality of cholera in both endemic and non-endemic regions. Our results prompt the need of region and cause-specific prediction models for cholera, employing appropriate environmental determinants.

  13. The scenario approach for countries considering the addition of oral cholera vaccination in cholera preparedness and control plans.

    PubMed

    Deen, Jacqueline; von Seidlein, Lorenz; Luquero, Francisco J; Troeger, Christopher; Reyburn, Rita; Lopez, Anna Lena; Debes, Amanda; Sack, David A

    2016-01-01

    Oral cholera vaccination could be deployed in a diverse range of situations from cholera-endemic areas and locations of humanitarian crises, but no clear consensus exists. The supply of licensed, WHO-prequalified cholera vaccines is not sufficient to meet endemic and epidemic needs worldwide and so prioritisation is needed. We have developed a scenario approach to systematically classify situations in which oral cholera vaccination might be useful. Our scenario approach distinguishes between five types of cholera epidemiology based on experiences from around the world and provides evidence that we hope will spur the development of detailed guidelines on how and where oral cholera vaccines could, and should, be most rationally deployed.

  14. Climate and infectious disease: use of remote sensing for detection of Vibrio cholerae by indirect measurement.

    PubMed

    Lobitz, B; Beck, L; Huq, A; Wood, B; Fuchs, G; Faruque, A S; Colwell, R

    2000-02-15

    It has long been known that cholera outbreaks can be initiated when Vibrio cholerae, the bacterium that causes cholera, is present in drinking water in sufficient numbers to constitute an infective dose, if ingested by humans. Outbreaks associated with drinking or bathing in unpurified river or brackish water may directly or indirectly depend on such conditions as water temperature, nutrient concentration, and plankton production that may be favorable for growth and reproduction of the bacterium. Although these environmental parameters have routinely been measured by using water samples collected aboard research ships, the available data sets are sparse and infrequent. Furthermore, shipboard data acquisition is both expensive and time-consuming. Interpolation to regional scales can also be problematic. Although the bacterium, V. cholerae, cannot be sensed directly, remotely sensed data can be used to infer its presence. In the study reported here, satellite data were used to monitor the timing and spread of cholera. Public domain remote sensing data for the Bay of Bengal were compared directly with cholera case data collected in Bangladesh from 1992-1995. The remote sensing data included sea surface temperature and sea surface height. It was discovered that sea surface temperature shows an annual cycle similar to the cholera case data. Sea surface height may be an indicator of incursion of plankton-laden water inland, e.g., tidal rivers, because it was also found to be correlated with cholera outbreaks. The extensive studies accomplished during the past 25 years, confirming the hypothesis that V. cholerae is autochthonous to the aquatic environment and is a commensal of zooplankton, i.e., copepods, when combined with the findings of the satellite data analyses, provide strong evidence that cholera epidemics are climate-linked.

  15. Climate and infectious disease: use of remote sensing for detection of Vibrio cholerae by indirect measurement

    NASA Technical Reports Server (NTRS)

    Lobitz, B.; Beck, L.; Huq, A.; Wood, B.; Fuchs, G.; Faruque, A. S.; Colwell, R.

    2000-01-01

    It has long been known that cholera outbreaks can be initiated when Vibrio cholerae, the bacterium that causes cholera, is present in drinking water in sufficient numbers to constitute an infective dose, if ingested by humans. Outbreaks associated with drinking or bathing in unpurified river or brackish water may directly or indirectly depend on such conditions as water temperature, nutrient concentration, and plankton production that may be favorable for growth and reproduction of the bacterium. Although these environmental parameters have routinely been measured by using water samples collected aboard research ships, the available data sets are sparse and infrequent. Furthermore, shipboard data acquisition is both expensive and time-consuming. Interpolation to regional scales can also be problematic. Although the bacterium, V. cholerae, cannot be sensed directly, remotely sensed data can be used to infer its presence. In the study reported here, satellite data were used to monitor the timing and spread of cholera. Public domain remote sensing data for the Bay of Bengal were compared directly with cholera case data collected in Bangladesh from 1992-1995. The remote sensing data included sea surface temperature and sea surface height. It was discovered that sea surface temperature shows an annual cycle similar to the cholera case data. Sea surface height may be an indicator of incursion of plankton-laden water inland, e.g., tidal rivers, because it was also found to be correlated with cholera outbreaks. The extensive studies accomplished during the past 25 years, confirming the hypothesis that V. cholerae is autochthonous to the aquatic environment and is a commensal of zooplankton, i.e., copepods, when combined with the findings of the satellite data analyses, provide strong evidence that cholera epidemics are climate-linked.

  16. Initial epidemic area is strongly associated with the yearly extent of soybean rust spread in North America.

    PubMed

    Mundt, Christopher C; Wallace, Larae D; Allen, Tom W; Hollier, Clayton A; Kemerait, Robert C; Sikora, Edward J

    2013-07-01

    Hosts of soybean rust (Phakopsora pachyrhizi) are sensitive to low temperatures, limiting this obligate parasite in the United States to overwintering sites in a restricted area along the Gulf Coast. This temperature sensitivity of soybean rust hosts allowed us to study spatial spread of epidemic invasions over similar territory for seven sequential years, 2005-2011. The epidemic front expanded slowly from early April through July, with the majority of expansion occurring from August through November. There was a 7.4-fold range of final epidemic extent (0.4 to 3.0 million km(2)) from the year of smallest final disease extent (2011) to that of the largest (2007). The final epidemic area of each year was regressed against epidemic areas recorded at one-week intervals to determine the association of final epidemic extent with current epidemic extent. Coefficients of determination for these regressions varied between 0.44 to 0.62 during April and May. The correlation coefficients varied between 0.70 and 0.96 from early June through October, and then increased monotonically to 1.0 by year's end. Thus, the spatial extent of disease when the epidemics began rapid expansion may have been a crucial contributor to subsequent spread of soybean rust. Our analyses used presence/absence data at the county level to evaluate the spread of the epidemic front only; the subsequent local intensification of disease could be strongly influenced by other factors, including weather.

  17. Initial epidemic area is strongly associated with the yearly extent of soybean rust spread in North America

    PubMed Central

    Mundt, Christopher C.; Wallace, LaRae D.; Allen, Tom W.; Hollier, Clayton A.; Kemerait, Robert C.; Sikora, Edward J.

    2012-01-01

    Hosts of soybean rust (Phakopsora pachyrhizi) are sensitive to low temperatures, limiting this obligate parasite in the United States to overwintering sites in a restricted area along the Gulf Coast. This temperature sensitivity of soybean rust hosts allowed us to study spatial spread of epidemic invasions over similar territory for seven sequential years, 2005–2011. The epidemic front expanded slowly from early April through July, with the majority of expansion occurring from August through November. There was a 7.4-fold range of final epidemic extent (0.4 to 3.0 million km2) from the year of smallest final disease extent (2011) to that of the largest (2007). The final epidemic area of each year was regressed against epidemic areas recorded at one-week intervals to determine the association of final epidemic extent with current epidemic extent. Coefficients of determination for these regressions varied between 0.44 to 0.62 during April and May. The correlation coefficients varied between 0.70 and 0.96 from early June through October, and then increased monotonically to 1.0 by year's end. Thus, the spatial extent of disease when the epidemics began rapid expansion may have been a crucial contributor to subsequent spread of soybean rust. Our analyses used presence/absence data at the county level to evaluate the spread of the epidemic front only; the subsequent local intensification of disease could be strongly influenced by other factors, including weather. PMID:23853520

  18. Survival of classic cholera in Bangladesh.

    PubMed

    Siddique, A K; Baqui, A H; Eusof, A; Haider, K; Hossain, M A; Bashir, I; Zaman, K

    1991-05-11

    During the present cholera pandemic the El Tor biotype of Vibrio cholerae has completely displaced the classic biotype, except in Bangladesh. We studied the distribution of these two biotypes in twenty-four rural districts during epidemics in 1988-89; there was clustering of the classic biotype in the southern region and of the El Tor biotype in all other regions. These findings suggest that the southern coastal region is now (and may always have been) the habitat of classic cholera. The selective distribution of V cholerae O1 biotypes in Bangladesh may have been affected by ecological changes occurring in the country.

  19. The Potential Financial Costs of Climate Change on Health of Urban and Rural Citizens: A Case Study of Vibrio cholerae Infections at Bukavu Town, South Kivu Province, Eastern of Democratic Republic of Congo

    PubMed Central

    MUNYULI, MB Théodore; KAVUVU, J-M Mbaka; MULINGANYA, Guy; BWINJA, G Mulinganya

    2013-01-01

    Background: Cholera epidemics have a recorded history in eastern Congo dating to 1971. A study was conducted to find out the linkage between climate variability/change and cholera outbreak and to assess the related economic cost in the management of cholera in Congo. Methods: This study integrates historical data (20 years) on temperature and rainfall with the burden of disease from cholera in South-Kivu province, eastern Congo. Results: Analyses of precipitation and temperatures characteristics in South-Kivu provinces showed that cholera epidemics are closely associated with climatic factors variability. Peaks in Cholera new cases were in synchrony with peaks in rainfalls. Cholera infection cases declined significantly (P<0.05) with the rise in the average temperature. The monthly number of new Cholera cases oscillated between 5 and 450. For every rise of the average temperature by 0.35 °C to 0.75 °C degree Celsius, and for every change in the rainfall variability by 10–19%, it is likely cholera infection risks will increase by 17 to 25%. The medical cost of treatment of Cholera case infection was found to be of US$50 to 250 per capita. The total costs of Cholera attributable to climate change were found to fall in the range of 4 to 8% of the per capita in annual income in Bukavu town. Conclusion: It is likely that high rainfall favor multiplication of the bacteria and contamination of water sources by the bacteria (Vibrio cholerae). The consumption of polluted water, promiscuity, population density and lack of hygiene are determinants favoring spread and infection of the bacteria among human beings living in over-crowded environments. PMID:24427750

  20. Epidemic typhoid in Chile: analysis by molecular and conventional methods of Salmonella typhi strain diversity in epidemic (1977 and 1981) and nonepidemic (1990) years.

    PubMed Central

    Fica, A E; Prat-Miranda, S; Fernandez-Ricci, A; D'Ottone, K; Cabello, F C

    1996-01-01

    From 1977 to 1986, Chile experienced an important typhoid fever epidemic, despite statistics that indicated apparently improving levels of sanitation of drinking water and sewage disposal. The lack of antibiotic resistance among the Salmonella typhi strains isolated during this period, the mild clinical presentation of the disease, and the initially low level of efficacy of the S. typhi Ty21a vaccine in the population exposed to the epidemic suggested that this epidemic might have resulted from the dissemination of S. typhi strains with unique characteristics. To investigate this hypothesis, we used conventional methods (bacteriophage typing and biotyping) and molecular methods (restriction fragment length polymorphism analysis, ribotyping, IS200 typing, and PCR amplification of the fliC-d gene) to study a population of 149 S. typhi isolates during 1977, 1981, and 1990, the years that included periods with low (when the disease was endemic) and high (when the disease was epidemic) morbidities. Our results indicate that these S. typhi isolates in Chile represent a number of highly diverse variants of the clone of S. typhi with a worldwide distribution described by Selander et al. (R. K. Selander, P. Beltran, N.H. Smith, R. Helmuth, F.A. Rubin, D.J. Kopecko, K. Ferris, B.D. Tall, A. Cravioto, and J.M. Musser, Infect. Immun. 58:2262-2275, 1990). For example, we detected 26 PstI and 10 ClaI ribotypes among 47 and 16 S. typhi strains belonging to this clone, respectively. These results suggest that the Chilean epidemic was probably produced by multiple sources of infection because of deficient sanitary conditions. These findings illustrate the usefulness of molecular methods for characterizing the potential causes of the typhoid epidemics and the possible routes of transmission of S. typhi strains in typhoid epidemics. PMID:8784573

  1. Local environmental predictors of cholera in Bangladesh and Vietnam.

    PubMed

    Emch, Michael; Feldacker, Caryl; Yunus, Mohammad; Streatfield, Peter Kim; DinhThiem, Vu; Canh, Do Gia; Ali, Mohammad

    2008-05-01

    Environmental factors have been shown to be related to cholera and thus might prove useful for prediction. In Bangladesh and Vietnam, temporal cholera distributions are related to satellite-derived and in-situ environmental time series data in order to examine the relationships between cholera and the local environment. Ordered probit models examine associations in Bangladesh; probit models examine associations at 2 sites in Vietnam. Increases in ocean chlorophyll concentration are related to an increased magnitude of cholera in Bangladesh. Increases in sea surface temperature are most influential in Hue, Vietnam, whereas increases in river height have a significant role in Nha Trang, Vietnam. Cholera appearance and epidemic magnitude are related to the local environment. Local environmental parameters have consistent effects when cholera is regular and more prevalent in endemic settings, but in situations where cholera epidemics are rare there are differential environmental effects.

  2. Influence of diffusion on the stability of equilibria in a reaction-diffusion system modeling cholera dynamic.

    PubMed

    Capone, Florinda; De Cataldis, Valentina; De Luca, Roberta

    2015-11-01

    A reaction-diffusion system modeling cholera epidemic in a non-homogeneously mixed population is introduced. The interaction between population and toxigenic Vibrio cholerae concentration in contaminated water has been taken into account. The existence of biologically meaningful equilibria is investigated together with their linear and nonlinear stability. Using the data collected during the Haiti cholera epidemic, a numerical simulation is performed.

  3. Clinical and functional characteristics of patients two years after being affected by the soybean asthma epidemic in Barcelona.

    PubMed Central

    Sabrià, J.; Antó, J. M.; Sunyer, J.; Roca, J.; Morell, F.; Rodríguez-Roisín, R.; Rodrigo, M. J.; Codina, R.

    1994-01-01

    BACKGROUND--Patients affected during the asthma outbreaks caused by soybean dust inhalation in Barcelona presented with sudden onset of severe asthma followed by the rapid relief of symptoms after treatment. Two years after the epidemics ended, a case-control study was conducted in which the clinical, functional, and immunological characteristics of these asthma patients (a randomised sample of asthmatic patients admitted as emergency cases on epidemic days, n = 213) were compared with those of a control group (a random sample of asthmatic patients admitted as emergency cases for attacks of asthma on non-epidemic days, n = 170). METHODS--The study included the administration of the ATS-DLD78 standardised respiratory questionnaire, the measurement of atopy, and performance of spirometric tests and a methacholine inhalation test. RESULTS--Patients with epidemic asthma reported fewer symptoms of asthma, had attended emergency departments less frequently during the previous year for acute attacks of asthma, were taking fewer inhaled corticosteroids at the time of the study, and attended medical follow up less frequently than did the patients with non-epidemic asthma. However, the cases and controls showed no differences in ventilatory capacity or reactivity to the methacholine bronchoprovocation test. CONCLUSIONS--Two years after the end of the soybean epidemics, people affected by epidemic asthma had a favourable prognosis. This finding contrasts with a higher risk of life threatening asthma and death during the epidemics. This paradox could be the result of a complex interaction between host and conditions of exposure. Images PMID:7940432

  4. Seasonal Cholera Caused by Vibrio cholerae Serogroups O1 and O139 in the Coastal Aquatic Environment of Bangladesh

    PubMed Central

    Alam, Munirul; Hasan, Nur A.; Sadique, Abdus; Bhuiyan, N. A.; Ahmed, Kabir U.; Nusrin, Suraia; Nair, G. Balakrish; Siddique, A. K.; Sack, R. Bradley; Sack, David A.; Huq, Anwar; Colwell, Rita R.

    2006-01-01

    Since Vibrio cholerae O139 first appeared in 1992, both O1 El Tor and O139 have been recognized as the epidemic serogroups, although their geographic distribution, endemicity, and reservoir are not fully understood. To address this lack of information, a study of the epidemiology and ecology of V. cholerae O1 and O139 was carried out in two coastal areas, Bakerganj and Mathbaria, Bangladesh, where cholera occurs seasonally. The results of a biweekly clinical study (January 2004 to May 2005), employing culture methods, and of an ecological study (monthly in Bakerganj and biweekly in Mathbaria from March 2004 to May 2005), employing direct and enrichment culture, colony blot hybridization, and direct fluorescent-antibody methods, showed that cholera is endemic in both Bakerganj and Mathbaria and that V. cholerae O1, O139, and non-O1/non-O139 are autochthonous to the aquatic environment. Although V. cholerae O1 and O139 were isolated from both areas, most noteworthy was the isolation of V. cholerae O139 in March, July, and September 2004 in Mathbaria, where seasonal cholera was clinically linked only to V. cholerae O1. In Mathbaria, V. cholerae O139 emerged as the sole cause of a significant outbreak of cholera in March 2005. V. cholerae O1 reemerged clinically in April 2005 and established dominance over V. cholerae O139, continuing to cause cholera in Mathbaria. In conclusion, the epidemic potential and coastal aquatic reservoir for V. cholerae O139 have been demonstrated. Based on the results of this study, the coastal ecosystem of the Bay of Bengal is concluded to be a significant reservoir for the epidemic serogroups of V. cholerae. PMID:16751520

  5. IncA/C plasmids harboured in serious multidrug-resistant Vibrio cholerae serogroup O139 strains in China.

    PubMed

    Wang, Ruibai; Yu, Dong; Zhu, Lianhui; Li, Jie; Yue, Junjie; Kan, Biao

    2015-03-01

    Vibrio cholerae serogroup O139 emerged in 1992 and is one of two major serogroups to have caused cholera epidemics. After 1998, serious multidrug-resistant (MDR) O139 strains quickly became common in China, showing a multidrug resistance profile to eight antibiotics. It is a great threat to public health, and elucidation of its mechanisms of resistance will provide a helpful guide for the clinical treatment and prevention of cholera. In this study, mega-plasmids from MDR V. cholerae O139 strains were identified by pulsed-field gel electrophoresis (PFGE) without enzyme digestion. One plasmid was isolated and sequenced, belonging to the IncA/C family. Ten antibiotic resistance genes were found in the MDR regions, including a blaTEM-20 gene, and these genes endowed the host with resistance to seven antibiotics. This kind of plasmid was positive in 71.2% (198/278) of toxigenic O139 strains, and the rate of plasmid positivity was consistent with the yearly change in MDR rates of these strains. This study reveals an important role of the IncA/C family plasmid in the spread of multiple antibiotic resistance of epidemic V. cholerae serogroup O139 strains, which has recombined with plasmids from different bacterial species and transferred among V. cholerae strains.

  6. [Cholera update and vaccination problems].

    PubMed

    Fournier, J M; Villeneuve, S

    1998-01-01

    Cholera remains an important public health problem. The long-term control of cholera depends on good personal hygiene, uncontaminated water supply and appropriate sewage disposal. However, the improvement of hygiene is distant goal for many countries. Thus the availability of an effective cholera vaccine is important for the prevention of cholera in these countries. Research on new cholera vaccines has mainly focused on oral formulations that stimulate the mucosal secretory immune system. Two oral cholera vaccines were experimented on large scale in human. The first vaccine, containing inactivated bacterial cells and B-subunit of cholera toxin, has been tested in Bangladesh from 1985 to 1989. This vaccine, according to WHO, may prove useful in the stable phase of refugee/displaced person crises, especially when given preventively. The second vaccine is a live attenuated vaccine containing the genetically manipulated Vibrio cholerae O1 strain CVD 103-HgR. Despite its efficacy in adult volunteers, results of a large-scale field trial carried-out in Indonesia for 4 years have shown a surprisingly low protection. Moreover, one of the safety concerns associated with live cholera vaccine is a possible horizontal gene transfer and recombination event leading to reversion to virulence. A new vaccine development program for cholera is based upon the hypothesis that immunoglobulins G directed to the O-specific polysaccharide of Vibrio cholerae O1 could confer protective immunity to cholera by inactivating the inoculum on intestinal mucosal surface. This program may lead to the development of cholera conjugate vaccines to elicit protection in infants.

  7. Non-toxigenic environmental Vibrio cholerae O1 strain from Haiti provides evidence of pre-pandemic cholera in Hispaniola

    PubMed Central

    Azarian, Taj; Ali, Afsar; Johnson, Judith A.; Jubair, Mohammad; Cella, Eleonora; Ciccozzi, Massimo; Nolan, David J.; Farmerie, William; Rashid, Mohammad H.; Sinha-Ray, Shrestha; Alam, Meer T.; Morris, J. Glenn; Salemi, Marco

    2016-01-01

    Vibrio cholerae is ubiquitous in aquatic environments, with environmental toxigenic V. cholerae O1 strains serving as a source for recurrent cholera epidemics and pandemic disease. However, a number of questions remain about long-term survival and evolution of V. cholerae strains within these aquatic environmental reservoirs. Through monitoring of the Haitian aquatic environment following the 2010 cholera epidemic, we isolated two novel non-toxigenic (ctxA/B-negative) Vibrio cholerae O1. These two isolates underwent whole-genome sequencing and were investigated through comparative genomics and Bayesian coalescent analysis. These isolates cluster in the evolutionary tree with strains responsible for clinical cholera, possessing genomic components of 6th and 7th pandemic lineages, and diverge from “modern” cholera strains around 1548 C.E. [95% HPD: 1532–1555]. Vibrio Pathogenicity Island (VPI)-1 was present; however, SXT/R391-family ICE and VPI-2 were absent. Rugose phenotype conversion and vibriophage resistance evidenced adaption for persistence in aquatic environments. The identification of V. cholerae O1 strains in the Haitian environment, which predate the first reported cholera pandemic in 1817, broadens our understanding of the history of pandemics. It also raises the possibility that these and similar environmental strains could acquire virulence genes from the 2010 Haitian epidemic clone, including the cholera toxin producing CTXϕ. PMID:27786291

  8. Non-toxigenic environmental Vibrio cholerae O1 strain from Haiti provides evidence of pre-pandemic cholera in Hispaniola.

    PubMed

    Azarian, Taj; Ali, Afsar; Johnson, Judith A; Jubair, Mohammad; Cella, Eleonora; Ciccozzi, Massimo; Nolan, David J; Farmerie, William; Rashid, Mohammad H; Sinha-Ray, Shrestha; Alam, Meer T; Morris, J Glenn; Salemi, Marco

    2016-10-27

    Vibrio cholerae is ubiquitous in aquatic environments, with environmental toxigenic V. cholerae O1 strains serving as a source for recurrent cholera epidemics and pandemic disease. However, a number of questions remain about long-term survival and evolution of V. cholerae strains within these aquatic environmental reservoirs. Through monitoring of the Haitian aquatic environment following the 2010 cholera epidemic, we isolated two novel non-toxigenic (ctxA/B-negative) Vibrio cholerae O1. These two isolates underwent whole-genome sequencing and were investigated through comparative genomics and Bayesian coalescent analysis. These isolates cluster in the evolutionary tree with strains responsible for clinical cholera, possessing genomic components of 6(th) and 7(th) pandemic lineages, and diverge from "modern" cholera strains around 1548 C.E. [95% HPD: 1532-1555]. Vibrio Pathogenicity Island (VPI)-1 was present; however, SXT/R391-family ICE and VPI-2 were absent. Rugose phenotype conversion and vibriophage resistance evidenced adaption for persistence in aquatic environments. The identification of V. cholerae O1 strains in the Haitian environment, which predate the first reported cholera pandemic in 1817, broadens our understanding of the history of pandemics. It also raises the possibility that these and similar environmental strains could acquire virulence genes from the 2010 Haitian epidemic clone, including the cholera toxin producing CTXϕ.

  9. Reduced Susceptibility to Extended-Spectrum β-Lactams in Vibrio cholerae Isolated in Bangladesh

    PubMed Central

    Ceccarelli, Daniela; Alam, Munirul; Huq, Anwar; Colwell, Rita R.

    2016-01-01

    β-lactams are antibiotic molecules able to inhibit cell wall biosynthesis. Among other mechanisms, resistance in Gram-negative bacteria is mostly associated with production of β-lactamase enzymes able to bind and hydrolyze the β-lactam ring. Extended-spectrum β-lactamases extend this ability also to third- and fourth-generation cephalosporins, as well as to carbapenems and monobactams. Vibrio cholerae is the causative agent of epidemic cholera and a public health burden for developing countries like Bangladesh. Although appropriate oral or intravenous rehydration is the therapy of choice for cholera, severe infections and V. cholerae-associated septicemia are treated with antimicrobial drugs, including doxycycline, erythromycin, azithromycin, ciprofloxacin, and/or third-generation cephalosporins. In the years after the introduction of antibiotics in clinical practice, V. cholerae developed resistance to commonly used drugs worldwide mostly through gene acquisition via horizontal gene transfer. Reduced susceptibility of V. cholerae to third-generation cephalosporins has been occasionally documented. However, carbapenemase-producing V. cholerae has been reported at higher rates than resistance to extended-spectrum β-lactams, mainly associated with blaNDM-1 emergence and successful plasmid dissemination. Recent findings suggest limited β-lactam resistance is present in V. cholerae O1 isolates collected during ecological and epidemiological surveillance in Bangladesh. However, a trend to intermediate-susceptibility insurgence was observed. Horizontal gene transfer of β-lactam resistance from enteric pathogens to environmental microorganisms should not be underrated, given the ability of V. cholerae to acquire new genetic information. PMID:27803895

  10. Increased Isolation Frequency of Toxigenic Vibrio cholerae O1 from Environmental Monitoring Sites in Haiti

    PubMed Central

    Alam, Meer T.; Weppelmann, Thomas A.; Longini, Ira; De Rochars, Valery Madsen Beau; Morris, John Glenn; Ali, Afsar

    2015-01-01

    Since the identification of the first cholera case in 2010, the disease has spread in epidemic form throughout the island nation of Haiti; as of 2014, about 700,000 cholera cases have been reported, with over 8,000 deaths. While case numbers have declined, the more fundamental question of whether the causative bacterium, Vibrio cholerae has established an environmental reservoir in the surface waters of Haiti remains to be elucidated. In a previous study conducted between April 2012 and March 2013, we reported the isolation of toxigenic V. cholerae O1 from surface waters in the Ouest Department. After a second year of surveillance (April 2013 to March 2014) using identical methodology, we observed a more than five-fold increase in the number of water samples containing culturable V. cholerae O1 compared to the previous year (1.7% vs 8.6%), with double the number of sites having at least one positive sample (58% vs 20%). Both seasonal water temperatures and precipitation were significantly related to the frequency of isolation. Our data suggest that toxigenic V. cholerae O1 are becoming more common in surface waters in Haiti; while the basis for this increase is uncertain, our findings raise concerns that environmental reservoirs are being established. PMID:25853552

  11. Increased isolation frequency of toxigenic Vibrio cholerae O1 from environmental monitoring sites in Haiti.

    PubMed

    Alam, Meer T; Weppelmann, Thomas A; Longini, Ira; De Rochars, Valery Madsen Beau; Morris, John Glenn; Ali, Afsar

    2015-01-01

    Since the identification of the first cholera case in 2010, the disease has spread in epidemic form throughout the island nation of Haiti; as of 2014, about 700,000 cholera cases have been reported, with over 8,000 deaths. While case numbers have declined, the more fundamental question of whether the causative bacterium, Vibrio cholerae has established an environmental reservoir in the surface waters of Haiti remains to be elucidated. In a previous study conducted between April 2012 and March 2013, we reported the isolation of toxigenic V. cholerae O1 from surface waters in the Ouest Department. After a second year of surveillance (April 2013 to March 2014) using identical methodology, we observed a more than five-fold increase in the number of water samples containing culturable V. cholerae O1 compared to the previous year (1.7% vs 8.6%), with double the number of sites having at least one positive sample (58% vs 20%). Both seasonal water temperatures and precipitation were significantly related to the frequency of isolation. Our data suggest that toxigenic V. cholerae O1 are becoming more common in surface waters in Haiti; while the basis for this increase is uncertain, our findings raise concerns that environmental reservoirs are being established.

  12. How Will Climate Change Impact Cholera Outbreaks?

    NASA Astrophysics Data System (ADS)

    Nasr Azadani, F.; Jutla, A.; Rahimikolu, J.; Akanda, A. S.; Huq, A.; Colwell, R. R.

    2014-12-01

    Environmental parameters associated with cholera are well documented. However, cholera continues to be a global public health threat. Uncertainty in defining environmental processes affecting growth and multiplication of the cholera bacteria can be affected significantly by changing climate at different temporal and spatial scales, either through amplification of the hydroclimatic cycle or by enhanced variability of large scale geophysical processes. Endemic cholera in the Bengal Delta region of South Asia has a unique pattern of two seasonal peaks and there are associated with asymmetric and episodic variability in river discharge. The first cholera outbreak in spring is related with intrusion of bacteria laden coastal seawater during low river discharge. Cholera occurring during the fall season is hypothesized to be associated with high river discharge related to a cross-contamination of water resources and, therefore, a second wave of disease, a phenomenon characteristic primarily in the inland regions. Because of difficulties in establishing linkage between coarse resolutions of the Global Climate Model (GCM) output and localized disease outbreaks, the impact of climate change on diarrheal disease has not been explored. Here using the downscaling method of Support Vector Machines from HADCM3 and ECHAM models, we show how cholera outbreak patterns are changing in the Bengal Delta. Our preliminary results indicate statistically significant changes in both seasonality and magnitude in the occurrence of cholera over the next century. Endemic cholera is likely to transform into epidemic forms and new geographical areas will be at risk for cholera outbreaks.

  13. Cholera studies*

    PubMed Central

    Pollitzer, R.

    1957-01-01

    Discussing the symptomatology of cholera, the author deals first with the incubation period, the clinical types, choleraic diarrhoea, and cholerine; he then considers in detail the various stages of cholera gravis and the relapses and complications that may be met. This is followed by sections on diagnosis and differential diagnosis, and on prognosis and the various factors influencing it. The author's highly detailed review of the treatment of cholera which concludes this study is divided into three parts, dealing with attempts at specific therapy, with infusion treatment, and with adjuvant treatment. PMID:13426761

  14. Cholera Epidemiology in Nigeria: an overview

    PubMed Central

    Adagbada, Ajoke Olutola; Adesida, Solayide Abosede; Nwaokorie, Francisca Obiageri; Niemogha, Mary-Theresa; Coker, Akitoye Olusegun

    2012-01-01

    Cholera is an acute diarrhoeal infection caused by ingestion of food or water contaminated with the bacterium, Vibrio cholera. Choleragenic V. cholera O1 and O139 are the only causative agents of the disease. The two most distinguishing epidemiologic features of the disease are its tendency to appear in explosive outbreaks and its predisposition to causing pandemics that may progressively affect many countries and spread into continents. Despite efforts to control cholera, the disease continues to occur as a major public health problem in many developing countries. Numerous studies over more than a century have made advances in the understanding of the disease and ways of treating patients, but the mechanism of emergence of new epidemic strains, and the ecosystem supporting regular epidemics, remain challenging to epidemiologists. In Nigeria, since the first appearance of epidemic cholera in 1972, intermittent outbreaks have been occurring. The later part of 2010 was marked with severe outbreak which started from the northern part of Nigeria, spreading to the other parts and involving approximately 3,000 cases and 781 deaths. Sporadic cases have also been reported. Although epidemiologic surveillance constitutes an important component of the public health response, publicly available surveillance data from Nigeria have been relatively limited to date. Based on existing relevant scientific literature on features of cholera, this paper presents a synopsis of cholera epidemiology emphasising the situation in Nigeria. PMID:22937199

  15. Role of phages in the epidemiology of cholera.

    PubMed

    Faruque, Shah M

    2014-01-01

    Understanding the genetic and ecological factors which support the periodic emergence of toxigenic Vibrio cholerae causing outbreaks of cholera in regions where the disease is endemic, is vital to develop preventive measures. Besides environmental factors which are not precisely defined, bacteriophages, and horizontally transmissible genetic elements are known to have a significant role in the epidemiology and evolution of the pathogen. Cholera epidemics are also known to be self-limiting, and hence identifying natural factors which contribute to the collapse of epidemics may have important implications in controlling the disease. Phages have been shown to play a crucial role in modulating cholera epidemics, and enhance V. cholerae evolution through a bactericidal selection process which favors the emergence of new clones.

  16. Cholera Illness and Symptoms

    MedlinePlus

    ... The CDC Cancel Submit Search The CDC Cholera - Vibrio cholerae infection Note: Javascript is disabled or is not ... Infection & Risk Factors Non-O1 and Non-O139 Vibrio cholerae Infections Diagnosis and Detection Laboratory Testing for Cholera ...

  17. Cholera Prevention and Control

    MedlinePlus

    ... The CDC Cancel Submit Search The CDC Cholera - Vibrio cholerae infection Note: Javascript is disabled or is not ... Infection & Risk Factors Non-O1 and Non-O139 Vibrio cholerae Infections Diagnosis and Detection Laboratory Testing for Cholera ...

  18. Distribution and molecular characteristics of Vibrio cholerae O1 El Tor isolates recovered in Guangdong Province, China, 1961-2013.

    PubMed

    Li, Baisheng; Chen, Rongfeng; Wang, Duochun; Tan, Hailing; Ke, Bixia; He, Dongmei; Ke, Changwen; Zhang, Yonghui

    2016-01-01

    China's Guangdong Province is located along the same latitude as Kolkata, India and Dhaka, Bangladesh, and is also considered a source of epidemic cholera. However, molecular description and the genetic relationships between Vibrio cholerae O1 El Tor isolates in Guangdong remain unclear. In this study, 381 clinical V. cholerae O1 isolates recovered from cholera cases presenting in Guangdong between 1961 and 2013 were investigated by PCR, amplicon sequencing and pulsed-field gel electrophoresis (PFGE). During this time frame, four distinct epidemic periods (1-4) were observed based on the different dominant serotype leading its epidemic, correspond to years; or time periods from/to 1961-1969, 1978-1989, 1990-2000, 2001-2013, respectively. Molecular analysis of representative isolates indicated that a single dominating clone was associated with each epidemic stage. All isolates from periods 1 and 2 carried the typical El Tor ctxB; this allele was displaced by classical ctxB beginning in 1993. However all isolates carried the El Tor-specific toxin-coregulated pili subunit A (tcpA). Isolates were grouped into five clusters on the basis of Not I enzyme digested PFGE, and the first four clusters were associated with specific periods, cluster I (period 1), II (period 3), III (period 2) and IV (period 4), respectively. While cluster V consisted of isolates from all four epidemic periods, but was most heterogeneous in appearance. Our data indicate genetic variations that shape the relationship among emerging isolates of V. cholerae O1 in Guangdong Province contribute to the 7th global pandemic.

  19. Cholera Vaccination in Urban Haiti

    PubMed Central

    Rouzier, Vanessa; Severe, Karine; Juste, Marc Antoine Jean; Peck, Mireille; Perodin, Christian; Severe, Patrice; Deschamps, Marie Marcelle; Verdier, Rose Irene; Prince, Sabine; Francois, Jeannot; Cadet, Jean Ronald; Guillaume, Florence D.; Wright, Peter F.; Pape, Jean W.

    2013-01-01

    Successful and sustained efforts have been made to curtail the major cholera epidemic that occurred in Haiti in 2010 with the promotion of hygiene and sanitation measures, training of health personnel and establishment of treatment centers nationwide. Oral cholera vaccine (OCV) was introduced by the Haitian Ministry of Health as a pilot project in urban and rural areas. This paper reports the successful OCV pilot project led by GHESKIO Centers in the urban slums of Port-au-Prince where 52,357 persons received dose 1 and 90.8% received dose 2; estimated coverage of the at-risk community was 75%. This pilot study demonstrated the effort, community mobilization, and organizational capacity necessary to achieve these results in a challenging setting. The OCV intervention paved the way for the recent launching of a national cholera vaccination program integrated in a long-term ambitious and comprehensive plan to address Haiti's critical need in water security and sanitation. PMID:24106194

  20. [Reemergence of measles. Epidemic situation in the Valencian Community during the years 2011 and 2012].

    PubMed

    Rodrigo, Silvia Guiral; Calatrava, Rosana Guaita; Vicenta Rigo Medrano, M; Vidal, Miquel Amat; Martín-Sierra Balibrea, Miguel; Zarco, Isabel Huertas; Ramón, Jorge Roda; Cifre, Antonio Salazar; Morán, Francisco González

    2014-02-01

    Measles incidence declined until becomes a sporadic reporting and infrequent notification in the last decade. The reemergence of the disease reached 744 cases in 2012, a rate of 14.50×10(5) inhabitants. A classic design in Public Health Surveillance was performed: retrospective analysis of cumulative incidence and characteristics of the affected subjects. Those dates were in record linkage with Valencia Microbiology Network (RedMIVA). Finally, 976 cases of measles were confirmed in 2011-2012 epidemic period. Time-line distribution shows three waves with amplitude length on 12-15 weeks. Proportion of unvaccinated or unknown subjects came up to 85% of cases. 25 outbreaks were reported, 499 cases associated. In 7 of the 10 community outbreaks early cases were from Roma population unvaccinated. In the city of Valencia was applied post-exposure prophylaxis in 32 schools and was observed low coverage: between 63% and 77% in 8 schools and less than 50% in 4. Serum negative rate was 12.4% and we highlight the rate under 16 months: 44.8%. Cohorts of 20-59 years had negative rates between 13.5 to 5.9%. The origin of the epidemic was the importation of cases to a territory with inadequate immune protection against measles. Its impact and development was conditioned by previous immunization coverage, the social and ethnic pattern of different areas or quarters and the extensive application of post-exposure prophylaxis at school and family contacts of cases.

  1. Comparative genome analysis of VSP-II and SNPs reveals heterogenic variation in contemporary strains of Vibrio cholerae O1 isolated from cholera patients in Kolkata, India.

    PubMed

    Imamura, Daisuke; Morita, Masatomo; Sekizuka, Tsuyoshi; Mizuno, Tamaki; Takemura, Taichiro; Yamashiro, Tetsu; Chowdhury, Goutam; Pazhani, Gururaja P; Mukhopadhyay, Asish K; Ramamurthy, Thandavarayan; Miyoshi, Shin-Ichi; Kuroda, Makoto; Shinoda, Sumio; Ohnishi, Makoto

    2017-02-13

    Cholera is an acute diarrheal disease and a major public health problem in many developing countries in Asia, Africa, and Latin America. Since the Bay of Bengal is considered the epicenter for the seventh cholera pandemic, it is important to understand the genetic dynamism of Vibrio cholerae from Kolkata, as a representative of the Bengal region. We analyzed whole genome sequence data of V. cholerae O1 isolated from cholera patients in Kolkata, India, from 2007 to 2014 and identified the heterogeneous genomic region in these strains. In addition, we carried out a phylogenetic analysis based on the whole genome single nucleotide polymorphisms to determine the genetic lineage of strains in Kolkata. This analysis revealed the heterogeneity of the Vibrio seventh pandemic island (VSP)-II in Kolkata strains. The ctxB genotype was also heterogeneous and was highly related to VSP-II types. In addition, phylogenetic analysis revealed the shifts in predominant strains in Kolkata. Two distinct lineages, 1 and 2, were found between 2007 and 2010. However, the proportion changed markedly in 2010 and lineage 2 strains were predominant thereafter. Lineage 2 can be divided into four sublineages, I, II, III and IV. The results of this study indicate that lineages 1 and 2-I were concurrently prevalent between 2007 and 2009, and lineage 2-III observed in 2010, followed by the predominance of lineage 2-IV in 2011 and continued until 2014. Our findings demonstrate that the epidemic of cholera in Kolkata was caused by several distinct strains that have been constantly changing within the genetic lineages of V. cholerae O1 in recent years.

  2. Comparative genome analysis of VSP-II and SNPs reveals heterogenic variation in contemporary strains of Vibrio cholerae O1 isolated from cholera patients in Kolkata, India

    PubMed Central

    Sekizuka, Tsuyoshi; Mizuno, Tamaki; Takemura, Taichiro; Yamashiro, Tetsu; Chowdhury, Goutam; Pazhani, Gururaja P.; Mukhopadhyay, Asish K.; Ramamurthy, Thandavarayan; Miyoshi, Shin-ichi; Kuroda, Makoto; Shinoda, Sumio; Ohnishi, Makoto

    2017-01-01

    Cholera is an acute diarrheal disease and a major public health problem in many developing countries in Asia, Africa, and Latin America. Since the Bay of Bengal is considered the epicenter for the seventh cholera pandemic, it is important to understand the genetic dynamism of Vibrio cholerae from Kolkata, as a representative of the Bengal region. We analyzed whole genome sequence data of V. cholerae O1 isolated from cholera patients in Kolkata, India, from 2007 to 2014 and identified the heterogeneous genomic region in these strains. In addition, we carried out a phylogenetic analysis based on the whole genome single nucleotide polymorphisms to determine the genetic lineage of strains in Kolkata. This analysis revealed the heterogeneity of the Vibrio seventh pandemic island (VSP)-II in Kolkata strains. The ctxB genotype was also heterogeneous and was highly related to VSP-II types. In addition, phylogenetic analysis revealed the shifts in predominant strains in Kolkata. Two distinct lineages, 1 and 2, were found between 2007 and 2010. However, the proportion changed markedly in 2010 and lineage 2 strains were predominant thereafter. Lineage 2 can be divided into four sublineages, I, II, III and IV. The results of this study indicate that lineages 1 and 2-I were concurrently prevalent between 2007 and 2009, and lineage 2-III observed in 2010, followed by the predominance of lineage 2-IV in 2011 and continued until 2014. Our findings demonstrate that the epidemic of cholera in Kolkata was caused by several distinct strains that have been constantly changing within the genetic lineages of V. cholerae O1 in recent years. PMID:28192431

  3. The Role Of The Aquatic Reservoir In Long-Term Cholera Dynamics

    NASA Astrophysics Data System (ADS)

    Righetto, L.; Bertuzzo, E.; Mari, L.; Casagrandi, R.; Gatto, M.; Rodriguez-Iturbe, I.; Rinaldo, A.

    2010-12-01

    A novel class of models for Cholera epidemics is described, where the dynamics of the water volume defining the aquatic reservoir of pathogens accessible to a given local community is explicitly considered. In particular, we study how the hydrologic dynamics affects the fluctuations of Vibrio cholerae concentrations in the local reservoir thus driving the evolution of the epidemics at local scales. The novelty of the approach lies in the coupling of an input-output hydrologic dynamics with an epidemiological model which tracks susceptibles, infected and recovered individuals, jointly with bacterial concentrations. Reservoir volumes fluctuating over time indeed control the concentrations of Vibrio cholerae: one of the most common mechanisms of cholera insurgence in endemic regions is, in fact, spring water drought. Here we consider a spatially implicit framework, in order to distinguish the contribution of local dynamics to cholera insurgence at community scales. Our main goal is to investigate the relation between yearly water volume oscillations and long-term trajectories of cholera infection. To this end we take into account a monsoonal fluctuation, with one summer peak in the water input. This simple addition allows us to derive relationships between hydrologic regimes and the epidemiological behavior of the system. Since most of the numerical values of model parameters can be reliably drawn from the literature on the subject, this method allows us to concentrate on significant but still uncertain quantities and associate different ranges of parameter values to different model behaviors which need to be clearly differentiated . Our analysis provides information on the characteristic value of the model parameters for real case studies, comparing simulations and real time series. The model can be very useful in particular for the inference of the intensity of the disease, expressed in terms of the basic reproductive number.

  4. Urban Cholera and Water Sustainability Challenges under Climatic and Anthropogenic Change

    NASA Astrophysics Data System (ADS)

    Akanda, A. S.; Jutla, A.; Huq, A.; Faruque, A. G.; Colwell, R. R.

    2013-12-01

    The last three decades of surveillance data shows a drastic increase of cholera prevalence in the largest cholera-endemic city of the world - Dhaka, Bangladesh. Emerging megacities in the developing world, especially those located in coastal regions of the tropics remain vulnerable to similar. However, there has not been any systematic study on linking the long-term disease trends with changes in related climatic, environmental, or societal variables. Here, we analyze the 30-year dynamics of urban cholera prevalence in Dhaka with changes in climatic or societal factors: regional hydrology, flooding, water usage, changes in distribution systems, population growth and density in urban settlements, as well as shifting climate patterns. An interesting change is observed in the seasonal trends of cholera incidence; while an endemic upward trend is seen in the dry season, the post-monsoon trend seem to be more epidemic in nature. Evidence points to growing urbanization and rising population in unplanned settlements that have negligible to poor water and sanitation systems compounded by increasing frequency of record flood events. Growing water scarcity in the dry season and lack of sustainable water and sanitation infrastructure for urban settlements have increased endemicity of spring outbreaks, while record flood events and prolonged post-monsoon inundation have contributed to increased epidemic outbreaks in fall. We analyze our findings with the World Health Organization recommended guidelines and investigate water sustainability challenges in the context of climatic and anthropogenic changes in the region.

  5. Methods to Assess the Impact of Mass Oral Cholera Vaccination Campaigns under Real Field Conditions

    PubMed Central

    Deen, Jacqueline; Ali, Mohammad; Sack, David

    2014-01-01

    There is increasing interest to use oral cholera vaccination as an additional strategy to water and sanitation interventions against endemic and epidemic cholera. There are two internationally-available and WHO-prequalified oral cholera vaccines: an inactivated vaccine containing killed whole-cells of V. cholerae O1 with recombinant cholera toxin B-subunit (WC/rBS) and a bivalent inactivated vaccine containing killed whole cells of V. cholerae O1 and V. cholerae O139 (BivWC). The efficacy, effectiveness, direct and indirect (herd) protection conferred by WC/rBS and BivWC are well established. Yet governments may need local evidence of vaccine impact to justify and scale-up mass oral cholera vaccination campaigns. We discuss various approaches to assess oral cholera vaccine protection, which may be useful to policymakers and public health workers considering deployment and evaluation of the vaccine. PMID:24516595

  6. Quorum Regulated Resistance of Vibrio cholerae against Environmental Bacteriophages

    PubMed Central

    Hoque, M. Mozammel; Naser, Iftekhar Bin; Bari, S. M. Nayeemul; Zhu, Jun; Mekalanos, John J.; Faruque, Shah M.

    2016-01-01

    Predation by bacteriophages can significantly influence the population structure of bacterial communities. Vibrio cholerae the causative agent of cholera epidemics interacts with numerous phages in the aquatic ecosystem, and in the intestine of cholera patients. Seasonal epidemics of cholera reportedly collapse due to predation of the pathogen by phages. However, it is not clear how sufficient number of the bacteria survive to seed the environment in the subsequent epidemic season. We found that bacterial cell density-dependent gene expression termed “quorum sensing” which is regulated by signal molecules called autoinducers (AIs) can protect V. cholerae against predatory phages. V. cholerae mutant strains carrying inactivated AI synthase genes were significantly more susceptible to multiple phages compared to the parent bacteria. Likewise when mixed cultures of phage and bacteria were supplemented with exogenous autoinducers CAI-1 or AI-2 produced by recombinant strains carrying cloned AI synthase genes, increased survival of V. cholerae and a decrease in phage titer was observed. Mutational analyses suggested that the observed effects of autoinducers are mediated in part through the quorum sensing-dependent production of haemaglutinin protease, and partly through downregulation of phage receptors. These results have implication in developing strategies for phage mediated control of cholera. PMID:27892495

  7. PREDICTIVE MODELING OF CHOLERA OUTBREAKS IN BANGLADESH

    PubMed Central

    Koepke, Amanda A.; Longini, Ira M.; Halloran, M. Elizabeth; Wakefield, Jon; Minin, Vladimir N.

    2016-01-01

    Despite seasonal cholera outbreaks in Bangladesh, little is known about the relationship between environmental conditions and cholera cases. We seek to develop a predictive model for cholera outbreaks in Bangladesh based on environmental predictors. To do this, we estimate the contribution of environmental variables, such as water depth and water temperature, to cholera outbreaks in the context of a disease transmission model. We implement a method which simultaneously accounts for disease dynamics and environmental variables in a Susceptible-Infected-Recovered-Susceptible (SIRS) model. The entire system is treated as a continuous-time hidden Markov model, where the hidden Markov states are the numbers of people who are susceptible, infected, or recovered at each time point, and the observed states are the numbers of cholera cases reported. We use a Bayesian framework to fit this hidden SIRS model, implementing particle Markov chain Monte Carlo methods to sample from the posterior distribution of the environmental and transmission parameters given the observed data. We test this method using both simulation and data from Mathbaria, Bangladesh. Parameter estimates are used to make short-term predictions that capture the formation and decline of epidemic peaks. We demonstrate that our model can successfully predict an increase in the number of infected individuals in the population weeks before the observed number of cholera cases increases, which could allow for early notification of an epidemic and timely allocation of resources. PMID:27746850

  8. [Feedback from primary care practitioners two years after the chikungunya epidemic on Reunion Island, 2005-2006].

    PubMed

    Fenétrier, E; Sissoko, D; Vernazza-Licht, N; Bley, D; Gaüzère, B-A; Malvy, D

    2013-08-01

    Primary care practitioners constitute key stakeholders in the surveillance and control of epidemic-prone infectious diseases. We carried out a survey in Reunion Island two years after the 2006 chikungunya epidemic using a purposive random sample of 100 general practitioners (GP). The objective was to describe and identity factors associated to GP involvement in case notification during the 2006 chikungunya epidemic. The methods were: administered face-to-face questionnaire and identification of notification determinants by univariate and multivariate analyses. Nearly 60% of participants declared having failed to join the case notification procedure. The main impeding factor was the acknowledgment of limited capacities consecutive to massive influx of patients. Inversely, practicing in group organization tended to show a favorable effect on case notification. In addition, most responders reported the relevance of the information provided by health authorities, despite a perceived limited efficacy of the procedure in the field. Primary care practitioners' involvement in the surveillance of epidemic infectious diseases requires to be reinforced by a preestablished partnership within a proactive network. This goal comprehends relevant training and preparation for epidemic surveillance.

  9. Vibrio cholerae Serogroup O139: Isolation from Cholera Patients and Asymptomatic Household Family Members in Bangladesh between 2013 and 2014

    PubMed Central

    Chowdhury, Fahima; Mather, Alison E.; Begum, Yasmin Ara; Asaduzzaman, Muhammad; Baby, Nabilah; Sharmin, Salma; Biswas, Rajib; Ikhtear Uddin, Muhammad; LaRocque, Regina C.; Harris, Jason B.; Calderwood, Stephen B.; Ryan, Edward T.; Clemens, John D.; Thomson, Nicholas R.; Qadri, Firdausi

    2015-01-01

    Background Cholera is endemic in Bangladesh, with outbreaks reported annually. Currently, the majority of epidemic cholera reported globally is El Tor biotype Vibrio cholerae isolates of the serogroup O1. However, in Bangladesh, outbreaks attributed to V. cholerae serogroup O139 isolates, which fall within the same phylogenetic lineage as the O1 serogroup isolates, were seen between 1992 and 1993 and in 2002 to 2005. Since then, V. cholerae serogroup O139 has only been sporadically isolated in Bangladesh and is now rarely isolated elsewhere. Methods Here, we present case histories of four cholera patients infected with V. cholerae serogroup O139 in 2013 and 2014 in Bangladesh. We comprehensively typed these isolates using conventional approaches, as well as by whole genome sequencing. Phenotypic typing and PCR confirmed all four isolates belonging to the O139 serogroup. Findings Whole genome sequencing revealed that three of the isolates were phylogenetically closely related to previously sequenced El Tor biotype, pandemic 7, toxigenic V. cholerae O139 isolates originating from Bangladesh and elsewhere. The fourth isolate was a non-toxigenic V. cholerae that, by conventional approaches, typed as O139 serogroup but was genetically divergent from previously sequenced pandemic 7 V. cholerae lineages belonging to the O139 or O1 serogroups. Conclusion These results suggest that previously observed lineages of V. cholerae O139 persist in Bangladesh and can cause clinical disease and that a novel disease-causing non-toxigenic O139 isolate also occurs. PMID:26562418

  10. No Evidence of Significant Levels of Toxigenic V. cholerae O1 in the Haitian Aquatic Environment During the 2012 Rainy Season

    PubMed Central

    Baron, Sandrine; Lesne, Jean; Moore, Sandra; Rossignol, Emmanuel; Rebaudet, Stanislas; Gazin, Pierre; Barrais, Robert; Magloire, Roc; Boncy, Jacques; Piarroux, Renaud

    2013-01-01

    Background: On October 21, 2010, Haiti was struck by a cholera epidemic for the first time in over a century. Epidemiological and molecular genetic data have clearly demonstrated that the bacterium was imported. Nevertheless, the persistence of the epidemic for more than two years, the high incidence rates in some coastal areas and the seasonal exacerbations of the epidemic during the rainy seasons have prompted us to examine the levels of toxigenic Vibrio cholerae in the Haitian aquatic environment. Methods: In July 2012, during the warm and rainy season, 36 aquatic stations were sampled to search for toxigenic V. cholerae. These stations included fresh, brackish and saline surface waters as well as waste water; the sampling sites were located in both rural and urban areas (around Port-au-Prince and Gonaïves) located in the West and Artibonite Departments. V. cholerae bacteria were detected in enrichment cultures of water samples (sample volumes included 1 L, 100 mL, 10 mL, 1 mL, 0.1 mL, 0.01 mL and 0.001 mL depending on the context). Detection methods included both culture on selective agar (for strain isolation) and PCR assays targeting the genes ompW (V. cholerae species), O1-rfb and O139-rfb (O1 and O139 V. cholerae serogroups, respectively), and the cholera toxin gene ctxA, which is present exclusively in toxigenic cholera strains. Results: A total of 411 culturable V. cholerae isolates from 29 stations were obtained via selective culture; however, only one of these isolates displayed a late positive reaction with polyvalent anti-O1 serum. Positive V. cholerae PCR results were obtained from each of the 32 tested stations (a total of 77 enrichments out of 107 yielded a positive result); only one sample yielded a positive V. cholerae O1 PCR result. The cholera toxin gene ctxA was never detected via PCR with either primer pair, which includes samples derived from the two stations yielding positive O1 culture or positive O1 PCR results. Therefore, we could not

  11. Vibrio cholerae: lessons for mucosal vaccine design

    PubMed Central

    Bishop, Anne L; Camilli, Andrew

    2011-01-01

    The ability of Vibrio cholerae to persist in bodies of water will continue to confound our ability to eradicate cholera through improvements to infrastructure, and thus cholera vaccines are needed. We aim for an inexpensive vaccine that can provide long-lasting protection from all epidemic cholera infections, currently caused by O1 or O139 serogroups. Recent insights into correlates of protection, epidemiology and pathogenesis may help us design improved vaccines. This notwithstanding, we have come to appreciate that even marginally protective vaccines, such as oral whole-cell killed vaccines, if widely distributed, can provide significant protection, owing to herd immunity. Further efforts are still required to provide more effective protection of young children. PMID:21162623

  12. Influence of human behavior on cholera dynamics.

    PubMed

    Wang, Xueying; Gao, Daozhou; Wang, Jin

    2015-09-01

    This paper is devoted to studying the impact of human behavior on cholera infection. We start with a cholera ordinary differential equation (ODE) model that incorporates human behavior via modeling disease prevalence dependent contact rates for direct and indirect transmissions and infectious host shedding. Local and global dynamics of the model are analyzed with respect to the basic reproduction number. We then extend the ODE model to a reaction-convection-diffusion partial differential equation (PDE) model that accounts for the movement of both human hosts and bacteria. Particularly, we investigate the cholera spreading speed by analyzing the traveling wave solutions of the PDE model, and disease threshold dynamics by numerically evaluating the basic reproduction number of the PDE model. Our results show that human behavior can reduce (a) the endemic and epidemic levels, (b) cholera spreading speeds and (c) the risk of infection (characterized by the basic reproduction number).

  13. Neurologic outcomes of toxic oil syndrome patients 18 years after the epidemic.

    PubMed

    de la Paz, Manuel Posada; Philen, Rossanne M; Gerr, Fredric; Letz, Richard; Ferrari Arroyo, Maria José; Vela, Lydia; Izquierdo, Maravillas; Arribas, Concepción Martín; Borda, Ignacio Abaitua; Ramos, Alejandro; Mora, Cristina; Matesanz, Gloria; Roldán, Maria Teresa; Pareja, Juan

    2003-08-01

    Toxic oil syndrome (TOS) resulted from consumption of rapeseed oil denatured with 2% aniline and affected more than 20,000 persons. Eighteen years after the epidemic, many patients continue to report neurologic symptoms that are difficult to evaluate using conventional techniques. We conducted an epidemiologic study to determine whether an exposure to toxic oil 18 years ago was associated with current adverse neurobehavioral effects. We studied a case group of 80 adults exposed to toxic oil 18 years ago and a referent group of 79 adult age- and sex-frequency-matched unexposed subjects. We interviewed subjects for demographics, health status, exposures to neurotoxicants, and responses to the Kaufman Brief Intelligence Test (K-BIT), Programa Integrado de Exploracion Neuropsicologica (PIEN), and Goldberg depression questionnaires and administered quantitative neurobehavioral and neurophysiologic tests by computer or trained nurses. The groups did not differ with respect to educational background or other critical variables. We examined associations between case and referent groups and the neurobehavioral and neurophysiologic outcomes of interest. Decreased distal strength of the dominant and nondominant hands and increased vibrotactile thresholds of the fingers and toes were significantly associated with exposure to toxic oil. Finger tapping, simple reaction time latency, sequence B latency, symbol digit latency, and auditory digit span were also significantly associated with exposure. Case subjects also had statistically significantly more neuropsychologic symptoms compared with referents. Using quantitative neurologic tests, we found significant adverse central and peripheral neurologic effects in a group of TOS patients 18 years after exposure to toxic oil when compared with a nonexposed referent group. These effects were not documented by standard clinical examination and were found more frequently in women.

  14. Neurologic outcomes of toxic oil syndrome patients 18 years after the epidemic.

    PubMed Central

    de la Paz, Manuel Posada; Philen, Rossanne M; Gerr, Fredric; Letz, Richard; Ferrari Arroyo, Maria José; Vela, Lydia; Izquierdo, Maravillas; Arribas, Concepción Martín; Borda, Ignacio Abaitua; Ramos, Alejandro; Mora, Cristina; Matesanz, Gloria; Roldán, Maria Teresa; Pareja, Juan

    2003-01-01

    Toxic oil syndrome (TOS) resulted from consumption of rapeseed oil denatured with 2% aniline and affected more than 20,000 persons. Eighteen years after the epidemic, many patients continue to report neurologic symptoms that are difficult to evaluate using conventional techniques. We conducted an epidemiologic study to determine whether an exposure to toxic oil 18 years ago was associated with current adverse neurobehavioral effects. We studied a case group of 80 adults exposed to toxic oil 18 years ago and a referent group of 79 adult age- and sex-frequency-matched unexposed subjects. We interviewed subjects for demographics, health status, exposures to neurotoxicants, and responses to the Kaufman Brief Intelligence Test (K-BIT), Programa Integrado de Exploracion Neuropsicologica (PIEN), and Goldberg depression questionnaires and administered quantitative neurobehavioral and neurophysiologic tests by computer or trained nurses. The groups did not differ with respect to educational background or other critical variables. We examined associations between case and referent groups and the neurobehavioral and neurophysiologic outcomes of interest. Decreased distal strength of the dominant and nondominant hands and increased vibrotactile thresholds of the fingers and toes were significantly associated with exposure to toxic oil. Finger tapping, simple reaction time latency, sequence B latency, symbol digit latency, and auditory digit span were also significantly associated with exposure. Case subjects also had statistically significantly more neuropsychologic symptoms compared with referents. Using quantitative neurologic tests, we found significant adverse central and peripheral neurologic effects in a group of TOS patients 18 years after exposure to toxic oil when compared with a nonexposed referent group. These effects were not documented by standard clinical examination and were found more frequently in women. PMID:12896854

  15. Haitian variant ctxB producing Vibrio cholerae O1 with reduced susceptibility to ciprofloxacin is persistent in Yavatmal, Maharashtra, India, after causing a cholera outbreak.

    PubMed

    Kumar, P; Mishra, D K; Deshmukh, D G; Jain, M; Zade, A M; Ingole, K V; Yadava, P K

    2014-05-01

    Vibrio cholerae O1 biotype El Tor producing Haitian variant Cholera Toxin (HCT) and showing reduced susceptibility to ciprofloxacin caused a cholera outbreak associated with a high case fatality rate (4.5) in India. HCT-secreting strains responsible for severe cholera epidemics in Orissa (India), Western Africa and Haiti were associated with increased mortality. There is a pressing need for an integrated multidisciplinary approach to combat further spread of newly emerging variant strains. The therapeutic effect of ciprofloxacin was diminished whereas use of doxycycline in moderate to severe cholera patients was found to be effective in outbreak management.

  16. Cholera studies*

    PubMed Central

    Pollitzer, R.

    1957-01-01

    After a general consideration of the loss of fluids and salts in evacuations from the gastro-intestinal tract, the author discusses in detail both the physical and the chemical changes in the blood of cholera patients. The author then deals exhaustively with the problems of circulatory and renal failure. PMID:13413649

  17. Ecological study of Vibrio cholerae in Vellore.

    PubMed Central

    Jesudason, M. V.; Balaji, V.; Mukundan, U.; Thomson, C. J.

    2000-01-01

    Vellore is endemic for cholera due to Vibrio cholerae O1 and O139. In a previous study the prevalence of Vibrio cholerae in drinking water, lakes and sewage outfalls in a single 2-months period in Vellore, India was determined. In addition water samples from three sites were also tested for the presence of V. cholerae O1 and O139 by fluorescent antibody staining. This follow on study has examined how the environmental distribution of V. cholerae at the same sites alters over a 12-month period and the relationship to the clinical pattern of cholera in Vellore. Samples of water were collected from fixed sites at three water bodies each month between April 1997 and March 1998. Bacteria isolated from samples were identified by standard biochemical tests and isolated strains of V. cholerae tested for their ability to agglutinate O1 and O139 antisera. Samples were also tested for the presence of V. cholerae O1 and O139 by fluorescent antibody staining. The clinical isolation rate of V. cholerae in Vellore, maximum temperature and rainfall were also studied. The results demonstrate the presence in the environment of viable but non-cultivable (VNC) V. cholerae in 10 of 12 months of the study year as well as their viability. Their prevalence in the environment also correlated with the isolation of these pathogens from clinical samples over the same study period. PMID:10813143

  18. Vibriosis, not cholera: toxigenic Vibrio cholerae non-O1, non-O139 infections in the United States, 1984-2014.

    PubMed

    Crowe, S J; Newton, A E; Gould, L H; Parsons, M B; Stroika, S; Bopp, C A; Freeman, M; Greene, K; Mahon, B E

    2016-11-01

    Toxigenic strains of Vibrio cholerae serogroups O1 and O139 have caused cholera epidemics, but other serogroups - such as O75 or O141 - can also produce cholera toxin and cause severe watery diarrhoea similar to cholera. We describe 31 years of surveillance for toxigenic non-O1, non-O139 infections in the United States and map these infections to the state where the exposure probably originated. While serogroups O75 and O141 are closely related pathogens, they differ in how and where they infect people. Oysters were the main vehicle for O75 infection. The vehicles for O141 infection include oysters, clams, and freshwater in lakes and rivers. The patients infected with serogroup O75 who had food traceback information available ate raw oysters from Florida. Patients infected with O141 ate oysters from Florida and clams from New Jersey, and those who only reported being exposed to freshwater were exposed in Arizona, Michigan, Missouri, and Texas. Improving the safety of oysters, specifically, should help prevent future illnesses from these toxigenic strains and similar pathogenic Vibrio species. Post-harvest processing of raw oysters, such as individual quick freezing, heat-cool pasteurization, and high hydrostatic pressurization, should be considered.

  19. Cholera studies*

    PubMed Central

    Pollitzer, R.

    1956-01-01

    The first portion of this study describes in detail the different aspects of stool examinations, including the collection, preservation, and pooling of specimens, macroscopic and bacterioscopic examination, enrichment methods, and cultivation on a variety of solid media. The author also deals with the examination of vomits and of water. The performance and value of different identification tests (agglutination, haemolysis, and bacteriophage) and confirmatory tests are then considered. An annex is included on bacteriological procedures in the laboratory diagnosis of cholera. PMID:13356145

  20. Vibrio cholerae O139 in Calcutta, 1992-1998: incidence, antibiograms, and genotypes.

    PubMed Central

    Basu, A.; Garg, P.; Datta, S.; Chakraborty, S.; Bhattacharya, T.; Khan, A.; Ramamurthy, S.; Bhattacharya, S. K.; Yamasaki, S.; Takeda, Y.; Nair, G. B.

    2000-01-01

    We report results of surveillance for cholera caused by Vibrio cholerae O139 from September 1992, when it was first identified, to December 1998. V. cholerae O139 dominated as the causative agent of cholera in Calcutta during 1992-93 and 1996- 97, while the O1 strains dominated during the rest of the period. Dramatic shifts in patterns of resistance to cotrimoxazole, neomycin, and streptomycin were observed. Molecular epidemiologic studies showed clonal diversity among the O139 strains and continuous emergence of new epidemic clones, reflected by changes in the structure, organization, and location of the CTX prophages in the V. cholerae O139 PMID:10756147

  1. Cholera in Children

    MedlinePlus

    ... infection of the intestines caused by bacteria called Vibrio cholerae. It causes a watery diarrhea that can range ... as raw or undercooked shellfish contaminated with V cholerae. Cholera has ... are some species of Vibrio that do not cause cholera, although they can ...

  2. Changing patterns of HIV epidemic in 30 years in East Asia.

    PubMed

    Suguimoto, S Pilar; Techasrivichien, Teeranee; Musumari, Patou Masika; El-saaidi, Christina; Lukhele, Bhekumusa Wellington; Ono-Kihara, Masako; Kihara, Masahiro

    2014-06-01

    The HIV epidemic in East Asia started relatively late compared to the rest of the world. All countries or areas, except for North Korea, had reported HIV and AIDS cases, with China being the major contributor to the epidemic. Though initially driven by injecting drug use in China, East Asia did not experience an explosive spread. Strong commitment in China and early harm reduction programs in Taiwan managed to reduce transmission substantially among injecting drug users. In contrast to China and Taiwan, injection drug use has accounted just a little, if not at all, for the spread of HIV in other East Asian counties. However, following a global trend, sexual contact has become a major route of infection across the region. While much progress has been achieved in this region, with the epidemic among other key populations relatively stable, the emerging epidemic through sex between men is a growing concern. Recent estimates suggest that HIV prevalence among men who have sex with men (MSM) has reached 6.3 % in China, 7.5 % in Mongolia, and ranges between 8.1 %-10.7 % in Taiwan and between 2.7 %- 6.5 % in South Korea. In Japan, 74 % of male HIV cases were among MSM in 2012, while Hong Kong has witnessed a sharp increase of HIV cases among MSM since 2004. There is urgent need to address issues of discrimination and stigma toward homosexuality, and to strengthen the strategies to reach and care for this population.

  3. Low detection of Vibrio cholerae carriage in healthcare workers returning to 12 Latin American countries from Haiti.

    PubMed

    Llanes, R; Somarriba, L; Hernández, G; Bardaji, Y; Aguila, A; Mazumder, R N

    2015-04-01

    SUMMARY This investigation was undertaken to characterize the prevalence of intestinal Vibrio cholerae in healthcare workers (HCWs) returning from Haiti due to the ongoing cholera epidemic. Eight hundred and fifty asymptomatic HCWs of the Cuban Medical Brigade, who planned to leave Haiti, were studied by laboratory screening of stool culture for V. cholerae. A very low percentage (0.23%) of toxigenic V. cholerae serogroup O1, serotype Ogawa was found. To the best of our knowledge, this study represents the largest reported screening study for V. cholerae infection in asymptomatic HCWs returning from a cholera-affected country. Cholera transmission to health personnel highlights a possible risk of transmitting cholera during mobilization of the population for emergency response. Aid workers are encouraged to take precautions to reduce their risk for acquiring cholera and special care should be taken by consuming safe water and food and practising regular hand washing.

  4. Considerations for oral cholera vaccine use during outbreak after earthquake in Haiti, 2010-2011.

    PubMed

    Date, Kashmira A; Vicari, Andrea; Hyde, Terri B; Mintz, Eric; Danovaro-Holliday, M Carolina; Henry, Ariel; Tappero, Jordan W; Roels, Thierry H; Abrams, Joseph; Burkholder, Brenton T; Ruiz-Matus, Cuauhtémoc; Andrus, Jon; Dietz, Vance

    2011-11-01

    Oral cholera vaccines (OCVs) have been recommended in cholera-endemic settings and preemptively during outbreaks and complex emergencies. However, experience and guidelines for reactive use after an outbreak has started are limited. In 2010, after over a century without epidemic cholera, an outbreak was reported in Haiti after an earthquake. As intensive nonvaccine cholera control measures were initiated, the feasibility of OCV use was considered. We reviewed OCV characteristics and recommendations for their use and assessed global vaccine availability and capacity to implement a vaccination campaign. Real-time modeling was conducted to estimate vaccine impact. Ultimately, cholera vaccination was not implemented because of limited vaccine availability, complex logistical and operational challenges of a multidose regimen, and obstacles to conducting a campaign in a setting with population displacement and civil unrest. Use of OCVs is an option for cholera control; guidelines for their appropriate use in epidemic and emergency settings are urgently needed.

  5. Genomic epidemiology of Vibrio cholerae O1 associated with floods, Pakistan, 2010.

    PubMed

    Shah, Muhammad Ali; Mutreja, Ankur; Thomson, Nicholas; Baker, Stephen; Parkhill, Julian; Dougan, Gordon; Bokhari, Habib; Wren, Brendan W

    2014-01-01

    In August 2010, Pakistan experienced major floods and a subsequent cholera epidemic. To clarify the population dynamics and transmission of Vibrio cholerae in Pakistan, we sequenced the genomes of all V. cholerae O1 El Tor isolates and compared the sequences to a global collection of 146 V. cholerae strains. Within the global phylogeny, all isolates from Pakistan formed 2 new subclades (PSC-1 and PSC-2), lying in the third transmission wave of the seventh-pandemic lineage that could be distinguished by signature deletions and their antimicrobial susceptibilities. Geographically, PSC-1 isolates originated from the coast, whereas PSC-2 isolates originated from inland areas flooded by the Indus River. Single-nucleotide polymorphism accumulation analysis correlated river flow direction with the spread of PSC-2. We found at least 2 sources of cholera in Pakistan during the 2010 epidemic and illustrate the value of a global genomic data bank in contextualizing cholera outbreaks.

  6. Considerations for Oral Cholera Vaccine Use during Outbreak after Earthquake in Haiti, 2010−2011

    PubMed Central

    Vicari, Andrea; Hyde, Terri B.; Mintz, Eric; Danovaro-Holliday, M. Carolina; Henry, Ariel; Tappero, Jordan W.; Roels, Thierry H.; Abrams, Joseph; Burkholder, Brenton T.; Ruiz-Matus, Cuauhtémoc; Andrus, Jon; Dietz, Vance

    2011-01-01

    Oral cholera vaccines (OCVs) have been recommended in cholera-endemic settings and preemptively during outbreaks and complex emergencies. However, experience and guidelines for reactive use after an outbreak has started are limited. In 2010, after over a century without epidemic cholera, an outbreak was reported in Haiti after an earthquake. As intensive nonvaccine cholera control measures were initiated, the feasibility of OCV use was considered. We reviewed OCV characteristics and recommendations for their use and assessed global vaccine availability and capacity to implement a vaccination campaign. Real-time modeling was conducted to estimate vaccine impact. Ultimately, cholera vaccination was not implemented because of limited vaccine availability, complex logistical and operational challenges of a multidose regimen, and obstacles to conducting a campaign in a setting with population displacement and civil unrest. Use of OCVs is an option for cholera control; guidelines for their appropriate use in epidemic and emergency settings are urgently needed. PMID:22099114

  7. Seasonal and Interannual Trends in Largest Cholera Endemic Megacity: Water Sustainability - Climate - Health Challenges in Dhaka, Bangladesh

    NASA Astrophysics Data System (ADS)

    Akanda, Ali S.; Jutla, Antarpreet; Faruque, Abu S. G.; Huq, Anwar; Colwell, Rita R.

    2014-05-01

    The last three decades of surveillance data shows a drastic increase of cholera prevalence in the largest cholera-endemic city in the world - Dhaka, Bangladesh. Emerging megacities in the region, especially those located in coastal areas also remain vulnerable to large scale drivers of cholera outbreaks. However, there has not been any systematic study on linking long-term disease trends with related changes in natural or societal variables. Here, we analyze the 30-year dynamics of urban cholera prevalence in Dhaka with changes in climatic or anthropogenic forcings: regional hydrology, flooding, water usage, changes in distribution systems, population growth and density in urban settlements, as well as shifting climate patterns and frequency of natural disasters. An interesting change is observed in the seasonal trends of cholera prevalence; while an endemic upward trend is seen in the dry season, the post-monsoon trend is epidemic in nature. In addition, the trend in the pre-monsoon dry season is significantly stronger than the post-monsoon wet season; and thus spring is becoming the dominant cholera season of the year. Evidence points to growing urbanization and rising population in unplanned settlements along the city peripheries. The rapid pressure of growth has led to an unsustainable and potentially disastrous situation with negligible-to-poor water and sanitation systems compounded by changing climatic patterns and increasing number of extreme weather events. Growing water scarcity in the dry season and lack of sustainable water and sanitation infrastructure for urban settlements have increased endemicity of cholera outbreaks in spring, while record flood events and prolonged post-monsoon inundation have contributed to increased epidemic outbreaks in fall. We analyze our findings with the World Health Organization recommended guidelines and investigate large scale water sustainability challenges in the context of climatic and anthropogenic changes in the

  8. Epidemic typhus.

    PubMed

    Bechah, Yassina; Capo, Christian; Mege, Jean-Louis; Raoult, Didier

    2008-07-01

    Epidemic typhus is transmitted to human beings by the body louse Pediculus humanus corporis. The disease is still considered a major threat by public-health authorities, despite the efficacy of antibiotics, because poor sanitary conditions are conducive to louse proliferation. Until recently, Rickettsia prowazekii, the causal agent, was thought to be confined to human beings and their body lice. Since 1975, R prowazekii infection in human beings has been related to contact with the flying squirrel Glaucomys volans in the USA. Moreover, Brill-Zinsser disease, a relapsed form of epidemic typhus that appears as sporadic cases many years after the initial infection, is unrelated to louse infestation. Stress or a waning immune system are likely to reactivate this earlier persistent infection, which could be the source of new epidemics when conditions facilitate louse infestation. Finally, R prowazekii is a potential category B bioterrorism agent, because it is stable in dried louse faeces and can be transmitted through aerosols. An increased understanding of the pathogenesis of epidemic typhus may be useful for protection against this bacterial threat.

  9. Linkage of Global Water Resources, Climate, and Human Health: A Conundrum for Which Cholera Offers a Paradigm (Invited)

    NASA Astrophysics Data System (ADS)

    Colwell, R.

    2010-12-01

    An environmental source of cholera was hypothesized as early as the late nineteenth century by Robert Koch. Standard bacteriological procedures for isolation of vibrios from environmental samples, including water, between epidemics generally were unsuccessful because Vibrio cholerae, a marine vibrio, enters into a dormant, "viable but nonculturable stage," when conditions are unfavorable for growth and reproduction. An association of Vibrio cholerae with zooplankton, notably copepods, has been established. Furthermore, the sporadicity and erraticity of cholera epidemics have been correlated with El Niño. Since zooplankton harbor the bacterium and zooplankton blooms follow phytoplankton blooms, remote sensing can be employed to predict cholera epidemics from sea surface temperature (SST), ocean height (OH), chlorophyll, and turbidity data. Cholera occurs seasonally in Bangladesh, with two annual peaks in the number of cases. From clinical remote sensing data, it has been found that SST, OH, and blooms of phytoplankton and zooplankton are correlated with cholera epidemics. Thus, selected climatological factors and incidence of V. cholerae can be recorded, bringing the potential of predicting conditions conducive to cholera outbreaks to reality. A simple filtration intervention takes into account the association of V. cholerae with plankton, and has proven to be a simple solution to the age-old problem of controlling this waterborne disease for villagers in remote regions of Bangladesh.

  10. The Second World Cholera Pandemic (1826-1849) in the Kingdom of the Two Sicilies with Special Reference to the Towns of San Prisco and Forio d'Ischia.

    PubMed

    Imperato, Pascal James; Imperato, Gavin H; Imperato, Austin C

    2015-12-01

    The second world cholera pandemic in Europe (1829-1849) was significant because of its geographic extent and the enormous numbers of people who fell ill or died. It was also singularly important because it demonstrated the profound levels of ignorance in both Europe and North America concerning the cause, modes of transmission, and treatment of cholera. This paper discusses the pandemic in the Kingdom of the Two Sicilies in great detail. Even though medical and public health authorities in this kingdom had several years to prepare for cholera's eventual arrival in 1836-1837, their elaborate preventive and therapeutic measures proved no more successful than elsewhere. Despite their efforts, it was estimated that there were 32,145 cases of cholera in the city of Naples by July 1837. Some 19,470 people were estimated to have died among the city's then 357,283 population. This amounted to a cholera-specific mortality rate of 54.5/1000 population. Sicily was also severely affected by the epidemic. It was estimated that 69,000 people died of cholera in Sicily, 24,000 of them in the city of Palermo. Two rural towns in the kingdom, San Prisco and Forio d'Ischia, were selected for in-depth epidemiologic study. The former had a population of 3700 in 1836-1837, while the latter had a population of 5500. The economic basis of both towns was agriculture. However, because Forio is located on an island, fishing and sea transport were then also important industries. Cholera appeared in San Prisco in July 1837 and quickly swept through the population. By August, the epidemic was essentially over. It is estimated that some 109 people died from cholera in San Prisco for a disease-specific mortality rate of 29.5/1000 population. The age range of those who died from cholera was 1 to 90 years. The majority of deaths (60.6 %) were among women. The first cases of cholera appeared in Forio d'Ischia in June 1837. The epidemic then peaked in July. It is estimated that approximately 316

  11. Use of filter paper as a transport medium for laboratory diagnosis of cholera under field conditions.

    PubMed

    Page, Anne-Laure; Alberti, Kathryn P; Guénolé, Alain; Mondongue, Vital; Lonlas Mayele, Sylvaine; Guerin, Philippe J; Quilici, Marie-Laure

    2011-08-01

    Confirmation of a cholera epidemic is based on bacteriological identification of the agent and requires the sending of samples to a culture laboratory, often in countries with limited resources. Comparison of the use of filter paper with the use of Cary-Blair reference medium for stool transport showed that this simple transport medium is appropriate for the recovery of Vibrio cholerae.

  12. Vibrio cholerae O1 from superficial water of the Tucunduba Stream, Brazilian Amazon

    PubMed Central

    Sá, L.L.C.; Vale, E.R.V.; Garza, D.R.; Vicente, A.C.P.

    2012-01-01

    Isolation and genetic characterization of an environmental Vibrio cholerae O1 from the Amazon is reported. This strain lacks two major virulence factors - CTX and TCP - but carries other genes related to virulence. Genetic similarity with epidemic strains is evaluated and the importance of V. cholerae surveillance in the Amazon is emphasized. PMID:24031874

  13. Knowledge, Attitudes, and Practices regarding Diarrhea and Cholera following an Oral Cholera Vaccination Campaign in the Solomon Islands

    PubMed Central

    Burnett, Eleanor; Dalipanda, Tenneth; Ogaoga, Divi; Gaiofa, Jenny; Jilini, Gregory; Halpin, Alison; Dietz, Vance; Date, Kashmira; Mintz, Eric; Hyde, Terri; Wannemuehler, Kathleen; Yen, Catherine

    2016-01-01

    Background In response to a 2011 cholera outbreak in Papua New Guinea, the Government of the Solomon Islands initiated a cholera prevention program which included cholera disease prevention and treatment messaging, community meetings, and a pre-emptive cholera vaccination campaign targeting 11,000 children aged 1–15 years in selected communities in Choiseul and Western Provinces. Methodology and Principal Findings We conducted a post-vaccination campaign, household-level survey about knowledge, attitudes, and practices regarding diarrhea and cholera in areas targeted and not targeted for cholera vaccination. Respondents in vaccinated areas were more likely to have received cholera education in the previous 6 months (33% v. 9%; p = 0.04), to know signs and symptoms (64% vs. 22%; p = 0.02) and treatment (96% vs. 50%; p = 0.02) of cholera, and to be aware of cholera vaccine (48% vs. 14%; p = 0.02). There were no differences in water, sanitation, and hygiene practices. Conclusions This pre-emptive OCV campaign in a cholera-naïve community provided a unique opportunity to assess household-level knowledge, attitudes, and practices regarding diarrhea, cholera, and water, sanitation, and hygiene (WASH). Our findings suggest that education provided during the vaccination campaign may have reinforced earlier mass messaging about cholera and diarrheal disease in vaccinated communities. PMID:27548678

  14. An outbreak of El Tor cholera associated with a tribal funeral in Irian Jaya, Indonesia.

    PubMed

    Korthuis, P T; Jones, T R; Lesmana, M; Clark, S M; Okoseray, M; Ingkokusumo, G; Wignall, F S

    1998-09-01

    An outbreak of El Tor biotype cholera occurring in a rural village in Irian Jaya, Indonesia was evaluated for risk factors associated with death from cholera. Among those dying in the village during the epidemic, a significant association between membership in one of the five tribal groups in the village complex was associated with an elevated risk of suffering a cholera death (odds ratio = 5.9). Interviews with members of the decedents' families revealed a very strong association (odds ratio = 11.6) between risk of cholera death and having attended the two day funeral of a woman who died of a cholera-like illness a few days prior to an outbreak of cholera-like diarrheal disease in the village complex. Recent flooding may have contributed to the creation of an environment conducive to cholera transmission.

  15. A case for critical ethnography: rethinking the early years of the AIDS epidemic in South Africa.

    PubMed

    Fassin, Didier

    2013-12-01

    The epidemic of AIDS in South Africa has been characterized not only by its rapid progression but also its impassioned controversies. Retrospectively examining a long-term anthropological project and discussing some reactions it elicited, the paper proposes a defense and illustration of a critical ethnography at three moments of the research. Ethnography is first discussed as fieldworks, proposing an alternative to the horizontal multi-sited approach via a vertical multi-layered method using various scales and locations, and thus connecting the disease endured by patients in townships and former homelands with the heated debates in scientific and political forums: this procedure substitutes a political economy of the disease for its cultural and behavioral interpretations. Ethnography is then discussed as writing, suggesting acknowledgment of the social intelligence of the agents as well as the need for a scientific distance: this principle allows the articulation of the objective historical condition of the individuals and their subjective experience of history, both revealed in the development of the epidemic. Ultimately ethnography is considered from the perspective of its afterlife, that is, the continuous process of its translation by readers and commentators, on the one hand, by the author trying to reach beyond the boundaries of the academic realm, on the other, the work of anthropology appearing as a living object open to public conversation and consequently a resource for knowledge and action.

  16. Cholera studies*

    PubMed Central

    Pollitzer, R.

    1957-01-01

    In discussing prevention, the author deals first with the provision of permanently safe water, supplied from waterworks or wells, and with other improvements in environmental sanitation. Control of food and drinks, public health propaganda and education, and vaccination are also considered under this heading. The greater part of this study is devoted to suppressive measures, affecting the individual, the environment, and persons in the mass. Discussion of the isolation, detection and management of cholera patients, the management of contacts, and the management and treatment of carriers is followed by sections on, inter alia, disinfection, temporary improvements in water supplies, fly control, and personal prophylaxis. In dealing with mass prophylaxis, the author pays particular attention to vaccination. In the concluding sections he goes into the control of pilgrimages and local and international quarantine measures. PMID:13479774

  17. Cholera Fact Sheet

    MedlinePlus

    ... works to: promote the design and implementation of global strategies to contribute to capacity development for cholera prevention ... countries for the implementation of effective cholera control strategies and monitoring ... global public health problem through the dissemination of information ...

  18. Understanding the Hydrology of Cholera in South Asia

    NASA Astrophysics Data System (ADS)

    Akanda, A. S.; Jutla, A. S.; Islam, S.

    2007-12-01

    Cholera is an acute waterborne illness caused by the bacterium Vibrio cholerae. The disease remains a major public health issue in several regions of the developing world, mainly in coastal areas around the tropics. Cholera incidences have been historically linked to climate variables and more recently with El Nino-Southern Oscillation. The occurrence of cholera shows bi-annual seasonal peaks and strong inter-annual variability in the Ganges basin region of South Asia. However, the role of hydrologic variables in the seasonal patterns of cholera epidemics is less understood. Preliminary results suggest that a unique combination of increasing water temperature and higher salinity in the coastal zone during the low flow season provide the situation amenable to the first outbreak of cholera in the spring season. Other major factors contributing to the subsequent spread of the disease are sea surface height, monsoon precipitation, and coastal phytoplankton concentration. We will further examine the lag periods between the dominant environmental variables and cholera incidences to understand the seasonal dynamics of cholera in South Asia.

  19. Does water hyacinth on East African lakes promote cholera outbreaks?

    PubMed

    Feikin, Daniel R; Tabu, Collins W; Gichuki, John

    2010-08-01

    Cholera outbreaks continue to occur regularly in Africa. Cholera has been associated with proximity to lakes in East Africa, and Vibrio cholerae has been found experimentally to concentrate on the floating aquatic plant, water hyacinth, which is periodically widespread in East African lakes since the late 1980s. From 1994 to 2008, Nyanza Province, which is the Kenyan province bordering Lake Victoria, accounted for a larger proportion of cholera cases than expected by its population size (38.7% of cholera cases versus 15.3% of national population). Yearly water-hyacinth coverage on the Kenyan section of Lake Victoria was positively associated with the number of cholera cases reported in Nyanza Province (r = 0.83; P = 0.0010). Water hyacinth on freshwater lakes might play a role in initiating cholera outbreaks and causing sporadic disease in East Africa.

  20. [Epidemic diseases in the Polish Kingdom in the thirties of the 19th century].

    PubMed

    Rutkowski, Marek

    2004-01-01

    We can observe that after downfall of the November Insurrection the authorities of the Polish Kingdom were effectively engaged in the fight against numerous epidemic diseases plaguing the local society. Among "contagions" of the time there were varicella, "gastric-nervous fever", "gastric-rhinitis fever" and typhus (especially in 1836). As usual, cholera was the most dangerous one. All medical and epidemiological services in the Polish Kingdom were making effective remedial measures in order to neutralize results of the epidemics. The implemented methods were effective enough to limit considerably the incidence and number of deceased during the epidemic, which started in October 1836 and lasted till the next year. An obligation of effective cooperation between the Polish authorities and the Russian army was introduced then. The sanitary action against cholera in 1836-1837 should be very highly assessed from the logistic point of view. The wide action of protective vaccination against varicella and numerous sanitary rules completed the favorable image of the Polish Kingdom sanitary services. All the factors mentioned above lead to a conclusion that in the thirtieth of the 19th century both civil and military authorities of the Polish Kingdom did practically utmost in order to limit negative results of cyclical recurrences of epidemic diseases. It should be also stressed that the protective actions undertaken in that time were both direct and long lasting enterprises.

  1. Cholera studies*†

    PubMed Central

    Pollitzer, R.; Burrows, W.

    1955-01-01

    Relevant information regarding the numerous problems encountered in cholera immunity is dealt with in great detail in this study. Toxin production, bacterial virulence, serological reactions, and the antigenic structure of V. cholerae are discussed. Natural, passive, and active cholera immunity receives special attention, the authors describing the various means of vaccination as well as the evaluation of the immunity induced. PMID:13240451

  2. Detection of Vibrio cholerae O1 and O139 in environmental waters of rural Bangladesh: a flow-cytometry-based field trial.

    PubMed

    Righetto, L; Zaman, R U; Mahmud, Z H; Bertuzzo, E; Mari, L; Casagrandi, R; Gatto, M; Islam, S; Rinaldo, A

    2015-08-01

    Presence of Vibrio cholerae serogroups O1 and O139 in the waters of the rural area of Matlab, Bangladesh, was investigated with quantitative measurements performed with a portable flow cytometer. The relevance of this work relates to the testing of a field-adapted measurement protocol that might prove useful for cholera epidemic surveillance and for validation of mathematical models. Water samples were collected from different water bodies that constitute the hydrological system of the region, a well-known endemic area for cholera. Water was retrieved from ponds, river waters, and irrigation canals during an inter-epidemic time period. Each sample was filtered and analysed with a flow cytometer for a fast determination of V. cholerae cells contained in those environments. More specifically, samples were treated with O1- and O139-specific antibodies, which allowed precise flow-cytometry-based concentration measurements. Both serogroups were present in the environmental waters with a consistent dominance of V. cholerae O1. These results extend earlier studies where V. cholerae O1 and O139 were mostly detected during times of cholera epidemics using standard culturing techniques. Furthermore, our results confirm that an important fraction of the ponds' host populations of V. cholerae are able to self-sustain even when cholera cases are scarce. Those contaminated ponds may constitute a natural reservoir for cholera endemicity in the Matlab region. Correlations of V. cholerae concentrations with environmental factors and the spatial distribution of V. cholerae populations are also discussed.

  3. Phenotypic and Genetic Heterogeneity in Vibrio cholerae O139 Isolated from Cholera Cases in Delhi, India during 2001-2006.

    PubMed

    Ghosh, Raikamal; Sharma, Naresh C; Halder, Kalpataru; Bhadra, Rupak K; Chowdhury, Goutam; Pazhani, Gururaja P; Shinoda, Sumio; Mukhopadhyay, Asish K; Nair, G Balakrish; Ramamurthy, Thadavarayan

    2016-01-01

    Incidence of epidemic Vibrio cholerae serogroup O139 has declined in cholera endemic countries. However, sporadic cholera caused by V. cholerae O139 with notable genetic changes is still reported from many regions. In the present study, 42 V. cholerae O139 strains isolated from 2001 to 2006 in Delhi, India, were retrospectively analyzed to understand their phenotype and molecular characteristics. The majority of isolates were resistant to ampicillin, furazolidone and nalidixic acid. Though the integrative conjugative element was detected in all the O139 isolates, the 2004-2006 isolates remained susceptible to co-trimoxazole, chloramphenicol, and streptomycin. Cholera toxin genotype 1 was present in the majority of the O139 isolates while few had type 3 or a novel type 4. In the cholera toxin encoding gene (ctx) restriction fragment length polymorphism, the majority of the isolates harbored three copies of CTX element, of which one was truncated. In this study, the ctx was detected for the first time in the small chromosome of V. cholerae O139 and one isolate harbored 5 copies of CTX element, of which 3 were truncated. The ribotype BII pattern was found in most of the O139 isolates. Three V. cholerae O139 isolated in 2001 had a new ribotype BVIII. Pulsed-field gel electrophoresis analysis revealed clonal variation in 2001 isolates compared to the 2004-2006 isolates. Molecular changes in V. cholerae O139 have to be closely monitored as this information may help in understanding the changing genetic features of this pathogen in relation to the epidemiology of cholera.

  4. Phenotypic and Genetic Heterogeneity in Vibrio cholerae O139 Isolated from Cholera Cases in Delhi, India during 2001–2006

    PubMed Central

    Ghosh, Raikamal; Sharma, Naresh C.; Halder, Kalpataru; Bhadra, Rupak K.; Chowdhury, Goutam; Pazhani, Gururaja P.; Shinoda, Sumio; Mukhopadhyay, Asish K.; Nair, G. Balakrish; Ramamurthy, Thadavarayan

    2016-01-01

    Incidence of epidemic Vibrio cholerae serogroup O139 has declined in cholera endemic countries. However, sporadic cholera caused by V. cholerae O139 with notable genetic changes is still reported from many regions. In the present study, 42 V. cholerae O139 strains isolated from 2001 to 2006 in Delhi, India, were retrospectively analyzed to understand their phenotype and molecular characteristics. The majority of isolates were resistant to ampicillin, furazolidone and nalidixic acid. Though the integrative conjugative element was detected in all the O139 isolates, the 2004–2006 isolates remained susceptible to co-trimoxazole, chloramphenicol, and streptomycin. Cholera toxin genotype 1 was present in the majority of the O139 isolates while few had type 3 or a novel type 4. In the cholera toxin encoding gene (ctx) restriction fragment length polymorphism, the majority of the isolates harbored three copies of CTX element, of which one was truncated. In this study, the ctx was detected for the first time in the small chromosome of V. cholerae O139 and one isolate harbored 5 copies of CTX element, of which 3 were truncated. The ribotype BII pattern was found in most of the O139 isolates. Three V. cholerae O139 isolated in 2001 had a new ribotype BVIII. Pulsed-field gel electrophoresis analysis revealed clonal variation in 2001 isolates compared to the 2004–2006 isolates. Molecular changes in V. cholerae O139 have to be closely monitored as this information may help in understanding the changing genetic features of this pathogen in relation to the epidemiology of cholera. PMID:27555841

  5. Deadly AIDS policy failure by the highest levels of the US government: a personal look back 30 years later for lessons to respond better to future epidemics.

    PubMed

    Francis, Donald P

    2012-08-01

    Successful control of any dangerous epidemic requires: (i) early understanding of the epidemiology of the disease and (ii) rapid applications of preventive interventions. Through the lack of both policy and financial support, the United States Centers for Disease Control (CDC) was severely handicapped during the early years of the AIDS epidemic. Senior staff of the Reagan Administration did not understand the essential role of Government in disease prevention. Although CDC clearly documented the dangers of HIV and AIDS early in the epidemic, refusal by the White House to deliver prevention programs then certainly allowed HIV to become more widely seeded. As much of the international health community relies on CDC for up-to-date prevention advice, these actions by the White House surely increased the spread of HIV around the world. To respond better to future epidemics, we need to understand the deadly forces that inhibited CDC at that time.

  6. Antimicrobial drugs for treating cholera

    PubMed Central

    Leibovici-Weissman, Ya'ara; Neuberger, Ami; Bitterman, Roni; Sinclair, David; Salam, Mohammed Abdus; Paul, Mical

    2014-01-01

    effects observed in severely and non-severely ill patients. Azithromycin and tetracycline may have some advantages over other antibiotics. PLAIN LANGUAGE SUMMARY Antibiotics for treating cholera Cochrane Collaboration researchers conducted a review of the effects of antibiotics for treating people with cholera. After searching for relevant trials, they included 39 randomized controlled trials enrolling 4623 people with cholera. What is cholera and how might antibiotics work Cholera is a form of severe watery diarrhoea, which spreads from person to person through food and water contaminated with the bacterium Vibrio cholerae. Cholera is common in places with poor water and sanitation, and sometimes causes large epidemics with thousands of people falling ill. Cholera can cause severe dehydration and death, so the main treatment is to give fluids and salt either orally as oral rehydration salts, or by injection. By clearing the bacteria earlier than the patients own immune system, antibiotics could reduce the duration and severity of the illness, and reduce onward transmission to other people. What the research says Antibiotic treatment shortened the duration of diarrhoea by about one and a half days (the normal duration is between three and four days), and reduced the total amount of diarrhoea fluid by half. Consequently, the need for rehydration fluids was also reduced by almost half. Antibiotic treatment also shortened the period of time where the patient remains contagious by reducing the duration of excretion of Vibrio cholerae in the diarrhoea. The benefits of antibiotics were seen in trials recruiting only people with severe dehydration, and in those recruiting people with mixed levels of dehydration. Tetracycline or azithromycin appear more effective than some of the other antibiotics tested, but the choice of which antibiotic to use will depend on local drug resistance. PMID:24944120

  7. A large cholera outbreak due to a new cholera toxin variant of the Vibrio cholerae O1 El Tor biotype in Orissa, Eastern India.

    PubMed

    Kumar, P; Jain, M; Goel, A K; Bhadauria, S; Sharma, S K; Kamboj, D V; Singh, L; Ramamurthy, T; Nair, G B

    2009-02-01

    A total of 32 Vibrio cholerae isolates were collected during a recent large cholera outbreak in Eastern India. Biochemical and serological studies revealed that all of the isolates belonged to serogroup O1, biotype El Tor, serotype Ogawa. Two multiplex PCR assays confirmed the presence of various toxigenic and pathogenic genes - ace, ctxAB, hlyA, ompU, ompW, rfbO1, rtx, tcp, toxR and zot - in all of the isolates. Sequencing of the ctxB gene from the isolates revealed a novel mutation in the gene. Sequencing also confirmed the presence of altered cholera toxin B of the classical biotype in all of the El Tor isolates, suggesting infection of isolates by classical CTXPhi. The molecular diversity of V. cholerae isolates studied by enterobacterial repetitive intergenic consensus sequence PCR, BOX-PCR and randomly amplified polymorphic DNA analysis uniformly showed the clonal relationship among the outbreak V. cholerae O1 isolates. The results of this study suggest that cholera-causing V. cholerae strains are constantly evolving in epidemic areas, highlighting the potential of the emergence of more virulent strains.

  8. Isolation frequency and susceptibility pattern of non-O1 and non-O139 Vibrio cholerae in a tertiary health care laboratory, 1999-2012.

    PubMed

    Irfan, S; Fasih, N; Ghanchi, N K; Khan, E

    2016-04-28

    In the past decade the importance of non-O1 and non-O139 strains of Vibrio cholerae has been highlighted globally. This study aimed to evaluate the frequency and antimicrobial susceptibility profile of non-O1 and non-O139 V. cholerae in Pakistan. Data of stool specimens yielding growth of non-O1 and non-O139 V. cholerae isolated at a national referral laboratory from 1999 to 2012 were retrospectively analysed and evaluated for resistance to ampicillin, tetracycline, chloramphenicol, co-trimoxazole and ofloxacin. A total of 95 800 stool samples submitted over 1999-2012 yielded 3668 strains of V. cholerae, of which 6% were non-O1 and non-O139 V. cholerae. A high isolation rate was found in the summer season, with a peak in the year 2003. Antimicrobial susceptibility data revealed increasing resistance to co-trimoxazole and ampicillin, but strains remained highly susceptible to ofloxacin. Active surveillance of serotypes and antimicrobial susceptibility is essential to predict future epidemics and define measures to curtail the disease.

  9. Phage-bacterial interactions in the evolution of toxigenic Vibrio cholerae.

    PubMed

    Faruque, Shah M; Mekalanos, John J

    2012-11-15

    Understanding the genetic and ecological factors which support the emergence of new clones of pathogenic bacteria is vital to develop preventive measures. Vibrio cholerae the causative agent of cholera epidemics represents a paradigm for this process in that this organism evolved from environmental non-pathogenic strains by acquisition of virulence genes. The major virulence factors of V. cholerae, cholera toxin (CT) and toxin coregulated pilus (TCP) are encoded by a lysogenic bacteriophage (CTXφ) and a pathogenicity island, respectively. Additional phages which cooperate with the CTXφ in horizontal transfer of genes in V. cholerae have been characterized, and the potential exists for discovering yet new phages or genetic elements which support the transfer of genes for environmental fitness and virulence leading to the emergence of new epidemic strains. Phages have also been shown to play a crucial role in modulating seasonal cholera epidemics. Thus, the complex array of natural phenomena driving the evolution of pathogenic V. cholerae includes, among other factors, phages that either participate in horizontal gene transfer or in a bactericidal selection process favoring the emergence of new clones of V. cholerae.

  10. Mesenteric Panniculitis Associated With Vibrio cholerae Infection

    PubMed Central

    Roginsky, Grigory; Mazulis, Andrew; Ecanow, Jacob S.

    2015-01-01

    We report the first case of acute Vibrio cholerae infection with computed tomography (CT) changes consistent with mesenteric panniculitis (MP). A 78-year-old Indian man returned from overseas travel with progressively severe nausea, vomiting, abdominal pain, and watery diarrhea. His stool tested positive twice for Vibrio cholerae. CT revealed prominent lymph nodes and a hazy mesentery consistent with MP. Antibiotic treatment resulted in complete resolution of MP on follow-up CT 8 months later. In the setting of Vibrio cholerae infection, the CT finding of MP appears to be the result of a immunologically mediated reactive inflammatory disorder of the mesentery. PMID:26504876

  11. Effects of local climate variability on transmission dynamics of cholera in Matlab, Bangladesh.

    PubMed

    Islam, M S; Sharker, M A Y; Rheman, S; Hossain, S; Mahmud, Z H; Islam, M S; Uddin, A M K; Yunus, M; Osman, M S; Ernst, R; Rector, I; Larson, C P; Luby, S P; Endtz, H P; Cravioto, A

    2009-11-01

    Cholera is considered as a model for climate-related infectious diseases. In Bangladesh, cholera epidemics occur during summer and winter seasons, but it is not known how climate variability influences the seasonality of cholera. Therefore, the variability pattern of cholera events was studied in relation to the variation in local climate variables in Matlab, Bangladesh. Classification and regression tree (CART) and principal component analysis (PCA) were used to study the dependency and variability pattern of monthly total cholera cases. An average temperature <23.25 degrees C corresponded to the lowest average cholera occurrence (23 cases/month). At a temperature of >or=23.25 degrees C and sunshine <4.13h/day, the cholera occurrence was 39 cases/month. With increased sunshine (>or=4.13h/day) and temperature (23.25-28.66 degrees C), the second highest cholera occurrence (44 cases/month) was observed. When the sunshine was >or=4.13h/day and the temperature was >28.66 degrees C, the highest cholera occurrence (54 cases/month) was observed. These results demonstrate that in summer and winter seasons in Bangladesh, temperature and sunshine hours compensate each other for higher cholera incidence. The synergistic effect of temperature and sunshine hours provided the highest number of cholera cases.

  12. [Epidemiological Surveillance of Cholera in Russia During the Period of the Seventh Pandemic].

    PubMed

    Onishhenko, G G; Moskvitina, E A; Kruglikov, V D; Titova, S V; Adamenko, O L; Vodop'ianov, A S; Vodop'ianov, S O

    2015-01-01

    In this work basic stages of formation of the epidemiological surveillance of cholera in Russia are described. In 1990-s for the first time zoning by epidemic manifestations of cholera was carried out at the level of subjects forming parts of Russia and other Republics of the Soviet Union with the introduction of differential tactics of epidemiological surveillance. Improvement of epidemiological surveillance of cholera was aimed at harmonization with the IHR (2005), integration of epidemiological surveillance of cholera and social-hygienic monitoring of water objects of I and II categories. Characterization of isolated Vibrio cholerae strains (1990-2014) on the genomic basis determined the emergence of new VNTR-genotypes of V. cholerae O1 ctxAB+ tcpA+, responsible for outbreaks, simultaneously with isolation of V. cholerae 01 ctxAB-tcpA-strains during monitoring of environmental objectsfor cholera. A viewpoint is considered of the beginning of the eighth cholera pandemic in the context of emergence of V. cholerae El Tor strains with CTXφ prophage carrying ctxB gene of cholera toxin of classical biovar. Main directions offurther enhancement ofepidemiological surveillance include the study of basic data structures used in the epidemiological surveillance system, the use of zoning of municipal units offederal subjects with corresponding surveillance tactics and expected economic effect.

  13. [Cholera and environmental medicine in the manuscript "Cholera-morbus" (1832), by Antonio Correa de Lacerda (1777-1852)].

    PubMed

    Sanjad, Nelson

    2004-01-01

    In the first half of the nineteenth century, the environmentalist paradigm dominated medical debate. In Brazil, it engendered the construction of a hygienist agenda that framed physicians' work and provided an interpretive key to public health-related issues The article addresses these and other questions from teh perspective of a text by Portuguese physician Antonio Correa de Lacerda who resided in Belém (Pará) and São Luís (Maranhão) between 1818 and 1852. Entitled "Cholera-morbus," the manuscript was written in 1832, the year the epidemic hit Paris. Lacerda calls on different areas of knowledge in his presentation of a coherent explanation of the disease, affording us a view of an anticontagionist interpretation grounded in anatomopathological practice. He likewise demonstrates how it was possible for a provincial doctor to produce original knowledge on the relation between climate, health, and culture, including the medicinal use of Amazon plants.

  14. Understanding Climate Change Impacts in a Cholera Endemic Megacity: Disease Trends, Hydroclimatic Indicators and Near Future-Term Projections

    NASA Astrophysics Data System (ADS)

    Akanda, A. S. S.; Hasan, M. A.; Serman, E. A.; Jutla, A.; Huq, A.; Colwell, R. R.

    2015-12-01

    The last three decades of surveillance data shows a drastic increase of cholera prevalence in the largest cholera-endemic city in the world - Dhaka, Bangladesh. While an endemic trend is getting stronger in the dry season, the post-monsoon season shows increased variability and is epidemic in nature. The pre-monsoon dry season is becoming the dominant cholera season of the year, followed by monsoon flood related propagation in later months of the year. Although the heavily populated and rapidly urbanizing Dhaka region has experienced noticeable shifts in pre monsoon temperature and precipitation patterns and subsequent monsoon variations, to date, there has not been any systematic study on linking the long-term disease trends with observed changes in hydroclimatic indicators. Here, we focus on the past 30-year dynamics of urban cholera prevalence in Dhaka with changes in climatic or anthropogenic forcings to develop projections for the next 30-year period. We focus on the dry and the wet season indicators individually, and develop trends of maximum rainfall intensity, lowest rainfall totals in the pre-monsoon period, number of consecutive dry days, number of wet days, and number of rainy days with greater than 500mm rainfall using a recently developed gridded data product - and compare with regional hydrology, flooding, water usage, changes in distribution systems, population growth and density in urban settlements, and frequency of natural disasters. We then use a bias correction method to develop the next 30 years projections of CMIP5 Regional Climate Model outputs and impacts on cholera prevalence using a probabilistic forecasting approach.

  15. Genetic characterization of Vibrio cholerae isolates from Argentina by V. cholerae repeated sequences-polymerase chain reaction.

    PubMed

    Castañeda, Nancy Claudia; Pichel, Mariana; Orman, Betina; Binsztein, Norma; Roy, Paul H; Centrón, Daniela

    2005-11-01

    We have developed a novel typing method based on Vibrio cholerae repeat sequences (VCR) using primers directed out of the VCR sequences. To evaluate the VCR-polymerase chain reaction (PCR) as a typing system, 2 categories, efficacy and efficiency, were analyzed in 69 strains of human and environmental V. cholerae O1 toxigenic and nontoxigenic, and non-O1 strains isolated since 1992-2000 from Argentina. The discriminatory power (0.91), stability (0.95), reproducibility (1), typeability (1), rapidity, accessibility, as well ease of use, indicated that the VCR-PCR method provides an alternative useful tool for molecular epidemiology of V. cholerae. The VCR-PCR of V. cholerae isolates showed 29 patterns, of which pattern 1 represented 68% of the V. cholerae O1 isolates, supporting the hypothesis that a clone with epidemic behavior was responsible for the epidemic in Latin America. These results showed a good correlation and a better epidemiologic analysis when the results were compared in parallel with repetitive extragenic palindromic sequences-PCR. In conclusion, VCR-PCR showed excellent performance as a typing method for cholera surveillance programs.

  16. [Antiretroviral therapy in HIV-infected children and adolescents: lessons learned in 30 years of the epidemic].

    PubMed

    Bazin, Gabriela Ricordi; Gaspar, Mariza Curto Saavedra; Silva, Nicole Carvalho Xavier Micheloni da; Mendes, Carolina da Costa; Oliveira, Cora Pichler de; Bastos, Leonardo Soares; Cardoso, Claudete Aparecida Araújo

    2014-04-01

    This study aims to evaluate antiretroviral therapy in children and adolescents with AIDS. We selected 247 abstracts published from 1983 to 2013, collected from the PubMed and LILACS databases. Sixty-nine articles were selected. Attention to research in the pediatric age bracket in 30 years of the epidemic is explained by the age group's immunological characteristics, since AIDS progresses faster in children than in adults. Recent studies focus on the initiation of highly active antiretroviral therapy before the onset of symptoms. Early introduction of combination antiretroviral therapy has been implemented effectively and safely in populations with limited resources, leading to significantly improved survival. The current challenge is to manage a chronic disease with acute complications. New studies should focus on population specificities and identify the individual needs of pediatric patients.

  17. Cholera in Haiti: Reproductive numbers and vaccination coverage estimates

    PubMed Central

    Mukandavire, Zindoga; Smith, David L.; Morris Jr, J. Glenn

    2013-01-01

    Cholera reappeared in Haiti in October, 2010 after decades of absence. Cases were first detected in Artibonite region and in the ensuing months the disease spread to every department in the country. The rate of increase in the number of cases at the start of epidemics provides valuable information about the basic reproductive number (). Quantitative analysis of such data gives useful information for planning and evaluating disease control interventions, including vaccination. Using a mathematical model, we fitted data on the cumulative number of reported hospitalized cholera cases in Haiti. varied by department, ranging from 1.06 to 2.63. At a national level, 46% vaccination coverage would result in an () <1, which would suppress transmission. In the current debate on the use of cholera vaccines in endemic and non-endemic regions, our results suggest that moderate cholera vaccine coverage would be an important element of disease control in Haiti. PMID:23308338

  18. Cholera in Haiti and Other Caribbean Regions, 19th Century

    PubMed Central

    Szabo, Victoria

    2011-01-01

    Medical journals and other sources do not show evidence that cholera occurred in Haiti before 2010, despite the devastating effect of this disease in the Caribbean region in the 19th century. Cholera occurred in Cuba in 1833–1834; in Jamaica, Cuba, Puerto Rico, St. Thomas, St. Lucia, St. Kitts, Nevis, Trinidad, the Bahamas, St. Vincent, Granada, Anguilla, St. John, Tortola, the Turks and Caicos, the Grenadines (Carriacou and Petite Martinique), and possibly Antigua in 1850–1856; and in Guadeloupe, Cuba, St. Thomas, the Dominican Republic, Dominica, Martinique, and Marie Galante in 1865–1872. Conditions associated with slavery and colonial military control were absent in independent Haiti. Clustered populations, regular influx of new persons, and close quarters of barracks living contributed to spread of cholera in other Caribbean locations. We provide historical accounts of the presence and spread of cholera epidemics in Caribbean islands. PMID:22099117

  19. Cholera in Haiti: Reproductive numbers and vaccination coverage estimates

    NASA Astrophysics Data System (ADS)

    Mukandavire, Zindoga; Smith, David L.; Morris, J. Glenn, Jr.

    2013-01-01

    Cholera reappeared in Haiti in October, 2010 after decades of absence. Cases were first detected in Artibonite region and in the ensuing months the disease spread to every department in the country. The rate of increase in the number of cases at the start of epidemics provides valuable information about the basic reproductive number (). Quantitative analysis of such data gives useful information for planning and evaluating disease control interventions, including vaccination. Using a mathematical model, we fitted data on the cumulative number of reported hospitalized cholera cases in Haiti. varied by department, ranging from 1.06 to 2.63. At a national level, 46% vaccination coverage would result in an () <1, which would suppress transmission. In the current debate on the use of cholera vaccines in endemic and non-endemic regions, our results suggest that moderate cholera vaccine coverage would be an important element of disease control in Haiti.

  20. Cholera in Haiti: reproductive numbers and vaccination coverage estimates.

    PubMed

    Mukandavire, Zindoga; Smith, David L; Morris, J Glenn

    2013-01-01

    Cholera reappeared in Haiti in October, 2010 after decades of absence. Cases were first detected in Artibonite region and in the ensuing months the disease spread to every department in the country. The rate of increase in the number of cases at the start of epidemics provides valuable information about the basic reproductive number (R(0)). Quantitative analysis of such data gives useful information for planning and evaluating disease control interventions, including vaccination. Using a mathematical model, we fitted data on the cumulative number of reported hospitalized cholera cases in Haiti. R(0) varied by department, ranging from 1.06 to 2.63. At a national level, 46% vaccination coverage would result in an (R(0)) <1, which would suppress transmission. In the current debate on the use of cholera vaccines in endemic and non-endemic regions, our results suggest that moderate cholera vaccine coverage would be an important element of disease control in Haiti.

  1. Hydroclimatological And Anthropogenic Drivers For Cholera Spreading

    NASA Astrophysics Data System (ADS)

    Righetto, Lorenzo; Bertuzzo, Enrico; Mari, Lorenzo; Casagrandi, Renato; Gatto, Marino; Rinaldo, Andrea

    2010-05-01

    The nature of waterborne diseases, among which cholera has a prominent importance, calls for a better understanding of the link between epidemic spreading, water and climate. To this end, we have developed a framework which involves a network-based description of a river system, connected with local communities which act as nodes of the network. This has allowed us to produce consistent simulations of real case studies. More recent investigations comprise the evaluation of the spreading velocity of an epidemic wave by means of a reaction-diffusion modeling approach. In particular, we have found that both transport processes and epidemiological quantities, such as the basic reproduction number, have a crucial effect in controlling the spreading of the epidemics. We first developed a description of bacterial movement along the network driven by advection and diffusion; afterward, we have included the movement of human populations. This latter model allowed us to establish the conditions that can trigger epidemic waves that start from the coastal region, where bacteria are autochthonous, and travel inland. In particular, our findings suggest that even relatively low values of human diffusion can have the epidemic propagate upstream. The interaction between climate, hydrology and epidemic events is still much debated, since no clear correlation between climatologic and epidemiological phenomena has emerged so far. However, a spatial assessment of hydrological and epidemiological mechanisms could be crucial to understand the evolution of cholera outbreaks. In particular, a hotly debated topic is the understanding of the mechanisms that can generate patterns of cholera incidence that exhibit an intra-annual double peak, as frequently observed in endemic region such as Bangladesh. One of the possible explanations proposed in the literature is that spring droughts cause bacteria concentration in water to rise dramatically, triggering the first peak. On the other hand

  2. Studies of cholera El Tor in the Philippines*

    PubMed Central

    Mosley, W. H.; Alvero, M. G.; Joseph, P. R.; Tamayo, J. F.; Gomez, C. Z.; Montague, T.; Dizon, J. J.; Henderson, D. A.

    1965-01-01

    As part of a broad study on the epidemiology of cholera El Tor in the Philippines, the authors conducted bacteriological surveys among the community contacts of suspect cholera patients hospitalized in the Negros Occidental Provincial Hospital from August through October 1962. Fourteen (2%) of 698 community contacts of persons with confirmed cholera patients were found on initial culture to be infected. Intensive studies in two communities suggested that infection was spread primarily by close personal contact; in a third community, contamined well-water presumably served as a vehicle for the transmission of infection. Diagnosed and undiagnosed cases, undiagnosed cholera deaths and asymptomatic infections all played a role in cholera transmission. The studies tend to confirm that the second or recurrent epidemic in Negros Occidental was primarily caused by person-to-person spread. Although the seemingly isolated or sporadic cases were sometimes associated with a more general distribution of the cholera vibrio, the cholera infections invariably were highly localized among close contacts even within densely populated areas with poor sanitation. PMID:5295146

  3. Cell Vacuolation Caused by Vibrio cholerae Hemolysin

    PubMed Central

    Figueroa-Arredondo, Paula; Heuser, John E.; Akopyants, Natalia S.; Morisaki, J. Hiroshi; Giono-Cerezo, Silvia; Enríquez-Rincón, Fernando; Berg, Douglas E.

    2001-01-01

    Non-O1 strains of Vibrio cholerae implicated in gastroenteritis and diarrhea generally lack virulence determinants such as cholera toxin that are characteristic of epidemic strains; the factors that contribute to their virulence are not understood. Here we report that at least one-third of diarrhea-associated nonepidemic V. cholerae strains from Mexico cause vacuolation of cultured Vero cells. Detailed analyses indicated that this vacuolation was related to that caused by aerolysin, a pore-forming toxin of Aeromonas; it involved primarily the endoplasmic reticulum at early times (∼1 to 4 h after exposure), and resulted in formation of large, acidic, endosome-like multivesicular vacuoles (probably autophagosomes) only at late times (∼16 h). In contrast to vacuolation caused by Helicobacter pylori VacA protein, that induced by V. cholerae was exacerbated by agents that block vacuolar proton pumping but not by endosome-targeted weak bases. It caused centripetal redistribution of endosomes, reflecting cytoplasmic alkalinization. The gene for V. cholerae vacuolating activity was cloned and was found to correspond to hlyA, the structural gene for hemolysin. HlyA protein is a pore-forming toxin that causes ion leakage and, ultimately, eukaryotic cell lysis. Thus, a distinct form of cell vacuolation precedes cytolysis at low doses of hemolysin. We propose that this vacuolation, in itself, contributes to the virulence of V. cholerae strains, perhaps by perturbing intracellular membrane trafficking or ion exchange in target cells and thereby affecting local intestinal inflammatory or other defense responses. PMID:11179335

  4. Epidemiologic and Drug Resistance Pattern of Vibrio cholerae O1 Biotype El Tor, Serotype Ogawa, in the 2011 Cholera Outbreak, in Alborz Province, Iran

    PubMed Central

    Barati, Hojatolah; Moradi, Ghobad; Rasouli, Mohammad Aziz; Mohammadi, Parvin

    2015-01-01

    Background: Although the national guidelines recommend special antibiotics, based on the antibiogram of National Reference Laboratory, it seems that, because of uncontrolled usage of antibiotics in the society and due to the changes in the serotypes causing the disease, it is essential to monitor the status of drug resistance, permanently, and to revise the current prescriptions guidelines. Objectives: This study aimed to assess the epidemiological aspects and drug resistance pattern of Vibrio cholerae O1, biotype El Tor, serotype Ogawa, in cholera outbreak, in Alborz province in Iran, during 2011. Materials and Methods: This is a cross-sectional study, which reviews a cholera epidemic that occurred in Iran. A total of 9844 specimens were taken from suspected cases, among diarrheal patients, via rectal swabs. The specimens were placed in Cary-Blair transport medium and sent to laboratory. Samples were enriched, in alkaline peptone water, and isolated on thiosulphate-citrate-bile salt-sucrose agar. From the 244 confirmed cases, 239 cases underwent antibiogram test, via disk diffusion method and based on national committee for clinical laboratory standards (NCCLS) instructions. The standard Escherichia coli ATCC 25922 was used for antibiogram quality control and, eventually, all results were interpreted and reported using NCCLS standard table. Results: In total, until October 22, 2011, which was announced as the end of outbreak, 9844 samples were taken from diarrheal patients. Regarding the type of V. cholerae, 244 El Tor biotype positive cases were reported. The case fatality rate was 1.3%. The mean age of patients was 37.8 years and the highest incidence rate occurred in the age group 21 - 30 years. After conducting antibiotic susceptibility test in the 244 V. cholerae, biotype El Tor, serotype Ogawa, it was found that ciprofloxacin had the highest level of antibiotic susceptibility (99.6%) and the highest level of antibiotic resistance was observed in co

  5. Molecular characterization of Vibrio cholerae O1 strains isolated during cholera outbreaks in Guinea-Bissau.

    PubMed Central

    Dalsgaard, A; Mortensen, H F; Mølbak, K; Dias, F; Serichantalergs, O; Echeverria, P

    1996-01-01

    In the present study, 19 strains of Vibrio cholerae O1 biotype El Tor isolated during outbreaks of cholera in Guinea-Bissau in 1987, 1994, and 1995 were characterized to investigate a possible epidemiological relationship among the isolates. On the basis of ribotyping with the restriction enzyme BglI, 5 strains isolated in 1987 showed two closely related ribotypes, while 14 strains isolated in 1994 and 1995 showed the same ribotype that was distinct from the ribotypes of strains isolated in 1987. Southern blot hybridization of BglI-digested genomic DNA with a cholera toxin probe demonstrated that the strains isolated in 1987 showed an identical cholera toxin genotype, whereas O1 strains isolated in 1994 and 1995 showed the same genotype that was distinct from the genotype of strains isolated in 1987. These results were supported by the results of antibiotic susceptibility testing, in which strains isolated in 1987 showed resistance to polymyxin B only, while each of the strains from 1994 and 1995 showed resistance to polymyxin B, trimethoprim-sulfamethoxazole, and the vibriostatic agent O/129. Although our results are based on a limited number of V. cholerae O1 strains, they suggest that the epidemic in Guinea-Bissau in 1994 and 1995 was due to the introduction of a new strain to the country. PMID:8727901

  6. Genome assortment, not serogroup, defines Vibrio cholerae pandemic strains

    SciTech Connect

    Brettin, Thomas S; Bruce, David C; Challacombe, Jean F; Detter, John C; Han, Cliff S; Munik, A C; Chertkov, Olga; Meincke, Linda; Saunders, Elizabeth; Choi, Seon Y; Haley, Bradd J; Taviani, Elisa; Jeon, Yoon - Seong; Kim, Dong Wook; Lee, Jae - Hak; Walters, Ronald A; Hug, Anwar; Colwell, Rita R

    2009-01-01

    Vibrio cholerae, the causative agent of cholera, is a bacterium autochthonous to the aquatic environment, and a serious public health threat. V. cholerae serogroup O1 is responsible for the previous two cholera pandemics, in which classical and El Tor biotypes were dominant in the 6th and the current 7th pandemics, respectively. Cholera researchers continually face newly emerging and re-emerging pathogenic clones carrying combinations of new serogroups as well as of phenotypic and genotypic properties. These genotype and phenotype changes have hampered control of the disease. Here we compare the complete genome sequences of 23 strains of V. cholerae isolated from a variety of sources and geographical locations over the past 98 years in an effort to elucidate the evolutionary mechanisms governing genetic diversity and genesis of new pathogenic clones. The genome-based phylogeny revealed 12 distinct V. cholerae phyletic lineages, of which one, designated the V. cholerae core genome (CG), comprises both O1 classical and EI Tor biotypes. All 7th pandemic clones share nearly identical gene content, i.e., the same genome backbone. The transition from 6th to 7th pandemic strains is defined here as a 'shift' between pathogenic clones belonging to the same O1 serogroup, but from significantly different phyletic lineages within the CG clade. In contrast, transition among clones during the present 7th pandemic period can be characterized as a 'drift' between clones, differentiated mainly by varying composition of laterally transferred genomic islands, resulting in emergence of variants, exemplified by V.cholerae serogroup O139 and V.cholerae O1 El Tor hybrid clones that produce cholera toxin of classical biotype. Based on the comprehensive comparative genomics presented in this study it is concluded that V. cholerae undergoes extensive genetic recombination via lateral gene transfer, and, therefore, genome assortment, not serogroup, should be used to define pathogenic V

  7. Vibrio cholerae Biofilms and Cholera Pathogenesis

    PubMed Central

    Silva, Anisia J.; Benitez, Jorge A.

    2016-01-01

    Vibrio cholerae can switch between motile and biofilm lifestyles. The last decades have been marked by a remarkable increase in our knowledge of the structure, regulation, and function of biofilms formed under laboratory conditions. Evidence has grown suggesting that V. cholerae can form biofilm-like aggregates during infection that could play a critical role in pathogenesis and disease transmission. However, the structure and regulation of biofilms formed during infection, as well as their role in intestinal colonization and virulence, remains poorly understood. Here, we review (i) the evidence for biofilm formation during infection, (ii) the coordinate regulation of biofilm and virulence gene expression, and (iii) the host signals that favor V. cholerae transitions between alternative lifestyles during intestinal colonization, and (iv) we discuss a model for the role of V. cholerae biofilms in pathogenicity. PMID:26845681

  8. Investigating the role of water in the Diffusion of Cholera using Agent-Based simulation

    NASA Astrophysics Data System (ADS)

    Augustijn, Ellen-Wien; Doldersum, Tom; Augustijn, Denie

    2014-05-01

    Traditionally, cholera was considered to be a waterborne disease. Currently we know that many other factors can contribute to the spread of this disease including human mobility and human behavior. However, the hydrological component in cholera diffusion is significant. The interplay between cholera and water includes bacteria (V. cholera) that survive in the aquatic environment, the possibility that run-off water from dumpsites carries the bacteria to surface water (rivers and lakes), and when the bacteria reach streams they can be carried downstream to infect new locations. Modelling is a very important tool to build theory on the interplay between different types of transmission mechanisms that together are responsible for the spread of Cholera. Agent-based simulation models are very suitable to incorporate behavior at individual level and to reproduce emergence. However, it is more difficult to incorporate the hydrological components in this type of model. In this research we present the hydrological component of an Agent-Based Cholera model developed to study a Cholera epidemic in Kumasi (Ghana) in 2005. The model was calibrated on the relative contribution of each community to the distributed pattern of cholera rather than the absolute number of incidences. Analysis of the results shows that water plays an important role in the diffusion of cholera: 75% of the cholera cases were infected via river water that was contaminated by runoff from the dumpsites. To initiate infections upstream, the probability of environment-to-human transmission seemed to be overestimated compared to what may be expected from literature. Scenario analyses show that there is a strong relation between the epidemic curve and the rainfall. Removing dumpsites that are situated close to the river resulted in a strong decrease in the number of cholera cases. Results are sensitive to the scheduling of the daily activities and the survival time of the cholera bacteria.

  9. Environmental determinants of cholera outbreaks in inland Africa: a systematic review of main transmission foci and propagation routes.

    PubMed

    Rebaudet, Stanislas; Sudre, Bertrand; Faucher, Benoît; Piarroux, Renaud

    2013-11-01

    Cholera is generally regarded as the prototypical waterborne and environmental disease. In Africa, available studies are scarce, and the relevance of this disease paradigm is questionable. Cholera outbreaks have been repeatedly reported far from the coasts: from 2009 through 2011, three-quarters of all cholera cases in Africa occurred in inland regions. Such outbreaks are either influenced by rainfall and subsequent floods or by drought- and water-induced stress. Their concurrence with global climatic events has also been observed. In lakes and rivers, aquatic reservoirs of Vibrio cholerae have been evocated. However, the role of these reservoirs in cholera epidemiology has not been established. Starting from inland cholera-endemic areas, epidemics burst and spread to various environments, including crowded slums and refugee camps. Human displacements constitute a major determinant of this spread. Further studies are urgently needed to better understand these complex dynamics, improve water and sanitation efforts, and eliminate cholera from Africa.

  10. Cholera studies*†

    PubMed Central

    Pollitzer, R.

    1955-01-01

    In this study, the author describes in detail experimental cholera infection of mammals (infection by the oral route, intragastric inoculation, and intestinal, gall-bladder, and parenteral infection). The pathogenicity for lower animals is examined, and certain observations on insects are included. The second part of the study is devoted to the pathology of human cholera (morbid anatomy distribution of the causative organisms in the dead bodies of cholera victims, and pathogenesis). PMID:13284569

  11. Modeling cholera outbreaks

    PubMed Central

    Longini, Ira M.; Morris, J. Glenn

    2014-01-01

    Mathematical modeling can be a valuable tool for studying infectious disease outbreak dynamics and simulating the effects of possible interventions. Here, we describe approaches to modeling cholera outbreaks and how models have been applied to explore intervention strategies, particularly in Haiti. Mathematical models can play an important role in formulating and evaluating complex cholera outbreak response options. Major challenges to cholera modeling are insufficient data for calibrating models and the need to tailor models for different outbreak scenarios. PMID:23412687

  12. Cholera toxin structure, gene regulation and pathophysiological and immunological aspects.

    PubMed

    Sánchez, J; Holmgren, J

    2008-05-01

    Many notions regarding the function, structure and regulation of cholera toxin expression have remained essentially unaltered in the last 15 years. At the same time, recent findings have generated additional perspectives. For example, the cholera toxin genes are now known to be carried by a non-lytic bacteriophage, a previously unsuspected condition. Understanding of how the expression of cholera toxin genes is controlled by the bacterium at the molecular level has advanced significantly and relationships with cell-density-associated (quorum-sensing) responses have recently been discovered. Regarding the cell intoxication process, the mode of entry and intracellular transport of cholera toxin are becoming clearer. In the immunological field, the strong oral immunogenicity of the non-toxic B subunit of cholera toxin (CTB) has been exploited in the development of a now widely licensed oral cholera vaccine. Additionally, CTB has been shown to induce tolerance against co-administered (linked) foreign antigens in some autoimmune and allergic diseases.

  13. The role of China in the global spread of the current cholera pandemic.

    PubMed

    Didelot, Xavier; Pang, Bo; Zhou, Zhemin; McCann, Angela; Ni, Peixiang; Li, Dongfang; Achtman, Mark; Kan, Biao

    2015-03-01

    Epidemics and pandemics of cholera, a severe diarrheal disease, have occurred since the early 19th century and waves of epidemic disease continue today. Cholera epidemics are caused by individual, genetically monomorphic lineages of Vibrio cholerae: the ongoing seventh pandemic, which has spread globally since 1961, is associated with lineage L2 of biotype El Tor. Previous genomic studies of the epidemiology of the seventh pandemic identified three successive sub-lineages within L2, designated waves 1 to 3, which spread globally from the Bay of Bengal on multiple occasions. However, these studies did not include samples from China, which also experienced multiple epidemics of cholera in recent decades. We sequenced the genomes of 71 strains isolated in China between 1961 and 2010, as well as eight from other sources, and compared them with 181 published genomes. The results indicated that outbreaks in China between 1960 and 1990 were associated with wave 1 whereas later outbreaks were associated with wave 2. However, the previously defined waves overlapped temporally, and are an inadequate representation of the shape of the global genealogy. We therefore suggest replacing them by a series of tightly delineated clades. Between 1960 and 1990 multiple such clades were imported into China, underwent further microevolution there and then spread to other countries. China was thus both a sink and source during the pandemic spread of V. cholerae, and needs to be included in reconstructions of the global patterns of spread of cholera.

  14. Hydroclimatic Extremes and Cholera Dynamics in the 21st Century

    NASA Astrophysics Data System (ADS)

    Akanda, A. S.; Jutla, A. S.; Islam, S.

    2012-12-01

    Cholera, an acute water-borne diarrheal illness, has reemerged as a significant health threat across much of the developing world. Despite major advances in the ecological and the microbiological understanding of the causative agent, V. cholerae, the role of the underlying climatic and environmental processes in propagating transmission is not adequately understood. Recent findings suggest a more prominent role of hydroclimatic extremes - droughts and floods - on the unique dual cholera peaks in the Bengal Delta region of South Asia, the native homeland of cholera. Increasing water scarcity and abundance, and coastal sea-level rise, influenced by changing climate patterns and large-scale climatic phenomena, is likely to adversely impact cholera transmission in South Asia. We focus on understanding how associated changes in macro-scale conditions in this region will impact micro-scale processes related to cholera in coming decades. We use the PRECIS Regional Climate Model over the Ganges-Brahmaputra-Meghna (GBM) basin region to simulate detailed high resolution projections of climate patterns for the 21st century. Precipitation outputs are analyzed for the 1980-2040 period to identify the trends and changes in hydroclimatic extremes and potential impacts on cholera dynamics over the next three decades (2010-2040), in relation to the cholera surveillance operations over the past three decades (1980-2010). We find that an increased number of extreme precipitation events with prolonged dry periods in the Ganges basin region will likely adversely affect dry season cholera outbreaks. Increased monsoon precipitation volumes in the Brahmaputra basin catchments are likely to cause record floods and subsequently trigger large epidemics in downstream areas. Our results provide new insight by identifying the changes in the two distinctly different, pre and post monsoon, cholera transmission mechanisms related to large-scale climatic controls that prevail in the region. A

  15. Adapting to the global shortage of cholera vaccines: targeted single dose cholera vaccine in response to an outbreak in South Sudan.

    PubMed

    Parker, Lucy A; Rumunu, John; Jamet, Christine; Kenyi, Yona; Lino, Richard Laku; Wamala, Joseph F; Mpairwe, Allan M; Ciglenecki, Iza; Luquero, Francisco J; Azman, Andrew S; Cabrol, Jean-Clement

    2017-01-18

    Shortages of vaccines for epidemic diseases, such as cholera, meningitis, and yellow fever, have become common over the past decade, hampering efforts to control outbreaks through mass reactive vaccination campaigns. Additionally, various epidemiological, political, and logistical challenges, which are poorly documented in the literature, often lead to delays in reactive campaigns, ultimately reducing the effect of vaccination. In June 2015, a cholera outbreak occurred in Juba, South Sudan, and because of the global shortage of oral cholera vaccine, authorities were unable to secure sufficient doses to vaccinate the entire at-risk population-approximately 1 million people. In this Personal View, we document the first public health use of a reduced, single-dose regimen of oral cholera vaccine, and show the details of the decision-making process and timeline. We also make recommendations to help improve reactive vaccination campaigns against cholera, and discuss the importance of new and flexible context-specific dose regimens and vaccination strategies.

  16. Cholera studies*†

    PubMed Central

    Pollitzer, R.

    1955-01-01

    The morphological characteristics, biochemical properties, and cultural characteristics of V. cholerae are described in great detail in this study. The author also discusses the resistance of the organism to temperature, humidity, sunlight, and various chemicals, as well as the viability of V. cholerae outside the body (in faeces, contaminated material, food, beverages, water, etc.). PMID:14379012

  17. [Observations on the 1348 plague epidemic. Measures taken to combat its tragic effects and avoid epidemic recrudescence].

    PubMed

    Sabbatani, Sergio

    2003-03-01

    When the "Black Death" swept through Europe from southern France in 1348, in the short space of two years the Europeans were hit by one of the most serious epidemics ever recorded in human history. Yersinia pestis reached Europe by sea, its contamination propagated by the Genoese ships coming from the Crimean port of Jaffa. For the first time the world experienced microbiological unification: East and West were equally involved in the tragedy that spread, and no town remained unscathed during the various epidemic waves which succeeded one another in the following three centuries. The authors of this article describe how and why the epidemic spread, as well as the factors that led to the swift, and often fatal, involment of millions of Europeans. The second part of the article deals with the measures taken by the healthcare authorities of European towns and countries in order to halt the proliferation of the disease. According to the data and observations by authoritative authors, selected among the many who studied the disease that from the 14th century spread like a scourge throughout the known world at the time, the epidemic could have been even more serious, in terms of mortality and morbidity, without the disciplinary and provisional health measures taken. The experience gained in Italy and all over Europe at the time proved useful not only to better manage the epidemics which cyclically broke out, but also to efficiently combat the cholera epidemics of the 19th century. With the 14th century plague epidemic, the Europeans and their political and administrative representatives may well have realized for the very first time that contamination could be combatted by adopting a set of rational, scientific norms - although in practice such rules were mostly inspired by misguided scientific theories. Humankind was no longer alone. A new society was emerging, one that was not going to passively accept the more or less mysterious ways of a superior being of fate. The

  18. Hydrology and Human Health: Predicting Cholera Outbreaks using Remote Sensing Data

    NASA Astrophysics Data System (ADS)

    Jutla, A. S.; Akanda, A. S.; Islam, S.

    2010-12-01

    Cholera bacteria survive and thrive in two distinctively different environments: the micro- and the macro-environmental processes that vary over a range of spatial and temporal scales. While micro-environmental conditions are necessary for maintaining epidemic conditions, macro-environmental conditions set the stage for initial outbreak and endemicity of the disease. As macro-environmental processes provide natural ecological niche for V. cholerae and there is powerful evidence of new biotypes emerging, it is unlikely that cholera will be fully eradicated, a condition which necessitates exploration of alternate means to develop prediction mechanism for cholera outbreaks. Satellite remote sensing data provides reliable estimates of plankton abundance through chlorophyll content which then can be used to understand cholera - chlorophyll relationships. However, the functional nature of association of cholera incidence with chlorophyll and its predictive capabilities are not well understood. Here we show that cholera outbreaks in Bengal Delta can be predicted two to three months in advance with an overall prediction accuracy of greater than 80% using combination of satellite derived chlorophyll and air temperature. Such high prediction accuracy is achievable because the two seasonal peaks of cholera in Bengal Delta are controlled by two distinctive macro-environmental processes. We have found that interannual variability of pre- monsoonal cholera outbreaks is intricately linked with coastal plankton through a cascade of hydro-coastal processes. Post- monsoonal cholera outbreaks, on the other hand, are related with wide spreading flooding and subsequent breakdown of the sanitary conditions. Our results demonstrate that satellite data, with a careful choice of space and time scales, can be very effective to develop a cholera prediction model for the Bengal delta with several months lead time. We anticipate that our modeling framework will provide essential lead time for

  19. Trends in the genomic epidemiology of Vibrio cholerae O1 isolated worldwide since 1961.

    PubMed

    Jaiswal, Abhishek; Sarkar, Sounak; Das, Parijat; Nandy, Suman; Koley, Hemanta; Sarkar, Banwarilal

    2015-10-01

    Here we describe the international scenario of Vibrio cholerae with a comparative analysis of different aspects of typing. Representative V. cholerae strains (n=108) associated with endemic cholera regions from 29 states of India and worldwide were subjected to microbiological, molecular and phylogenetic study. All of the strains were V. cholerae serogroup O1 biotype El Tor and were typed according to both the new phage (NP) type and Basu & Mukherjee (BM) typing schemes. The predominant phage type was T-27 (NP)/T-4 (BM) (65.7%; n=71), followed by phage type T-27 (NP)/T-2 (BM) (14.8%; n=16), T-26 (NP)/T4 (BM) (12.0%; n=13), T-13 (NP)/T-4 (BM) (2.8%; n=3), T-20 (NP)/T-4 (BM) (1.9%; n=2), T-3 (NP)/T-4 (BM) (0.9%; n=1), T-23 (NP)/T-4 (BM) (0.9%; n=1) and T-24 (NP)/T-2 (BM) (0.9%; n=1). Mismatch amplification mutation assay PCR (MAMA-PCR) findings showed the dominance of ctxB El Tor genotype (77.1%; 54/70) from 1961-1991, whilst the next two epochs showed the supremacy of ctxB classical genotype. Multidrug-resistant strains showed resistance to erythromycin, streptomycin, trimethoprim/sulfamethoxazole, norfloxacin and ampicillin. The regional resistance of epidemic clones in India draws a layout of the rapid dissemination of resistance in the past 30 years and the necessity of proper treatment to protect populations at risk.

  20. [Cholera in Europe and Denmark in the 19th century].

    PubMed

    Bonderup, G

    1996-01-01

    There are several reasons for dealing with cholera in the 19th century: it acted as a spotlight throwing into sharp relief the darkest corners of society that are seldom mentioned in the sources. We learn about everyday life in large parts of the population, especially the poor. The fight against the disease also reveals how a society worked socially and politically. When cholera arrived in Europe -- the first time was in the 1830's and several times after that--the population reacted very violently, often by lynching doctors, while the authorities more or less let matters take their course. That is why international researchers have come to see cholera as a catalyst for the constantly latent social unrest following in the train of wars and revolutions. During my research on cholera in Denmark it became clear to me that matters were different here. There were no riots, nor any signs of social unrest--neither before nor after the outbreak of cholera. On the contrary, the authorities and the population joined forces against the epidemic. There was an atmosphere of mutual trust, and almost everybody turned out to be worthy of such trust. That points to a balanced society based on consensus, so cholera also functions as a detector of the fundamental structure of a society.

  1. Considerations around the introduction of a cholera vaccine in Bangladesh.

    PubMed

    Nelson, Christopher B; Mogasale, Vittal; Bari, Tajul Islam A; Clemens, John D

    2014-12-12

    Cholera is an endemic and epidemic disease in Bangladesh. On 3 March 2013, a meeting on cholera and cholera vaccination in Bangladesh was convened by the Foundation Mérieux jointly with the International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR, B). The purpose of the meeting was to discuss the investment case for cholera vaccination as a complimentary control and prevention strategy. The performance of a new low cost oral cholera vaccine, Shanchol™, used in recent trials in Bangladesh, was also reviewed in the context of a potential large-scale public-sector vaccination program. Findings showed the oral vaccine to be highly cost-effective when targeting ages 1-14 y, and cost-effective when targeting ages 1+y, in high-burden/high-risk districts. Other vaccination strategies targeting urban slums and rural areas without improved water were found to be cost-effective. Regardless of cost-effectiveness (value), the budget impact (affordability) will be an important determinant of which target population and vaccination strategy is selected. Most importantly, adequate vaccine supply for the proposed vaccination programs must be addressed in the context of global efforts to establish a cholera vaccine stockpile and supply other control and prevention efforts.

  2. Costs of Dengue Control Activities and Hospitalizations in the Public Health Sector during an Epidemic Year in Urban Sri Lanka

    PubMed Central

    Thalagala, Neil; Tissera, Hasitha; Palihawadana, Paba; Amarasinghe, Ananda; Ambagahawita, Anuradha; Wilder-Smith, Annelies; Shepard, Donald S.; Tozan, Yeşim

    2016-01-01

    Background Reported as a public health problem since the 1960s in Sri Lanka, dengue has become a high priority disease for public health authorities. The Ministry of Health is responsible for controlling dengue and other disease outbreaks and associated health care. The involvement of large numbers of public health staff in dengue control activities year-round and the provision of free medical care to dengue patients at secondary care hospitals place a formidable financial burden on the public health sector. Methods We estimated the public sector costs of dengue control activities and the direct costs of hospitalizations in Colombo, the most heavily urbanized district in Sri Lanka, during the epidemic year of 2012 from the Ministry of Health’s perspective. The financial costs borne by public health agencies and hospitals are collected using cost extraction tools designed specifically for the study and analysed retrospectively using a combination of activity-based and gross costing approaches. Results The total cost of dengue control and reported hospitalizations was estimated at US$3.45 million (US$1.50 per capita) in Colombo district in 2012. Personnel costs accounted for the largest shares of the total costs of dengue control activities (79%) and hospitalizations (46%). The results indicated a per capita cost of US$0.42 for dengue control activities. The average costs per hospitalization ranged between US$216–609 for pediatric cases and between US$196–866 for adult cases according to disease severity and treatment setting. Conclusions This analysis is a first attempt to assess the economic burden of dengue response in the public health sector in Sri Lanka. Country-specific evidence is needed for setting public health priorities and deciding about the deployment of existing or new technologies. Our results suggest that dengue poses a major economic burden on the public health sector in Sri Lanka. PMID:26910907

  3. Linking Satellite Derived Land Surface Temperature with Cholera: A Case Study for South Sudan

    NASA Astrophysics Data System (ADS)

    Aldaach, H. S. V.; Jutla, A.; Akanda, A. S.; Colwell, R. R.

    2014-12-01

    A sudden onset of cholera in South Sudan, in April 2014 in Northern Bari in Juba town resulted in more than 400 cholera cases after four weeks of initial outbreak with a case of fatality rate of CFR 5.4%. The total number of reported cholera cases for the period of April to July, 2014 were 5,141 including 114 deaths. With the limited efficacy of cholera vaccines, it is necessary to develop mechanisms to predict cholera occurrence and thereafter devise intervention strategies for mitigating impacts of the disease. Hydroclimatic processes, primarily precipitation and air temperature are related to epidemic and episodic outbreak of cholera. However, due to coarse resolution of both datasets, it is not possible to precisely locate the geographical location of disease. Here, using Land Surface Temperature (LST) from MODIS sensors, we have developed an algorithm to identify regions susceptible for cholera. Conditions for occurrence of cholera were detectable at least one month in advance in South Sudan and were statistically sensitive to hydroclimatic anomalies of land surface and air temperature, and precipitation. Our results indicate significant spatial and temporal averaging required to infer usable information from LST over South Sudan. Preliminary results that geographically location of cholera outbreak was identifiable within 1km resolution of the LST data.

  4. "I'm not dog, no!": cries of resistance against cholera control campaigns.

    PubMed

    Nations, M K; Monte, C M

    1996-09-01

    Popular reactions toward government efforts to control the recent cholera epidemic in Northeast Brazil are evaluated. Intensive ethnographic interviews and participant-observation in two urban slums (favelas), reveal a high level of resistance on the part of impoverished residents towards official cholera control interventions and mass media campaigns. "Non-compliance" with recommended regimens is described more as a revolt against accusatory attitudes and actions of the elite than as an outright rejection of care by the poor. "Hidden transcripts" about "The Dog's Disease," as cholera is popularly called, voices a history of social and economic inequity and domination in Northeast Brazil. Here, cholera is encumbered by the trappings of metaphor. Two lurid cultural stereotypes, pessoa imunda (filthy, dirty person) and vira lata (stray mutt dog) are used, it is believed, to equate the poor with cholera. The morally disgracing and disempowering imagery of cholera is used to blame and punish the poor and to collectively taint and separate their communities from wealthy neighborhoods. The authors argue that metaphoric trappings have tragic consequences: they deform the experience of having cholera and inhibit the sick and dying from seeking treatment early enough. Controlling cholera requires eliminating "blaming the victim" rhetoric while attacking the social roots of cholera: poverty, low earning power, female illiteracy, sexism, lack of basic sanitation and clean water supplies, medical hegemony, etc. For health interventions to be effective, it is necessary to take into account people's "hidden transcripts" when designing action programs.

  5. Vibrio cholerae in an Historically Cholera-Free Country.

    PubMed

    Haley, Bradd J; Chen, Arlene; Grim, Christopher J; Clark, Philip; Diaz, Celia Municio; Taviani, Elisa; Hasan, Nur A; Sancomb, Elizabeth; Elnemr, Wessam Mahmoud; Islam, Muhammad A; Huq, Anwar; Colwell, Rita R; Benediktsdóttir, Eva

    2012-08-01

    We report the autochthonous existence of Vibrio cholerae in coastal waters of Iceland, a geothermally active country where cholera is absent and has never been reported. Seawater, mussel, and macroalgae samples were collected close to and distant from sites where geothermal activity causes a significant increase in water temperature during low tides. V. cholerae was detected only at geothermal-influenced sites during low-tides. None of the V. cholerae isolates encoded cholera toxin (ctxAB) and all were non-O1/non-O139 serogroups. However, all isolates encoded other virulence factors that are associated with cholera as well as extra-intestinal V. cholerae infections. The virulence factors were functional at temperatures of coastal waters of Iceland, suggesting an ecological role. It is noteworthy that V. cholerae was isolated from samples collected at sites distant from anthropogenic influence, supporting the conclusion that V. cholerae is autochthonous to the aquatic environment of Iceland.

  6. New variant of Vibrio cholerae O1 from clinical isolates in Amazonia.

    PubMed Central

    Coelho, A; Andrade, J R; Vicente, A C; Salles, C A

    1995-01-01

    A survey of pathogenic Vibrio cholerae O1 strains from the north of Brazil by using arbitrarily primed PCR fingerprints revealed a group of strains with similar fingerprint patterns that are distinct from those of the current El Tor epidemic strain. These strains have been analyzed by in vivo and in vitro techniques and the group has been denominated the Amazonian variant of V. cholerae O1. PMID:7535309

  7. Elimination of cholera in the democratic Republic of the Congo: the new national policy.

    PubMed

    Muyembe, Jean Jacques; Bompangue, Didier; Mutombo, Guy; Akilimali, Laurent; Mutombo, Annie; Miwanda, Berthe; Mpuruta, Jean de Dieu; Deka, Kabunga Kambale; Bitakyerwa, Fataki; Saidi, Jaime Mufitini; Mutadi, Armand Luhembwe; Kakongo, Raphael Senga; Birembano, Freddy; Mengel, Martin; Gessner, Bradford D; Ilunga, Benoît Kebela

    2013-11-01

    We evaluated published and unpublished data on cholera cases and deaths reported from clinical care facilities in the 56 health districts of the Democratic Republic of Congo to the National Ministry of Health during 2000-2011. Cholera incidence was highest in the eastern provinces bordering lakes and epidemics primarily originated in this region. Along with a strong seasonal component, our data suggest a potential Vibrio cholerae reservoir in the Rift Valley lakes and the possible contribution of the lakes' fishing industry to the spread of cholera. The National Ministry of Health has committed to the elimination-rather than control-of cholera in DRC and has adopted a new national policy built on improved alert, response, case management, and prevention. To achieve this goal and implement all these measures it will require strong partners in the international community with a similar vision.

  8. Predictors of disease severity in patients admitted to a cholera treatment center in urban Haiti.

    PubMed

    Valcin, Claude-Lyne; Severe, Karine; Riche, Claudia T; Anglade, Benedict S; Moise, Colette Guiteau; Woodworth, Michael; Charles, Macarthur; Li, Zhongze; Joseph, Patrice; Pape, Jean W; Wright, Peter F

    2013-10-01

    Cholera, previously unrecognized in Haiti, spread through the country in the fall of 2010. An analysis was performed to understand the epidemiological characteristics, clinical management, and risk factors for disease severity in a population seen at the GHESKIO Cholera Treatment Center in Port-au-Prince. A comprehensive review of the medical records of patients admitted during the period of October 28, 2010-July 10, 2011 was conducted. Disease severity on admission was directly correlated with older age, more prolonged length of stay, and presentation during the two epidemic waves seen in the observation period. Although there was a high seroprevalence of human immunodeficiency virus (HIV), severity of cholera was not greater with HIV infection. This study documents the correlation of cholera waves with rainfall and its reduction in settings with improved sanitary conditions and potable water when newly introduced cholera affects all ages equally so that interventions must be directed throughout the population.

  9. Vibrio cholerae O139 Bengal infections among tourists to Southeast Asia: an intercontinental foodborne outbreak.

    PubMed

    Boyce, T G; Mintz, E D; Greene, K D; Wells, J G; Hockin, J C; Morgan, D; Tauxe, R V

    1995-11-01

    To determine the source and extent of an outbreak of Vibrio cholerae O139 Bengal infections among 630 cruise ship passengers to Southeast Asia, a retrospective cohort study was done. Questionnaires were sent to all passengers from the United States, Canada, and the United Kingdom, and serum samples were requested from all passengers reporting diarrhea. A case was defined as diarrheal illness with onset between 8 and 28 February 1994 and a cholera antitoxic antibody titer > or = 800. Six passengers, including 1 with bacteremia, met the case definition. Illness was associated with eating yellow rice at a buffet restaurant in Bangkok on 10 February (relative risk undefined, P = .005). This international outbreak demonstrates foodborne transmission of Vibrio cholerae O139 Bengal, an emerging cause of epidemic cholera in Asia, to tourists from Western countries. Physicians should suspect infection with either V. cholerae O1 or O139 in any patient with severe watery diarrhea after travel to the developing world.

  10. Incidence and molecular analysis of Vibrio cholerae associated with cholera outbreak subsequent to the super cyclone in Orissa, India.

    PubMed

    Chhotray, G P; Pal, B B; Khuntia, H K; Chowdhury, N R; Chakraborty, S; Yamasaki, S; Ramamurthy, T; Takeda, Y; Bhattacharya, S K; Nair, G Balakrish

    2002-04-01

    An epidemiological study was carried out to find out the aetiological agent for diarrhoeal disorders in the cyclone and flood affected areas of Orissa, India. Rectal swabs collected from 107 hospitalized diarrhoea patients were bacteriologically analysed to isolate and identify the various enteropathogens. Detection of toxic genes among E. coli and V. cholerae was carried out by polymerase chain reaction (PCR) assay. Of the 107 rectal swabs analysed, 72.3% were positive for V. cholerae O1 Ogawa, 7.2% for V. cholerae O139, 1.2% for E. coli (EAggEC) and 1.2% for Shigella flexneri type 6. Using multiplex PCR assay it was found that all V. cholerae isolates were ctxA positive and El Tor biotype. Strains of V. cholerae O1 were observed to be resistant to nalidixic acid, furazolidone, streptomycin, co-trimoxazole and ampicillin. Except for nalidixic acid, the resistance pattern for O139 was identical to that of O1 strains. Representative strains of V. cholerae were further characterized by randomly amplified polymorphic DNA (RAPD) analysis and ribotyping. Both O1 and O139 V. cholerae strains exhibited the R3 pattern of ribotype and belonged to a similar pattern of RAPD compared with that of Calcutta strains. Early bacteriological and epidemiological investigations have revealed the dominance of V. cholerae O1 among the hospitalized patients in cyclone affected areas of Orissa. Drinking water scarcity and poor sanitation were thought to be responsible for these diarrhoeal outbreaks. Timely reporting and implementation of appropriate control measures could contain a vital epidemic in this area.

  11. Incidence and molecular analysis of Vibrio cholerae associated with cholera outbreak subsequent to the super cyclone in Orissa, India.

    PubMed Central

    Chhotray, G. P.; Pal, B. B.; Khuntia, H. K.; Chowdhury, N. R.; Chakraborty, S.; Yamasaki, S.; Ramamurthy, T.; Takeda, Y.; Bhattacharya, S. K.; Nair, G. Balakrish

    2002-01-01

    An epidemiological study was carried out to find out the aetiological agent for diarrhoeal disorders in the cyclone and flood affected areas of Orissa, India. Rectal swabs collected from 107 hospitalized diarrhoea patients were bacteriologically analysed to isolate and identify the various enteropathogens. Detection of toxic genes among E. coli and V. cholerae was carried out by polymerase chain reaction (PCR) assay. Of the 107 rectal swabs analysed, 72.3% were positive for V. cholerae O1 Ogawa, 7.2% for V. cholerae O139, 1.2% for E. coli (EAggEC) and 1.2% for Shigella flexneri type 6. Using multiplex PCR assay it was found that all V. cholerae isolates were ctxA positive and El Tor biotype. Strains of V. cholerae O1 were observed to be resistant to nalidixic acid, furazolidone, streptomycin, co-trimoxazole and ampicillin. Except for nalidixic acid, the resistance pattern for O139 was identical to that of O1 strains. Representative strains of V. cholerae were further characterized by randomly amplified polymorphic DNA (RAPD) analysis and ribotyping. Both O1 and O139 V. cholerae strains exhibited the R3 pattern of ribotype and belonged to a similar pattern of RAPD compared with that of Calcutta strains. Early bacteriological and epidemiological investigations have revealed the dominance of V. cholerae O1 among the hospitalized patients in cyclone affected areas of Orissa. Drinking water scarcity and poor sanitation were thought to be responsible for these diarrhoeal outbreaks. Timely reporting and implementation of appropriate control measures could contain a vital epidemic in this area. PMID:12002529

  12. The role of food in the epidemiology of cholera.

    PubMed

    Albert, M J; Neira, M; Motarjemi, Y

    1997-01-01

    Cholera is an acute dehydrating diarrhoeal disease, traditionally caused by vibrio cholerae O1, and also more recently by V. cholerae O139 (Bengal). Traditionally, water was recognized as the primary vehicle for transmission of cholera, but in the past 30 years, outbreaks of cholera associated with eating contaminated food have demonstrated that food also plays an important role, although in many instances water is the source of contamination of foods. Most commonly associated with cholera is seafood, both molluscan shellfish and crustaceans. Seafood may be contaminated in its natural environment or during preparation. Other food items associated with outbreaks are fruit and vegetables, meat, cooked grains, etc. Vegetables are usually contaminated by contact with sewage in soil and fruits when injected with contaminated water to increase weight and turgor. Food items initially free from V. cholerae organism may become contaminated when mixed with water, or other contaminated food, or through handling by infected persons who have not observed proper hygiene. Refrigeration, freezing, alkaline pH, high concentration of carbohydrate, humidity and absence of competing flora enhance the survival of V. cholerae in food. Survival of V. cholerae is shorter in food with acidic pH. Foodborne cholera can be averted by the hygienic preparation of food and its consumption. However, since the vehicles of transmission vary markedly from place to place, being affected by local customs and practices, selected control and preventive measures that are most important locally must be implemented. To this end, application of the Hazard Analysis and Critical Control Point system to food preparation is essential in order to identify the practices which may present a risk. Restrictions on importation of foods which do not present a risk of being contaminated from areas where cholera is endemic is not warranted.

  13. Clinical and Environmental Surveillance for Vibrio cholerae in Resource Constrained Areas: Application during a 1-Year Surveillance in the Far North Region of Cameroon

    PubMed Central

    Debes, Amanda K.; Ateudjieu, Jerome; Guenou, Etienne; Ebile, Walter; Sonkoua, Isaac Tadzong; Njimbia, Anthony Chebe; Steinwald, Peter; Ram, Malathi; Sack, David A.

    2016-01-01

    Biological confirmation of the presence of Vibrio cholerae in clinical and environmental samples is often constrained due to resource- and labor-intensive gold standard methods. To develop low-cost, simple, and sustainable surveillance techniques, we modified previously published specimen sampling and culture techniques and applied the use of enriched dipstick testing in conjunction with the use of filter paper for DNA specimen preservation during clinical and environmental surveillance in the Far North of Cameroon from August 2013 to October 2014. The enriched dipstick methodology during routine use in a remote setting demonstrated a specificity of 99.8% compared with polymerase chain reaction (PCR). The novel application of filter paper as a preservation method for cholera DNA specimens reduced the need for cold chain storage and allowed for PCR characterization and confirmation of V. cholerae. The application of basic technologies such as the enriched dipstick, the use of simplified gauze filtration for environmental sample collection, and the use of filter paper for sample preservation enabled early case identification with reduced logistics and supply cost while reporting minimal false-positive results. Simplified laboratory and epidemiological methodologies can improve the feasibility of cholera surveillance in rural and resource-constrained areas, facilitating early case detection and rapid response implementation. PMID:26755564

  14. Clinical and Environmental Surveillance for Vibrio cholerae in Resource Constrained Areas: Application During a 1-Year Surveillance in the Far North Region of Cameroon.

    PubMed

    Debes, Amanda K; Ateudjieu, Jerome; Guenou, Etienne; Ebile, Walter; Sonkoua, Isaac Tadzong; Njimbia, Anthony Chebe; Steinwald, Peter; Ram, Malathi; Sack, David A

    2016-03-01

    Biological confirmation of the presence of Vibrio cholerae in clinical and environmental samples is often constrained due to resource- and labor-intensive gold standard methods. To develop low-cost, simple, and sustainable surveillance techniques, we modified previously published specimen sampling and culture techniques and applied the use of enriched dipstick testing in conjunction with the use of filter paper for DNA specimen preservation during clinical and environmental surveillance in the Far North of Cameroon from August 2013 to October 2014. The enriched dipstick methodology during routine use in a remote setting demonstrated a specificity of 99.8% compared with polymerase chain reaction (PCR). The novel application of filter paper as a preservation method for cholera DNA specimens reduced the need for cold chain storage and allowed for PCR characterization and confirmation of V. cholerae. The application of basic technologies such as the enriched dipstick, the use of simplified gauze filtration for environmental sample collection, and the use of filter paper for sample preservation enabled early case identification with reduced logistics and supply cost while reporting minimal false-positive results. Simplified laboratory and epidemiological methodologies can improve the feasibility of cholera surveillance in rural and resource-constrained areas, facilitating early case detection and rapid response implementation.

  15. Historical Epidemiology of the Second Cholera Pandemic: Relevance to Present Day Disease Dynamics

    PubMed Central

    Chan, Christina H.; Tuite, Ashleigh R.; Fisman, David N.

    2013-01-01

    Despite nearly two centuries of study, the fundamental transmission dynamic properties of cholera remain incompletely characterized. We used historical time-series data on the spread of cholera in twelve European and North American cities during the second cholera pandemic, as reported in Amariah Brigham’s 1832 A Treatise on Epidemic Cholera, to parameterize simple mathematical models of cholera transmission. Richards growth models were used to derive estimates of the basic reproductive number (R0) (median: 16.0, range: 1.9 to 550.9) and the proportion of unrecognized cases (mean: 96.3%, SD: 0.04%). Heterogeneity in model-generated R0 estimates was consistent with variability in cholera dynamics described by contemporary investigators and may represent differences in the nature of cholera spread. While subject to limitations associated with measurement and the absence of microbiological diagnosis, historical epidemic data are a potentially rich source for understanding pathogen dynamics in the absence of control measures, particularly when used in conjunction with simple and readily interpretable mathematical models. PMID:23991117

  16. Historical epidemiology of the second cholera pandemic: relevance to present day disease dynamics.

    PubMed

    Chan, Christina H; Tuite, Ashleigh R; Fisman, David N

    2013-01-01

    Despite nearly two centuries of study, the fundamental transmission dynamic properties of cholera remain incompletely characterized. We used historical time-series data on the spread of cholera in twelve European and North American cities during the second cholera pandemic, as reported in Amariah Brigham's 1832 A Treatise on Epidemic Cholera, to parameterize simple mathematical models of cholera transmission. Richards growth models were used to derive estimates of the basic reproductive number (R0) (median: 16.0, range: 1.9 to 550.9) and the proportion of unrecognized cases (mean: 96.3%, SD: 0.04%). Heterogeneity in model-generated R0 estimates was consistent with variability in cholera dynamics described by contemporary investigators and may represent differences in the nature of cholera spread. While subject to limitations associated with measurement and the absence of microbiological diagnosis, historical epidemic data are a potentially rich source for understanding pathogen dynamics in the absence of control measures, particularly when used in conjunction with simple and readily interpretable mathematical models.

  17. Multidrug-Resistant Vibrio cholerae O1 was Responsible for a Cholera Outbreak in 2013 in Bagalkot, North Karnataka.

    PubMed

    Bhattacharya, Debdutta; Dey, Shuchismita; Roy, Subarna; Parande, Mahantesh V; Telsang, M; Seema, M H; Parande, Aisha V; Mantur, Basappa G

    2015-01-01

    Cholera is a major cause of illness in the developing world. During the monsoon season, small sporadic clusters of cholera cases are reported on an annual basis in Karnataka, India. During the monsoons of 2013, there was a cholera outbreak in Badami, a remote area of Bagalkot district in Karnataka. The multi-drug-resistant Vibrio cholerae O1 serotype Ogawa was found to be responsible for this outbreak. On 5 August 2013, a 30-year-old woman presented with severe dehydration and watery diarrhea at the Aganwadi Health Centre in Badami. A total of 49 suspected cholera cases were reported, with an attack rate of 3.5%. The V. cholerae isolates exhibited resistance to a wide range of drugs, including ampicillin, co-trimoxazole, nitrofurantoin, carbenicillin, and third generation cephalosporins, and showed reduced susceptibility to third generation fluoroquinolones. All of the cephalosporin-resistant V. cholerae strains produced extended-spectrum beta-lactamase. All V. cholerae O1 isolates harbored virulent genes (ctxA, ctxB, tcpA El Tor, Tox S, VPI, ToxT, ToxR, ToxRS, ace, zot, and tcpP) and were found to be genetically similar as determined by randomly amplified polymorphic DNA fingerprinting assay. To the best of our knowledge, this is the first report of a cholera outbreak in the district of Bagalkot. The resistance of V. cholerae to commonly used antimicrobial drugs is becoming a major public health concern in the region as clinicians are left with a limited choice of antibiotics for the treatment of cholera.

  18. 21 CFR 866.3930 - Vibrio cholerae serological reagents.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... cholera caused by the bacterium Vibrio cholerae and provides epidemiological information on cholera. Cholera is an acute infectious disease characterized by severe diarrhea with extreme fluid and...

  19. 21 CFR 866.3930 - Vibrio cholerae serological reagents.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... cholera caused by the bacterium Vibrio cholerae and provides epidemiological information on cholera. Cholera is an acute infectious disease characterized by severe diarrhea with extreme fluid and...

  20. 21 CFR 866.3930 - Vibrio cholerae serological reagents.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... cholera caused by the bacterium Vibrio cholerae and provides epidemiological information on cholera. Cholera is an acute infectious disease characterized by severe diarrhea with extreme fluid and...

  1. 21 CFR 866.3930 - Vibrio cholerae serological reagents.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... cholera caused by the bacterium Vibrio cholerae and provides epidemiological information on cholera. Cholera is an acute infectious disease characterized by severe diarrhea with extreme fluid and...

  2. [Cholera in pediatrics].

    PubMed

    Lezama-Basulto, L A; Mota-Hernández, F

    1993-09-01

    Cholerae is a grave and acute bacterial intestine infection which is caused by a bacilo, V. cholerae 01, that produces toxic products. Its clinical symptoms range from abundant liquid diarrhoea combined with vomiting and rapid dehydration. It is highly lethal when right treatment is not applied. There are also cases of cholera where victims do not show any symptoms of it, that is asymptomatic carriers. Any clinical suspicion of cholerae has to be corroborated by epidemiological data and its diagnostic confirmation should be done by isolating the bacteria, V. cholerae. When beginning the treatment, it is not necessary to confirm the diagnostic and this is based on the restitution of the liquids lost through vomiting and facing using any methods that are recommended for any other type of diarrhoea. The antimicrobial treatment is used only for grave cases. This present revision includes recent knowledge about cholerae emphasising on the effective management of cases through an adequate use of right treatment methods and also using the principal prevention measures against dissemination of this disease.

  3. Seroepidemiology of cholera in Gulf coastal Texas.

    PubMed Central

    Hunt, M D; Woodward, W E; Keswick, B H; Dupont, H L

    1988-01-01

    Single serum samples from 559 volunteers from a Texas Gulf Coast area were examined for vibriocidal antibody to Vibrio cholerae O1 (biotype El Tor, serotype Inaba) by a microtiter method. Elevated levels of vibriocidal antibody were present in 14% of the subjects. Also, 6.8% of the subjects had elevated levels of antibody to the enterotoxin of V. cholerae O1 by the immunoglobulin G enzyme-linked immunosorbent assay. Recent infection, defined on the basis of elevations in both vibriocidal and antitoxin antibodies, had occurred in 1.3% of the subjects. When subjects who reported Brucella infection, travel to a cholera-endemic area, and/or cholera vaccination within a year of the study were removed from the analysis, a prevalence of recent infection of 0.89% was obtained. Significantly higher titers of vibriocidal antibody were found in those with exposure to seawater (fishermen, shrimpers, merchant marines, and dock workers) than in those without such exposure (P less than 0.005). Furthermore, titers of antitoxin antibody were significantly higher in those who consumed shellfish than in nonconsumers. Finally, titers of vibriocidal antibody were significantly higher in Vietnamese subjects than in non-Vietnamese subjects. The results of this study indicate that an endemic focus of infection with V. cholerae occurs in this area. PMID:3415232

  4. Evaluation of a field appropriate membrane filtration method for the detection of Vibrio cholerae for the measurement of biosand filter performance in the Artibonite Valley, Haiti.

    PubMed

    Thomson, Ashley A; Gunsch, Claudia K

    2015-08-01

    Biosand filters in the Artibonite Valley of Haiti, the epicenter of the cholera epidemic that began in October 2010, were tested for total coliform and Vibrio cholerae removal efficiencies. While coliform are often used as an indicator organism for pathogenic bacteria, a correlation has never been established linking the concentration of coliform and V. cholerae, the causative agent for cholera. Hence, a method for field enumeration of V. cholerae was developed and tested. To this end, a plate count test utilizing membrane filtration technique was developed to measure viable V. cholerae cell concentration in the field. Method accuracy was confirmed by comparing plate count concentrations to microscopic counts. Additionally, biosand filters were sampled and removal efficiencies of V. cholerae and coliform bacteria compared. The correlation between removal efficiency and time in operation, biofilm ("schmutzdecke") composition, and idle time was also investigated. The plate count method for V. cholerae was found to accurately reflect microscope counts and was shown to be effective in the field. Overall, coliform concentration was not an appropriate indicator of V. cholerae concentration. In 90% of the influent samples from the study, coliform underestimated V. cholerae concentration (n = 26). Furthermore, coliform removal efficiency was higher than for V. cholerae hence providing a conservative measurement. Finally, time in operation and idle time were found to be important parameters controlling performance. Overall, this method shows promise for field applications and should be expanded to additional studies to confirm its efficacy to test for V. cholerae in various source waters.

  5. Vibrio cholerae O1 strains are facultative intracellular bacteria, able to survive and multiply symbiotically inside the aquatic free-living amoeba Acanthamoeba castellanii.

    PubMed

    Abd, Hadi; Saeed, Amir; Weintraub, Andrej; Nair, G Balakrish; Sandström, Gunnar

    2007-04-01

    Vibrio cholerae species are extracellular, waterborne, gram-negative bacteria that are overwhelmed by predators in aquatic environments. The unencapsulated serogroup V. cholerae O1 and encapsulated V. cholerae O139 cause epidemic and pandemic outbreaks of cholera. It has recently been shown that the aquatic and free-living amoeba Acanthamoeba castellanii is not a predator to V. cholerae O139; rather, V. cholerae O139 has shown an intracellular compatibility with this host. The aim of this study was to examine the ability of V. cholerae O1 classical and El Tor strains to grow and survive in A. castellanii. The interaction between A. castellanii and V. cholerae O1 strains was studied by means of amoeba cell counts and viable counts of the bacteria in the absence or presence of amoebae. The viable count of intracellularly growing bacteria was estimated by utilizing gentamicin assay. Confocal microscopy and electron microscopy were used to determine the intracellular localization of V. cholerae in A. castellanii. The results showed that V. cholerae O1 classical and El Tor strains grew and survived intracellularly in the cytoplasm of trophozoites, and that the bacteria were also found in the cysts of A. castellanii. The interaction showed a facultative intracellular behaviour of V. cholerae O1 classical and El Tor strains and a possible role of A. castellanii as an environmental host of V. cholerae species.

  6. Genetic characteristics of drug-resistant Vibrio cholerae O1 causing endemic cholera in Dhaka, 2006-2011.

    PubMed

    Rashed, Shah M; Mannan, Shahnewaj B; Johura, Fatema-Tuz; Islam, M Tarequl; Sadique, Abdus; Watanabe, Haruo; Sack, R Bradley; Huq, Anwar; Colwell, Rita R; Cravioto, Alejandro; Alam, Munirul

    2012-12-01

    Vibrio cholerae O1 biotype El Tor (ET), causing the seventh cholera pandemic, was recently replaced in Bangladesh by an altered ET possessing ctxB of the Classical (CL) biotype, which caused the first six cholera pandemics. In the present study, V. cholerae O1 strains associated with endemic cholera in Dhaka between 2006 and 2011 were analysed for major phenotypic and genetic characteristics. Of 54 representative V. cholerae isolates tested, all were phenotypically ET and showed uniform resistance to trimethoprim/sulfamethoxazole (SXT) and furazolidone (FR). Resistance to tetracycline (TE) and erythromycin (E) showed temporal fluctuation, varying from year to year, while all isolates were susceptible to gentamicin (CN) and ciprofloxacin (CIP). Year-wise data revealed erythromycin resistance to be 33.3 % in 2006 and 11 % in 2011, while tetracycline resistance accounted for 33, 78, 0, 100 and 27 % in 2006, 2007, 2008, 2009 and 2010, respectively; interestingly, all isolates tested were sensitive to TE in 2011, as observed in 2008. All V. cholerae isolates tested possessed genetic elements such as SXT, ctxAB, tcpA(ET), rstR(ET) and rtxC; none had IntlI (Integron I). Double mismatch amplification mutation assay (DMAMA)-PCR followed by DNA sequencing and analysis of the ctxB gene revealed a point mutation at position 58 (C→A), which has resulted in an amino acid substitution from histidine (H) to asparagine (N) at position 20 (genotype 7) since 2008. Although the multi-resistant strains having tetracycline resistance showed minor genetic divergence, V. cholerae strains were clonal, as determined by a PFGE (NotI)-based dendrogram. This study shows 2008-2010 to be the time of transition from ctxB genotype 1 to genotype 7 in V. cholerae ET causing endemic cholera in Dhaka, Bangladesh.

  7. A comprehensive response to the HIV/AIDS epidemic in Jamaica: a review of the past 20 years.

    PubMed

    Figueroa, J P; Duncan, J; Byfield, L; Harvey, K; Gebre, Y; Hylton-Kong, T; Hamer, F; Williams, E; Carrington, D; Brathwaite, A R

    2008-12-01

    Jamaica has a well-established, comprehensive National Human Immunodeficiency Virus (HIV) programme that has slowed the HIV epidemic and mitigated its impact. Adult HIV prevalence has been stable at approximately 1.5% since 1996. HIV rates are high among those most at risk such as sex-workers (9%) and men who have sex with men [MSM] (31.8%). Risk behaviour among adults with AIDS includes multiple sexual partners (80%), a history of a sexually transmitted infection [STI] (51.1%), commercial sex (23.9%) and crack/cocaine (8.0%). Approximately 20% of all reported AIDS cases, mainly women, give no history of any of the usual risk factors for HIV infection. The national programme is based in the Ministry of Health. Since 1988, Jamaica has had a national plan to guide its HIV response. A National AIDS Committee was established in 1988 to lead the multi-sectoral response. Prevention approaches have included information, education and communication campaigns, condom promotion, sexually transmitted infections (STI) control, targeted interventions, cultural approaches, outreach and peer education, workplace programmes and HIV counselling and testing. Concerted efforts have been made to reduce HIV stigma and discrimination. Antiretroviral therapy (ARV) was introduced for prevention of mother-to-child transmission in 2001 and a public access treatment programme introduced in 2004. A national HIV/AIDS Policy was adopted unanimously in parliament in 2005. The National Strategic plan 2007-2012 commits Jamaica to achieving universal access to HIVprevention, treatment and care. Awareness of HIV and how to prevent it is near universal though belief in myths remains strong. The condom market has increased from approximately 2.5 million in 1985 to 12 million in 2006 while condom use has grown significantly with nearly 75% of men and 65% of women reporting condom use at last sex with a non-regular partner The proportion of women 15-24 years reporting ever having a HIV test increased

  8. Protective efficacy of oral whole-cell/recombinant-B-subunit cholera vaccine in Peruvian military recruits.

    PubMed

    Sanchez, J L; Vasquez, B; Begue, R E; Meza, R; Castellares, G; Cabezas, C; Watts, D M; Svennerholm, A M; Sadoff, J C; Taylor, D N

    1994-11-05

    The cholera epidemic in South America has reinforced the need for safe and effective oral vaccines. In a randomised, double-blind, placebo-controlled efficacy trial among 1563 Peruvian military recruits we have investigated the protective efficacy of an oral inactivated whole-cell/recombinant-B-subunit (WC/rBS) cholera vaccine. Participants were given two oral doses of cholera vaccine or Escherichia coli K12 placebo, with an interval of 7-14 days. 1426 (91%) subjects received the two prescribed doses and were followed up for a mean of 18 weeks (median 21 weeks). After vaccination, Vibrio cholerae O1 El Tor Ogawa was isolated from 17 subjects with diarrhoea. 16 of the cholera cases occurred 2 weeks or longer after the second dose of vaccine (14 placebo recipients, 2 vaccinees). We also detected 14 symptomless infections (11 [7 placebo recipients, 4 vaccinees]) 2 weeks or longer after the second dose. The vaccine had significant protective efficacy against cholera (86% [95% CI 37-97], p < 0.01) but not against symptomless infection (42% [-96 to 85]). All cholera cases were in people of blood group O, who made up 76% of the study population (p < 0.01). Two doses of WC/rBS vaccine, given 1 to 2 weeks apart, provide rapid, short-term protection against symptomatic cholera in adult South Americans, who are predominantly of blood group O. Long-term efficacy studies in Peruvian adults and children are under way.

  9. Toxigenic Vibrio cholerae identified in estuaries of Tanzania using PCR techniques.

    PubMed

    Dalusi, Lucy; Lyimo, Thomas J; Lugomela, Charles; Hosea, Ken M M; Sjöling, Sara

    2015-03-01

    The current study assessed the occurrence of the Vibrio cholerae serogroups O1 and O139 in environmental samples along salinity gradients in three selected estuaries of Tanzania both through culture independent methods and by cultured bacteria. Occurrence of V. cholerae was determined by PCR targeting the V. cholerae outer membrane protein gene ompW. Furthermore, the presence of toxigenic strains and serogroups O1 and O139 was determined using multiplex PCR with specific primers targeting the cholera toxin gene subunit A, ctxA, and serotype specific primers, O1-rfb and O139-rfb, respectively. Results showed that V. cholerae occurred in approximately 10% (n = 185) of both the environmental samples and isolated bacteria. Eight of the bacteria isolates (n = 43) were confirmed as serogroup O1 while one belonged to serogroup O139, the first reported identification of this epidemic strain in East African coastal waters. All samples identified as serogroup O1 or O139 and a number of non-O1/O139 strains were ctxA positive. This study provides in situ evidence of the presence of pathogenic V. cholerae O1 and O139 and a number of V. cholerae non-O1/O139 that carry the cholera toxin gene in estuaries along the coast of Tanzania.

  10. 275 years since the epidemic of plague in Cluj: Dr. Alexandru Lenghel’s contribution to its investigation

    PubMed Central

    ROGOZEA, LILIANA; LEAȘU, FLORIN; DUMITRASCU, DINU IULIU; DUMITRASCU, DAN L.

    2015-01-01

    Plague is one of the most impressive diseases in the cultural history of mankind. Its lethality has influenced the evolution of society and it is frequently represented in fine arts and literature. The principality of Transylvania was also affected by this infection, the plague having strongly impacted both economic and social development. Between 1738 and 1739 an important plague epidemic spread in Transylvania. The authors introduce and discuss a less known work on this epidemic, with focus on its impact on the city of Cluj - a book written in 1930 by Dr. Alexandru Lenghel, who later became a target of political persecution during the Stalinist period, while his work entered a cone of shadow. PMID:26733757

  11. Diagnosis of Vibrio cholerae O1 infection in Africa.

    PubMed

    Keddy, Karen H; Sooka, Arvinda; Parsons, Michele B; Njanpop-Lafourcade, Berthe-Marie; Fitchet, Kaye; Smith, Anthony M

    2013-11-01

    Isolation of Vibrio cholerae O1 is necessary for cholera outbreak confirmation. Rapid diagnostic testing of fecal specimens, based on lipopolysaccharide detection of V. cholerae O1 or O139, may assist in early outbreak detection and surveillance. Cary-Blair transport medium is recommended for specimen transport. Filter paper, although used in epidemics, needs evaluation against rectal swab specimens. Fecal specimens are subcultured onto selective and nonselective media, including 5% blood agar and TCBS agar, for detection of V. cholerae O1 or O139. Suspicious, oxidase-positive isolates are serotyped in monovalent antisera. Antimicrobial-susceptibility testing is performed to detect resistance. Molecular characterization supports phenotypic identification and outbreak investigations. The presence of genes encoding cholera toxin, lipopolysaccharide, and El Tor biotype traits can be confirmed. Standardized pulsed-field gel electrophoresis analysis facilitates strain comparison. Quality management ensures reliability of results through validation and verification of functional laboratory equipment; quality control of testing procedures, laboratory reagents, and consumables; and participation in proficiency-testing schemes.

  12. Cholera between 1991 and 1997 in Mexico was associated with infection by classical, El Tor, and El Tor variants of Vibrio cholerae.

    PubMed

    Alam, Munirul; Nusrin, Suraia; Islam, Atiqul; Bhuiyan, Nurul A; Rahim, Niaz; Delgado, Gabriela; Morales, Rosario; Mendez, Jose Luis; Navarro, Armando; Gil, Ana I; Watanabe, Haruo; Morita, Masatomo; Nair, G Balakrish; Cravioto, Alejandro

    2010-10-01

    Vibrio cholerae O1 biotype El Tor (ET), the cause of the current 7th pandemic, has recently been replaced in Asia and Africa by an altered ET biotype possessing cholera toxin (CTX) of the classical (CL) biotype that originally caused the first six pandemics before becoming extinct in the 1980s. Until recently, the ET prototype was the biotype circulating in Peru; a detailed understanding of the evolutionary trend of V. cholerae causing endemic cholera in Latin America is lacking. The present retrospective microbiological, molecular, and phylogenetic study of V. cholerae isolates recovered in Mexico (n = 91; 1983 to 1997) shows the existence of the pre-1991 CL biotype and the ET and CL biotypes together with the altered ET biotype in both epidemic and endemic cholera between 1991 and 1997. According to sero- and biotyping data, the altered ET, which has shown predominance in Mexico since 1991, emerged locally from ET and CL progenitors that were found coexisting until 1997. In Latin America, ET and CL variants shared a variable number of phenotypic markers, while the altered ET strains had genes encoding the CL CTX (CTX(CL)) prophage, ctxB(CL) and rstR(CL), in addition to resident rstR(ET), as the underlying regional signature. The distinct regional fingerprints for ET in Mexico and Peru and their divergence from ET in Asia and Africa, as confirmed by subclustering patterns in a pulsed-field gel electrophoresis (NotI)-based dendrogram, suggest that the Mexico epidemic in 1991 may have been a local event and not an extension of the epidemics occurring in Asia and South America. Finally, the CL biotype reservoir in Mexico is unprecedented and must have contributed to the changing epidemiology of global cholera in ways that need to be understood.

  13. Viable but nonculturable Vibrio cholerae O1 in biofilms in the aquatic environment and their role in cholera transmission.

    PubMed

    Alam, Munirul; Sultana, Marzia; Nair, G Balakrish; Siddique, A K; Hasan, Nur A; Sack, R Bradley; Sack, David A; Ahmed, K U; Sadique, A; Watanabe, H; Grim, Christopher J; Huq, A; Colwell, Rita R

    2007-11-06

    Vibrio cholerae persists in aquatic environments predominantly in a nonculturable state. In this study coccoid, nonculturable V. cholerae O1 in biofilms maintained for 495 days in Mathbaria, Bangladesh, pond water became culturable upon animal passage. Culturability, biofilm formation, and the wbe, ctxA, and rstR2 genes were monitored by culture, direct fluorescent antibody (DFA), and multiplex PCR. DFA counts were not possible after formation of biofilm. Furthermore, wbe, but not ctxA, were amplifiable, even after incubation for 54 and 68 days at room temperature ( approximately 25 degrees C) and 4 degrees C, respectively, when no growth was detectable. Slower biofilm formation and extended culturability were observed for cultures incubated at 4 degrees C, compared with approximately 25 degrees C, suggesting biofilm production to be temperature dependent and linked to loss of culturability. Small colonies appearing after incubation in microcosms for 54 and 68 days at 25 degrees C and 4 degrees C, respectively, were wbe positive and ctxA and rstR2 negative, indicating loss of bacteriophage CTXphi. The coccoid V. cholerae O1 observed as free cells in microcosms incubated for 495 days could not be cultured, but biofilms in the same microcosms yielded culturable cells. It is concluded that biofilms can act as a reservoir for V. cholerae O1 between epidemics because of its long-term viability in biofilms. In contrast to biofilms produced in Mathbaria pond water, V. cholerae O1 in biofilms present in cholera stools and incubated under identical conditions as the Mathbaria pond water biofilms could not be cultured after 2 months, indicating that those V. cholerae cells freshly discharged into the environment are significantly less robust than cells adapted to environmental conditions.

  14. Examining rainfall and cholera dynamics in Haiti using statistical and dynamic modeling approaches.

    PubMed

    Eisenberg, Marisa C; Kujbida, Gregory; Tuite, Ashleigh R; Fisman, David N; Tien, Joseph H

    2013-12-01

    Haiti has been in the midst of a cholera epidemic since October 2010. Rainfall is thought to be associated with cholera here, but this relationship has only begun to be quantitatively examined. In this paper, we quantitatively examine the link between rainfall and cholera in Haiti for several different settings (including urban, rural, and displaced person camps) and spatial scales, using a combination of statistical and dynamic models. Statistical analysis of the lagged relationship between rainfall and cholera incidence was conducted using case crossover analysis and distributed lag nonlinear models. Dynamic models consisted of compartmental differential equation models including direct (fast) and indirect (delayed) disease transmission, where indirect transmission was forced by empirical rainfall data. Data sources include cholera case and hospitalization time series from the Haitian Ministry of Public Health, the United Nations Water, Sanitation and Health Cluster, International Organization for Migration, and Hôpital Albert Schweitzer. Rainfall data was obtained from rain gauges from the U.S. Geological Survey and Haiti Regeneration Initiative, and remote sensing rainfall data from the National Aeronautics and Space Administration Tropical Rainfall Measuring Mission. A strong relationship between rainfall and cholera was found for all spatial scales and locations examined. Increased rainfall was significantly correlated with increased cholera incidence 4-7 days later. Forcing the dynamic models with rainfall data resulted in good fits to the cholera case data, and rainfall-based predictions from the dynamic models closely matched observed cholera cases. These models provide a tool for planning and managing the epidemic as it continues.

  15. In vitro and in vivo cholera toxin production by classical and El Tor isolates of Vibrio cholerae.

    PubMed Central

    Turnbull, P C; Lee, J V; Miliotis, M D; Still, C S; Isaäcson, M; Ahmad, Q S

    1985-01-01

    A comparative study was carried out on the in vitro production of cholera toxin by 19 Vibrio cholerae El Tor isolates from patients with cholera in South Africa, one El Tor isolate from a patient in Malawi (a country approximately 1000 km north-northeast of South Africa), 6 El Tor and 12 classical type isolates from patients in Bangladesh, and 5 culture collection classical strains. Identical phage types and indistinguishable toxigenicities among the South African and Malawi V. cholerae, representing isolations obtained over a 10-year period, indicated that essentially a single strain was involved in the cholera of these regions. Similarly, phage typing and toxin profiles indicated that the 12 classical and 6 El Tor V. cholerae cultures in Bangladesh, all isolated in November 1983, represented just two strains. As assessed by titrations in Y-1 mouse adrenal and Chinese hamster ovary cell lines, the general order of toxigenicities was Bangladesh and culture collection classical greater than Bangladesh El Tor greater than southern African El Tor. The African isolates consistently gave rise to very low titers. Their relative reluctance to produce the toxin in vitro compared with the culture collection classical strains, particularly strain 569B, was confirmed by rocket electrophoresis. In somewhat of a contrast, maximum in vivo titers in rice water stools from cholera patients in South Africa and from both classical and El Tor type cholera patients in Bangladesh were essentially equal. It is postulated that under the continuous culture conditions that occur in vivo, cholera toxin concentrations can accumulate to a maximum level, depending on the rate of purging by the diarrheal fluid rather than the toxigenicity of the infecting stain. The relevance of these findings to the relative severities of classical and El Tor types of cholera is discussed. Images PMID:4008618

  16. Occurrence in Mexico, 1998-2008, of Vibrio cholerae CTX+ El Tor carrying an additional truncated CTX prophage.

    PubMed

    Alam, Munirul; Rashed, Shah Manzur; Mannan, Shahnewaj Bin; Islam, Tarequl; Lizarraga-Partida, Marcial Leonardo; Delgado, Gabriela; Morales-Espinosa, Rosario; Mendez, Jose Luis; Navarro, Armando; Watanabe, Haruo; Ohnishi, Makoto; Hasan, Nur A; Huq, Anwar; Sack, R Bradley; Colwell, Rita R; Cravioto, Alejandro

    2014-07-08

    The seventh cholera pandemic caused by Vibrio cholerae O1 El Tor (ET) has been superseded in Asia and Africa by altered ET possessing the cholera toxin (CTX) gene of classical (CL) biotype. The CL biotype of V. cholerae was isolated, along with prototypic and altered ET, during the 1991 cholera epidemic in Mexico and subsequently remained endemic until 1997. Microbiological, molecular, and phylogenetic analyses of clinical and environmental V. cholerae isolated in Mexico between 1998 and 2008 revealed important genetic events favoring predominance of ET over CL and altered ET. V. cholerae altered ET was predominant after 1991 but not after 2000. V. cholerae strains isolated between 2001 and 2003 and a majority isolated in 2004 lacked CTX prophage (Φ) genes encoding CTX subunits A and B and repeat sequence transcriptional regulators of ET and CL biotypes: i.e., CTXΦ(-). Most CTXΦ(-) V. cholerae isolated in Mexico between 2001 and 2003 also lacked toxin coregulated pili tcpA whereas some carried either tcpA(ET) or a variant tcpA with noticeable sequence dissimilarity from tcpA(CL). The tcpA variants were not detected in 2005 after CTXΦ(+) ET became dominant. All clinical and environmental V. cholerae O1 strains isolated during 2005-2008 in Mexico were CTXΦ(+) ET, carrying an additional truncated CTXΦ instead of RS1 satellite phage. Despite V. cholerae CTXΦ(-) ET exhibiting heterogeneity in pulsed-field gel electrophoresis patterns, CTXΦ(+) ET isolated during 2004-2008 displayed homogeneity and clonal relationship with V. cholerae ET N16961 and V. cholerae ET isolated in Peru.

  17. Occurrence in Mexico, 1998–2008, of Vibrio cholerae CTX+ El Tor carrying an additional truncated CTX prophage

    PubMed Central

    Alam, Munirul; Rashed, Shah Manzur; Mannan, Shahnewaj Bin; Islam, Tarequl; Lizarraga-Partida, Marcial Leonardo; Delgado, Gabriela; Morales-Espinosa, Rosario; Mendez, Jose Luis; Navarro, Armando; Watanabe, Haruo; Ohnishi, Makoto; Hasan, Nur A.; Huq, Anwar; Sack, R. Bradley; Colwell, Rita R.; Cravioto, Alejandro

    2014-01-01

    The seventh cholera pandemic caused by Vibrio cholerae O1 El Tor (ET) has been superseded in Asia and Africa by altered ET possessing the cholera toxin (CTX) gene of classical (CL) biotype. The CL biotype of V. cholerae was isolated, along with prototypic and altered ET, during the 1991 cholera epidemic in Mexico and subsequently remained endemic until 1997. Microbiological, molecular, and phylogenetic analyses of clinical and environmental V. cholerae isolated in Mexico between 1998 and 2008 revealed important genetic events favoring predominance of ET over CL and altered ET. V. cholerae altered ET was predominant after 1991 but not after 2000. V. cholerae strains isolated between 2001 and 2003 and a majority isolated in 2004 lacked CTX prophage (Φ) genes encoding CTX subunits A and B and repeat sequence transcriptional regulators of ET and CL biotypes: i.e., CTXΦ−. Most CTXΦ− V. cholerae isolated in Mexico between 2001 and 2003 also lacked toxin coregulated pili tcpA whereas some carried either tcpAET or a variant tcpA with noticeable sequence dissimilarity from tcpACL. The tcpA variants were not detected in 2005 after CTXΦ+ ET became dominant. All clinical and environmental V. cholerae O1 strains isolated during 2005–2008 in Mexico were CTXΦ+ ET, carrying an additional truncated CTXΦ instead of RS1 satellite phage. Despite V. cholerae CTXΦ− ET exhibiting heterogeneity in pulsed-field gel electrophoresis patterns, CTXΦ+ ET isolated during 2004–2008 displayed homogeneity and clonal relationship with V. cholerae ET N16961 and V. cholerae ET isolated in Peru. PMID:24958870

  18. Clinical Features of Human Immunodeficiency Virus-Infected Patients Presenting with Cholera in Port-au-Prince, Haiti.

    PubMed

    Sévère, Karine; Anglade, Stravinsky B; Bertil, Claudin; Duncan, Aynsley; Joseph, Patrice; Deroncenay, Alexandra; Mabou, Marie M; Ocheretina, Oksana; Reif, Lindsey; Seo, Grace; Pape, Jean W; Fitzgerald, Daniel W

    2016-11-02

    Human immunodeficiency virus (HIV) infection has been postulated to alter the natural history of cholera, including increased susceptibility to infection, severity of illness, and chronic carriage of Vibrio cholerae Haiti has a generalized HIV epidemic with an adult HIV prevalence of 1.9% and recently suffered a cholera epidemic. We conducted a prospective study at the cholera treatment center (CTC) of GHESKIO in Haiti to characterize the coinfection. Adults admitted at the CTC for acute diarrhea were invited to participate in the study. Vital signs, frequency, and volume of stools and/or vomiting were monitored, and single-dose doxycycline was administered. After counseling, participants were screened for HIV by enzyme-linked immunosorbent assay and for cholera by culture. Of 729 adults admitted to the CTC, 99 (13.6%) had HIV infection, and 457 (63%) had culture-confirmed cholera. HIV prevalence was three times higher in patients without cholera (23%, 63/272) than in those with culture-confirmed cholera (7.9%, 36/457). HIV prevalence in patients with culture-confirmed cholera (7.9%) was four times higher than the adult prevalence in Port-au-Prince (1.9%). Of the 36 HIV-infected patients with cholera, 25 (69%) had moderate/severe dehydration versus 302/421 (72%) in the HIV negative. Of 30 HIV-infected patients with weekly stool cultures performed after discharge, 29 (97%) were negative at week 1. Of 50 HIV-negative patients with weekly stool cultures, 49 (98%) were negative at week 1. In countries with endemic HIV infection, clinicians should consider screening patients presenting with suspected cholera for HIV coinfection.

  19. Strategies to Prevent Cholera Introduction during International Personnel Deployments: A Computational Modeling Analysis Based on the 2010 Haiti Outbreak

    PubMed Central

    Lewnard, Joseph A.; Antillón, Marina; Gonsalves, Gregg; Miller, Alice M.; Ko, Albert I.; Pitzer, Virginia E.

    2016-01-01

    Background Introduction of Vibrio cholerae to Haiti during the deployment of United Nations (UN) peacekeepers in 2010 resulted in one of the largest cholera epidemics of the modern era. Following the outbreak, a UN-commissioned independent panel recommended three pre-deployment intervention strategies to minimize the risk of cholera introduction in future peacekeeping operations: screening for V. cholerae carriage, administering prophylactic antimicrobial chemotherapies, or immunizing with oral cholera vaccines. However, uncertainty regarding the effectiveness of these approaches has forestalled their implementation by the UN. We assessed how the interventions would have impacted the likelihood of the Haiti cholera epidemic. Methods and Findings We developed a stochastic model for cholera importation and transmission, fitted to reported cases during the first weeks of the 2010 outbreak in Haiti. Using this model, we estimated that diagnostic screening reduces the probability of cases occurring by 82% (95% credible interval: 75%, 85%); however, false-positive test outcomes may hamper this approach. Antimicrobial chemoprophylaxis at time of departure and oral cholera vaccination reduce the probability of cases by 50% (41%, 57%) and by up to 61% (58%, 63%), respectively. Chemoprophylaxis beginning 1 wk before departure confers a 91% (78%, 96%) reduction independently, and up to a 98% reduction (94%, 99%) if coupled with vaccination. These results are not sensitive to assumptions about the background cholera incidence rate in the endemic troop-sending country. Further research is needed to (1) validate the sensitivity and specificity of rapid test approaches for detecting asymptomatic carriage, (2) compare prophylactic efficacy across antimicrobial regimens, and (3) quantify the impact of oral cholera vaccine on transmission from asymptomatic carriers. Conclusions Screening, chemoprophylaxis, and vaccination are all effective strategies to prevent cholera introduction

  20. The epidemiology and antimicrobial resistance of cholera cases in Iran during 2013

    PubMed Central

    Masoumi-Asl, Hossein; Gouya, Mohammad Mehdi; Rahbar, Mohammad; Sabourian, Roghieh

    2016-01-01

    Background and Objectives: Cholera is an endemic diarrheal disease in Iran, caused by Vibrio Cholerae. The epidemiology, transmission route, environmental determinants and antimicrobial resistant pattern of cholera have been changed during recent years. In this study the epidemiology and antimicrobial resistance of cholera in Iran during 2013 outbreak was investigated. Materials and Methods: A retrospective, cross-sectional study was carried out using cholera national surveillance system collected data in 2013. Bacterial identification and antimicrobial susceptibility testing were done on 60 Vibrio cholerae isolates, serotype Inaba. Results: During July to November 2013, 256 confirmed cholera cases were diagnosed by stool culture. Two hundred and eleven out of 256 (83%) cases were imported from Afghanistan and Pakistan. The prevalent age group was 16–30 years old, 90% were male, 98.8% affected by Inaba serotype and case fatality rate was 2.7%. The results of antimicrobial susceptibility testing on 60 V. cholerae, serotype Inaba showed that all isolates were resistant to nalidixic acid, tetracyclin and trimethoprim-sulfamethoxazole and intermediate resistance to erythromycin but sensitive to ciprofloxacin, cefixime and ampicillin. Conclusion: Migrants from neighboring countries played a key role in cholera outbreak in Iran during 2013. The results of antimicrobial susceptibility testing on 60 V. cholerae, serotype Inaba showed an increasing resistance rate in comparison with previous years. PMID:28210461

  1. Modeling the Epidemiology of Cholera to Prevent Disease Transmission in Developing Countries.

    PubMed

    Mukandavire, Zindoga; Morris, J Glenn

    2015-06-01

    Cholera remains an important global cause of morbidity and mortality, which is capable of causing periodic epidemic disease. A number of mathematical models have been developed to help in understanding the dynamics of cholera outbreaks and for use as a tool in planning interventions, including vaccination campaigns. We have explored the utility of models in assessing the spread of cholera in the recent epidemics in Zimbabwe and Haiti. In both instances, a mathematical model was formulated and fitted to cumulative cholera cases to estimate the basic reproductive number ℛ0, and the partial reproductive numbers reflecting potential differences in environmental-to-human versus human-to-human transmission were quantified. In Zimbabwe, estimated ℛ0 for the epidemic using aggregated data at the national level was 1.15; in Haiti, it was 1.55. However, when calculated at a provincial/departmental level, estimated basic reproductive numbers were highly heterogeneous, with a range of 1.11 to 2.72 in Zimbabwe and 1.06 to 2.63 in Haiti. Our models suggest that the underlying patterns of cholera transmission varied widely from region to region, with a corresponding variation in the amenability of outbreaks to control measures such as immunization. These data underscore the heterogeneity of transmission dynamics, potentially linked to differences in environment, socio-economic conditions, and cultural practices. They also highlight the potential utility of these types of models in guiding development of public health intervention strategies.

  2. [ACTUAL PROBLEMS OF EPIDEMIOLOGIC CONTROL, LABORATORY DIAGNOSTICS AND PROPHYLAXIS OF CHOLERA IN RUSSIAN FEDERATION].

    PubMed

    Onischenko, G G; Popova, A Yu; Kutyrev, V V; Smirnova, N I; Scherbakova, S A; Moskvitina, E A; Titova, S V

    2016-01-01

    Main problems of system of epidemiologic control for cholera active in Russian Federation, as well as laboratory diagnostics and vaccine prophylaxis of this especially dangerous infection, that had emerged in the contemporary period of the ongoing 7th pandemic of cholera, are discussed. Features of the genome of natural strains of Vibrio cholerae of El Tor biovar, that possess a poten- tial epidemic threat, as well as problems, that have emerged during isolation of these strains from samples of water of surface water bodies during their monitoring, are also examined. The main direction of enhancement of the system of epidemiologic control for cholera consist in develop- ment of a new algorithm of differentiation of administrative territories of Russian Federation by types of epidemic manifestations, as well as optimization of monitoring of environment objects. Integration of modern highly informative technologies into practice, as well as development of new generation diagnostic preparations based on DNA-chips and immunechips is necessary to increase effectiveness of the conducted operative and retrospective diagnostics in the contemporary period. Creation of national cholera vaccine, ensuring simultaneous protection from cholera causative agents of both O1 and O139 serogroups, is also required.

  3. The black cholera comes to the central valley of America in the 19th century - 1832, 1849, and later.

    PubMed

    Daly, Walter J

    2008-01-01

    In mid-19th Century, cholera was epidemic throughout the world. Small towns of the American Midwest were not spared. The disease was blamed on miasmas arising from local causes, so flight from affected localities were logical and common. Flight, added to mortality, caused virtual depopulation of many small towns. Drinking water was drawn from rivers or shallow wells, often near seeping cesspools. Local merchants tried unsuccessfully to calm panic by suppressing information. Cholera was not good for business. Business was depressed. Organized religion thrived. National and state days of prayer were appointed to appease an angry God. During these frightening times, the people learned nothing about the infectiousness of cholera or about its prevention through sanitation. Their experiences tended to reinforce their belief in miasmas or divine retribution. The great epidemics of mankind describe human behavior in times of unavoidable and incurable crisis. Nineteenth Century cholera experiences illustrate a people's reaction to catastrophic disease, which they believed was incurable and unpreventable.

  4. [Environmental drivers of emergence and spreading of Vibrio epidemics in South America].

    PubMed

    Gavilán, Ronnie G; Martínez-Urtaza, Jaime

    2011-03-01

    Vibrio cholerae and V. parahaemolyticus are the two Vibrio species with a major impact on human health. Diseases caused by both pathogens are acquiring increasing relevance due to their expansion at global scale. In this paper, we resume the ecological aspects associated with the arrival and spreading of infections caused by V. parahaemolyticus and V. cholerae in Peru from a South American perspective. Moreover, we discuss the similarities in the emergence in Peru of cholera cases in 1991 and V. parahaemolyticus infections in 1997. These constituted exceptional experiments to evaluate the relationships between the Vibrio epidemics and changes in the environment. The epidemic radiations of V. cholerae and V. parahaemolyticus constitute to clear examples supporting the oceanic dispersion of pathogenic vibrios and have enabled the identification of El Niño events as a potential mechanism for the spreading of diseases through the ocean.

  5. Molecular tools in understanding the evolution of Vibrio cholerae

    PubMed Central

    Rahaman, Md. Habibur; Islam, Tarequl; Colwell, Rita R.; Alam, Munirul

    2015-01-01

    Vibrio cholerae, the etiological agent of cholera, has been a scourge for centuries. Cholera remains a serious health threat for developing countries and has been responsible for millions of deaths globally over the past 200 years. Identification of V. cholerae has been accomplished using a variety of methods, ranging from phenotypic strategies to DNA based molecular typing and currently whole genomic approaches. This array of methods has been adopted in epidemiological investigations, either singly or in the aggregate, and more recently for evolutionary analyses of V. cholerae. Because the new technologies have been developed at an ever increasing pace, this review of the range of fingerprinting strategies, their relative advantages and limitations, and cholera case studies was undertaken. The task was challenging, considering the vast amount of the information available. To assist the study, key references representative of several areas of research are provided with the intent to provide readers with a comprehensive view of recent advances in the molecular epidemiology of V. cholerae. Suggestions for ways to obviate many of the current limitations of typing techniques are also provided. In summary, a comparative report has been prepared that includes the range from traditional typing to whole genomic strategies. PMID:26500613

  6. Molecular tools in understanding the evolution of Vibrio cholerae.

    PubMed

    Rahaman, Md Habibur; Islam, Tarequl; Colwell, Rita R; Alam, Munirul

    2015-01-01

    Vibrio cholerae, the etiological agent of cholera, has been a scourge for centuries. Cholera remains a serious health threat for developing countries and has been responsible for millions of deaths globally over the past 200 years. Identification of V. cholerae has been accomplished using a variety of methods, ranging from phenotypic strategies to DNA based molecular typing and currently whole genomic approaches. This array of methods has been adopted in epidemiological investigations, either singly or in the aggregate, and more recently for evolutionary analyses of V. cholerae. Because the new technologies have been developed at an ever increasing pace, this review of the range of fingerprinting strategies, their relative advantages and limitations, and cholera case studies was undertaken. The task was challenging, considering the vast amount of the information available. To assist the study, key references representative of several areas of research are provided with the intent to provide readers with a comprehensive view of recent advances in the molecular epidemiology of V. cholerae. Suggestions for ways to obviate many of the current limitations of typing techniques are also provided. In summary, a comparative report has been prepared that includes the range from traditional typing to whole genomic strategies.

  7. Cellulose acetate phthalate microparticles containing Vibrio cholerae: steps toward an oral cholera vaccine.

    PubMed

    Pastor, Marta; Esquisabel, Amaia; Marquínez, Iratxe; Talavera, Arturo; Pedraz, José Luis

    2014-07-01

    Oral cholera vaccine (OCV) has been recommended in some endemic areas and epidemic situations since 1999. Although safe and effective vaccines are currently on the market, the burden of transport and storage remains an issue. Herein, we report an approach to develop an alternative OCV in the form of a gastro-resistant powder. Heat-killed Vibrio cholerae (VC) was encapsulated with a spray-drying technique at different temperatures. Cellulose acetate phthalate (Aquacoat® CPD) was chosen as the core polymer and the addition of alginate was studied. The microparticles (MPs) produced were characterized by surface morphology, particle size, drug loading, antigenicity and gastro resistance. The MPs obtained were 6 µm in size and had appropriate drug content, ranging from 8.16 to 8.64%. Furthermore, antigenicity was maintained, never dropping below 85%, and enteric properties were achieved for all the formulations. Next, an in vivo study was carried out with Aquacoat® CPD MP prepared at 80 °C with and without alginate. Two different doses were assayed, 30 and 60 mg, and compared to the VC suspension. The evoked immune responses showed that alginate containing MPs, especially at the 30 mg dose, displayed values that were very similar to those of VC. In conclusion, spray-dried alginate VC MPs seem to be a promising step toward a powder-form cholera vaccination.

  8. Epidemiologic application of a standardized ribotype scheme for Vibrio cholerae O1.

    PubMed Central

    Popovic, T; Bopp, C; Olsvik, O; Wachsmuth, K

    1993-01-01

    A standardized scheme of 27 different BglI ribotypes and subtypes of Vibrio cholerae O1 strains is proposed on the basis of data from 214 human and environmental strains isolated in 35 countries and 14 U.S. states over the past 60 years. The ribotype patterns obtained are reproducible and stable over time. Seven different but very similar ribotypes (1a to 1g) were observed among 16 strains of the classical biotype. Twenty ribotypes and subtypes were identified among 198 V. cholerae O1 strains of the El Tor biotype. Six different patterns were found among the strains causing the current seventh pandemic. Strains of ribotype 8 originated only in central African countries, while those of ribotype 3 originated mainly in Asia and the Pacific Islands. The most widely distributed strains were those of ribotype 6, which was subdivided into three very similar but still distinguishable subtypes. The present Latin American epidemic is caused by strains of ribotype 5. Strains of this ribotype were isolated from several other geographic locations but can be differentiated from the Latin American strains by other molecular methods. Strains associated with two documented environmental reservoirs exhibited three distinct ribotype patterns; those isolated from patients who ate food from the U.S. Gulf waters were all of ribotype 2, while the strains related to the northeast Australian rivers were of ribotypes 9 and 10. Nontoxigenic V. cholerae O1 strains originating in Latin America and the U.S. Gulf Coast did not form a specific cluster of ribotypes. Ribotyping in combination with other well-defined methods can assist in epidemiologic investigations, helping to trace the movement of strains and to identify their geographic origins. Images PMID:7691876

  9. Cholera Modeling: Challenges to Quantitative Analysis and Predicting the Impact of Interventions

    PubMed Central

    Grad, Yonatan H.; Miller, Joel C.; Lipsitch, Marc

    2012-01-01

    Several mathematical models of epidemic cholera have recently been proposed in response to outbreaks in Zimbabwe and Haiti. These models aim to estimate the dynamics of cholera transmission and the impact of possible interventions, with a goal of providing guidance to policy-makers in deciding among alternative courses of action, including vaccination, provision of clean water, and antibiotics. Here we discuss concerns about model misspecification, parameter uncertainty, and spatial heterogeneity intrinsic to models for cholera. We argue for caution in interpreting quantitative predictions, particularly predictions of the effectiveness of interventions. We specify sensitivity analyses that would be necessary to improve confidence in model-based quantitative prediction, and suggest types of monitoring in future epidemic settings that would improve analysis and prediction. PMID:22659546

  10. Implementation of a Symptomatic Approach Leads to Increased Efficiency of a Cholera Treatment Unit

    PubMed Central

    Ticona, Eduardo; Kirwan, Daniela E.; Soria, Jaime; Gilman, Robert H.

    2014-01-01

    Cholera is a disease of poverty that remains prevalent in resource-limited countries. The abrupt emergence of an epidemic frequently takes communities and health systems by surprise. Spread is rapid and initial mortality high: delays in organizing an appropriate response, lack of health worker training, and high patient numbers contribute to high rates of complications and deaths. PMID:25092822

  11. Disease dynamics in a coupled cholera model linking within-host and between-host interactions.

    PubMed

    Wang, Xueying; Wang, Jin

    2016-09-19

    A new modelling framework is proposed to study the within-host and between-host dynamics of cholera, a severe intestinal infection caused by the bacterium Vibrio cholerae. The within-host dynamics are characterized by the growth of highly infectious vibrios inside the human body. These vibrios shed from humans contribute to the environmental bacterial growth and the transmission of the disease among humans, providing a link from the within-host dynamics at the individual level to the between-host dynamics at the population and environmental level. A fast-slow analysis is conducted based on the two different time scales in our model. In particular, a bifurcation study is performed, and sufficient and necessary conditions are derived that lead to a backward bifurcation in cholera epidemics. Our result regarding the backward bifurcation highlights the challenges in the prevention and control of cholera.

  12. Introducing cholera vaccination in Asia, Africa and Haiti: a meeting report.

    PubMed

    Hall, Robert H; Sack, David A

    2015-01-15

    Orally-administered cholera vaccine (OCV) has been increasingly examined as an additional tool to intervene against endemic and epidemic cholera. In 2013, short- and long-term field experience with OCV under nine distinctive field settings was reported from India, Bangladesh, Vietnam, Guinea, Haiti, and Thailand. Lead investigators from each of these projects presented their findings at a symposium chaired by Drs. David A. Sack and Robert H. Hall at the Vaccines for Enteric Diseases (VED) Conference in Bangkok on November 7, 2013. The objective of the symposium was to describe the unique features of each setting and project, share field experience of implementing cholera vaccination, discuss results, and identify constraints to the wider use of OCV. The VED provided a forum where >200 attendees engaged with this exciting and potentially decisive new development in the cholera field.

  13. Cholera studies*†

    PubMed Central

    Pollitzer, R.

    1954-01-01

    In this, the first of a series of cholera studies, the history of the disease from its earliest recorded appearance up to 1923 is outlined, and its geographical distribution described. The origins and main routes of spread of the six great pandemics are indicated; possible causes of the variations in mortality which accompanied them are discussed. PMID:13160764

  14. No change in impaired cellular immune response of HIV-negative homosexuals after 15 years of HIV epidemic in Eastern/Central European region.

    PubMed

    Barabás, E; González, R; Nagy, K; Várkonyi, V; Horváth, A

    2001-01-01

    Impaired cell-mediated immune reactivity to polyclonal mitogens was determined in HIV-negative homosexual men (HIV-MSM). Results were compared to those we reported in a complex clinical and immunological investigation in the same risk groups 15 years ago, before the onset of the AIDS epidemic in Hungary. Cellular immune reactivity to polyclonal mitogens was studied in 74 HIV-infected or HIV-uninfected homosexual men and heterosexual controls. Lymphocytes in whole-blood cultures were stimulated with various doses of phytohaemagglutinin (PHA), concanavalin-A (Con-A), and pokeweed mitogen (PWM) in a blast transformation assay. A significant difference (p = .0002) in lymphocyte proliferation between HIV-MSM vs. heterosexuals using PWM in both concentrations was found. Proliferative capacity was similar in HIV- MSM and HIV infected males with CD4+ > 500/microl. Con-A and PHA showed a less expressed proliferative response. Decreased lymphocyte reactivity to PWM, similar to the one in early HIV infection, could be observed in HIV-MSM. This HIV-independent mild immunodeficiency in MSM is a sign of an increased susceptibility and predisposes to subsequent HIV infection. It seems, however, that MSM's impaired immune response observed over a period of 15 years is an immunodeficiency not changed by the emerging HIV/AIDS epidemic. Our study provides an explanation why the incidence of new HIV cases in homo-/bisexual individuals is still high (> 70%), and it indicates that it remains high in Hungary.

  15. Epidemic vomiting

    PubMed Central

    Smith, H. C. T.

    1974-01-01

    Two outbreaks of epidemic vomiting are described. One affected 107 students and staff at a college of education out of a total of 398 persons. The other affected 172 pupils and staff out of 357 at a secondary school. Evidence is presented that in both cases infection was acquired in the dining hall of the institution concerned but no specific item of food was found as a likely cause. The literature is reviewed. Possible mechanisms of spread are suggested. PMID:4531452

  16. Cholera at the crossroads: the association between endemic cholera and national access to improved water sources and sanitation.

    PubMed

    Nygren, Benjamin L; Blackstock, Anna J; Mintz, Eric D

    2014-11-01

    We evaluated World Health Organization (WHO) national water and sanitation coverage levels and the infant mortality rate as predictors of endemic cholera in the 5-year period following water and sanitation coverage estimates using logistic regression, receiver operator characteristic curves, and different definitions of endemicity. Each was a significant predictors of endemic cholera at P < 0.001. Using a value of 250 for annual cases reported in 3 of 5 years, a national water access level of 71% has 65% sensitivity and 65% specificity in predicting endemic cholera, a sanitation access level of 39% has 63% sensitivity and 62% specificity, and an infant mortality rate of 65/1,000 has 67% sensitivity and 69% specificity. Our findings reveal the tradeoff between sensitivity and specificity for these predictors of endemic cholera and highlight the substantial uncertainty in the data. More accurate global surveillance data will enable more precise characterization of the benefits of improved water and sanitation.

  17. Intracellular survival and replication of Vibrio cholerae O139 in aquatic free-living amoebae.

    PubMed

    Abd, Hadi; Weintraub, Andrej; Sandström, Gunnar

    2005-07-01

    Vibrio cholerae is a highly infectious bacterium responsible for large outbreaks of cholera among humans at regular intervals. A seasonal distribution of epidemics is known but the role of naturally occurring habitats are virtually unknown. Plankton has been suggested to play a role, because bacteria can attach to such organisms forming a biofilm. Acanthamoebea castellanii is an environmental amoeba that has been shown to be able to ingest and promote growth of several bacteria of different origin. The aim of the present study was to determine whether or not an intra-amoebic behaviour of V. cholerae O139 exists. Interaction between these microorganisms in co-culture was studied by culturable counts, gentamicin assay, electron microscopy, and polymerase chain reaction. The interaction resulted in intra-amoebic growth and survival of V. cholerae in the cytoplasm of trophozoites as well as in the cysts of A. castellanii. These data show symbiosis between these microorganisms, a facultative intracellular behaviour of V. cholerae contradicting the generally held view, and a role of free-living amoebae as hosts for V. cholerae O139. Taken together, this opens new doors to study the ecology, immunity, epidemiology, and treatment of cholera.

  18. Bactericidal activity of lemon juice and lemon derivatives against Vibrio cholerae.

    PubMed

    de Castillo, M C; de Allori, C G; de Gutierrez, R C; de Saab, O A; de Fernandez, N P; de Ruiz, C S; Holgado, A P; de Nader, O M

    2000-10-01

    Food products can be possible vectors of the agent responsible for cholera epidemics, because some of these products allow Vibrio cholerae O1 to develop to concentrations above the dangerous level. This study deals with the behaviour of essential oils, natural and concentrated lemon juice and fresh and dehydrated lemon peel against V. cholerae O1 biotype Eltor serotype Inaba tox+. Our aim was to evaluate whether these products, used at different dilutions, exhibit bactericidal or bacteriostatic activity against the microorganism, when present at concentrations of 10(2), 10(4), 10(6) and 10(8) colony forming units (CFU) ml(-1), and after different exposure times. 10(8) CFU ml(-1) was considered an infectious dose. Concentrated lemon juice and essential oils inhibited V. cholerae completely at all studied dilutions and exposure times. Fresh lemon peel and dehydrated lemon peel partially inhibited growth of V. cholerae. Freshly squeezed lemon juice, diluted to 10(-2), showed complete inhibition of V. cholerae at a concentration of 10(8) CFU ml(-1) after 5 min of exposure time; a dilution of 2 x 10(-3) produced inhibition after 15 min and a dilution of 10(-3) after 30 min. It can be concluded that lemon, a natural product which is easily obtained, acts as a biocide against V. cholerae, and is, therefore, an efficient decontaminant, harmless to humans.

  19. Quorum-sensing autoinducers resuscitate dormant Vibrio cholerae in environmental water samples.

    PubMed

    Bari, S M Nayeemul; Roky, M Kamruzzaman; Mohiuddin, M; Kamruzzaman, M; Mekalanos, John J; Faruque, Shah M

    2013-06-11

    Cholera epidemics have long been known to spread through water contaminated with human fecal material containing the toxigenic bacterium Vibrio cholerae. However, detection of V. cholerae in water is complicated by the existence of a dormant state in which the organism remains viable, but resists cultivation on routine bacteriological media. Growth in the mammalian intestine has been reported to trigger "resuscitation" of such dormant cells, and these studies have prompted the search for resuscitation factors. Although some positive reports have emerged from these investigations, the precise molecular signals that activate dormant V. cholerae have remained elusive. Quorum-sensing autoinducers are small molecules that ordinarily regulate bacterial gene expression in response to cell density or interspecies bacterial interactions. We have found that isolation of pathogenic clones of V. cholerae from surface waters in Bangladesh is dramatically improved by using enrichment media containing autoinducers either expressed from cloned synthase genes or prepared by chemical synthesis. These results may contribute to averting future disasters by providing a strategy for early detection of V. cholerae in surface waters that have been contaminated with the stools of cholera patients or asymptomatic infected human carriers.

  20. Vaccination Strategies to Combat an Infectious Globe: Oral Cholera Vaccines

    PubMed Central

    López-Gigosos, Rosa M; Plaza, Elena; Díez-Díaz, Rosa M; Calvo, Maria J

    2011-01-01

    Cholera is a substantial health burden in many countries in Africa and Asia, where it is endemic. It is as well responsible for ongoing epidemics in sub-Saharan Africa which are becoming greater in terms of frequency, extension, and duration. Given the availability of two oral cholera vaccines and the new data on their efficacy, field effectiveness, feasibility, and acceptance in cholera-affected populations and in travelers, these vaccines should be used in endemic areas, in travelers for these areas and should be considered in areas at risk for outbreaks. The two vaccines currently available in worldwide are: (1) The killed oral vaccine (Dukoral, licensed by SBL–Sweden to Crucell–Holland) is recommended since 1999 by WHO and consists of a mixture of four preparations of heat or formalin killed whole cell Vibrio cholera O1 (Inaba and Ogaba serotypes, and classical and El Tor biotypes) that are then added with purified recombinant cholera toxin (CT) B subunit. Because CT cross-reacts with Escherichia coli LT the vaccine also provides short-term protection against ETEC (enterotoxigenic E. coli) which is of added benefit for travelers. It is available in more than 60 countries. (2) A bivalent O1 and O139 whole cell oral vaccine without CT B subunit (Shanchol) has been lately developed in Vietnam (licensed by VaBiotech–Viet Nam to Shantha Biotechnics–India. It is available in India and Indonesia. A structured search of papers in PubMed and reports on cholera vaccines by WHO and CDC, as well as critical reading and synthesis of the information was accomplished. Inclusion criteria were defined according to reports quality and relevance. PMID:21572610

  1. Cholera outbreaks in South and Southeast Asia: descriptive analysis, 2003-2012.

    PubMed

    Mahapatra, Tanmay; Mahapatra, Sanchita; Babu, Giridhara R; Tang, Weiming; Banerjee, Barnali; Mahapatra, Umakanta; Das, Aritra

    2014-01-01

    We conducted descriptive analysis of available information regarding the epidemiology of cholera outbreaks in South and Southeast Asia during 2003-2012. Information from 58 articles, 8 reports, and World Health Organization databases were analyzed. Overall, 113 cholera outbreaks were studied in South and Southeast Asia during the past 10 years. The majority of the outbreaks (69%) occurred in Southeast Asia, including India (52%). The highest number of outbreaks was observed in 2004 (25.7%). The most commonly identified source was contaminated water: however, in some countries, the spread of cholera was facilitated via contaminated seafood (e.g., Myanmar, Thailand, and Singapore). Several genotypes and phenotypes of Vibrio cholerae, the causative agent of cholera, were identified in the outbreaks, including V. cholerae O1 El Tor (Ogawa and Inaba) and V. cholerae O139. The emergence of multidrug-resistant V. cholerae strains was a major concern. Cholera-related mortality was found to be low across the outbreaks, except in Orissa, India (currently Odisha) during 2007, where the case fatality rate was 8.6%. Potential limitations included underreporting, discrepancies, possible exclusion of nonindexed reports, and incomprehensive search terms. The provision of safe water and proper sanitation appear to be critical for the control of further spread of cholera in South Asian and Southeast Asian regions.

  2. Effects of dwarf mistletoe on stand structure of lodgepole pine forests 21-28 years post-mountain pine beetle epidemic in central Oregon.

    PubMed

    Agne, Michelle C; Shaw, David C; Woolley, Travis J; Queijeiro-Bolaños, Mónica E

    2014-01-01

    Lodgepole pine (Pinus contorta) forests are widely distributed throughout North America and are subject to mountain pine beetle (Dendroctonus ponderosae) epidemics, which have caused mortality over millions of hectares of mature trees in recent decades. Mountain pine beetle is known to influence stand structure, and has the ability to impact many forest processes. Dwarf mistletoe (Arceuthobium americanum) also influences stand structure and occurs frequently in post-mountain pine beetle epidemic lodgepole pine forests. Few studies have incorporated both disturbances simultaneously although they co-occur frequently on the landscape. The aim of this study is to investigate the stand structure of lodgepole pine forests 21-28 years after a mountain pine beetle epidemic with varying levels of dwarf mistletoe infection in the Deschutes National Forest in central Oregon. We compared stand density, stand basal area, canopy volume, proportion of the stand in dominant/codominant, intermediate, and suppressed cohorts, average height and average diameter of each cohort, across the range of dwarf mistletoe ratings to address differences in stand structure. We found strong evidence of a decrease in canopy volume, suppressed cohort height, and dominant/codominant cohort diameter with increasing stand-level dwarf mistletoe rating. There was strong evidence that as dwarf mistletoe rating increases, proportion of the stand in the dominant/codominant cohort decreases while proportion of the stand in the suppressed cohort increases. Structural differences associated with variable dwarf mistletoe severity create heterogeneity in this forest type and may have a significant influence on stand productivity and the resistance and resilience of these stands to future biotic and abiotic disturbances. Our findings show that it is imperative to incorporate dwarf mistletoe when studying stand productivity and ecosystem recovery processes in lodgepole pine forests because of its potential to

  3. The First Epidemic and New-emerging Human Fascioliasis in Kermanshah (Western Iran) and a Ten-year Follow Up, 1998-2008

    PubMed Central

    Hatami, Hossein; Asmar, Mahdi; Masoud, Jafar; Mansouri, Feizollah; Namdaritabar, Hengameh; Ramazankhani, Ali

    2012-01-01

    Background: Fascioliasis is one of the most common zoonotic diseases in Iran and other parts of the world. Although the largest epidemic of this disease has occurred in northern provinces of Iran (Guilan) during the past two decades and a few cases have also been reported in Tehran and the other provinces, there has been no evidence of its’ occurrence in western provinces of Iran such as Kermanshah before the outbreak which is being reported. Methods: The study was conducted by teamwork of infectious disease specialist, parasitologist, general practitioner, entomologist, and laboratory technician. It is an “epidemic investigation” and a cross sectional descriptive one. Clinical data and para-clinical changes are recorded considering all of the population of a village in Kangavar, one of the suburbs of Kermanshah (western Iran). Results: The mean age was 21.65, (SD=12.44). Fifty three percent were female, and all of them were farmers. Eighty two percent had a history of watercress ingestion in a period of 1-2 months before the admission and 18% consumed other vegetables. The average of eosinophils was 32.35% (SD=26). The patients’ Enzyme Linked Immunosorbent Assay (ELISA) and Counter Current Immuno-electrophoresis (CCIE) serological tests were reported positive by the department of parasitology, Pasteur Institute of Iran. Treatment response to triclabendazole was excellent. A ten-year clinical and laboratory follow-up revealed no evidence of abnormality in treated patients. Conclusions: It was the first case of human fascioliasis in west Iran and was a real epidemic and an emerging infectious disease for this area at that time. The clinical symptoms were less severe compared with other reports. Health education to inhabitants and health care workers can lead to rapid detection of such outbreaks. PMID:22624083

  4. Effects of Dwarf Mistletoe on Stand Structure of Lodgepole Pine Forests 21-28 Years Post-Mountain Pine Beetle Epidemic in Central Oregon

    PubMed Central

    Agne, Michelle C.; Shaw, David C.; Woolley, Travis J.; Queijeiro-Bolaños, Mónica E.

    2014-01-01

    Lodgepole pine (Pinus contorta) forests are widely distributed throughout North America and are subject to mountain pine beetle (Dendroctonus ponderosae) epidemics, which have caused mortality over millions of hectares of mature trees in recent decades. Mountain pine beetle is known to influence stand structure, and has the ability to impact many forest processes. Dwarf mistletoe (Arceuthobium americanum) also influences stand structure and occurs frequently in post-mountain pine beetle epidemic lodgepole pine forests. Few studies have incorporated both disturbances simultaneously although they co-occur frequently on the landscape. The aim of this study is to investigate the stand structure of lodgepole pine forests 21–28 years after a mountain pine beetle epidemic with varying levels of dwarf mistletoe infection in the Deschutes National Forest in central Oregon. We compared stand density, stand basal area, canopy volume, proportion of the stand in dominant/codominant, intermediate, and suppressed cohorts, average height and average diameter of each cohort, across the range of dwarf mistletoe ratings to address differences in stand structure. We found strong evidence of a decrease in canopy volume, suppressed cohort height, and dominant/codominant cohort diameter with increasing stand-level dwarf mistletoe rating. There was strong evidence that as dwarf mistletoe rating increases, proportion of the stand in the dominant/codominant cohort decreases while proportion of the stand in the suppressed cohort increases. Structural differences associated with variable dwarf mistletoe severity create heterogeneity in this forest type and may have a significant influence on stand productivity and the resistance and resilience of these stands to future biotic and abiotic disturbances. Our findings show that it is imperative to incorporate dwarf mistletoe when studying stand productivity and ecosystem recovery processes in lodgepole pine forests because of its potential to

  5. Cholera toxin expression by El Tor Vibrio cholerae in shallow culture growth conditions.

    PubMed

    Cobaxin, Mayra; Martínez, Haydee; Ayala, Guadalupe; Holmgren, Jan; Sjöling, Asa; Sánchez, Joaquín

    2014-01-01

    Vibrio cholerae O1 classical, El Tor and O139 are the primary biotypes that cause epidemic cholera, and they also express cholera toxin (CT). Although classical V. cholerae produces CT in various settings, the El Tor and O139 strains require specific growth conditions for CT induction, such as the so-called AKI conditions, which consist of growth in static conditions followed by growth under aerobic shaking conditions. However, our group has demonstrated that CT production may also take place in shallow static cultures. How these type of cultures induce CT production has been unclear, but we now report that in shallow culture growth conditions, there is virtual depletion of dissolved oxygen after 2.5 h of growth. Concurrently, during the first three to 4 h, endogenous CO2 accumulates in the media and the pH decreases. These findings may explain CT expression at the molecular level because CT production relies on a regulatory cascade, in which the key regulator AphB may be activated by anaerobiosis and by low pH. AphB activation stimulates TcpP synthesis, which induces ToxT production, and ToxT directly stimulates ctxAB expression, which encodes CT. Importantly, ToxT activity is enhanced by bicarbonate. Therefore, we suggest that in shallow cultures, AphB is activated by initial decreases in oxygen and pH, and subsequently, ToxT is activated by intracellular bicarbonate that has been generated from endogenous CO2. This working model would explain CT production in shallow cultures and, possibly, also in other growth conditions.

  6. Cholera in the United States, 2001-2011: a reflection of patterns of global epidemiology and travel.

    PubMed

    Loharikar, A; Newton, A E; Stroika, S; Freeman, M; Greene, K D; Parsons, M B; Bopp, C; Talkington, D; Mintz, E D; Mahon, B E

    2015-03-01

    US cholera surveillance offers insight into global and domestic trends. Between 2001 and 2011, 111 cases were reported to the Centers for Disease Control and Prevention. Cholera was associated with international travel in 90 (81%) patients and was domestically acquired in 20 (18%) patients; for one patient, information was not available. From January 2001 to October 2010, the 42 (47%) travel-associated cases were associated with travel to Asia. In October 2010, a cholera epidemic started in Haiti, soon spreading to the Dominican Republic (Hispaniola). From then to December 2011, 40 (83%) of the 48 travel-associated cases were associated with travel to Hispaniola. Of 20 patients who acquired cholera domestically, 17 (85%) reported seafood consumption; 10 (59%) ate seafood from the US Gulf Coast. In summary, an increase in travel-associated US cholera cases was associated with epidemic cholera in Hispaniola in 2010-2011. Travel to Asia and consumption of Gulf Coast seafood remained important sources of US cholera cases.

  7. Spatio-temporal clustering of cholera: the impact of flood control in Matlab, Bangladesh, 1983-2003.

    PubMed

    Carrel, Margaret; Emch, Michael; Streatfield, Peter K; Yunus, Mohammad

    2009-09-01

    Introducing flood control to an area of endemic waterborne diseases could have significant impacts on spatio-temporal occurrence of cholera. Using 21-year data from Bangladesh, we conducted cluster analysis to explore changes in spatial and temporal distribution of cholera incidence since the construction of flood control structures. Striking changes in temporal cluster patterns emerged, including a shift from dry-season to rainy-season clusters following flood protection and delayed clustering inside the protected areas. Spatial differences in pre-flood protection and post-protection cholera clusters are weaker. Changes in spatio-temporal cholera clustering, associated with implementation of flood protection strategies, could affect local cholera prevention efforts.

  8. Rapid Spread of Vibrio cholerae O1 El Tor Variant in Odisha, Eastern India, in 2008 and 2009

    PubMed Central

    Khuntia, H. K.; Pal, B. B.; Samal, S. K.

    2013-01-01

    The emergence and spread of Vibrio cholerae O1 El Tor variant strains causing severe diarrhea has been witnessed worldwide in recent years. In the state of Odisha, India, the spread of the V. cholerae O1 El Tor variant strains was studied during outbreaks in 2008 and 2009. Analysis of 194 V. cholerae O1 Ogawa strains revealed that V. cholerae O1 El Tor variant strains are spreading gradually throughout the state, causing outbreaks replacing typical V. cholerae O1 El Tor biotype strains. PMID:23515546

  9. [Epidemic typhus in Africa].

    PubMed

    Ndihokubwayo, J B; Raoult, D

    1999-01-01

    Epidemic typhus is caused by a small strictly intracellular virus named Rickettsia prowazekii, a member of the Rickettsial family. It is transmitted to man by the body louse, Pediculus humanus. Although now rare in Western countries, exanthematic typhus remains common in the Southern hemisphere due to poverty, inadequate clothing hygiene, and poor socioeconomic conditions. In Africa, outbreaks have historically occurred in Burundi, Rwanda, southwest Ouganda, and Ethiopia. The largest outbreak of epidemic typhus since the World War II was reported in Burundi where ongoing civil war since October 1993 has forced 10 p. 100 of the population of Burundi to live in cold, promiscuity, and malnutrition of makeshift refugee camps. The purpose of this report based on our two-year experience working with this unfortunate population is to describe the characteristics of this disease in Africa where the epidemic form had become rare until recently. Indeed political unrest as well as numerous civil wars are now epidmiological factors favorizing outbreaks of epidemic typhus at any time. This overview also provides an opportunity to recall epidemiological, bacteriological, and clinical aspects of typhus as well as diagnosis and treatment of the disease in the context of Africa.

  10. 30 Years Retrospective Review of Tuberculosis Cases in a Tuberculosis Dispensary in Bursa/Nilufer, Turkey (1985–2014): Changes of Epidemics*

    PubMed Central

    Pala, Kayıhan; Gerçek, Harika; Taş, Tuncay Aydin; Çakir, Rukiye; Özgüç, Sedef; Yildiz, Timur

    2016-01-01

    Objective The aim of this study is to describe the epidemiological and clinical aspects of patients who applied to the Bursa Nilufer Tuberculosis Dispensary by investigating the trends in epidemics over three decades. Method In this retrospective observational study, the records of all tuberculosis cases (1630 patients) treated in the last 30 years (1985–2014) at the Bursa Nilufer Tuberculosis Dispensary were examined and statistically analyzed. Results Males comprised 65.2% of the patients. The ages of the patients ranged from 1 to 87 years, and the mean age was 37.4 (95% CI: 36.6–38.2). Among the cases, 86.7% were new infections and 74.1% were pulmonary tuberculosis. In the last decade, the education level, the percentage of patients who had received a BCG vaccination, the proportion of women and active employees among them increased (p<0.05), while it decreased among men (p<0.05). Clinical symptoms accompanying TB such as weakness, anorexia, weight loss, and cough, decreased to a statistically significant degree (p<0.05). In the last decade, the mortality rate was 3.6% and increased compared with previous decades (p<0.05). Mortality was higher among patients who were elderly, male, did not have a BCG scar or had a chronic disease (p<0.05). Conclusion This study adds information about the change of TB epidemics in Turkey in the last 30 years. Further studies are needed to determine the risk factors associated with tuberculosis mortality and to evaluate the effectiveness control programs of this disease. PMID:27872739

  11. Survival of Vibrio cholerae in Nutrient-Poor Environments Is Associated with a Novel “Persister” Phenotype

    PubMed Central

    Jubair, Mohamma; Morris, J. Glenn; Ali, Afsar

    2012-01-01

    In response to antibiotic and/or environmental stress, some species of bacteria shift to a “persister” phenotype. Although toxigenic Vibrio cholerae, responsible for the disease cholera, can be found in nutrient-poor aquatic environments in endemic areas, the underlying mechanism(s) by which culturable cells persist in these environmental reservoirs is largely unknown. Here we report that introduction of V. cholerae into a nutrient-poor filter sterilized lake water (FSLW) microcosm promoted a shift to what we have defined as a “persister” phenotype (PP) which was culturable for >700 days. Direct transfer of PP of V. cholerae from original microcosms to freshly prepared FSLW resulted in the same pattern of persistence seen in the original microcosms. Scanning electron microscopy of cells persisting for over 700 days demonstrated cell morphologies that were very small in size, with a high degree of aggregation associated with flagella emanating from all aspects of the cell. V. cholerae PP cells reverted to a typical V. cholerae morphology when transferred to nutrient-rich L- broth. Cell-free supernatants obtained from microcosms at 24 hours, 180 days, and 700 days all showed >2-fold increase in CAI-1 signaling molecules, consistent with quorum sensing activity, as has been described for Pseudomonas aeruginosa persister cells. Chitin and phosphate promoted cell growth. Our data suggest that nutrient stress can select a V. cholerae persister phenotype in environmental reservoirs, with these strains then seeding subsequent cholera epidemics in response to chitin and phosphate availability. PMID:23028836

  12. A retrospective study detects a novel variant of porcine epidemic diarrhea virus in England in archived material from the year 2000

    PubMed Central

    Dastjerdi, Akbar; Peake, Julie; La Rocca, S. Anna; Tobin, Frank P.; Frossard, Jean-Pierre; Williamson, Susanna

    2016-01-01

    Outbreaks of porcine epidemic diarrhea (PED) were first recorded in England in the 1970s and continued to be confirmed until 2002. Retrospective analysis of archived material from one of the last confirmed cases in England in the year 2000 demonstrates the previous existence of a very diverse PED virus strain. Following the outbreaks of PED in North America in 2013, there has been renewed interest in phylogenetic analysis of sequences from PEDV strains worldwide. There is a gap in the available sequence data between the mid 1980s and the mid 2000s. This work is an example of how this gap can be at least partially filled by the examination of archived material. PMID:27812401

  13. Immune Responses to the O-Specific Polysaccharide Antigen in Children Who Received a Killed Oral Cholera Vaccine Compared to Responses following Natural Cholera Infection in Bangladesh

    PubMed Central

    Uddin, Taher; Xu, Peng; Aktar, Amena; Johnson, Russell A.; Rahman, Mohammad Arif; Alam, Mohammad Murshid; Bufano, Meagan Kelly; Eckhoff, Grace; Wu-Freeman, Ying; Yu, Yanan; Sultana, Tania; Khanam, Farhana; Saha, Amit; Chowdhury, Fahima; Khan, Ashraf I.; Charles, Richelle C.; LaRocque, Regina C.; Harris, Jason B.; Calderwood, Stephen B.; Kováč, Pavol; Qadri, Firdausi; Ryan, Edward T.

    2013-01-01

    Current oral cholera vaccines induce lower levels of protective efficacy and shorter durations of protection in young children than in adults. Immunity against cholera is serogroup specific, and immune responses to Vibrio cholerae lipopolysaccharide (LPS), the antigen that mediates serogroup-specific responses, are associated with protection against disease. Despite this, responses against V. cholerae O-specific polysaccharide (OSP), a key component of the LPS responsible for specificity, have not been characterized in children. Here, we report a comparison of polysaccharide antibody responses in children from a region in Bangladesh where cholera is endemic, including infants (6 to 23 months, n = 15), young children (24 to 59 months, n = 14), and older children (5 to 15 years, n = 23) who received two doses of a killed oral cholera vaccine 14 days apart. We found that infants and young children receiving the vaccine did not mount an IgG, IgA, or IgM antibody response to V. cholerae OSP or LPS, whereas older children showed significant responses. In comparison to the vaccinees, young children with wild-type V. cholerae O1 Ogawa infection did mount significant antibody responses against OSP and LPS. We also demonstrated that OSP responses correlated with age in vaccinees, but not in cholera patients, reflecting the ability of even young children with wild-type cholera to develop OSP responses. These differences might contribute to the lower efficacy of protection rendered by vaccination than by wild-type disease in young children and suggest that efforts to improve lipopolysaccharide-specific responses might be critical for achieving optimal cholera vaccine efficacy in this younger age group. PMID:23515016

  14. Peak occurrences of ciguatera fish poisoning precede cholera outbreaks in Hong Kong.

    PubMed Central

    Kwan, L. C.; Cheung, D. K. F.; Kam, K. M.

    2003-01-01

    Occurrences of ciguatera fish poisoning (CFP) and Vibrio cholerae infected patients in Hong Kong were reviewed for the 13-year period 1989-2001. Peak activity of CFP preceded peak activity of cholera in nine of the years except in 4 years (1990, 1991, 1992, 1996) where it was observed that the total number of cholera cases were all less than or equal to five per year (P < 0.05). Average time interval was 2.4 months between peaks of CFP and Vibrio cholerae outbreaks. Findings suggested that the factors that affect cholera and ciguatera occurrences may not be operating in some years but when they are operating, they will affect both cholera and CFP. CFP peaks have consistently occurred before Vibrio cholerae peaks in our locality so much so that the occurrence of the latter can now be almost accurately predicted since 1998. CFP peaks served as an early warning for public measures to be in place before occurrence of cholera outbreaks. PMID:12948360

  15. El Niño, Climate, and Cholera Associations in Piura, Peru, 1991-2001: A Wavelet Analysis.

    PubMed

    Ramírez, Iván J; Grady, Sue C

    2016-03-01

    In Peru, it was hypothesized that epidemic cholera in 1991 was linked to El Niño, the warm phase of El Niño-Southern Oscillation. While previous studies demonstrated an association in 1997-1998, using cross-sectional data, they did not assess the consistency of this relationship across the decade. Thus, how strong or variable an El Niño-cholera relationship was in Peru or whether El Niño triggered epidemic cholera early in the decade remains unknown. In this study, wavelet and mediation analyses were used to characterize temporal patterns among El Niño, local climate variables (rainfall, river discharge, and air temperature), and cholera incidence in Piura, Peru from 1991 to 2001 and to estimate the mediating effects of local climate on El Niño-cholera relationships. The study hypothesis is that El Niño-related connections with cholera in Piura were transient and interconnected via local climate pathways. Overall, our findings provide evidence that a strong El Niño-cholera link, mediated by local hydrology, existed in the latter part of the 1990s but found no evidence of an El Niño association in the earlier part of the decade, suggesting that El Niño may not have precipitated cholera emergence in Piura. Further examinations of cholera epicenters in Peru are recommended to support these results in Piura. For public health planning, the results may improve existing efforts that utilize El Niño monitoring for preparedness during future climate-related extremes in the region.

  16. Genetic Diversity and Population Structure of Vibrio cholerae

    PubMed Central

    Beltrán, Pilar; Delgado, Gabriela; Navarro, Armando; Trujillo, Francisca; Selander, Robert K.; Cravioto, Alejandro

    1999-01-01

    Multilocus enzyme electrophoresis (MLEE) of 397 Vibrio cholerae isolates, including 143 serogroup reference strains and 244 strains from Mexico and Guatemala, identified 279 electrophoretic types (ETs) distributed in two major divisions (I and II). Linkage disequilibrium was demonstrated in both divisions and in subdivision Ic of division I but not in subdivision Ia, which includes 76% of the ETs. Despite this evidence of relatively frequent recombination, clonal lineages may persist for periods of time measured in at least decades. In addition to the pandemic clones of serogroups O1 and O139, which form a tight cluster of four ETs in subdivision Ia, MLEE analysis identified numerous apparent clonal lineages of non-O1 strains with intercontinental distributions. A clone of serogroup O37 that demonstrated epidemic potential in the 1960s is closely related to the pandemic O1/O139 clones, but the nontoxigenic O1 Inaba El Tor reference strain is not. A strain of serogroup O22, which has been identified as the most likely donor of exogenous rfb region DNA to the O1 progenitor of the O139 clone, is distantly related to the O1/O139 clones. The close evolutionary relationships of the O1, O139, and O37 epidemic clones indicates that new cholera clones are likely to arise by the modification of a lineage that is already epidemic or is closely related to such a clone. PMID:9986816

  17. [Bacteriological survey of diarrheal epidemics in the 1998 Bangladesh floods].

    PubMed

    Tanabe, K; Nakamura, S; Kunii, O

    1999-09-01

    In 1998, the worst flood disaster in Bangladesh ravaged more than half of its land and diarrheal epidemics broke out. We examined fecal specimens of diarrheal patients at rural hospitals in Chandpor district located 140 km southeast of Dhaka to analyze the enteric bacterial pathogens in post-flood period October. Of the 76 patients stools examined, Vibrio cholerae O1 biotype El Tor, serotype Ogawa, and Vibrio cholerae O139 Bengal were detected in 25 (33%) and in 14 (18%) respectively. Other enteropathogenic bacteria confirmed were Vibrio cholerae O5, Vibrio fluvialis and Enteropathogenic Escherichia coli O44. Neither Shigella nor Salmonella species was detected in this study. A drug susceptibility test was performed using TC, DOXY, CPFX, NA, and AMPC disks to cholera Vibrios. The O1 Vibrios showed the same susceptible pattern as O139 excluding NA susceptibility. TC resistant strain among the Vibrios was not detected though TC is a common therapeutic drug for diarrhea in this area. Our result clearly suggested that the epidemic potentiality of O139 still existed in rural Bangladesh.

  18. Predicting the evolution of large cholera outbreaks: lessons learnt from the Haiti case study

    NASA Astrophysics Data System (ADS)

    Bertuzzo, Enrico; Mari, Lorenzo; Righetto, Lorenzo; Knox, Allyn; Finger, Flavio; Casagrandi, Renato; Gatto, Marino; Rodriguez-Iturbe, Ignacio; Rinaldo, Andrea

    2013-04-01

    Mathematical models can provide key insights into the course of an ongoing epidemic, potentially aiding real-time emergency management in allocating health care resources and possibly anticipating the impact of alternative interventions. Spatially explicit models of waterborne disease are made routinely possible by widespread data mapping of hydrology, road network, population distribution, and sanitation. Here, we study the ex-post reliability of predictions of the ongoing Haiti cholera outbreak. Our model consists of a set of dynamical equations (SIR-like, i.e. subdivided into the compartments of Susceptible, Infected and Recovered individuals) describing a connected network of human communities where the infection results from the exposure to excess concentrations of pathogens in the water, which are, in turn, driven by hydrologic transport through waterways and by mobility of susceptible and infected individuals. Following the evidence of a clear correlation between rainfall events and cholera resurgence, we test a new mechanism explicitly accounting for rainfall as a driver of enhanced disease transmission by washout of open-air defecation sites or cesspool overflows. A general model for Haitian epidemic cholera and the related uncertainty is thus proposed and applied to the dataset of reported cases now available. The model allows us to draw predictions on longer-term epidemic cholera in Haiti from multi-season Monte Carlo runs, carried out up to January 2014 by using a multivariate Poisson rainfall generator, with parameters varying in space and time. Lessons learned and open issues are discussed and placed in perspective. We conclude that, despite differences in methods that can be tested through model-guided field validation, mathematical modeling of large-scale outbreaks emerges as an essential component of future cholera epidemic control.

  19. A cluster of Vibrio cholerae O1 infections in French travelers to Rajasthan (India), May 2006.

    PubMed

    Tarantola, Arnaud; Vaucel, Jacques; Laviolle, Céline; Quilici, Marie-Laure; Thiolet, Jean-Michel; Fournier, Jean-Michel

    2008-01-01

    A woman aged 60 years was hospitalized for Vibrio cholerae serogroup O1 cholera. Twenty-six fellow travelers and 48 health care workers who cared for the patient were individually traced and contacted. Of the 23/27 travelers with diarrhea during the trip, 4 presented antibodies. There was no person-to-person transmission.

  20. Connecting Environmental Observations with Cholera Outbreaks in Bangladesh

    NASA Astrophysics Data System (ADS)

    Stack, D.; Sandborn, A.; Widmeyer, P. A.; Escobar, V. M.

    2011-12-01

    Research has demonstrated that cholera epidemics in Bangladesh occur seasonally. This bimodal outbreak pattern closely follows times when large monsoon events are most frequent (spring and fall). While these patterns are presented in regional data, this knowledge alone cannot forecast the severity and location of cholera outbreaks until a monsoon event occurs, or an outbreak is reported. Therefore, there can only be reactive responses to cholera outbreaks. A heightened understanding of the link between environmental factors and outbreak occurrence will greatly enhance disease management capabilities. A predictive tool capable of giving an advanced warning of the environmental hazards that lead to location specific outbreaks allows for proactive and preventative responses, minimizing negative effects. A specific goal of this research was to relate latitude-longitude data with existing points associated with V. cholerae human case data collected from four cities in Bangladesh. Remotely sensed products were used to better understand the correlation between human outbreak occurrences, chlorophyll-a estimates, sea surface temperature (SST), and rainfall. Using MODIS, SeaWiFS, and TRMM satellite data, a gridded regional image was developed. Correlation analyses of the data were studied within the context of geographically diverse locations for the four cities of interest. Seasonal relationships were found between the cholera case data and all three of the chosen remotely sensed parameters. The strongest correlation found was between chlorophyll-a concentrations and reported human cases. The primary deliverable of this project was the production of an interactive Google Earth base map for use in a pilot design study that will lead to the development of applications to connect earth science products with water and health studies. The base map, with its inherent value of merging remotely sensed data with in situ observation points, can be used as a basis for constructing

  1. Satellites and Human Health: Potential for Tracking Cholera Outbreaks

    NASA Astrophysics Data System (ADS)

    Jutla, A. S.; Akanda, A. S.; Islam, S.

    2009-12-01

    Cholera continues to be a significant health threat across the globe. The pattern and magnitude of the seven global pandemics suggest that cholera outbreaks primarily originate in coastal regions and spread inland through secondary means. Cholera bacteria show strong association with zooplankton and phytoplankton abundance in coastal ecosystems. Characterization of space-time variability of chlorophyll, a surrogate for phytoplankton abundance, in Northern Bay of Bengal (BoB) is an essential step to develop any methodology for tracking cholera in the Bengal Delta from space. Using ten years of satellite data, this study (a) quantifies the space-time distribution of chlorophyll in BoB region and (b) presents a hypothesis as to how coastal plankton may be related with cholera outbreaks. Preliminary results suggest that variability of chlorophyll at daily scale, irrespective of spatial averaging, resembles white noise. At a monthly scale, chlorophyll shows distinct annual seasonality and chlorophyll values are significantly higher close to the coast than those in the offshore regions. At pixel level (9 km) on monthly scale, on the other hand, chlorophyll does not exhibit much persistence in time. With increased spatial averaging, temporal persistence of monthly chlorophyll increases and lag one autocorrelation stabilizes around 0.60 for 1200 km2 or larger areal averages. Spatial analyses of chlorophyll suggest that coastal region in BoB have a stable sill at 100 km range. Using satellite chlorophyll data, we observe that phytoplankton blooms occur every year in BoB, yet severe cholera outbreaks happen in certain years. This study provides a working hypothesis on how BoB coastal plankton blooms aided by regional hydroclimatic processes may lead to possible cholera outbreaks in Bengal Delta.

  2. Review of Two Decades of Cholera Diagnostics – How Far Have We Really Come?

    PubMed Central

    Dick, Michal H.; Guillerm, Martine; Moussy, Francis; Chaignat, Claire-Lise

    2012-01-01

    Background Cholera, an ancient scourge, continues to inflict high rates of mortality today. The rising incidence of epidemics in areas of poor sanitation and crowding highlight the need for better epidemic prevention and early response. Such interventions require the availability of rapid and accurate diagnostic techniques to trigger timely response and mitigate the scale of the outbreak. The current gold standard of bacterial culture is inadequate for rapid diagnosis, highlighting the overarching neglect of field diagnostic needs. This paper was written to support the World Health Organisation's Global Task Force on Cholera Control mandated Cholera and diarrhoeal disease laboratory Network (CholdiNet) in devising a protocol for the validation of Rapid Diagnostic Tests (RDTs) for Vibrio cholerae. The status of diagnostic tools for Vibrio cholerae is assessed, describing products that have been commercialised over the last two decades and discussing their peer-reviewed evaluation. Method Review of post-1990 peer-reviewed and grey literature on rapid diagnostic tests for Vibrio cholerae. Results Since 1990, twenty four diagnostic tests have been developed for the detection of Vibrio cholerae in human faecal samples. Fourteen of these have also been described in the literature, with rapid chromatographic-immuno assays (CIA) featuring strongly. Polymerase chain reaction (PCR) assays maintain the ability to detect the lowest amount of bacteria; however CIAs achieve both low detection thresholds and high sensitivity and specificity, making them possible candidates for use in field conditions. Field and laboratory studies were performed in a wide range of settings demonstrating variability in performance, however only a few of these studies were sufficiently stringent, highlighting five RDTs that showed promise in field conditions; COAT, IP cholera dipstick, SMART, IP dipstick and Medicos. In light of non-independent reporting, the authors would like to see these five

  3. Report of the 1966-67 cholera vaccine field trial in rural East Pakistan*

    PubMed Central

    Mosley, Wiley H.; McCormack, William M.; Fahimuddin, M.; Aziz, K. M. A.; Rahman, A. S. M. Mizanur; Chowdhury, A. K. M. Alauddin; Martin, Albert R.; Feeley, John C.; Phillips, Robert A.

    1969-01-01

    A controlled cholera vaccine field trial was carried out in rural East Pakistan during the 1966-67 cholera season. A commercial cholera vaccine of average potency was tested in 40 000 children aged 3 months to 14 years in 1- and 2-dose schedules. In the cholera season extending for 8 months following immunization, a single dose produced an over-all protection of 46%; 2 doses at an interval of 1 month provided 64% protection. The single dose was virtually ineffective in children under 5 years, but provided significant protection in older children. The enhanced effect of the 2-dose schedule was primarily due to the boosting of protection in children under the age of 5 years. The duration of significant protection, even with the 2-dose schedule, did not appear to extend beyond the first 3 months of the 8-month cholera season. PMID:5306538

  4. The cholera outbreak in Haiti: where and how did it begin?

    PubMed

    Lantagne, Daniele; Balakrish Nair, G; Lanata, Claudio F; Cravioto, Alejandro

    2014-01-01

    In October 2010, cholera appeared in Haiti for the first time in nearly a century. The Secretary-General of the United Nations formed an Independent Panel to "investigate and seek to determine the source of the 2010 cholera outbreak in Haiti". To fulfill this mandate, the Panel conducted concurrent epidemiological, water and sanitation, and molecular analysis investigations. Our May 2011 findings indicated that the 2010 Haiti cholera outbreak was caused by bacteria introduced into Haiti as a result of human activity; more specifically by the contamination of the Meye Tributary System of the Artibonite River with a pathogenic strain of the current South Asian type Vibrio cholerae. Recommendations were presented to assist in preventing the future introduction and spread of cholera in Haiti and worldwide. In this chapter, we discuss both the results of the Independent Panel's investigation and the context the report sat within; including background information, responses to the report's release, additional research subsequent to our report, and the public health implications of the Haiti cholera epidemic.

  5. Estimating the cost of cholera-vaccine delivery from the societal point of view: A case of introduction of cholera vaccine in Bangladesh.

    PubMed

    Sarker, Abdur Razzaque; Islam, Ziaul; Khan, Iqbal Ansary; Saha, Amit; Chowdhury, Fahima; Khan, Ashraful Islam; Cravioto, Alejandro; Clemens, John David; Qadri, Firdausi; Khan, Jahangir A M

    2015-09-11

    Cholera is a major global public health problem that causes both epidemic and endemic disease. The World Health Organization recommends oral cholera vaccines as a public health tool in addition to traditional prevention practices and treatments in both epidemic and endemic settings. In many developing countries like Bangladesh, the major issue concerns the affordability of this vaccine. In February 2011, a feasibility study entitled, "Introduction of Cholera Vaccine in Bangladesh (ICVB)", was conducted for a vaccination campaign using inactivated whole-cell cholera vaccine (Shanchol) in a high risk area of Mirpur, Dhaka. Empirical data obtained from this trial was used to determine the vaccination cost for a fully immunized person from the societal perspective. A total of 123,661 people were fully vaccinated receiving two doses of the vaccine, while 18,178 people received one dose of the same vaccine. The total cost for vaccine delivery was US$ 492,238 giving a total vaccination cost per fully-vaccinated individual of US$ 3.98. The purchase cost of the vaccine accounted for 58% of the overall cost of vaccination. Attempts to reduce the per-dose cost of the vaccine are likely to have a large impact on the cost of similar vaccination campaigns in the future.

  6. [Epidemic parotiditis, a reportable disease].

    PubMed

    Boverhoff, J C; Baart, J A

    2013-01-01

    Three consecutive patients with an acute swelling of one of the cheeks, were diagnosed with epidemic parotiditis. The first phase of the diagnostic procedure for an acute cheek swelling is to eliminate the possibility of odontogenic causes. When odontogenic problems have been excluded, non-dentition-related causes may be considered. An acute, progressive swelling in the preauricular area can often be attributed to an inflammation of the parotid gland, but epidemic parotiditis should also be considered. Epidemic parotiditis, or mumps, is caused by the mumps virus. Contamination occurs aerogenically. In the Netherlands, mumps vaccine is an ingredient of the governmental combined mump-measles-rubella inoculation programme. However, in recent years several small-scale parotiditis epidemics have broken out, predominantly among young, inoculated adults. Oropharyngeal mucus and blood samples are needed to diagnose the disease. Each case of the disease should be reported to the community healthcare service.

  7. [Differences in virulence genes in Vibrio cholerae eltor strains isolated from different sources in Turkmenistan territory].

    PubMed

    Smirnova, N I; Kostromitina, E A; Cheldyshova, N B; Kutyrev, V V

    2002-01-01

    Polymerase chain reaction (PCR) detected the presence of various genes associated with virulence in genome of strains V. cholerae eltor isolated in Turkmenistan territory during epidemic and epidemic-free perios. It was found that a complete set of virulence genes (ctxA+, tcpA+ and toxR+) contained strains isolated from patients, carriers and environment only in cholera epidemics. Strains isolated from the environment in the period free of epidemics did not contain ctxA and tcpA in 78.2% of cases, but 5.2% of the strains carried a complete set of virulence genes. There were also nontoxigenic strains containing genes tcpA and toxR. Such strains were isolated from the environment (16.6%) and vibrion carriers (42.9%). Isolated were also strains V.cholerae eltor carrying bacteriophage CTX phi with incomplete set of virulence genes and having genotype ctxA-, ace+ and zot+. Almost all the strains ctxA-, tcpA+ carry attRS1-site in genome. This shows that such strains may transform into toxigenic as a result of infection with bacteriophage CTX phi.

  8. Identifying environmental risk factors of cholera in a coastal area with geospatial technologies.

    PubMed

    Xu, Min; Cao, Chunxiang; Wang, Duochun; Kan, Biao

    2014-12-29

    Satellites contribute significantly to environmental quality and public health. Environmental factors are important indicators for the prediction of disease outbreaks. This study reveals the environmental factors associated with cholera in Zhejiang, a coastal province of China, using both Remote Sensing (RS) and Geographic information System (GIS). The analysis validated the correlation between the indirect satellite measurements of sea surface temperature (SST), sea surface height (SSH) and ocean chlorophyll concentration (OCC) and the local cholera magnitude based on a ten-year monthly data from the year 1999 to 2008. Cholera magnitude has been strongly affected by the concurrent variables of SST and SSH, while OCC has a one-month time lag effect. A cholera prediction model has been established based on the sea environmental factors. The results of hot spot analysis showed the local cholera magnitude in counties significantly associated with the estuaries and rivers.

  9. Identifying Environmental Risk Factors of Cholera in a Coastal Area with Geospatial Technologies

    PubMed Central

    Xu, Min; Cao, Chunxiang; Wang, Duochun; Kan, Biao

    2014-01-01

    Satellites contribute significantly to environmental quality and public health. Environmental factors are important indicators for the prediction of disease outbreaks. This study reveals the environmental factors associated with cholera in Zhejiang, a coastal province of China, using both Remote Sensing (RS) and Geographic information System (GIS). The analysis validated the correlation between the indirect satellite measurements of sea surface temperature (SST), sea surface height (SSH) and ocean chlorophyll concentration (OCC) and the local cholera magnitude based on a ten-year monthly data from the year 1999 to 2008. Cholera magnitude has been strongly affected by the concurrent variables of SST and SSH, while OCC has a one-month time lag effect. A cholera prediction model has been established based on the sea environmental factors. The results of hot spot analysis showed the local cholera magnitude in counties significantly associated with the estuaries and rivers. PMID:25551518

  10. Development of lipopolysaccharide-mimicking peptides and their immunoprotectivity against Vibrio cholerae serogroup O1.

    PubMed

    Mohammad Pour Ghazi, Fatemeh; Gargari, Seyed Latif Mousavi

    2016-11-01

    Vibrio cholerae serogroup O1 is the main causative agent of cholera diseases defined by life threatening rice watery diarrhea. Cholera routine vaccination has failed in controlling epidemics in developing countries because of their hard and expensive production. In this study, our aim was to investigate phage displayed mimotopes that could mimic V. cholerae lipopolysaccharide (LPS). Although LPS of Vibrio, as an endotoxin, can stimulate the immune system, thereby making it a suitable candidate for cholera vaccine, its toxicity remains as a main problem. Phage particles displaying 12 amino acid peptides were selected from phage library mimicking the antigenic epitopes of LPS from vibrio. The screening was carried out using single-domain antibody fragment VHH against LPS as target through three rounds of selection. Three clones with highest affinity to VHH were selected. To find out a new and efficient vaccine against cholera, these three phage particles containing high-affinity peptides were administered to mice to investigate the active and passive immunity. Out of 20 particles, three showed the highest affinity toward VHH. ELISA was carried out with immunized mice sera using LPS and three selected phages particles individually. ETEC, Shigella sonnei, and clinical isolates were used as bacterial targets. These three selected phages (individually or in combination) could stimulate mice immune system producing active and passive immunity. The mice immunized with phage particles could protect about 14 LD50 of V. cholerae. In conclusion, these peptides are mimicking LPS and can potentially act as vaccine candidates against V. cholerae. Copyright © 2016 European Peptide Society and John Wiley & Sons, Ltd.

  11. ​​​History of Cholera Outbreaks in Iran during the 19th and 20th Centuries

    PubMed Central

    Azizi, MH; Azizi, F

    2010-01-01

    Cholera is an acute infectious disease with high mortality if left untreated. Historically, between the 19th and 20th centuries seven great pandemics of cholera occurred and worldwide, thousands of people died. Based on an old theory, cholera was considered an air-born disease and the emergence of its outbreaks were attributed to bad weather or miasma. However later in the 18th century, British physician John Snow (1813-1858) explained the association of a terrible cholera outbreak in London in 1849 to contamination of the drinking water supply with human excreta. Despite his finding, the causative agent of this dreaded illness was unidentified until later in the 19th century. In 1854, Filippo Pacini (1812-1883) an anatomist from Italy and then in 1883, Robert Koch (1843-1910) the German bacteriologist, discovered ‘vibrio cholerae’ as the etiologic agent. During the major pandemics of cholera in 19th and 20th centuries this illness reached Iran and led to vast depopulation and a crucial impact on the country’s socioeconomic status. Poor public health conditions, lack of a well-organized public health authority for implementing preventive and quarantine measures as well as Iran’s specific geographic location were the main facilitating factors of the emergence of various epidemics, including cholera in Iran. The present paper briefly reviews the cholera outbreaks in Iran during the 19th and 20th centuries. PMID:25197514

  12. From Fall to Spring, or Spring to Fall? Seasonal Cholera Transmission Cycles and Implications for Climate Change

    NASA Astrophysics Data System (ADS)

    Akanda, A. S.; Jutla, A. S.; Huq, A.; Colwell, R.; Islam, S.; WE Reason

    2010-12-01

    Cholera remains a major public health threat in many developing countries around the world. The striking seasonality and the annual recurrence of this infectious disease in endemic areas continues to be of considerable interest to scientists and public health workers. Despite major advances in the ecological, and microbiological understanding of Vibrio cholerae, the causative agent, the role of underlying macro-scale hydroclimatic processes in propagating the disease in different seasons and years is not well understood. The incidence of cholera in the Bengal Delta region, the ‘native homeland’ of cholera, shows distinct biannual peaks in the southern floodplains, as opposed to single annual peaks in coastal areas and the northern parts of Bangladesh, as well as other cholera-endemic regions in the world. A coupled analysis of the regional hydroclimate and cholera incidence reveals a strong association of the spatio-temporal variability of incidence peaks with seasonal processes and extreme events. At a seasonal scale, the cycles indicate a spring-fall transmission pattern, contrary to the prevalent notion of a fall-spring transmission cycle. We show that the asymmetric seasonal hydroclimatology affects regional cholera dynamics by providing a coastal growth environment for bacteria in spring, while propagating transmission to fall by flooding. This seasonal interpretation of the progression of cholera has important implications, for formulating effective cholera intervention and mitigation efforts through improved water management and understanding the impacts of changing climate patterns on seasonal cholera transmission. (Water Environental Research Education Actionable Solutions Network)

  13. Pediatric Epidemic of Salmonella enterica Serovar Typhimurium in the Area of L’Aquila, Italy, Four Years after a Catastrophic Earthquake

    PubMed Central

    Nigro, Giovanni; Bottone, Gabriella; Maiorani, Daniela; Trombatore, Fabiana; Falasca, Silvana; Bruno, Gianfranco

    2016-01-01

    Background: A Salmonella enterica epidemic occurred in children of the area of L’Aquila (Central Italy, Abruzzo region) between June 2013 and October 2014, four years after the catastrophic earthquake of 6 April 2009. Methods: Clinical and laboratory data were collected from hospitalized and ambulatory children. Routine investigations for Salmonella infection were carried out on numerous alimentary matrices of animal origin and sampling sources for drinking water of the L’Aquila district, including pickup points of the two main aqueducts. Results: Salmonella infection occurred in 155 children (83 females: 53%), aged 1 to 15 years (mean 2.10). Of these, 44 children (28.4%) were hospitalized because of severe dehydration, electrolyte abnormalities, and fever resistant to oral antipyretic and antibiotic drugs. Three children (1.9%) were reinfected within four months after primary infection by the same Salmonella strain. Four children (2.6%), aged one to two years, were coinfected by rotavirus. A seven-year old child had a concomitant right hip joint arthritis. The isolated strains, as confirmed in about the half of cases or probable/possible in the remaining ones, were identified as S. enterica serovar Typhimurium [4,5:i:-], monophasic variant. Aterno river, bordering the L’Aquila district, was recognized as the main responsible source for the contamination of local crops and vegetables derived from polluted crops. Conclusions: The high rate of hospitalized children underlines the emergence of a highly pathogenic S. enterica strain probably subsequent to the contamination of the spring water sources after geological changes occurred during the catastrophic earthquake. PMID:27164121

  14. Population vulnerability to biannual cholera outbreaks and associated macro-scale drivers in the Bengal Delta.

    PubMed

    Akanda, Ali Shafqat; Jutla, Antarpreet S; Gute, David M; Sack, R Bradley; Alam, Munirul; Huq, Anwar; Colwell, Rita R; Islam, Shafiqul

    2013-11-01

    The highly populated floodplains of the Bengal Delta have a long history of endemic and epidemic cholera outbreaks, both coastal and inland. Previous studies have not addressed the spatio-temporal dynamics of population vulnerability related to the influence of underlying large-scale processes. We analyzed spatial and temporal variability of cholera incidence across six surveillance sites in the Bengal Delta and their association with regional hydroclimatic and environmental drivers. More specifically, we use salinity and flood inundation modeling across the vulnerable districts of Bangladesh to test earlier proposed hypotheses on the role of these environmental variables. Our results show strong influence of seasonal and interannual variability in estuarine salinity on spring outbreaks and inland flooding on fall outbreaks. A large segment of the population in the Bengal Delta floodplains remain vulnerable to these biannual cholera transmission mechanisms that provide ecologic and environmental conditions for outbreaks over large geographic regions.

  15. Cholera and the Scientific Method.

    ERIC Educational Resources Information Center

    Cronin, Jim

    1993-01-01

    Describes an approach to teaching the scientific method where an outbreak of cholera within the school is simulated. Students act like epidemiologists in an attempt to track down the source of the contamination. (PR)

  16. In Silico Screening of Antibacterial Compounds from Herbal Sources Against Vibrio cholerae

    PubMed Central

    Perveen, Sabah; Chaudhary, Hotam Singh

    2015-01-01

    Background: The prolonged use of antibiotic viz., tetracycline, quinolones, ampicillin, etc., to reduce the infection of cholera, may failed due to the emergence of new Vibrio cholerae antibiotics resistant strains. Moreover, these antibiotics even restricted for patient suffering from severe dehydration. Hence, there is a call to find an alternative therapeutics against V. cholerae. The natures serve different herbs in its lap which might contain several natural therapeutic compounds almost all diseases. Computer-aided designing is the initial steps for screening the novel inhibitors. Objective: To identify and evaluate natural compounds with low side effects with high efficacy against V. cholerae has been done. Materials and Methods: In silico screening, absorption, digestion, metabolism, and excretion (ADME), and docking of herbal compounds have been performed on to the target ToxT (transcriptional activator of V. cholerae). The compound with good ADME properties and drug-likeness property were subjected to docking. Results: From 70 herbal compounds, some compounds such as aloin, campesterol, lupeol, and ursolic acid showed a violation of the rule of five and compounds such as lupeol and beta carotene showed negative binding energy. Luteolin, catechin, brevifolin, etc., compounds were selected based on ADME, drug-likeness property, and docking studies. Conclusion: Two compounds named catechin and luteolin showed better inhibition properties against ToxT and good ADME and drug-likeness property were selected as a better lead molecule for drug development in future. The Genetic Optimization for Ligand Docking fitness score for catechin is 48.74 kcal/mol and luteolin 38.12 kcal/mol. SUMMARY Vibrio cholerae became antibiotic resistance and associated with several cholera epidemic and pandemic. Hence, there is a need to find an alternative therapeutics against V. cholerae. Many herbal compounds present in nature having high medicinal value. From in-silico study

  17. Hydroclimatology of dual-peak annual cholera incidence: Insights from a spatially explicit model

    NASA Astrophysics Data System (ADS)

    Bertuzzo, E.; Mari, L.; Righetto, L.; Gatto, M.; Casagrandi, R.; Rodriguez-Iturbe, I.; Rinaldo, A.

    2012-03-01

    Cholera incidence in some regions of the Indian subcontinent may exhibit two annual peaks although the main environmental drivers that have been linked to the disease (e.g., sea surface temperature, zooplankton abundance, river discharge) peak once per year during the summer. An empirical hydroclimatological explanation relating cholera transmission to river flows and to the disease spatial spreading has been recently proposed. We specifically support and substantiate mechanistically such hypothesis by means of a spatially explicit model of cholera transmission. Our framework directly accounts for the role of a model river network in transporting and redistributing cholera bacteria among human communities as well as for spatial and temporal annual fluctuations of river flows. The model is forced by seasonal environmental drivers, namely river flow, temperature and chlorophyll concentration in the coastal environment, a proxy for Vibrio cholerae concentration. Our results show that these drivers may suffice to generate dual-peak cholera prevalence patterns for proper combinations of timescales involved in pathogen transport, hydrologic variability and disease unfolding. The model explains the possible occurrence of spatial patterns of cholera incidence characterized by a spring peak confined to coastal areas and a fall peak involving inland regions. Our modeling framework suggests insights on how environmental drivers concert the generation of complex spatiotemporal infections and proposes an explanation for the different cholera patterns (dual or single annual peaks) exhibited by regions that share similar hydroclimatological forcings.

  18. Environmental factor analysis of cholera in China using remote sensing and geographical information systems.

    PubMed

    Xu, M; Cao, C X; Wang, D C; Kan, B; Xu, Y F; Ni, X L; Zhu, Z C

    2016-04-01

    Cholera is one of a number of infectious diseases that appears to be influenced by climate, geography and other natural environments. This study analysed the environmental factors of the spatial distribution of cholera in China. It shows that temperature, precipitation, elevation, and distance to the coastline have significant impact on the distribution of cholera. It also reveals the oceanic environmental factors associated with cholera in Zhejiang, which is a coastal province of China, using both remote sensing (RS) and geographical information systems (GIS). The analysis has validated the correlation between indirect satellite measurements of sea surface temperature (SST), sea surface height (SSH) and ocean chlorophyll concentration (OCC) and the local number of cholera cases based on 8-year monthly data from 2001 to 2008. The results show the number of cholera cases has been strongly affected by the variables of SST, SSH and OCC. Utilizing this information, a cholera prediction model has been established based on the oceanic and climatic environmental factors. The model indicates that RS and GIS have great potential for designing an early warning system for cholera.

  19. The silent epidemic of reproductive morbidity among ever married women (15-49 years) in an urban area of Delhi.

    PubMed

    Bhatnagar, Nidhi; Khandekar, Jyoti; Singh, Amarjeet; Saxena, Sonal

    2013-04-01

    Concept of reproductive health has long been discussed and need to focus on reproductive morbidity as a measure of reproductive health has evolved. There is poor reproductive health with neglect of women's own health. Compounded with socio-cultural factors, the result is poor treatment seeking and hence poor quality of life. This community based study was conducted to find out the magnitude, type of reproductive morbidity and treatment seeking behavior for the same. Cross sectional study was conducted in Palam Village among married women aged 15-49 years. 750 women were interviewed by visiting every fifth house through systematic random sampling. Symptomatic women were referred for gynecological examination and investigations. The overall prevalence of Reproductive Morbidity was found to be 46.3 %: Gynaecological morbidity in 31.3 % subjects, obstetric morbidity in 43.4 % of the eligible women and contraceptive induced morbidity in 11.2 % of the ever contraceptive users with 5 % reporting more than one symptom. Problem perception and treatment compliance was poor for subjects with gynecological morbidity as compared with contraceptive and obstetric morbidity respectively. High self-reported obstetric morbidity was observed with good treatment seeking behavior as compared to poor treatment seeking behavior in women with gynaecological morbidity. Contraceptive morbidity was reported by fewer subjects but treatment seeking was good. There is a need to understand the pattern of reporting and health seeking behavior among women suffering from reproductive morbidity. The large magnitude of reproductive morbidity warrants attention and hints the poor quality of MCH care delivered to women.

  20. Changing genotypes of cholera toxin (CT) of Vibrio cholerae O139 in Bangladesh and description of three new CT genotypes.

    PubMed

    Bhuiyan, Nurul A; Nusrin, Suraia; Alam, Munirul; Morita, Masatomo; Watanabe, Haruo; Ramamurthy, Thandavarayan; Cravioto, Alejandro; Nair, Gopinath Balakrish

    2009-11-01

    We determined the genotype of cholera toxin by amplifying and sequencing the B-subunit in a sequential collection of 90 strains of Vibrio cholerae O139 isolated over the past 13 years since its first description in 1992. Representative strains isolated during 1993-1997 harboured ctxB of El Tor type (genotype 3). Twenty-six strains isolated during 1999, 2001, 2005 and three strains isolated in 1998, 2000 and 2002 were identified to belong to new ctxB genotypes 4 and 5, respectively. Genotype 5 was similar to genotype 1 except at position 28 (D-->A). The genotype 6 was similar to genotype 4 except at position 34 (H-->P). The implication of switch in terms of function of the toxin and its impact on human disease is unclear. How this change has influenced their prevalence relative to that of V. cholerae O1 in human infection is also not clear. The other common virulence gene clusters including the Vibrio pathogenicity island-1, Vibrio seventh pandemic island (VSP)-I and VSP-II of V. cholerae O139 did not show any remarkable difference from that of the O1 El Tor strains. Overall, the majority of the O139 strains tested in this study were similar to the El Tor strains but had altered ctxB genotype. This change and the impact that it causes to the epidemiology of cholera caused by O139 should be closely monitored.

  1. [Cholera in children. A report of 8 cases].

    PubMed

    Lezama-Basulto, L A; Mota-Hernández, F; Bravo-Barrios, E

    1993-11-01

    Cholera is an acute intestinal infection caused by Vibrio cholerae 01. When an infected person presents severe dehydration and is not adequately treated, he or she will develop hypovolemic shock and eventually could died. There is scarce information concerning this disease in the Pediatric group. Herein we report on eight cases of Pediatric cholera, in children 17 month to four years of age. Seven patients out of eight were admitted presenting dehydration. Four presenting mild or moderate dehydration and three presenting hypovolemic shock. These three patients were rehydrated by intravenous route and thereafter the hydration was maintained by oral therapy. The outcome was uneventful in six patients. One patient developed abdominal distention probably due to hypopotassemia, and another patient presented hyponatremia and seizures. All the patients recovered within five days after admission.

  2. Spatially explicit cholera model: effects of population, water resources and health conditions distributions.

    NASA Astrophysics Data System (ADS)

    Bertuzzo, E.; Casagrandi, R.; Gatto, M.; Rodriguez-Iturbe, I.; Rinaldo, A.

    2009-04-01

    Cholera epidemics are still a major public health concern to date in many areas of the world. In order to understand and forecast cholera outbreaks, one of the most important factors is the role played by the environmental matrix in which the disease spreads. The environmental matrix is constituted by different human communities and their interconnections. Each community is characterized by its spatial position, population size, water resources availability and hygiene conditions. By implementing a spatially explicit cholera model we seek the effects on epidemic dynamics of: i) the topology and metrics of the pathogens pathways that connect different communities; ii) the spatial distribution of the population size; and iii) the spatial distributions of water resources and public health conditions, and how they vary with population size. We further extend the model by deriving the speed of propagation of traveling fronts in the case of uniformly distributed systems for different topologies: one and two dimensional lattices and river networks. The derivation of the spreading celerity proves instrumental in establishing the overall conditions for the relevance of spatially explicit models. The conditions are sought by comparison between spreading and disease timescales. Consider a cholera epidemic that starts from a point and spreads throughout a finite size system, it is possible to identify two different timescales: i) the spreading timescale, that is the time needed for the disease to spread and involve all the communities in the system; and ii) the epidemic timescale, defined by the duration of the epidemic in a single community. While the latter mainly depends on biological factors, the former is controlled also by the geometry of the environmental matrix. If the epidemics timescales are comparable or larger than pathogens' spreading timescales, one expects that the spatial variability does not play a role and the system may be approximated by a well

  3. A legacy in 20th-century medicine: Robert Allan Phillips and the taming of cholera.

    PubMed

    Savarino, Stephen J

    2002-09-15

    The legacy of Captain Robert Allan Phillips (1906-1976) was to establish effective, evidence-based rehydration methods for the treatment of cholera. As a Navy Lieutenant at the Rockefeller Institute for Medical Research (New York, New York) during World War II, Phillips developed a field method for the rapid assessment of fluid loss in wounded servicemen. After the war, he championed the establishment of United States Naval Medical Research Unit (NAMRU)-3 (Cairo; 1946) and NAMRU-2 (Taipei; 1955), serving at the helm of both units. Phillips embarked on cholera studies during the 1947 Egyptian cholera epidemic and brought them to maturity at NAMRU-2 (1958-1965), elucidating the pathophysiologic derangements induced by cholera and developing highly efficacious methods of intravenous rehydration. His conception of a simpler cholera treatment was realized in the late 1960s with the development of glucose-based oral rehydration therapy, a monumental breakthrough to which many other investigators made vital contributions. Today, these simple advances have been integrated into everyday medical practice across the globe, saving millions of lives annually.

  4. Notes from the Field: Ongoing Cholera Outbreak - Kenya, 2014-2016.

    PubMed

    George, Githuka; Rotich, Jacob; Kigen, Hudson; Catherine, Kiama; Waweru, Bonface; Boru, Waqo; Galgalo, Tura; Githuku, Jane; Obonyo, Mark; Curran, Kathryn; Narra, Rupa; Crowe, Samuel J; O'Reilly, Ciara E; Macharia, Daniel; Montgomery, Joel; Neatherlin, John; De Cock, Kevin M; Lowther, Sara; Gura, Zeinab; Langat, Daniel; Njeru, Ian; Kioko, Jackson; Muraguri, Nicholas

    2016-01-29

    On January 6, 2015, a man aged 40 years was admitted to Kenyatta National Hospital in Nairobi, Kenya, with acute watery diarrhea. The patient was found to be infected with toxigenic Vibrio cholerae serogroup O1, serotype Inaba. A subsequent review of surveillance reports identified four patients in Nairobi County during the preceding month who met either of the Kenya Ministry of Health suspected cholera case definitions: 1) severe dehydration or death from acute watery diarrhea (more than four episodes in 12 hours) in a patient aged ≥5 years, or 2) acute watery diarrhea in a patient aged ≥2 years in an area where there was an outbreak of cholera. An outbreak investigation was immediately initiated. A confirmed cholera case was defined as isolation of V. cholerae O1 or O139 from the stool of a patient with suspected cholera or a suspected cholera case that was epidemiologically linked to a confirmed case. By January 15, 2016, a total of 11,033 suspected or confirmed cases had been reported from 22 of Kenya's 47 counties (Table). The outbreak is ongoing.

  5. Scanning the landscape of genome architecture of non-O1 and non-O139 Vibrio cholerae by whole genome mapping reveals extensive population genetic diversity.

    PubMed

    Chapman, Carol; Henry, Matthew; Bishop-Lilly, Kimberly A; Awosika, Joy; Briska, Adam; Ptashkin, Ryan N; Wagner, Trevor; Rajanna, Chythanya; Tsang, Hsinyi; Johnson, Shannon L; Mokashi, Vishwesh P; Chain, Patrick S G; Sozhamannan, Shanmuga

    2015-01-01

    Historically, cholera outbreaks have been linked to V. cholerae O1 serogroup strains or its derivatives of the O37 and O139 serogroups. A genomic study on the 2010 Haiti cholera outbreak strains highlighted the putative role of non O1/non-O139 V. cholerae in causing cholera and the lack of genomic sequences of such strains from around the world. Here we address these gaps by scanning a global collection of V. cholerae strains as a first step towards understanding the population genetic diversity and epidemic potential of non O1/non-O139 strains. Whole Genome Mapping (Optical Mapping) based bar coding produces a high resolution, ordered restriction map, depicting a complete view of the unique chromosomal architecture of an organism. To assess the genomic diversity of non-O1/non-O139 V. cholerae, we applied a Whole Genome Mapping strategy on a well-defined and geographically and temporally diverse strain collection, the Sakazaki serogroup type strains. Whole Genome Map data on 91 of the 206 serogroup type strains support the hypothesis that V. cholerae has an unprecedented genetic and genomic structural diversity. Interestingly, we discovered chromosomal fusions in two unusual strains that possess a single chromosome instead of the two chromosomes usually found in V. cholerae. We also found pervasive chromosomal rearrangements such as duplications and indels in many strains. The majority of Vibrio genome sequences currently in public databases are unfinished draft sequences. The Whole Genome Mapping approach presented here enables rapid screening of large strain collections to capture genomic complexities that would not have been otherwise revealed by unfinished draft genome sequencing and thus aids in assembling and finishing draft sequences of complex genomes. Furthermore, Whole Genome Mapping allows for prediction of novel V. cholerae non-O1/non-O139 strains that may have the potential to cause future cholera outbreaks.

  6. Scanning the landscape of genome architecture of non-O1 and non-O139 Vibrio cholerae by whole genome mapping reveals extensive population genetic diversity

    DOE PAGES

    Chapman, Carol; Henry, Matthew; Bishop-Lilly, Kimberly A.; ...

    2015-03-20

    Historically, cholera outbreaks have been linked to V. cholerae O1 serogroup strains or its derivatives of the O37 and O139 serogroups. A genomic study on the 2010 Haiti cholera outbreak strains highlighted the putative role of non O1/non-O139 V. cholerae in causing cholera and the lack of genomic sequences of such strains from around the world. Here we address these gaps by scanning a global collection of V. cholerae strains as a first step towards understanding the population genetic diversity and epidemic potential of non O1/non-O139 strains. Whole Genome Mapping (Optical Mapping) based bar coding produces a high resolution, orderedmore » restriction map, depicting a complete view of the unique chromosomal architecture of an organism. To assess the genomic diversity of non-O1/non-O139 V. cholerae, we applied a Whole Genome Mapping strategy on a well-defined and geographically and temporally diverse strain collection, the Sakazaki serogroup type strains. Whole Genome Map data on 91 of the 206 serogroup type strains support the hypothesis that V. cholerae has an unprecedented genetic and genomic structural diversity. Interestingly, we discovered chromosomal fusions in two unusual strains that possess a single chromosome instead of the two chromosomes usually found in V. cholerae. We also found pervasive chromosomal rearrangements such as duplications and indels in many strains. The majority of Vibrio genome sequences currently in public databases are unfinished draft sequences. The Whole Genome Mapping approach presented here enables rapid screening of large strain collections to capture genomic complexities that would not have been otherwise revealed by unfinished draft genome sequencing and thus aids in assembling and finishing draft sequences of complex genomes. Furthermore, Whole Genome Mapping allows for prediction of novel V. cholerae non-O1/non-O139 strains that may have the potential to cause future cholera outbreaks.« less

  7. Epidemic processes in complex networks

    NASA Astrophysics Data System (ADS)

    Pastor-Satorras, Romualdo; Castellano, Claudio; Van Mieghem, Piet; Vespignani, Alessandro

    2015-07-01

    In recent years the research community has accumulated overwhelming evidence for the emergence of complex and heterogeneous connectivity patterns in a wide range of biological and sociotechnical systems. The complex properties of real-world networks have a profound impact on the behavior of equilibrium and nonequilibrium phenomena occurring in various systems, and the study of epidemic spreading is central to our understanding of the unfolding of dynamical processes in complex networks. The theoretical analysis of epidemic spreading in heterogeneous networks requires the development of novel analytical frameworks, and it has produced results of conceptual and practical relevance. A coherent and comprehensive review of the vast research activity concerning epidemic processes is presented, detailing the successful theoretical approaches as well as making their limits and assumptions clear. Physicists, mathematicians, epidemiologists, computer, and social scientists share a common interest in studying epidemic spreading and rely on similar models for the description of the diffusion of pathogens, knowledge, and innovation. For this reason, while focusing on the main results and the paradigmatic models in infectious disease modeling, the major results concerning generalized social contagion processes are also presented. Finally, the research activity at the forefront in the study of epidemic spreading in coevolving, coupled, and time-varying networks is reported.

  8. Revisiting Cholera-Climate Teleconnections in the Native Homeland: ENSO and other Extremes through the Regional Hydroclimatic Drivers

    NASA Astrophysics Data System (ADS)

    Akanda, A. S.; Jutla, A.; Huq, A.; Colwell, R. R.

    2014-12-01

    Cholera is a global disease, with significantly large outbreaks occurring since the 1990s, notably in Sub-Saharan Africa and South Asia and recently in Haiti, in the Caribbean. Critical knowledge gaps remain in the understanding of the annual recurrence in endemic areas and the nature of epidemic outbreaks, especially those that follow extreme hydroclimatic events. Teleconnections with large-scale climate phenomena affecting regional scale hydroclimatic drivers of cholera dynamics remain largely unexplained. For centuries, the Bengal delta region has been strongly influenced by the asymmetric availability of water in the rivers Ganges and the Brahmaputra. As these two major rivers are known to have strong contrasting affects on local cholera dynamics in the region, we argue that the role of El Nino-Southern Oscillation (ENSO), Indian Ocean Dipole (IOD), or other phenomena needs to be interpreted in the context of the seasonal role of individual rivers and subsequent impact on local environmental processes, not as a teleconnection having a remote and unified effect. We present a modified hypothesis that the influences of large-scale climate phenomena such as ENSO and IOD on Bengal cholera can be explicitly identified and incorporated through regional scale hydroclimatic drivers. Here, we provide an analytical review of the literature addressing cholera and climate linkages and present hypotheses, based on recent evidence, and quantification on the role of regional scale hydroclimatic drivers of cholera. We argue that the seasonal changes in precipitation and temperature, and resulting river discharge in the GBM basin region during ENSO and IOD events have a dominant combined effect on the endemic persistence and the epidemic vulnerability to cholera outbreaks in spring and fall seasons, respectively, that is stronger than the effect of localized hydrological and socio-economic sensitivities in Bangladesh. In addition, systematic identification of underlying seasonal

  9. Epidemic Percolation Networks, Epidemic Outcomes, and Interventions

    DOE PAGES

    Kenah, Eben; Miller, Joel C.

    2011-01-01

    Epidemic percolation networks (EPNs) are directed random networks that can be used to analyze stochastic “Susceptible-Infectious-Removed” (SIR) and “Susceptible-Exposed-Infectious-Removed” (SEIR) epidemic models, unifying and generalizing previous uses of networks and branching processes to analyze mass-action and network-based S(E)IR models. This paper explains the fundamental concepts underlying the definition and use of EPNs, using them to build intuition about the final outcomes of epidemics. We then show how EPNs provide a novel and useful perspective on the design of vaccination strategies.

  10. Expanding multiple antibiotic resistance among clinical strains of Vibrio cholerae isolated from 1992-7 in Calcutta, India.

    PubMed Central

    Garg, P.; Chakraborty, S.; Basu, I.; Datta, S.; Rajendran, K.; Bhattacharya, T.; Yamasaki, S.; Bhattacharya, S. K.; Takeda, Y.; Nair, G. B.; Ramamurthy, T.

    2000-01-01

    Antimicrobial susceptibilities of Vibrio cholerae strains isolated from cholera patients admitted to the Infectious Diseases Hospital, Calcutta, India for 6 years were analysed to determine the changing trends; 840 V. cholerae strains isolated in 1992-1997 were included in this study. Among V. cholerae serogoup O1 and O139, ampicillin resistance increased from 1992 (35 and 70%, respectively) to 1997 (both serogroups 100%). Resistance to furazolidone and streptomycin was constantly high among V. cholerae O1 strains with gradual increase in resistance to other drugs such as ciprofloxacin, co-trimoxazole, neomycin and nalidixic acid. V. cholerae O139 strains exhibited susceptibilities to furazolidone and streptomycin comparable with those of O1 strains. However, after initial increase in resistance to chloramphenicol and co-trimoxazole, all the V. cholerae O139 strains became susceptible to these two drugs from 1995 onwards. Both V. cholerae O1 and O139 remained largely susceptible to gentamicin and tetracycline. V. cholerae non-O1, non-O139 strains, in contrast, exhibited high levels of resistance to virtually every class of antimicrobial agents tested in this study especially from 1995. Kruskal-Wallis one-way analysis showed that V. cholerae O1 Ogawa serogroup exhibited significant yearly increase in resistance to nine antibiotics followed by non-O1 non-O139 and O139 strains to six antibiotics and two antibiotics respectively. Interesting observation encountered in this study was the dissipation of some of the resistant patterns commonly found among V. cholerae non-O1 non-O139 or O1 serogroups to the O139 serogroup and vice versa during the succeeding years. PMID:10982062

  11. Hydroclimatic influences on seasonal and spatial cholera transmission cycles: Implications for public health intervention in the Bengal Delta

    NASA Astrophysics Data System (ADS)

    Akanda, Ali Shafqat; Jutla, Antarpreet S.; Alam, Munirul; de Magny, Guillaume Constantin; Siddique, A. Kasem; Sack, R. Bradley; Huq, Anwar; Colwell, Rita R.; Islam, Shafiqul

    2011-03-01

    Cholera remains a major public health threat in many developing countries around the world. The striking seasonality and annual recurrence of this infectious disease in endemic areas remain of considerable interest to scientists and public health workers. Despite major advances in the ecological and microbiological understanding of Vibrio cholerae, the causative agent of the disease, the role of underlying large-scale hydroclimatic processes in propagating the disease for different seasons and spatial locations is not well understood. Here we show that the cholera outbreaks in the Bengal Delta region are propagated from the coastal to the inland areas and from spring to fall by two distinctly different transmission cycles, premonsoon and postmonsoon, influenced by coastal and terrestrial hydroclimatic processes, respectively. A coupled analysis of the regional hydroclimate and cholera incidence reveals a strong association of the space-time variability of incidence peaks with seasonal processes and extreme climatic events. We explain how the asymmetric seasonal hydroclimatology affects regional cholera dynamics by providing a coastal growth environment for bacteria in spring, while propagating the disease to fall by monsoon flooding. Our findings may serve as the basis for "climate-informed" early warnings and for prompting effective means for intervention and preempting epidemic cholera outbreaks in vulnerable regions.

  12. Chromosome Segregation in Vibrio cholerae

    PubMed Central

    Ramachandran, R.; Jha, J; Chattoraj, DK

    2014-01-01

    The study of chromosome segregation is currently one of the most exciting research frontiers in cell biology. In this review, we discuss our current knowledge of the chromosome segregation process in Vibrio cholerae, based primarily on findings from fluorescence microscopy experiments. This bacterium is of special interest because of its eukaryotic feature of having a divided genome, a feature shared with 10% of known bacteria. We also discuss how the segregation mechanisms of V. cholerae compare with those in other bacteria, and highlight some of the remaining questions regarding the process of bacterial chromosome segregation. PMID:25732338

  13. Diagnostic limitations to accurate diagnosis of cholera.

    PubMed

    Alam, Munirul; Hasan, Nur A; Sultana, Marzia; Nair, G Balakrish; Sadique, A; Faruque, A S G; Endtz, Hubert P; Sack, R B; Huq, A; Colwell, R R; Izumiya, Hidemasa; Morita, Masatomo; Watanabe, Haruo; Cravioto, Alejandro

    2010-11-01

    The treatment regimen for diarrhea depends greatly on correct diagnosis of its etiology. Recent diarrhea outbreaks in Bangladesh showed Vibrio cholerae to be the predominant cause, although more than 40% of the suspected cases failed to show cholera etiology by conventional culture methods (CMs). In the present study, suspected cholera stools collected from every 50th patient during an acute diarrheal outbreak were analyzed extensively using different microbiological and molecular tools to determine their etiology. Of 135 stools tested, 86 (64%) produced V. cholerae O1 by CMs, while 119 (88%) tested positive for V. cholerae O1 by rapid cholera dipstick (DS) assay; all but three samples positive for V. cholerae O1 by CMs were also positive for V. cholerae O1 by DS assay. Of 49 stools that lacked CM-based cholera etiology despite most being positive for V. cholerae O1 by DS assay, 25 (51%) had coccoid V. cholerae O1 cells as confirmed by direct fluorescent antibody (DFA) assay, 36 (73%) amplified primers for the genes wbe O1 and ctxA by multiplex-PCR (M-PCR), and 31 (63%) showed El Tor-specific lytic phage on plaque assay (PA). Each of these methods allowed the cholera etiology to be confirmed for 97% of the stool samples. The results suggest that suspected cholera stools that fail to show etiology by CMs during acute diarrhea outbreaks may be due to the inactivation of V. cholerae by in vivo vibriolytic action of the phage and/or nonculturability induced as a host response.

  14. Vibrio metoecus sp. nov., a close relative of Vibrio cholerae isolated from coastal brackish ponds and clinical specimens.

    PubMed

    Kirchberger, Paul C; Turnsek, Maryann; Hunt, Dana E; Haley, Bradd J; Colwell, Rita R; Polz, Martin F; Tarr, Cheryl L; Boucher, Yan

    2014-09-01

    A Gram-staining-negative, curved-rod-shaped bacterium with close resemblance to Vibrio cholerae, the aetiological agent of cholera, was isolated over the course of several years from coastal brackish water (17 strains) and from clinical cases (two strains) in the United States. 16S rRNA gene identity with V. cholerae exceeded 98 % yet an average nucleotide identity based on genome data of around 86 % and multi locus sequence analysis of six housekeeping genes (mdh, adk, gyrB, recA, pgi and rpoB) clearly delineated these isolates as a distinct genotypic cluster within the V. cholerae-V. mimicus clade. Most standard identification techniques do not differentiate this cluster of isolates from V. cholerae. Only amplification of the ompW gene using V. cholerae-specific primers and a negative Voges-Proskauer test showed a difference between the two clusters. Additionally, all isolated strains differed phenotypically from V. cholerae in their ability to utilize N-acetyl-d-galactosamine and d-glucuronic acid as sole carbon sources. Furthermore, they were generally unable to infect the slime mould Dictyostelium discoideum, a widespread ability in V. cholerae. Based on these clear phenotypic differences that are not necessarily apparent in standard tests as well as average nucleotide identity and phylogeny of protein-coding genes, we propose the existence of a novel species, Vibrio metoecus sp. nov. with the type strain OP3H(T) ( = LMG 27764(T) = CIP 110643(T)). Due to its close resemblance to V. cholerae and the increasing number of strains isolated over the past several years, we suggest that V. metoecus sp. nov. is a relatively common species of the genus Vibrio, isolates of which have been identified as atypical isolates of V. cholerae in the past. Its isolation from clinical samples also indicates that strains of this species, like V. cholerae, are opportunistic pathogens.

  15. Characterization of Vibrio cholerae isolates from 1976 to 2013 in Shandong Province, China.

    PubMed

    Lü, Hui; Yuan, Yuqi; Sun, Na; Bi, Zhenwang; Guan, Bing; Shao, Kun; Wang, Tongzhan; Bi, Zhenqiang

    Cholera continues to be a serious public health issue in developing countries. We analyzed the epidemiological data of cholera from 1976 to 2013 in Shandong Province, an eastern coastal area of China. A total of 250 Vibrio cholerae isolates were selected for PCR analysis of virulence genes and pulsed-field gel electrophoresis (PFGE). The analysis of the virulence genes showed that the positive rates for tcpA and tcpI were the highest among strains from the southwest region, which had the highest incidence rate of cholera. Low positive rates for tcpA, tcpI and ctxAB among isolates from after 2000 may be an influencing factor contributing to the contemporary decline in cholera incidence rates. Spatiotemporal serotype shifts (Ogawa, Inaba, Ogawa, Inaba and O139) generally correlated with the variations in the PFGE patterns (PIV, PIIIc, PIa, PIIIb, PIIIa, PIb, and PII). O1 strains from different years or regions also had similar PFGE patterns, while O139 strains exclusively formed one cluster and differed from all other O1 strains. These data indicate that V. cholerae isolates in Shandong Province have continually undergone spatiotemporal changes. The serotype switching between Ogawa and Inaba originated from indigenous strains, while the emergence of serogroup O139 appeared to be unrelated to endemic V. cholerae O1 strains.

  16. Geospatial and temporal patterns of annual cholera outbreaks in Matlab, Bangladesh

    NASA Astrophysics Data System (ADS)

    Majumder, M. S.; de Klerk, K.; Meyers, D.

    2012-12-01

    Cholera is a waterborne diarrheal disease endemic to Bangladesh, resulting in 1 million diagnoses annually. Such disease burden results in incalculable lost wages and treatment expenses, taken from the pockets of an already impoverished society. Two seasonally correlated outbreaks of cholera occur in Bangladesh every year. In the spring and early summer, the Bay of Bengal - which serves as a natural reservoir for the cholera bacteria - flows inland, causing the first outbreak amongst coastal communities. Waste containing the cholera bacteria enters the sewage system and remains untreated due to poor water and sanitation infrastructure. Therefore, during the following monsoon season, flooding of cholera-contaminated sewage into drinking water sources results in a second outbreak. Though considered common knowledge among local populations, this geographic and temporal progression has not been empirically verified in the current literature. The aim of our ongoing study is to systematically analyze the seasonal trajectory of endemic cholera in Bangladesh. This paper discusses the results obtained from a comprehensive survey of available cholera data from the International Centre of Diarrheal Disease Research, Bangladesh (ICDDR,B) in Matlab, Bangladesh. Matlab thana is a near-coastal community that consists of 142 villages. Monsoon season takes place from June through October. Due to its proximity to the Meghna River, which opens into the Bay of Bengal, the area experiences significant flooding during these months. Using 10 years of geographically referenced cholera data, cases were plotted in time and space. Preliminary patterns suggest that villages closer to the Meghna River experience the majority of the area's cholera outbreaks and that case count is highest in late spring and late fall. April/May and November/December represent 25% and 23% of total annual case counts respectively. Moreover, villages further from the coastline demonstrate 57% higher relative

  17. Immune Responses to an Oral Cholera Vaccine in Internally Displaced Persons in South Sudan.

    PubMed

    Iyer, Anita S; Bouhenia, Malika; Rumunu, John; Abubakar, Abdinasir; Gruninger, Randon J; Pita, Jane; Lino, Richard Lako; Deng, Lul L; Wamala, Joseph F; Ryan, Edward T; Martin, Stephen; Legros, Dominique; Lessler, Justin; Sack, David A; Luquero, Francisco J; Leung, Daniel T; Azman, Andrew S

    2016-10-24

    Despite recent large-scale cholera outbreaks, little is known about the immunogenicity of oral cholera vaccines (OCV) in African populations, particularly among those at highest cholera risk. During a 2015 preemptive OCV campaign among internally displaced persons in South Sudan, a year after a large cholera outbreak, we enrolled 37 young children (1-5 years old), 67 older children (6-17 years old) and 101 adults (≥18 years old), who received two doses of OCV (Shanchol) spaced approximately 3 weeks apart. Cholera-specific antibody responses were determined at days 0, 21 and 35 post-immunization. High baseline vibriocidal titers (>80) were observed in 21% of the participants, suggesting recent cholera exposure or vaccination. Among those with titers ≤80, 90% young children, 73% older children and 72% adults seroconverted (≥4 fold titer rise) after the 1(st) OCV dose; with no additional seroconversion after the 2(nd) dose. Post-vaccination immunological endpoints did not differ across age groups. Our results indicate Shanchol was immunogenic in this vulnerable population and that a single dose alone may be sufficient to achieve similar short-term immunological responses to the currently licensed two-dose regimen. While we found no evidence of differential response by age, further immunologic and epidemiologic studies are needed.

  18. Immune Responses to an Oral Cholera Vaccine in Internally Displaced Persons in South Sudan

    PubMed Central

    Iyer, Anita S.; Bouhenia, Malika; Rumunu, John; Abubakar, Abdinasir; Gruninger, Randon J.; Pita, Jane; Lino, Richard Lako; Deng, Lul L.; Wamala, Joseph F.; Ryan, Edward T.; Martin, Stephen; Legros, Dominique; Lessler, Justin; Sack, David A.; Luquero, Francisco J.; Leung, Daniel T.; Azman, Andrew S.

    2016-01-01

    Despite recent large-scale cholera outbreaks, little is known about the immunogenicity of oral cholera vaccines (OCV) in African populations, particularly among those at highest cholera risk. During a 2015 preemptive OCV campaign among internally displaced persons in South Sudan, a year after a large cholera outbreak, we enrolled 37 young children (1–5 years old), 67 older children (6–17 years old) and 101 adults (≥18 years old), who received two doses of OCV (Shanchol) spaced approximately 3 weeks apart. Cholera-specific antibody responses were determined at days 0, 21 and 35 post-immunization. High baseline vibriocidal titers (>80) were observed in 21% of the participants, suggesting recent cholera exposure or vaccination. Among those with titers ≤80, 90% young children, 73% older children and 72% adults seroconverted (≥4 fold titer rise) after the 1st OCV dose; with no additional seroconversion after the 2nd dose. Post-vaccination immunological endpoints did not differ across age groups. Our results indicate Shanchol was immunogenic in this vulnerable population and that a single dose alone may be sufficient to achieve similar short-term immunological responses to the currently licensed two-dose regimen. While we found no evidence of differential response by age, further immunologic and epidemiologic studies are needed. PMID:27775046

  19. The purifying trend in the chromosomal integron in Vibrio cholerae strains during the seventh pandemic.

    PubMed

    Zhang, Cuicai; Pang, Bo; Zhou, Zhemin; Wang, Haiyin; Zhou, Haijian; Lu, Xin; Du, Pengcheng; Zhang, Lijuan; Li, Jie; Cui, Zhigang; Chen, Chen; Stokes, H W; Kan, Biao

    2014-08-01

    Chromosomal integron (CI) arrays in Vibrio spp. are generally large and display great variation. Here we determined the sequence of CI array in a toxigenic O139 Vibriocholerae strain and compared it with the arrays from the genome of different O1 biotypes available in GenBank. Then PCR scanning was used to determine the CI array variations in 83 epidemic O139 strains and subsequently these variations were compared with that found in toxigenic O1 El Tor strains in our previous work. Few differences were observed in the cohort of toxigenic O139 strains compared to the toxigenic O1 El Tor strains. On the basis of CI arrays, the toxigenic O1 El Tor and O139 strains isolated concurrently in recent years appear to be more similar to each other than to the O1 strains isolated in previous decades, suggesting a closer evolutionary relationship between them. Comparison of CI arrays in toxigenic O1 El Tor and O139 V. cholerae strains isolated between 1961 and 2009 revealed a purifying trend in the CI arrays in the chronological order during the seventh pandemic.

  20. Cholera transmission dynamic models for public health practitioners

    PubMed Central

    2014-01-01

    Great progress has been made in mathematical models of cholera transmission dynamics in recent years. However, little impact, if any, has been made by models upon public health decision-making and day-to-day routine of epidemiologists. This paper provides a brief introduction to the basics of ordinary differential equation models of cholera transmission dynamics. We discuss a basic model adapted from Codeço (2001), and how it can be modified to incorporate different hypotheses, including the importance of asymptomatic or inapparent infections, and hyperinfectious V. cholerae and human-to-human transmission. We highlight three important challenges of cholera models: (1) model misspecification and parameter uncertainty, (2) modeling the impact of water, sanitation and hygiene interventions and (3) model structure. We use published models, especially those related to the 2010 Haitian outbreak as examples. We emphasize that the choice of models should be dictated by the research questions in mind. More collaboration is needed between policy-makers, epidemiologists and modelers in public health. PMID:24520853

  1. Assessing effects of cholera vaccination in the presence of interference.

    PubMed

    Perez-Heydrich, Carolina; Hudgens, Michael G; Halloran, M Elizabeth; Clemens, John D; Ali, Mohammad; Emch, Michael E

    2014-09-01

    Interference occurs when the treatment of one person affects the outcome of another. For example, in infectious diseases, whether one individual is vaccinated may affect whether another individual becomes infected or develops disease. Quantifying such indirect (or spillover) effects of vaccination could have important public health or policy implications. In this article we use recently developed inverse-probability weighted (IPW) estimators of treatment effects in the presence of interference to analyze an individually-randomized, placebo-controlled trial of cholera vaccination that targeted 121,982 individuals in Matlab, Bangladesh. Because these IPW estimators have not been employed previously, a simulation study was also conducted to assess the empirical behavior of the estimators in settings similar to the cholera vaccine trial. Simulation study results demonstrate the IPW estimators can yield unbiased estimates of the direct, indirect, total, and overall effects of vaccination when there is interference provided the untestable no unmeasured confounders assumption holds and the group-level propensity score model is correctly specified. Application of the IPW estimators to the cholera vaccine trial indicates the presence of interference. For example, the IPW estimates suggest on average 5.29 fewer cases of cholera per 1000 person-years (95% confidence interval 2.61, 7.96) will occur among unvaccinated individuals within neighborhoods with 60% vaccine coverage compared to neighborhoods with 32% coverage. Our analysis also demonstrates how not accounting for interference can render misleading conclusions about the public health utility of vaccination.

  2. Cholera in Bahrain: epidemiological characteristics of an outbreak*

    PubMed Central

    Gunn, Robert A.; Kimball, Ann M.; Mathew, P. P.; Dutta, S. R.; Rifaat, A. H. M.

    1981-01-01

    In the period 10 August 1978-23 January 1979, 913 culture-confirmed cases of cholera caused by Vibrio cholerae, biotype El Tor, serotype Ogawa, occurred in Bahrain. After discovery of the initial cases, others occurred sporadically, and the incidence reached a peak of 25-35 cases per day during the seventh week of the outbreak (16-22 September). The overall attack rate (27 per 10 000) was low and the outbreak subsided without mass immunization campaigns or rigorous border control of persons and imports. Investigation of 746 culture-confirmed cases that occurred in the period 10 August—13 October 1978, showed that cases occurred throughout most areas of the country and mainly affected infants, young children, and adult working-age males. Symptoms were very mild; fewer than 20% of patients required specific rehydration therapy. The highest attack rate (84 per 10 000) occurred in infants less than 1 year of age. No common vehicle or mode of transmission was identified. A matched-pair study of 35 cases and controls showed that adult cases were more likely than controls to have consumed food or beverage outside of the home before becoming ill. V. cholerae was isolated from stored drinking water in the houses of 8 cases but not from numerous samples of food and tap-water. It was presumed that cholera transmission occurred through a complex interaction of mild and asymptomatically infected persons with food, water, and the environment. PMID:6973417

  3. Identifying the most sensitive and specific sign and symptom combinations for cholera: results from an analysis of laboratory-based surveillance data from Haiti, 2012-2013.

    PubMed

    Lucien, Mentor Ali Ber; Schaad, Nicolas; Steenland, Maria W; Mintz, Eric D; Emmanuel, Rossignol; Freeman, Nicole; Boncy, Jacques; Adrien, Paul; Joseph, Gerard A; Katz, Mark A

    2015-04-01

    Since October 2010, over 700,000 cholera cases have been reported in Haiti. We used data from laboratory-based surveillance for diarrhea in Haiti to evaluate the sensitivity, specificity, and positive (PPV) and negative predictive values (NPV) of the cholera case definitions recommended by the World Health Organization (WHO). From April 2012 to May 2013, we tested 1,878 samples from hospitalized patients with acute watery diarrhea; 1,178 (62.7%) yielded Vibrio cholerae O1. The sensitivity and specificity of the WHO case definition for cholera in an epidemic setting were 91.3% and 43.1%, respectively, and the PPV and NPV were 72.8% and 74.8%, respectively. The WHO case definition for cholera in an area where cholera is not known to be present had lower sensitivity (63.1%) and NPV (55.1%) but higher specificity (74.2%) and PPV (80.0%). When laboratory diagnostic testing is not immediately available, clinicians can evaluate signs and symptoms to more accurately identify cholera patients.

  4. [The knowledge of the population about cholera].

    PubMed

    de la Cruz, A M; de Rojas, V; Delgado, J; Alonso, A; Finlay, C M

    1996-01-01

    In order to determine the impact of the educational campaign about cholera on the knowledge and believes of the population, a survey was made in 1993 among 1324 persons from 14 provinces and from Isla de la Juventud special municipality. 85% were 20-59 years old and 89% had an secondary basic or higher educational level. 69% had the minimum knowledge to face the disease, 90% would see a doctor if they had and suspicion, 72% knew that diarrhea is the main symptom of cholera, 54% new how it is transmitted 89% thought that they may be infected by drinking water, 54% understood the importance of giving liquids to the sick subject, and 78% realized the significance of washing their hands before eating anf cooking. It is concluded that even though our population has a general knowledge about the disease, due to the fact that our country is located in an endemic zone, health education must be reinforced, specifically those aspects connected with the communication and with the increase of liquids administration to the patients.

  5. Spatial epidemiological techniques in cholera mapping and analysis towards a local scale predictive modelling

    NASA Astrophysics Data System (ADS)

    Rasam, A. R. A.; Ghazali, R.; Noor, A. M. M.; Mohd, W. M. N. W.; Hamid, J. R. A.; Bazlan, M. J.; Ahmad, N.

    2014-02-01

    Cholera spatial epidemiology is the study of the spread and control of the disease spatial pattern and epidemics. Previous studies have shown that multi-factorial causation such as human behaviour, ecology and other infectious risk factors influence the disease outbreaks. Thus, understanding spatial pattern and possible interrelationship factors of the outbreaks are crucial to be explored an in-depth study. This study focuses on the integration of geographical information system (GIS) and epidemiological techniques in exploratory analyzing the cholera spatial pattern and distribution in the selected district of Sabah. Spatial Statistic and Pattern tools in ArcGIS and Microsoft Excel software were utilized to map and analyze the reported cholera cases and other data used. Meanwhile, cohort study in epidemiological technique was applied to investigate multiple outcomes of the disease exposure. The general spatial pattern of cholera was highly clustered showed the disease spread easily at a place or person to others especially 1500 meters from the infected person and locations. Although the cholera outbreaks in the districts are not critical, it could be endemic at the crowded areas, unhygienic environment, and close to contaminated water. It was also strongly believed that the coastal water of the study areas has possible relationship with the cholera transmission and phytoplankton bloom since the areas recorded higher cases. GIS demonstrates a vital spatial epidemiological technique in determining the distribution pattern and elucidating the hypotheses generating of the disease. The next research would be applying some advanced geo-analysis methods and other disease risk factors for producing a significant a local scale predictive risk model of the disease in Malaysia.

  6. Actions of cholera toxin and the prevention and treatment of cholera

    NASA Astrophysics Data System (ADS)

    Holmgren, Jan

    1981-07-01

    The drastic intestinal secretion of fluid and electrolytes that is characteristic of cholera is the result of reasonably well understood cellular and biochemical actions of the toxin secreted by Vibrio cholerae. Based on this understanding it is possible to devise new techniques for the treatment and prophylaxis of cholera to complement those based on fluid replacement therapy and sanitation.

  7. Incidence of severe diarrhoea due to Vibrio cholerae in the catchment area of six surveillance hospitals in Bangladesh.

    PubMed

    Paul, R C; Faruque, A S G; Alam, M; Iqbal, A; Zaman, K; Islam, N; Sobhan, A; DAS, S K; Malek, M A; Qadri, F; Cravioto, A; Luby, S P

    2016-04-01

    Cholera is an important public health problem in Bangladesh. Interventions to prevent cholera depend on their cost-effectiveness which in turn depends on cholera incidence. Hospital-based diarrhoeal disease surveillance has been ongoing in six Bangladeshi hospitals where a systematic proportion of patients admitted with diarrhoea were enrolled and tested for Vibrio cholerae. However, incidence calculation using only hospital data underestimates the real disease burden because many ill persons seek treatment elsewhere. We conducted a healthcare utilization survey in the catchment areas of surveillance hospitals to estimate the proportion of severe diarrhoeal cases that were admitted to surveillance hospitals and estimated the population-based incidence of severe diarrhoea due to V. cholerae by combining both hospital surveillance and catchment area survey data. The estimated incidence of severe diarrhoea due to cholera ranged from 0.3 to 4.9/1000 population in the catchment area of surveillance hospitals. In children aged <5 years, incidence ranged from 1.0 to 11.0/1000 children. Diarrhoeal deaths were most common in the Chhatak Hospital's catchment area (18.5/100 000 population). This study provides a credible estimate of the incidence of severe diarrhoea due to cholera in Bangladesh, which can be used to assess the cost-effectiveness of cholera prevention activities.

  8. The burden of cholera in the slums of Kolkata, India: data from a prospective, community based study

    PubMed Central

    Sur, D; Deen, J; Manna, B; Niyogi, S; Deb, A; Kanungo, S; Sarkar, B; Kim, D; Danovaro-Holliday, M; Holliday, K; Gupta, V; Ali, M; von Seidlein, L; Clemens, J; Bhattacharya, S

    2005-01-01

    Aims: To conduct a prospective, community based study in an impoverished urban site in Kolkata (formerly Calcutta) in order to measure the burden of cholera, describe its epidemiology, and search for potential risk factors that could be addressed by public health strategies. Methods: The study population was enumerated at the beginning and end of the study period. Surveillance through five field outposts and two referral hospitals for acute, watery, non-bloody diarrhoea was conducted from 1 May 2003 to 30 April 2004. Data and a stool sample for culture of Vibrio cholerae were collected from each patient. Treatment was provided in accordance with national guidelines. Results: From 62 329 individuals under surveillance, 3284 diarrhoea episodes were detected, of which 3276 (99%) had a stool sample collected and 126 (4%) were culture confirmed cholera. Nineteen (15%) were children less than 2 years of age, 29 (23%) had severe dehydration, and 48 (38%) were hospitalised. Risk factors for cholera included a household member with cholera during the period of surveillance, young age, and lower educational level. Conclusions: There was a substantial burden of cholera in Kolkata with risk factors not easily amenable to intervention. Young children bear the brunt not only of diarrhoeal diseases in general, but of cholera as well. Mass vaccination could be a potentially useful tool to prevent and control seasonal cholera in this community. PMID:15964861

  9. Multi-species patterns of avian cholera mortality in Nebraska's rainwater basin

    USGS Publications Warehouse

    Blanchong, Julie A.; Samuel, M.D.; Mack, G.

    2006-01-01

    Nebraska's Rainwater Basin (RWB) is a key spring migration area for millions of waterfowl and other avian species. Avian cholera has been endemic in the RWB since the 1970s and in some years tens of thousands of waterfowl have died from the disease. We evaluated patterns of avian cholera mortality in waterfowl species using the RWB during the last quarter of the 20th century. Mortality patterns changed between the years before (1976 - 1988) and coincident with (1989 - 1999) the dramatic increases in lesser snow goose abundance and mortality. Lesser snow geese (Chen caerulescens caerulescens) have commonly been associated with mortality events in the RWB and are known to carry virulent strains of Pasteurella multocida, the agent causing avian cholera. Lesser snow geese appeared to be the species most affected by avian cholera during 1989 - 1999; however, mortality in several other waterfowl species was positively correlated with lesser snow goose mortality. Coincident with increased lesser snow goose mortality, spring avian cholera outbreaks were detected earlier and ended earlier compared to 1976 - 1988. Dense concentrations of lesser snow geese may facilitate intraspecific disease transmission through bird-to-bird contact and wetland contamination. Rates of interspecific avian cholera transmission within the waterfowl community, however, are difficult to determine.

  10. The Black Cholera Comes to the Central Valley of America in the 19th Century - 1832, 1849, and Later

    PubMed Central

    Daly, Walter J.

    2008-01-01

    In mid-19th Century, cholera was epidemic throughout the world. Small towns of the American Midwest were not spared. The disease was blamed on miasmas arising from local causes, so flight from affected localities were logical and common. Flight, added to mortality, caused virtual depopulation of many small towns. Drinking water was drawn from rivers or shallow wells, often near seeping cesspools. Local merchants tried unsuccessfully to calm panic by suppressing information. Cholera was not good for business. Business was depressed. Organized religion thrived. National and state days of prayer were appointed to appease an angry God. During these frightening times, the people learned nothing about the infectiousness of cholera or about its prevention through sanitation. Their experiences tended to reinforce their belief in miasmas or divine retribution. The great epidemics of mankind describe human behavior in times of unavoidable and incurable crisis. Nineteenth Century cholera experiences illustrate a people's reaction to catastrophic disease, which they believed was incurable and unpreventable. PMID:18596846

  11. Clonal transmission, dual peak, and off-season cholera in Bangladesh.

    PubMed

    Alam, Munirul; Islam, Atiqul; Bhuiyan, Nurul A; Rahim, Niaz; Hossain, Anowar; Khan, G Yeahia; Ahmed, Dilruba; Watanabe, Haruo; Izumiya, Hidemasa; Faruque, Abu S G; Akanda, Ali S; Islam, Shafiqul; Sack, R Bradley; Huq, Anwar; Colwell, Rita R; Cravioto, Alejandro

    2011-01-01

    Vibrio cholerae is an estuarine bacterium associated with a single peak of cholera (March-May) in coastal villages of Bangladesh. For an unknown reason, however, cholera occurs in a unique dual peak (March-May and September-November) pattern in the city of Dhaka that is bordered by a heavily polluted freshwater river system and flood embankment. In August 2007, extreme flooding was accompanied by an unusually severe diarrhea outbreak in Dhaka that resulted in a record high illness. This study was aimed to understand the unusual outbreak and if it was related to the circulation of a new V. cholerae clone. Nineteen V. cholerae isolated during the peak of the 2007 outbreak were subjected to extensive phenotypic and molecular analyses, including multi-locus genetic screening by polymerase chain reaction (PCR), sequence-typing of the ctxB gene, and pulsed-field gel electrophoresis (PFGE). Factors associated with the unusual incidence of cholera were determined and analysis of the disease severity was done. Overall, microbiological and molecular data confirmed that the hypervirulent V. cholerae was O1 biotype El Tor (ET) that possessed cholera toxin (CT) of the classical biotype. The PFGE (NotI) and dendrogram clustering confirmed that the strains were clonal and related to the pre-2007 variant ET from Dhaka and Matlab and resembled one of two distinct clones of the variant ET confirmed to be present in the estuarine ecosystem of Bangladesh. Results of the analyses of both diarrheal case data for three consecutive years (2006-2008) and regional hydroclimatology over three decades (1980-2009) clearly indicate that the pattern of cholera occurring in Dhaka, and not seen at other endemic sites, was associated with flood waters transmitting the infectious clone circulating via the fecal-oral route during and between the dual seasonal cholera peaks in Dhaka. Circular river systems and flood embankment likely facilitate transmission of infectious V. cholerae throughout the

  12. Clonal transmission, dual peak, and off-season cholera in Bangladesh

    PubMed Central

    Alam, Munirul; Islam, Atiqul; Bhuiyan, Nurul A.; Rahim, Niaz; Hossain, Anowar; Khan, G. Yeahia; Ahmed, Dilruba; Watanabe, Haruo; Izumiya, Hidemasa; Faruque, Abu S. G.; Akanda, Ali S.; Islam, Shafiqul; Sack, R. Bradley; Huq, Anwar; Colwell, Rita R.; Cravioto, Alejandro

    2011-01-01

    Vibrio cholerae is an estuarine bacterium associated with a single peak of cholera (March–May) in coastal villages of Bangladesh. For an unknown reason, however, cholera occurs in a unique dual peak (March–May and September–November) pattern in the city of Dhaka that is bordered by a heavily polluted freshwater river system and flood embankment. In August 2007, extreme flooding was accompanied by an unusually severe diarrhea outbreak in Dhaka that resulted in a record high illness. This study was aimed to understand the unusual outbreak and if it was related to the circulation of a new V. cholerae clone. Nineteen V. cholerae isolated during the peak of the 2007 outbreak were subjected to extensive phenotypic and molecular analyses, including multi-locus genetic screening by polymerase chain reaction (PCR), sequence-typing of the ctxB gene, and pulsed-field gel electrophoresis (PFGE). Factors associated with the unusual incidence of cholera were determined and analysis of the disease severity was done. Overall, microbiological and molecular data confirmed that the hypervirulent V. cholerae was O1 biotype El Tor (ET) that possessed cholera toxin (CT) of the classical biotype. The PFGE (NotI) and dendrogram clustering confirmed that the strains were clonal and related to the pre-2007 variant ET from Dhaka and Matlab and resembled one of two distinct clones of the variant ET confirmed to be present in the estuarine ecosystem of Bangladesh. Results of the analyses of both diarrheal case data for three consecutive years (2006–2008) and regional hydroclimatology over three decades (1980–2009) clearly indicate that the pattern of cholera occurring in Dhaka, and not seen at other endemic sites, was associated with flood waters transmitting the infectious clone circulating via the fecal-oral route during and between the dual seasonal cholera peaks in Dhaka. Circular river systems and flood embankment likely facilitate transmission of infectious V. cholerae

  13. Molecular Typing of Vibrio cholerae O1 Isolates from Thailand by Pulsed-field Gel Electrophoresis

    PubMed Central

    Tapchaisri, Pramuan; Na-Ubol, Mathukorn; Tiyasuttipan, Watcharee; Chaiyaroj, Sansanee C.; Yamasaki, Shinji; Wongsaroj, Thitima; Hayashi, Hideo; Nair, G. Balakrish; Chongsa-Nguan, Manas; Kurazono, Hisao; Chaicumpa, Wanpen

    2008-01-01

    The aim of the present study was to genotypically characterize Vibrio cholerae strains isolated from cholera patients in various provinces of Thailand. Two hundred and forty V. cholerae O1 strains, isolated from patients with cholera during two outbreaks, i.e. March 1999–April 2000 and December 2001–February 2002, in Thailand, were genotypically characterized by NotI digestion and pulsed-field gel electrophoresis (PFGE). In total, 17 PFGE banding patterns were found and grouped into four Dice-coefficient clusters (PF-I to PF-IV). The patterns of V. cholerae O1, El Tor reference strains from Australia, Peru, Romania, and the United States were different from the patterns of reference isolates from Asian countries, such as Bangladesh, India, and Thailand, indicating a close genetic relationship or clonal origin of the isolates in the same geographical region. The Asian reference strains, regardless of their biotypes and serogroups (classical O1, El Tor O1, O139, or O151), showed a genetic resemblance, but had different patterns from the strains collected during the two outbreaks in Thailand. Of 200 Ogawa strains collected during the first outbreak in Thailand, two patterns (clones)—PF-I and PF-II—predominated, while other isolates caused sporadic cases and were grouped together as pattern PF-III. PF-II also predominated during the second outbreak, but none of the 40 isolates (39 Inaba and 1 Ogawa) of the second outbreak had the pattern PF-I; a minority showed a new pattern—PF-IV, and others caused single cases, but were not groupable. In summary, this study documented the sustained appearance of the pathogenic V. cholerae O1 clone PF-II, the disappearance of clones PF-I and PF-III, and the emergence of new pathogenic clones during the two outbreaks of cholera. Data of the study on molecular characteristics of indigenous V. cholerae clinical isolates have public-health implications, not only for epidemic tracing of existing strains but also for the

  14. Diarrheal epidemics in Dhaka, Bangladesh, during three consecutive floods: 1988, 1998, and 2004.

    PubMed

    Schwartz, Brian S; Harris, Jason B; Khan, Ashraful I; Larocque, Regina C; Sack, David A; Malek, Mohammad A; Faruque, Abu S G; Qadri, Firdausi; Calderwood, Stephen B; Luby, Stephen P; Ryan, Edward T

    2006-06-01

    We examined demographic, microbiologic, and clinical data from patients presenting during 1988, 1998, and 2004 flood-associated diarrheal epidemics at a diarrhea treatment hospital in Dhaka, Bangladesh. Compared with non-flood periods, individuals presenting during flood-associated epidemics were older, more severely dehydrated, and of lower socioeconomic status. During flood-associated epidemics, Vibrio cholerae was the most commonly identified cause of diarrhea, and the only diarrheal pathogen whose incidence proportionally increased in each epidemic compared with seasonally matched periods. Rotavirus was the second most frequently identified flood-associated pathogen, although the proportion of cases caused by rotavirus infection decreased during floods compared with matched periods. Other causes of diarrhea did not proportionally change, although more patients per day presented with enterotoxigenic Escherichia coli, Shigella, and Salmonella species-associated diarrhea during floods compared with matched periods. Our findings suggest that cholera is the predominant cause of flood-associated diarrheal epidemics in Dhaka, but that other organisms spread by the fecal-oral route also contribute.

  15. Injecting epidemiology into population viability analysis: avian cholera transmission dynamics at an arctic seabird colony.

    PubMed

    Iverson, Samuel A; Gilchrist, H Grant; Soos, Catherine; Buttler, Isabel I; Harms, N Jane; Forbes, Mark R

    2016-11-01

    Infectious diseases have the potential to spread rapidly and cause high mortality within populations of immunologically naïve hosts. The recent appearance of avian cholera, a highly virulent disease of birds caused by the bacterium Pasteurella multocida, at remote Arctic seabird colonies is an emerging conservation concern. Determining disease risk to population viability requires a quantitative understanding of transmission potential and the factors that regulate epidemic persistence. Estimates of the basic (R0 ) and real-time (Rt ) reproductive number are critical in this regard - enumerating the number of secondary infections caused by each primary infection in a newly invaded host population and the decline in transmission rate as susceptible individuals are removed via mortality or immunized recovery. Here, we use data collected at a closely monitored common eider (Somateria mollissima) breeding colony located in the Canadian Arctic to examine transmission and host population dynamics. Specifically, we infer epidemic curves from daily mortality observations and use a likelihood-based procedure to estimate changes in the reproductive number over a series of annual outbreaks. These data are interpreted in relation to concurrent changes in host numbers to assess local extinction risk. Consistent with expectations for a novel pathogen invasion, case incidence increased exponentially during the initial wave of exposure (R0  = 2·5; generation time = 6·5 days ± 1·1 SD). Disease conditions gradually abated, but only after several years of smouldering infection (Rt  ≈ 1). In total, 6194 eider deaths were recorded during outbreaks spanning eight consecutive breeding seasons. Breeding pair abundance declined by 56% from the pre-outbreak peak; however, a robust population of >4000 pairs remained intact upon epidemic fade-out. Overall, outbreak patterns were consistent with herd immunity acting as a mitigating factor governing in the extent and duration of

  16. Tainted commons, public health: the politico-moral significance of cholera in Vietnam.

    PubMed

    Lincoln, Martha L

    2014-09-01

    In October 2007, a series of cholera epidemics broke out in Hanoi, interrupting a moment of economic triumphalism in post-transition Vietnam. In seeking the source of a refractory disease associated with poverty and underdevelopment, officials, media, and citizens not only identified scapegoats and proposed solutions, they also endorsed particular visions of moral conduct, social order, and public health. Controversy over cholera, a potent politico-moral symbol, expressed an imaginary of "tainted commons" (i.e., an emergent space of civil society and small-scale entrepreneurship from which the state has partially withdrawn, while still exercising some measure of scrutiny and control). The ambiguities of this situation permitted the state to assume moral postures, evade responsibility, and deflect criticism to convenient targets. Prevalent outbreak narratives thus played on anxieties regarding specifically classed and gendered social groups, whose behavior was imagined to contravene ideals of public health and order.

  17. Cholera Incidence and Mortality in Sub-Saharan African Sites during Multi-country Surveillance

    PubMed Central

    Sauvageot, Delphine; Njanpop-Lafourcade, Berthe-Marie; Akilimali, Laurent; Anne, Jean-Claude; Bidjada, Pawou; Bompangue, Didier; Bwire, Godfrey; Coulibaly, Daouda; Dengo-Baloi, Liliana; Dosso, Mireille; Orach, Christopher Garimoi; Inguane, Dorteia; Kagirita, Atek; Kacou-N’Douba, Adele; Keita, Sakoba; Kere Banla, Abiba; Kouame, Yao Jean-Pierre; Landoh, Dadja Essoya; Langa, Jose Paulo; Makumbi, Issa; Miwanda, Berthe; Malimbo, Muggaga; Mutombo, Guy; Mutombo, Annie; NGuetta, Emilienne Niamke; Saliou, Mamadou; Sarr, Veronique; Senga, Raphael Kakongo; Sory, Fode; Sema, Cynthia; Tante, Ouyi Valentin; Gessner, Bradford D.; Mengel, Martin A.

    2016-01-01

    Background Cholera burden in Africa remains unknown, often because of weak national surveillance systems. We analyzed data from the African Cholera Surveillance Network (www.africhol.org). Methods/ Principal findings During June 2011–December 2013, we conducted enhanced surveillance in seven zones and four outbreak sites in Togo, the Democratic Republic of Congo (DRC), Guinea, Uganda, Mozambique and Cote d’Ivoire. All health facilities treating cholera cases were included. Cholera incidences were calculated using culture-confirmed cholera cases and culture-confirmed cholera cases corrected for lack of culture testing usually due to overwhelmed health systems and imperfect test sensitivity. Of 13,377 reported suspected cases, 34% occurred in Conakry, Guinea, 47% in Goma, DRC, and 19% in the remaining sites. From 0–40% of suspected cases were aged under five years and from 0.3–86% had rice water stools. Within surveillance zones, 0–37% of suspected cases had confirmed cholera compared to 27–38% during outbreaks. Annual confirmed incidence per 10,000 population was <0.5 in surveillance zones, except Goma where it was 4.6. Goma and Conakry had corrected incidences of 20.2 and 5.8 respectively, while the other zones a median of 0.3. During outbreaks, corrected incidence varied from 2.6 to 13.0. Case fatality ratios ranged from 0–10% (median, 1%) by country. Conclusions/Significance Across different African epidemiological contexts, substantial variation occurred in cholera incidence, age distribution, clinical presentation, culture confirmation, and testing frequency. These results can help guide preventive activities, including vaccine use. PMID:27186885

  18. Hydroclimatology of Dual-Peak Annual Cholera Incidence: Insights from a Spatially Explicit Model

    NASA Astrophysics Data System (ADS)

    Bertuzzo, E.; Mari, L.; Righetto, L.; Gatto, M.; Casagrandi, R.; Rodriguez-Iturbe, I.; Rinaldo, A.

    2012-12-01

    Cholera incidence in some regions of the Indian subcontinent may exhibit two annual peaks although the main environmental drivers that have been linked to the disease (e.g. sea surface temperature, zooplankton abundance, river discharge) peak once per year during the summer. An empirical hydroclimatological explanation relating cholera transmission to river flows and to the disease spatial spreading has been recently proposed. We specifically support and substantiate mechanistically such hypothesis by means of a spatially explicit model of cholera transmission. Our framework directly accounts for the role of the river network in transporting and redistributing cholera bacteria among human communities as well as for spatial and temporal annual fluctuations of precipitation and river flows. To single out the single out the hydroclimatologic controls on the prevalence patterns in a non-specific geographical context, we first apply the model to Optimal Channel Networks as a general model of hydrological networks. Moreover, we impose a uniform distribution of population. The model is forced by seasonal environmental drivers, namely precipitation, temperature and chlorophyll concentration in the coastal environment, a proxy for Vibrio cholerae concentration. Our results show that these drivers may suffice to generate dual-peak cholera prevalence patterns for proper combinations of timescales involved in pathogen transport, hydrologic variability and disease unfolding. The model explains the possible occurrence of spatial patterns of cholera incidence characterized by a spring peak confined to coastal areas and a fall peak involving inland regions. We then proceed applying the model to the specific settings of Bay of Bengal accounting for the actual river networks (derived from digital terrain map manipulations), the proper distribution of population (estimated from downscaling of census data based on remotely sensed features) and precipitation patterns. Overall our

  19. A cholera outbreak in Alborz Province, Iran: a matched case-control study

    PubMed Central

    2016-01-01

    OBJECTIVES: A total of 229 confirmed cholera cases were reported in Alborz Province during an outbreak that lasted from June 2011 to August 2011. This study aimed to identify potential sources of transmission in order to determine suitable interventions in similar outbreaks. In other words, the lessons learned from this retrospective study can be utilized to manage future similar outbreaks. METHODS: An age-matched and sex-matched case-control study was conducted during the outbreak. For each case, two control subjects were selected from the neighborhood. A case of cholera was defined as a bacteriologically confirmed case with signs and symptoms of cholera. This study was conducted from June 14, 2011 through August 23, 2011. The data were analyzed by calculating odds ratios (ORs) using the logistic regression method. RESULTS: In this outbreak, 229 confirmed cholera cases were diagnosed. The following risk factors were found to be associated with cholera: consumption of unrefrigerated leftover food (OR, 3.05; 95% confidence interval [CI], 1.72 to 5.41), consumption of vegetables and fruits in the previous three days (OR, 2.75; 95% CI, 1.95 to 3.89), and a history of traveling in the previous five days (OR, 5.31; 95% CI, 2.21 to 9.72). CONCLUSIONS: Consumption of vegetables and fruits has remained an unresolved risk factor in cholera outbreaks in Iran in recent years. In order to reduce the risk of cholera, sanitary standards for fruits and vegetables should be observed at all points from production to consumption, the population should be educated regarding hygienic food storage during outbreaks, and sanitary standards should be maintained when traveling during cholera outbreaks. PMID:27188308

  20. Cholera Outbreaks in Urban Bangladesh In 2011

    PubMed Central

    Haque, Farhana; Hossain, M. Jahangir; Kundu, Subodh Kumar; Naser, Abu Mohd.; Rahman, Mahmudur; Luby, Stephen P.

    2015-01-01

    Background In 2011, a multidisciplinary team investigated two diarrhoea outbreaks affecting urban Bangladeshi communities from the districts of Bogra and Kishorganj to identify etiology, pathways of transmission, and factors contributing to these outbreaks. Methods We defined case-patients with severe diarrhoea as residents from affected communities admitted with ≥3 loose stools per day. We listed case-patients, interviewed and examined them, and collected rectal swabs. We visited the affected communities to explore the water and sanitation infrastructure. We tested the microbial load of water samples from selected case household taps, tube wells, and pump stations. We conducted anthropological investigations to understand community perceptions regarding the outbreaks. Results We identified 21 case-patients from Bogra and 84 from Kishorganj. The median age in Bogra was 23 years, and 21 years in Kishorganj. There were no reported deaths. We isolated Vibrio in 29% (5/17) of rectal swabs from Bogra and in 40% (8/20) from Kishorganj. We found Vibrio in 1/8 tap water samples from Bogra and in both of the samples from Kishorganj. We did not find Vibrio in water samples from pumps or tube wells in either outbreak. Ground water extracted through deep tube wells was supplied intermittently through interconnected pipes without treatment in both areas. We found leakages in the water pipes in Bogra, and in Kishorganj water pipes passed through open sewers. Conclusion The rapid onset of severe diarrhoea predominantly affecting adults and the isolation of cholera in rectal swabs confirmed that these outbreaks were caused by Vibrio cholerae. The detection of Vibrio in water samples organisms from taps but not from pumps or tube wells, suggested contamination within the pipes. Safe water provision is difficult in municipalities where supply is intermittent, and where pipes commonly leak. Research to develop and evaluate water purification strategies could identify appropriate

  1. Molecular mechanism of acquisition of the cholera toxin genes.

    PubMed

    Das, Bhabatosh; Bischerour, Julien; Barre, Francois-Xavier

    2011-02-01

    One of the major pathogenic determinants of Vibrio cholerae, the cholera toxin, is encoded in the genome of a filamentous phage, CTXφ. CTXφ makes use of the chromosome dimer resolution system of V. cholerae to integrate its single stranded genome into one, the other, or both V. cholerae chromosomes. Here, we review current knowledge about this smart integration process.

  2. The value of cholera vaccination in promoting travel health.

    PubMed

    Hainsworth, Terry

    Cholera is a diarrhoeal disease caused by intestinal infection with Vibrio cholerae bacterium (Health Protection Agency, 2004). Travellers are now able to obtain a cholera vaccine in the UK. Although cholera is rare in travellers from the UK, its potential severity is a cause for concern. Nurses will need to consider the availability of this new vaccine when providing health promotion to travellers.

  3. Prediction of the spatial evolution and effects of control measures for the unfolding Haiti cholera outbreak

    NASA Astrophysics Data System (ADS)

    Bertuzzo, E.; Mari, L.; Righetto, L.; Gatto, M.; Casagrandi, R.; Blokesch, M.; Rodriguez-Iturbe, I.; Rinaldo, A.

    2011-03-01

    Here we propose spatially explicit predictions of the residual progression of the current Haiti cholera outbreak accounting for the dynamics of susceptible and infected individuals within different local human communities, and for the redistribution among them of Vibrio cholerae, the causative agent of the disease. Spreading mechanisms include the diffusion of pathogens in the aquatic environment and their dissemination due to the movement of human carriers. The model reproduces the spatiotemporal features of the outbreak to date, thus suggesting the robustness of predicted future developments of the epidemic. We estimate that, under unchanged conditions, the number of new cases in the whole country should start to decrease in January. During this month the epidemic should mainly involve the Ouest department (Port-au-Prince) while fading out in northern regions. Our spatially explicit model allows also the analysis of the effectiveness of alternative intervention strategies. To that end our results show that mass vaccinations would have a negligible impact at this stage of the epidemic. We also show that targeted sanitation strategies, providing clean drinking water supply and/or staging educational campaigns aimed at reducing exposure, may weaken the strength of the residual evolution of the infection.

  4. 9 CFR 311.3 - Hog cholera.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... kidneys and the lymph nodes which resemble lesions of hog cholera, they shall be regarded as those of hog... kidneys and lymph nodes of carcasses of hogs which appeared normal on ante-mortem inspection, further..., characteristic lesions of hog cholera are found in some organ or tissue in addition to those in the kidneys or...

  5. 9 CFR 311.3 - Hog cholera.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... kidneys and the lymph nodes which resemble lesions of hog cholera, they shall be regarded as those of hog... kidneys and lymph nodes of carcasses of hogs which appeared normal on ante-mortem inspection, further..., characteristic lesions of hog cholera are found in some organ or tissue in addition to those in the kidneys or...

  6. 9 CFR 311.3 - Hog cholera.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... kidneys and the lymph nodes which resemble lesions of hog cholera, they shall be regarded as those of hog... kidneys and lymph nodes of carcasses of hogs which appeared normal on ante-mortem inspection, further..., characteristic lesions of hog cholera are found in some organ or tissue in addition to those in the kidneys or...

  7. 9 CFR 311.3 - Hog cholera.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... kidneys and the lymph nodes which resemble lesions of hog cholera, they shall be regarded as those of hog... kidneys and lymph nodes of carcasses of hogs which appeared normal on ante-mortem inspection, further..., characteristic lesions of hog cholera are found in some organ or tissue in addition to those in the kidneys or...

  8. 9 CFR 311.3 - Hog cholera.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... kidneys and the lymph nodes which resemble lesions of hog cholera, they shall be regarded as those of hog... kidneys and lymph nodes of carcasses of hogs which appeared normal on ante-mortem inspection, further..., characteristic lesions of hog cholera are found in some organ or tissue in addition to those in the kidneys or...

  9. Crystallization of isoelectrically homogeneous cholera toxin

    SciTech Connect

    Spangler, B.D.; Westbrook, E.M. )

    1989-02-07

    Past difficulty in growing good crystals of cholera toxin has prevented the study of the crystal structure of this important protein. The authors have determined that failure of cholera toxin to crystallize well has been due to its heterogeneity. They have now succeeded in overcoming the problem by isolating a single isoelectric variant of this oligomeric protein (one A subunit and five B subunits). Cholera toxin purified by their procedure readily forms large single crystals. The crystal form has been described previously. They have recorded data from native crystals of cholera toxin to 3.0-{angstrom} resolution with our electronic area detectors. With these data, they have found the orientation of a 5-fold symmetry axis within these crystals, perpendicular to the screw dyad of the crystal. They are now determining the crystal structure of cholera toxin by a combination of multiple heavy-atom isomorphous replacement and density modification techniques, making use of rotational 5-fold averaging of the B subunits.

  10. Vibrio cholerae O1 with Reduced Susceptibility to Ciprofloxacin and Azithromycin Isolated from a Rural Coastal Area of Bangladesh

    PubMed Central

    Rashed, Shah M.; Hasan, Nur A.; Alam, Munirul; Sadique, Abdus; Sultana, Marzia; Hoq, Md. Mozammel; Sack, R. Bradley; Colwell, Rita R.; Huq, Anwar

    2017-01-01

    Cholera outbreaks occur each year in the remote coastal areas of Bangladesh and epidemiological surveillance and routine monitoring of cholera in these areas is challenging. In this study, a total of 97 Vibrio cholerae O1 isolates from Mathbaria, Bangladesh, collected during 2010 and 2014 were analyzed for phenotypic and genotypic traits, including antimicrobial susceptibility. Of the 97 isolates, 95 possessed CTX-phage mediated genes, ctxA, ace, and zot, and two lacked the cholera toxin gene, ctxA. Also both CTX+ and CTX− V. cholerae O1 isolated in this study carried rtxC, tcpAET, and hlyA. The classical cholera toxin gene, ctxB1, was detected in 87 isolates, while eight had ctxB7. Of 95 CTX+ V. cholerae O1, 90 contained rstRET and 5 had rstRCL. All isolates, except two, contained SXT related integrase intSXT. Resistance to penicillin, streptomycin, nalidixic acid, sulfamethoxazole-trimethoprim, erythromycin, and tetracycline varied between the years of study period. Most importantly, 93% of the V. cholerae O1 were multidrug resistant. Six different resistance profiles were observed, with resistance to streptomycin, nalidixic acid, tetracycline, and sulfamethoxazole-trimethoprim predominant every year. Ciprofloxacin and azithromycin MIC were 0.003–0.75 and 0.19–2.00 μg/ml, respectively, indicating reduced susceptibility to these antibiotics. Sixteen of the V. cholerae O1 isolates showed higher MIC for azithromycin (≥0.5 μg/ml) and were further examined for 10 macrolide resistance genes, erm(A), erm(B), erm(C), ere(A), ere(B), mph(A), mph(B), mph(D), mef(A), and msr(A) with none testing positive for the macrolide resistance genes. PMID:28270803

  11. Using computer algebra and SMT-solvers to analyze a mathematical model of cholera propagation

    NASA Astrophysics Data System (ADS)

    Trujillo Arredondo, Mariana

    2014-06-01

    We analyze a mathematical model for the transmission of cholera. The model is already defined and involves variables such as the pathogen agent, which in this case is the bacterium Vibrio cholera, and the human population. The human population is divided into three classes: susceptible, infectious and removed. Using Computer Algebra, specifically Maple we obtain two equilibrium states: the disease free state and the endemic state. Using Maple it is possible to prove that the disease free state is locally asymptotically stable if and only if R0 < 1. Using Maple it is possible to prove that the endemic equilibrium state is locally stable when it exists, it is to say when R0 > 1. Using the package Red-Log of the Computer algebra system Reduce and the SMT-Solver Z3Py it is possible to obtain numerical conditions for the model. The formula for the basic reproductive number makes a synthesis with all epidemic parameters in the model. Also it is possible to make numerical simulations which are very illustrative about the epidemic patters that are expected to be observed in real situations. We claim that these kinds of software are very useful in the analysis of epidemic models given that the symbolic computation provides algebraic formulas for the basic reproductive number and such algebraic formulas are very useful to derive control measures. For other side, computer algebra software is a powerful tool to make the stability analysis for epidemic models given that the all steps in the stability analysis can be made automatically: finding the equilibrium points, computing the jacobian, computing the characteristic polynomial for the jacobian, and applying the Routh-Hurwitz theorem to the characteristic polynomial. Finally, using SMT-Solvers is possible to make automatically checks of satisfiability, validity and quantifiers elimination being these computations very useful to analyse complicated epidemic models.

  12. Epidemics and public health in early colonial Somaliland.

    PubMed

    Mohamed, J

    1999-02-01

    The early colonial period in the Somaliland Protectorate was marked by the intrusion of new 'colonial' epidemics and diseases, such as smallpox, cholera, influenza, venereal diseases, tuberculosis, relapsing fever and the decline of the population. The aetiology of the diseases was social. They were introduced into the country through the movement of imperial armies and displaced people, the improvement in transportation and the integration of the country into the British Empire. The protectorate administration attempted to control the epidemics. However, since the medical staff and medical facilities were thin on the ground, the effect of the medical campaigns were limited. Not all the medical campaigns were a 'mirage', however. Medical campaigns played an important role in the control of venereal diseases, particularly syphilis. Overall, the incidence of epidemics declined from 1937 onwards. The cause was again social and had very little to do with medical campaigns. The ending of the campaigns of conquest, the massive movement of armies and people and the development of relative stability in the country played a key and decisive role in the decline in the incidence of diseases. The aetiology of colonial epidemics and their decline had both socio-political origins and explanations. The article deals with that neglected aspect of the history of Somaliland.

  13. Using health and demographic surveillance for the early detection of cholera outbreaks: analysis of community- and hospital-based data from Matlab, Bangladesh.

    PubMed

    Saulnier, Dell D; Persson, Lars-Åke; Streatfield, Peter Kim; Faruque, A S G; Rahman, Anisur

    2016-01-01

    Background Cholera outbreaks are a continuing problem in Bangladesh, and the timely detection of an outbreak is important for reducing morbidity and mortality. In Matlab, the ongoing Health and Demographic Surveillance System (HDSS) data records symptoms of diarrhea in children under the age of 5 years at the community level. Cholera surveillance in Matlab currently uses hospital-based data. Objective The objective of this study is to determine whether increases in cholera in Matlab can be detected earlier by using HDSS diarrhea symptom data in a syndromic surveillance analysis, when compared to hospital admissions for cholera. Methods HDSS diarrhea symptom data and hospital admissions for cholera in children under 5 years of age over a 2-year period were analyzed with the syndromic surveillance statistical program EARS (Early Aberration Reporting System). Dates when significant increases in either symptoms or cholera cases occurred were compared to one another. Results The analysis revealed that there were 43 days over 16 months when the cholera cases or diarrhea symptoms increased significantly. There were 8 months when both data sets detected days with significant increases. In 5 of the 8 months, increases in diarrheal symptoms occurred before increases of cholera cases. The increases in symptoms occurred between 1 and 15 days before the increases in cholera cases. Conclusions The results suggest that the HDSS survey data may be able to detect an increase in cholera before an increase in hospital admissions is seen. However, there was no direct link between diarrheal symptom increases and cholera cases, and this, as well as other methodological weaknesses, should be taken into consideration.

  14. Using health and demographic surveillance for the early detection of cholera outbreaks: analysis of community- and hospital-based data from Matlab, Bangladesh

    PubMed Central

    Saulnier, Dell D.; Persson, Lars-Åke; Streatfield, Peter Kim; Faruque, A. S. G.; Rahman, Anisur

    2016-01-01

    Background Cholera outbreaks are a continuing problem in Bangladesh, and the timely detection of an outbreak is important for reducing morbidity and mortality. In Matlab, the ongoing Health and Demographic Surveillance System (HDSS) data records symptoms of diarrhea in children under the age of 5 years at the community level. Cholera surveillance in Matlab currently uses hospital-based data. Objective The objective of this study is to determine whether increases in cholera in Matlab can be detected earlier by using HDSS diarrhea symptom data in a syndromic surveillance analysis, when compared to hospital admissions for cholera. Methods HDSS diarrhea symptom data and hospital admissions for cholera in children under 5 years of age over a 2-year period were analyzed with the syndromic surveillance statistical program EARS (Early Aberration Reporting System). Dates when significant increases in either symptoms or cholera cases occurred were compared to one another. Results The analysis revealed that there were 43 days over 16 months when the cholera cases or diarrhea symptoms increased significantly. There were 8 months when both data sets detected days with significant increases. In 5 of the 8 months, increases in diarrheal symptoms occurred before increases of cholera cases. The increases in symptoms occurred between 1 and 15 days before the increases in cholera cases. Conclusions The results suggest that the HDSS survey data may be able to detect an increase in cholera before an increase in hospital admissions is seen. However, there was no direct link between diarrheal symptom increases and cholera cases, and this, as well as other methodological weaknesses, should be taken into consideration. PMID:27193264

  15. The cyclic AMP (cAMP)-cAMP receptor protein signaling system mediates resistance of Vibrio cholerae O1 strains to multiple environmental bacteriophages.

    PubMed

    Zahid, M Shamim Hasan; Waise, T M Zaved; Kamruzzaman, M; Ghosh, Amar N; Nair, G Balakrish; Mekalanos, John J; Faruque, Shah M

    2010-07-01

    Toxigenic Vibrio cholerae, the causative agent of the epidemic diarrheal disease cholera, interacts with diverse environmental bacteriophages. These interactions promote genetic diversity or cause selective enrichment of phage-resistant bacterial clones. To identify bacterial genes involved in mediating the phage-resistant phenotype, we screened a transposon insertion library of V. cholerae O1 El Tor biotype strain C6706 to identify mutants showing altered susceptibility to a panel of phages isolated from surface waters in Bangladesh. Mutants with insertion in cyaA or crp genes encoding adenylate cyclase or cyclic AMP (cAMP) receptor protein (CRP), respectively, were susceptible to a phage designated JSF9 to which the parent strain was completely resistant. Application of the cyaA mutant as an indicator strain in environmental phage monitoring enhanced phage detection, and we identified 3 additional phages to which the parent strain was resistant. Incorporation of the cyaA or crp mutations into other V. cholerae O1 strains caused similar alterations in their phage susceptibility patterns, and the susceptibility correlated with the ability of the bacteria to adsorb these phages. Our results suggest that cAMP-CRP-mediated downregulation of phage adsorption may contribute to a mechanism for the V. cholerae O1 strains to survive predation by multiple environmental phages. Furthermore, the cyaA or crp mutant strains may be used as suitable indicators in monitoring cholera phages in the water.

  16. [Epidemics, state and society: the case of Minas Gerais in the second half of the 19th century].

    PubMed

    Torres Silveira, Anny Jackeline

    2011-01-01

    One of the characteristics of historical analyses of epidemic diseases is the notion of crisis: epidemics are generally perceived as events that do not fit within the framework of everyday order and practices and go beyond individual experiences (suffering, threat of death), jeopardizing social structures, public order, economic activities and moral values. However, epidemic events also shed light on how societies organize healthcare in times of normality, including the extent and limits of the action of health authorities and the role of populations in meeting their own daily needs. This article discusses the organization of healthcare in Minas Gerais province of Brazil during two epidemic episodes, i.e., smallpox (from 1873 to 1875) and cholera (from 1855 to 1856), with the aim of identifying the problems experienced by the population of Minas and the actions taken by the public health authorities during these epidemics. We suggest that the difficulties caused by the arrival of cholera and/or intensification of the smallpox epidemic contributed to expose and exacerbate the shortcomings characterizing healthcare in that society. We also observe that the social mobilization of patients during these events was nothing new, given the low participation of the state in public health during this period, which counted on initiatives and support from civil society.

  17. Remodeling of the Vibrio cholerae membrane by incorporation of exogenous fatty acids from host and aquatic environments

    PubMed Central

    Giles, David K.; Hankins, Jessica V.; Guan, Ziqiang; Trent, M. Stephen

    2011-01-01

    Summary The Gram-negative bacteria Vibrio cholerae poses significant public health concerns by causing an acute intestinal infection afflicting millions of people each year. V. cholerae motility, as well as virulence factor expression and outer membrane protein production, have been shown to be affected by bile (Childers & Klose, 2007). The current study examines the effects of bile on V. cholerae phospholipids. Bile exposure caused significant alterations to the phospholipid profile of V. cholerae but not of other enteric pathogens. These changes consisted of a quantitative increase and migratory difference in cardiolipin, decreases in phosphatidylglycerol and phosphatidylethanolamine, and the dramatic appearance of an unknown phospholipid determined to be lyso-phosphatidylethanolamine. Major components of bile were not responsible for the observed changes, but long chain polyunsaturated fatty acids, which are minor components of bile, were shown to be incorporated into phospholipids of V. cholerae. Although the bile-induced phospholipid profile was independent of the V. cholerae virulence cascade, we identified another relevant environment in which V. cholerae assimilates unique fatty acids into its membrane phospholipids—marine sediment. Our results suggest that Vibrio species possess unique machinery conferring the ability to take up a wider range of exogenous fatty acids than other enteric bacteria. PMID:21255114

  18. Safety of the Recombinant Cholera Toxin B Subunit, Killed Whole-Cell (rBS-WC) Oral Cholera Vaccine in Pregnancy

    PubMed Central

    Hashim, Ramadhan; Khatib, Ahmed M.; Enwere, Godwin; Park, Jin Kyung; Reyburn, Rita; Ali, Mohammad; Chang, Na Yoon; Kim, Deok Ryun; Ley, Benedikt; Thriemer, Kamala; Lopez, Anna Lena; Clemens, John D.; Deen, Jacqueline L.; Shin, Sunheang; Schaetti, Christian; Hutubessy, Raymond; Aguado, Maria Teresa; Kieny, Marie Paule; Sack, David; Obaro, Stephen; Shaame, Attiye J.; Ali, Said M.; Saleh, Abdul A.; von Seidlein, Lorenz; Jiddawi, Mohamed S.

    2012-01-01

    Introduction Mass vaccinations are a main strategy in the deployment of oral cholera vaccines. Campaigns avoid giving vaccine to pregnant women because of the absence of safety data of the killed whole-cell oral cholera (rBS-WC) vaccine. Balancing this concern is the known higher risk of cholera and of complications of pregnancy should cholera occur in these women, as well as the lack of expected adverse events from a killed oral bacterial vaccine. Methodology/Principal Findings From January to February 2009, a mass rBS-WC vaccination campaign of persons over two years of age was conducted in an urban and a rural area (population 51,151) in Zanzibar. Pregnant women were advised not to participate in the campaign. More than nine months after the last dose of the vaccine was administered, we visited all women between 15 and 50 years of age living in the study area. The outcome of pregnancies that were inadvertently exposed to at least one oral cholera vaccine dose and those that were not exposed was evaluated. 13,736 (94%) of the target women in the study site were interviewed. 1,151 (79%) of the 1,453 deliveries in 2009 occurred during the period when foetal exposure to the vaccine could have occurred. 955 (83%) out of these 1,151 mothers had not been vaccinated; the remaining 196 (17%) mothers had received at least one dose of the oral cholera vaccine. There were no statistically significant differences in the odds ratios for birth outcomes among the exposed and unexposed pregnancies. Conclusions/Significance We found no statistically significant evidence of a harmful effect of gestational exposure to the rBS-WC vaccine. These findings, along with the absence of a rational basis for expecting a risk from this killed oral bacterial vaccine, are reassuring but the study had insufficient power to detect infrequent events. Trial Registration ClinicalTrials.gov NCT00709410 PMID:22848772

  19. An assistant ship surgeon's account of cholera at sea.

    PubMed

    Goodyer, Bronwen E J

    2008-09-01

    The diary of Thomas Graham, a naval ship surgeon, brings the voyage of HMS troopship Apollo in 1849 to life. A year after England's second great cholera outbreak, the pervasive fear of the disease became a reality onboard when cholera broke out. The intended voyage from England to China was diverted to South America where the ship was put into quarantine. So bad were the conditions onboard that the Times correspondent wrote: 'I have never seen a convict-ship in which the convicts were not more comfortably lodged'. Graham's writing provides an insightful record of life at sea in the mid-nineteenth century and the circumstances that led to this cholera outbreak, namely the overcrowding and poor hygiene. He wrote about the current beliefs and assumptions surrounding the disease; that the foul air was to blame. He also noted the varied methods taken to confine patients and treat the disease. The diary is supported by evidence from naval records and newspaper articles. Graham's writing gives us a glimpse into the life of a man who saw the world from a perspective inaccessible to us and the experience of observing newly discovered continents, cultures and wildlife, which he meticulously recorded. This was Graham's last piece of writing as he died unexpectedly of malaria shortly after the journey's end. The diary encapsulates the struggle to overcome disease and the tragic plight a humble ship surgeon shared with the crew.

  20. Detection, Isolation, and Identification of Vibrio cholerae from the Environment

    PubMed Central

    Huq, Anwar; Haley, Bradd J.; Taviani, Elisa; Chen, Arlene; Hasan, Nur A.; Colwell, Rita R.

    2012-01-01

    Recent molecular advances in microbiology have greatly improved the detection of bacterial pathogens in the environment. Improvement and a downward trend in the cost of molecular detection methods have contributed to increased frequency of detection of pathogenic microorganisms where traditional culture-based detection methods have failed. Culture methods also have been greatly improved and the confluence of the two suites of methods provides a powerful tool for detection, isolation, and characterization of pathogens. While molecular detection provides data on the presence and type of pathogens, culturing methods allow a researcher to preserve the organism of interest for “–omics” studies, such as genomic, metabolomic, secretomic, and transcriptomic analysis, which are rapidly becoming more affordable. This has yielded a clearer understanding of the ecology and epidemiology of microorganisms that cause disease. Specifically, important advances have been made over the past several years on isolation, detection, and identification of Vibrio cholerae, the causative agent of cholera in humans. In this unit, we present commonly accepted methods for isolation, detection, and characterization of V. cholerae, providing more extensive knowledge of the ecology and epidemiology of this organism. This unit has been fully revised and updated from the earlier unit (Huq, Grim et al. 2006) with the latest knowledge and additional information not previously included. We have also taken into account of cost of reagents and equipment that may be prohibitive for many researchers and have, therefore, included protocols for all laboratories, including those with limited resources, likely to be located in regions of cholera endemicity. PMID:22875567

  1. [Isolation of Vibrio cholerae in imported frozen seafood and their cholera-enterotoxin production].

    PubMed

    Shiraishi, S; Takeda, K; Taga, K; Hirata, K; Hayashi, K; Honda, T

    1996-02-01

    A survey study for Vibrio cholerae in imported seafood was conducted during January 1991 to December 1994. A total of 7,439 specimens (approximately 20% of all imported food) were randomly picked up and examined for contamination of V. cholerae. Among these, V. cholerae O1 were isolated from 9 specimens, but they were all cholerae enterotoxin (CT)-negative. In terms of V. cholerae non-O1, a total of 2,803 specimens (37.4%) were contaminated with this vibrio. Shrimp, especially the ones still in their shells and imported from Asian countries such as India and Indonesia, were highly contaminated with V. cholerae. Although no strains of V. cholerae O1 isolated in this study produced CT, 2 strains of V. cholerae non-O1 were proved to be CT-producers. Taking together the high contamination of V. cholerae in imported seafood and a part of those strains producing CT, we believe that careful survey for the possible contamination of V. choleare in imported seafood is necessary.

  2. An epidemic of pediculosis capitis.

    PubMed

    Slonka, G F; Fleissner, M L; Berlin, J; Puleo, J; Harrod, E K; Schultz, M G

    1977-04-01

    An epidemic due to Pediculus humanus capitis occurred in the public schools of Buffalo, New York, in the winter of 1973. A survey at one elementary school showed that 20% of whites and no blacks were infested, and a city-wide prevalence survey during the academic year September 1972 to May 1973 showed that 7.2% of all pupils were infested. An epidemiological investigation showed that sex, age, race, socioeconomic status, crowding, method of closeting garments, and family size influenced the distribution of pediculosis but that hair length apparently was not a factor. Poverty and ignorance appeared to contribute to the persistence of infestation.

  3. Surveillance and control of epidemic keratoconjunctivitis.

    PubMed Central

    Gottsch, J D

    1996-01-01

    PURPOSE: The purpose of this study was to determine if the implementation of a formal set of infection-control policy and procedures (ICPPs) can reduce the number of outbreaks of epidemic keratoconjunctivitis (EKC) and the number of nosocomially infected patients in a large teaching eye institute. METHODS: A retrospective and prospective study of the incidence of EKC and the number of affected patients was performed for the years 1984 through 1991. Infection-control measures (ICPPs) were formulated in 1992 with regulations implemented for patient control and management, hand washing, instrument disinfection, medication distribution, and employee furloughs. Two levels of ICPPs were established on the basis of nonepidemic or epidemic conditions. After implementation of ICPPs, a prospective 4-year study (1992 through 1995) and statistical analysis were performed to determine whether the number of outbreaks of EKC and affected patients significantly decreased. RESULTS: The incidence of institutional EKC epidemics per year was at least one and as many as three from 1984 through 1991. After implementation of a formal set of ICPPs, no epidemics occurred in 2 of 4 years studied. The number of epidemics and affected patients was significantly less when the years before and after implementation of ICPPs were compared by chi-square analysis (P < .01 and P <. 01, respectively). CONCLUSIONS: In this first prospective study of institutional outbreaks of EKC, the implementation of ICPPs was demonstrated to be an effective means to decrease the number of EKC outbreaks and nosocomially infected patients for this particular institution. Although several reports of institutional outbreaks of EKC have described infection-control measures that eventually controlled an outbreak well under way, this study provides policies and procedures that may effectively decrease the number and size of nosocomial epidemics of adenoviral conjunctivitis in large teaching eye institutions. PMID:8981712

  4. A simple filtration method to remove plankton-associated Vibrio cholerae in raw water supplies in developing countries.

    PubMed

    Huq, A; Xu, B; Chowdhury, M A; Islam, M S; Montilla, R; Colwell, R R

    1996-07-01

    Plankton to which cells of Vibrio cholerae O1 and/or O139 were attached was introduced into 0.5% Instant Ocean microcosms maintained at 25 degrees C. The bulk of the plankton and associated particulates was removed with a filter constructed from either nylon net and one of several different types of sari material, the latter being very inexpensive and readily available in villages in Bangladesh, where V. cholerae is endemic. V. cholerae was enumerated before and after filtration to evaluate the efficiency of the filtration procedure. The results obtained indicate that 99% of V. cholerae, i.e., those cells attached to plankton, were removed from the water samples. Epidemic strains of V. cholerae O1 and O139 from various geographical sources, including Bangladesh, Brazil, India, and Mexico, were included in the experiments. Removal of vibrios from water by this simple filtration method was found to yield consistent results with all strains examined in this study. Thus, it is concluded that a simple filtration procedure involving the use of domestic sari material can reduce the number of cholera vibrios attached to plankton in raw water from ponds and rivers commonly used for drinking. Since untreated water from such sources serves as drinking water for millions of people living in developing countries (e.g., Bangladesh), filtration should prove effective at reducing the incidence and severity of outbreaks, especially in places that lack fuel wood for boiling water and/or municipal water treatment plants. The results of this study provide the basis for determining such reductions, which are to be carried out in the near future.

  5. Identification of Vibrio cholerae serotypes in high-risk marine products with non-gel sieving capillary electrophoresis.

    PubMed

    Zhou, Chen; Li, Ming; Sun, Chengjun; Zou, Haimin; Wu, Xin; Zhang, Liyin; Tao, Siyuan; Wang, Bingyue; Li, Yongxin

    2016-02-01

    Vibrio cholerae, a natural inhabitant of the marine environment, poses a threat to human health, and its new epidemic variants have been reported. A method of multiplex polymerase chain reaction-capillary electrophoresis-laser-induced fluorescence (PCR-CE-LIF) detection has been developed to detect and identify V. cholerae in marine products sensitively, rapidly, and reliably. Four sets of primers were selected to amplify genus-specific VCC gene, O139 serogroup-specific O139 gene, O1 serogroup-specific O1 gene, and ctxA gene associated with the CT toxin of enterotoxigenic V. cholerae. The PCR products were detected using CE-LIF with SYBR Gold serving as the DNA fluorescent dye. The parameters of PCR and the separation conditions of CE-LIF were optimized. Under the optimal conditions, V. cholerae was detected and four serotypes were identified simultaneously within 8 min. The alignment analysis showed that the PCR products had good agreement with the published sequences from GenBank, indicating that the primers selected in this study had high specificity and the PCR results were reliable. The proposed method could detect 5 to 20 cfu/ml V. cholerae. The intraday precisions of migration time and peak area of DNA marker and PCR products were in the ranges of 1.60-2.56% and 1.60-6.29%, respectively. The specificity results showed that only five standard bacteria used in this study showed the specific peaks when the target bacteria were mixed with seven other common intestinal pathogenic bacteria at the same concentration. The assay was applied to 71 high-risk marine products, and different serotypes of V. cholerae could be identified sensitively and reliably.

  6. Model distinguishability and inference robustness in mechanisms of cholera transmission and loss of immunity.

    PubMed

    Lee, Elizabeth C; Kelly, Michael R; Ochocki, Brad M; Akinwumi, Segun M; Hamre, Karen E S; Tien, Joseph H; Eisenberg, Marisa C

    2017-01-24

    Mathematical models of cholera and waterborne disease vary widely in their structures, in terms of transmission pathways, loss of immunity, and a range of other features. These differences can affect model dynamics, with different models potentially yielding different predictions and parameter estimates from the same data. Given the increasing use of mathematical models to inform public health decision-making, it is important to assess model distinguishability (whether models can be distinguished based on fit to data) and inference robustness (whether inferences from the model are robust to realistic variations in model structure). In this paper, we examined the effects of uncertainty in model structure in the context of epidemic cholera, testing a range of models with differences in transmission and loss of immunity structure, based on known features of cholera epidemiology. We fit these models to simulated epidemic and long-term data, as well as data from the 2006 Angola epidemic. We evaluated model distinguishability based on fit to data, and whether the parameter values, model behavior, and forecasting ability can accurately be inferred from incidence data. In general, all models were able to successfully fit to all data sets, both real and simulated, regardless of whether the model generating the simulated data matched the fitted model. However, in the long-term data, the best model fits were achieved when the loss of immunity structures matched those of the model that simulated the data. Two parameters, one representing person-to-person transmission and the other representing the reporting rate, were accurately estimated across all models, while the remaining parameters showed broad variation across the different models and data sets. The basic reproduction number (R0) was often poorly estimated even using the correct model, due to practical unidentifiability issues in the waterborne transmission pathway which were consistent across all models. Forecasting

  7. Transmission of Infectious Vibrio cholerae through Drinking Water among the Household Contacts of Cholera Patients (CHoBI7 Trial)

    PubMed Central

    Rafique, Raisa; Rashid, Mahamud-ur; Monira, Shirajum; Rahman, Zillur; Mahmud, Md. Toslim; Mustafiz, Munshi; Saif-Ur-Rahman, K. M.; Johura, Fatema-Tuz; Islam, Saiful; Parvin, Tahmina; Bhuyian, Md. Sazzadul I.; Sharif, Mohsena B.; Rahman, Sabita R.; Sack, David A.; Sack, R. Bradley; George, Christine M.; Alam, Munirul

    2016-01-01

    Recurrent cholera causes significant morbidity and mortality among the growing population of Dhaka, the capital city of Bangladesh. Previous studies have demonstrated that household contacts of cholera patients are at >100 times higher risk of cholera during the week after the presentation of the index patient. Our prospective study investigated the mode of transmission of Vibrio cholerae, the cause of cholera, in the households of cholera patients in Dhaka city. Out of the total 420 rectal swab samples analyzed from 84 household contacts and 330 water samples collected from 33 households, V. cholerae was isolated from 20%(17/84) of household contacts, 18%(6/33) of stored drinking water, and 27%(9/33) of source water samples. Phenotypic and molecular analyses results confirmed the V. cholerae isolates to be toxigenic and belonging to serogroup O1 biotype El Tor (ET) possessing cholera toxin of classical biotype (altered ET). Phylogenetic analysis by pulsed-field gel electrophoresis (PFGE) showed the V. cholerae isolates to be clonally linked, as >95% similarity was confirmed by sub-clustering patterns in the PFGE (NotI)-based dendrogram. Mapping results showed cholera patients to be widely distributed across 25 police stations. The data suggesting the transmission of infectious V. cholerae within the household contacts of cholera patients through drinking water underscores the need for safe water to prevent spread of cholera and related deaths in Dhaka city. PMID:27803695

  8. Transmission of Infectious Vibrio cholerae through Drinking Water among the Household Contacts of Cholera Patients (CHoBI7 Trial).

    PubMed

    Rafique, Raisa; Rashid, Mahamud-Ur; Monira, Shirajum; Rahman, Zillur; Mahmud, Md Toslim; Mustafiz, Munshi; Saif-Ur-Rahman, K M; Johura, Fatema-Tuz; Islam, Saiful; Parvin, Tahmina; Bhuyian, Md Sazzadul I; Sharif, Mohsena B; Rahman, Sabita R; Sack, David A; Sack, R Bradley; George, Christine M; Alam, Munirul

    2016-01-01

    Recurrent cholera causes significant morbidity and mortality among the growing population of Dhaka, the capital city of Bangladesh. Previous studies have demonstrated that household contacts of cholera patients are at >100 times higher risk of cholera during the week after the presentation of the index patient. Our prospective study investigated the mode of transmission of Vibrio cholerae, the cause of cholera, in the households of cholera patients in Dhaka city. Out of the total 420 rectal swab samples analyzed from 84 household contacts and 330 water samples collected from 33 households, V. cholerae was isolated from 20%(17/84) of household contacts, 18%(6/33) of stored drinking water, and 27%(9/33) of source water samples. Phenotypic and molecular analyses results confirmed the V. cholerae isolates to be toxigenic and belonging to serogroup O1 biotype El Tor (ET) possessing cholera toxin of classical biotype (altered ET). Phylogenetic analysis by pulsed-field gel electrophoresis (PFGE) showed the V. cholerae isolates to be clonally linked, as >95% similarity was confirmed by sub-clustering patterns in the PFGE (NotI)-based dendrogram. Mapping results showed cholera patients to be widely distributed across 25 police stations. The data suggesting the transmission of infectious V. cholerae within the household contacts of cholera patients through drinking water underscores the need for safe water to prevent spread of cholera and related deaths in Dhaka city.

  9. A Randomized, Placebo-Controlled Trial Evaluating Safety and Immunogenicity of the Killed, Bivalent, Whole-Cell Oral Cholera Vaccine in Ethiopia.

    PubMed

    Desai, Sachin N; Akalu, Zenebe; Teshome, Samuel; Teferi, Mekonnen; Yamuah, Lawrence; Kim, Deok Ryun; Yang, Jae Seung; Hussein, Jemal; Park, Ju Yeong; Jang, Mi Seon; Mesganaw, Chalachew; Taye, Hawult; Beyene, Demissew; Bedru, Ahmed; Singh, Ajit Pal; Wierzba, Thomas F; Aseffa, Abraham

    2015-09-01

    Killed whole-cell oral cholera vaccine (OCV) has been a key component of a comprehensive package including water and sanitation measures for recent cholera epidemics. The vaccine, given in a two-dose regimen, has been evaluated in a large number of human volunteers in India, Vietnam, and Bangladesh, where it has demonstrated safety, immunogenicity, and clinical efficacy. We conducted a double-blind randomized placebo-controlled trial in Ethiopia, where we evaluated the safety and immunogenicity of the vaccine in 216 healthy adults and children. OCV was found to be safe and elicited a robust immunological response against Vibrio cholerae O1, with 81% adults and 77% children demonstrating seroconversion 14 days after the second dose of vaccine. This is the first study to evaluate safety and immunogenicity of the vaccine in a population outside Asia using a placebo-controlled, double-blind, randomized study design.

  10. Immunizing Canada geese against avian cholera

    USGS Publications Warehouse

    Price, J.I.

    1985-01-01

    A small flock of captive giant Canada geese were vaccinated with the experimental bac- terin in Nebraska to test its efficacy under field conditions. Only 2 of 157 vaccinates died from avian cholera during an annual spring die-off.

  11. Are wetlands the reservoir for avian cholera?

    USGS Publications Warehouse

    Samuel, M.D.; Shadduck, D.J.; Goldberg, D.R.

    2004-01-01

    Wetlands have long been suspected to be an important reservoir for Pasteurella multocida and therefore the likely source of avian cholera outbreaks. During the fall of 1995a??98 we collected sediment and water samples from 44 wetlands where avian cholera epizootics occurred the previous winter or spring. We attempted to isolate P. multocida in sediment and surface water samples from 10 locations distributed throughout each wetland. We were not able to isolate P. multocida from any of the 440 water and 440 sediment samples collected from these wetlands. In contrast, during other investigations of avian cholera we isolated P. multocida from 20 of 44 wetlands, including 7% of the water and 4.5% of the sediment samples collected during or shortly following epizootic events. Our results indicate that wetlands are an unlikely reservoir for the bacteria that causes avian cholera.

  12. Mapping to Support Fine Scale Epidemiological Cholera Investigations: A Case Study of Spatial Video in Haiti

    PubMed Central

    Curtis, Andrew; Blackburn, Jason K.; Smiley, Sarah L.; Yen, Minmin; Camilli, Andrew; Alam, Meer Taifur; Ali, Afsar; Morris, J. Glenn

    2016-01-01

    The cartographic challenge in many developing world environments suffering a high disease burden is a lack of granular environmental covariates suitable for modeling disease outcomes. As a result, epidemiological questions, such as how disease diffuses at intra urban scales are extremely difficult to answer. This paper presents a novel geospatial methodology, spatial video, which can be used to collect and map environmental covariates, while also supporting field epidemiology. An example of epidemic cholera in a coastal town of Haiti is used to illustrate the potential of this new method. Water risks from a 2012 spatial video collection are used to guide a 2014 survey, which concurrently included the collection of water samples, two of which resulted in positive lab results “of interest” (bacteriophage specific for clinical cholera strains) to the current cholera situation. By overlaying sample sites on 2012 water risk maps, a further fifteen proposed water sample locations are suggested. These resulted in a third spatial video survey and an additional “of interest” positive water sample. A potential spatial connection between the “of interest” water samples is suggested. The paper concludes with how spatial video can be an integral part of future fine-scale epidemiological investigations for different pathogens. PMID:26848672

  13. Mapping to Support Fine Scale Epidemiological Cholera Investigations: A Case Study of Spatial Video in Haiti.

    PubMed

    Curtis, Andrew; Blackburn, Jason K; Smiley, Sarah L; Yen, Minmin; Camilli, Andrew; Alam, Meer Taifur; Ali, Afsar; Morris, J Glenn

    2016-02-03

    The cartographic challenge in many developing world environments suffering a high disease burden is a lack of granular environmental covariates suitable for modeling disease outcomes. As a result, epidemiological questions, such as how disease diffuses at intra urban scales are extremely difficult to answer. This paper presents a novel geospatial methodology, spatial video, which can be used to collect and map environmental covariates, while also supporting field epidemiology. An example of epidemic cholera in a coastal town of Haiti is used to illustrate the potential of this new method. Water risks from a 2012 spatial video collection are used to guide a 2014 survey, which concurrently included the collection of water samples, two of which resulted in positive lab results "of interest" (bacteriophage specific for clinical cholera strains) to the current cholera situation. By overlaying sample sites on 2012 water risk maps, a further fifteen proposed water sample locations are suggested. These resulted in a third spatial video survey and an additional "of interest" positive water sample. A potential spatial connection between the "of interest" water samples is suggested. The paper concludes with how spatial video can be an integral part of future fine-scale epidemiological investigations for different pathogens.

  14. The Lake Chad Basin, an Isolated and Persistent Reservoir of Vibrio cholerae O1: A Genomic Insight into the Outbreak in Cameroon, 2010

    PubMed Central

    Kaas, Rolf S.; Ngandjio, Antoinette; Nzouankeu, Ariane; Siriphap, Achiraya; Fonkoua, Marie-Christine; Aarestrup, Frank M.; Hendriksen, Rene S.

    2016-01-01

    The prevalence of reported cholera was relatively low around the Lake Chad basin until 1991. Since then, cholera outbreaks have been reported every couple of years. The objective of this study was to investigate the 2010/2011 Vibrio cholerae outbreak in Cameroon to gain insight into the genomic make-up of the V. cholerae strains responsible for the outbreak. Twenty-four strains were isolated and whole genome sequenced. Known virulence genes, resistance genes and integrating conjugative element (ICE) elements were identified and annotated. A global phylogeny (378 genomes) was inferred using a single nucleotide polymorphism (SNP) analysis. The Cameroon outbreak was found to be clonal and clustered distant from the other African strains. In addition, a subset of the strains contained a deletion that was found in the ICE element causing less resistance. These results suggest that V. cholerae is endemic in the Lake Chad basin and different from other African strains. PMID:27191718

  15. The asbestos cancer epidemic.

    PubMed Central

    LaDou, Joseph

    2004-01-01

    The asbestos cancer epidemic may take as many as 10 million lives before asbestos is banned worldwide and exposures are brought to an end. In many developed countries, in the most affected age groups, mesothelioma may account for 1% of all deaths. In addition to mesotheliomas, 5-7% of all lung cancers can be attributed to occupational exposures to asbestos. The asbestos cancer epidemic would have been largely preventable if the World Health Organization (WHO) and the International Labor Organization (ILO) had responded early and responsibly. The WHO was late in recognizing the epidemic and failed to act decisively after it was well under way. The WHO and the ILO continue to fail to address the problem of asbestos mining, manufacturing, and use and world trade of a known human carcinogen. Part of the problem is that the