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Background Global estimates for cholera annually approximate 4 million cases worldwide with 95,000 deaths. Recent outbreaks, including Haiti and Yemen, are reminders that cholera is still a global health concern. Cholera outbreaks can rapidly induce high death tolls by overwhelming the capacity of health facilities, especially in remote areas or areas of civil unrest. Recent studies demonstrated that stool specimens preserved on filter paper facilitate molecular analysis of Vibrio cholerae in resource limited settings. Specimens preserved in a rapid, low-cost, safe and sustainable manner for sequencing provides previously unavailable data about circulating cholera strains. This may ultimately contribute new information to shape public policy response on cholera control and elimination. Methodology/Principal findings Whole genome sequencing (WGS) recovered close to a complete sequence of the V. cholerae O1 genome with satisfactory genome coverage from stool specimens enriched in alkaline peptone water (APW) and V. cholerae culture isolates, both spotted on filter paper. The minimum concentration of V. cholerae DNA sufficient to produce quality genomic information was 0.02 ng/μL. The genomic data confirmed the presence or absence of genes of epidemiological interest, including cholera toxin and pilus loci. WGS identified a variety of diarrheal pathogens from APW-enriched specimen spotted filter paper, highlighting the potential for this technique to explore the gut microbiome, potentially identifying co-infections, which may impact the severity of disease. WGS demonstrated that these specimens fit within the current global cholera phylogenetic tree, identifying the strains as the 7th pandemic El Tor. Conclusions WGS results allowed for mapping of short reads from APW-enriched specimen and culture isolate spotted filter papers. This provided valuable molecular epidemiological sequence information on V. cholerae strains from remote, low-resource settings. These results identified the presence of co-infecting pathogens while providing rare insight into the specific V. cholerae strains causing outbreaks in cholera-endemic areas., Author summary Cholera affects more than 4 million people globally every year; people predominantly living in poverty or in resource-constrained conditions including political crises or natural disasters. Cholera’s typical presentation is characterized by rapid onset of acute watery diarrhea and vomiting which can progress from watery stool to shock in as little as four hours. Laboratory conditions needed for culture confirmation and strain preservation are rarely to never present in these affected areas. In fact, many cholera endemic areas in Sub-Saharan African are so remote that even treatment response alone is often challenging. Here we present the genomic analysis of DNA extracted from dried filter paper, which is a low-cost, low-tech and sustainable method. Previously this method has facilitated cholera confirmation by PCR, but we demonstrate that this method is also suitable for whole genome sequencing and subsequent strain characterization by presenting the analysis of samples from an outbreak in a remote area of Cameroon. This method will facilitate the understanding of the molecular epidemiology in cholera-prone areas, which were previously too challenging to attempt. It also introduces a method that can be used on a broader scale for diarrheal disease surveillance, including providing a window into co-infection and microbiome analyses.

Cholera is now considered to be endemic in Haiti, often with increased incidence during rainy seasons. The challenge of cholera surveillance is exacerbated by the cost of sample collection and laboratory analysis. A diagnostic tool is needed that is low cost, easy-to-use, and able to detect and quantify Vibrio cholerae accurately in water samples within 18-24h, and perform reliably in remote settings lacking laboratory infrastructure and skilled staff. The two main objectives of this study were to develop and evaluate a new culture medium embedded in a new diagnostic tool (PAD for paper based analytical device) for detecting Vibrio cholerae from water samples collected in Haiti. The intent is to provide guidance for corrective action, such as chlorination, for water positive for V. cholerae epidemic strains. For detecting Vibrio cholerae, a new chromogenic medium was designed and evaluated as an alternative to thiosulfate citrate bile salts sucrose (TCBS) agar for testing raw water samples. Sensitivity and specificity of the medium were assessed using both raw and spiked water samples. The Vibrio cholerae chromogenic medium was proved to be highly selective against most of the cultivable bacteria in the water samples, without loss of sensitivity in detection of V. cholerae. Thus, reliability of this new culture medium for detection of V. cholerae in the presence of other Vibrio species in water samples offers a significant advantage. A new paper based device containing the new chromogenic medium previously evaluated was compared with reference methods for detecting V. cholerae from spiked water sample. The microbiological PAD specifications were evaluated in Haiti. More precisely, a total of 185 water samples were collected at five sites in Haiti, June 2014 and again in June 2015. With this new tool, three V. cholerae O1 and 17 V. cholerae non-O1/O139 strains were isolated. The presence of virulence-associated and regulatory genes, including ctxA, zot, ace, and toxR, was confirmed using multiplex PCR. The three V. cholerae O1 isolates were positive for three of the four virulence-associated and regulatory genes. Twelve of the V. cholerae non-O1/O139 isolates were found to carry toxR, but none were ctxA+, zot+, or ace+. However, six of the V. cholerae non-O1/O139 isolates were resistant to penicillin, ampicillin, trimethoprim/sulfamethoxazole, nalidixic acid, and ciprofloxacin. The paper based analytical device (PAD) provides advantages in that standard culture methods employing agar plates are not required. Also, intermediary isolation steps were not required, including transfer to selective growth media, hence these steps being omitted reduced time to results. Furthermore, experienced technical skills also were not required. Thus, PAD is well suited for resource-limited settings.

This article presents the World Health Organization's (WHO) recommendations on the use of cholera vaccines excerpted from the Cholera vaccines: WHO position paper, August 2017, published in the Weekly Epidemiological Record (Cholera vaccine, 2017) [1]. This position paper replaces the 2010 WHO position paper on cholera vaccines (Cholera vaccine, 2010) [2]. It incorporates the most recent evidence on cholera vaccination and provides revised recommendations on the target populations for cholera immunization. Footnotes to this paper provide a number of core references including references to grading tables that assess the quality of the scientific evidence, and to the evidence-to-recommendation table. In accordance with its mandate to provide guidance to Member States on health policy matters, WHO issues a series of regularly updated position papers on vaccines and combinations of vaccines against diseases that have an international public health impact. These papers are concerned primarily with the use of vaccines in large-scale immunization programmes; they summarize essential background information on diseases and vaccines, and conclude with WHO's current position on the use of vaccines in the global context. Recommendations on the use of cholera vaccines were discussed by the Strategic Advisory Group of Experts (SAGE) in April 2017; evidence presented at these meetings can be accessed at: www.who.int/immunization/sage/meetings/2017/April/presentations_background_docs/en/.

The cholera vaccine can protect patients with inflammatory bowel disease (IBD) against both cholera and travelers’ diarrhea. However, both immunosuppressive treatment and IBD can affect its vaccine immunogenicity. The aim of this study was to assess the immunogenicity and safety of the cholera vaccine in children with IBD. Children older than 6 years with diagnosed IBD were enrolled in this multicenter study. All patients were administered two doses of the oral cholera vaccine (Dukoral®). Anti-cholera toxin B subunit IgA and IgG seroconversion rates were evaluated in a group with immunosuppressive (IS) treatment and a group without IS treatment (NIS). Immunogenicity was assessed in 70 children, 79% of whom received IS treatment. Post-vaccination seroconversion was displayed by 33% of children, for IgA, and 70% of children, for IgG. No statistically significant differences were found in the immune responses between the IS and NIS groups: 35% vs. 27% (p = .90), for IgA, and 68% vs. 80.0% (p = .16), for IgG, respectively. One case of IBD exacerbation after vaccination was reported. The oral cholera vaccine is safe. The immunogenicity of the oral cholera vaccine in children with IBD was lower than previously observed in healthy ones. The treatment type does not seem to affect the vaccine immunogenicity.

Cholera is both an endemic and epidemic disease in many low and middle-income countries (LMICs). Strategies for cholera control include improving water, sanitation, and hygiene; providing early and effective treatment; and deploying oral cholera vaccine (OCV). This last strategy is relatively new, and countries considering its introduction are interested in knowing the potential cost not only of the vaccine, but also the cost of introduction. This paper describes the costing of OCV introduction in LMICs using a publicly available Excel-based tool known as the CholTool. It includes estimates of delivery cost categories which cover not only the service delivery costs (e.g. vaccine procurement, handling, storage, and transport; vaccination administration, monitoring supervision, and field support), but also the programmatic costs associated with introducing a new vaccine (i.e. microplanning, communication and training materials development, sensitization/social mobilization, and personnel training) to ensure that a comprehensive estimate is provided with health payer perspective. CholTool takes the user through a structured sequence of interlinked modules containing input parameter cells (assumptions), decision cells (variable selections), and formulas (calculations) to produce customized cost estimates based on standardized methods. The tool provides both financial and economic cost estimates, to ensure that both costs are available for consideration. Four examples of applications of CholTool are presented in three countries- one in Ethiopia, two in Malawi and one in Nepal. The estimates of economic delivery cost per dose (including service delivery and programmatic costs) were (in USD 2016): $2.89 in Ethiopia, $3.04 in Malawi1, $3.35 in Malawi2 and $3.06 in Nepal. A cost projection conducted before the campaign using the tool and a retrospective costing using the tool in Nepal resulted in no significant difference between economic delivery costs per dose.

Dear Sir: We read with great interest the recent article by Debes and others1 concerning simplified cholera surveillance methods performed in the Far North Region of Cameroon in 2013–2014. The authors described the novel use of filter paper to preserve DNA specimens for polymerase chain reaction (PCR) confirmation of cholera. In another recent article,2 they used the same sampling method to genotype Vibrio cholerae using multiple loci variable number tandem repeat (VNTR) analysis (MLVA), in the same resource-constrained area. In both studies, stool specimens were initially enriched for 6–8 hours in alkaline peptone water (APW). One to two drops of the enrichment were subsequently aliquoted onto Whatman 903 Protein Saver Cards (GE Healthcare Limited, Chalfont St.Giles, UK) and allowed to air-dry. While investigating the origin of a cholera epidemic in the Republic of Guinea3 in September 2012, we experimented direct dried stool sampling on filter paper in the neighboring Sierra Leone, without prior enrichment in APW. Indeed, analysis of surveillance data and field investigations suggested a recent importation of cholera from Sierra Leone. However, lacking laboratory capacities in this country impaired the inclusion of samples for genetic comparison with Guinean culture isolates.4 Dried blood or saliva specimens on filter paper are relatively easy to collect, store, and transport, as they are not subject to United Nations biosafety regulations for transport of category B infectious substances.5 Moreover, direct PCR detection of V. cholerae on stool samples has been shown to represent a successful diagnosis method for cholera.6 With official authorization of Sierra Leonean health authorities, 17 suspected cholera patients were thus anonymously sampled in cholera treatment units in several coastal districts (Supplemental Figure 1). One or two drops of their watery diarrhea were directly collected from nonchlorinated buckets below cholera cots and then deposited onto each sample area of Whatman FTA Elute Micro Cards (GE Healthcare Limited, Chalfont St. Giles, UK). Each sample was air-dried for approximately 5 minutes in a shaded area, sealed with a Desiccant Packet (GE Healthcare Limited, Chalfont St. Giles, UK) into individual Multi-Barrier Pouches (GE Healthcare Limited, Chalfont St. Giles, UK), transported to Marseille, France, and stored at ambient temperature. For technical reasons, DNA extraction was performed only in June 2015. Using a scalpel, a 1-cm2 area of the filter paper was removed and suspended in 500 μL NucliSENS® easyMAG® lysis buffer (bioMerieux, Marcy l'Etoile, France) overnight at 4°C. The DNA was then extracted using a NucliSENS® easyMAG® platform (bioMerieux, Marcy l'Etoile, France) as previously described,7 and the supernatants were stored at −20°C for downstream PCR assays. To check for conserved DNA, a 16S ribosomal DNA PCR was performed as previously described.8 Six previously described VNTRs7 were independently genotyped for each sample. All primer pairs were verified to be specific for V. cholerae using National Center for Biotechnology Information (NCBI) Basic Local Alignment Search Tool (BLAST), and one primer set was located within the cholera toxin A subunit promoter region. MLVA results of the Sierra Leonean samples were included within the genotype panel of 35 Guinean isolates isolated via conventional culture in February–September 2012 (Supplemental Figure 1) and genotyped using the same method.7 The presence of amplifiable bacterial DNA was confirmed by 16S PCR in all 17 filter paper samples (Supplemental Table 1). Toxigenic V. cholerae was confirmed and MLVA genotyping was completed for nine of them. All VNTR-specific PCRs were negative for the eight remaining samples, which suggest that the corresponding patients may have been affected by noncholera acute watery diarrhea. The panel of nine genotyped samples from Sierra Leone displayed four distinct MLVA types (1, 5, 6, and 7). Together with the samples from Guinea, these MLVA types formed a single clonal complex of 13 closely related MLVA types (Supplemental Figure 1). Two MLVA types (5 and 6) were common to both Sierra Leonean and Guinean samples (Supplemental Figure 1). We thus confirm that filter paper is a very convenient, inexpensive, and efficient tool to sample suspected cholera cases for delayed molecular studies, including V. cholerae MLVA genotyping, even after several years of storage at room temperature. Moreover, we demonstrate that prior stool enrichment in APW is not necessary to perform specific V. cholerae PCRs, which renders sampling even easier. Further experiments are required to determine whether this method of DNA collection and conservation is sufficient for V. cholerae whole-genome single nucleotide polymorphism–based phylogenetics. In addition, MLVA genotyping of these cholera filter paper samples further bolsters the initial conclusion that Sierra Leone and the Republic of Guinea were affected in 2012 by the same transborder cholera epidemic,3 which was genetically related to outbreaks in Togo between 2010 and 2012.7 Such genotyping results can provide valuable insight to optimize control and prevention strategies. Direct stool sampling on filter papers should therefore be included in the rapid response package to investigate cholera epidemics, especially when V. cholerae culture and strain storage facilities are not available or biosafety shipping to specialized genotyping laboratories is too complicated.

Cholera is one of the major public health problems in the state of Odisha, India since centuries. The current paper is a comprehensive report on epidemiology of cholera in Odisha, which was documented from 1993. PubMed and Web of Knowledge were searched for publications reporting cholera in Odisha during the period 1993–2015. The search was performed using the keywords ‘Odisha’ and/or ‘Orissa’ and ‘Cholera’. In addition, manual search was undertaken to find out relevant papers. During the study period, a total of 37 cholera outbreaks were reported with an average of >1.5 cholera outbreaks per year and case fatality ratio was 0.3%. Vibrio cholerae O1 Ogawa serotype was the major causative agent in most of the cholera cases. The recent studies demonstrated the prevalence of V. cholerae O1, El Tor variants carrying ctxB1, ctxB7 and Haitian variant tcpA allele associated with polymyxin B sensitivity and these variants are replacing the proto type El Tor. The first report of variant ctxB7 in Odisha during super-cyclone 1999 predicted its emergence and subsequent spread causing cholera outbreaks. The prevalence of multidrug-resistant V. cholerae at different time periods created alarming situation. The efficacy trial of oral cholera vaccine (OCV, Shanchol) in a public health set-up in Odisha has shown encouraging results which should be deployed for community level vaccination among the vulnerable population. This paper has taken an effort to disseminate the valuable information of epidemiology of cholera that will influence the policy-makers and epidemiologists for constant surveillance in other parts of Odisha, India and around the globe.

Background: The new influx of Forcibly Displaced Myanmar Nationals (FDMNs) into Bangladesh started in August 2017 through different entry points of Bangladesh. Considering the imminent threat of infectious diseases outbreaks, the Government of Bangladesh (GoB) decided to vaccinate children against three deadly diseases (measles, rubella and poliomyelitis) and oral cholera vaccine (OCV) for all except

Background Yemen has recently faced the largest cholera outbreak in the world, which started at the end of 2016. By the end of 2017, the cumulative reported cases from all governorates reached 777,229 with 2134 deaths. Al Hudaydah was one of the most strongly affected areas, with 88,741 (18%) cases and 244 (12%) deaths reported. Objective The aim of this study was to determine the risk factors associated with cholera transmission in Al Hudaydah city, Yemen. Methods From December 1, 2017 to January 10, 2018, a total of 104 patients with cholera (57 women and 47 men) who presented at cholera treatment centers in Al Hudaydah city with three or more watery stools in a 24-hour period and with moderate or severe dehydration were identified for inclusion in this study. Each case was matched by age and gender with two controls who were living in the neighboring house. A semistructured questionnaire was used to collect data on behavioral and environmental risk factors such as drinking water from public wells, storing water in containers, consumption of unwashed vegetables or fruits, and sharing a toilet. Results The median age of the cases and controls was 20 years (range 5-80) and 23 years (range 5-85), respectively. Only 6% of cases and 4% of controls were employed. Multivariate analysis showed that eating unwashed vegetables or fruits (odds ratio [OR] 7.0, 95% CI 1.6-30.6, P=.01), storing water in containers (OR 3.0, 95% CI 1.3-7.3, P=.01), drinking water from a public well (OR 2.5, 95% CI 1.1-5.7, P=.02), and using a public toilet (OR 5.2, 95% CI 1.1-24.4, P=.04) were significantly associated with cholera infection risk. Conclusions The cholera transmission risk factors in Al Hudaydah city were related to water and sanitation hygiene. Therefore, increasing awareness of the population on the importance of water chlorination, and washing fruits and vegetables through a health education campaign is strongly recommended.

Background Cholera poses a significant global health burden. In Bangladesh, cholera is endemic and causes more than 100,000 cases each year. Established environmental reservoirs leave millions at risk of infection through the consumption of contaminated water. The Global Task Force for Cholera Control has called for increased environmental surveillance to detect contaminated water sources prior to human infection in an effort to reduce cases and deaths. The OmniVis rapid cholera detection device uses loop-mediated isothermal amplification and particle diffusometry detection methods integrated into a handheld hardware device that attaches to an iPhone 6 to identify and map contaminated water sources. Objective The aim of this study was to evaluate the usability of the OmniVis device with targeted end users to advance the iterative prototyping process and ultimately design a device that easily integrates into users’ workflow. Methods Water quality workers were trained to use the device and subsequently completed an independent device trial and usability questionnaire. Pretraining and posttraining knowledge assessments were administered to ensure training quality did not confound trial and questionnaire Results Device trials identified common user errors and device malfunctions including incorrect test kit insertion and device powering issues. We did not observe meaningful differences in user errors or device malfunctions accumulated per participant across demographic groups. Over 25 trials, the mean time to complete a test was 47 minutes, a significant reduction compared with laboratory protocols, which take approximately 3 days. Overall, participants found the device easy to use and expressed confidence and comfort in using the device independently. Conclusions These results are used to advance the iterative prototyping process of the OmniVis rapid cholera detection device so it can achieve user uptake, workflow integration, and scale to ultimately impact cholera control and elimination strategies. We hope this methodology will promote robust usability evaluations of rapid pathogen detection technologies in device development.

Introduction In Yemen, the largest cholera epidemic of modern times started in late 2016. By March 2018, more than one million cases had been reported. A national electronic Disease Early Warning System (eDEWS) for infectious disease surveillance was established in 2013. Aim This study assessed the eDEWS's timelines for reported cholera cases. Methods Quantitative data published in eDEWS and the Weekly Epidemiological Bulletin of the Yemen Ministry of Health from March 2013 until March 2018 were analyzed. For assessing the early detection of cholera cases, 262 weekly bulletins were reviewed. The raw data of the immediately generated eDEWS alerts during the first outbreak wave were used to assess response timeliness. Results Reported cholera incidence peaked at 1,698 cases (first wave) in 2016 week 49, and then reached 46,667 cases (second wave) in 2017 week 26. The mean time period between reporting and the first response was 2.85 days. Only 31% of the eDEWS alerts were verified within the first 24 hours, and the majority (83%) were verified within one week. There were major differences in the timeliness between the governorates, ranging from 8%-62% for reporting within the first 24 hours. Conclusion The eDEWS is able to detect and alert health authorities about cholera cases even under conditions of ongoing war and civil war, however, the timeliness of the response needs improvement.

We conducted a matched case-control (MCC), test-negative case-control (TNCC) and case-cohort study in 2016 in Lusaka, Zambia, following a mass vaccination campaign. Confirmed cholera cases served as cases in all three study designs. In the TNCC, control-subjects were cases with negative cholera culture and polymerase chain reaction results. Matched controls by age and sex were selected among neighbours of the confirmed cases in the MCC study. For the case-cohort study, we recruited a cohort of randomly selected individuals living in areas considered at-risk of cholera. We recruited 211 suspected cases (66 confirmed cholera cases and 145 non-cholera diarrhoea cases), 1055 matched controls and a cohort of 921. Adjusted vaccine effectiveness of one dose of oral cholera vaccine (OCV) was 88.9% (95% confidence interval (CI) 42.7–97.8) in the MCC study, 80.2% (95% CI: 16.9–95.3) in the TNCC design and 89.4% (95% CI: 64.6–96.9) in the case-cohort study. Three study designs confirmed the short-term effectiveness of single dose OCV. Major healthcare-seeking behaviour bias did not appear to affect our estimates. Most of the protection among vaccinated individuals could be attributed to the direct effect of the vaccine.

Background: Cholera is a considerable health burden in developing country settings including Bangladesh. The oral cholera vaccine (OCV) is a preventative tool to control the disease. The objective of this study was to describe whether the International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), could provide the OCV to rural communities using existing government infrastructure. Methods: The study was conducted in rural sub-district Keraniganj, 20 km from the capital city Dhaka. All listed participants one year and above in age (excluding pregnant women) were offered two doses of OCV at a 14 day interval. Existing government facilities were used to deliver and also maintain the cold chain required for the vaccine. All events related to vaccination were recorded at the 17 vaccination sites to evaluate the coverage and feasibility of OCV program. Results: A total of 29,029 individuals received the 1st dose (90% of target) and 26,611 individuals received the 2nd dose (83% of target and 92% of 1st dose individuals) of OCV. The highest vaccination coverage was in younger children (1–9 years) and the lowest was amongst 18–29-year age group. Somewhat better coverage was seen amongst the female participants than males (92% vs. 88% for the 1st dose and 93% vs. 90% for the 2nd dose). The cost of vaccine cost was calculated as US$1.00 per dose plus freight, insurance, and transportation and the total vaccine delivery cost was US$70,957. Conclusion: This was a project undertaken using existing public health program resources to collect empirical evidence on the use of a mass OCV campaign in the rural setting. Mass vaccination with the OCV is feasible in the rural setting using existing governmental vaccine delivery systems in Bangladesh.

Shanchol™, a WHO-prequalified oral cholera vaccine (OCV), has been used to control endemic cholera in Asia, as well as in emergencies and outbreaks elsewhere. The vaccine has not been used by public health systems in cholera-endemic settings of Africa although several outbreak response campaigns have been conducted. Here we present experiences from a mass vaccination campaign in a cholera-endemic setting of Ethiopia in which Shanchol™ was introduced through the public health system. The vaccination site was selected based on cholera cases reported in previous years. Social mobilization involved sensitization of community leaders, household visits, and mass distribution of banners, posters and leaflets. The vaccination was implemented after careful microplanning of logistics and cold chain, manpower, transportation, vaccine supply and supervision and monitoring of adverse events. Vaccine administration was recorded on individual vaccination cards. Vaccine delivery costs were collected and analyzed after vaccination. As there was no experience with Shanchol™ in Ethiopia, a bridging trial was conducted to demonstrate safety and immunogenicity of the vaccine in the local population prior to the mass vaccination. Oral cholera vaccination was conducted in two rounds of four days each in February 2015 and March 2015 in 10 selected villages of Shashemenae rural district of Ethiopia. A total of 62,161 people targeted. 47,137 people (76%) received the first dose, and 40,707 (65%) received two doses. The financial cost of the vaccination campaign was estimated at US $2·60 per dose or US $5·64 per fully immunized person. The cost of vaccine delivery excluding vaccine procurement was $0·68 per dose or $1·48 per fully immunized person. The study demonstrates that mass cholera vaccination administered through the public health system in Ethiopia is feasible, can be implemented through the existing health system at an affordable cost, and the vaccine is acceptable to the community. The lessons from this study are useful for deploying OCV in other African endemic settings through the public health system and may guide future immunization policy decisions.

The Dominican Republic, historically non-endemic for cholera, is experiencing an ongoing cholera epidemic. We assessed the safety and immunogenicity of two doses of the killed bivalent (O1 and O139) whole-cell oral cholera vaccine (OCV) on day (D)0 and D14 in healthy participants aged ≥1 year. Immediate unsolicited systemic adverse events (AEs) were monitored up to 30 minutes and solicited systemic reactions, up to 7 days after each vaccination. Unsolicited AEs were recorded up to D14 (post-dose 1) and 30 days post-dose 2. A vibriocidal antibody assay with microtiter technique was used to measure serum antibodies to V. cholerae strains (O1 El Tor Inaba, O1 El Tor Ogawa, O139) on D0, D14 and D28. Geometric mean titers (GMTs) and seroconversion (≥4-fold increase from D0) rates were calculated. We recruited 336 participants; 112 in three age groups (1–4, 5–14 and ≥15 years). No safety concerns were observed. GMTs increased from baseline for all serotypes, with marked increases for O1 Inaba and Ogawa post-dose 1. Post-dose 2 GMTs tended to be equal or slightly lower, with ranges: O1 Inaba, 283 (95% confidence interval 191–419) to 612 (426–880); O1 Ogawa, 346 (223–536) to 754 (553–1028); and O139, 20.3 (13.5–30.6) to 43.8 (30.1–63.7). Seroconversion rates post-dose 2 for O1 Inaba and Ogawa were high (≥87%) for all age groups. OCV demonstrated an acceptable safety profile and robust immunogenicity in these participants, in-line with previous observations in epidemic and endemic settings.This study is registered on www.clinicaltrials.gov (NCT02434822).

The killed bivalent (O1 and O139) whole cell oral cholera vaccine (OCV) (Shanchol™) was first licensed in India in 2009 and World Health Organization pre-qualified in 2011. We assessed the safety and immunogenicity of this OCV in the Philippines. This was a phase IV, single-arm, descriptive, open-label study. We recruited 336 participants from 2 centers: 112 participants in each age group (1–4, 5–14 and ≥ 15 years). Participants received 2 OCV doses 14 d apart. Safety was monitored throughout the trial. Blood samples were collected at baseline (pre-vaccination) and 14 d after each dose. Serum vibriocidal antibody titers to V. cholerae O1 (El Tor Inaba and El Tor Ogawa) and O139 strains were assessed, with seroconversion defined as ≥ 4-fold increase from baseline in titers. No immediate unsolicited systemic adverse events/reactions were observed. Unsolicited systemic adverse events were mostly grade 1 intensity. One serious adverse event occurred after the first dose, but was unrelated to vaccination. High seroconversion rates (range 69–92%) were achieved against the O1 serotypes with a trend toward higher rates in the 1–4 y (86–92%) and 5–14 y (86–88%) age groups than the ≥ 15 y age group (69–83%). Lower seroconversion rates were achieved against the O139 serotype (35–70%), particularly in those aged ≥ 15 y (35–42%). The 2-dose regimen of the killed bivalent whole cell OCV was well-tolerated in this study conducted in the Philippines, a cholera-endemic country. Robust immune responses were observed even after a single-dose.

SUMMARYVibrio alginolyticuscauses soft tissue and bloodstream infection; little systematically collected clinical and epidemiological information is available. In the USA,V. alginolyticusinfections are reported to the Cholera and OtherVibrioIllness Surveillance system. Using data from 1988 to 2012, we categorised infections using specimen source and exposure history, analysed case characteristics, and calculated incidence rates using US Census Bureau data. Most (96%) of the 1331V. alginolyticusinfections were from coastal states. Infections of the skin and ear were most frequent (87%); ear infections occurred more commonly in children, lower extremity infections more commonly in older adults. Most (86%) infections involved water activity. Reported incidence of infections increased 12-fold over the study period, although the extent of diagnostic or surveillance bias is unclear. Prevention efforts should target waterborne transmission in coastal areas and provider education to promote more rapid diagnosis and prevent complications.

A series of sixteen benzenesulfonamide derivatives has been synthesised and tested as inhibitors of Vibrio cholerae carbonic anhydrase (CA) enzymes, belonging to α-CA, β-CA, and γ-CA classes (VchCAα, VchCAβ, and VchCAγ). The determined Ki values were compared to those of selected human CA isoforms (hCA I and hCA II). Structure-affinity relationship analysis highlighted that all tested compounds proved to be active inhibitors of VchCAα at nanomolar concentration. The VchCAβ activity was lower to respect inhibitory efficacy toward VchCAα, whereas, these benzenesulfonamide derivatives failed to inhibit VchCAγ. Interestingly, compound 7e combined the best activity toward VchCAα and VchCAβ. In order to obtain a model for binding mode of our inhibitors toward bacterial CAs, we carried out docking simulations by using the available crystal structures of VchCAβ., GRAPHICAL ABSTRACT

PurposeEpidemics of diarrhea caused by toxigenic strains of Vibrio cholerae are of global public health concern, but non-cholera Vibrio (NCV) species are also important causes of disease. These pathogens are thermophilic, and climate change could increase the risk of NCV infection. The El Niño Southern Oscillation (ENSO) is a “natural experiment” that may presage ocean warming effects on disease incidence.MethodWe obtained vibriosis case counts in the United States by digitizing annual reports from the U.S. Cholera and Other Vibrio Illness Surveillance system. Trends and environmental impacts (of ENSO and the North Atlantic Oscillation) were evaluated using negative binomial and distributed nonlinear lag models. Associations between latitude and changing risk were evaluated with meta-regression.ResultsTrend models demonstrated significant seasonality (P < 0.001) and a 7% annual increase in disease risk from 1999 to 2014 (annual IRR 1.071, 95% CI 1.061-1.081). Distributed lag models demonstrated increased vibriosis risk following ENSO conditions over the subsequent 12 months (integrated RR 1.940, 95% CI 1.298-2.901). The rate of change in vibriosis risk increased with state latitude (RR per 10° increase 1.066, 95% CI 1.027-1.107).ConclusionVibriosis risk in the United States appears to be impacted by irregular large-scale ocean warming and exhibits a north-south gradient in rate of change as would be expected if changing disease incidence is attributable to ocean warming. Vulnerable populations, which include high-income countries with well-developed public health systems, may experience increased risk of this disease as a result of climate change.

The WHO African region is characterised by the largest infectious disease burden in the world. We conducted a retrospective descriptive analysis using records of all infectious disease outbreaks formally reported to the WHO in 2018 by Member States of the African region. We analysed the spatio-temporal distribution, the notification delay as well as the morbidity and mortality associated with these outbreaks. In 2018, 96 new disease outbreaks were reported across 36 of the 47 Member States. The most commonly reported disease outbreak was cholera which accounted for 20.8% (n = 20) of all events, followed by measles (n = 11, 11.5%) and Yellow fever (n = 7, 7.3%). About a quarter of the outbreaks (n = 23) were reported following signals detected through media monitoring conducted at the WHO regional office for Africa. The median delay between the disease onset and WHO notification was 16 days (range: 0–184). A total of 107 167 people were directly affected including 1221 deaths (mean case fatality ratio (CFR): 1.14% (95% confidence interval (CI) 1.07%–1.20%)). The highest CFR was observed for diseases targeted for eradication or elimination: 3.45% (95% CI 0.89%–10.45%). The African region remains prone to outbreaks of infectious diseases. It is therefore critical that Member States improve their capacities to rapidly detect, report and respond to public health events.

The Infectious Diseases and Beliaghata General Hospital, Kolkata, India witnessed a sudden increase in admissions of diarrhoea cases during the first 2 weeks of August 2015 following heavy rainfall. This prompted us to investigate the event. Cases were recruited through hospital-based surveillance along with the collection of socio-demographic characteristics and clinical profile using a structured questionnaire. Stool specimens were tested at bacteriological laboratory of the National Institute of Cholera and Enteric Diseases (NICED), Kolkata. Admission of 3003 diarrhoea cases, clearly indicated occurrence of outbreak in Kolkata municipal area as it was more than two standard deviation of the mean number (911; s.d. = 111) of diarrhoea admissions during the same period in previous 7 years. Out of 164 recruited cases, 25% were under-5 children. Organisms were isolated from 80 (49%) stool specimens. Vibrio cholerae O1 was isolated from 50 patients. Twenty-eight patients had this organism as the sole pathogen. Among 14 infants, five had cholera. All V. cholerae O1 isolates were resistant to nalidixic acid, followed by co-trimoxazole (96%), streptomycin (92%), but sensitive to fluroquinolones. We confirmed the occurrence of a cholera outbreak in Kolkata during August 2015 due to V. cholerae O1 infection, where infants were affected.

SUMMARYToxigenic strains ofVibrio choleraeserogroups 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 pathogenicVibriospecies. Post-harvest processing of raw oysters, such as individual quick freezing, heat-cool pasteurization, and high hydrostatic pressurization, should be considered.

SUMMARYVibrio cholerae O139 emerged as a causative agent of epidemic cholera in 1992 in India and Bangladesh, and was subsequently reported in China in 1993. The genetic relatedness and molecular characteristics of V. cholerae O139 in Guangdong Province, located in the southern coastal area of China, remains undetermined. In this study, we investigated 136 clinical V. cholerae O139 isolates from 1993 to 2013 in Guangdong. By conventional PCR, 123 (90·4%) isolates were positive for ctxB, ace and zot. Sequencing of the positive amplicons indicated 113 (91·7%) isolates possessed the El Tor allele of ctxB (genotype 3); seven carried the classical ctxB type (genotype 1) and three harboured a novel ctxB type (genotype 5). With respect to tcpA, 123 (90·4%) isolates were positive for the El Tor allele. In addition, pulsed-field gel electrophoresis (with NotI digestion) differentiated the isolates into clusters A and B. Cluster A contained seven of the non-toxigenic isolates from 1998 to 2000; another six non-toxigenic isolates (from 1998 and 2007) and all of the toxigenic isolates formed cluster B. Our results suggest that over a 20-year period, the predominant O139 clinical isolates have maintained a relatively tight clonal structure, although some genetic variance and shift has occurred. Our data highlight the persistence of toxigenic V. cholerae O139 in clinical settings in the southern coastal area of China.

Many infectious diseases have emerged or reemerged in Africa in the 21st century. Some of them are associated with newly discovered microorganisms such as Rickettsia felis and Tropheryma whipplei; others are known, historical diseases such as plague and cholera. In addition are diseases related to previously known microorganisms which recently have been involved for the first time in massive outbreaks with worldwide impacts (such as Ebola virus, Zika virus and Chikungunya virus). Research on emerging infectious diseases needs to be identified as a priority. Keywords: Africa, cholera, emerging infectious diseases, fever, plague

Marseille has been exposed to epidemics for two millennia, including plague, cholera and yellow fever. This long-standing exposure to epidemics has given the people of Marseilles a particular expertise in fighting epidemics. Lazarets and other quarantine measures were implemented as a response to preventing the further spread of the disease in the community. The Institut Hospitalier Universitaire Méditerranée Infection is paving the way today, with its responses built on the region's long history and knowledge of epidemics, infectious diseases and medical microbiology. Keywords: Cholera, epidemics, infectious diseases, Marseille, medical microbiology, plague, The Institut Hospitalier Universitaire Méditerranée Infection, yellow fever

The aim of this study was to assess the cumulative immunogenicity properties of rZot and rAce combination and their potential ability to increase the clearance rate of pathogenic standard Vibrio cholerae strain in challenge experiments in mice model. The recombinant Zot and Ace proteins were produced and used to raise polyclonal antibodies of anti-Zot and anti-Ace recombinant proteins in rabbit. Six-week female BALB/c mice were immunized with different antigens via oral route. Blood samples were collected, and the total amount of IgG and IgA antibodies against rZot and rAce were measured in blood and stool samples of each immunized mouse. Challenge experiments were done with toxigenic V. cholerae strain. The anti-Zot and anti-Ace IgG titers were significantly higher in immunized mice in comparison with control group. The IgG and IgA titers were higher in the sera of mice immunized by recombinant Ace than in group immunized by rZot, indicating the higher immunogenicity of rAce than rZot. The use of rAce and rZot mixture led to synergistic activities in increasing the level of IgG and IgA in comparison with the use of each protein separately. The clearance rate was significantly higher in different challenge groups than in the control group, and the coherence between rZot and rAce reduced the bacterial shedding significantly. In conclusion, the use of recombinant Zot and Ace mixture can produce the proper amount of IgA and IgG against to toxigenic V. cholerae, reduce bacterial shedding in immunized mice significantly, and be used as a potent candidate in cholera vaccine research.

The crystal structure of the major outer membrane protein U (OmpU) from Vibrio cholerae has been determined, which exhibits distinct structural features from other structurally characterized porins and provides the structural basis for the bacterial invasion and phage recognition., Vibrio cholerae causes a severe disease that kills thousands of people annually. The outer membrane protein OmpU is the most abundant outer membrane protein in V. cholerae, and has been identified as an important virulence factor that is involved in host-cell interaction and recognition, as well as being critical for the survival of the pathogenic V. cholerae in the host body and in harsh environments. The mechanism of these processes is not well understood owing to a lack of the structure of V. cholerae OmpU. Here, the crystal structure of the V. cholerae OmpU trimer is reported to a resolution of 2.2 Å. The protomer forms a 16-β-stranded barrel with a noncanonical N-terminal coil located in the lumen of the barrel that consists of residues Gly32–Ser42 and is observed to participate in forming the second gate in the pore. By mapping the published functional data onto the OmpU structure, the OmpU structure reinforces the notion that the long extracellular loop L4 with a β-hairpin-like motif may be critical for host-cell binding and invasion, while L3, L4 and L8 are crucially implicated in phage recognition by V. cholerae.

SUMMARYA total of 45 strains ofVibrio choleraeO1 isolated from 10 different places in India where they were associated with cases of cholera between the years 2007 and 2008 were examined by molecular methods. With the help of phenotypic and genotypic tests the strains were confirmed to be O1 El Tor biotype strains with classicalctxBgene. Polymerase chain reaction (PCR) analysis by double – mismatch amplification mutation assay PCR showed 16 of these strains carried thectxB-7allele reported in Haitian strains. Sequencing of thectxBgene in all the 45 strains revealed that in 16 strains the histidine at the 20th amino acid position had been replaced by asparagine and this single nucleotide polymorphism did not affect cholera toxin production as revealed by beads enzyme-linked immunosorbent assay. This study shows that the newctxBgene sequence was circulating in different places in India. Seven representatives of these 45 strains analysed by pulsed – field gel electrophoresis showed four distinctNot Idigested profiles showing that multiple clones were causing cholera in 2007 and 2008.

It is well established that the contamination sources of cholera causing bacteria, Vibrio cholerae, are water and food, but little is known about the transmission role of the fomites (surfaces that can carry pathogens) commonly used in households. In the absence of appropriate nutrients or growth conditions on fomites, bacteria have been known to assume a viable but non-culturable (VBNC) state after a given period of time. To investigate whether and when V. cholerae O1 assumes such a state, this study investigated the survival and viable quantification on a range of fomites such as paper, wood, glass, plastic, cloth and several types of metals under laboratory conditions. The fomites were inoculated with an outbreak strain of V. cholerae and its culturability was examined by drop plate count method at 30 min intervals for up to 6 h. For molecular detection, the viable/dead stain ethidium monoazide (EMA) which inhibits amplification of DNA from dead cells was used in combination with real-time polymerase chain reaction (EMA-qPCR) for direct quantitative analyses of viable V. cholerae at 2, 4, 6, 24 h and 7 day time intervals. Results showed that V. cholerae on glass and aluminum surfaces lost culturability within one hour after inoculation but remained culturable on cloth and wood for up to four hours. VBNC V. cholerae on dry fomite surfaces was detected and quantified by EMA-qPCR even 7 days after inoculation. In conclusion, the prolonged survival of V. cholerae on various household fomites may play vital role in cholera transmission and needs to be further investigated.

Background Vibrio cholerae is endemic in South Asia and Africa where outbreaks of cholera occur widely and are particularly associated with poverty and poor sanitation. Knowledge of the genetic diversity of toxigenic V. cholerae isolates, particularly in Africa, remains scarce. The constraints in improving this understanding is not only the lack of regular cholera disease surveillance, but also the lack of laboratory capabilities in endemic countries to preserve, store and ship isolates in a timely manner. We evaluated the use of simplified sample preservation methods for molecular characterization using multi-locus variable-number tandem-repeat analysis (MLVA) for differentiation of Vibrio cholerae genotypes. Methods and Findings Forty-seven V. cholerae isolates and 18 enriched clinical specimens (e.g. stool specimens after enrichment in broth) from cholera outbreaks in Cameroon were preserved on Whatman filter paper for DNA extraction. The samples were collected from two geographically distinct outbreaks in the Far North of Cameroon (FNC) in June 2014 and October 2014. In addition, a convenience sample of 14 isolates from the Philippines and 8 from Mozambique were analyzed. All 87 DNAs were successfully analyzed including 16 paired samples, one a cultured isolate and the other the enriched specimen from which the isolate was collected. Genotypic results were identical between 15 enriched specimens and their culture isolates and the other pair differed at single locus. Two closely related, but distinct clonal complexes were identified among the Cameroonian specimens from 2014. Conclusions Collecting V. cholerae using simplified laboratory methods in remote and low-resource settings allows for subsequent advanced molecular characterization of V. cholerae O1. These simplified DNA preservation methods identify V. cholerae and make possible timely information regarding the genetic diversity of V. cholerae; our results set the stage for continued molecular epidemiological research to better understand the transmission and dissemination of V. cholerae in Africa and elsewhere worldwide., Author Summary Cholera, caused by the bacterium Vibrio cholerae, causes an estimated 3–5 million cases every year and more than 100,000 deaths. The highest disease burden is reported from Africa, however, the epidemic potential and transmission patterns among circulating strains is scarcely understood. The challenges of disease surveillance are constrained by the costs associated with laboratory confirmation and sample preservation. To improve the ability to identify the cholera disease burden, to subsequently understand the molecular epidemiology of circulating cholera strains, and to elucidate transmission patterns, we applied simplified collection methodologies to facilitate timely molecular characterization of V. cholerae isolates from Cameroon, Mozambique and the Philippines. Enriched specimens as well as cultured isolates were examined, demonstrating that enriched specimens provide sufficient material for genetic analysis. The results of the genetic analyses did not suggest significant genetic diversity within two distinct outbreaks in Cameroon. The study detected a possible relationship between isolates present in Cameroon and two isolates from Mozambique, two geographically distant nations in Africa. Whole genome sequencing can test whether this hypothesis is correct. Our findings set the stage for surveillance and molecular characterization in these areas to elucidate more fully the relationship and disease transmission patterns.

The study assessed the knowledge, attitudes and practices of cholera prevention and preparedness in Ga-Mampuru village (Limpopo, South Africa). Interviewers collected data using a two-pronged method, namely a household questionnaire (open- and closed-ended questions) to assess knowledge and attitudes about cholera and observations to assess practices in the prevention and management of the disease. Additionally, interviewers took pictures with the respondents’ permission. Ninety-six respondents were interviewed. Most respondents (86%) indicated they knew how cholera was contracted with 84% indicating contaminated water as a source. Ninety percent of the respondents indicated they knew how to prevent contracting cholera. All respondents generally knew that cholera could be treated with medicine received at a health-care facility or worker. Fewer respondents (58%) had specific knowledge such as the use of rehydration solutions. The respondents’ high level of prevention practices could be biased. Interviewers observed that many practices were not adhered to, like not washing hands, not using toilet paper and throwing waste in respondents’ yards. Therefore, the community of Ga-Mampuru had not reached a stage of adequate cholera prevention and preparedness in spite of the fact that they were aware of cholera risks and risk-reduction measures.

In this short paper, we establish a priori L∞-norm estimates for solutions of a class of reaction-diffusion systems which can be used to model the spread of infectious disease. The developed technique may find applications in other reaction-diffusion systems.

The five B-subunits (CTB5) of the Vibrio cholerae (cholera) toxin can bind to the intestinal cell surface so the entire AB5 toxin can enter the cell. Simultaneous binding can occur on more than one of the monosialotetrahexosylganglioside (GM1) units present on the cell surface. Such simultaneous binding arising from the toxins multivalency is believed to enhance its affinity. Thus, blocking the initial attachment of the toxin to the cell surface using inhibitors with GM1 subunits has the potential to stop the disease. Previously we showed that tetravalent GM1 molecules were sub-nanomolar inhibitors of CTB5. In this study, we synthesized a pentavalent version and compared the binding and potency of penta- and tetravalent cholera toxin inhibitors, based on the same scaffold, for the first time. The pentavalent geometry did not yield major benefits over the tetravalent species, but it was still a strong inhibitor, and no major steric clashes occurred when binding the toxin. Thus, systems which can adopt more geometries, such as those described here, can be equally potent, and this may possibly be due to their ability to form higher-order structures or simply due to more statistical options for binding. Carbohydrates combating cholera! Simultaneous binding of the five B-subunits of the cholera toxin (CTB5) enhances its affinity and facilitates its cellular entry. Thus, blocking the toxins initial attachment to the cell surface could stop the disease. The binding pattern and potency of tetra- and pentavalent CTB5 inhibitors based on the same GM1 ganglioside scaffold are compared for the first time.

In the aftermath of a severe cyclonic storm on 7 January 2012, a cluster of acute diarrhoea cases was reported from two localities in Pondicherry, Southern India. We investigated the outbreak to identify causes and recommend control measures. We defined a case as occurrence of diarrhoea of more than three loose stools per day with or without vomiting in a resident of affected areas during 6-18 January 2012. We used active (door-to-door survey) and stimulated passive (healthy facility-based) surveillance to identify cases. We described the outbreak by time, place, and person. We compared the case-patients with up to three controls without any apparent signs and symptoms of diarrhoea and matched for age, gender, and neighbourhood. We calculated matched odds ratio (MOR), 95% confidence intervals (CI), and population attributable fractions (PAF). We collected rectal swabs and water samples for laboratory diagnosis and tested water samples for microbiological quality. We identified 921 cases and one death among 8,367 residents (attack rate: 11%, case-fatality: 0.1%). The attack rate was the highest among persons of 50 years and above (14%) and females (12%). The outbreak started on 6 January and peaked on the 9th and lasted till 14 January. Cases were clustered around two major leakages in water supply system. Nine of the 16 stool samples yielded V. cholerae O1 Ogawa. We identified that consumption of water from the public distribution system (MOR=37, 95% CI 4.9-285, PAF: 97%), drinking unboiled water (MOR=35, 95% CI 4.5-269, PAF: 97%), and a common latrine used by two or more households (MOR=2.7, 95% CI 1.3-5.6) were independently associated with cholera. Epidemiological evidence suggested that this outbreak was due to ingestion of water contaminated by drainage following rains during cyclone. We recommended repair of the water supply lines, cleaning-up of the drains, handwashing, and drinking of boiled water.

The authorʼs systematic analysis of the registers of births, marriages, and deaths and the Status Animarum for Veli Brgud, as well as analysis of numerous other historical sources gathered a lot of data about life, epidemics, and many disasters that marked the lives of the village residents during the 19th century. This paper serves to present the information to the general public. Veli Brgud still remembers only one of those epidemics and disasters – the 1855 cholera, while others are completely forgotten. The paper tackles epidemics and disasters that depict the difficult life of the village during the 19th century. Additionally, the example of cholera serves to give an insight into the functioning of the then authorities on prevention and protection against the spread of infections, which can be deemed effective even from a time distance of almost 170 years.

Climate change and health challenges such as the HIV and AIDS have motivated religious leaders to rethink their beliefs and practices, considering how to apply these to health crises. Christian theologians and biblical scholars have risen to the occasion and developed new ways of interpreting the bible that offer a response to current situations. The new ways of interpreting the bible include approaching the text with a degree of wariness and traditional readings of the bible are often transgressed. The experience of the marginalised or the dismembered is used as a starting point for bible interpretation and theological reflection. This paper contributes to the shifts in bible interpretation and theological reflection by offering an eco-theological interpretation of Deuteronomy 23:14–15 in the context of cholera. The paper shows that, in the context of cholera in Zambia, an eco-theological interpretation of the biblical text can foster hygiene and proper management of human waste which would be an important contribution to the prevention of cholera outbreaks.

In a recent paper, Che et al. [5] used a continuous-time Ordinary Differential Equation (ODE) model with risk structure to study cholera infections in Cameroon. However, the population and the reported cholera cases in Cameroon are censored at discrete-time annual intervals. In this paper, unlike in [5], we introduce a discrete-time risk-structured cholera model with no spatial structure. We use our discrete-time demographic equation to 'fit' the annual population of Cameroon. Furthermore, we use our fitted discrete-time model to capture the annually reported cholera cases from 1987 to 2004 and to study the impact of vaccination, treatment and improved sanitation on the number of cholera infections from 2004 to 2019. Our discrete-time cholera model confirms the results of the ODE model in [5]. However, our discrete-time model predicts a decrease in the number of cholera cases in a shorter period of cholera intervention (2004-2019) as compared to the ODE model's period of intervention (2004-2022).

Drugs have been used by many farmers for the treatment of most infectious diseases in chicken regardless of their residue effects to human health if proper management has not adhered. This paper focuses on finding out the common chicken diseases, their prevalence, drugs used for treatment, and their residue implication in the chicken products and by-products. A systematic literature-review was used to synthesis the information from soft and hard copy sources of information. In this paper, it was noted that different infectious diseases were affecting chicken in Tanzania and other countries including Newcastle (Prevalence 7-90 percent percent per flock), Infectious bursal disease (Prevalence 7-100 percent per flock), Fowl Cholera (Prevalence 1-60 percent per flock), and Fowl Typhoid (Prevalence 0-20 percent per flock). As a remedy, drugs such as Amprolium, oxytetracycline, and sulphanilamide were used for treatment which could prompt antibiotic residues in chicken products and by-products. The antibiotic residue was reported in meat, eggs, liver, and kidneys of the chicken which are considered edible to a human thus posing public health challenges. In this regard, there is a need to create awareness to the farmers on the proper use of the drugs. In this case, the understanding of the withdrawal period for the applied drugs can minimize the risk of drug residues in chicken products.

The present paper examines the use and description of colonial medicine for cholera and its practices in J.G. Farrell’s historical novel, The Siege of Krishnapur (1973). The paper shows that by engaging the two doctors stationed at the British residency in Krishnapur in a debate, Farrell contextualises an episode in British medical history to foreground popular medical beliefs on the aetiology of cholera and its treatment prevalent in nineteenth century Britain. The paper then argues that Farrell’s critique of an outdated medicinal theory and welcoming of the scientific future of colonial medicine simultaneously is an attempt to reinstate the position of “civilised medicine” in colonial India. It further establishes a vital link between Farrell and cholera by bringing in contemporary contexts, and discusses how cholera served as a dual tool to not only satisfy his compulsive interest in disease and doctors but also his aspirations for historical creativeness.

During the period of social transformation in modern China, the sudden onslaught of malignant infectious diseases, the helplessness of the public, and the impact of the modern Western medical system promoted the profound self-revolution of traditional Chinese medicine (TCM). Multiple factors, including politics, economy or religion contributed to the formulation of paper-based “TCM proclamation”. This paper, based on the prevention and control of cholera advocated in TCM proclamation, analyzes the new ways of cholera spread in China in early modern times and the complicated “country-region-medical institutions-other institutions-individuals” correlations.

International audience; We reviewed research papers related to pandemics/epidemics (disease outbreaks of a global/regional scope) published in major operations management, operations research, and management science journals through the end of 2019. We evaluate and categorize these papers. We study research trends, explore research gaps, and provide directions for more efficient and effective research in the future. In addition, our recommendations include the lessons learned from the ongoing pandemic, COVID-19. We discuss papers in the following categories: (a) warning signals/surveillance, (b) disease propagation leading to pandemic conditions, (c) mitigation, (d) vaccines and therapeutics development, (e) resource management, (f) supply chain configuration, (g) decision support systems for managing pandemics/epidemics, and (h) risk assessment.

During the 1854 cholera outbreak in Florence, Italy, Filippo Pacini documented that the cause of the infection was a bacterium. This conclusion was also independently reached by John Snow during the 1854 cholera outbreak in London. By using an epidemiological method, Snow found that the infection spread through a polluted water network. Snow identified a water pump as the source of the disease. After removing the infected handle of this pump, the cases of cholera rapidly began to decrease. A microscopic examination of the water showed organic impurities but no bacteria. This discovery was ignored during Snow’s lifetime. In contrast, through microscopy during the autopsies of cholera victims, Pacini observed that the disruption of their intestinal mucosa was closely associated with millions of the bacteria that he called Vibrio cholerae . Via histological techniques, Pacini detected that intestinal mucosa reabsorption dysfunction was the cause of debilitating diarrhoea, vomiting, severe dehydration and death. Nevertheless, his discovery of Vibrio cholerae was ignored during Pacini’s lifetime. A survey of Pacini’s autographic manuscripts suggests that Pacini and Snow may have shared mutual knowledge within their respective seminal papers. This survey also facilitates, for the first time, the creation of maps that illustrate the worldwide distribution of Pacini’s cholera papers from 1854 to 1881. The consistent neglect of Pacini’s discovery remains a true enigma.

In this paper, we provide an overview of how spatial video data collection enriched with contextual mapping can be used as a universal tool to investigate sub-neighborhood scale health risks, including cholera, in challenging environments. To illustrate the method’s flexibility, we consider the life cycle of the Mujoga relief camp set up after the Nyiragongo volcanic eruption in the Democratic Republic of Congo on 22 May 2021. More specifically we investigate how these methods have captured the deteriorating conditions in a camp which is also experiencing lab-confirmed cholera cases. Spatial video data are collected every month from June 2021 to March 2022. These coordinate-tagged images are used to make monthly camp maps, which are then returned to the field teams for added contextual insights. At the same time, a zoom-based geonarrative is used to discuss the camp’s changes, including the cessation of free water supplies and the visible deterioration of toilet facilities. The paper concludes by highlighting the next data science advances to be made with SV mapping, including machine learning to automatically identify and map risks, and how these are already being applied in Mujoga.

Cholera is an acute diarrheal infection due to ingestion of food or water contaminated by bacterium ‘’Vibrio cholera’’. It is endemic in many parts of Nigeria and is often fatal if not treated urgently. This cross-sectional descriptive study was conducted to assess the prevalence and associated risk factors of cholera infection among the inhabitants of Gwagwalada Area Council, FCT, Abuja, Nigeria. A total of 423 stool samples were collected from individual whose ages ranges from 2 to 70 years with mean age of 30 years using multi-stage random sampling technique to determine the prevalence using culture techniques. Social-demographic data were collected using structured self-administered questionnaire. The data collected were analyzed using simple percentages, Odd Ratios and Chi-square analytical methods. Out of 423 samples tested for Cholera, 150(35.5%) were positive, while, the age-related prevalence, was highest in 18-29 year old age group (OR=3.21; P=0.001) with 70.8%, followed by those within the age bracket of 5-10 years (OR=2.12) with 51.4%. The gender-related prevalence was higher in females (OR=2.23; P=0.037) with 42.6%, while, their male counter-parts (OR=1.01) had 27.5% of the infection. Sources of drinking water, educational status, age and gender had significant effects on the prevalence of cholera among the population. There is significant association between gender (X2 = 4.33; P = 0.037); age (X2 = 53.80; P = 0.001) and Cholera infection in the area. Government should encourage public health campaign, in form of health education, provision of portable water as well as hygiene and sanitation practices to drastically reduce the rate of infection. Keywords: Cholera, Association, Vibrio, Gwagwalada, Abuja, Prevalence. Title: CHOLERA AND ASSOCIATED RISK FACTORS IN GWAGWALADA AREA COUNCIL, FCT, ABUJA, NIGERIA Author: Okoroiwu.G.I.A, Onah.M.C. International Journal of Novel Research in Healthcare and Nursing ISSN 2394-7330 Vol. 10, Issue 2, May 2023 - August 2023 Page No: 49-57 Novelty Journals Website: www.noveltyjournals.com Published Date: 08-June-2023 DOI: https://doi.org/10.5281/zenodo.8017352 Paper Download Link (Source) https://www.noveltyjournals.com/upload/paper/CHOLERA%20AND%20ASSOCIATED-08062023-5.pdf, International Journal of Novel Research in Healthcare and Nursing, ISSN 2394-7330, Novelty Journals, Website: www.noveltyjournals.com

India has been swept by pandemics of plague, influenza, smallpox, cholera and other diseases. The scale and impact of these events was often cataclysmic and writers offered a glimpse into the everyday life of ordinary people who lost their lives and livelihoods and suffered the angst and trauma of mental, physical and emotional loss. This paper focuses on the devastation caused by pandemics especially in the Ganges deltaic plains of India. Through selected texts of 20th century Hindi writers – Munshi Premchand, Phanishwar Nath Renu, Suryakant Tripathi Nirala, Bhagwan Das, Harishankar Parsai, Pandey Bechan Sharma – this paper aims to bring forth the suffering and struggles against violence, social injustices and public health crises in India during waves of epidemics and pandemics when millions died as they tried to combat the rampant diseases.

U radu se na temelju brojnih arhivskih izvora, novina te liječničkih zapisa promatraju i analiziraju epidemije kolere u Dalmaciji sredinom 19. stoljeća. Razmatra se razina saznanja o bolesti i protuepidemijske mjere, napose njihova učinkovitost te aktualnost s obzirom na postojeće i rastuće rasprave o etiologiji bolesti. U drugom dijelu rada kao primjer slučaja analizirana je epidemija kolere u Zadru 1849. godine. Na temelju zapisa o koleri u matičnim knjigama umrlih u Zadru prikazuje se broj, dobna, spolna i društvena struktura umrlih., Based on numerous archival sources, newspapers, and medical records, this paper discusses and analyses cholera epidemics in Dalmatia in the mid-19th century. The level of knowledge about the disease and the anti-epidemic measures has been considered, especially their effectiveness and topicality in view of the existing and growing discussions about the aetiology of diseases. In the second part of the paper, the cholera epidemic in Zadar in 1849 has been analysed as a case study. Records of cholera in the registers of deaths in Zadar allow us to estimate the number and age, gender, and social structure of deaths. The epidemic lasted three months and took 62 lives. It affected both men and women, and all age groups, especially the fertile one. Given the aetiology of the disease, the most endangered and most severely affected by the epidemic were the individuals of lower social and financial status, whose living and business conditions favoured a faster, stronger, and more intensive development of the disease.