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Purpose: Waterborne pathogens pose a significant threat to public health, emphasizing the continuous necessity for advancing robust detection techniques, particularly in preventing outbreaks associated with these pathogens. This study focuses on cholera, an infectious disease caused by Vibrio cholerae, serogroups O1 and O139, often transmitted through contaminated water and food, raising significant public health concerns in areas with poor sanitation and limited access to clean water. Methods: We developed a colorimetric biosensor using aptamer-functionalized gold nanoparticles to identify Vibrio cholerae O139 and address this issue. The detection mechanism relies on the color change of gold nanoparticles (AuNPs) from red to blue-purple induced by NaCl after the pathogen incubation and aptamer-target binding. Initial steps involved synthesizing and characterizing AuNPs, then exploring the impact of aptamer and NaCl concentrations on AuNP agglomeration. Optimization procedures for aptamer concentration and salt addition identified the optimal conditions for detection as 120 pM aptamers and 1 M NaCl. Results: The aptasensor demonstrated a robust linear relationship, detecting V. cholerae concentrations from 103 to 108 CFU/mL, with a limit of detection (LOD) of 587 CFU/mL. Specificity tests and accurate sample analyses confirmed the efficiency of the AuNPs aptasensor, showcasing its reliability and speed compared to traditional culture examination methods. Moreover, we extended the aptasensor to a paper-based sensing platform with similar detection principles. Conclusion: The change in color upon target binding was captured with a smartphone and analyzed using image processing software. The paper-based device detected the target in less than 2 min, demonstrating its convenience for on-field applications. [ABSTRACT FROM AUTHOR]

Cholera is an acute diarrheal disease caused by Vibrio cholera, its prevalence occurs in almost all the continents of the world, annually there are about 1.3 to 4.0 million cases of cholera and 21, 000 to 143, 000 deaths worldwide. In this paper, we propose a deterministic model for the transmission dynamics of cholera to assess the impact of vaccines in decreasing the spread of cholera infection in Nigeria. Moreover, we develop an optimal control strategy, in which we consider personal hygiene a control strategy on infection class, with u(t) as the control function. The best values of the fitting parameters have been obtained using least square minimization to validate the model with the help of experimental data obtained from Nigeria. We perform sensitivity analysis to determine the key parameters that have impacts on the control of the spread of cholera infections in the population. In addition, the numerical simulation of the model reveals that the use of vaccines and personal hygiene will effectively control the spread of cholera infection. [ABSTRACT FROM AUTHOR]

In this paper, a metapopulation model has been developed and analysed to describe the transmission dynamics of cholera between two communities linked by migration, in the presence of an imperfect vaccine and a varying media awareness impact. Stability analysis shows that the disease-free equilibrium is both locally and globally asymptotically stable when the vaccine reproduction number is less than unity. The endemic equilibria have also been shown to be locally asymptotically stable when the vaccine reproduction number is greater than unity. The simulation results show that with an imperfect vaccine and efficient media awareness, cholera transmission is reduced. The transmission rates have also been shown to be nonidentical in the two communities. It is therefore advisable, that health practitioners embrace the use of both vaccination and media awareness when designing and implementing community-specific cholera intervention strategies. [ABSTRACT FROM AUTHOR]

In this paper, we propose a stochastic cholera model that incorporates media coverage and two time delays driven by Lévy noise in order to deeply understand the propagation process of cholera in the real world, generalized nonlinear incidence rates β1(M) and β2(M) are also introduced. First, we discuss the existence and uniqueness of the global positive solution of the stochastic model by using the Lyapunov method. Moreover, the dynamic properties of stochastic solution around the disease-free and endemic equilibria are demonstrated. At last, we present numerical simulation results to reveal how Lévy jumps, time delays and media coverage affect the asymptotic properties of the stochastic model. [ABSTRACT FROM AUTHOR]

In this paper, we propose and analyze a coupled disease‐economic model to study the impact of poverty on cholera outbreaks. We consider the stock of capital per effective units of labor, reflecting the effect of the stock of capital on cholera outbreak and transmission. The system has positive bounded solutions. We show that the disease‐free equilibrium is globally asymptotically stable whenever R01≤1$$ {\mathcal{R}}_{01}\le 1 $$, while when R01>1$$ {\mathcal{R}}_{01}>1 $$, the disease‐free equilibrium is unstable. The sensitivity analysis of the model has been performed in order to determine the impact of related parameters on outbreak severity. We further study various cases for the investment rate upon critical value of the investment in order to describe the effect of poverty on the infected individuals over time. The results we obtained show that increasing of the stock of capital per effective units of labor and the implementation of strategies combining awareness programs and therapeutic treatments will reduce the proportion of the infected population. To verify our analytical results, the numerical simulations on the model are performed. [ABSTRACT FROM AUTHOR]

Cholera, caused by Vibrio cholerae , is a severe diarrheal disease that necessitates prompt diagnosis and effective treatment. This review comprehensively examines various diagnostic methods, from traditional microscopy and culture to advanced nucleic acid testing like polymerase spiral reaction and rapid diagnostic tests, highlighting their advantages and limitations. Additionally, we explore evolving treatment strategies, with a focus on the challenges posed by antibiotic resistance due to the activation of the SOS response pathway in V. cholerae. We discuss promising alternative treatments, including low-pressure plasma sterilization, bacteriophages, and selenium nanoparticles. The paper emphasizes the importance of multidisciplinary approaches combining novel diagnostics and treatments in managing and preventing cholera, a persistent global health challenge. The current re-emergent 7th pandemic of cholera commenced in 1961 and shows no signs of abeyance. This is probably due to the changing genetic profile of V. cholerae concerning bacterial pathogenic toxins. Given this factor, we argue that the disease is effectively re-emergent, particularly in Eastern Mediterranean countries such as Lebanon, Syria, etc. This review considers the history of the current pandemic, the genetics of the causal agent, and current treatment regimes. In conclusion, cholera remains a significant global health challenge that requires prompt diagnosis and effective treatment. Understanding the history, genetics, and current treatments is crucial in effectively addressing this persistent and re-emergent disease. [ABSTRACT FROM AUTHOR]

In this paper, we consider a reaction-diffusion cholera model with hyperinfectious vibrios and spatio-temporal delay. In the model, it is assumed that cholera has a fixed latent period and the latent individuals can diffuse, and a non-local term is incorporated to describe the mobility of individuals during the latent period. It is shown that the existence and nonexistence of traveling wave solutions are fully determined by the basic reproduction number R 0 and the critical wave speed c*. Firstly, when R 0 > 1 and the wave speed c > c*, the existence of strong traveling waves is obtained by using Schauder's fixed point theorem and Lyapunov functional approach. By employing a limiting argument, the existence of strong traveling waves is established when R 0 > 1 and c = c*. Next, when R 0 ≤ 1 , the nonexistence of traveling wave solutions is established by contradiction. Besides, when R 0 > 1 and c < c*, the nonexistence of traveling wave solutions is obtained by means of two-sided Laplace transform. This indicates that c* is indeed the minimal wave speed. Numerical simulations are carried out to illustrate the theoretical results. [ABSTRACT FROM AUTHOR]

Cholera is a global epidemic infectious disease that seriously endangers human life. It is disturbed by random factors in the process of transmission. Therefore, in this paper, a class of stochastic SIRB cholera model with Ornstein–Uhlenbeck process is established. On the basis of verifying that the model exists a unique global solution to any initial value, a sufficient criterion for the existence of a stationary distribution of the positive solution of the random model is established by constructing an appropriate random Lyapunov function. Furthermore, under the same condition that there is a stationary distribution, the specific expression of the probability density function of the random model around the positive equilibrium point is calculated. Finally, the theoretical results are verified by numerical model. [ABSTRACT FROM AUTHOR]

Background: An outbreak of cholera was reported in the Middle East by the second half of 2022. Raising public awareness and vaccination against cholera represent critical factors in the preventive efforts. The current study aimed to assess the knowledge of cholera and attitude towards its vaccination among a sample of the general public residing in Jordan. Methods: An online self-administered questionnaire was distributed to the residents in Jordan using a snowball convenience-based sampling approach. The questionnaire based on previously published studies included items to evaluate sociodemographic variables, knowledge about cholera symptoms, transmission, and prevention and the willingness to accept cholera vaccination. Additionally, four items based on the validated 5 C scale in Arabic were included to assess the psychological factors influencing attitude to cholera vaccination. Results: The final study sample comprised 1339 respondents, of whom 1216 (90.8%) heard of cholera before the study. Among those who heard of cholera, and on a scale from 0 to 20, the overall mean cholera Knowledge score (K-score) was 12.9 ± 3.8. In multivariate analysis, being over 30 years old and occupation as healthcare workers or students in healthcare-related colleges were significantly associated with a higher K-score compared to younger individuals and students in non-healthcare-related colleges. Overall, the acceptance of cholera vaccination if cases are recorded in Jordan, and if the vaccine is safe, effective, and provided freely was reported among 842 participants (69.2%), while 253 participants were hesitant (20.8%) and 121 participants were resistant (10.0%). In linear regression, the significant predictors of cholera vaccine acceptance were solely the three psychological factors namely high confidence, low constraints, and high collective responsibility. Conclusions: In this study, the identified gaps in cholera knowledge emphasize the need to enhance educational initiatives. Although cholera vaccine acceptance was relatively high, a significant minority of the respondents exhibited vaccination hesitancy or resistance. The evident correlation between the psychological determinants and attitudes toward cholera vaccination emphasizes the need to consider these factors upon designing public health campaigns aimed at cholera prevention. The insights of the current study highlight the importance of addressing both knowledge gaps and psychological barriers to optimize cholera control strategies. [ABSTRACT FROM AUTHOR]

Malawi experienced its deadliest Vibrio cholerae (Vc) outbreak following devastating cyclones, with >58,000 cases and >1700 deaths reported between March 2022 and May 2023. Here, we use population genomics to investigate the attributes and origin of the Malawi 2022–2023 Vc outbreak isolates. Our results demonstrate the predominance of ST69 clone, also known as the seventh cholera pandemic El Tor (7PET) lineage, expressing O1 Ogawa (~ 80%) serotype followed by Inaba (~ 16%) and sporadic non-O1/non-7PET serogroups (~ 4%). Phylogenetic reconstruction revealed that the Malawi outbreak strains correspond to a recent importation from Asia into Africa (sublineage AFR15). These isolates harboured known antimicrobial resistance and virulence elements, notably the ICEGEN/ICEVchHai1/ICEVchind5 SXT/R391-like integrative conjugative elements and a CTXφ prophage with the ctxB7 genotype compared to historical Malawian Vc isolates. These data suggest that the devastating cyclones coupled with the recent importation of 7PET serogroup O1 strains, may explain the magnitude of the 2022–2023 cholera outbreak in Malawi. Malawi experienced a large cholera outbreak in 2022-2023 that was associated with high morbidity and mortality and distributed across all 29 districts of the country. This study describes the epidemiological and genomic features of the outbreak and attempts to understand the reasons for its severity. [ABSTRACT FROM AUTHOR]

In this study, a cholera infection model with a bilinear infection rate is developed by considering the perturbation of the infection rate by the mean-reverting process. First of all, we give the existence of a globally unique positive solution for a stochastic system at an arbitrary initial value. On this basis, the sufficient condition for the model to have an ergodic stationary distribution is given by constructing proper Lyapunov functions and tight sets. This indicates in a biological sense the long-term persistence of cholera infection. Furthermore, after transforming the stochastic model to a relevant linearized system, an accurate expression for the probability density function of the stochastic model around a quasi-endemic equilibrium is derived. Subsequently, the sufficient condition to make the disease extinct is also derived. Eventually, the theoretical findings are shown by numerical simulations. Numerical simulations show the impact of regression speed and fluctuation intensity on stochastic systems. [ABSTRACT FROM AUTHOR]

Background: Developing nations have to overcome a number of obstacles to fulfill the Sustainable Development Goals. The Democratic Republic of Congo is one of the five poorest nations in the world and faces several challenges in combating problems related to poverty, health, and sanitation while linking the environment to anthropogenic activities. Methods: This study analyzes anthropogenic activities and their impact on the environment while providing access to the public health of the Congolese population based on the objectives of sustainable development. Thirty‐five articles were selected for further analysis as well as relative data. Results: In 2022, 21 million cases of malaria were recorded by the national malaria control program, with 13,000 cases of death. The Democratic Republic of Congo has the highest typhoid incidence, with 315 cases per 100,000 people. A number of 31,342 cases of cholera were reported in 2023, according to multiple reports, with 230 deaths, mainly affecting children. In the same year, a triple epidemic of typhoid, shigellosis, and cholera was identified, with 2389 cases and 52 deaths. These observations cause a health emergency, which can be alleviated and resolved by the establishment of an adequate sanitation system. Waste can be recycled and returned to usable raw materials. Conclusion: Finally, it will be necessary to establish a water safety management plan to combat all diseases linked to the consumption of nonpotable water and improve national coverage on the treatment of recent cases to reduce and at best avoid observed cases of death. [ABSTRACT FROM AUTHOR]

The paper presents an analysis and assessment of risks of complication of epidemiological situation regarding cholera in the Russian Federation and a forecast for 2024. It briefly characterizes the dynamics of the epidemic process around the world during the last decade (2013–2022). The forecast of cholera importation into the Russian Federation, due to activity of the epidemic process in endemic countries, has been confirmed. In 2023, two cases of cholera importation from India were reported. It was established that the toxigenic strains isolated from patients belonged to the currently dominant in the world “post-Haitian” group, including in India and Bangladesh, with the genotype ctxB7 tcpACIRS rtxA4a VSP-IIΔ0495-0512. Furthermore, non-toxigenic Vibrio cholerae O1 strains were isolated from samples of biological material from persons arriving from India, containing preCTX prophage and distinct from the strain (ctxAB– tcpAEТ–) isolated from a patient with acute intestinal infection (Zaporozhye Region, Melitopol). Nontoxigenic NAG vibrios were isolated from 13 patients with acute intestinal infections, which is 1.9 times more than in 2022. Regardless of importations, a strain of V. cholerae O1 (ctxB1+tcpAEТ) of the “pre-Haitian” group was isolated from a water sample of a surface reservoir. 52 non-toxigenic V. сholerae O1 strains were found on the territory of 11 constituent entities of the Russian Federation, which is 18.9 % more than in 2022. In 2024, epidemiological risks of cholera importation from endemic countries to any administrative territory of the Russian Federation remain. The risks of epidemic manifestations of cholera are especially high in the territories of the constituent entities of the Russian Federation which are under ongoing emergency, due to migration processes, and the impact of other risk-forming factors that contribute to an increase in the degree of contact of the population with water bodies contaminated with cholera vibrios. If epidemic foci of cholera are to emerge in a neighboring country, there will be a high probability of spread of this infection in the stated constituent entities of the Russian Federation and in other territories of southern Russia. In the absence of epidemic manifestations of cholera, the possibility of occasional detection of toxigenic O1 serogroup strains in water samples due to unidentified introductions from cholera-affected areas cannot be ruled out.

In Bangladesh, cholera poses a significant environmental health risk. Yet, information about the severity of cholera risk is limited as risk varies over time and changing weather patterns make historical cholera risk predictions less reliable. In this paper, we examine how households use geographically and temporally personalized cholera risk predictions to inform their beliefs and behaviors related to cholera and its aversion. We estimate how access to a smartphone application containing monthly cholera risk predictions unique to a user's home location affects households' beliefs about their cholera risk and their water use and hygiene behaviors. We find that households with access to this application feel more equipped to respond to environmental and health risks and reduce their reliance on surface water for bathing and washing – a common cholera transmission pathway. We do not find that households invest additional resources into drinking water treatment, nor do we find reductions in self-reported cholera incidence. Further, households with a static, non-personalized app containing public health information about cholera exhibit similar patterns of beliefs updating. Taken together, our results suggest that access to risk information can help households make safer water choices, yet improving design and credibility remain important dimensions for increasing application usability. • Satellite observations provide improved information for cholera risk. • Households in rural Bangladesh find improved information for cholera risk valuable. • Dynamic, personalized cholera risk information can change household water behaviors. • Households with a cholera early warning system reduce reliance on surface water. • Early warning system design affects sustained application use. [ABSTRACT FROM AUTHOR]

Introduction: Despite several interventions on the control of cholera, it still remains a significant public health problem in Africa. According to the World Health Organization, 251,549 cases and 4,180 deaths (CFR: 2.9%) were reported from 19 African countries in 2023. Tools exist to enhance the surveillance of cholera but there is limited evidence on their deployment and application. There is limited evidence on the harmonization of the deployment of tools for the evaluation of cholera surveillance. We systematically reviewed available literature on the deployment of these tools in the evaluation of surveillance systems in Africa. Method: Three electronic databases (PubMed, Medline and Embase) were used to search articles published in English between January 2012 to May 2023. Grey literature was also searched using Google and Google Scholar. Only articles that addressed a framework used in cholera surveillance in Africa were included. The quality of articles was assessed using the appropriate tools. Data on the use of surveillance tools and frameworks were extracted from articles for a coherent synthesis on their deployment. Result: A total of 13 records (5 frameworks and 8 studies) were fit for use for this study. As per the time of the study, there were no surveillance frameworks specific for the evaluation of surveillance systems of cholera in Africa, however, five frameworks for communicable diseases and public health events could be adapted for cholera surveillance evaluation. None (0%) of the studies evaluated capacities on cross border surveillance, multisectoral one health approach and linkage of laboratory networks to surveillance systems. All (100%) studies assessed surveillance attributes even though there was no synergy in the attributes considered even among studies with similar objectives. There is therefore the need for stakeholders to harmoniously identify a spectrum of critical parameters and attributes to guide the assessment of cholera surveillance system performance. [ABSTRACT FROM AUTHOR]

At the beginning of the initial cholera outbreak in China, Wang Qingren, after years of clinical trials, became an early representative who discovered the infectious characteristics and observed the course of cholera in the field of traditional Chinesse medicine (TCM). Kou Langa and Xu Zimo both medical practitioners, constructed a diagnosis and treatment system for cholera with cold patterns under the theory of typhoid. They represented "School of Cholera with Cold Patterns" (SCCP). In the 1860s, with the influence of Wang Shixiong's studies on the nature of cholera under the theory of epidemic febrile disease, the "School of Cholera with Heated Patterns" (SCHP) prevailed thereafter. The two schools complemented each other in theories and contributed to the integrity of TCM in cholera diagnosis and treatment. By reviewing previous literature, books, clinical cases, and historical materials in medical field, this article aims 1) to summarise the influence of TCM on the cognitive development towards cholera in the late Qing dynasty; 2) to explore the origin of the controversy between SCCP and SCHP from historical evidence; 3) to summarize the historical lessons from the debate over cholera in TCM based on the principle of treatment based on pattern identification, and offer suggestions for the current prevention and treatment of new diseases using TCM. [ABSTRACT FROM AUTHOR]

Countries are currently negotiating a new global health treaty in response to the Covid-19 pandemic. This treaty is expected to address future pandemics and is different from previous health treaties due to the nature of fast-emerging and unknown diseases. The scope of the treaty is broader and needs to be embedded in existing international law on trade, environment, and human rights. The process of negotiating this treaty is more complex and involves a larger number of countries and diverse perspectives. The negotiations are also happening alongside amendments to the existing International Health Regulations. The future of global health security depends on finding a balance between the pandemic treaty and the International Health Regulations. The negotiations involve new ways of engagement, such as hybrid meetings and the formation of cross-regional interest groups. Additionally, international mechanisms related to the pandemic, such as the International Pathogen Surveillance Network and the Global Health Emergency Corps, have been established during the negotiations. These mechanisms may need to be integrated into the final treaty. [Extracted from the article]

In this study, we develop a comprehensive mathematical model to analyze the dynamics of epidemic cholera, characterized by acute diarrhea due to pathogen overabundance in the human body. The model is first developed from a deterministic point of view, and then it is modified to include the randomness by stochastic differential equations. The study selected Lévy noise above other well-known types of noise, emphasizing its importance in epidemic modeling. Besides presenting a biological justification for the stochastic system, we demonstrate that the equivalent deterministic model exhibits possible equilibria. The introduction is followed by theoretical analysis of the model. Through rigorous analysis, we establish that the stochastic model ensures a unique global solution. Lyapunov function theory is applied to construct necessary conditions, which on average, guarantee the model's stability for R 0 s > 1 . Our findings suggest the likelihood of eradicating the disease when R s is below one, a significant insight supported by graphical simulations of the model. Graphical illustrations were generated from simulating the model in order to increase the analytical results' robustness. This work provides a strong theoretical framework for a thorough comprehension of a range of such diseases. This research not only provides a deeper understanding of cholera dynamics but also offers a robust theoretical framework applicable to a range of similar diseases, alongside a novel approach for constructing Lyapunov functions for nonlinear models with random disturbances. [ABSTRACT FROM AUTHOR]

Bacteria in the genus Vibrio are ubiquitous in estuarine and coastal waters. Some species (including Vibrio cholerae and Vibrio vulnificus) are known human pathogens causing ailments like cholera, diarrhea, or septicemia. Notably, V. vulnificus can also cause a severe systemic infection (known as vibriosis) in eels raised in aquaculture facilities. Water samples were periodically collected from the estuary of the Asahi River, located in the southern part of Okayama City, Japan. These samples were directly plated onto CHROMagar Vibrio plates, and colonies displaying turquoise-blue coloration were selected. Thereafter, polymerase chain reaction was used to identify V. cholerae and V. vulnificus. A total of 30 V. cholerae strains and 194 V. vulnificus strains were isolated during the warm season when the water temperature (WT) was higher than 20 °C. Concurrently, an increase in coliforms was observed during this period. Notably, V. vulnificus has two genotypes, designated as genotype 1 and genotype 2. Genotype 1 is pathogenic to humans, while genotype 2 is pathogenic to both humans and eels. The loop-mediated isothermal amplification method was developed to rapidly determine genotypes at a low cost. Of the 194 strains isolated, 80 (41.2%) were identified as genotype 1 strains. Among the 41 strains isolated when the WTs were higher than 28 °C, 25 strains (61.0%) belonged to genotype 1. In contrast, of the 32 strains isolated when the WTs were lower than 24 °C, 27 strains (84.4%) belonged to genotype 2. These results suggest that the distribution of the two genotypes was influenced by WT. [ABSTRACT FROM AUTHOR]

Background: Mozambique is one of the countries in Africa that is continuously at risk of cholera outbreaks due to poor sanitation, hygiene, and limited access to potable water in some districts. The Mozambique Cholera Prevention and Surveillance (MOCA) project was implemented in Cuamba District, Niassa Province to prevent and control cholera outbreaks through a preemptive cholera vaccination, strengthened surveillance system for cholera and diarrheal diseases, and better understanding of cholera-related healthcare seeking behavior of local populations, which may further guide the national cholera control and prevention strategies. This article presents the surveillance component of the MOCA project. Methodology/Principal findings: A prospective healthcare facility (HCF)-based surveillance of cholera and diarrheal disease was conducted in six HCFs in the District of Cuamba from March 2019 to December 2020. A systematic surveillance procedure has been put in place with capacity building in selected sentinel HCFs and a basic microbiology laboratory established on-site. Patients presenting with suspected cholera or other diarrheal symptoms were eligible for enrollment. Clinical data and rectal swab samples were collected for laboratory confirmation of Vibrio Cholerae and other pathogens. A total of 419 eligible patients from six HCFs were enrolled. The median age was 19.8 years with a similar age distribution between sentinel sites. The majority were patients who exhibited diarrhea symptoms not suspected of cholera (88.8%; n = 410). Among those, 59.2% (210/397) were female and 59.9% (235/392) were 15 years and above. There were 2 cholera cases, coming outside of the catchment area. The incidence of diarrheal diseases ranged from 40–103 per 100,000 population. No Vibrio cholerae was isolated among surveillance catchment population and Escherichia coli spp. (82/277; 29.6%) was the most common pathogen isolated. Conclusion/Significance: Efforts were made to strengthen the systematic surveillance of suspected cholera with standardised patient screening, enrolment, and diagnostics. The first basic microbiology laboratory in Niassa Province established in Cuamba District under the MOCA project needs to be integrated into the national network of laboratories for sustainability. No reports of laboratory confirmed cholera cases from the surveillance catchment area may be highly related to the pre-emptive oral cholera vaccine (OCV) mass vaccination campaign conducted in 2018 and the use of drugs by local populations prior to visiting the sentinel HCFs. Continued systematic cholera surveillance is needed to closely monitor the cholera endemicity and epidemics, and further evaluate the long-term impact of this vaccination. High incidence of diarrheal illnesses needs to be addressed with improved water, sanitation, and hygiene (WaSH) conditions in Cuamba District. Efforts integrated with the prioritization of prevention measures are fundamental for the control of cholera in the country. Author summary: Mozambique faces an ongoing risk of cholera outbreaks, due to factors such as poor sanitation and limited access to clean and potable water. To address this challenge, the Mozambique Cholera Prevention and Surveillance (MOCA) project was launched in one of the high-risk areas, Cuamba District, Niassa Province, in 2018. This initiative was an integral part of Mozambique's efforts to develop a comprehensive National Cholera Plan, aiming to bolster cholera and diarrheal disease surveillance and inform national prevention strategies. Under the MOCA project, we conducted a preemptive oral cholera vaccine (OCV) mass vaccination campaign in 2018 and implemented a healthcare facility-based surveillance for cholera and diarrheal diseases in six healthcare facilities in Cuamba District. A systematic cholera surveillance system was put in place in the study sentinel sites with standardised patient screening, enrolment, and diagnostic procedures. The first basic microbiology laboratory in Niassa province was established in Cuamba District in 2018 with funding and technical support made available under this MOCA project. A significant portion of patients in our surveillance system exhibited diarrheal symptoms unrelated to cholera, with a notable representation of females and individuals aged 15 years and older during the surveillance period in 2019–2020. No suspected cholera patients enrolled was laboratory-confirmed with Vibrio cholerae, which may be highly related to the cholera vaccination campaign performed in 2018 and the local populations' tendency on the use of drugs before seeking healthcare at the HCFs. Continued surveillance is recommended to track cholera endemicity and outbreaks and also to assess the long-term impact of OCV vaccination in Cuamba District. Better infrastructure and practice of WaSH is needed to reduce the high incidence of diarrheal illnesses in the local populations. Sustainable technical and financial support is needed in the rural remote areas of Cuamba District for the continued systematic cholera and infectious disease surveillance system, including laboratory confirmation. Integrating these efforts with preventive measures is crucial for effective cholera control in Mozambique. [ABSTRACT FROM AUTHOR]

Public health decisions must be made about when and how to implement interventions to control an infectious disease epidemic. These decisions should be informed by data on the epidemic as well as current understanding about the transmission dynamics. Such decisions can be posed as statistical questions about scientifically motivated dynamic models. Thus, we encounter the methodological task of building credible, data-informed decisions based on stochastic, partially observed, nonlinear dynamic models. This necessitates addressing the tradeoff between biological fidelity and model simplicity, and the reality of misspecification for models at all levels of complexity. We assess current methodological approaches to these issues via a case study of the 2010-2019 cholera epidemic in Haiti. We consider three dynamic models developed by expert teams to advise on vaccination policies. We evaluate previous methods used for fitting these models, and we demonstrate modified data analysis strategies leading to improved statistical fit. Specifically, we present approaches for diagnosing model misspecification and the consequent development of improved models. Additionally, we demonstrate the utility of recent advances in likelihood maximization for high-dimensional nonlinear dynamic models, enabling likelihood-based inference for spatiotemporal incidence data using this class of models. Our workflow is reproducible and extendable, facilitating future investigations of this disease system. Author summary: Quantitative understanding of infectious disease transmission dynamics relies upon mathematical models informed by scientific knowledge and relevant data. The models aim to provide a statistical description of the trajectory of an epidemic and its uncertainty, together with a representation of the underlying biological mechanisms. Evaluation of success at these goals is necessary in order for a model to provide a reliable tool for guiding evidence-based public policy interventions. In this article, we conduct a re-analysis of the 2010–2019 cholera outbreak in Haiti. We use this case study to investigate current procedures for fitting mechanistic models to time series data, while identifying limitations of these methodologies and proposing remedies. Our analysis presents methodology for diagnosing how well a model describes observed data. Using objective measures to assess model fit ensures that our evaluation is based on quantifiable criteria. Incorporating reproducibility into this assessment results in a framework that enables the validation or refinement of model based inferences when revisiting the data, facilitating scientific discovery. Our data analysis workflow is supported by recent advances in algorithms, software and hardware, which facilitate statistical fitting of nonlinear stochastic dynamic models to observed incidence data. However, inference for high-dimensional systems remains a methodological challenge. One of the models under consideration involves spatially coupled stochastic meta-populations, and we demonstrate how a recently developed algorithm permits likelihood-based inference and model diagnostics in this setting. We contend that raising the currently accepted standards of infectious disease modeling will result in a greater ability of scientists and policy makers to understand and respond to future infectious disease outbreaks. [ABSTRACT FROM AUTHOR]

Controlled human infection models are important tools for the evaluation of vaccines against diseases where an appropriate correlate of protection has not been identified. Enterotoxigenic Escherichia coli (ETEC) strain LSN03-016011/A (LSN03) is an LT enterotoxin and CS17-expressing ETEC strain useful for evaluating vaccine candidates targeting LT-expressing strains. We sought to confirm the ability of the LSN03 strain to induce moderate-to-severe diarrhea in a healthy American adult population, as well as the impact of immunization with an investigational cholera/ETEC vaccine (VLA-1701) on disease outcomes. A randomized, double-blinded pilot study was conducted in which participants received two doses of VLA1701 or placebo orally, one week apart; eight days after the second vaccination, 30 participants (15 vaccinees and 15 placebo recipients) were challenged with approximately 5 × 109 colony-forming units of LSN03. The vaccine was well tolerated, with no significant adverse events. The vaccine also induced serum IgA and IgG responses to LT. After challenge, 11 of the placebo recipients (73.3%; 95%CI: 48.0–89.1) and 7 of the VLA1701 recipients (46.7%; 95%CI: 24.8–68.8) had moderate-to-severe diarrhea (p = 0.26), while 14 placebo recipients (93%) and 8 vaccine recipients (53.3%) experienced diarrhea of any severity, resulting in a protective efficacy of 42.9% (p = 0.035). In addition, the vaccine also appeared to provide protection against more severe diarrhea (p = 0.054). Vaccinees also tended to shed lower levels of the LSN03 challenge strain compared to placebo recipients (p = 0.056). In addition, the disease severity score was lower for the vaccinees than for the placebo recipients (p = 0.046). In summary, the LSN03 ETEC challenge strain induced moderate-to-severe diarrhea in 73.3% of placebo recipients. VLA1701 vaccination ameliorated disease severity, as observed by several parameters, including the percentage of participants experiencing diarrhea, as well as stool frequency and ETEC severity scores. These data highlight the potential value of LSN03 as a suitable ETEC challenge strain to evaluate LT-based vaccine targets (NCT03576183). [ABSTRACT FROM AUTHOR]

John Snow, the London doctor who studied cholera in the 1840s and 1850s, argued in Snow (1856) that water exerted an "overwhelming influence" on mortality in a region of south London during the 1854 outbreak. In a paper re-assessing Snow's analysis, Koch and Denike (2006) claim that "Snow made not merely minor arithmetic errors but more importantly critical, conceptual mistakes that adversely affected his results." The claim of errors and mistakes is incorrect and due to a misreading or misunderstanding of Snow's data and analysis. Koch and Denike apply an inappropriate statistical test to Snow's original data (and do so incorrectly). More importantly, due to the misreading of the historical record they alter the underlying primary-source data, rendering their results invalid. Analysis of the data following Snow's approach but with modern statistical tools strongly supports Snow's claim for the primacy of water in accounting for variation in cholera mortality. • Review a 2006 critique of John Snow's methodology in his 1856 analysis of south London. • Apply modern statistical techniques to re-examine John Snow's south London analysis. • Conclude that Snow's work did not suffer from the claimed methodological problems. • Support and confirm Snow's conclusion that water had an overwhelming effect on mortality. [ABSTRACT FROM AUTHOR]

We previously established the selection-marker-free rice-based oral cholera vaccine (MucoRice-CTB) line 51A for human use by Agrobacterium-mediated co-transformation and conducted a double-blind, randomized, placebocontrolled phase I trial in Japan and the United States. Although MucoRice-CTB 51A was acceptably safe and well tolerated by healthy Japanese and U.S. subjects and induced CTB-specific antibodies neutralizing cholera toxin secreted by Vibrio cholerae, we were limited to a 6-g cohort in the U.S. trial because of insufficient production of MucoRice-CTB. Since MucoRice-CTB 51A did not grow in sunlight, we re-examined the previously established marker-free lines and selected MucoRice-CTB line 19A. Southern blot analysis of line 19A showed a single copy of the CTB gene. We resequenced the whole genome and detected the transgene in an intergenic region in chromosome 1. After establishing a master seed bank of MucoRice-CTB line 19A, we established a hydroponic production facility with LED lighting to reduce electricity consumption and to increase production capacity for clinical trials. Shotgun MS/MS proteomics analysis of MucoRice-CTB 19A showed low levels of a-amylase/trypsin inhibitor-like proteins (major rice allergens), which was consistent with the data for line 51A. We also demonstrated that MucoRice-CTB 19A had high oral immunogenicity and induced protective immunity against cholera toxin challenge in mice. These results indicate that MucoRice-CTB 19A is a suitable oral cholera vaccine candidate for Phase I and II clinical trials in humans, including a V. cholerae challenge study. [ABSTRACT FROM AUTHOR]

Cholera continues to be a global health threat. Understanding how cholera spreads between locations is fundamental to the rational, evidence-based design of intervention and control efforts. Traditionally, cholera transmission models have used cholera case-count data. More recently, whole-genome sequence data have qualitatively described cholera transmission. Integrating these data streams may provide much more accurate models of cholera spread; however, no systematic analyses have been performed so far to compare traditional case-count models to the phylodynamic models from genomic data for cholera transmission. Here, we use high-fidelity case-count and whole-genome sequencing data from the 1991 to 1998 cholera epidemic in Argentina to directly compare the epidemiological model parameters estimated from these two data sources. We find that phylodynamic methods applied to cholera genomics data provide comparable estimates that are in line with established methods. Our methodology represents a critical step in building a framework for integrating case-count and genomic data sources for cholera epidemiology and other bacterial pathogens. [ABSTRACT FROM AUTHOR]

effective public health planning and intervention strategies. This study presents a comprehensive analysis of the spatiotemporal distribution of disease incidences in Ethiopia, focusing on six major diseases: Malaria, Meningitis, Cholera and Dysentery, over the period from 2010 to 2022, whereas Dengue Fever and Leishmaniasis from 2018 to 2023. Methods Using data from Ethiopian public health institute: public health emergency management (PHEM), and Ministry of Health, we examined the occurrence and spread of each disease across different regions of Ethiopia. Spatial mapping and time series analysis were employed to identify hotspots, trends, and seasonal variations in disease incidence. Results The findings reveal distinct patterns for each disease, with varying cases and temporal dynamics. Monthly wise, Malaria exhibits a cyclical pattern with a peak during the rainy and humid season, while Dysentery, Meningitis and Cholera displays intermittent incidences. Dysentery cases show a consistent presence throughout the years, while Meningitis remains relatively low in frequency but poses a potential threat due to its severity. Dengue fever predominantly occurs in the eastern parts of Ethiopia. A significant surge in reported incident cases occurred during the years 2010 to 2013, primarily concentrated in the Amhara, Sidama, Oromia, Dire Dawa, and Benishangul-Gumuz regionsConclusions This study helps to a better understanding of disease epidemiology in Ethiopia and can serve as a foundation for evidence-based decision-making in disease prevention and control. By recognizing the patterns and seasonal changes associated with each disease, health authorities can implement proactive measures to mitigate the impact of outbreaks and safeguard public health in the region. [ABSTRACT FROM AUTHOR]

The Type VI Secretion System (T6SS) is a widespread and highly effective mechanism of microbial warfare; it confers the ability to efficiently kill susceptible cells within close proximity. Due to its large physical size, complexity, and ballistic basis for intoxication, it has widely been assumed to incur significant growth costs in the absence of improved competitive outcomes. In this study, we precisely examine the fitness costs of constitutive T6SS firing in the bacterium Vibrio cholerae. We find that, contrary to expectations, constitutive expression of the T6SS has a negligible impact on growth, reducing growth fitness by 0.025 ± 0.5% (95% CI) relative to a T6SS− control. Mathematical modeling of microbial populations demonstrates that, due to clonal interference, constitutive expression of the T6SS will often be neutral, with little impact on evolutionary outcomes. Our findings underscore the importance of precisely measuring the fitness costs of microbial social behaviors and help explain the prevalence of the T6SS across Gram‐negative bacteria. [ABSTRACT FROM AUTHOR]

Our understanding of the burden and drivers of cholera mortality is hampered by limited surveillance and confirmation capacity. Leveraging enhanced clinical and laboratory surveillance in the cholera-endemic community of Uvira, eastern Democratic Republic of Congo, we describe cholera deaths across 3 epidemics between September 2021 and September 2023 following mass vaccination. [ABSTRACT FROM AUTHOR]

Introduction: Malnutrition is a public health problem in low- and middle-income countries among children. Although illnesses such as diarrhea are common immediate drivers of childhood malnutrition, their consequences could be averted through optimal sick child feeding and care to ensure the continuum of care. This study aimed to explore the lived experiences of mothers/caregivers on continuum of care to prevent malnutrition among children with cholera in Ethiopia. Methods: A phenomenology study design was applied to explore experiences of mothers/caregivers in the Bale and Guji zones of the Oromia region, southeast Ethiopia, from November to December 2022 using an unstructured interview guide. The saturation of ideas was used to stop the in-depth interview. Translated data were cleaned and imported into ATLAS.ti7 software for analysis. Using an open coding system, the data were coded into a meaningful context. Deeper immersion into data with repeated reading, creating themes, subthemes, and family/category were carried out. In coding and categorization, multiple coders were involved. The finding was presented using well-spoken verbatim/quotes as illustrations and in narratives. Results: In this qualitative study, ten participants were taken to explore their lived experience on the continuum of care for children with acute malnutrition and cholera. The study found that poverty, expensive cost of living, and poor utilization of diversified food were challenges. Moreover, health facilities did not provide any services to mothers whose child was admitted for malnutrition treatment. Children five years and above were excluded from both therapeutic food and screening for malnutrition program. Interruptions of supplies, low attention given to child feeding, inadequate knowledge, and lack of time to prepare diversified food were the main findings. Conclusion: Poverty, poor feeding habits, supplies interruption and non-inclusion of malnourished children five and above in screening for malnutrition and in the therapeutic feeding program is missed opportunities that lead to decreased early detection and treatment of malnutrition among children with cholera. Moreover, mothers/caregivers did not receive any service from health facilities when their child was admitted for treatment of malnutrition. This situation forces them to stop treatment before their child recovers from malnutrition, which has a negative impact on the continuum of care and prevention of malnutrition. Therefore, we strongly recommend strengthening emergency nutrition within the country's health system and revising the food and nutrition policy to incorporate emergency nutrition, with a particular focus on children under the age of fifteen. Additionally, it is important that the study's recommendations underscore the significance of a multi-sectoral approach that involves collaboration among the health sector, government agencies, and non-governmental organizations. Moreover, adaptive agricultural products be made easily accessible to the community which is crucial in effective preventing and reducing malnutrition in children in the study and similar settings. [ABSTRACT FROM AUTHOR]

This study investigates the confluence between accounting and natural disasters by examining the case of the cholera epidemic that occurred in Bologna in 1855, a city of the Papal States, where there was a strong (medical) intellectual class critical of the central government exercised by the Pope and clergy. We analysed primary and secondary sources available in Bologna in the Municipal Library of the Archiginnasio, State Archive, and Municipal Historical Archive to demonstrate how the accounting for and of the epidemic overturned the traditional power structures of the Papal States. Specifically, the medical establishment, leveraging the medical-administrative accounting technologies, replaced the clergy and local aristocracy as the governing body of the city, paving the way for the future secularisation of the administration. The study contributes to the literature by providing political implications of accounting technologies for natural disasters. [ABSTRACT FROM AUTHOR]

We build a new dataset covering 90 years of Cholera spreading in Hindustan from 1814 to 1904. We gather data from a collection of primary sources issued from medical reports. We propose a harmonization procedure to make these data comparable and corresponding to the current borders of India, Pakistan, Nepal, and Bangladesh. Our methodology is corroborated when comparing our newly produced data with other accounts, in particular Roger (1926)'s estimations. It opens the door to research aiming at estimating the effect of the successive waves of Cholera on the economic, social and epidemiological dynamics of the region. [ABSTRACT FROM AUTHOR]

In this article, a fractional-order epidemic model for cholera is proposed and analyzed. Two transmission routes for cholera are considered to develop the compartmental epidemic model. The basic biological properties of the solutions of the fractional-order model are investigated. The global asymptotic stability of the equilibrium points have been established using appropriate Lyapunov functional. Moreover, a fractional-order control problem is presented, and its analytical solution is derived using Pontryagin's maximum principle. Also, some graphical visualizations of the theoretical results are provided. It is found that the factional-order derivative only affect the time to reach the stationary states. Sensitivity analysis reveals that by reducing the rates of new recruitment and both the disease transmission rates, it may be possible to reduce the value of the basic reproduction number. [ABSTRACT FROM AUTHOR]

As lovers, we pretend perfect symmetry; the language of love is, however, essentially asymmetrical. Roland Barthes' A Lover's Discourse (1977) is a philosophical exploration of a lover's inner monologue in which the chaotic flux of emotions that spring from a lover's mind create the asymmetrical space of possibility. García Márquez's Love in The Time of Cholera is the tale of a melancholy passion that never rises into oblivion. Florentino Ariza, the protagonist who suffers without adjustment, reenacts in fiction Barthes's psychological mediation. By confronting his relation with time, in terms of eternity rather than future, and by encountering love with wait rather than possession, Florentino, transforms the classical Liebestod into a cathartic and transcendental experience. [ABSTRACT FROM AUTHOR]

Introduction: An upsurge of diarrheal cases occurred in Dhaka, Bangladesh, with approximately 30% of the cases being identified as cholera in 2022. To combat this situation, a reactive Oral Cholera Vaccination campaign was organized in five highly cholera-affected areas of Dhaka city. The paper is a descriptive tale of experience gathering, organization and implementation of reactive oral cholera vaccination campaign. Study design: This is a descriptive report of a reactive oral cholera vaccination campaign. Methods: Population density maps were generated using GIS technology before launching the campaign. The target population comprised individuals aged over one year, excluding pregnant women, totaling 2,374,976 people residing in above mentioned areas. The campaign utilized Euvichol-Plus, an OCV with adherence to the necessary cold chain requirements. Total 700 teams, each consisting of six members, were deployed across the five zones. The campaign was conducted in two rounds, where first round took place in June–July 2022, followed by second round in August 2022. During the campaign, data on adverse events following immunization (AEFI) was collected. Expert teams from various government and non-government organizations monitored regularly and ensured the campaign's success. Results: The first round achieved a coverage rate of 99%, whereas in the second round, 86.3% of individuals among the first dose recipients. During the campaigns, a total of 57 AEFIs were reported. Conclusions: This campaign serves as a model for a multispectral approach in combating cholera epidemics, highlighting the collaborative efforts of policymakers, health authorities, local communities, and health partners.

Vaccines and clean water shortages continue to give rise to cholera outbreaks in Africa. Coordinated efforts to increase vaccine distribution and improve physical infrastructure are needed while considering future outbreaks and water demands due to conflicts and climate events. [ABSTRACT FROM AUTHOR]

In this paper, a compartmental model for the transmission of the co-infection of cholera and malaria was developed and analyzed. The reproduction numbers for each sub-model and the full model were calculated. In order to study the impact of each disease on the other, a sensitivity analysis was carried out and its results show that malaria infection is linked to an increased risk of cholera, whereas cholera infection is not associated with an increased risk of malaria. A set of seven variables’ controlling strategies, ranging from vector control to water sanitation and treatment, were added to the model; and their effect have been studied using the optimal control technique. Numerical simulations show the impact of these controlling strategies on the reduction of the new infections in humans and vectors as well as the reduction of the Cholera vibrio concentration in the environment. In order to find the most cost-effective controlling strategy, and all the three major cost-effectiveness analysis techniques were implemented to our model after we categorized all the controlling strategies into three scenarios, namely Cholera controlling strategy, Malaria controlling strategy, and Cholera–Malaria controlling strategy. The numerical results show that the most cost-effective controlling strategy in reducing the number of new infection is the vector control strategy.

The article focuses on the impact of the COVID-19 pandemic on global travel and the quieting of transportation hubs, using the example of the William H. Gray III 30th Street Station in Philadelphia and its historic sculpture, Spirit of Transportation, which depicts various modes of travel. It mentions the sculpture, created by Karl Bitter in 1895, highlights the role of transportation in facilitating the unintentional spread of disease-causing microbes.