Recent Cholera Publications on PubMed

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Fatal Infectious Epidemics in Iran in the Last Two Centuries; What Lessons Can We Learn from Preceding Outbreaks? A Brief Historical Review.

September 18, 2020
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Fatal Infectious Epidemics in Iran in the Last Two Centuries; What Lessons Can We Learn from Preceding Outbreaks? A Brief Historical Review.

Arch Iran Med. 2020 08 01;23(8):578-581

Authors: Azizi MH, Azizi F

Abstract
In the past two centuries, several fatal infectious outbreaks have arisen in Iran. Presented here is a brief historical account of four fatal epidemics including cholera, plague, Spanish influenza of 1918 and smallpox between1796 and 1979. The lessons from these outbreaks could be helpful for better combatting other deadly epidemics including the present-day disastrous COVID-19 pandemic.

PMID: 32894975 [PubMed - indexed for MEDLINE]

Stemming cholera tides in Zimbabwe through mass vaccination.

September 17, 2020
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Stemming cholera tides in Zimbabwe through mass vaccination.

Int J Infect Dis. 2020 Jul;96:222-227

Authors: Mukandavire Z, Manangazira P, Nyabadza F, Cuadros DF, Musuka G, Morris JG

Abstract
BACKGROUND: In 2018, Zimbabwe declared another major cholera outbreak a decade after recording one of the worst cholera outbreaks in Africa.
METHODS: A mathematical model for cholera was used to estimate the magnitude of the cholera outbreak and vaccination coverage using cholera cases reported data. A Markov chain Monte Carlo method based on a Bayesian framework was used to fit the model in order to estimate the basic reproductive number and required vaccination coverage for cholera control.
RESULTS: The results showed that the outbreak had a basic reproductive number of 1.82 (95% credible interval [CrI] 1.53-2.11) and required vaccination coverage of at least 58% (95% Crl 45-68%) to be contained using an oral cholera vaccine of 78% efficacy. Sensitivity analysis demonstrated that a vaccine with at least 55% efficacy was sufficient to contain the outbreak but at higher coverage of 75% (95% Crl 58-88%). However, high-efficacy vaccines would greatly reduce the required coverage, with 100% efficacy vaccine reducing coverage to 45% (95% Crl 35-53%).
CONCLUSIONS: These findings reinforce the crucial need for oral cholera vaccines to control cholera in Zimbabwe, considering that the decay of water reticulation and sewerage infrastructure is unlikely to be effectively addressed in the coming years.

PMID: 32371191 [PubMed - indexed for MEDLINE]

Implications and measurement of herd protection (indirect effects) for enteric vaccine development.

September 17, 2020
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Implications and measurement of herd protection (indirect effects) for enteric vaccine development.

Vaccine. 2019 08 07;37(34):4775-4777

Authors: Wierzba TF

Abstract
Diarrhea remains one of the top five causes of disease and death among young children in developing nations. Fortunately, scientists are making progress developing vaccines against enterotoxigenic E. coli (ETEC) and Shigella, two of the leading diarrhea pathogens. As vaccine developers start to consider field efficacy trials of these vaccines, they should be aware of the importance of evaluating not only vaccine direct effects on the immunized, but also the herd effects that vaccination can afford to the unimmunized in a community. In a workshop held at the conference titled "Vaccines against Shigella and ETEC (VASE)", we described to participants what herd effects are and we presented on methods used in cholera and rotavirus studies that could be useful for future ETEC and Shigella vaccine trials conducted in low and middle-income nations. We also presented evidence on the effects of vaccine herd effects for estimates of vaccine cost-effectiveness.

PMID: 31358237 [PubMed - indexed for MEDLINE]

Volcanic activity controls cholera outbreaks in the East African Rift.

September 15, 2020
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Volcanic activity controls cholera outbreaks in the East African Rift.

PLoS Negl Trop Dis. 2020 08;14(8):e0008406

Authors: Batumbo Boloweti D, Giraudoux P, Deniel C, Garnier E, Mauny F, Kasereka CM, Kizungu R, Muyembe JJ, Bompangue D, Bornette G

Abstract
We hypothesized that Cholera (Vibrio cholerae) that appeared along Lake Kivu in the African Rift in the seventies, might be controlled by volcano-tectonic activity, which, by increasing surface water and groundwater salinity and temperature, may partly rule the water characteristics of Lake Kivu and promote V. cholerae proliferation. Volcanic activity (assessed weekly by the SO2 flux of Nyiragongo volcano plume over the 2007-2012 period) is highly positively correlated with the water conductivity, salinity and temperature of the Kivu lake. Over the 2007-2012 period, these three parameters were highly positively correlated with the temporal dynamics of cholera cases in the Katana health zone that border the lake. Meteorological variables (air temperature and rainfall), and the other water characteristics (namely pH and dissolved oxygen concentration in lake water) were unrelated to cholera dynamics over the same period. Over the 2016-2018 period, we sampled weekly lake water salinity and conductivity, and twice a month vibrio occurrence in lake water and fish. The abundance of V. cholerae in the lake was positively correlated with lake salinity, temperature, and the number of cholera cases in the population of the Katana health zone. V. cholerae abundance in fishes was positively correlated with V. cholerae abundance in lake water, suggesting that their consumption directly contaminate humans. The activity of the volcano, by controlling the physico-chemical characteristics of Lake Kivu, is therefore a major determinant of the presence of the bacillus in the lake. SO2 fluxes in the volcano plume can be used as a tool to predict epidemic risks.

PMID: 32776919 [PubMed - indexed for MEDLINE]

What are the drivers of recurrent cholera transmission in Nigeria? Evidence from a scoping review.

September 12, 2020
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What are the drivers of recurrent cholera transmission in Nigeria? Evidence from a scoping review.

BMC Public Health. 2020 Apr 03;20(1):432

Authors: Elimian KO, Mezue S, Musah A, Oyebanji O, Fall IS, Yennan S, Yao M, Abok PO, Williams N, Omar LH, Balde T, Ampah K, Okudo I, Ibrahim L, Jinadu A, Alemu W, Peter C, Ihekweazu C

Abstract
BACKGROUND: The 2018 cholera outbreak in Nigeria affected over half of the states in the country, and was characterised by high attack and case fatality rates. The country continues to record cholera cases and related deaths to date. However, there is a dearth of evidence on context-specific drivers and their operational mechanisms in mediating recurrent cholera transmission in Nigeria. This study therefore aimed to fill this important research gap, with a view to informing the design and implementation of appropriate preventive and control measures.
METHODS: Four bibliographic literature sources (CINAHL (Plus with full text), Web of Science, Google Scholar and PubMed), and one journal (African Journals Online) were searched to retrieve documents relating to cholera transmission in Nigeria. Titles and abstracts of the identified documents were screened according to a predefined study protocol. Data extraction and bibliometric analysis of all eligible documents were conducted, which was followed by thematic and systematic analyses.
RESULTS: Forty-five documents met the inclusion criteria and were included in the final analysis. The majority of the documents were peer-reviewed journal articles (89%) and conducted predominantly in the context of cholera epidemics (64%). The narrative analysis indicates that social, biological, environmental and climatic, health systems, and a combination of two or more factors appear to drive cholera transmission in Nigeria. Regarding operational dynamics, a substantial number of the identified drivers appear to be functionally interdependent of each other.
CONCLUSION: The drivers of recurring cholera transmission in Nigeria are diverse but functionally interdependent; thus, underlining the importance of adopting a multi-sectoral approach for cholera prevention and control.

PMID: 32245445 [PubMed - indexed for MEDLINE]

Sero-prevalence of arthropod-borne viral infections among Lukanga swamp residents in Zambia.

September 10, 2020
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Sero-prevalence of arthropod-borne viral infections among Lukanga swamp residents in Zambia.

PLoS One. 2020;15(7):e0235322

Authors: Chisenga CC, Bosomprah S, Musukuma K, Mubanga C, Chilyabanyama ON, Velu RM, Kim YC, Reyes-Sandoval A, Chilengi R

Abstract
INTRODUCTION: The re-emergence of vector borne diseases affecting millions of people in recent years has drawn attention to arboviruses globally. Here, we report on the sero-prevalence of chikungunya virus (CHIKV), dengue virus (DENV), mayaro virus (MAYV) and zika virus (ZIKV) in a swamp community in Zambia.
METHODS: We collected blood and saliva samples from residents of Lukanga swamps in 2016 during a mass-cholera vaccination campaign. Over 10,000 residents were vaccinated with two doses of Shanchol™ during this period. The biological samples were collected prior to vaccination (baseline) and at specified time points after vaccination. We tested a total of 214 baseline stored serum samples for IgG antibodies against NS1 of DENV and ZIKV and E2 of CHIKV and MAYV on ELISA. We defined sero-prevalence as the proportion of participants with optical density (OD) values above a defined cut-off value, determined using a finite mixture model.
RESULTS: Of the 214 participants, 79 (36.9%; 95% CI 30.5-43.8) were sero-positive for Chikungunya; 23 (10.8%; 95% CI 6.9-15.7) for Zika, 36 (16.8%; 95% CI 12.1-22.5) for Dengue and 42 (19.6%; 95% CI 14.5-25.6) for Mayaro. Older participants were more likely to have Zika virus whilst those involved with fishing activities were at greater risk of contracting Chikungunya virus. Among all the antigens tested, we also found that Chikungunya saliva antibody titres correlated with baseline serum titres (Spearman's correlation coefficient = 0.222; p = 0.03).
CONCLUSION: Arbovirus transmission is occurring in Zambia. This requires proper screening tools as well as surveillance data to accurately report on disease burden in Zambia.

PMID: 32609784 [PubMed - indexed for MEDLINE]

Hepatitis-B virus infection in India: Findings from a nationally representative serosurvey, 2017-18.

September 9, 2020
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Hepatitis-B virus infection in India: Findings from a nationally representative serosurvey, 2017-18.

Int J Infect Dis. 2020 Sep 04;:

Authors: Murhekar MV, Santhosh Kumar M, Kamaraj P, Khan SA, Allam RR, Barde P, Dwibedi B, Kanungo S, Mohan U, Mohanty SS, Roy S, Sagar V, Savargaonkar D, Tandale BV, Topno RK, C P GK, R S, Bitragunta S, Grover GS, P V M L, Mishra CM, Sadhukhan P, Sahoo PK, Singh SK, Yadav CP, Kumar R, Dutta S, Toteja GS, Gupta N, Mehendale SM, ICMR - Serosurvey group

Abstract
INTRODUCTION: India introduced hepatitis-B (HB) vaccine in Universal immunization program in 2002-2003 on pilot basis, expanded to 10 states in 2007-2008 (phase-1) and entire country in 2011-2012 (phase-2). We tested sera from a nationally representative serosurvey, to estimate seroprevalence of different markers of HB infection among children aged 5-17 years in India and assess the impact of vaccination.
METHODS: We tested sera from 8273 children for different makers of HB infection and estimated weighted age-group specific seroprevalence of children who were chronically infected (HBsAg and anti-HBc positive) and immune due to past infection (anti-HBc positive and HBsAg negative) and having serological evidence of HB vaccination. We compared prevalence of serological markers among children born before (aged 11-17 years) and after (aged 5-10 years) introduction of HB-vaccine from phase-1 states.
RESULTS: Among children aged 5-8 years, 1.1% were chronic carriers, 5.3% immune due to past infection, and 23.2% vaccinated. The corresponding proportions among children aged 9-17 years were 1.1%, 8.0% and 12.0% respectively. In phase-1 states, children aged 5-10 years had significantly lower prevalence of anti-HBc (4.9% vs 7.6%, p < 0.001) and higher prevalence of anti-HBs (37.7% vs 14.7%, p < 0.001) compared to children aged 11-17 years. HBsAg positivity however was not different in two age groups.
CONCLUSIONS: Children born after introduction of HB vaccination had lower prevalence of past HBV infection and higher prevalence of anti-HBs. The findings of our study could be considered as an interim assessment of impact of hepatitis B vaccine introduction in India.

PMID: 32896662 [PubMed - as supplied by publisher]

An empirical comparison of three methods for multiple cut-off diagnostic test meta-analysis of the Patient Health Questionnaire-9 (PHQ-9) depression screening tool using published data versus individual level data.

September 9, 2020
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An empirical comparison of three methods for multiple cut-off diagnostic test meta-analysis of the Patient Health Questionnaire-9 (PHQ-9) depression screening tool using published data versus individual level data.

Res Synth Methods. 2020 Sep 07;:

Authors: Andrea B, Brooke L, Gerta R, Jones Hayley E, Martin S, Ioannidis John PA, Brett T, DEPRESsion Screening Data (DEPRESSD) Collaboration

Abstract
Selective cut-off reporting in primary diagnostic accuracy studies with continuous or ordinal data may result in biased estimates when meta-analyzing studies. Collecting individual participant data (IPD) and estimating accuracy across all relevant cut-offs for all studies can overcome such bias but is labour-intensive. We meta-analyzed the diagnostic accuracy of the Patient Health Questionnaire-9 (PHQ-9) depression screening tool. We compared results for two statistical methods proposed by Steinhauser and by Jones to account for missing cut-offs, with results from a series of bivariate random effects models (BRM) estimated separately at each cut-off. We applied the methods to a dataset that contained information only on cut-offs that were reported in the primary publications, and to the full IPD dataset that contained information for all cut-offs for every study. For each method, we estimated pooled sensitivity and specificity and associated 95% confidence intervals for each cut-off and area under the curve (AUC). The full IPD dataset comprised data from 45 studies, 15 020 subjects and 1972 cases of major depression, and included information on every possible cut-off. When using data available in publications, using statistical approaches out-performed the BRM applied to the same data. AUC was similar for all approaches when using the full IPD dataset, though pooled estimates were slightly different. Overall, using statistical methods to fill in missing cut-off data recovered the receiver operating characteristic (ROC) curve from the full IPD dataset well when using only the published subset. All methods performed similarly when applied to the full IPD dataset. This article is protected by copyright. All rights reserved.

PMID: 32896096 [PubMed - as supplied by publisher]

Developing a forecasting model for cholera incidence in Dhaka megacity through time series climate data.

September 3, 2020
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Developing a forecasting model for cholera incidence in Dhaka megacity through time series climate data.

J Water Health. 2020 Apr;18(2):207-223

Authors: Daisy SS, Saiful Islam AKM, Akanda AS, Faruque ASG, Amin N, Jensen PKM

Abstract
Cholera, an acute diarrheal disease spread by lack of hygiene and contaminated water, is a major public health risk in many countries. As cholera is triggered by environmental conditions influenced by climatic variables, establishing a correlation between cholera incidence and climatic variables would provide an opportunity to develop a cholera forecasting model. Considering the auto-regressive nature and the seasonal behavioral patterns of cholera, a seasonal-auto-regressive-integrated-moving-average (SARIMA) model was used for time-series analysis during 2000-2013. As both rainfall (r = 0.43) and maximum temperature (r = 0.56) have the strongest influence on the occurrence of cholera incidence, single-variable (SVMs) and multi-variable SARIMA models (MVMs) were developed, compared and tested for evaluating their relationship with cholera incidence. A low relationship was found with relative humidity (r = 0.28), ENSO (r = 0.21) and SOI (r = -0.23). Using SVM for a 1 °C increase in maximum temperature at one-month lead time showed a 7% increase of cholera incidence (p < 0.001). However, MVM (AIC = 15, BIC = 36) showed better performance than SVM (AIC = 21, BIC = 39). An MVM using rainfall and monthly mean daily maximum temperature with a one-month lead time showed a better fit (RMSE = 14.7, MAE = 11) than the MVM with no lead time (RMSE = 16.2, MAE = 13.2) in forecasting. This result will assist in predicting cholera risks and better preparedness for public health management in the future.

PMID: 32300093 [PubMed - indexed for MEDLINE]

Cholera remains a public health threat in Haiti.

September 1, 2020
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Cholera remains a public health threat in Haiti.

Lancet Glob Health. 2020 08;8(8):e984

Authors: Francois J

PMID: 32710871 [PubMed - indexed for MEDLINE]

Small alarmones (p)ppGpp regulate virulence associated traits and pathogenesis of Salmonella enterica serovar Typhi.

August 29, 2020
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Small alarmones (p)ppGpp regulate virulence associated traits and pathogenesis of Salmonella enterica serovar Typhi.

Cell Microbiol. 2019 08;21(8):e13034

Authors: Dasgupta S, Das S, Biswas A, Bhadra RK, Das S

Abstract
How Salmonella enterica serovar Typhi (S. Typhi), an important human pathogen, survives the stressful microenvironments inside the gastrointestinal tract and within macrophages remains poorly understood. We report here that S. Typhi has a bonafide stringent response (SR) system, which is mediated by (p)ppGpp and regulates multiple virulence-associated traits and the pathogenicity of the S. Typhi Ty2 strain. In an iron overload mouse model of S. Typhi infection, the (p)ppGpp0 (Ty2ΔRelAΔSpoT) strain showed minimal systemic spread and no mortality, as opposed to 100% death of the mice challenged with the isogenic wild-type strain. Ty2ΔRelAΔSpoT had markedly elongated morphology with incomplete septa formation and demonstrated severely attenuated motility and chemotaxis due to the loss of flagella. Absence of the Vi-polysaccharide capsule rendered the mutant strain highly susceptible to complement-mediated lysis. The phenotypes of Ty2ΔRelAΔSpoT was contributed by transcriptional repression of several genes, including fliC, tviA, and ftsZ, as found by reverse transcriptase quantitative polymerase chain reaction and gene complementation studies. Finally, Ty2ΔRelAΔSpoT had markedly reduced invasion into intestinal epithelial cells and significantly attenuated survival within macrophages. To the best of our knowledge, this was the first study that addressed SR in S. Typhi and showed that (p)ppGpp was essential for optimal pathogenic fitness of the organism.

PMID: 31013389 [PubMed - indexed for MEDLINE]

A protracted cholera outbreak among residents in an urban setting, Nairobi county, Kenya, 2015.

August 28, 2020
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A protracted cholera outbreak among residents in an urban setting, Nairobi county, Kenya, 2015.

Pan Afr Med J. 2020;36:127

Authors: Kigen HT, Boru W, Gura Z, Githuka G, Mulembani R, Rotich J, Abdi I, Galgalo T, Githuku J, Obonyo M, Muli R, Njeru I, Langat D, Nsubuga P, Kioko J, Lowther S

Abstract
Introduction: in 2015, a cholera outbreak was confirmed in Nairobi county, Kenya, which we investigated to identify risk factors for infection and recommend control measures.
Methods: we analyzed national cholera surveillance data to describe epidemiological patterns and carried out a case-control study to find reasons for the Nairobi county outbreak. Suspected cholera cases were Nairobi residents aged >2 years with acute watery diarrhea (>4 stools/≤12 hours) and illness onset 1-14 May 2015. Confirmed cases had Vibrio cholerae isolated from stool. Case-patients were frequency-matched to persons without diarrhea (1:2 by age group, residence), interviewed using standardized questionaires. Logistic regression identified factors associated with case status. Household water was analyzed for fecal coliforms and Escherichia coli.
Results: during December 2014-June 2015, 4,218 cholera cases including 282 (6.7%) confirmed cases and 79 deaths (case-fatality rate [CFR] 1.9%) were reported from 14 of 47 Kenyan counties. Nairobi county reported 781 (19.0 %) cases (attack rate, 18/100,000 persons), including 607 (78%) hospitalisations, 20 deaths (CFR 2.6%) and 55 laboratory-confirmed cases (7.0%). Seven (70%) of 10 water samples from communal water points had coliforms; one had Escherichia coli. Factors associated with cholera in Nairobi were drinking untreated water (adjusted odds ratio [aOR] 6.5, 95% confidence interval [CI] 2.3-18.8), lacking health education (aOR 2.4, CI 1.1-7.9) and eating food outside home (aOR 2.4, 95% CI 1.2-5.7).
Conclusion: we recommend safe water, health education, avoiding eating foods prepared outside home and improved sanitation in Nairobi county. Adherence to these practices could have prevented this protacted cholera outbreak.

PMID: 32849982 [PubMed - in process]

Highly Resistant Cholera Outbreak Strain in Zimbabwe.

August 26, 2020
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Highly Resistant Cholera Outbreak Strain in Zimbabwe.

N Engl J Med. 2020 08 13;383(7):687-689

Authors: Mashe T, Domman D, Tarupiwa A, Manangazira P, Phiri I, Masunda K, Chonzi P, Njamkepo E, Ramudzulu M, Mtapuri-Zinyowera S, Smith AM, Weill FX

PMID: 32786196 [PubMed - indexed for MEDLINE]

Demographic and social context of deaths during the 1854 cholera outbreak in Soho, London: a reappraisal of Dr John Snow's investigation.

August 22, 2020

Demographic and social context of deaths during the 1854 cholera outbreak in Soho, London: a reappraisal of Dr John Snow's investigation.

Health Place. 2020 Aug 18;65:102402

Authors: Walford NS

Abstract
Deaths from cholera in Soho, London (late July to end of September 1854) exposed the epidemiology of the disease and demonstrated applied geospatial analysis by highlighting the shortest path principle followed by local residents when they obtained drinking water from a contaminated pump. The present investigation explores if households and individuals with different demographic and socio-economic characteristics were more or less likely to obtain their water from the pump and succumb to the disease. It combines information from the 1851 Population Census and topographic databases with the digital deaths and water pump data to reveal the risk of exposure and the mortality rate were greater for certain occupations, age groups and people living at high residential density irrespective of proximity to the contaminated water pump.

PMID: 32823142 [PubMed - as supplied by publisher]

Authors' response.

August 20, 2020
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Authors' response.

Indian J Med Res. 2020 Aug 17;:

Authors: Chatterjee P, Anand T, Singh KJ, Rasaily R, Singh R, Das S, Singh H, Praharaj I, Gangakhedkar RR, Bhargava B, Panda S

PMID: 32811799 [PubMed - as supplied by publisher]

Hotspots of H1N1 influenza in India: analysis of reported cases and deaths (2010-2017).

August 19, 2020
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Hotspots of H1N1 influenza in India: analysis of reported cases and deaths (2010-2017).

Trop Doct. 2020 Apr;50(2):166-169

Authors: Chatterjee P, Seth B, Biswas T

Abstract
Influenza A (H1N1) caused significant mortality and morbidity globally. We identified the hotspots for H1N1 influenza in India using cases and deaths reported in the Integrated Disease Surveillance Program between 2010 and 2017. A total of 114,667 cases and 8543 deaths were reported from across India, at an overall case fatality rate of 7.5%. While Maharashtra accounted for 21% of cases and 31% of deaths, Delhi and Gujarat were ranked the highest based on the population-adjusted ranks for morbidity and mortality, respectively. The current analysis identified states and union territories in western India (Delhi, Punjab, Rajasthan, Gujarat and Maharashtra) to be especially vulnerable.

PMID: 31771428 [PubMed - indexed for MEDLINE]

Microbes in Pipes (MIP): The Microbiology of the Water Distribution System

August 19, 2020

Microbes in Pipes (MIP): The Microbiology of the Water Distribution System

Book. 2013

Authors:

Abstract
The construction of sanitary water delivery systems that ended the scourges of typhoid, cholera and other diseases was one of the public health triumphs of the last century. So successful was the investment in clean water distribution systems that in the developed world, we take for granted the safety of our water. Certainly, we do not look to this long-established public sector as the setting for major scientific or technological advances. But despite the vast improvements in water safety in the last century, drinking water is still occasionally contaminated with pathogens and waterborne illnesses continue to occur, albeit at much lower levels than in the past. Ensuring that the water distribution system delivers safe water at a reasonable cost requires ongoing vigilance and investment, and water utility companies are continually looking for ways to make our water even safer. In the last decade, revolutionary advances in the field of microbiology are providing new ways to think about how water distribution systems are designed and managed. For the first time, the true diversity of microbes that live in our drinking water distribution system is something we can observe and study. The scientific and technological advances necessary to characterize distribution system ecosystems come at a time when the need to make informed decisions about replacing and upgrading existing water distribution systems has never been greater. The American Association of Civil Engineers in 2009 gave the U.S. drinking water infrastructure a grade of D- and estimated that in the next 30 years, 30% of the water distribution system infrastructure in the United States will need to be replaced at an estimated annual cost of 11 billion dollars. These numbers do not include additions to the systems that will be necessary to accommodate increased demand for drinking water over the next 30 years. At the same time new green technologies and water conservation and reuse strategies are becoming more popular and new water treatment strategies are being developed. All of these have the potential to significantly alter the microbial ecology of water distribution systems in ways that we cannot now predict. Many non-microbiologists probably assume that the goal has always been, and should remain, the elimination of all microbes from our drinking water. But the water we drink has never been sterile; perfectly safe water contains millions of non-pathogenic microbes in every glassful — and this is just as true, by the way, of bottled water as it is of tap water. Like every other human built environment, the entire water distribution system — every reservoir, every well, every pipe, and every faucet — are home to hundreds or thousands of species of bacteria, algae, invertebrates, and viruses, most of which are completely harmless to humans. This has always been the case and in a way it is especially remarkable that our drinking water can contain so many microbes, but nevertheless be virtually pathogen-free. Indeed, it is possible that the non-pathogenic residents actually suppress pathogens. A new opportunity has emerged whereby the people whose job it is to provide us with safe water, and the scientists who are working to understand the vast microbial world that surrounds us, can work together to their mutual advantage. Water utilities have the potential to apply deeper understanding of the microbial ecology of water distribution systems to develop and apply more effective microbiological monitoring, pathogen detection, and treatment approaches. Overall, the microbial ecology of the water distribution system is exceptionally diverse because there are so many different microhabitats. However, defined portions of the system (for example the biofilm on one stretch of pipe) is likely simpler than many natural habitats. As a result, water distribution systems could provide access for microbiologists to microbial communities that are less complicated than those found in many natural environments but are nevertheless genuine ecosystems that develop and change over time. In many ways, the water delivery infrastructure could serve as a ‘model system’ for the study of microbial communities, and it is likely that discoveries made in that environment will be highly transferable to our understanding of microbial communities in more complex natural settings. New partnerships between academic microbiologists and water utilities could take advantage of this historic opportunity to the benefit of both groups, and to society at large. To consider these opportunities, the American Academy of Microbiology held a colloquium in April of 2012 focused on identifying specific challenges and gaps in our understanding of the microbial ecosystems of water distribution systems, and developing a research plan to address them. The colloquium brought together microbiologists with experts from many other science and engineering communities, including public health, infectious disease, epidemiology, risk assessment, materials science, civil and environmental engineering, water quality monitoring, and water policy, each of whom specialize in some aspect of the interaction between microbes and the water distribution infrastructure. The participants addressed three areas of interest: ▪ What is the composition and activity of the microbial communities living in the water distribution system? ▪ What are realistic goals for understanding and influencing these communities? What would we like to achieve? ▪ What do we need to do to advance the study of these communities? What collaborations need to be fostered? What advances in science and technology are needed? The group considered how an interdisciplinary, integrated approach to understanding the microbial ecology of water distribution infrastructure could leverage each discipline's expertise and generate an understanding that is greater than the sum of the current parts. This report, the output of the colloquium, outlines the challenges that must be tackled to enhance our understanding of the ecology of water distribution systems, and a plan to address these challenges in the most effective way possible, as part of a greater effort to continue to ensure healthful drinking water within a sustainable infrastructure. Thus this report should be of use not only to microbiologists, but also utilities, government agencies, public health professionals, hospitals, and even industries that rely on safe water for the manufacture of products.


PMID: 32809306

Authors' response.

August 18, 2020

Authors' response.

Indian J Med Res. 2020 Aug 13;:

Authors: Chatterjee P, Anand T, Singh KJ, Rasaily R, Singh R, Das S, Singh H, Praharaj I, Gangakhedkar RR, Bhargava B, Panda S

PMID: 32801227 [PubMed - as supplied by publisher]

Authors' response.

August 18, 2020

Authors' response.

Indian J Med Res. 2020 Aug 13;:

Authors: Chatterjee P, Anand T, Singh KJ, Rasaily R, Singh R, Das S, Singh H, Praharaj I, Gangakhedkar RR, Bhargava B, Panda S

PMID: 32801225 [PubMed - as supplied by publisher]

Can cholera 'hotspots' be converted to cholera 'coldspots' in cholera endemic countries? The Matlab, Bangladesh experience.

August 18, 2020
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Can cholera 'hotspots' be converted to cholera 'coldspots' in cholera endemic countries? The Matlab, Bangladesh experience.

Int J Infect Dis. 2020 Jun;95:28-31

Authors: Zaman K, Ryun Kim D, Ali M, Ahmmed F, Im J, Islam MT, Khan AI, Yunus M, Khan MA, Marks F, Qadri F, Kim J, Clemens JD

Abstract
BACKGROUND: Cholera remains a major public health threat in low- and middle-income countries. The World Health Organization (WHO) has recently launched a global initiative to end preventable cholera by 2030. Key to the success of this initiative will be the elimination of cholera transmission in cholera 'hotspots' with regularly recurrent disease; this can be achieved via improved surveillance to define hotspot populations, through the use of oral cholera vaccines, and through the implementation of improved water, sanitation, and hygiene (WASH).
METHODS: This study was performed to analyze the trend in cholera incidence during the years 1974-2018 in Matlab, Bangladesh (defined population of about 200 000) that has been recognized as one of the world's cholera hotspots. During this period, Matlab has maintained a demographically defined population and comprehensive, culture-based surveillance for cholera, supplemented by periodic surveys to characterize the socioeconomic status of the population, as well as water sources and facilities for defecation.
RESULTS: Cholera transmission has nearly been eliminated in Matlab, despite a continuing high cholera burden in many other parts of Bangladesh and despite trends of increasing ambient and sea surface temperatures, which are known to increase cholera incidence. Concomitantly, the socioeconomic status of the population has increased modestly, and the use of simple tubewells for drinking water has reached 95% and the installation of sanitary latrines has reached 85%.
CONCLUSIONS: The factors responsible for the decline in cholera are difficult to pinpoint precisely, but this decline has occurred with the installation of inexpensive improvements in water sources and latrines and despite environmental factors that should have augmented cholera incidence. These observations lend optimism to the current global initiative to end preventable cholera by 2030.

PMID: 32126325 [PubMed - indexed for MEDLINE]

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