Recent Cholera Publications on PubMed

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Modeling the 2016-2017 Yemen cholera outbreak with the impact of limited medical resources.

November 19, 2019
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Modeling the 2016-2017 Yemen cholera outbreak with the impact of limited medical resources.

J Theor Biol. 2018 08 14;451:80-85

Authors: He D, Wang X, Gao D, Wang J

Abstract
We present a mathematical model to investigate the transmission dynamics of the 2016-2017 Yemen cholera outbreak. Our model describes the interaction between the human hosts and the pathogenic bacteria, under the impact of limited medical resources. We fit our model to Yemen epidemic data published by the World Health Organization, at both the country and regional levels. We find that the Yemen cholera outbreak is shaped by the interplay of environmental, socioeconomic, and climatic factors. Our results suggest that improvement of the public health system and strategic implementation of control measures with respect to time and location are key to future cholera prevention and intervention in Yemen.

PMID: 29727633 [PubMed - indexed for MEDLINE]

Corrigendum to: Cholera outbreak during a scientific conference at a Nairobi hotel, Kenya 2017.

November 16, 2019
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Corrigendum to: Cholera outbreak during a scientific conference at a Nairobi hotel, Kenya 2017.

J Public Health (Oxf). 2019 Nov 15;:

Authors: Mwenda V, Niyomwungere A, Oyugi E, Githuku J, Obonyo M, Gura Z

PMID: 31728506 [PubMed - as supplied by publisher]

Health facility preparedness for cholera outbreak response in four cholera-prone districts in Cameroon: a cross sectional study.

November 16, 2019
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Health facility preparedness for cholera outbreak response in four cholera-prone districts in Cameroon: a cross sectional study.

BMC Health Serv Res. 2019 Jul 08;19(1):458

Authors: Ateudjieu J, Yakum MN, Goura AP, Nafack SS, Chebe AN, Azakoh JN, Chukuwchindun BA, Bayiha EJ, Kangmo C, Tachegno GVB, Bissek AZK

Abstract
BACKGROUND: The risk of cholera outbreak remains high in Cameroon. This is because of the persistent cholera outbreaks in neighboring countries coupled with the poor hygiene and sanitation conditions in Cameroon. The objective of this study was to assess the readiness of health facilities to respond to cholera outbreak in four cholera-prone districts in Cameroon.
METHODOLOGY: A cross-sectional study was conducted targeting all health facilities in four health districts, labeled as cholera hotspots in Cameroon in August 2016. Data collection was done by interview with a questionnaire and by observation regarding the availability of resources and materials for surveillance and case management, access to water, hygiene, and sanitation. Data analysis was descriptive with STATA 11.
PRINCIPAL FINDINGS: A total of 134 health facilities were evaluated, most of which (108/134[81%]) were urban facilities. The preparedness regarding surveillance was limited with 13 (50%) health facilities in the Far North and 22(20%) in the Littoral having cholera case definition guide. ORS for Case management was present in 8(31%) health facilities in the Far North and in 94(87%) facilities in the littoral. Less than half of the health facilities had a hand washing protocol and 7(5.1%) did not have any source of drinking water or relied on unimproved sources like lake. A total of 4(3.0%) health facilities, all in the Far North region, did not have a toilet.
CONCLUSIONS: The level of preparedness of health facilities in Cameroon for cholera outbreak response presents a lot of weaknesses. These are present in terms of lack of basic surveillance and case management materials and resources, low access to WaSH. If not addressed now, these facilities might not be able to play their role in case there is an outbreak and might even turn to be transmission milieus.

PMID: 31286934 [PubMed - indexed for MEDLINE]

Seasonal influence, enteropathogenic microbial load and diarrhoeal enigma in the Gangetic Delta, India: Present scenario and health implications.

November 15, 2019
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Seasonal influence, enteropathogenic microbial load and diarrhoeal enigma in the Gangetic Delta, India: Present scenario and health implications.

J Infect Public Health. 2019 Jul - Aug;12(4):540-548

Authors: Saha S, Halder M, Mookerjee S, Palit A

Abstract
BACKGROUND: Environmental diarrheagenic enteropathogens, effect of surrounding attributes and disease dynamicity remains far from being conclusively explored. Population flux, poor sanitation and hygienic practice poses potential health threat in diarrhoea endemic tropical countries like India. We aim to identify environmental attributes, seasonality of water-borne enteropathogens and health risk assessment off the river Ganges.
METHODS: A yearlong sampling data generated from three sites on either sides of the River was analysed and implications have been reported. Immediately after sample collection, physico chemical and bacterial indices were measured at the sampling site and laboratory respectively, followed by further statistical analysis of the findings.
RESULTS: Annual variation of physico-chemical indices viz., temperature 18°C-36°C, pH 7.49-8.67, conductivity 215-468μS/cm and turbidity 25.6-593 NTU was recorded in the riverine water samples. High temperature and turbidity were recorded in the summer and monsoon at all sites. High bacterial dispersion has been positively correlated with turbidity and temperature variation (P<0.01; P<0.1) as we report TBC 103-105CFU/ml, TCC 103-104CFU/ml and CVC 4-212CFU/ml, with higher distribution in the monsoon and reverse in the winter. This suggests that the bacterial pool proliferates at higher temperature whereas turbidity enhances their survival providing the substratum for the bacterial pool. CVC could be positively correlated with conductivity which implies that ionic content of water augments the Vibrio load. Adaptive capability of Vibrios to sustain in very low saline riverine setting seems to be assisted by turbid water coupled with nutrient rich organic matter.
CONCLUSION: Our present work establishes the interplay of seasonal variants on the dynamicity of enteropathogenic bacteria in flowing aquatic ecosystem. It also categorises the existing microbial threats in the Ganga River to help monitor the conventional as well as emerging diarrhoeal pathogens to reduce diarrheal recurrences.

PMID: 30792073 [PubMed - indexed for MEDLINE]

Reviving Phage Therapy for the Treatment of Cholera.

November 13, 2019
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Reviving Phage Therapy for the Treatment of Cholera.

J Infect Dis. 2019 02 15;219(5):786-794

Authors: Bhandare S, Colom J, Baig A, Ritchie JM, Bukhari H, Shah MA, Sarkar BL, Su J, Wren B, Barrow P, Atterbury RJ

Abstract
Cholera remains a major risk in developing countries, particularly after natural or man-made disasters. Vibrio cholerae El Tor is the most important cause of these outbreaks, and is becoming increasingly resistant to antibiotics, so alternative therapies are urgently needed. In this study, a single bacteriophage, Phi_1, was used to control cholera prophylactically and therapeutically in an infant rabbit model. In both cases, phage-treated animals showed no clinical signs of disease, compared with 69% of untreated control animals. Bacterial counts in the intestines of phage-treated animals were reduced by up to 4 log10 colony-forming units/g. There was evidence of phage multiplication only in animals that received a V. cholerae challenge. No phage-resistant bacterial mutants were isolated from the animals, despite extensive searching. This is the first evidence that a single phage could be effective in the treatment of cholera, without detectable levels of resistance. Clinical trials in human patients should be considered.

PMID: 30395214 [PubMed - indexed for MEDLINE]

Seasonal Pattern of Pathogenic V. cholerae and V. paraheamolyticus in Surface Water of Dhaka, Bangladesh.

November 9, 2019
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Seasonal Pattern of Pathogenic V. cholerae and V. paraheamolyticus in Surface Water of Dhaka, Bangladesh.

Mymensingh Med J. 2019 Oct;28(4):872-880

Authors: Kabir A, Khaleque M, Akhter H, Begum A

Abstract
V. cholerae and V. parahaemolyticus are responsible for majority of the Vibrio-related infections world wide. In this observational study, we selected three important river and pondsites of Dhaka city, Bangladesh to observe the presence of pathogenic V. cholerae, and V. parahaemolyticus. Surface water samples were collected from July 2013 to April 2014. Identification of V. cholerae was confirmed by the presence of ompW gene by PCR. Vibrio cholerae was found in the unique dual peak (March to May and September to November) patternin Mirpur-1 Mazar pond and Abdullahpur bridge river site, like many other studies reported earlier in Dhaka with only one exception of finding V. cholerae in the month of July 2013 in Mirpur-1 Mazar pond. A single peak was found from September to November in Mirpur-1 river sites. The ctxB positive non- O1 V. cholerae has also been reported. The presence of ctxB gene was observed by MAMA PCR. The O1 and O139 serogroups were confirmed by O1rfb and O139 rfb genes in PCR. Both classical and El-Tor biotypes were observed in this one year round study. V. paraheamolyticus was confirmed by the presence of ToxRVP gene and all the strains were negative for tdh pathogenic gene by PCR. This study observed for the first time the seasonal pattern of V. parahaemolyticus in water bodies in Bangladesh showing a peak from February to April in all three sampling sites and another additional peak which span from August to September in Mirpur-1 Mazar pond, Dhaka, Bangladesh.

PMID: 31599254 [PubMed - indexed for MEDLINE]

Antibiotic resistance in Vibrio cholerae El Tor strains isolated during cholera complications in Siberia and the Far East of Russia.

November 7, 2019
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Antibiotic resistance in Vibrio cholerae El Tor strains isolated during cholera complications in Siberia and the Far East of Russia.

Infect Genet Evol. 2019 Nov 02;:104096

Authors: Gladkikh AS, Feranchuk SI, Ponomareva AS, Bochalgin NO, Mironova LV

Abstract
Currently, the spread of antimicrobial resistance (AMR) is a global trend and poses a severe threat to public health. The causative agent of cholera, an extremely virulent disease with pandemic expansion, becomes more and more resistant to a wider range of drugs with every coming year. The Vibrio cholerae genome is highly flexible and adaptive; the acquisition of the SXT mobile element with a cluster of antibiotic resistance genes on it has marked a new stage in the adaptive evolution of the pathogen. The territory of Siberia and Russian Far East is free of cholera; however, in the 1970s and 1990s a number of infection importation cases and acute outbreaks associated with the cholera importation were reported. The aim of this study was to describe the phenotypic characteristics and genetic determinants of AMR in V. cholerae strains isolated during epidemic complications in Siberia and the Far East of Russia, as well as to clarify the origin of the strains. The present research comprises analysis of nine V. cholerae El Tor strains isolated from patients and water sources during epidemic complications in Siberia and the Russian Far East in the 1990s. Here, we compared the phenotypic manifestations of antibiotic resistance among strains, harbored the resistance patterns in genomes; we also determined the structure, the type of SXT elements, and the mobilome profile based on the accepted classification. We identified that strains that caused outbreaks in Vladivostok and Yuzhno-Sakhalinsk in 1999 had ICEVchCHN4210 type SXT element with deletion of some loci. The research shows that the integration of the core genome, the SNP analysis and the analysis of mobilome, associated with antibiotic resistance, is necessary to understand the cholera epidemiology, it also helps to establish the origin of the strains. The study of resistance determinants features allowed to make a conclusion about the heterogeneity of V. cholerae strains that were isolated during outbreaks in Vladivostok and Yuzhno-Sakhalinsk in 1999.

PMID: 31689544 [PubMed - as supplied by publisher]

Herd protection of unvaccinated adults by oral cholera vaccines in rural Bangladesh.

November 7, 2019
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Herd protection of unvaccinated adults by oral cholera vaccines in rural Bangladesh.

Int Health. 2019 05 01;11(3):229-234

Authors: Ali M, Kim P, Zaman K, Clemens J

Abstract
BACKGROUND: Past research has suggested that the most cost-effective approach to using oral cholera vaccines (OCVs) to control endemic cholera may be to target only children <15 y of age. However, the assumption that vaccination of children with OCVs protects unvaccinated adults has never been tested.
METHODS: We reanalyzed the data of an OCV trial in Bangladesh in which children 2-15 y of age and women >15 y of age were allocated to OCV or placebo and assessed herd protection by relating the risk of cholera in each nonvaccinated adult (>15 y) to OCV coverage (OCVC) of residents residing in virtual clusters within 500 m of the residence of that unvaccinated adult.
RESULTS: The risk of cholera in unvaccinated adults decreased by 14% with each 10% increase of OCVC of all targeted age groups (95% 7 to 21%, p=0.0004). Also, the risk of cholera in unvaccinated adults decreased by 13% with each 10% increase in OCVC of children 2-15 y of age (95% CI 6 to 20%, p=0.0007). A high correlation between levels of OCVC of children and adult females precluded an assessment of the herd protection of unvaccinated adults by vaccinating children <16 y of age, independent of concomitant vaccination of adult women.
CONCLUSIONS: Unvaccinated adults benefitted from herd protection conferred by OCVs in this trial. Vaccination of children may be sufficient to confer this protection, but this possibility needs to be evaluated in further studies.

PMID: 30496408 [PubMed - indexed for MEDLINE]

Cholera: ending a 50-year pandemic.

November 7, 2019
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Cholera: ending a 50-year pandemic.

Lancet. 2017 10 07;390(10103):1623

Authors: The Lancet

PMID: 29131781 [PubMed - indexed for MEDLINE]

Immunogenicity and Protection From a Single Dose of Internationally Available Killed Oral Cholera Vaccine: A Systematic Review and Metaanalysis.

November 5, 2019
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Immunogenicity and Protection From a Single Dose of Internationally Available Killed Oral Cholera Vaccine: A Systematic Review and Metaanalysis.

Clin Infect Dis. 2018 06 01;66(12):1960-1971

Authors: Lopez AL, Deen J, Azman AS, Luquero FJ, Kanungo S, Dutta S, von Seidlein L, Sack DA

Abstract
In addition to improved water supply and sanitation, the 2-dose killed oral cholera vaccine (OCV) is an important tool for the prevention and control of cholera. We aimed to document the immunogenicity and protection (efficacy and effectiveness) conferred by a single OCV dose against cholera. The metaanalysis showed that an estimated 73% and 77% of individuals seroconverted to the Ogawa and Inaba serotypes, respectively, after an OCV first dose. The estimates of single-dose vaccine protection from available studies are 87% at 2 months decreasing to 33% at 2 years. Current immunologic and clinical data suggest that protection conferred by a single dose of killed OCV may be sufficient to reduce short-term risk in outbreaks or other high-risk settings, which may be especially useful when vaccine supply is limited. However, until more data suggest otherwise, a second dose should be given as soon as circumstances allow to ensure robust protection.

PMID: 29177437 [PubMed - indexed for MEDLINE]

Formative research for the design of a scalable water, sanitation, and hygiene mobile health program: CHoBI7 mobile health program

November 1, 2019
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Formative research for the design of a scalable water, sanitation, and hygiene mobile health program: CHoBI7 mobile health program

BMC Public Health. 2019 07 31;19(1):1028

Authors: George CM, Zohura F, Teman A, Thomas E, Hasan T, Rana S, Parvin T, Sack DA, Bhuyian SI, Labrique A, Masud J, Winch P, Leontsini E, Zeller K, Begum F, Khan AH, Tahmina S, Munum F, Monira S, Alam M

Abstract
BACKGROUND: The Cholera-Hospital-Based-Intervention-for-7-Days (CHoBI7) is a handwashing with soap and water treatment intervention program delivered by a health promoter bedside in a health facility and through home visits to diarrhea patients and their household members during the 7 days after admission to a health facility. In a randomized controlled trial among cholera patient households in Bangladesh, the 7-day CHoBI7 program resulted in a significant reduction in cholera among household members of cholera patients and sustained improvements in drinking water quality and handwashing with soap practices 12 months post-intervention. In an effort to take this intervention to scale across Bangladesh in partnership with the Bangladesh Ministry of Health and Family Welfare, this study evaluates the feasibility and acceptability of mobile health (mHealth) programs as a low-cost, scalable approach for CHoBI7 program delivery.
METHODS: Formative research for the development of the CHoBI7 mHealth intervention included 40 semi-structured interviews, 4 mHealth workshops, 2 group discussions, and a pilot study of 52 households to assess the feasibility and acceptability of the developed mHealth program. Thematic analysis of the interviews and group discussions was conducted by two individuals separately based on emergent themes, and then themes were compared and discussed.
RESULTS: A theory- and evidence-based approach using qualitative research methods was implemented to design the CHoBI7 mHealth program. Semi-structured interviews with government stakeholders identified perceptions and preferences for scaling the CHoBI7 mHealth program. Group discussions and semi-structured interviews with diarrhea patients and their family members identified beneficiary perceptions of mHealth and preferences for CHoBI7 mHealth program delivery. mHealth workshops were conducted as an interactive approach to draft and refine mobile message content based on stakeholder preferences. The pilot findings indicate that the CHoBI7 mHealth program has high user acceptability and is feasible to deliver to diarrhea patients that present at health facilities for treatment in Bangladesh. Both text and voice messages were recommended for program delivery. Dr. Chobi, the sender of mHealth messages, was viewed as a credible source of information that could be shared with others.
CONCLUSION: This study presents a theory- and evidence-based approach that can be implemented for the development of future water, sanitation, and hygiene mHealth programs in low-resource settings.

PMID: 31366398 [PubMed - indexed for MEDLINE]

Epidemiology and antibiotic susceptibility of Vibrio cholerae associated with the 2017 outbreak in Kasese district, Uganda.

October 31, 2019
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Epidemiology and antibiotic susceptibility of Vibrio cholerae associated with the 2017 outbreak in Kasese district, Uganda.

BMC Public Health. 2019 Oct 29;19(1):1405

Authors: Iramiot JS, Rwego IB, Kansiime C, Asiimwe BB

Abstract
BACKGROUND: Uganda is among the 51 countries where cholera outbreaks are common with epidemics occurring predominantly along the western border with Democratic Republic of Congo (DRC), Kampala city slums, Busia district which is a border town with Western Kenya, Mbale district and the Karamoja Sub-region. This report summarizes findings from the epidemiologic investigation, which aimed at identifying the mode of transmission and antibiotic susceptibility patterns of the Vibrio cholerae isolated in Kasese district, Uganda.
METHODS: A descriptive cross-sectional study was carried out between 2017 and 2018 to describe the epidemiology of the cholera epidemic in Kasese district, Uganda. Rectal swabs were collected from 69 suspected case-persons and cultured on Thiosulphate-Citrate-Bile-Salts Sucrose (TCBS™; SEIKEN Japan) agar and incubated at 37 °C for 18-24 h. The isolates were serotyped with polyvalent 01 antiserum and monovalent serotype Inaba and Ogawa antisera (Denka Seiken, Tokyo, Japan) to determine which serotype was responsible for the outbreak. Antimicrobial susceptibility testing was performed using the Kirby-Bauer disk diffusion method on Mueller-Hinton agar. A list of discharged patients was obtained from the isolation units of Bwera hospital and Kagando hospital and the individuals were followed to the community where they live. Questionnaires were administered to a total of 75 participants who were either the cases or relatives to the case. GPS points of the homes of the cases and pictures of potential source infection were also taken and cases were mapped.
RESULTS: A total of 222 cases were recorded in the Kasese District outbreak between the month of September 2017 and January 2018 with the case fatality rate (CFR) of 1.4%. Children below the age of 14 years contributed the biggest proportion of the cases (70%) and out of these, 33% were aged below 5 years. Culture isolated 69 V. cholerae 01 serotype Inaba from the total of 71 samples. Salmonella typhi was Isolated from the other two samples which were negative for V. cholerae. Antibiotic susceptibility using Kirby-Bauer disc diffusion method was done on isolates from 69 participants and showed 100% resistance to Ampicillin and over 50% were resistant to trimethoprim/Sulfamethoxazole whereas gentamicin showed 100% susceptibility. Environmental assessment revealed rampant cases of open defecation.
CONCLUSION: Though we did not culture water to confirm contamination with Vibrio cholerae, we hypothesize that the cholera epidemic in Kasese 2017 was sparked off by consumption of contaminated water following the heavy floods that washed away latrines into water sources in Bwera, Isango and Nakiyumbu sub-counties. V. cholerae was also highly resistant to the commonly used antibiotics.

PMID: 31664972 [PubMed - in process]

Whole genome sequence of Vibrio cholerae directly from dried spotted filter paper.

October 29, 2019
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Whole genome sequence of Vibrio cholerae directly from dried spotted filter paper.

PLoS Negl Trop Dis. 2019 05;13(5):e0007330

Authors: Bénard AHM, Guenou E, Fookes M, Ateudjieu J, Kasambara W, Siever M, Rebaudet S, Boncy J, Adrien P, Piarroux R, Sack DA, Thomson N, Debes AK

Abstract
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.

PMID: 31145741 [PubMed - indexed for MEDLINE]

Cholera: under diagnosis and differentiation from other diarrhoeal diseases.

October 29, 2019
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Cholera: under diagnosis and differentiation from other diarrhoeal diseases.

J Travel Med. 2018 May 01;25(suppl_1):S46-S51

Authors: Learoyd TP, Gaut RM

Abstract
Background: Globally 1.4 billion people are at risk from cholera in countries where the disease is endemic, with an estimated 2.8 million cases annually. The disease is significantly under reported due to economic, social and political disincentives as well as poor laboratory resources and epidemiological surveillance in those regions. In addition, identification of cholera from other diarrhoeal causes is often difficult due to shared pathology and symptoms with few reported cases in travellers from Northern Europe.
Methods: A search of PubMed and Ovid Medline for publications on cholera diagnosis from 2010 through 2017 was conducted. Search terms included were cholera, Rapid Diagnostic Test (RDT), multiplex PCR and diagnosis of diarrhoea. Studies were included if they are published in English, French or Spanish.
Results: An increase of RDT study publications for diarrhoeal disease and attempted test validations were seen over the publication period. RDTs were noted as having varied selectivity and specificity, as well as associated costs and local resource requirements that can prohibit their use.
Conclusions: Despite opportunities to employ RDTs with high selectivity and specificity in epidemic areas, or in remote locations without access to health services, such tests are limited to surveillance use. This may represent a missed opportunity to discover the true global presence of Vibrio cholerae and its role in all cause diarrhoeal disease in underdeveloped countries and in travellers to those areas. The wider applicability of RDTs may also represent an opportunity in the wider management of traveller's diarrhoea.

PMID: 29718439 [PubMed - indexed for MEDLINE]

Isolation, Purification, Characterization and Direct Conjugation of the Lipid A-Free Lipopolysaccharide of Vibrio cholerae O139.

October 24, 2019
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Isolation, Purification, Characterization and Direct Conjugation of the Lipid A-Free Lipopolysaccharide of Vibrio cholerae O139.

Chemistry. 2019 Oct 08;25(56):12946-12956

Authors: Xu P, Korcová J, Baráth P, Čížová A, Valáriková J, Qadri F, Kelly M, O'Connor RD, Ryan ET, Bystrický S, Kováč P

Abstract
The lipopolysaccharide (LPS) of Vibrio cholerae O139, strain CIRS245, was isolated conventionally, and the lipid A was removed by mild acid hydrolysis (0.1 m NaOAc buffer containing 1 % SDS, pH 4.2, 95 °C, 8 h). The crude product was a complex mixture consisting mainly of constituent fragments of the O-specific polysaccharide-core (OSPc). The OSPc was only a minor component in the mixture. Two-stage purification of the crude OSPc by HPLC gave pure OSPc fragment of the LPS, as shown by NMR spectroscopy, analytical HPLC and ESI-MS. This material is the purest OSPc fragment of the LPS from Vibrio cholerae O139 reported to date. The purified OSPc was readily converted to the corresponding methyl squarate derivative and the latter was conjugated to BSA. The conjugate, when examined by ELISA, showed immunoreactivity with sera from patients in Bangladesh recovering from cholera caused by V. cholerae O139, but not O1.

PMID: 31306528 [PubMed - indexed for MEDLINE]

The inverse relationship between national food security and annual cholera incidence: a 30-country analysis.

October 23, 2019
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The inverse relationship between national food security and annual cholera incidence: a 30-country analysis.

BMJ Glob Health. 2019;4(5):e001755

Authors: Richterman A, Azman AS, Constant G, Ivers LC

Abstract
Introduction: Individual and household-level evidence suggests a relationship between food insecurity and cholera risk. The relationship between national food security and the size of cholera outbreaks is unknown.
Methods: We analysed the relationship between national food security and annual cholera incidence rate from 2012 to 2015 across 30 countries. We used components of the Global Food Security Index (GFSI) as measures of food security. We included countries with available GFSI reporting cases of cholera during the study period, excluding high-income countries. We developed multivariable zero-inflated negative binomial models with annual cholera incidence rate as the outcome, GFSI components as the exposure of interest, fixed effects for country and year, and time-varying effects related to water, sanitation, and hygiene, oral cholera vaccine deployment, healthcare expenditure, conflict and extreme weather.
Results: The 30 countries reported 550 106 total cases of cholera from 2012 to 2015, with a median annual incidence rate of 3.1 cases per 100 000 people (IQR 0.3-9.9). We found independent inverse relationships between cholera and Overall GFSI (incidence rate ratio (IRR) 0.57, 95% CI 0.43 to 0.78), GFSI-Availability (IRR 0.81, 95% CI 0.70 to 0.95) and GFSI-Affordability (IRR 0.76, 95% CI 0.62 to 0.92).
Conclusions: We identified a strong inverse relationship between national food security and annual incidence rate of cholera. In the context of prior evidence at the individual and household levels, this suggests that there is a linkage between food insecurity and cholera at the national level that should be further considered in assessing cholera risk in vulnerable regions and in designing cholera control interventions.

PMID: 31637028 [PubMed]

Metagenomics: aid to combat antimicrobial resistance in diarrhea.

October 23, 2019
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Metagenomics: aid to combat antimicrobial resistance in diarrhea.

Gut Pathog. 2019;11:47

Authors: De R

Abstract
Antimicrobial resistance (AMR) has emerged as an obstacle in the supple administration of antimicrobial agents to critical diarrheal patients. Most diarrheal pathogens have developed resistance against the major classes of antibiotics commonly used for assuaging diarrheal symptoms. Antimicrobial resistance develops when pathogens acquire antimicrobial resistance genes (ARGs) through genetic recombination from commensals and pathogens. These are the constituents of the complex microbiota in all ecological niches. The recombination events may occur in the environment or in the gut. Containment of AMR can be achieved through a complete understanding of the complex and diverse structure and function of the microbiota. Its taxonomic entities serve as focal points for the dissemination of antimicrobial resistance genetic determinants. Molecular methods complemented with culture-based diagnostics have been historically implemented to document these natural events. However, the advent of next-generation sequencing has revolutionized the field of molecular epidemiology. It has revolutionized the method of addressing relevant problems like diagnosis and surveillance of infectious diseases and the issue of antimicrobial resistance. Metagenomics is one such next-generation technique that has proved to be a monumental advancement in the area of molecular taxonomy. Current understanding of structure, function and dysbiosis of microbiota associated with antimicrobial resistance was realized due to its conception. This review describes the major milestones achieved due to the advent and implementation of this new technique in the context of antimicrobial resistance. These achievements span a wide panorama from the discovery of novel microorganisms to invention of translational value.

PMID: 31636714 [PubMed]

Retrospective Study of Pasteurella multocida Diagnosed in Commercial Turkeys Submitted to California Animal Health and Food Safety Laboratory System; 1991-2017.

October 23, 2019
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Retrospective Study of Pasteurella multocida Diagnosed in Commercial Turkeys Submitted to California Animal Health and Food Safety Laboratory System; 1991-2017.

Avian Dis. 2018 12 01;62(4):364-372

Authors: Blakey J, Shivaprasad HL, Crispo M, Ochoa J, Stoute S

Abstract
Fowl cholera is caused by the bacterium Pasteurella multocida and is known to cause significant economic losses in the commercial turkey industry. Four hundred and thirty cases of P. multocida in commercial turkeys, submitted to the California Animal Health and Food Safety Laboratory System (CAHFS) from January 1, 1991, to December 31, 2017, were analyzed. Records examined included CAHFS branch location, date of submission, clinical signs, company and premise of origin, age and sex of submitted turkeys, macroscopic findings, organs in which P. multocida was isolated, and serotype and fingerprint information. Increased mortality as high as 1200 birds per day was the most common complaint at submission, with acute septicemic lesions observed in the majority of cases. The mean age of turkeys diagnosed with fowl cholera was 14 wk, with a median age of 17 wk. Cases most frequently occurred from September to November, with 36% of cases occurring during this time period. Serotyping was performed in 350 cases, while fingerprinting was performed in 171 cases. Serotypes 3 and 3,4 were frequently identified in the 26-yr time period, while the fingerprints identified varied over time. Despite the decreasing population of commercial turkeys in California since the 1990s, fowl cholera continues to be an economically significant disease in this sector.

PMID: 31119920 [PubMed - indexed for MEDLINE]

Temporal trend and spatial clustering of cholera epidemic in Kumasi-Ghana.

October 23, 2019
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Temporal trend and spatial clustering of cholera epidemic in Kumasi-Ghana.

Sci Rep. 2018 12 14;8(1):17848

Authors: Osei FB, Stein A

Abstract
Knowledge of the temporal trends and spatial patterns will have significant implications for effective preparedness in future epidemics. Our objective was to investigate the temporal trends and the nature of the spatial interaction of cholera incidences, dwelling on an outbreak in the Kumasi Metropolis, Ghana. We developed generalized nonparametric and segmented regression models to describe the epidemic curve. We used the pair correlation function to describe the nature of spatial clustering parameters such as the maximum scale of interaction and the scale of maximal interaction. The epidemic rose suddenly to a peak with 40% daily increments of incidences. The decay, however, was slower with 5% daily reductions. Spatial interaction occurred within 1 km radius. Maximal interaction occurred within 0.3 km, suggesting a household level of interactions. Significant clustering during the first week suggests secondary transmissions sparked the outbreak. The nonparametric and segmented regression models, together with the pair correlation function, contribute to understanding the transmission dynamics. The issue of underreporting remains a challenge we seek to address in future. These findings, however, will have innovative implications for developing preventive measures during future epidemics.

PMID: 30552392 [PubMed - indexed for MEDLINE]

Identifying potential emerging threats through epidemic intelligence activities - looking for the needle in the haystack?

October 20, 2019
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Identifying potential emerging threats through epidemic intelligence activities - looking for the needle in the haystack?

Int J Infect Dis. 2019 Oct 16;:

Authors: Jennifer W, Catherine OC, Amanda LW, Dilys M

Abstract
BACKGROUND: Epidemic intelligence (EI) for emerging infections is the process of identifying key information on emerging infectious diseases and specific incidents. Automated web-based infectious disease surveillance technologies are available; however, human input is still needed to review, validate and interpret these sources. In this study, entries captured by Public Health England's (PHE) manual event-based EI system were examined to inform future intelligence gathering activities.
METHODS: A descriptive analysis of unique events captured in a database between 2013-2017 was conducted. The top five diseases, in terms of number of entries, were described in depth to determine the effectiveness of PHE's EI surveillance system compared to other sources.
FINDINGS: Between 2013 and 2017, 22,847 unique entries were added to the database. The top three initial and definitive information sources varied considerably by disease. Ebola entries dominated the database, making up 23·7% of the total, followed by Zika virus (11·8%), MERS-CoV (6·7%), cholera (5·5%) and yellow fever and undiagnosed morbidity (both 3·3%). Initial reports of major outbreaks due to the top five agents were picked up through our manual system prior to being publicly reported by official sources.
INTERPRETATION: PHE's manual EI process quickly and accurately detected global public health threats at the earliest stages and allowed for monitoring of events as they evolved.

PMID: 31629079 [PubMed - as supplied by publisher]

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