Recent Cholera Publications on PubMed

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Building a new platform to support public health emergency response in Africa: the AFENET Corps of Disease Detectives, 2018-2019.

October 19, 2020

Building a new platform to support public health emergency response in Africa: the AFENET Corps of Disease Detectives, 2018-2019.

BMJ Glob Health. 2020 Oct;5(10):

Authors: Masiira B, Antara SN, Kazoora HB, Namusisi O, Gombe NT, Magazani AN, Nguku PM, Kazambu D, Gitta SN, Kihembo C, Sawadogo B, Bogale TA, Ohuabunwo C, Nsubuga P, Tshimanga M

Abstract
Public health emergency (PHE) response in sub-Saharan Africa is constrained by inadequate skilled public health workforce and underfunding. Since 2005, the African Field Epidemiology Network (AFENET) has been supporting field epidemiology capacity development and innovative strategies are required to use this workforce. In 2018, AFENET launched a continental rapid response team: the AFENET Corps of Disease Detectives (ACoDD). ACoDD comprises field epidemiology graduates and residents and was established to support PHE response. Since 2018, AFENET has deployed the ACoDD to support response to several PHEs. The main challenges faced during ACoDD deployments were financing of operations, ACoDD safety and security, resistance to interventions and distrust of the responders by some communities. Our experience during these deployments showed that it was feasible to mobilise and deploy ACoDD within 48 hours. However, the sustainability of deployments will depend on establishing strong linkages with the employers of ACoDD members. PHEs are effectively controlled when there is a fast deployment and strong linkages between the stakeholders. There are ongoing efforts to strengthen PHE preparedness and response in sub-Saharan Africa. ACoDD members are a competent workforce that can effectively augment PHE response. ACoDD teams mentored front-line health workers and community health workers who are critical in PHE response. Public health emergence response in sub-Saharan Africa is constrained by inadequacies in a skilled workforce and underfunding. ACoDD can be utilised to overcome the challenges of accessing a skilled public health workforce. To improve health security in sub-Saharan Africa, more financing of PHE response is needed.

PMID: 33051282 [PubMed - in process]

Learning from the past in the COVID-19 era: rediscovery of quarantine, previous pandemics, origin of hospitals and national healthcare systems, and ethics in medicine.

October 19, 2020
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Learning from the past in the COVID-19 era: rediscovery of quarantine, previous pandemics, origin of hospitals and national healthcare systems, and ethics in medicine.

Postgrad Med J. 2020 Oct;96(1140):633-638

Authors: Bassareo PP, Melis MR, Marras S, Calcaterra G

Abstract
After the dramatic coronavirus outbreak at the end of 2019 in Wuhan, Hubei province, China, on 11 March 2020, a pandemic was declared by the WHO. Most countries worldwide imposed a quarantine or lockdown to their citizens, in an attempt to prevent uncontrolled infection from spreading. Historically, quarantine is the 40-day period of forced isolation to prevent the spread of an infectious disease. In this educational paper, a historical overview from the sacred temples of ancient Greece-the cradle of medicine-to modern hospitals, along with the conceive of healthcare systems, is provided. A few foods for thought as to the conflict between ethics in medicine and shortage of personnel and financial resources in the coronavirus disease 2019 era are offered as well.

PMID: 32907877 [PubMed - indexed for MEDLINE]

Genome Dynamics of Vibrio cholerae Isolates Linked to Seasonal Outbreaks of Cholera in Dhaka, Bangladesh.

October 19, 2020
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Genome Dynamics of Vibrio cholerae Isolates Linked to Seasonal Outbreaks of Cholera in Dhaka, Bangladesh.

mBio. 2020 02 11;11(1):

Authors: Baddam R, Sarker N, Ahmed D, Mazumder R, Abdullah A, Morshed R, Hussain A, Begum S, Shahrin L, Khan AI, Islam MS, Ahmed T, Alam M, Clemens JD, Ahmed N

Abstract
The temporal switching of serotypes from serotype Ogawa to Inaba and back to Ogawa was identified in Vibrio cholerae O1, which was responsible for seasonal outbreaks of cholera in Dhaka during the period 2015 to 2018. In order to delineate the factors responsible for this serotype transition, we performed whole-genome sequencing (WGS) of V. cholerae O1 multidrug-resistant strains belonging to both the serotypes that were isolated during this interval where the emergence and subsequent reduction of the Inaba serotype occurred. The whole-genome-based phylogenetic analysis revealed clonal expansion of the Inaba isolates mainly responsible for the peaks of infection during 2016 to 2017 and that they might have evolved from the prevailing Ogawa strains in 2015 which coclustered with them. Furthermore, the wbeT gene in these Inaba serotype isolates was inactivated due to insertion of a transposable element at the same position signifying the clonal expansion. Also, V. cholerae isolates in the Inaba serotype dominant clade mainly contained classical ctxB allele and revealed differences in the genetic composition of Vibrio seventh pandemic island II (VSP-II) and the SXT integrative and conjugative element (SXT-ICE) compared to those of Ogawa serotype strains which remerged in 2018. The variable presence of phage-inducible chromosomal island-like element 1 (PLE1) was also noted in the isolates of the Inaba serotype dominant clade. The detailed genomic characterization of the sequenced isolates has shed light on the forces which could be responsible for the periodic changes in serotypes of V. cholerae and has also highlighted the need to analyze the mobilome in greater detail to obtain insights into the mechanisms behind serotype switching.IMPORTANCE The switching of serotype from Ogawa to Inaba and back to Ogawa has been observed temporally in Vibrio cholerae O1, which is responsible for endemic cholera in Bangladesh. The serospecificity is key for effective intervention and for preventing cholera, a deadly disease that continues to cause significant morbidity and mortality worldwide. In the present study, WGS of V. cholerae allowed us to better understand the factors associated with the serotype switching events observed during 2015 to 2018. Genomic data analysis of strains isolated during this interval highlighted variations in the genes ctxB, tcpA, and rtxA and also identified significant differences in the genetic content of the mobilome, which included key elements such as SXT ICE, VSP-II, and PLE. Our results indicate that selective forces such as antibiotic resistance and phage resistance might contribute to the clonal expansion and predominance of a particular V. cholerae serotype responsible for an outbreak.

PMID: 32047137 [PubMed - indexed for MEDLINE]

Prevalence of Multidrug Resistant Salmonellae with Increasing Frequency of Salmonella enterica Serovars Kentucky and Virchow among Hospitalized Diarrheal Cases in and around Delhi, India.

October 19, 2020
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Prevalence of Multidrug Resistant Salmonellae with Increasing Frequency of Salmonella enterica Serovars Kentucky and Virchow among Hospitalized Diarrheal Cases in and around Delhi, India.

Jpn J Infect Dis. 2020 Mar 24;73(2):119-123

Authors: Sharma NC, Kumar D, Sarkar A, Chowdhury G, Mukhopadhyay AK, Ramamurthy T

Abstract
Non-typhoidal salmonellae (NTS) are a major cause of acute diarrhea with characteristic multidrug resistance (MDR). In a hospital-based study, 81 NTS were isolated and tested for serotypes and antimicrobial resistance (AMR). Salmonella enterica isolates were classified into 7 different typable serovars, however, 19 (23%) isolates remained untypable. The most common serovars were S. Kentucky (48%), and S. Virchow (22%). Most of the NTS isolates displayed resistance to nalidixic acid (NA) (73%), ciprofloxacin (CIP) (48%), ampicillin (AM) and norfloxacin (NOR) (36% each), and gentamicin (CN) (31%). The AMR profiles for CN and NA; and AM, CIP, NA and NOR, were found to be high in S. Virchow (83%) and S. Kentucky (43%), respectively. Analysis of the pulsed-field gel electrophoresis patterns of S. Kentucky revealed 3 clusters. S. Kentucky has clones closely related to become prominent in recent years in Delhi. The AMR appears to be consistent with the change in MDR patterns during 2014-2017. The observed prevalence of S. Kentucky and S. Virchow in large numbers of diarrheal cases is novel. The NTS are mostly resistant to fluoroquinolones, which is the current drug of choice for treating diarrheal cases. MDR is very common among clonally related S. Kentucky.

PMID: 31666490 [PubMed - indexed for MEDLINE]

The epidemiology of cholera in the Islamic Republic of Iran, 1965-2014.

October 14, 2020

The epidemiology of cholera in the Islamic Republic of Iran, 1965-2014.

East Mediterr Health J. 2020 Sep 24;26(9):1097-1104

Authors: Masoumi-Asl H, Kolifarhood G, Gouya MM

Abstract
Background: Cholera is endemic in the Islamic Republic of Iran. According to surveillance system records and historical documents, cholera epidemics have led to thousands of deaths throughout the country in past centuries.
Aims: The aim of this study was an overview of cholera disease during the last 5 decades (1965-2014) and the epidemiological features of the most recent large-scale outbreaks.
Methods: In this descriptive study, cholera incidence data provided by the National Surveillance Database were extracted and significant fluctuating trends for 1965-2014 were tested using the Cochran-Armitage test. To identify the factors most associated with cholera incidence in the outbreaks, adjusted odds ratios were computed by ordinal logistic regression.
Results: Analysis of data has shown a tremendous decrease in incidence trends, from 19.7/100 000 to 0.01/100 000 over the 9 cholera epidemics that occurred at 5-6 year intervals during 1965-2014. Younger age groups (15-44 years) and inhabitants in urban areas have been more vulnerable to cholera in recent epidemics. The virulence of the pathogen and the case fatality rates have not changed during the last 3 epidemics.
Conclusion: The burden of cholera in terms of case load has dramatically reduced during 1965-2014. Furthermore, the epidemiological feature of cholera with regard to transmission route, domicile, age, immigration, mortality and antimicrobial resistance has changed considerably in recent epidemics. While the number of epidemic regions has diminished, some areas are still susceptible to cholera outbreaks.

PMID: 33047801 [PubMed - in process]

Pre-existing Helicobacter pylori serum IgG enhances the vibriocidal antibody response to CVD 103-HgR live oral cholera vaccine in Malian adults.

October 11, 2020

Pre-existing Helicobacter pylori serum IgG enhances the vibriocidal antibody response to CVD 103-HgR live oral cholera vaccine in Malian adults.

Sci Rep. 2020 Oct 09;10(1):16871

Authors: Muhsen K, Sow SO, Tapia MD, Haidara FC, Reymann M, Asato V, Chen WH, Pasetti MF, Levine MM

Abstract
Accumulating evidence indicates that persistent Helicobacter pylori gastric infection influences immune responses to oral enteric vaccines. We studied the association between pre-existing H. pylori serum IgG and serum pepsinogens levels (PGs) as markers of gastric inflammation and the immune response to single-dose live oral cholera vaccine CVD 103-HgR in Malian adults. Baseline sera obtained during a phase 2 safety/immunogenicity clinical trial of cholera vaccine CVD 103-HgR among 93 healthy Malian adults were tested for H. pylori IgG antibodies and PGI and PGII levels using enzyme linked immunosorbent assays. Overall 74/93 (80%) vaccine recipients were H. pylori IgG seropositive at baseline. Vibriocidal antibody seroconversion (≥ fourfold increase 14 days following administration of CVD 103-HgR compared to baseline) among vaccine recipients was 56%. However, vibriocidal antibody seroconversion was markedly higher among H. pylori seropositives than seronegatives 64% vs. 26% (p = 0.004); adjusted relative risk: 2.20 (95% confidence intervals 1.00-4.80; p = 0.049). Among H. pylori seropositive vaccine recipients, there were no significant associations between PGI, PGII and PGI:PGII levels and vibriocidal seroconversion. The enhanced seroconversion to oral cholera vaccine CVD 103-HgR among H. pylori seropositive African adults provides further evidence of the immunomodulating impact of H. pylori on oral vaccine immunogenicity.

PMID: 33037244 [PubMed - as supplied by publisher]

Diversity of rotavirus genotypes circulating in children < 5 years of age hospitalized for acute gastroenteritis in India from 2005 to 2016: analysis of temporal and regional genotype variation.

October 11, 2020

Diversity of rotavirus genotypes circulating in children < 5 years of age hospitalized for acute gastroenteritis in India from 2005 to 2016: analysis of temporal and regional genotype variation.

BMC Infect Dis. 2020 Oct 09;20(1):740

Authors: Giri S, Kumar CPG, Khakha SA, Chawla-Sarkar M, Gopalkrishna V, Chitambar SD, Ray P, Venkatasubramanian S, Borkakoty BJ, Roy S, Bhat J, Dwibedi B, Das P, Paluru V, Ramani S, Babji S, Arora R, Mehendale SM, Gupte MD, Kang G, National Rotavirus Surveillance Network investigators

Abstract
BACKGROUND: From 2016, the Government of India introduced the oral rotavirus vaccine into the national immunization schedule. Currently, two indigenously developed vaccines (ROTAVAC, Bharat Biotech; ROTASIIL, Serum Institute of India) are included in the Indian immunization program. We report the rotavirus disease burden and the diversity of rotavirus genotypes from 2005 to 2016 in a multi-centric surveillance study before the introduction of vaccines.
METHODS: A total of 29,561 stool samples collected from 2005 to 2016 (7 sites during 2005-2009, 3 sites from 2009 to 2012, and 28 sites during 2012-2016) were included in the analysis. Stools were tested for rotavirus antigen using enzyme immunoassay (EIA). Genotyping was performed on 65.8% of the EIA positive samples using reverse transcription- polymerase chain reaction (RT-PCR) to identify the G (VP7) and P (VP4) types. Multinomial logistic regression was used to quantify the odds of detecting genotypes across the surveillance period and in particular age groups.
RESULTS: Of the 29,561 samples tested, 10,959 (37.1%) were positive for rotavirus. There was a peak in rotavirus positivity during December to February across all sites. Of the 7215 genotyped samples, G1P[8] (38.7%) was the most common, followed by G2P[4] (12.3%), G9P[4] (5.8%), G12P[6] (4.2%), G9P[8] (4%), and G12P[8] (2.4%). Globally, G9P[4] and G12P[6] are less common genotypes, although these genotypes have been reported from India and few other countries. There was a variation in the geographic and temporal distribution of genotypes, and the emergence or re-emergence of new genotypes such as G3P[8] was seen. Over the surveillance period, there was a decline in the proportion of G2P[4], and an increase in the proportion of G9P[4]. A higher proportion of mixed and partially typed/untyped samples was also seen more in the age group 0-11 months.
CONCLUSIONS: This 11 years surveillance highlights the high burden of severe rotavirus gastroenteritis in Indian children < 5 years of age before inclusion of rotavirus vaccines in the national programme. Regional variations in rotavirus epidemiology were seen, including the emergence of G3P[8] in the latter part of the surveillance. Having pre-introduction data is important to track changing epidemiology of rotaviruses, particularly following vaccine introduction.

PMID: 33036575 [PubMed - as supplied by publisher]

Prevalence and diversity of enteric pathogens among cholera treatment centre patients with acute diarrhea in Uvira, Democratic Republic of Congo.

October 11, 2020

Prevalence and diversity of enteric pathogens among cholera treatment centre patients with acute diarrhea in Uvira, Democratic Republic of Congo.

BMC Infect Dis. 2020 Oct 09;20(1):741

Authors: Williams C, Cumming O, Grignard L, Rumedeka BB, Saidi JM, Grint D, Drakeley C, Jeandron A

Abstract
BACKGROUND: Cholera remains a major global health challenge. Uvira, in the Democratic Republic of the Congo (DRC), has had endemic cholera since the 1970's and has been implicated as a possible point of origin for national outbreaks. A previous study among this population, reported a case confirmation rate of 40% by rapid diagnostic test (RDT) among patients at the Uvira Cholera Treatment Centre (CTC). This study considers the prevalence and diversity of 15 enteric pathogens in suspected cholera cases seeking treatment at the Uvira CTC.
METHODS: We used the Luminex xTAG® multiplex PCR to test for 15 enteric pathogens, including toxigenic strains of V. cholerae in rectal swabs preserved on Whatman FTA Elute cards. Results were interpreted on MAGPIX® and analyzed on the xTAG® Data Analysis Software. Prevalence of enteric pathogens were calculated and pathogen diversity was modelled with a Poisson regression.
RESULTS: Among 269 enrolled CTC patients, PCR detected the presence of toxigenic Vibrio cholerae in 38% (103/269) of the patients, which were considered to be cholera cases. These strains were detected as the sole pathogen in 36% (37/103) of these cases. Almost half (45%) of all study participants carried multiple enteric pathogens (two or more). Enterotoxigenic Escherichia coli (36%) and Cryptosporidium (28%) were the other most common pathogens identified amongst all participants. No pathogen was detected in 16.4% of study participants. Mean number of pathogens was highest amongst boys and girls aged 1-15 years and lowest in women aged 16-81 years. Ninety-three percent of toxigenic V. cholerae strains detected by PCR were found in patients having tested positive for V. cholerae O1 by RDT.
CONCLUSIONS: Our study supports previous results from DRC and other cholera endemic areas in sub-Sahara Africa with less than half of CTC admissions positive for cholera by PCR. More research is required to determine the causes of severe acute diarrhea in these low-resource, endemic areas to optimize treatment measures.
TRIAL REGISTRATION: This study is part of the impact evaluation study entitled: "Impact Evaluation of Urban Water Supply Improvements on Cholera and Other Diarrheal Diseases in Uvira, Democratic Republic of Congo" registered on 10 October 2016 at clinicaltrials.gov Identification number: NCT02928341 .

PMID: 33036564 [PubMed - as supplied by publisher]

Oral cholera vaccination coverage after the first global stockpile deployment in Haiti, 2014.

October 9, 2020
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Oral cholera vaccination coverage after the first global stockpile deployment in Haiti, 2014.

Vaccine. 2019 10 08;37(43):6348-6355

Authors: Burnett EM, Francois J, Sreenivasan N, Wannemuehler K, Faye PC, Tohme RA, Delly P, Deslouches YG, Etheart MD, Dismer AM, Patel R, Date K

Abstract
INTRODUCTION: In 2014, an oral cholera vaccine (OCV) campaign targeting 185,314 persons aged ≥1 years was conducted in 3 departments via fixed post and door-to-door strategies. This was the first use of the global OCV stockpile in Haiti.
METHODS: We conducted a multi-stage cluster survey to assess departmental OCV coverage. Target population estimates were projected from the 2003 Haiti population census with adjustments for population growth and estimated proportion of pregnant women. In the three departments, we sampled 30/106 enumeration areas (EAs) in Artibonite, 30/244 EAs in Centre, and 20/29 EAs in Ouest; 20 households were systematically sampled in each EA. Household and individual interviews using a standard questionnaire were conducted in each selected household; data on OCV receipt were obtained from vaccination card or verbal report. We calculated OCV campaign coverage estimates and 95% confidence intervals (CIs) accounting for survey design.
RESULTS: Overall two-dose OCV coverage was 70% (95% CI: 60, 79), 63% (95% CI: 55, 71), and 44% (95% CI: 35, 53) in Artibonite, Centre, and Ouest, respectively. Two-dose coverage was higher in the 1-4 years age group than among those ≥ 15 years in Artibonite (difference: 11%; 95% CI: 5%, 17%) and Ouest (difference: 12%; 95% CI: 3, 20). A higher percentage of children aged 5-14 years received both recommended doses than did those ≥ 15 years (Artibonite: 14% (95% CI: 8%, 19%) difference; Centre: 11% difference (95% CI: 5%, 17%); Ouest: 10% difference (95% CI: 2%, 17%). The most common reason for not receiving any OCV dose was being absent during the campaign or not having heard about vaccination activities.
CONCLUSIONS: While coverage estimates in Artibonite and Centre were comparable with other OCV campaigns in Haiti and elsewhere, inadequate social mobilization and outdated population estimates might have contributed to lower coverage in Ouest.

PMID: 31521413 [PubMed - indexed for MEDLINE]

Mozambique's response to cyclone Idai: how collaboration and surveillance with water, sanitation and hygiene (WASH) interventions were used to control a cholera epidemic.

October 7, 2020
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Mozambique's response to cyclone Idai: how collaboration and surveillance with water, sanitation and hygiene (WASH) interventions were used to control a cholera epidemic.

Infect Dis Poverty. 2020 Jun 16;9(1):68

Authors: Lequechane JD, Mahumane A, Chale F, Nhabomba C, Salomão C, Lameira C, Chicumbe S, Semá Baltazar C

Abstract
Cyclone Idai, which hit Mozambique in March 2019, was one of the worst climate-related natural disasters on record in the Southern Hemisphere causing massive destruction of housing and disruption to vital infrastructure including the electrical grid, communications and water supply. Almost two million people were affected with over 600 deaths, hundreds of thousands of people displaced accompanied by rapid spread of cholera. We describe emergency measures taken by the Government of Mozambique, in collaboration with multilateral partners, to establish a real-time disease surveillance system, implement interventions recommended by a Water, Sanitation and Hygiene (WASH) taskforce and rapidly scale up a massive community vaccination program to control a cholera epidemic.

PMID: 32546268 [PubMed - indexed for MEDLINE]

Household spraying in cholera outbreaks: Insights from three exploratory, mixed-methods field effectiveness evaluations.

October 6, 2020
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Household spraying in cholera outbreaks: Insights from three exploratory, mixed-methods field effectiveness evaluations.

PLoS Negl Trop Dis. 2020 08;14(8):e0008661

Authors: Gallandat K, Huang A, Rayner J, String G, Lantagne DS

Abstract
Household spraying is a commonly implemented, yet an under-researched, cholera response intervention where a response team sprays surfaces in cholera patients' houses with chlorine. We conducted mixed-methods evaluations of three household spraying programs in the Democratic Republic of Congo and Haiti, including 18 key informant interviews, 14 household surveys and observations, and 418 surface samples collected before spraying, 30 minutes and 24 hours after spraying. The surfaces consistently most contaminated with Vibrio cholerae were food preparation areas, near the patient's bed and the latrine. Effectiveness varied between programs, with statistically significant reductions in V. cholerae concentrations 30 minutes after spraying in two programs. Surface contamination after 24 hours was variable between households and programs. Program challenges included difficulty locating households, transportation and funding limitations, and reaching households quickly after case presentation (disinfection occurred 2-6 days after reported cholera onset). Program advantages included the concurrent deployment of hygiene promotion activities. Further research is indicated on perception, recontamination, cost-effectiveness, viable but nonculturable V. cholerae, and epidemiological coverage. We recommend that, if spraying is implemented, spraying agents should: disinfect surfaces systematically until wet using 0.2/2.0% chlorine solution, including kitchen spaces, patients' beds, and latrines; arrive at households quickly; and, concurrently deploy hygiene promotion activities.

PMID: 32866145 [PubMed - indexed for MEDLINE]

Conflict and Cholera: Yemen's Man-Made Public Health Crisis and the Global Implications of Weaponizing Health.

October 6, 2020
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Conflict and Cholera: Yemen's Man-Made Public Health Crisis and the Global Implications of Weaponizing Health.

Health Secur. 2020 Mar/Apr;18(2):125-131

Authors: Blackburn CC, Lenze PE, Casey RP

Abstract
The cholera epidemic in Yemen, which began in October 2016 and reached its peak in 2017, was the largest disease outbreak in modern history. Suspected cases topped 1 million, and there were more than 2,000 confirmed deaths in the first 8 months of the outbreak. Although cholera is an ancient disease, and there were other countries around the globe experiencing outbreaks at the same time as the outbreak in Yemen, Yemen's outbreak had a number of unique features. The outbreak spread at an unprecedented pace and has been directly linked to the country's ongoing armed conflict. In this article we ask: What does the recent cholera outbreak in Yemen teach us about the relationship between conflict and infectious disease? Is the intentional targeting of infrastructure, as is occurring in Yemen, the new face of modern warfare? And what implications does a strategy of infrastructure destruction have for global health security? To answer these questions, we examined the history of the conflict in Yemen, the relationship between conflict and infectious disease, the intentional destruction of infrastructure throughout Yemen, and the resulting cholera outbreak. We discuss health as a weapon of war and seek to understand whether this indirect form of biological warfare is a new standard war tactic. Lastly, we address what the weaponization of health means for both global health security and US national security.

PMID: 32324073 [PubMed - indexed for MEDLINE]

Improving Cross-Border Preparedness and Response: Lessons Learned from 3 Lassa Fever Outbreaks Across Benin, Nigeria, and Togo, 2017-2019.

October 6, 2020
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Improving Cross-Border Preparedness and Response: Lessons Learned from 3 Lassa Fever Outbreaks Across Benin, Nigeria, and Togo, 2017-2019.

Health Secur. 2020 Jan;18(S1):S105-S112

Authors: Kakaī CG, Okunromade OF, Dan-Nwafor CC, Chabi AIB, Martial GTP, Dalhat MM, Ward S, Tante O, Nguku PM, Hamadi A, Ilori E, Lokossou V, Brito C, Ojo OE, Kone I, Agbeko TT, Ihekweazu C, Merrill RD

Abstract
Long-standing cultural, economic, and political relationships among Benin, Nigeria, and Togo contribute to the complexity of their cross-border connectivity. The associated human movement increases the risk of international spread of communicable disease. The Benin and Togo ministries of health and the Nigeria Centre for Disease Control, in collaboration with the Abidjan Lagos Corridor Organization (a 5-country intergovernmental organization) and the US Centers for Disease Control and Prevention, sought to minimize the risk of cross-border outbreaks by defining and implementing procedures for binational and multinational public health collaboration. Through 2 multinational meetings, regular district-level binational meetings, and fieldwork to characterize population movement and connectivity patterns, the countries improved cross-border public health coordination. Across 3 sequential cross-border Lassa fever outbreaks identified in Benin or Togo between February 2017 and March 2019, the 3 countries improved their collection and sharing of patients' cross-border travel histories, shortened the time between case identification and cross-border information sharing, and streamlined multinational coordination during response efforts. Notably, they refined collaborative efforts using lessons learned from the January to March 2018 Benin outbreak, which had a 100% case fatality rate among the 5 laboratory-confirmed cases, 3 of whom migrated from Nigeria across porous borders when ill. Aligning countries' expectations for sharing public health information would assist in reducing the international spread of communicable diseases by facilitating coordinated preparedness and responses strategies. Additionally, these binational and multinational strategies could be made more effective by tailoring them to the unique cultural connections and population movement patterns in the region.

PMID: 32004125 [PubMed - indexed for MEDLINE]

An Integrated Approach for Spatio-Temporal Cholera Disease Hotspot Relation Mining for Public Health Management in Punjab, Pakistan.

October 3, 2020
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An Integrated Approach for Spatio-Temporal Cholera Disease Hotspot Relation Mining for Public Health Management in Punjab, Pakistan.

Int J Environ Res Public Health. 2020 05 26;17(11):

Authors: Khalique F, Khan SA, Butt WH, Matloob I

Abstract
Public health management can generate actionable results when diseases are studied in context with other candidate factors contributing to disease dynamics. In order to fully understand the interdependent relationships of multiple geospatial features involved in disease dynamics, it is important to construct an effective representation model that is able to reveal the relationship patterns and trends. The purpose of this work is to combine disease incidence spatio-temporal data with other features of interest in a mutlivariate spatio-temporal model for investigating characteristic disease and feature patterns over identified hotspots. We present an integrated approach in the form of a disease management model for analyzing spatio-temporal dynamics of disease in connection with other determinants. Our approach aligns spatio-temporal profiles of disease with other driving factors in public health context to identify hotspots and patterns of disease and features of interest in the identified locations. We evaluate our model against cholera disease outbreaks from 2015-2019 in Punjab province of Pakistan. The experimental results showed that the presented model effectively address the complex dynamics of disease incidences in the presence of other features of interest over a geographic area representing populations and sub populations during a given time. The presented methodology provides an effective mechanism for identifying disease hotspots in multiple dimensions and relation between the hotspots for cost-effective and optimal resource allocation as well as a sound reference for further predictive and forecasting analysis.

PMID: 32466471 [PubMed - indexed for MEDLINE]

Tube Well Use as Protection Against Rotavirus Infection During the Monsoons in an Urban Setting.

October 2, 2020
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Tube Well Use as Protection Against Rotavirus Infection During the Monsoons in an Urban Setting.

J Infect Dis. 2020 01 02;221(2):238-242

Authors: Martinez PP, Mahmud AS, Yunus M, Faruque ASG, Ahmed T, Pascual M, Buckee CO

Abstract
Rotavirus, a diarrheal pathogen spread via fecal-oral transmission, is typically characterized by a winter incidence peak in most countries. Unlike for cholera and other waterborne infections, the role of sanitation and socioeconomic factors on the spatial variation of rotavirus seasonality remains unclear. In the current study, we analyzed their association with rotavirus seasonality, specifically the odds of monsoon cases, across 46 locations from 2001 to 2012 in Dhaka. Drinking water from tube wells, compared to other sources, has a clear protective effect against cases during the monsoon, when flooding and water contamination are more likely. This finding supports a significant environmental component of transmission.

PMID: 31776559 [PubMed - indexed for MEDLINE]

Genetic characterization of group-A rotaviruses among children in eastern India during 2014-2016: Phylodynamics of co-circulating genotypes.

September 29, 2020
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Genetic characterization of group-A rotaviruses among children in eastern India during 2014-2016: Phylodynamics of co-circulating genotypes.

Vaccine. 2019 10 23;37(45):6842-6856

Authors: Nayak MK, Banerjee A, Sarkar R, Mitra S, Dutta K, Ganguly N, Ghosh C, Girish Kumar CP, Niyogi P, Panda S, Dutta S, Chawla-Sarkar M

Abstract
BACKGROUND: Group-A human rotaviruses (GARV) are among the major cause of childhood diarrhea worldwide. In lieu of monitoring the circulatory GARV strains and underscoring the burden of GARV related hospitalization, a systematic surveillance was conducted in three hospitals of eastern India. In this hospital-based diarrheal disease surveillance (2014-2016), GARV was the most common cause of acute infantile gastroenteritis. The strains were genotyped and characterized to understand their prevalence and phylodynamics prior to the introduction of vaccine in eastern India.
MATERIALS AND METHODS: A total of 3652 stool samples were screened from children (≤5 years) hospitalized with acute diarrhea during 2014-2016. Initial screening for VP6 antigen was done by ELISA. GARV positive samples were genotyped by multiplex semi-nested PCR and DNA sequencing and phylogenetic analyses were based on the capsid proteins VP4 and VP7.
RESULTS: Of 3652 samples, 1817 (49.8%) were GARV positive. G1, G2, G3 and G9 in conjunction with P[4], P[6]and P[8]genotypes were seen to co-circulate in the population. A sharp deflection from G1 to G3 occurred since 2016; upsurge of G9 strains was seen in alternate years, whereas G2 strains had a low frequency. All the circulating genotypes depicted a low phylogenetic relatedness to the vaccine strains. Differences in antigenic epitopes of VP4 and VP7 proteins in local strains were seen when compared to the vaccine strains. A significant difference in the degree of dehydration, duration of mean hospital stay and frequency of vomiting/24 h between GARV positive and negative children was evident.
CONCLUSION: The study provides a relevant set of base-line data on high burden of rotaviral gastroenteritis and the varied genotypic diversity among children prior to the introduction of GARV vaccine in this endemic region. Continuous monitoring during post-vaccination era will be required to assess the impact of vaccination in this region.

PMID: 31543416 [PubMed - indexed for MEDLINE]

Disease Extinction Versus Persistence in Discrete-Time Epidemic Models.

September 29, 2020
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Disease Extinction Versus Persistence in Discrete-Time Epidemic Models.

Bull Math Biol. 2019 11;81(11):4412-4446

Authors: van den Driessche P, Yakubu AA

Abstract
We focus on discrete-time infectious disease models in populations that are governed by constant, geometric, Beverton-Holt or Ricker demographic equations, and give a method for computing the basic reproduction number, [Formula: see text]. When [Formula: see text] and the demographic population dynamics are asymptotically constant or under geometric growth (non-oscillatory), we prove global asymptotic stability of the disease-free equilibrium of the disease models. Under the same demographic assumption, when [Formula: see text], we prove uniform persistence of the disease. We apply our theoretical results to specific discrete-time epidemic models that are formulated for SEIR infections, cholera in humans and anthrax in animals. Our simulations show that a unique endemic equilibrium of each of the three specific disease models is asymptotically stable whenever [Formula: see text].

PMID: 29651670 [PubMed - indexed for MEDLINE]

An Accidental Nutritionist.

September 24, 2020
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An Accidental Nutritionist.

Annu Rev Nutr. 2020 Sep 23;40:1-23

Authors: Sommer A

Abstract
My career as an accidental nutritionist began with my immersion in cholera control, a cyclone disaster, a smallpox epidemic, and formal training in ophthalmology and epidemiology. Interest in blindness prevention inexplicably led me to (re)pioneer the effects, treatment, and prevention of vitamin A deficiency, while faced with intense criticism by many leading scientists in the nutrition community. The resulting efforts by the World Health Organization and UNICEF in support of programs for the global control of vitamin A deficiency still face vocal opposition by some senior scientists, despite having been estimated to have saved tens of millions of children from unnecessary death and blindness. This entire journey was largely an accident!

PMID: 32966182 [PubMed - as supplied by publisher]

Genomic characterization of antibiotic resistance-encoding genes in clinical isolates of Vibrio cholerae non-O1/non-O139 strains from Kolkata, India: generation of novel types of genomic islands containing plural antibiotic resistance genes.

September 23, 2020
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Genomic characterization of antibiotic resistance-encoding genes in clinical isolates of Vibrio cholerae non-O1/non-O139 strains from Kolkata, India: generation of novel types of genomic islands containing plural antibiotic resistance genes.

Microbiol Immunol. 2020 Jun;64(6):435-444

Authors: Morita D, Takahashi E, Morita M, Ohnishi M, Mizuno T, Miyoshi SI, Dutta D, Ramamurthy T, Chowdhury G, Mukhopadhyay AK, Okamoto K

Abstract
Non-O1/non-O139 nontoxigenic Vibrio cholerae associated with cholera-like diarrhea has been reported in Kolkata, India. However, the property involved in the pathogenicity of these strains has remained unclear. The character of 25 non-O1/non-O139 nontoxigenic V. cholerae isolated during 8 years from 2007 to 2014 in Kolkata was examined. Determination of the serogroup showed that the serogroups O6, O10, O35, O36, O39, and O70 were represented by two strains in each serogroup, and the remaining isolates belonged to different serogroups. To clarify the character of antibiotic resistance of these isolates, an antibiotic resistance test and the gene analysis were performed. According to antimicrobial drug susceptibility testing, 13 strains were classified as drug resistant. Among them, 10 strains were quinolone resistant and 6 of the 13 strains were resistant to more than three antibiotics. To define the genetic background of the antibiotic character of these strains, whole-genome sequences of these strains were determined. From the analysis of these sequences, it becomes clear that all quinolone resistance isolates have mutations in quinolone resistance-determining regions. Further research on the genome sequence showed that four strains possess Class 1 integrons in their genomes, and that three of the four integrons are found to be located in their genomic islands. These genomic islands are novel types. This indicates that various integrons containing drug resistance genes are spreading among V. cholerae non-O1/non-O139 strains through the action of newly generated genomic islands.

PMID: 32222116 [PubMed - indexed for MEDLINE]

Dynamics of an SLIR model with nonmonotone incidence rate and stochastic perturbation.

September 23, 2020
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Dynamics of an SLIR model with nonmonotone incidence rate and stochastic perturbation.

Math Biosci Eng. 2019 06 14;16(5):5504-5530

Authors: Zhang JH, Ren JL, Zhang XA

Abstract
In this paper we study an SLIR epidemic model with nonmonotonic incidence rate, which describes the psychological effect of certain serious diseases on the community when the number of infectives is getting larger. By carrying out a global analysis of the model and studying the stability of the disease-free equilibrium and the endemic equilibrium, we show that either the number of infective individuals tends to zero or the disease persists as time evolves. For the stochastic model, we prove the existence, uniqueness and positivity of the solution of the model. Then, we investigate the stability of the model and we prove that the infective tends asymptotically to zero exponentially almost surely as R0 < 1. We also proved that the SLIR model has the ergodic property as the fluctuation is small, where the positive solution converges weakly to the unique stationary distribution.

PMID: 31499723 [PubMed - indexed for MEDLINE]

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