Recent Cholera Publications on PubMed

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Humanistic Epidemiology: Love in the time of cholera, COVID-19 and other outbreaks.

April 27, 2020
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Humanistic Epidemiology: Love in the time of cholera, COVID-19 and other outbreaks.

Eur J Epidemiol. 2020 Apr 25;:

Authors: Soriano JB

PMID: 32335765 [PubMed - as supplied by publisher]

Unmasking herd protection by an oral cholera vaccine in a cluster-randomized trial.

April 24, 2020
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Unmasking herd protection by an oral cholera vaccine in a cluster-randomized trial.

Int J Epidemiol. 2019 08 01;48(4):1252-1261

Authors: Ali M, Qadri F, Kim DR, Islam T, Im J, Ahmmed F, Chon Y, Islam Khan A, Zaman K, Marks F, Clemens JD

Abstract
BACKGROUND: Several studies have shown that inactivated, whole-cell oral cholera vaccines (OCVs) confer both direct protection on vaccinees and herd protection on populations. Because our earlier cluster-randomized effectiveness trial (CRT) in urban Bangladesh failed to detect OCV herd protection, we reanalysed the trial to assess whether herd effects were masked in our original analysis.
METHODS: A total of 267 270 persons were randomized to 90 approximately equal-sized clusters. In 60 clusters persons aged 1 year and older were eligible to receive OCV and in 30 clusters persons received no intervention and served as controls. We analysed OCV protection against severely dehydrating cholera for the entire clusters, as in our original analysis, and for subclusters consisting of residents of innermost households. We hypothesized that if OCV herd protection was attenuated by cholera transmission into the clusters from the outside in this densely populated setting, herd protection would be most evident in the innermost households.
RESULTS: During 2 years of follow-up of all residents of the clusters, total protection (protection of OCV recipients relative to control residents) was 58% [95% confidence interval (CI): 43%, 70%; P<0.0001], indirect protection (protection of non-OCV recipients in OCV clusters relative to control participants) was 16% (95% CI: -20%, 41%; P=0.35) and overall OCV protection (protection of all residents in the OCV clusters relative to control residents) was 46% (95% CI: 30%, 59%; P<0.0001). Analyses of the inner 75% and 50% households of the clusters showed similar findings. However, total protection was 75% (95% CI: 50%, 87%, P<0.0001), indirect protection 52% (95% CI: -9%, 79%; P=0.08) and overall protection 72% (95% CI: 49%, 84%; P<0.0001) for the innermost 25% households.
CONCLUSION: Consistent with past studies, substantial OCV herd protective effects were identified, but were unmasked only by analysing innermost households of the clusters. Caution is needed in defining clusters for analysis of vaccine herd effects in CRTs of vaccines.

PMID: 30968110 [PubMed - indexed for MEDLINE]

Public health round-up.

April 21, 2020
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Public health round-up.

Bull World Health Organ. 2019 Dec 01;97(12):793-794

Authors:

PMID: 31819285 [PubMed - indexed for MEDLINE]

Vaccines for Older Travelers.

April 20, 2020
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Vaccines for Older Travelers.

Interdiscip Top Gerontol Geriatr. 2020;43:158-181

Authors: Jilg W

Abstract
People who travel to countries where they are at risk of contracting specific infections often need specific vaccines. To make correct recommendations in this respect several points have to be considered. The state of health of the traveler should be known as well as his or her destination and travel style. Very important, however, is the age of the traveler. As advancing age leads to changes in the immune system, in older individuals many infections are more severe. On the other hand, most vaccines are less immunogenic in the elderly. In this chapter, we will discuss which vaccines are necessary for older travelers visiting (mainly) tropical and subtropical countries, how these vaccines have to be used, and if perhaps their use has to be altered in older individuals. First, standard vaccinations will be addressed. When the immunization state of the individual is incomplete because certain vaccinations are expired or missing, it has to be updated. Vaccinations against tetanus, diphtheria, influenza, pneumococcal diseases, measles, and poliomyelitis have to be considered in this respect, because the risk of getting infected with these diseases in tropical and subtropical regions or in regions with poor hygienic conditions is often higher or at least the same as in industrialized countries. The second and main part of this chapter contains the typical travel vaccines. We will deal with vaccinations against cholera, hepatitis A and B, Japanese encephalitis, invasive meningococcal diseases, rabies, typhoid fever, and yellow fever. Clinical courses and epidemiology of the different infections are presented. The respective vaccines are discussed in detail, especially their efficiency in older individuals as far as data are available in this respect. Finally, recommendations for their use in older travelers will be given.

PMID: 32305985 [PubMed - as supplied by publisher]

COVID-19: Hygiene and Public Health to the front.

April 17, 2020
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COVID-19: Hygiene and Public Health to the front.

Acta Biomed. 2020 04 07;91(3-S):7-8

Authors: Signorelli C, Fara GM

Abstract
Public Health professionals and academics have been on the frontline of Italian history during the COVID-19 response like they never did before. Ancient professors of Hygiene such as Celli, Pagliani, Sclavo, Petragnani, Seppilli and Giovanardi flanked politicians in other critical moments. They helped them to manage healthcare reforms, earthquakes response, Seveso Dioxin disaster, cholera and poliomielitis epidemics and other health threats.   The ongoing COVID-19 epidemic has highlighted the paramount importance of the practical application of basic concepts of public health, which were considered so far became obsolete, such as personal hygiene, quarantine, individual protective devices or basic epidemiological measures. Hygiene and Public Health used to have a targeted audience in professionals and lecturers. Nowadays, these topics are critical and of concern of a much larger audience. Public Health women and men are now asked to act in task forces, media broadcasts, webinars and consulting activities.   In phase 2 of this epidemic - which is about to begin when this volume is to be published - the role of Public Health professionals could become even more relevant. However, this unexpected season must be managed with seriousness and intelligence, capitalizing it also for the future. If our Post-Graduate Schools of Public Health ("Igiene e Medicina Preventiva"), our scientific associations, our academic lecturers and our officers do not prove to be up to the situation, a dull future for the discipline might very well be. On the contrary, if as we all hope, we will be able to ride the wave of a dramatic health crisis, transforming it into a relevant scientific and professional opportunity, then we will be able to build on the post-COVID-19 a cutting-edge, a more attractive, relevant and modern discipline. This Supplement of Acta Biomedica, planned before the onset of the epidemic emergency in Italy, but already successful in presenting two papers on COVID-19, is further proof of how current and lively our discipline is.

PMID: 32275261 [PubMed - indexed for MEDLINE]

Estimating the sample mean and standard deviation from commonly reported quantiles in meta-analysis.

April 16, 2020
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Estimating the sample mean and standard deviation from commonly reported quantiles in meta-analysis.

Stat Methods Med Res. 2020 Jan 30;:962280219889080

Authors: McGrath S, Zhao X, Steele R, Thombs BD, Benedetti A, DEPRESsion Screening Data (DEPRESSD) Collaboration

PMID: 32292115 [PubMed - as supplied by publisher]

The cholera epidemic in Yemen - How did it start? The role of El Niño conditions followed by regional winds.

April 16, 2020
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The cholera epidemic in Yemen - How did it start? The role of El Niño conditions followed by regional winds.

Environ Res. 2019 09;176:108571

Authors: Paz S

Abstract
The largest cholera epidemic of modern times began during the autumn of 2016 in Yemen, under ongoing war conditions. What exactly caused the epidemic to emerge is unclear. It is suggested that a combination of the impact of the strong El Niño of 2015-16 on cholera incidence in Somalia, followed by southwestern winds over the Gulf of Aden throughout the summer of 2016, contributed to the disease spreading through dissemination of cholera-contaminated flying insects (chironomids) from the Horn of Africa to Yemen.

PMID: 31288197 [PubMed - indexed for MEDLINE]

Determinants of linear growth faltering among children with moderate-to-severe diarrhea in the Global Enteric Multicenter Study.

April 15, 2020
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Determinants of linear growth faltering among children with moderate-to-severe diarrhea in the Global Enteric Multicenter Study.

BMC Med. 2019 11 25;17(1):214

Authors: Brander RL, Pavlinac PB, Walson JL, John-Stewart GC, Weaver MR, Faruque ASG, Zaidi AKM, Sur D, Sow SO, Hossain MJ, Alonso PL, Breiman RF, Nasrin D, Nataro JP, Levine MM, Kotloff KL

Abstract
BACKGROUND: Moderate-to-severe diarrhea (MSD) in the first 2 years of life can impair linear growth. We sought to determine risk factors for linear growth faltering and to build a clinical prediction tool to identify children most likely to experience growth faltering following an episode of MSD.
METHODS: Using data from the Global Enteric Multicenter Study of children 0-23 months old presenting with MSD in Africa and Asia, we performed log-binomial regression to determine clinical and sociodemographic factors associated with severe linear growth faltering (loss of ≥ 0.5 length-for-age z-score [LAZ]). Linear regression was used to estimate associations with ΔLAZ. A clinical prediction tool was developed using backward elimination of potential variables, and Akaike Information Criterion to select the best fit model.
RESULTS: Of the 5902 included children, mean age was 10 months and 43.2% were female. Over the 50-90-day follow-up period, 24.2% of children had severe linear growth faltering and the mean ΔLAZ over follow-up was - 0.17 (standard deviation [SD] 0.54). After adjustment for age, baseline LAZ, and site, several factors were associated with decline in LAZ: young age, acute malnutrition, hospitalization at presentation, non-dysenteric diarrhea, unimproved sanitation, lower wealth, fever, co-morbidity, or an IMCI danger sign. Compared to children 12-23 months old, those 0-6 months were more likely to experience severe linear growth faltering (adjusted prevalence ratio [aPR] 1.97 [95% CI 1.70, 2.28]), as were children 6-12 months of age (aPR 1.72 [95% CI 1.51, 1.95]). A prediction model that included age, wasting, stunting, presentation with fever, and presentation with an IMCI danger sign had an area under the ROC (AUC) of 0.67 (95% CI 0.64, 0.69). Risk scores ranged from 0 to 37, and a cut-off of 21 maximized sensitivity (60.7%) and specificity (63.5%).
CONCLUSION: Younger age, acute malnutrition, MSD severity, and sociodemographic factors were associated with short-term linear growth deterioration following MSD. Data routinely obtained at MSD may be useful to predict children at risk for growth deterioration who would benefit from interventions.

PMID: 31767012 [PubMed - indexed for MEDLINE]

Haitian-like genetic traits with creeping MIC of Azithromycin in Vibrio cholerae O1 isolates from Puducherry, India.

April 14, 2020
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Haitian-like genetic traits with creeping MIC of Azithromycin in Vibrio cholerae O1 isolates from Puducherry, India.

J Med Microbiol. 2020 Mar;69(3):372-378

Authors: Mohanraj RS, Samanta P, Mukhopadhyay AK, Mandal J

Abstract
Introduction. The emergence of novel strains of Vibrio cholerae O1 El Tor biotype has gained attention due to causing several epidemics around the world. Variant strains have evolved as a result of the acquisition of genes that confer extended virulence and pathogenicity.Aim. This study aimed to determine the presence of the most recently emerging Haitian-like genetic traits among the isolates from Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, Southern India. We also wanted to detect the prevalence of the sulfamethoxazole and trimethoprim (SXT) element, which is an integrating conjugative element (ICE) and the antimicrobial resistance genes present in our isolates.Methodology. Identification of Haitian-specific alleles was done by mismatched amplification mutation assay PCR (MAMA-PCR). The presence of SXT elements was carried out by PCR by detecting int, eex, att-prfC and setR genes. Detection of antibiotic resistance determinant, sul(1,2,3); dfr(A1,18,5) for trimethoprim resistance, tet(A,B,C,D,E,Y,G,M), tet34 for tetracycline resistance and erm(A,B,C), mph(A,B), ere(A,B), msr(A,D) for azithromycin resistance were targeted by PCR. The MIC of tetracycline, ciprofloxacin and azithromycin was determined by the E-test method.Results. Of the 95 isolates, 60 % of the isolates were found to carry Haitian-specific alleles of ctxB, tcpA and rtxA gene, 100 % of the isolates were found to carry SXT elements. All the isolates harboured the four conserved genes of the SXT element, except one which had only eex, att-prfC, setR genes. About 99 % harboured sul2 and dfrA1 genes. No tet and macrolide genes were detected. We observed a progressive increase in the MIC of azithromycin ranging from 0.75 µg ml-1 to 2 µg ml-1.Conclusion. None of the isolates were the prototype El Tor biotype. All the isolates were a Haitian variant. The presence of SXT elements across all our isolates and their creeping MIC of azithromycin is a matter of concern. Further testing for other genetic determinants of resistance will be carried out in our future studies.

PMID: 31961790 [PubMed - indexed for MEDLINE]

Risk perception and behavioral change during epidemics: Comparing models of individual and collective learning.

April 9, 2020
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Risk perception and behavioral change during epidemics: Comparing models of individual and collective learning.

PLoS One. 2020;15(1):e0226483

Authors: Abdulkareem SA, Augustijn EW, Filatova T, Musial K, Mustafa YT

Abstract
Modern societies are exposed to a myriad of risks ranging from disease to natural hazards and technological disruptions. Exploring how the awareness of risk spreads and how it triggers a diffusion of coping strategies is prominent in the research agenda of various domains. It requires a deep understanding of how individuals perceive risks and communicate about the effectiveness of protective measures, highlighting learning and social interaction as the core mechanisms driving such processes. Methodological approaches that range from purely physics-based diffusion models to data-driven environmental methods rely on agent-based modeling to accommodate context-dependent learning and social interactions in a diffusion process. Mixing agent-based modeling with data-driven machine learning has become popularity. However, little attention has been paid to the role of intelligent learning in risk appraisal and protective decisions, whether used in an individual or a collective process. The differences between collective learning and individual learning have not been sufficiently explored in diffusion modeling in general and in agent-based models of socio-environmental systems in particular. To address this research gap, we explored the implications of intelligent learning on the gradient from individual to collective learning, using an agent-based model enhanced by machine learning. Our simulation experiments showed that individual intelligent judgement about risks and the selection of coping strategies by groups with majority votes were outperformed by leader-based groups and even individuals deciding alone. Social interactions appeared essential for both individual learning and group learning. The choice of how to represent social learning in an agent-based model could be driven by existing cultural and social norms prevalent in a modeled society.

PMID: 31905206 [PubMed - indexed for MEDLINE]

Difference of Phenotype and Genotype Between Human and Environmental: Isolated Vibrio cholerae in Surabaya, Indonesia.

April 8, 2020
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Difference of Phenotype and Genotype Between Human and Environmental: Isolated Vibrio cholerae in Surabaya, Indonesia.

Indian J Microbiol. 2020 Jun;60(2):230-238

Authors: Osawa K, Shigemura K, Kitagawa K, Kuntaman K, Mertaniasih NM, Setyarini W, Arizandy D, Rahadjo D, Osawa R, Shirakawa T, Fujisawa M

Abstract
Cholera due to Vibrio cholerae has been spreading worldwide, although the reports focusing on Indonesian V. cholerae are few. In this study, in order to investigate how V. cholerae transmitted to human from environment. We extended an epidemiological report that had investigated the genotype of V. cholerae isolated from human pediatric samples and environmental samples. We examined 44 strains of V. cholerae isolated from pediatric diarrhea patients and the environment such as shrimps or oysters collected in three adjacent towns in Surabaya, Indonesia. Susceptibilities were examined for 11 antibiotics. Serotype O1 or O139 genes and pathogenic genes including cholera toxin were detected. Multi-locus sequence typing (MLST) and enterobacterial repetitive intergenic consensus (ERIC)-PCR were also performed to determine genetic diversity of those isolates. Serotype O1 was seen in 17 strains (38.6%) with all pathogenic genes among 44 isolates. Other isolates were non-O1/non-O139 V. cholerae. Regarding antibiotic susceptibilities, those isolates from environmental samples showed resistance to ampicillin (11.4%), streptomycin (9.1%) and nalidixic acid (2.3%) but those isolates from pediatric stools showed no resistance to those 3 kinds of antibiotics. MLST revealed sequence type (ST) 69 in 17 strains (38.6%), ST198 in 3 strains (6.8%) and non-types in 24 strains (54.5%). All the ST69 strains were classified to O1 type with more than 95% similarity by ERIC-PCR, including all 6 (13.6%) isolates from environmental samples with resistance to streptomycin. In conclusion, V. cholerae O1 ST69 strains has been clonally spreading in Surabaya, exhibiting pathogenic factors and antibiotic resistance to streptomycin, especially in the isolates from environment.

PMID: 32255856 [PubMed - as supplied by publisher]

Laboratory preparedness for SARS-CoV-2 testing in India: Harnessing a network of Virus Research & Diagnostic Laboratories.

April 4, 2020
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Laboratory preparedness for SARS-CoV-2 testing in India: Harnessing a network of Virus Research & Diagnostic Laboratories.

Indian J Med Res. 2020 Mar 31;:

Authors: Gupta N, Potdar V, Praharaj I, Giri S, Sapkal G, Yadav P, Choudhary ML, Dar L, Sugunan AP, Kaur H, Munivenkatappa A, Shastri J, Kaveri K, Dutta S, Malhotra B, Jain A, Nagamani K, Shantala GB, Raut S, Vegad MM, Sharma A, Choudhary A, Brijwal M, Balakrishnan A, Manjunatha J, Pathak M, Srinivasan S, Banu H, Sharma H, Jain P, Sunita P, Ambica R, Fageria B, Patel D, Rajbongshi G, Vijay N, Narayan J, Aggarwal N, Nagar A, Gangakhedkar RR, Abraham P

Abstract
Background & objectives: : An outbreak of respiratory illness of unknown aetiology was reported from Hubei province of Wuhan, People's Republic of China, in December 2019. The outbreak was attributed to a novel coronavirus (CoV), named as severe acute respiratory syndrome (SARS)-CoV-2 and the disease as COVID-19. Within one month, cases were reported from 25 countries. In view of the novel viral strain with reported high morbidity, establishing early countrywide diagnosis to detect imported cases became critical. Here we describe the role of a countrywide network of VRDLs in early diagnosis of COVID-19.
Methods: : The Indian Council of Medical Research (ICMR)-National Institute of Virology (NIV), Pune, established screening as well as confirmatory assays for SARS-CoV-2. A total of 13 VRDLs were provided with the E gene screening real-time reverse transcription-polymerase chain reaction (rRT-PCR) assay. VRDLs were selected on the basis of their presence near an international airport/seaport and their past performance. The case definition for testing included all individuals with travel history to Wuhan and symptomatic individuals with travel history to other parts of China. This was later expanded to include symptomatic individuals returning from Singapore, Japan, Hong Kong, Thailand and South Korea.
Results: : Within a week of standardization of the test at NIV, all VRDLs could initiate testing for SARS-CoV-2. Till February 29, 2020, a total of 2,913 samples were tested. This included both 654 individuals quarantined in the two camps and others fitting within the case definition. The quarantined individuals were tested twice - at days 0 and 14. All tested negative on both occasions. Only three individuals belonging to different districts in Kerala were found to be positive.
Interpretation & conclusions: : Sudden emergence of SARS-CoV-2 and its potential to cause a pandemic posed an unsurmountable challenge to the public health system of India. However, concerted efforts of various arms of the Government of India resulted in a well-coordinated action at each level. India has successfully demonstrated its ability to establish quick diagnosis of SARS-CoV-2 at NIV, Pune, and the testing VRDLs.

PMID: 32242875 [PubMed - as supplied by publisher]

Multi-scale modeling of cholera dynamics in a spatially heterogeneous environment.

April 3, 2020
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Multi-scale modeling of cholera dynamics in a spatially heterogeneous environment.

Math Biosci Eng. 2019 Nov 07;17(2):948-974

Authors: Ratchford C, Wang J

Abstract
We propose a multi-group, multi-scale mathematical model to investigate the betweenhost and within-host dynamics of cholera. At the between-host level, we divide the total population into a number of host groups with different characteristics representing spatial heterogeneity. Our model incorporates the dual transmission pathways that include both the environment-to-human and human-to-human transmission routes. At the within-host level, our model describes the interaction among the pathogenic bacteria, viruses, and host immune response. For each host group, we couple the between-host disease transmission and within-host pathogen dynamics at different time scales. Our study thus integrates multi-scale modeling and multi-group modeling into one single framework. We describe the general modeling framework and demonstrate it through two specific and biologically important cases. We conduct detailed analysis for each case and obtain threshold results regarding the multi-scale dynamics of cholera in a spatially heterogeneous environment. In particular, we find that the between-host reproduction number is shaped by the collection of the disease risk factors from all the individual host groups. Our findings highlight the importance of a whole-population approach for cholera prevention and intervention.

PMID: 32233565 [PubMed - in process]

Infectious disease outbreaks in the African region: overview of events reported to the World Health Organization in 2018.

April 3, 2020
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Infectious disease outbreaks in the African region: overview of events reported to the World Health Organization in 2018.

Epidemiol Infect. 2019 11 11;147:e299

Authors: Mboussou F, Ndumbi P, Ngom R, Kamassali Z, Ogundiran O, Van Beek J, Williams G, Okot C, Hamblion EL, Impouma B

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

PMID: 31709961 [PubMed - indexed for MEDLINE]

Effects of large-scale oceanic phenomena on non-cholera vibriosis incidence in the United States: implications for climate change.

April 3, 2020
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Effects of large-scale oceanic phenomena on non-cholera vibriosis incidence in the United States: implications for climate change.

Epidemiol Infect. 2019 01;147:e243

Authors: Logar-Henderson C, Ling R, Tuite AR, Fisman DN

Abstract
Non-cholera Vibrio (NCV) species are important causes of disease. These pathogens are thermophilic and climate change could increase the risk of NCV infection. The El Niño Southern Oscillation (ENSO) is a 'natural experiment' that may presage ocean warming effects on disease incidence. In order to evaluate possible climatic contributions to observed increases in NCV infection, we obtained NCV case counts for the United States from publicly available surveillance data. Trends and impacts of large-scale oceanic phenomena, including ENSO, were evaluated using negative binomial and distributed non-linear lag models (DNLM). Associations between latitude and changing risk were evaluated with meta-regression. Trend models demonstrated expected seasonality (P &lt; 0.001) and a 7% (6.1%-8.1%) annual increase in incidence from 1999 to 2014. DNLM demonstrated increased vibriosis risk following ENSO conditions over the subsequent 12 months (relative risk 1.940, 95% confidence interval (CI) 1.298-2.901). The 'relative-relative risk' (RRR) of annual disease incidence increased with latitude (RRR per 10° increase 1.066, 95% CI 1.027-1.107). We conclude that NCV risk in the United States is impacted by ocean warming, which is likely to intensify with climate change, increasing NCV risk in vulnerable populations.

PMID: 31364581 [PubMed - indexed for MEDLINE]

Mapping 123 million neonatal, infant and child deaths between 2000 and 2017.

March 28, 2020
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Mapping 123 million neonatal, infant and child deaths between 2000 and 2017.

Nature. 2019 10;574(7778):353-358

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Abstract
Since 2000, many countries have achieved considerable success in improving child survival, but localized progress remains unclear. To inform efforts towards United Nations Sustainable Development Goal 3.2-to end preventable child deaths by 2030-we need consistently estimated data at the subnational level regarding child mortality rates and trends. Here we quantified, for the period 2000-2017, the subnational variation in mortality rates and number of deaths of neonates, infants and children under 5 years of age within 99 low- and middle-income countries using a geostatistical survival model. We estimated that 32% of children under 5 in these countries lived in districts that had attained rates of 25 or fewer child deaths per 1,000 live births by 2017, and that 58% of child deaths between 2000 and 2017 in these countries could have been averted in the absence of geographical inequality. This study enables the identification of high-mortality clusters, patterns of progress and geographical inequalities to inform appropriate investments and implementations that will help to improve the health of all populations.

PMID: 31619795 [PubMed - indexed for MEDLINE]

Re: "Outpatient Breastfeeding Champion Program: Breastfeeding Support in Primary Care" by Patterson et al. (Breastfeed Med 2020;15(1):44-48. DOI: 10.1089/bfm.2019.0108).

March 27, 2020
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Re: "Outpatient Breastfeeding Champion Program: Breastfeeding Support in Primary Care" by Patterson et al. (Breastfeed Med 2020;15(1):44-48. DOI: 10.1089/bfm.2019.0108).

Breastfeed Med. 2020 Mar 25;:

Authors: Debnath F, Chakraborty D, Deb AK

PMID: 32208928 [PubMed - as supplied by publisher]

Emergence of Haitian variant genotype and altered drug susceptibility in Vibrio cholerae O1 El Tor-associated cholera outbreaks in Solapur, India.

March 26, 2020
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Emergence of Haitian variant genotype and altered drug susceptibility in Vibrio cholerae O1 El Tor-associated cholera outbreaks in Solapur, India.

Int J Antimicrob Agents. 2020 Mar;55(3):105853

Authors: Kumar P, Yadav P, Ingole KV, Jaiswal RK, Khalid NS, Deshmukh DG, Goel AK, Yadava PK

Abstract
It is evident from previous cholera epidemics/outbreaks in India, Africa and America that isolates of the seventh pandemic Vibrio cholerae El Tor (7PET) with Haitian cholera toxin (HCT) genotype were associated with increased mortality. The present study highlights the emergence of 7PET-HCT isolates causing two cholera outbreaks in Walsang and Wagdari (Solapur, India) in 2016. Molecular analyses revealed that 7PET strains from earlier outbreaks (2010 and 2012) were progenitors of the current 7PET-HCT isolates. Isolates from the 2016 outbreaks carried qnrVC and floR genes and showed reduced susceptibility to tetracycline, ciprofloxacin and azithromycin, drugs recommended by the World Health Organization (WHO) for the treatment of cholera. Remarkably, protein profiling and mass spectrometry revealed disappearance of the outer membrane protein U (OmpU) porin in 7PET-HCT isolates from the second outbreak in 2016. Downregulation of ompU gene expression was also confirmed at the transcriptional level. Strains with downregulated OmpU showed reduced minimum inhibitory concentrations (MICs) for polymyxin B, which is a pore-forming antimicrobial agent. A multipronged approach is of utmost importance to prevent further spread of circulating 7PET-HCT strains. There is a pressing need for the formulation and implementation of international policies to closely monitor the effective use of antibiotics in order to prevent the further rise and spread of antimicrobial resistance.

PMID: 31770631 [PubMed - indexed for MEDLINE]

Post-monsoon waterlogging-associated upsurge of cholera cases in and around Kolkata metropolis, 2015.

March 26, 2020
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Post-monsoon waterlogging-associated upsurge of cholera cases in and around Kolkata metropolis, 2015.

Epidemiol Infect. 2019 01;147:e167

Authors: Mukhopadhyay AK, Deb AK, Chowdhury G, Debnath F, Samanta P, Saha RN, Manna B, Bhattacharya MK, Datta D, Okamoto K, Bhadra UK, Dutta S

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

PMID: 31063116 [PubMed - indexed for MEDLINE]

Nonlinear two-point boundary value problems: applications to a cholera epidemic model.

March 24, 2020
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Nonlinear two-point boundary value problems: applications to a cholera epidemic model.

Proc Math Phys Eng Sci. 2020 Feb;476(2234):20190673

Authors: Chowdhury A, Tanveer S, Wang X

Abstract
This paper is concerned primarily with constructive mathematical analysis of a general system of nonlinear two-point boundary value problem when an empirically constructed candidate for an approximate solution (quasi-solution) satisfies verifiable conditions. A local analysis in a neighbour- hood of a quasi-solution assures the existence and uniqueness of solutions and, at the same time, provides error bounds for approximate solutions. Applying this method to a cholera epidemic model, we obtain an analytical approximation of the steady-state solution with rigorous error bounds that also displays dependence on a parameter. In connection with this epidemic model, we also analyse the basic reproduction number, an important threshold quantity in the epidemiology context. Through a complex analytic approach, we determine the principal eigenvalue to be real and positive in a range of parameter values.

PMID: 32201479 [PubMed]

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