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Challenges, best practices, and lessons learned from oral cholera mass vaccination campaign in urban Cameroon during the COVID-19 era

Vaccine. 2022 Nov 8;40(47):6873-6879. doi: 10.1016/j.vaccine.2022.08.025. Epub 2022 Aug 18.


BACKGROUND: Since 1971, Cameroon has been facing an ever-growing series of cholera epidemics; despite all the efforts made by the government to address this substantial public health problem. In 2020, in addition to the COVID-19 pandemic, Cameroon recorded a high cholera case fatality rate of 5.3% following epidemics noted in the South, Littoral, and South-West regions which is far higher than the 1% World Health Organization acceptable rate.

METHODOLOGY/PRINCIPAL FINDINGS: The Ministry of Public Health organized a reactive vaccination campaign against cholera to address the high mortality rate in the affected health districts. The first round was in August 2020 and the second in March 2021. We conducted a cross-sectional study and reviewed this vaccination campaign's challenges, best practices, and lessons. The vaccination coverage for the two doses of the oral cholera vaccine was 80.4%, with a refusal rate as high as 67%. People 20 years and above recorded the lowest vaccination coverage. The main challenge was misinformation about the cholera vaccine. The best practice was thorough population sensitization through community actors.

CONCLUSION: Proper communication will always brave the odds of hesitancy and favor mass population vaccination to thwart hesitancy and consolidate herd immunity.

PMID:36270892 | PMC:PMC9385732 | DOI:10.1016/j.vaccine.2022.08.025

Cholera: WHO rations vaccines to preserve stocks amid rising outbreaks

BMJ. 2022 Oct 21;379:o2528. doi: 10.1136/bmj.o2528.


PMID:36270641 | DOI:10.1136/bmj.o2528

Randomized Controlled Trial of the Cholera-Hospital-Based-Intervention-for-7-Days (CHoBI7) Cholera Rapid Response Program to Reduce Diarrheal Diseases in Bangladesh

Int J Environ Res Public Health. 2022 Oct 8;19(19):12905. doi: 10.3390/ijerph191912905.


(a) Objective: To build an evidence base on effective water, sanitation, and hygiene interventions to reduce diarrheal diseases in cholera hotspots, we developed the CHoBI7 Cholera Rapid Response Program. (b) Methods: Once a cholera patient (confirmed by bacterial culture) is identified at a health facility, a health promoter delivers a targeted WASH intervention to the cholera hotspot (households within 20 m of a cholera patient) through both in-person visits during the first week and bi-weekly WASH mobile messages for the 3-month program period. A randomized controlled trial of the CHoBI7 Cholera Rapid Response Program was conducted with 284 participants in 15 cholera hotspots around cholera patients in urban Dhaka, Bangladesh. This program was compared to the standard message in Bangladesh on the use of oral rehydration solution for dehydration. Five-hour structured observation of handwashing with soap and diarrhea surveillance was conducted monthly. (c) Findings: Handwashing with soap at food- and stool-related events was significantly higher in the CHoBI7 Cholera Rapid Response Program arm compared to the standard message arm at all timepoints (overall 54% in the CHoBI7 arm vs. 23% in the standard arm, p < 0.05). Furthermore, there was a significant reduction in diarrheal prevalence for all participants (adults and children) (Prevalence Ratio (PR) 0.35, 95% CI: 0.14-0.85) and for children under 5 years of age (PR: 0.27, 95% CI: 0.085-0.87) during the 3-month program. (d) Conclusions: These findings demonstrate that the CHoBI7 Cholera Rapid Response Program is effective in lowering diarrhea prevalence and increasing handwashing with soap for a population at high risk of cholera.

PMID:36232205 | PMC:PMC9566036 | DOI:10.3390/ijerph191912905

Formative Research for the Development of Evidence-Based Targeted Water, Sanitation, and Hygiene Interventions to Reduce Cholera in Hotspots in the Democratic Republic of the Congo: Preventative Intervention for Cholera for 7 Days (PICHA7) Program

Int J Environ Res Public Health. 2022 Sep 27;19(19):12243. doi: 10.3390/ijerph191912243.


Compared to the general public, household members of cholera patients are at a 100 times higher risk of contracting cholera during the 7-day high-risk period after a cholera patient has been admitted to a health facility for treatment. The Preventative-Intervention-for-Cholera-for-7-days (PICHA7) program aims to reduce household transmission of cholera during this 7-day high-risk period through a health facility-initiated water, sanitation, and hygiene (WASH) program promoting handwashing with soap, water treatment, and safe water storage. The PICHA7 program is delivered to cholera patient households through: (1) a pictorial flipbook delivered by a health promoter; (2) a cholera prevention package (handwashing station, drinking water vessel with lid and tap, and chlorine tablets); and (3) weekly WASH mobile messages sent to patient households in the Democratic Republic of the Congo (DRC). The objectives of this study were to conduct formative research to identify facilitators and barriers of the promoted WASH behaviors for cholera patient households and to tailor the PICHA7 program to target these facilitators and barriers. Formative research included 93 semi-structured interviews with diarrhea patient households and healthcare workers during exploratory research and a pilot study of 518 participants. Barriers to the promoted WASH behaviors identified during exploratory and pilot study interviews included: (1) low awareness of cholera transmission and prevention; (2) unaffordability of soap for handwashing; and (3) intermittent access to water limiting water for handwashing. For intervention development, narratives of the lived experiences of patient households in our study were presented by health promoters to describe cholera transmission and prevention, and soapy water and ash were promoted in the program flipbook and mobile messages to address the affordability of soap for handwashing. A jerry can was provided to allow for additional water storage, and a tap with a slower flow rate was attached to the handwashing station to reduce the amount of water required for handwashing. The pilot findings indicate that the PICHA7 program has high user acceptability and is feasible to deliver to cholera patients that present at health facilities for treatment in our study setting. Formative research allowed for tailoring this targeted WASH program for cholera patient households in the DRC.

PMID:36231546 | PMC:PMC9566157 | DOI:10.3390/ijerph191912243

Navigating the COVID-19 outbreak in Zambia

J Infect Dev Ctries. 2022 Sep 30;16(9):1385-1389. doi: 10.3855/jidc.13897.


COVID-19 is a global public health crisis wreaking havoc in nearly every corner of the globe and Zambia is not an exception. Amid an already existing disease burden of HIV/AIDS, malaria, malnutrition, and cholera, the resilience of the health care system is yet to be tested especially since it lacks about 40% of its estimated workforce. Meanwhile, the government has already established measures to contain the spread of COVID-19. This includes; reorientation and training for health workers, indefinite closure of all learning institutions, and banning non-essential traveling. With the COVID-19 vaccine roll-out on the ground, the milestones achieved thus far in fighting the pandemic are expected to intensify.

PMID:36223611 | DOI:10.3855/jidc.13897

Occurrence of waterborne pathogens and antibiotic resistance in water supply systems in a small town in Mozambique

BMC Microbiol. 2022 Oct 8;22(1):243. doi: 10.1186/s12866-022-02654-3.


BACKGROUND: . Microbiological quality of drinking water supplied in Moamba, a small town in southern Mozambique, was assessed by collecting and analyzing 91 water sample from 5 sampling sites: raw or inlet water, treated water and 3 household taps along the water distribution system. The presence of Escherichia coli as indicator fecal contamination, three bacterial pathogens, Vibrio cholerae, Salmonella and Campylobacter spp., and Cefotaximee resistant E. coli as antibiotic resistance determinant, was assessed.

RESULTS: . The results showed fecal contamination in all types of water samples: E. coli was found in 100% of inlet water samples, in 21% of treated water samples, and in 22% of tap water samples. No Salmonella spp. was detected during the study. The presence of V. cholerae was detected in 42% of all water samples tested: 100% of inlet water samples, in 16% of treated water samples, and in 23% household tap water samples. All V. cholerae confirmed isolates where genotyped by PCR as non-O1/non-O139; however, 9 isolates showed the presence of the genes encoding for cholera toxin. The presence of Campylobacter spp. was detected in 36% of the water samples tested: in 95% of inlet water samples, in 10% of treated water samples and in 23% household tap water samples. Cefotaxime resistant E. coli was detected in 63% of inlet water, 16% of treated water, and in 9% of tap water samples, these isolates were also resistant to multiple other antibiotics: ampicillin, streptomycin, tetracycline chloramphenicol. All 70 V. cholerae non-O1/non-O139 confirmed isolated were resistant to ampicillin, 51% to streptomycin, 13% to gentamycin, and 1 isolate was resistant to tetracycline; 13% showed a multi-drug resistant profile, being resistant to at least three antibiotics.

CONCLUSION: . The presence of fecal contamination and pathogens in the water treatment system and household taps in Moamba indicates a health risk for the population. This burden increases by the presence of bacterial pathogens showing multidrug resistance.

PMID:36209065 | PMC:PMC9547466 | DOI:10.1186/s12866-022-02654-3


Trans Am Clin Climatol Assoc. 2022;132:1-21.


PMID:36196193 | PMC:PMC9480559

Twitter-based crowdsourcing: What kind of measures can help to end the COVID-19 pandemic faster?

Front Med (Lausanne). 2022 Sep 16;9:961360. doi: 10.3389/fmed.2022.961360. eCollection 2022.


BACKGROUND: Crowdsourcing is a low-cost, adaptable, and innovative method to collect ideas from numerous contributors with diverse backgrounds. Crowdsourcing from social media like Twitter can be used for generating ideas in a noticeably brief time based on contributions from globally distributed users. The world has been challenged by the COVID-19 pandemic in the last several years. Measures to combat the pandemic continue to evolve worldwide, and ideas and opinions on optimal counteraction strategies are of high interest.

OBJECTIVE: This study aimed to validate the use of Twitter as a crowdsourcing platform in order to gain an understanding of public opinion on what measures can help to end the COVID-19 pandemic faster.

METHODS: This cross-sectional study was conducted during the period from December 22, 2021, to February 4, 2022. Tweets were posted by accounts operated by the authors, asking "How to faster end the COVID-19 pandemic?" and encouraging the viewers to comment on measures that they perceive would be effective to achieve this goal. The ideas from the users' comments were collected and categorized into two major themes - personal and institutional measures. In the final stage of the campaign, a Twitter poll was conducted to get additional comments and to estimate which of the two groups of measures were perceived to be important amongst Twitter users.

RESULTS: The crowdsourcing campaign generated seventeen suggested measures categorized into two major themes (personal and institutional) that received a total of 1,727 endorsements (supporting comments, retweets, and likes). The poll received a total of 325 votes with 58% of votes underscoring the importance of both personal and institutional measures, 20% favoring personal measures, 11% favoring institutional measures, and 11% of the votes given just out of curiosity to see the vote results.

CONCLUSIONS: Twitter was utilized successfully for crowdsourcing ideas on strategies how to end the COVID-19 pandemic faster. The results indicate that the Twitter community highly values the significance of both personal responsibility and institutional measures to counteract the pandemic. This study validates the use of Twitter as a primary tool that could be used for crowdsourcing ideas with healthcare significance.

PMID:36186802 | PMC:PMC9523003 | DOI:10.3389/fmed.2022.961360

Cholera Vaccine: Recommendations of the Advisory Committee on Immunization Practices, 2022

MMWR Recomm Rep. 2022 Sep 30;71(2):1-8. doi: 10.15585/mmwr.rr7102a1.


THIS REPORT SUMMARIZES ALL RECOMMENDATIONS FROM CDC'S ADVISORY COMMITTEE ON IMMUNIZATION PRACTICES (ACIP) FOR THE USE OF LYOPHILIZED CVD 103-HGR VACCINE (CVD 103-HGR) (VAXCHORA, EMERGENT BIOSOLUTIONS, GAITHERSBURG, MD) IN THE UNITED STATES. THE LIVE ATTENUATED ORAL CHOLERA VACCINE IS DERIVED FROM: Vibrio cholerae O1 and is administered in a single dose. Cholera is a toxin-mediated bacterial gastrointestinal illness caused by toxigenic V. cholerae serogroup O1 or, uncommonly, O139. Up to 10% of infections manifest as severe cholera (i.e., cholera gravis), profuse watery diarrhea that can cause severe dehydration and death within hours. Fluid replacement therapy can reduce the fatality rate to <1%. Risk factors for cholera gravis include high dose exposure, blood group O, increased gastric pH (e.g., from antacid therapy), and partial gastrectomy. Cholera is rare in the United States, but cases occur among travelers to countries where cholera is endemic or epidemic and associated with unsafe water and inadequate sanitation. Travelers might be at increased risk for poor outcomes from cholera if they cannot readily access medical services or if they have a medical condition that would be worsened by dehydration, such as cardiovascular or kidney disease. This report describes previously published ACIP recommendations about use of CVD 103-HgR for adults aged 18-64 years and introduces a new recommendation for use in children and adolescents aged 2-17 years. ACIP recommends CVD 103-HgR, the only cholera vaccine licensed for use in the United States, for prevention of cholera among travelers aged 2-64 years to an area with active cholera transmission. Health care providers can use these guidelines to develop the pretravel consultation for persons traveling to areas with active cholera transmission.

PMID:36173766 | DOI:10.15585/mmwr.rr7102a1

Integrated disease surveillance and response in humanitarian context: South Sudan experience

Pan Afr Med J. 2022 Jun 17;42(Suppl 1):13. doi: 10.11604/pamj.supp.2022.42.1.33779. eCollection 2022.


INTRODUCTION: decades of instability continue to impact the implementation of the Integrated Disease Surveillance and Response (IDSR) strategy. The study reviewed the progress and outcomes of rolling out IDSR in South Sudan.

METHODS: this descriptive cross-sectional study used epidemiological data for 2019, 2020, and other program data to assess indicators for the five surveillance components including surveillance priorities, core and support functions, and surveillance system structure and quality.

RESULTS: South Sudan expanded the priority disease scope from 26 to 59 to align with national and regional epidemiological trends and the International Health Regulations (IHR) 2005. Completing the countrywide rollout of electronic Early Warning Alert and Response (EWARS) reporting has improved both the timeliness and completeness of weekly reporting to 78% and 90%, respectively, by week 39 of 2020 in comparison to a baseline of 54% on both timeliness and completeness of reporting in 2019. The National Public Health Laboratory confirmatory testing capacities have been expanded to include cholera, measles, HIV, tuberculosis (TB), influenza, Ebola, yellow fever, and Severe Acute Respiratory Syndrome 2 (SARS-COV-2). Rapid response teams have been established to respond to epidemics and pandemics.

CONCLUSION: since 2006, South Sudan has registered progress towards using indicator and event-based surveillance and continues to strengthen IHR (2005) capacities. Following the adoption of third edition IDSR guidelines, the current emphasis entails maintaining earlier gains and strengthening community and event-based surveillance, formalizing cross-sectoral one-health engagement, optimal EWARS and District Health Information Systems (DHIS2) use, and strengthening cross-border surveillance. It is also critical that optimal government, and donors' resources are dedicated to supporting health system strengthening and disease surveillance.

PMID:36158932 | PMC:PMC9474851 | DOI:10.11604/pamj.supp.2022.42.1.33779

Use of mobile medical teams to fill critical gaps in health service delivery in complex humanitarian settings, 2017-2020: a case study of South Sudan

Pan Afr Med J. 2022 Jun 9;42(Suppl 1):8. doi: 10.11604/pamj.supp.2022.42.1.33865. eCollection 2022.


The vulnerable populations in the protracted humanitarian crisis in South Sudan are faced with constrained access to health services and frequent disease outbreaks. Here, we describe the experiences of emergency mobile medical teams (eMMT) assembled by the World Health Organization (WHO) South Sudan to respond to public health emergencies. Interventions: the eMMTs, multidisciplinary teams based at national, state and county levels, are rapidly deployed to conduct rapid assessments, outbreak investigations, and initiate public health response during acute emergencies. The eMMTs were deployed to locations affected by flooding, conflicts, famine, and disease outbreaks. We reviewed records of deployment reports, outreach and campaign registers, and analyzed the key achievements of the eMMTs for 2017 through 2020. Achievements: the eMMTs investigated disease outbreaks including cholera, measles, Rift Valley fever and coronavirus disease (COVID-19) in 13 counties, conducted mobile outreaches in emergency locations in 38 counties (320,988 consultations conducted), trained 550 healthcare workers including rapid response teams, and supported reactive measles vaccination campaigns in seven counties [148,726, (72-125%) under-5-year-old children vaccinated] and reactive oral cholera vaccination campaigns in four counties (355,790 vaccinated). The eMMT is relevant in humanitarian settings and can reduce excess morbidity and mortality and fill gaps that routine health facilities and health partners could not bridge. However, the scope of the services offered needs to be broadened to include mental and psychosocial care and a strategy for ensuring continuity of vaccination services and management of chronic conditions after the mobile outreach is instituted.

PMID:36158930 | PMC:PMC9474833 | DOI:10.11604/pamj.supp.2022.42.1.33865

War driving cholera in Syria

Lancet. 2022 Sep 24;400(10357):986. doi: 10.1016/S0140-6736(22)01836-0.


PMID:36154682 | DOI:10.1016/S0140-6736(22)01836-0


Ann Ib Postgrad Med. 2021 Dec;19(2):103-111.


INTRODUCTION: Primary Health Care (PHC) workers are usually the frontline health workers involved in disseminating health education to the community and implementing cholera prevention and management guidelines. Given that inadequate health worker performance has been a problem in resource-limited settings such as Nigeria and poor health worker knowledge has been implicated in poor health status in developing nations, continuous training of health workers to improve their knowledge has been recommended to improve health outcomes.

OBJECTIVE: This study seeks to ascertain the level of improvement in the knowledge of health workers on cholera, if any, after one of such interventions was carried out in Oyo State. Similarly, the study seeks to discern the specific domains of knowledge on cholera, if any, which were significantly affected by the intervention.

METHODS: The research was conducted utilizing a pre-post study design to recruit PHC health workers from four local government areas of Oyo State between October and November 2016. Baseline and endline data were collected at both intervention and control sites using a self-administered questionnaire with sections eliciting responses to questions on general knowledge of symptoms of cholera, prevention methods, knowledge and practice of safety procedures health workers. Descriptive statistics and chi-square tests were used to present the data and test for statistical associations between categorical variables at 5% respectively.

RESULTS: A total of 542 health workers divided into 2 groups (intervention and control), were interviewed at baseline and at endline. At baseline, the 40-49 years age group was the most represented in the intervention arm (40.0%), the 30-39 years age group was the most represented in the control arm (34.2%). At baseline, only 35.2% of health workers in the intervention sites had good knowledge on cholera. This figure was increased to 52.7% after the intervention. This difference in proportions was also statistically significant (p=0.004). In the control sites, the opposite was observed as the proportion of health workers with good knowledge on cholera slightly reduced from 47.2% to 43.6%. This difference was however not statistically significant (p=0.563).

CONCLUSION: The results from the evaluation of the intervention show that the training significantly improved the overall knowledge of health workers. However, future training interventions can be aimed at improving knowledge of health workers on alert threshold of cholera. In addition, continuous education programs on disease and surveillance and notification should be planned for PHC workers to improve their knowledge.

PMID:36159040 | PMC:PMC9484319

Are better existing WASH practices in urban slums associated with a lower long-term risk of severe cholera? A prospective cohort study with 4 years of follow-up in Mirpur, Bangladesh

BMJ Open. 2022 Sep 21;12(9):e060858. doi: 10.1136/bmjopen-2022-060858.


OBJECTIVE: To investigate the association between existing household water quality, sanitation and hygiene (WASH) practices and severe cholera risk in a dense urban slum where cholera is highly endemic.

DESIGN, SETTING AND PARTICIPANTS: We assembled a large prospective cohort within a cluster randomised trial evaluating the effectiveness of oral cholera vaccine. Our dynamic cohort population (n=193 576) comprised individuals living in the 'non-intervention' clusters of the trial, and were followed over 4 years. This study was conducted in a dense urban slum community of Dhaka, Bangladesh and cholera surveillance was undertaken in 12 hospitals serving the study area.

PRIMARY OUTCOME MEASURE: First severe cholera episode detected during follow-up period.

METHODS: We applied a machine learning algorithm on a training subpopulation (n=96 943) to develop a binary ('better', 'not better') composite WASH variable predictive of severe cholera. The WASH rule was evaluated for performance in a separate validation subpopulation (n=96 633). Afterwards, we used Cox regression models to evaluate the association between 'better' WASH households and severe cholera risk over 4 years in the entire study population.

RESULTS: The 'better' WASH rule found that water quality and access were the most significant factors associated with severe cholera risk. Members of 'better' WASH households, constituting one-third of the population, had a 47% reduced risk of severe cholera (95% CI: 29 to 69; p<0.001), after adjusting for covariates. The protective association between living in a 'better' WASH household and severe cholera persisted in all age groups.

CONCLUSIONS: Salutary existing household WASH practices were associated with a significantly reduced long-term risk of severe cholera in an urban slum of Dhaka. These findings suggest that WASH adaptations already practised in the community may be important for developing and implementing effective and sustainable cholera control programmes in similar settings.

TRIAL REGISTRATION NUMBER: This article is a re-analysis of data from a cluster randomized trial; can be found on ClinicalTrials.gov NCT01339845.

PMID:36130764 | DOI:10.1136/bmjopen-2022-060858

Determining factors associated with cholera disease in Ethiopia using Bayesian hierarchical modeling

BMC Public Health. 2022 Sep 20;22(1):1779. doi: 10.1186/s12889-022-14153-1.


BACKGROUND: Cholera is a diarrheal disease caused by infection of the intestine with the gram-negative bacteria Vibrio cholera. It is caused by the ingestion of food or water and infected all age groups. This study aimed at identifying risk factors associated with cholera disease in Ethiopia using the Bayesian hierarchical model.

METHODS: The study was conducted in Ethiopia across regions and this study used secondary data obtained from the Ethiopian public health institute. Latent Gaussian models were used in this study; which is a group of models that contains most statistical models used in practice. The posterior marginal distribution of the Latent Gaussian models with different priors is determined by R-Integrated Nested Laplace Approximation.

RESULTS: There were 2790 cholera patients in Ethiopia across the regions. There were 81.61% of patients are survived from cholera outbreak disease and the rest 18.39% have died. There was 39% variation across the region in Ethiopia. Latent Gaussian models including random and fixed effects with standard priors were the best model to fit the data based on deviance. The odds of surviving from cholera outbreak disease for inpatient status are 0.609 times less than the outpatient status.

CONCLUSIONS: The authors conclude that the fitted latent Gaussian models indicate the predictor variables; admission status, aged between 15 and 44, another sick person in a family, dehydration status, oral rehydration salt, intravenous, and antibiotics were significantly associated with cholera outbreak disease.

PMID:36123680 | PMC:PMC9487065 | DOI:10.1186/s12889-022-14153-1

Epidemiology, diagnostics and factors associated with mortality during a cholera epidemic in Nigeria, October 2020-October 2021: a retrospective analysis of national surveillance data

BMJ Open. 2022 Sep 19;12(9):e063703. doi: 10.1136/bmjopen-2022-063703.


OBJECTIVES: Nigeria reported an upsurge in cholera cases in October 2020, which then transitioned into a large, disseminated epidemic for most of 2021. This study aimed to describe the epidemiology, diagnostic performance of rapid diagnostic test (RDT) kits and the factors associated with mortality during the epidemic.

DESIGN: A retrospective analysis of national surveillance data.

SETTING: 33 of 37 states (including the Federal Capital Territory) in Nigeria.

PARTICIPANTS: Persons who met cholera case definition (a person of any age with acute watery diarrhoea, with or without vomiting) between October 2020 and October 2021 within the Nigeria Centre for Disease Control surveillance data.

OUTCOME MEASURES: Attack rate (AR; per 100 000 persons), case fatality rate (CFR; %) and accuracy of RDT performance compared with culture using area under the receiver operating characteristic curve (AUROC). Additionally, individual factors associated with cholera deaths and hospitalisation were presented as adjusted OR with 95% CIs.

RESULTS: Overall, 93 598 cholera cases and 3298 deaths (CFR: 3.5%) were reported across 33 of 37 states in Nigeria within the study period. The proportions of cholera cases were higher in men aged 5-14 years and women aged 25-44 years. The overall AR was 46.5 per 100 000 persons. The North-West region recorded the highest AR with 102 per 100 000. Older age, male gender, residency in the North-Central region and severe dehydration significantly increased the odds of cholera deaths. The cholera RDT had excellent diagnostic accuracy (AUROC=0.91; 95% CI 0.87 to 0.96).

CONCLUSIONS: Cholera remains a serious public health threat in Nigeria with a high mortality rate. Thus, we recommend making RDT kits more widely accessible for improved surveillance and prompt case management across the country.

PMID:36123095 | DOI:10.1136/bmjopen-2022-063703

Genetic, Epigenetic, and Molecular Biology of Obesity: From Pathology to Therapeutics the Way Forward

J Assoc Physicians India. 2022 Sep;70(9):11-12. doi: 10.5005/japi-11001-0080.


Obesity is a globally expanding silent epidemic having multiple risk factors and consequences associated with it. Genetic factors have been found to be playing undeniable roles in obesity. Intermingled relationship between epigenetics, metagenomics, and the environment influences obesity traits. High precision diagnostic tools have outlined many single nucleotide polymorphisms (SNPs), as well as many novel genes, that have been identified that create an obesogenic environment. Rare single-gene diseases can lead to early childhood obesity and less satiety. With almost 30% of the global population being under the grip of obesity, the coming days are alarming. This review summarizes the existing knowledge on the genetic causes of obesity including the epidemiology as well as the issues of concern and new additions to the list. Furthermore, we discuss the ways to enhance the healthcare outcome for patients of obesity through interdepartmental collaborations apart from pharmacological therapy that is still limited to a few drugs. The teamwork of geneticists, genetic counselors, physicians, bariatric surgeons, nurses, endocrinologists, and pharmacists may provide promising results in intervention.

PMID:36082890 | DOI:10.5005/japi-11001-0080

An Assessment of Household Knowledge and Practices during a Cholera Epidemic-Dar es Salaam, Tanzania, 2016

Am J Trop Med Hyg. 2022 Sep 6:tpmd210597. doi: 10.4269/ajtmh.21-0597. Online ahead of print.


From August 15, 2015 to March 5, 2016, Tanzania reported 16,521 cholera cases and 251 deaths, with 4,596 cases and 44 deaths in its largest city, Dar es Salaam. To evaluate outbreak response efforts, we conducted a household survey with drinking water testing in the five most affected wards in Dar es Salaam. We interviewed 641 households 6 months after the beginning of the outbreak. Although most respondents knew that cholera causes diarrhea (90%) and would seek care if suspecting cholera (95%), only 45% were aware of the current outbreak in the area and only 5% would use oral rehydration salts (ORS) if ill. Of 200 (31%) respondents reporting no regular water treatment, 46% believed treatment was unnecessary and 18% believed treatment was too expensive. Fecal contamination was found in 45% of water samples and was associated with water availability (P = 0.047). Only 11% of samples had detectable free chlorine residual, which was associated with water availability (P = 0.025), reported current water treatment (P = 0.006), and observed free chlorine product in the household (P = 0.015). The provision of accessible, adequately chlorinated water supply, and implementation of social mobilization campaigns advocating household water treatment and use of ORS should be prioritized to address gaps in cholera prevention and treatment activities.

PMID:36067990 | DOI:10.4269/ajtmh.21-0597

Epidemiology for public health practice: The application of spatial epidemiology

World J Diabetes. 2022 Jul 15;13(7):584-586. doi: 10.4239/wjd.v13.i7.584.


Spatial epidemiology is the description and analysis of geographic patterns and variations in disease risk factors, morbidity and mortality with respect to their distributions associated with demographic, socioeconomic, environmental, health behavior, and genetic risk factors, and time-varying changes. In the Letter to Editor, we had a brief description of the practice for the mortality and the space-time patterns of John Snow's map of cholera epidemic in London, United Kingdom in 1854. This map is one of the earliest public heath practices of developing and applying spatial epidemiology. In the early history, spatial epidemiology was predominantly applied in infectious disease and risk factor studies. However, since the recent decades, noncommunicable diseases have become the leading cause of death in both developing and developed countries, spatial epidemiology has been used in the study of noncommunicable disease. In the Letter, we addressed two examples that applied spatial epidemiology to cluster and identify stroke belt and diabetes belt across the states and counties in the United States. Similar to any other epidemiological study design and analysis approaches, spatial epidemiology has its limitations. We should keep in mind when applying spatial epidemiology in research and in public health practice.

PMID:36051429 | PMC:PMC9329838 | DOI:10.4239/wjd.v13.i7.584

The Vibrio cholerae Seventh Pandemic Islands act in tandem to defend against a circulating phage

PLoS Genet. 2022 Aug 26;18(8):e1010250. doi: 10.1371/journal.pgen.1010250. eCollection 2022 Aug.


The current circulating pandemic El Tor biotype of Vibrio cholerae has persisted for over sixty years and is characterized by its acquisition of two unique genomic islands called the Vibrio Seventh Pandemic Islands 1 and 2 (VSP-I and VSP-II). However, the functions of most of the genes on VSP-I and VSP-II are unknown and the advantages realized by El Tor through these two islands are not clear. Recent studies have broadly implicated these two mobile genetic elements with phage defense. Still, protection against phage infection through these islands has not been observed directly in any V. cholerae El Tor biotype. Here we report the isolation of a circulating phage from a cholera patient stool sample and demonstrate that propagation of this phage in its native host is inhibited by elements in both VSP-I and VSP-II, providing direct evidence for the role of these genomic islands in phage defense. Moreover, we show that these defense systems are regulated by quorum sensing and active only at certain cell densities. Finally, we have isolated a naturally occurring phage variant that is resistant to the defense conferred by the VSP islands, illustrating the countermeasures used by phages to evade these defense mechanisms. Together, this work demonstrates a functional role for the VSPs in V. cholerae and highlights the key regulatory and mechanistic insights that can be gained by studying anti-phage systems in their native contexts.

PMID:36026491 | PMC:PMC9455884 | DOI:10.1371/journal.pgen.1010250