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Walton MG, Cubillejo I, Nag D, Withey JH. Advances in cholera research: from molecular biology to public health initiatives. Front Microbiol 2023; 14:1178538. [PMID: 37283925 PMCID: PMC10239892 DOI: 10.3389/fmicb.2023.1178538] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 04/14/2023] [Indexed: 06/08/2023] Open
Abstract
The aquatic bacterium Vibrio cholerae is the etiological agent of the diarrheal disease cholera, which has plagued the world for centuries. This pathogen has been the subject of studies in a vast array of fields, from molecular biology to animal models for virulence activity to epidemiological disease transmission modeling. V. cholerae genetics and the activity of virulence genes determine the pathogenic potential of different strains, as well as provide a model for genomic evolution in the natural environment. While animal models for V. cholerae infection have been used for decades, recent advances in this area provide a well-rounded picture of nearly all aspects of V. cholerae interaction with both mammalian and non-mammalian hosts, encompassing colonization dynamics, pathogenesis, immunological responses, and transmission to naïve populations. Microbiome studies have become increasingly common as access and affordability of sequencing has improved, and these studies have revealed key factors in V. cholerae communication and competition with members of the gut microbiota. Despite a wealth of knowledge surrounding V. cholerae, the pathogen remains endemic in numerous countries and causes sporadic outbreaks elsewhere. Public health initiatives aim to prevent cholera outbreaks and provide prompt, effective relief in cases where prevention is not feasible. In this review, we describe recent advancements in cholera research in these areas to provide a more complete illustration of V. cholerae evolution as a microbe and significant global health threat, as well as how researchers are working to improve understanding and minimize impact of this pathogen on vulnerable populations.
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Affiliation(s)
| | | | | | - Jeffrey H. Withey
- Department of Biochemistry, Microbiology, and Immunology, Wayne State University School of Medicine, Detroit, MI, United States
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Madullu MT, Thomas DSK, Nyanza EC, Seni J, Ngallaba SE, Kiluvia S, Asori M, Kangmennaang J. Spatial distribution of suspected and confirmed cholera cases in Mwanza City, Northern Tanzania. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001261. [PMID: 36962896 PMCID: PMC10022096 DOI: 10.1371/journal.pgph.0001261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 12/06/2022] [Indexed: 01/09/2023]
Abstract
Cholera, which is caused by Vibrio cholerae, persists as a devastating acute diarrheal disease. Despite availability of information on socio-cultural, agent and hosts risk factors, the disease continues to claim lives of people in Tanzania. The present study explores spatial patterns of cholera cases during a 2015-16 outbreak in Mwanza, Tanzania using a geographical information system (GIS) to identify concentrations of cholera cases. This cross-sectional study was conducted in Ilemela and Nyamagana Districts, Mwanza City. The two-phase data collection included: 1) retrospectively reviewing and capturing 852 suspected cholera cases from clinical files during the outbreak between August, 2015, and April, 2016, and 2) mapping of residence of suspected and confirmed cholera cases using global positioning systems (GPS). A majority of cholera patients were from Ilemela District (546, 64.1%), were males (506, 59.4%) and their median age was 27 (19-36) years. Of the 452 (55.1%) laboratory tests, 352 (77.9%) were confirmed to have Vibrio cholerae infection. Seven patients (0.80%) died. Cholera cases clustered in certain areas of Mwanza City. Sangabuye, Bugogwa and Igoma Wards had the largest number of confirmed cholera cases, while Luchelele Ward had no reported cholera cases. Concentrations may reflect health-seeking behavior as much as disease distribution. Topographical terrain, untreated water, physical and built environment, and health-seeking behaviors play a role in cholera epidemic in Mwanza City. The spatial analysis suggests patterns of health-seeking behavior more than patterns of disease. Maps similar to those generated in this study would be an important future resource for identifying an impending cholera outbreak in real-time to coordinate community members, community leaders and health personnel for guiding targeted education, outreach, and interventions.
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Affiliation(s)
- Monica T Madullu
- Department of Environmental, Occupational and Research GIS, School of Public Health, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Deborah S K Thomas
- Department of Geography and Earth Sciences, University of North Carolina at Charlotte, Charlotte, North Carolina, United States of America
| | - Elias C Nyanza
- Department of Environmental, Occupational and Research GIS, School of Public Health, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Jeremiah Seni
- Department of Microbiology and Immunology, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Sospatro E Ngallaba
- Department of Environmental, Occupational and Research GIS, School of Public Health, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Sophia Kiluvia
- Environmental Health Department, Mwanza City Council, Mwanza, Tanzania
| | - Moses Asori
- Department of Geography and Earth Sciences, University of North Carolina at Charlotte, Charlotte, North Carolina, United States of America
| | - Joseph Kangmennaang
- School of Kinesiology and Health Studies, Queens University, Kingston Ontario, Canada
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Griffiths K, Moise K, Piarroux M, Gaudart J, Beaulieu S, Bulit G, Marseille JP, Jasmin PM, Namphy PC, Henrys JH, Piarroux R, Rebaudet S. Delineating and Analyzing Locality-Level Determinants of Cholera, Haiti. Emerg Infect Dis 2021; 27:170-181. [PMID: 33350917 PMCID: PMC7774537 DOI: 10.3201/eid2701.191787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Centre Department, Haiti, was the origin of a major cholera epidemic during 2010–2019. Although no fine-scale spatial delineation is officially available, we aimed to analyze determinants of cholera at the local level and identify priority localities in need of interventions. After estimating the likely boundaries of 1,730 localities by using Voronoi polygons, we mapped 5,322 suspected cholera cases reported during January 2015–September 2016 by locality alongside environmental and socioeconomic variables. A hierarchical clustering on principal components highlighted 2 classes with high cholera risk: localities close to rivers and unimproved water sources (standardized incidence ratio 1.71, 95% CI 1.02–2.87; p = 0.04) and urban localities with markets (standardized incidence ratio 1.69, 95% CI 1.25–2.29; p = 0.0006). Our analyses helped identify and characterize areas where efforts should be focused to reduce vulnerability to cholera and other waterborne diseases; these methods could be used in other contexts.
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Fitzgibbon WE, Morgan JJ, Webb GF, Wu Y. Modelling the aqueous transport of an infectious pathogen in regional communities: application to the cholera outbreak in Haiti. J R Soc Interface 2020; 17:20200429. [PMID: 32752993 DOI: 10.1098/rsif.2020.0429] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
A mathematical model is developed to describe the dynamics of the spread of a waterborne disease among communities located along a flowing waterway. The model is formulated as a system of reaction-diffusion-advection partial differential equations in this spatial setting. The compartments of the model consist of susceptible, infected, and recovered individuals in the communities along the waterway, together with a term representing the pathogen load in each community and a term representing the spatial concentration of pathogens flowing along the waterway. The model is applied to the cholera outbreak in Haiti in 2010.
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Affiliation(s)
| | - Jeffrey J Morgan
- Department of Mathematics, University of Houston, Houston, TX 77204, USA
| | - Glenn F Webb
- Department of Mathematics, Vanderbilt University, Nashville, TN 37212, USA
| | - Yixiang Wu
- Department of Mathematical Sciences, Middle Tennessee State University, Murfreesboro, TN 37132, USA
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Pathways to a policy for cholera control in India. Vaccine 2020; 38 Suppl 1:A157-A159. [DOI: 10.1016/j.vaccine.2019.06.036] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 05/20/2019] [Accepted: 06/14/2019] [Indexed: 11/22/2022]
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Rebaudet S, Moore S, Rossignol E, Bogreau H, Gaudart J, Normand AC, Laraque MJ, Adrien P, Boncy J, Piarroux R. Epidemiological and molecular forensics of cholera recurrence in Haiti. Sci Rep 2019; 9:1164. [PMID: 30718586 PMCID: PMC6361935 DOI: 10.1038/s41598-018-37706-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 12/05/2018] [Indexed: 01/01/2023] Open
Abstract
Cholera has affected Haiti with damping waves of outbreaks since October 2010. However, mechanisms behind disease persistence during lull periods remain poorly understood. By mid 2014, cholera transmission seemed to only persist in the northern part of Haiti. Meanwhile, cholera appeared nearly extinct in the capital, Port-au-Prince, where it eventually exploded in September 2014. This study aimed to determine whether this outbreak was caused by local undetected cases or by re-importation of the disease from the north. Applying an integrated approach between November 2013 and November 2014, we assessed the temporal and spatial dynamics of cholera using routine surveillance data and performed population genetics analyses of 178 Vibrio cholerae O1 clinical isolates. The results suggest that the northern part of the country exhibited a persisting metapopulation pattern with roaming oligoclonal outbreaks that could not be effectively controlled. Conversely, undetected and unaddressed autochthonous low-grade transmission persisted in the Port-au-Prince area, which may have been the source of the acute outbreak in late-2014. Cholera genotyping is a simple but powerful tool to adapt control strategies based on epidemic specificities. In Haiti, these data have already yielded significant progress in cholera surveillance, which is a key component of the strategy to eventually eliminate cholera.
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Affiliation(s)
- Stanislas Rebaudet
- Assistance Publique - Hôpitaux de Marseille, DRCI, Marseille, France. .,Hôpital Européen Marseille, Marseille, France.
| | | | - Emmanuel Rossignol
- Ministry of Public Health and Population, National Public Health Laboratory, Delmas, Haiti
| | - Hervé Bogreau
- Institut de Recherche Biomédicale des Armées, Département des Maladies Infectieuses, Unité de Parasitologie et d'Entomologie, Marseille, France.,Aix Marseille Univ, Institut Hospitalo-Universitaire Méditerranée Infection, VITROME, Marseille, France
| | - Jean Gaudart
- Aix Marseille Univ, APHM, IRD, INSERM, SESSTIM, BioSTIC, Marseille, France
| | - Anne-Cécile Normand
- Sorbonne Université, INSERM, Institut Pierre-Louis d'Epidémiologie et de Santé Publique, AP-HP, Hôpital Pitié-Salpêtrière, F-, 75013, Paris, France
| | - Marie-José Laraque
- Ministry of Public Health and Population, National Public Health Laboratory, Delmas, Haiti
| | - Paul Adrien
- Ministry of Public Health and Population, Directorate of Epidemiology Laboratory and Research, Delmas, Haiti
| | - Jacques Boncy
- Ministry of Public Health and Population, National Public Health Laboratory, Delmas, Haiti
| | - Renaud Piarroux
- Sorbonne Université, INSERM, Institut Pierre-Louis d'Epidémiologie et de Santé Publique, AP-HP, Hôpital Pitié-Salpêtrière, F-, 75013, Paris, France
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Franke MF, Jerome JG, Matias WR, Ternier R, Hilaire IJ, Harris JB, Ivers LC. Comparison of two control groups for estimation of oral cholera vaccine effectiveness using a case-control study design. Vaccine 2017; 35:5819-5827. [PMID: 28916247 DOI: 10.1016/j.vaccine.2017.09.025] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 09/05/2017] [Accepted: 09/06/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND Case-control studies to quantify oral cholera vaccine effectiveness (VE) often rely on neighbors without diarrhea as community controls. Test-negative controls can be easily recruited and may minimize bias due to differential health-seeking behavior and recall. We compared VE estimates derived from community and test-negative controls and conducted bias-indicator analyses to assess potential bias with community controls. METHODS From October 2012 through November 2016, patients with acute watery diarrhea were recruited from cholera treatment centers in rural Haiti. Cholera cases had a positive stool culture. Non-cholera diarrhea cases (test-negative controls and non-cholera diarrhea cases for bias-indicator analyses) had a negative culture and rapid test. Up to four community controls were matched to diarrhea cases by age group, time, and neighborhood. RESULTS Primary analyses included 181 cholera cases, 157 non-cholera diarrhea cases, 716 VE community controls and 625 bias-indicator community controls. VE for self-reported vaccination with two doses was consistent across the two control groups, with statistically significant VE estimates ranging from 72 to 74%. Sensitivity analyses revealed similar, though somewhat attenuated estimates for self-reported two dose VE. Bias-indicator estimates were consistently less than one, with VE estimates ranging from 19 to 43%, some of which were statistically significant. CONCLUSIONS OCV estimates from case-control analyses using community and test-negative controls were similar. While bias-indicator analyses suggested possible over-estimation of VE estimates using community controls, test-negative analyses suggested this bias, if present, was minimal. Test-negative controls can be a valid low-cost and time-efficient alternative to community controls for OCV effectiveness estimation and may be especially relevant in emergency situations.
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Affiliation(s)
- Molly F Franke
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA.
| | | | - Wilfredo R Matias
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Ralph Ternier
- Zanmi Lasante/Partners In Health, Port au Prince, Haiti
| | | | - Jason B Harris
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
| | - Louise C Ivers
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA; Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA
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