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Ayling S, Milusheva S, Maidei Kashangura F, Hoo YR, Sturrock H, Joseph G. A stitch in time: The importance of water and sanitation services (WSS) infrastructure maintenance for cholera risk. A geospatial analysis in Harare, Zimbabwe. PLoS Negl Trop Dis 2023; 17:e0011353. [PMID: 37327203 DOI: 10.1371/journal.pntd.0011353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Accepted: 05/03/2023] [Indexed: 06/18/2023] Open
Abstract
Understanding the factors associated with cholera outbreaks is an integral part of designing better approaches to mitigate their impact. Using a rich set of georeferenced case data from the cholera epidemic that occurred in Harare from September 2018 to January 2019, we apply spatio-temporal modelling to better understand how the outbreak unfolded and the factors associated with higher risk of being a reported case. Using Call Detail Records (CDR) to estimate weekly population movement of the community throughout the city, results suggest that broader human movement (not limited to infected agents) helps to explain some of the spatio-temporal patterns of cases observed. In addition, results highlight a number of socio-demographic risk factors and suggest that there is a relationship between cholera risk and water infrastructure. The analysis shows that populations living close to the sewer network, with high access to piped water are associated with at higher risk. One possible explanation for this observation is that sewer bursts led to the contamination of the piped water network. This could have turned access to piped water, usually assumed to be associated with reduced cholera risk, into a risk factor itself. Such events highlight the importance of maintenance in the provision of SDG improved water and sanitation infrastructure.
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Affiliation(s)
- Sophie Ayling
- Water Global Practice, World Bank Group, Washington DC, United States of America
| | - Sveta Milusheva
- Development Impact Evaluation Unit (DIME), World Bank Group, Washington DC, United States of America
| | | | - Yi Rong Hoo
- Water Global Practice, World Bank Group, Washington DC, United States of America
| | | | - George Joseph
- Water Global Practice, World Bank Group, Washington DC, United States of America
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Saleem A, Chen J, Liu M, Liu N, Usman M, Wang K, Haris M, Zhang Y, Li P. Versatile Magnetic Mesoporous Carbon Derived Nano-Adsorbent for Synchronized Toxic Metal Removal and Bacterial Disinfection from Water Matrices. SMALL (WEINHEIM AN DER BERGSTRASSE, GERMANY) 2023; 19:e2207348. [PMID: 36617518 DOI: 10.1002/smll.202207348] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 12/26/2022] [Indexed: 06/17/2023]
Abstract
Contamination of water resources by toxic metals and opportunistic pathogens remains a serious challenge. The development of nano-adsorbents with desired features to tackle this problem is a continuously evolving field. Here, magnetic mesoporous carbon nanospheres grafted by antimicrobial polyhexamethylene biguanidine (PHMB) are reported. Detailed mechanistic investigations reveal that the electrostatic stabilizer modified magnetic nanocore interfaced mesoporous shell can be programmatically regulated to tune the size and related morphological properties. The core-shell nano-adsorbent shows tailorable shell thickness (≈20-55 nm), high surface area (363.47 m2 g-1 ), pore volume (0.426 cm3 g-1 ), radially gradient pores (11.26 nm), and abundant biguanidine functionality. Importantly, the nano-adsorbent has high adsorption capacity for toxic thallium (Tl(I) ions (≈559 mg g-1 ), excellent disinfection against Staphylococcus aureus and Escherichia coli (>99.99% at 2 and 2.5 µg mL-1 ), ultrafast disinfection kinetics rate (>99.99% within ≈4 min), and remarkable regeneration capability when exposed to polluted water matrices. The Tl(I) removal is attributed to surface complexation and physical adsorption owing to open ended mesopores, while disinfection relies on contact of terminal biguanidines with phospholipid head groups of membrane. The significance of this work lies in bringing up effective synchronic water purification technology to combat pathogenic microorganisms and toxic metal.
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Affiliation(s)
- Atif Saleem
- Frontiers Science Center for Flexible Electronics (FSCFE), Shaanxi Institute of Flexible Electronics (SIFE) & Shaanxi Institute of Biomedical Materials and Engineering (SIBME), Northwestern Polytechnical University (NPU), 127 West Youyi Road, Xi'an, 710072, P. R. China
| | - Jingjie Chen
- Frontiers Science Center for Flexible Electronics (FSCFE), Shaanxi Institute of Flexible Electronics (SIFE) & Shaanxi Institute of Biomedical Materials and Engineering (SIBME), Northwestern Polytechnical University (NPU), 127 West Youyi Road, Xi'an, 710072, P. R. China
| | - Meng Liu
- Frontiers Science Center for Flexible Electronics (FSCFE), Shaanxi Institute of Flexible Electronics (SIFE) & Shaanxi Institute of Biomedical Materials and Engineering (SIBME), Northwestern Polytechnical University (NPU), 127 West Youyi Road, Xi'an, 710072, P. R. China
| | - Nian Liu
- Frontiers Science Center for Flexible Electronics (FSCFE), Shaanxi Institute of Flexible Electronics (SIFE) & Shaanxi Institute of Biomedical Materials and Engineering (SIBME), Northwestern Polytechnical University (NPU), 127 West Youyi Road, Xi'an, 710072, P. R. China
| | - Muhammad Usman
- École Nationale Supérieure de Chimie de Rennes, CNRS, UMR 6226, Rennes, 35708, France
| | - Ke Wang
- Frontiers Science Center for Flexible Electronics (FSCFE), Shaanxi Institute of Flexible Electronics (SIFE) & Shaanxi Institute of Biomedical Materials and Engineering (SIBME), Northwestern Polytechnical University (NPU), 127 West Youyi Road, Xi'an, 710072, P. R. China
| | - Muhammad Haris
- School of Environmental Science and Engineering, Shaanxi University of Science & Technology, Xi'an, 710021, P. R. China
| | - Yuezhou Zhang
- Frontiers Science Center for Flexible Electronics (FSCFE), Shaanxi Institute of Flexible Electronics (SIFE) & Shaanxi Institute of Biomedical Materials and Engineering (SIBME), Northwestern Polytechnical University (NPU), 127 West Youyi Road, Xi'an, 710072, P. R. China
- Ningbo Institute of Northwestern Polytechnical University, Frontiers Science Center for Flexible Electronics (FSCFE), Key Laboratory of Flexible Electronics of Zhejiang Province, Ningbo Institute of Northwestern Polytechnical University, 218 Qingyi Road, Ningbo, 315103, China
| | - Peng Li
- Frontiers Science Center for Flexible Electronics (FSCFE), Shaanxi Institute of Flexible Electronics (SIFE) & Shaanxi Institute of Biomedical Materials and Engineering (SIBME), Northwestern Polytechnical University (NPU), 127 West Youyi Road, Xi'an, 710072, P. R. China
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Liu N, Ren P, Saleem A, Feng W, Huo J, Ma H, Li S, Li P, Huang W. Simultaneous Efficient Decontamination of Bacteria and Heavy Metals via Capacitive Deionization Using Polydopamine/Polyhexamethylene Guanidine Co-deposited Activated Carbon Electrodes. ACS APPLIED MATERIALS & INTERFACES 2021; 13:61669-61680. [PMID: 34915703 DOI: 10.1021/acsami.1c20145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
The contamination of pathogenic micro-organisms and heavy metals in drinking water sources poses a serious threat to human health, which raises the demand for efficient water treatments. Herein, multi-functional capacitive deionization (CDI) electrodes were developed for the simultaneous decontamination of bacteria and heavy metal contaminants. Polyhexamethylene guanidine (PHMG), an antibacterial polymer, was deposited on the surface of the activated carbon (AC) electrode with the assistance of mussel-inspired polydopamine (PDA) chemistry. The main characterization results proved successful co-deposition of PDA and PHMG on the AC electrode, forming a hydrophilic coating layer in one step. Electrochemical analyses indicated that the AC-PDA/PHMG electrodes presented satisfactory capacitive behaviors, with outstanding salt adsorption capacity and cycling stability. The modified electrodes also exhibit excellent disinfection performance and heavy metal adsorption performance. The bacterial elimination rate of co-deposited electrodes grew along with the increase in the PHMG content. Particularly, AC-PDA/PHMG2 electrodes successfully removed and deactivated 99.11% Escherichia coli and 98.67% Pseudomonas aeruginosa (104 CFU mL-1) in water within 60 min. Furthermore, three flow cells made by AC-PDA/PHMG2 electrodes connected in series achieved efficient removal of salt, heavy metals such as lead and cadmium, and bacteria simultaneously, which indicated that the adsorption performance is significantly improved compared with pristine AC electrodes. These results denote the enormous potential of this one-step prepared multi-functional electrodes for facile and effective water purification using CDI technology.
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Affiliation(s)
- Nian Liu
- Frontiers Science Center for Flexible Electronics (FSCFE), Xi'an Institute of Flexible Electronics (IFE) and Xi'an Institute of Biomedical Materials & Engineering (IBME), Northwestern Polytechnical University (NPU), 127 West Youyi Road, Xi'an 710072, China
- Key Laboratory of Flexible Electronics (KLOFE) and Institute of Advanced Materials (IAM), Nanjing Tech University (NanjingTech), 30 South Puzhu Road, Nanjing 211816, China
| | - Panyu Ren
- Frontiers Science Center for Flexible Electronics (FSCFE), Xi'an Institute of Flexible Electronics (IFE) and Xi'an Institute of Biomedical Materials & Engineering (IBME), Northwestern Polytechnical University (NPU), 127 West Youyi Road, Xi'an 710072, China
| | - Atif Saleem
- Frontiers Science Center for Flexible Electronics (FSCFE), Xi'an Institute of Flexible Electronics (IFE) and Xi'an Institute of Biomedical Materials & Engineering (IBME), Northwestern Polytechnical University (NPU), 127 West Youyi Road, Xi'an 710072, China
| | - Wei Feng
- Frontiers Science Center for Flexible Electronics (FSCFE), Xi'an Institute of Flexible Electronics (IFE) and Xi'an Institute of Biomedical Materials & Engineering (IBME), Northwestern Polytechnical University (NPU), 127 West Youyi Road, Xi'an 710072, China
- Key Laboratory of Flexible Electronics (KLOFE) and Institute of Advanced Materials (IAM), Nanjing Tech University (NanjingTech), 30 South Puzhu Road, Nanjing 211816, China
| | - Jingjing Huo
- Frontiers Science Center for Flexible Electronics (FSCFE), Xi'an Institute of Flexible Electronics (IFE) and Xi'an Institute of Biomedical Materials & Engineering (IBME), Northwestern Polytechnical University (NPU), 127 West Youyi Road, Xi'an 710072, China
| | - Huifang Ma
- Frontiers Science Center for Flexible Electronics (FSCFE), Xi'an Institute of Flexible Electronics (IFE) and Xi'an Institute of Biomedical Materials & Engineering (IBME), Northwestern Polytechnical University (NPU), 127 West Youyi Road, Xi'an 710072, China
| | - Sheng Li
- Key Laboratory of Flexible Electronics (KLOFE) and Institute of Advanced Materials (IAM), Nanjing Tech University (NanjingTech), 30 South Puzhu Road, Nanjing 211816, China
| | - Peng Li
- Frontiers Science Center for Flexible Electronics (FSCFE), Xi'an Institute of Flexible Electronics (IFE) and Xi'an Institute of Biomedical Materials & Engineering (IBME), Northwestern Polytechnical University (NPU), 127 West Youyi Road, Xi'an 710072, China
- Key Laboratory of Flexible Electronics (KLOFE) and Institute of Advanced Materials (IAM), Nanjing Tech University (NanjingTech), 30 South Puzhu Road, Nanjing 211816, China
| | - Wei Huang
- Frontiers Science Center for Flexible Electronics (FSCFE), Xi'an Institute of Flexible Electronics (IFE) and Xi'an Institute of Biomedical Materials & Engineering (IBME), Northwestern Polytechnical University (NPU), 127 West Youyi Road, Xi'an 710072, China
- Key Laboratory of Flexible Electronics (KLOFE) and Institute of Advanced Materials (IAM), Nanjing Tech University (NanjingTech), 30 South Puzhu Road, Nanjing 211816, China
- State Key Laboratory of Organic Electronics and Information Displays (SKLOEID), Institute of Advanced Materials (IAM), Nanjing University of Posts & Telecommunications, 9 Wenyuan Road, Nanjing 210023, China
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Ding X, Wang A, Tong W, Xu FJ. Biodegradable Antibacterial Polymeric Nanosystems: A New Hope to Cope with Multidrug-Resistant Bacteria. SMALL (WEINHEIM AN DER BERGSTRASSE, GERMANY) 2019; 15:e1900999. [PMID: 30957927 DOI: 10.1002/smll.201900999] [Citation(s) in RCA: 105] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Revised: 03/19/2019] [Indexed: 05/14/2023]
Abstract
The human society is faced with daunting threats from bacterial infections. Over decades, a variety of antibacterial polymeric nanosystems have exhibited great promise for the eradication of multidrug-resistant bacteria and persistent biofilms by enhancing bacterial recognition and binding capabilities. In this Review, the "state-of-the-art" biodegradable antibacterial polymeric nanosystems, which could respond to bacteria environments (e.g., acidity or bacterial enzymes) for controlled antibiotic release or multimodal antibacterial treatment, are summarized. The current antibacterial polymeric nanosystems can be categorized into antibiotic-containing and intrinsic antibacterial nanosystems. The antibiotic-containing polymeric nanosystems include antibiotic-encapsulated nanocarriers (e.g., polymeric micelles, vesicles, nanogels) and antibiotic-conjugated polymer nanosystems for the delivery of antibiotic drugs. On the other hand, the intrinsic antibacterial polymer nanosystems containing bactericidal moieties such as quaternary ammonium groups, phosphonium groups, polycations, antimicrobial peptides (AMPs), and their synthetic mimics, are also described. The biodegradability of the nanosystems can be rendered by the incorporation of labile chemical linkages, such as carbonate, ester, amide, and phosphoester bonds. The design and synthesis of the degradable polymeric building blocks and their fabrications into nanosystems are also explicated, together with their plausible action mechanisms and potential biomedical applications. The perspectives of the current research in this field are also described.
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Affiliation(s)
- Xiaokang Ding
- State Key Laboratory of Chemical Resource Engineering, Beijing University of Chemical Technology, Beijing, 100029, China
- Key Lab of Biomedical Materials of Natural Macromolecules, Beijing University of Chemical Technology, Ministry of Education, Beijing, 100029, China
- Beijing Laboratory of Biomedical Materials, Beijing Advanced Innovation Center for Soft Matter Science and Engineering, Beijing University of Chemical Technology, Beijing, 100029, China
| | - Anzhi Wang
- State Key Laboratory of Chemical Resource Engineering, Beijing University of Chemical Technology, Beijing, 100029, China
- Key Lab of Biomedical Materials of Natural Macromolecules, Beijing University of Chemical Technology, Ministry of Education, Beijing, 100029, China
- Beijing Laboratory of Biomedical Materials, Beijing Advanced Innovation Center for Soft Matter Science and Engineering, Beijing University of Chemical Technology, Beijing, 100029, China
| | - Wei Tong
- State Key Laboratory of Chemical Resource Engineering, Beijing University of Chemical Technology, Beijing, 100029, China
- Key Lab of Biomedical Materials of Natural Macromolecules, Beijing University of Chemical Technology, Ministry of Education, Beijing, 100029, China
- Beijing Laboratory of Biomedical Materials, Beijing Advanced Innovation Center for Soft Matter Science and Engineering, Beijing University of Chemical Technology, Beijing, 100029, China
| | - Fu-Jian Xu
- State Key Laboratory of Chemical Resource Engineering, Beijing University of Chemical Technology, Beijing, 100029, China
- Key Lab of Biomedical Materials of Natural Macromolecules, Beijing University of Chemical Technology, Ministry of Education, Beijing, 100029, China
- Beijing Laboratory of Biomedical Materials, Beijing Advanced Innovation Center for Soft Matter Science and Engineering, Beijing University of Chemical Technology, Beijing, 100029, China
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Flecknoe D, Charles Wakefield B, Simmons A. Plagues & wars: the 'Spanish Flu' pandemic as a lesson from history. Med Confl Surviv 2018; 34:61-68. [PMID: 29764189 DOI: 10.1080/13623699.2018.1472892] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Affiliation(s)
- Daniel Flecknoe
- a Derby Teaching Hospitals NHS Foundation Trust , Derby , UK.,b University of Sheffield , Sheffield , UK
| | | | - Aidan Simmons
- d Chesterfield Royal Hospital , Chesterfield , UK.,e Public Health Department , Nottinghamshire County Council , Nottingham , UK
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Saha A, Hayen A, Ali M, Rosewell A, MacIntyre CR, Clemens JD, Qadri F. Socioeconomic drivers of vaccine uptake: An analysis of the data of a geographically defined cluster randomized cholera vaccine trial in Bangladesh. Vaccine 2018; 36:4742-4749. [PMID: 29752024 PMCID: PMC6046469 DOI: 10.1016/j.vaccine.2018.04.084] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 04/28/2018] [Accepted: 04/30/2018] [Indexed: 10/25/2022]
Abstract
BACKGROUND Evaluations of oral cholera vaccines (OCVs) have demonstrated their effectiveness in diverse settings. However, low vaccine uptake in some settings reduces the opportunity for prevention. This paper identifies the socioeconomic factors associated with vaccine uptake in a mass vaccination program. METHODS This was a three-arm (vaccine, vaccine plus behavioral change, and non-intervention) cluster randomized trial conducted in Dhaka, Bangladesh. Socio-demographic and vaccination data were collected from 268,896 participants. A geographical information system (GIS) was used to design and implement the vaccination program. A logistic regression model was used to assess the association between vaccine uptake and socioeconomic characteristics. RESULTS The GIS supported the implementation of the vaccination program by identifying ideal locations of vaccination centres for equitable population access, defining catchment areas of daily activities, and providing daily coverage maps during the campaign. Among 188,206 individuals in the intervention arms, 123,686 (66%) received two complete doses, and 64,520 (34%) received one or no doses of the OCV. The vaccine uptake rate was higher in females than males (aOR: 1.80; 95% CI = 1.75-1.84) and in younger (<15 years) than older participants (aOR: 2.19; 95% CI = 2.13-3.26). Individuals living in their own house or having a higher monthly family expenditure were more likely to receive the OCV (aOR: 1.60; 95% CI = 1.50-1.70 and aOR: 1.14; 95% CI = 1.10-1.18 respectively). Individuals using treated water for drinking or using own tap as the source of water were more likely to receive the OCV (aOR: 1.23; 95% CI = 1.17-1.29 and aOR: 1.14; 95% CI = 1.02-1.25 respectively) than their counterpart. Vaccine uptake was also significantly higher in participants residing farther away from health facilities (aOR: 95% 1.80; CI = 1.36-2.37). CONCLUSION The GIS was useful in designing field activities, facilitating vaccine delivery and identifying socioeconomic drivers of vaccine uptake in the urban area of Bangladesh. Addressing these socioeconomic drivers may help improve OCV uptake, thereby effectiveness of the OCV in a community.
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Affiliation(s)
- Amit Saha
- School of Public Health and Community Medicine, UNSW Australia, NSW, Australia; International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh.
| | - Andrew Hayen
- Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, Australia
| | - Mohammad Ali
- Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Alexander Rosewell
- School of Public Health and Community Medicine, UNSW Australia, NSW, Australia
| | - C Raina MacIntyre
- School of Public Health and Community Medicine, UNSW Australia, NSW, Australia
| | - John D Clemens
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh; UCLA Fielding School of Public Health, Los Angeles, USA; Korea University School of Medicine, Seoul, South Korea
| | - Firdausi Qadri
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
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Diaconu K, Falconer J, O’May F, Jimenez M, Matragrano J, Njanpop-Lafourcade B, Ager A. Cholera diagnosis in human stool and detection in water: protocol for a systematic review of available technologies. Syst Rev 2018; 7:29. [PMID: 29458416 PMCID: PMC5819268 DOI: 10.1186/s13643-018-0679-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 01/11/2018] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Cholera is a highly infectious diarrheal disease spread via fecal contamination of water and food sources; it is endemic in parts of Africa and Asia and recent outbreaks have been reported in Haiti, the Zambia and Democratic Republic of the Congo. If left untreated, the disease can be fatal in less than 24 h and result in case fatality ratios of 30-50%. Cholera disproportionately affects those living in areas with poor access to water and sanitation: the long-term public health response is focused on improving water and hygiene facilities and access. Short-term measures for infection prevention and control, and disease characterization and surveillance, are impaired by diagnostic delays: culture methods are slow and rely on the availability of infrastructure and specialist equipment. Rapid diagnostic tests have shown promise under field conditions and further innovations in this area have been proposed. METHODS This paper is the protocol for a systematic review focused on identifying current technologies and methods used for cholera diagnosis in stool, and detection in water. We will synthesize and appraise information on product technical specifications, accuracy and design features in order to inform infection prevention and control and innovation development. Embase, MEDLINE, CINAHL, Proquest, IndMed and the WHO and Campbell libraries will be searched. We will include studies reporting on field evaluations, including within-study comparisons against a reference standard, and laboratory evaluations reporting on product validation against field stool or water samples. We will extract data according to protocol and attempt meta-analyses if appropriate given data availability and quality. DISCUSSION The systematic review builds on a previous scoping review in this field and expands upon this by synthesising data on both product technical characteristics and design features. The review will be of particular value to stakeholders engaged in diagnostic procurement and manufacturers interested in developing cholera or diarrheal disease diagnostics. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42016048428 .
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Affiliation(s)
- Karin Diaconu
- Institute for Global Health and Development, Queen Margaret University - Edinburgh, Musselburgh, EH21 6UU Scotland
| | - Jennifer Falconer
- Institute for Global Health and Development, Queen Margaret University - Edinburgh, Musselburgh, EH21 6UU Scotland
| | - Fiona O’May
- Institute for Global Health and Development, Queen Margaret University - Edinburgh, Musselburgh, EH21 6UU Scotland
| | - Miguel Jimenez
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139 USA
| | - Joe Matragrano
- Columbia University, 116th St & Broadway, New York, NY 10027 USA
| | | | - Alastair Ager
- Institute for Global Health and Development, Queen Margaret University - Edinburgh, Musselburgh, EH21 6UU Scotland
- Mailman School of Public Health, 116th St & Broadway, New York, NY 10027 USA
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Muhling BA, Jacobs J, Stock CA, Gaitan CF, Saba VS. Projections of the future occurrence, distribution, and seasonality of three Vibrio species in the Chesapeake Bay under a high-emission climate change scenario. GEOHEALTH 2017; 1:278-296. [PMID: 32158993 PMCID: PMC7007099 DOI: 10.1002/2017gh000089] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 07/20/2017] [Accepted: 08/04/2017] [Indexed: 05/05/2023]
Abstract
Illness caused by pathogenic strains of Vibrio bacteria incurs significant economic and health care costs in many areas around the world. In the Chesapeake Bay, the two most problematic species are V. vulnificus and V. parahaemolyticus, which cause infection both from exposure to contaminated water and consumption of contaminated seafood. We used existing Vibrio habitat models, four global climate models, and a recently developed statistical downscaling framework to project the spatiotemporal probability of occurrence of V. vulnificus and V. cholerae in the estuarine environment, and the mean concentration of V. parahaemolyticus in oysters in the Chesapeake Bay by the end of the 21st century. Results showed substantial future increases in season length and spatial habitat for V. vulnificus and V. parahaemolyticus, while projected increase in V. cholerae habitat was less marked and more spatially heterogeneous. Our findings underscore the need for spatially variable inputs into models of climate impacts on Vibrios in estuarine environments. Overall, economic costs associated with Vibrios in the Chesapeake Bay, such as incidence of illness and management measures on the shellfish industry, may increase under climate change, with implications for recreational and commercial uses of the ecosystem.
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Affiliation(s)
- Barbara A. Muhling
- Princeton University Program in Atmospheric and Oceanic SciencesPrincetonNew JerseyUSA
- NOAA Geophysical Fluid Dynamics LaboratoryPrincetonNew JerseyUSA
- Now at Cooperative Institute for Marine Ecosystems and ClimateUniversity of CaliforniaSanta CruzCaliforniaUSA
| | - John Jacobs
- National Oceanic and Atmospheric Administration, National Ocean Service, National Centers for Coastal Ocean Science, Cooperative Oxford LabOxfordMarylandUSA
| | - Charles A. Stock
- NOAA Geophysical Fluid Dynamics LaboratoryPrincetonNew JerseyUSA
| | | | - Vincent S. Saba
- National Oceanic and Atmospheric Administration, National Marine Fisheries Service, Northeast Fisheries Science Center, Geophysical Fluid Dynamics LaboratoryPrinceton University Forrestal CampusPrincetonNew JerseyUSA
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Oladokun MO, Okoh IA. Vibrio cholerae: A historical perspective and current trend. ASIAN PACIFIC JOURNAL OF TROPICAL DISEASE 2016. [DOI: 10.1016/s2222-1808(16)61154-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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10
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Ngwa MC, Liang S, Kracalik IT, Morris L, Blackburn JK, Mbam LM, Ba Pouth SFB, Teboh A, Yang Y, Arabi M, Sugimoto JD, Morris JG. Cholera in Cameroon, 2000-2012: Spatial and Temporal Analysis at the Operational (Health District) and Sub Climate Levels. PLoS Negl Trop Dis 2016; 10:e0005105. [PMID: 27855171 PMCID: PMC5113893 DOI: 10.1371/journal.pntd.0005105] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Accepted: 10/12/2016] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Recurrent cholera outbreaks have been reported in Cameroon since 1971. However, case fatality ratios remain high, and we do not have an optimal understanding of the epidemiology of the disease, due in part to the diversity of Cameroon's climate subzones and a lack of comprehensive data at the health district level. METHODS/FINDINGS A unique health district level dataset of reported cholera case numbers and related deaths from 2000-2012, obtained from the Ministry of Public Health of Cameroon and World Health Organization (WHO) country office, served as the basis for the analysis. During this time period, 43,474 cholera cases were reported: 1748 were fatal (mean annual case fatality ratio of 7.9%), with an attack rate of 17.9 reported cases per 100,000 inhabitants per year. Outbreaks occurred in three waves during the 13-year time period, with the highest case fatality ratios at the beginning of each wave. Seasonal patterns of illness differed strikingly between climate subzones (Sudano-Sahelian, Tropical Humid, Guinea Equatorial, and Equatorial Monsoon). In the northern Sudano-Sahelian subzone, highest number of cases tended to occur during the rainy season (July-September). The southern Equatorial Monsoon subzone reported cases year-round, with the lowest numbers during peak rainfall (July-September). A spatial clustering analysis identified multiple clusters of high incidence health districts during 2010 and 2011, which were the 2 years with the highest annual attack rates. A spatiotemporal autoregressive Poisson regression model fit to the 2010-2011 data identified significant associations between the risk of transmission and several factors, including the presence of major waterbody or highway, as well as the average daily maximum temperature and the precipitation levels over the preceding two weeks. The direction and/or magnitude of these associations differed between climate subzones, which, in turn, differed from national estimates that ignored subzones differences in climate variables. CONCLUSIONS/SIGNIFICANCE The epidemiology of cholera in Cameroon differs substantially between climate subzones. Development of an optimal comprehensive country-wide control strategy for cholera requires an understanding of the impact of the natural and built environment on transmission patterns at the local level, particularly in the setting of ongoing climate change.
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Affiliation(s)
- Moise C. Ngwa
- Emerging Pathogens Institute, University of Florida, Gainesville, Florida, United States of America
- Department of Environmental and Global Health, College of Public Health and Health Professions, University of Florida, Gainesville, Florida, United States of America
| | - Song Liang
- Emerging Pathogens Institute, University of Florida, Gainesville, Florida, United States of America
- Department of Environmental and Global Health, College of Public Health and Health Professions, University of Florida, Gainesville, Florida, United States of America
| | - Ian T. Kracalik
- Emerging Pathogens Institute, University of Florida, Gainesville, Florida, United States of America
- Spatial Epidemiology and Ecology Research Laboratory, Department of Geography, College of Liberal Arts and Sciences, University of Florida, Gainesville, Florida, United States of America
| | - Lillian Morris
- Emerging Pathogens Institute, University of Florida, Gainesville, Florida, United States of America
- Spatial Epidemiology and Ecology Research Laboratory, Department of Geography, College of Liberal Arts and Sciences, University of Florida, Gainesville, Florida, United States of America
| | - Jason K. Blackburn
- Emerging Pathogens Institute, University of Florida, Gainesville, Florida, United States of America
- Spatial Epidemiology and Ecology Research Laboratory, Department of Geography, College of Liberal Arts and Sciences, University of Florida, Gainesville, Florida, United States of America
| | - Leonard M. Mbam
- World Health Organization country office for The Republic of Cameroon, Yaoundé, Republic of Cameroon
| | - Simon Franky Baonga Ba Pouth
- Cellule de Supervision, Suivi et Evaluation, Délégation Régionale de la Santé Publique du Centre, Yaoundé, Cameroun
| | - Andrew Teboh
- Field Epidemiology and Laboratory Training Program, University of Yaoundé, Yaoundé, Republic of Cameroon
| | - Yang Yang
- Emerging Pathogens Institute, University of Florida, Gainesville, Florida, United States of America
- Department of Biostatistics, College of Public Health and Health Professions, University of Florida, Gainesville, Florida, United States of America
| | - Mouhaman Arabi
- Higher Institute of the Sahel, University of Maroua, Maroua, Republic of Cameroon
| | - Jonathan D. Sugimoto
- Center for Inference and Dynamics of Infectious Diseases and Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle Washington, United States of America
| | - John Glenn Morris
- Emerging Pathogens Institute, University of Florida, Gainesville, Florida, United States of America
- Department of Medicine, College of Medicine, University of Florida, Gainesville, Florida, United States of America
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Wang A, Hardy C, Rajasingham A, Martinsen A, Templin L, Kamwaga S, Sebunya K, Jhuthi B, Habtu M, Kiberiti S, Massa K, Quick R, Mulungu J, Eidex R, Handzel T. Notes from the Field: Chlorination Strategies for Drinking Water During a Cholera Epidemic — Tanzania, 2016. MMWR-MORBIDITY AND MORTALITY WEEKLY REPORT 2016; 65:1150-1151. [DOI: 10.15585/mmwr.mm6541a6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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12
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Herzog C. Successful comeback of the single-dose live oral cholera vaccine CVD 103-HgR. Travel Med Infect Dis 2016; 14:373-7. [DOI: 10.1016/j.tmaid.2016.07.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 07/07/2016] [Accepted: 07/08/2016] [Indexed: 02/05/2023]
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Abstract
Mass-gathering (MG) events pose challenges to the most adept of public health practitioners in ensuring the health safety of the population. These MGs can be for sporting events, musical festivals, or more commonly, have religious undertones. The Kumbh Mela 2013 at Allahabad, India may have been the largest gathering of humanity in history with nearly 120 million pilgrims having thronged the venue. The scale of the event posed a challenge to the maintenance of public health security and safety. A snapshot of the experience of managing the hygiene and sanitation aspects of this mega event is presented herein, highlighting the importance of proactive public health planning and preparedness. There having been no outbreaks of disease is vindication of the steps undertaken in planning and preparedness, notwithstanding obvious limitations of unsanitary behaviors and traditional beliefs of those attending the festival. The evident flaw on post-event analyses was the failure to cater adequately for environmental mopping-up operations after the festival. Besides, a system of real-time monitoring of disease and morbidity patterns, harnessing low cost technology alternatives, should be planned for at all such future events.
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Incidence of severe diarrhoea due to Vibrio cholerae in the catchment area of six surveillance hospitals in Bangladesh. Epidemiol Infect 2015; 144:927-39. [PMID: 26391481 DOI: 10.1017/s0950268815002174] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Cholera is an important public health problem in Bangladesh. Interventions to prevent cholera depend on their cost-effectiveness which in turn depends on cholera incidence. Hospital-based diarrhoeal disease surveillance has been ongoing in six Bangladeshi hospitals where a systematic proportion of patients admitted with diarrhoea were enrolled and tested for Vibrio cholerae. However, incidence calculation using only hospital data underestimates the real disease burden because many ill persons seek treatment elsewhere. We conducted a healthcare utilization survey in the catchment areas of surveillance hospitals to estimate the proportion of severe diarrhoeal cases that were admitted to surveillance hospitals and estimated the population-based incidence of severe diarrhoea due to V. cholerae by combining both hospital surveillance and catchment area survey data. The estimated incidence of severe diarrhoea due to cholera ranged from 0.3 to 4.9/1000 population in the catchment area of surveillance hospitals. In children aged <5 years, incidence ranged from 1.0 to 11.0/1000 children. Diarrhoeal deaths were most common in the Chhatak Hospital's catchment area (18.5/100 000 population). This study provides a credible estimate of the incidence of severe diarrhoea due to cholera in Bangladesh, which can be used to assess the cost-effectiveness of cholera prevention activities.
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Dzotsi EK, Dongdem AZ, Boateng G, Antwi L, Owusu-Okyere G, Nartey DB, Olu-Taiwo M, Adjabeng MJ, Amankwa J, Sarkodie B, Addo J, Antwi E, Aryee E, Opintan JA. Surveillance of Bacterial Pathogens of Diarrhoea in Two Selected Sub Metros Within the Accra Metropolis. Ghana Med J 2015; 49:65-71. [PMID: 26339088 DOI: 10.4314/gmj.v49i2.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND In recent years, many localities within the Greater Accra Region (GAR) have witnessed several episodes of cholera outbreaks, with some deaths. Compared to previous epidemics, which usually followed heavy rains, recent outbreaks show no seasonality. OBJECTIVES To investigate infective bacterial diseases in selected sub metros within the GAR. METHODS We used existing disease surveillance systems in Ghana, and investigated all reported cases of diarrhoea that met our case-definition. A three-day training workshop was done prior to the start of study, to sensitize prescribers at the Korle-Bu Polyclinic and Maamobi General hospital. A case-based investigation form was completed per patient, and two rectal swabs were taken for culture at the National Public Health and Reference Laboratory. Serotyping and antibiogram profiles of identified bacteria were determined. Potential risk factors were also assessed using a questionnaire. RESULTS Between January and June 2012, a total of 361 diarrhoeal cases with 5 deaths were recorded. Out of a total of 218 rectal swabs cultured, 71 (32.6%) Vibrio cholerae O1 Ogawa serotypes, and 1 (0.5%) Salmonella (O group B) were laboratory confirmed. No Shigella was isolated. The Vibrio cholerae isolates were susceptible to ciprofloxacin and tetracycline. Greater than 80% of patients reported having drank sachet water 24 h prior to diarrhoea onset, and many (144/361) young adults (20-29 years) reported with diarrhoea. CONCLUSION Enhanced surveillance of diarrhoeal diseases (enteric pathogens) within cholera endemic regions, will serve as an early warning signal, and reduce fatalities associated with infective diarrhoea.
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Affiliation(s)
- E K Dzotsi
- Disease Surveillance Department, Ghana Health Service, Accra Ghana
| | - A Z Dongdem
- National Public Health and Reference Laboratory
| | - G Boateng
- National Public Health and Reference Laboratory
| | - L Antwi
- National Public Health and Reference Laboratory
| | | | - D B Nartey
- National Public Health and Reference Laboratory
| | - M Olu-Taiwo
- Department of Microbiology, University of Ghana Medical School, P. O. Box 4236, Accra, Ghana
| | - M J Adjabeng
- Disease Surveillance Department, Ghana Health Service, Accra Ghana
| | - J Amankwa
- Disease Surveillance Department, Ghana Health Service, Accra Ghana
| | - B Sarkodie
- Disease Surveillance Department, Ghana Health Service, Accra Ghana
| | - J Addo
- Disease Surveillance Department, Ghana Health Service, Accra Ghana
| | - E Antwi
- Greater Accra Regional Health Directorate, Ghana Health Service, Accra, Ghana
| | - E Aryee
- National Public Health and Reference Laboratory
| | - J A Opintan
- Department of Microbiology, University of Ghana Medical School, P. O. Box 4236, Accra, Ghana
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Bengtsson L, Gaudart J, Lu X, Moore S, Wetter E, Sallah K, Rebaudet S, Piarroux R. Using mobile phone data to predict the spatial spread of cholera. Sci Rep 2015; 5:8923. [PMID: 25747871 PMCID: PMC4352843 DOI: 10.1038/srep08923] [Citation(s) in RCA: 121] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Accepted: 02/10/2015] [Indexed: 02/08/2023] Open
Abstract
Effective response to infectious disease epidemics requires focused control measures in areas predicted to be at high risk of new outbreaks. We aimed to test whether mobile operator data could predict the early spatial evolution of the 2010 Haiti cholera epidemic. Daily case data were analysed for 78 study areas from October 16 to December 16, 2010. Movements of 2.9 million anonymous mobile phone SIM cards were used to create a national mobility network. Two gravity models of population mobility were implemented for comparison. Both were optimized based on the complete retrospective epidemic data, available only after the end of the epidemic spread. Risk of an area experiencing an outbreak within seven days showed strong dose-response relationship with the mobile phone-based infectious pressure estimates. The mobile phone-based model performed better (AUC 0.79) than the retrospectively optimized gravity models (AUC 0.66 and 0.74, respectively). Infectious pressure at outbreak onset was significantly correlated with reported cholera cases during the first ten days of the epidemic (p < 0.05). Mobile operator data is a highly promising data source for improving preparedness and response efforts during cholera outbreaks. Findings may be particularly important for containment efforts of emerging infectious diseases, including high-mortality influenza strains.
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Affiliation(s)
- Linus Bengtsson
- 1] Department of Public Health Sciences. Karolinska Institutet, Stockholm, Sweden [2] Flowminder Foundation, Stockholm, Sweden
| | - Jean Gaudart
- Aix-Marseille University, UMR 912 SESSTIM (INSERM-IRD-AMU), Marseille, France
| | - Xin Lu
- 1] College of Information System and Management, National University of Defence Technology, Changsha, China [2] Department of Public Health Sciences. Karolinska Institutet, Stockholm, Sweden [3] Flowminder Foundation, Stockholm, Sweden
| | - Sandra Moore
- Aix-Marseille University, UMR MD 3, Marseille, France
| | - Erik Wetter
- 1] Flowminder Foundation, Stockholm, Sweden [2] Stockholm School of Economics, Stockholm, Sweden
| | - Kankoe Sallah
- Aix-Marseille University, UMR 912 SESSTIM (INSERM-IRD-AMU), Marseille, France
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Kabir S. Critical analysis of compositions and protective efficacies of oral killed cholera vaccines. CLINICAL AND VACCINE IMMUNOLOGY : CVI 2014; 21:1195-205. [PMID: 25056361 PMCID: PMC4178583 DOI: 10.1128/cvi.00378-14] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Two cholera vaccines, sold as Shanchol and Dukoral, are currently available. This review presents a critical analysis of the protective efficacies of these vaccines. Children under 5 years of age are very vulnerable to cholera and account for the highest incidence of cholera cases and more than half of the resulting deaths. Both Shanchol and Dukoral are two-spaced-dose oral vaccines comprising large numbers of killed cholera bacteria. The former contains Vibrio cholerae O1 and O139 cells, and the latter contains V. cholerae O1 cells with the recombinant B subunit of cholera toxin. In a field trial in Kolkata (India), Shanchol, the preferred vaccine, protected 45% of the test subjects in all of the age groups and only 17% of the children under 5 years of age during the first year of surveillance. In a field trial in Peru, two spaced doses of Dukoral offered negative protection in children under 5 years of age and little protection (15%) in vaccinees over 6 years of age during the first year of surveillance. Little is known about Dukoral's long-term protective efficacy. Both of these vaccines have questionable compositions, using V. cholerae O1 strains isolated in 1947 that have been inactivated by heat and formalin treatments that may denature protein. Immunological studies revealed Dukoral's reduced and short-lived efficacy, as measured by several immunological endpoints. Various factors, such as the necessity for multiple doses, poor protection of children under 5 years of age, the requirement of a cold supply chain, production costs, and complex logistics of vaccine delivery, greatly reduce the suitability of either of these vaccines for endemic or epidemic cholera control in resource-poor settings.
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Affiliation(s)
- Shahjahan Kabir
- Academic Research and Information Management, Uppsala, Sweden
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18
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Widmer JM, Weppelmann TA, Alam MT, Morrissey BD, Redden E, Rashid MH, Diamond U, Ali A, De Rochars MB, Blackburn JK, Johnson JA, Morris JG. Water-related infrastructure in a region of post-earthquake Haiti: high levels of fecal contamination and need for ongoing monitoring. Am J Trop Med Hyg 2014; 91:790-797. [PMID: 25071005 PMCID: PMC4183406 DOI: 10.4269/ajtmh.14-0165] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
We inventoried non-surface water sources in the Leogane and Gressier region of Haiti (approximately 270 km2) in 2012 and 2013 and screened water from 345 sites for fecal coliforms and Vibrio cholerae. An international organization/non-governmental organization responsible for construction could be identified for only 56% of water points evaluated. Sixteen percent of water points were non-functional at any given time; 37% had evidence of fecal contamination, with spatial clustering of contaminated sites. Among improved water sources (76% of sites), 24.6% had fecal coliforms versus 80.9% in unimproved sources. Fecal contamination levels increased significantly from 36% to 51% immediately after the passage of Tropical Storm Sandy in October of 2012, with a return to 34% contamination in March of 2013. Long-term sustainability of potable water delivery at a regional scale requires ongoing assessment of water quality, functionality, and development of community-based management schemes supported by a national plan for the management of potable water.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - J. Glenn Morris
- *Address correspondence to J. Glenn Morris Jr., Emerging Pathogens Institute, University of Florida, 2055 Mowry Road, PO Box 100009, Gainesville, FL 32610. E-mail:
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Affiliation(s)
- Anne Schuchat
- Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
- Correspondence to: Dr Anne Schuchat, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Mailstop A-27, 1600 Clifton Rd, NE, Atlanta, GA 30333, USA
| | - Jordan Tappero
- Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - John Blandford
- Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
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20
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Cholera in the United States, 2001-2011: a reflection of patterns of global epidemiology and travel. Epidemiol Infect 2014; 143:695-703. [PMID: 24865664 DOI: 10.1017/s0950268814001186] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
US cholera surveillance offers insight into global and domestic trends. Between 2001 and 2011, 111 cases were reported to the Centers for Disease Control and Prevention. Cholera was associated with international travel in 90 (81%) patients and was domestically acquired in 20 (18%) patients; for one patient, information was not available. From January 2001 to October 2010, the 42 (47%) travel-associated cases were associated with travel to Asia. In October 2010, a cholera epidemic started in Haiti, soon spreading to the Dominican Republic (Hispaniola). From then to December 2011, 40 (83%) of the 48 travel-associated cases were associated with travel to Hispaniola. Of 20 patients who acquired cholera domestically, 17 (85%) reported seafood consumption; 10 (59%) ate seafood from the US Gulf Coast. In summary, an increase in travel-associated US cholera cases was associated with epidemic cholera in Hispaniola in 2010-2011. Travel to Asia and consumption of Gulf Coast seafood remained important sources of US cholera cases.
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Pullan RL, Freeman MC, Gething PW, Brooker SJ. Geographical inequalities in use of improved drinking water supply and sanitation across Sub-Saharan Africa: mapping and spatial analysis of cross-sectional survey data. PLoS Med 2014; 11:e1001626. [PMID: 24714528 PMCID: PMC3979660 DOI: 10.1371/journal.pmed.1001626] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Accepted: 02/27/2014] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Understanding geographic inequalities in coverage of drinking-water supply and sanitation (WSS) will help track progress towards universal coverage of water and sanitation by identifying marginalized populations, thus helping to control a large number of infectious diseases. This paper uses household survey data to develop comprehensive maps of WSS coverage at high spatial resolution for sub-Saharan Africa (SSA). Analysis is extended to investigate geographic heterogeneity and relative geographic inequality within countries. METHODS AND FINDINGS Cluster-level data on household reported use of improved drinking-water supply, sanitation, and open defecation were abstracted from 138 national surveys undertaken from 1991-2012 in 41 countries. Spatially explicit logistic regression models were developed and fitted within a Bayesian framework, and used to predict coverage at the second administrative level (admin2, e.g., district) across SSA for 2012. Results reveal substantial geographical inequalities in predicted use of water and sanitation that exceed urban-rural disparities. The average range in coverage seen between admin2 within countries was 55% for improved drinking water, 54% for use of improved sanitation, and 59% for dependence upon open defecation. There was also some evidence that countries with higher levels of inequality relative to coverage in use of an improved drinking-water source also experienced higher levels of inequality in use of improved sanitation (rural populations r = 0.47, p = 0.002; urban populations r = 0.39, p = 0.01). Results are limited by the quantity of WSS data available, which varies considerably by country, and by the reliability and utility of available indicators. CONCLUSIONS This study identifies important geographic inequalities in use of WSS previously hidden within national statistics, confirming the necessity for targeted policies and metrics that reach the most marginalized populations. The presented maps and analysis approach can provide a mechanism for monitoring future reductions in inequality within countries, reflecting priorities of the post-2015 development agenda. Please see later in the article for the Editors' Summary.
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Affiliation(s)
- Rachel L. Pullan
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Matthew C. Freeman
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Peter W. Gething
- Spatial Ecology and Epidemiology Group, Department of Zoology, University of Oxford, Oxford, United Kingdom
| | - Simon J. Brooker
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
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Valcin CL, Severe K, Riche CT, Anglade BS, Moise CG, Woodworth M, Charles M, Li Z, Joseph P, Pape JW, Wright PF. Predictors of disease severity in patients admitted to a cholera treatment center in urban Haiti. Am J Trop Med Hyg 2013; 89:625-632. [PMID: 24106188 PMCID: PMC3795091 DOI: 10.4269/ajtmh.13-0170] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Cholera, previously unrecognized in Haiti, spread through the country in the fall of 2010. An analysis was performed to understand the epidemiological characteristics, clinical management, and risk factors for disease severity in a population seen at the GHESKIO Cholera Treatment Center in Port-au-Prince. A comprehensive review of the medical records of patients admitted during the period of October 28, 2010–July 10, 2011 was conducted. Disease severity on admission was directly correlated with older age, more prolonged length of stay, and presentation during the two epidemic waves seen in the observation period. Although there was a high seroprevalence of human immunodeficiency virus (HIV), severity of cholera was not greater with HIV infection. This study documents the correlation of cholera waves with rainfall and its reduction in settings with improved sanitary conditions and potable water when newly introduced cholera affects all ages equally so that interventions must be directed throughout the population.
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Affiliation(s)
- Claude-Lyne Valcin
- *Address correspondence to Claude-Lyne Valcin, Dartmouth Medical School, Division of Infectious Diseases and International Health, 1 Medical Center Drive, Lebanon, NH 03756. E-mail:
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Rouzier V, Severe K, Juste MAJ, Peck M, Perodin C, Severe P, Deschamps MM, Verdier RI, Prince S, Francois J, Cadet JR, Guillaume FD, Wright PF, Pape JW. Cholera vaccination in urban Haiti. Am J Trop Med Hyg 2013; 89:671-681. [PMID: 24106194 PMCID: PMC3795097 DOI: 10.4269/ajtmh.13-0171] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Successful and sustained efforts have been made to curtail the major cholera epidemic that occurred in Haiti in 2010 with the promotion of hygiene and sanitation measures, training of health personnel and establishment of treatment centers nationwide. Oral cholera vaccine (OCV) was introduced by the Haitian Ministry of Health as a pilot project in urban and rural areas. This paper reports the successful OCV pilot project led by GHESKIO Centers in the urban slums of Port-au-Prince where 52,357 persons received dose 1 and 90.8% received dose 2; estimated coverage of the at-risk community was 75%. This pilot study demonstrated the effort, community mobilization, and organizational capacity necessary to achieve these results in a challenging setting. The OCV intervention paved the way for the recent launching of a national cholera vaccination program integrated in a long-term ambitious and comprehensive plan to address Haiti's critical need in water security and sanitation.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | - Jean W. Pape
- *Address correspondence to Jean W. Pape, Division of Infectious Diseases, Weill Cornell Medical College, New York, NY 10065. E-mail:
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Chun-Hai Fung I, Fitter DL, Borse RH, Meltzer MI, Tappero JW. Modeling the effect of water, sanitation, and hygiene and oral cholera vaccine implementation in Haiti. Am J Trop Med Hyg 2013; 89:633-640. [PMID: 24106189 PMCID: PMC3795092 DOI: 10.4269/ajtmh.13-0201] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2013] [Accepted: 07/31/2013] [Indexed: 11/07/2022] Open
Abstract
In 2010, toxigenic Vibrio cholerae was newly introduced to Haiti. Because resources are limited, decision-makers need to understand the effect of different preventive interventions. We built a static model to estimate the potential number of cholera cases averted through improvements in coverage in water, sanitation and hygiene (WASH) (i.e., latrines, point-of-use chlorination, and piped water), oral cholera vaccine (OCV), or a combination of both. We allowed indirect effects and non-linear relationships between effect and population coverage. Because there are limited incidence data for endemic cholera in Haiti, we estimated the incidence of cholera over 20 years in Haiti by using data from Malawi. Over the next two decades, scalable WASH interventions could avert 57,949-78,567 cholera cases, OCV could avert 38,569-77,636 cases, and interventions that combined WASH and OCV could avert 71,586-88,974 cases. Rate of implementation is the most influential variable, and combined approaches maximized the effect.
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Affiliation(s)
- Isaac Chun-Hai Fung
- National Center for Emerging and Zoonotic Infectious Diseases, and Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - David L. Fitter
- National Center for Emerging and Zoonotic Infectious Diseases, and Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | - Jordan W. Tappero
- National Center for Emerging and Zoonotic Infectious Diseases, and Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia
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