Recent Cholera Publications on PubMed

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[Study on infectious diseases in Guizhou during the Republic of China].

August 22, 2019
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[Study on infectious diseases in Guizhou during the Republic of China].

Zhonghua Yi Shi Za Zhi. 2019 Mar 28;49(2):83-88

Authors: Gao XC, Hu AH

Abstract
There are many infectious diseases in Guizhou Province during the Republican period, including cholera, smallpox, typhoid, typhus, dysentery, scarlet fever, diphtheria, epidemic cerebrospinal meningitis, recurrent fever, malaria, trachoma, acute conjunctivitis, skin diseases, venereal diseases, leprosy and so on. Natural and social factors together led to the prevalence of infectious diseases during that period. For example, natural factors mainly include Guizhou province's special geographical condition and its frequent flood disasters, and social factors such as the unhealthy lifestyle and low medical level have also caused bad effects. In general, infectious diseases during the Republican period have resulted in a large number of mortalities and great financial losses, hindering the development of Guizhou economic society at that time.

PMID: 31137156 [PubMed - indexed for MEDLINE]

Diagnostic techniques for rapid detection of Vibrio cholerae O1/O139.

August 21, 2019
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Diagnostic techniques for rapid detection of Vibrio cholerae O1/O139.

Vaccine. 2019 Aug 16;:

Authors: Ramamurthy T, Das B, Chakraborty S, Mukhopadhyay AK, Sack DA

Abstract
Cholera caused by the toxigenic Vibrio cholerae is still a major public health problem in many countries. This disease is mainly due to poor sanitation, hygiene and consumption of unsafe water. Several recent epidemics of cholera showed its increasing intensity, duration and severity of the illness. This indicates an urgent need for effective management and preventive measures in controlling the outbreaks and epidemics. In preventing and spread of epidemic cholera, rapid diagnostic tests (RDTs) are useful in screening suspected stool specimens, water/food samples. Several RDTs developed recently are considered as investigative tools in confirming cholera cases, as the culture techniques are difficult to establish and/or maintain. The usefulness of RDTs will be more at the point-of-care facilities as it helps to make appropriate decisions in the management of outbreaks or epidemiological surveillance by the public health authorities. Apart from RDTs, several other tests are available for the direct detection of either V. cholerae or its cholera toxin. Viable but non-culturable (VBNC) state of V. cholerae poses a great challenge in developing RDTs. The aim of this article is to provide an overview of current knowledge about RDT and other techniques with reference to their status and future potentials in detecting cholera/V. cholerae.

PMID: 31427135 [PubMed - as supplied by publisher]

Low case fatality during 2017 cholera outbreak in Borno State, North Eastern Nigeria.

August 21, 2019
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Low case fatality during 2017 cholera outbreak in Borno State, North Eastern Nigeria.

Ann Afr Med. 2018 Oct-Dec;17(4):203-209

Authors: Denue BA, Akawu CB, Kwayabura SA, Kida I

Abstract
Background: Cholera is endemic in sub-Saharan Africa, especially in areas affected by natural disaster and human conflict. Northeastern Nigeria is experiencing a health crisis due to the destruction of essential amenities such as health infrastructure, sanitation facilities, water supplies, and human resources by Boko Haram insurgents. In 2017, a cholera outbreak occurred in five local government areas (LGAs) hosting internally displaced persons. The Nigeria Center for Disease Control, World Health Organization, Mĕdecins Sans Frontiĕres International, and several other organizations supported disease containment. An emergency operating center (EOC) established by the State Ministry of Health (SMoH) then coordinated the outbreak response.
Methods: We conducted a retrospective analysis of data extracted from the line list utilized by the SMoH to investigate outbreaks. We evaluated the outbreak by time, place, and person. Attack rate by LGA and age-specific case fatality rate (CFR) was calculated based on cases with complete records for age, sex, place of residence, date of symptom onset, and disease outcome.
Results: A total of 5889 cholera cases were reported from five LGAs with an overall attack rate of 395.3/100,000 population. Among 4956 cases with documented outcome, the overall CFR was 0.87%, with CFR ranging from 0% to 6.98% by LGA. The age-specific CFR was highest among those aged ≥60 years (1.92%) and least among those aged 20-29 years at 0.3%. The epidemiological curve revealed two peaks that coincided with periods of heavy rain and flooding.
Conclusion: This study reports on the largest ever documented cholera outbreak in five LGAs in Borno State. The outbreak was focused in LGA hit hardest by the destructive activities of insurgents and then spread to neighboring LGAs. The low CFR recorded in this cholera outbreak was achieved through timely detection, reporting, and response by the coordinated efforts of the EOC established by the SMoH that harmonized the outbreak response.

PMID: 30588934 [PubMed - indexed for MEDLINE]

Yemen in a Time of Cholera: Current Situation and Challenges.

August 20, 2019
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Yemen in a Time of Cholera: Current Situation and Challenges.

Am J Trop Med Hyg. 2018 06;98(6):1558-1562

Authors: Al-Mekhlafi HM

Abstract
Since early 2015, Yemen has been in the throes of a grueling civil war, which has devastated the health system and public services, and created one of the world's worst humanitarian disasters. The country is currently facing a cholera epidemic the world's largest on record, surpassing one million (1,061,548) suspected cases, with 2,373 related deaths since October 2016. Cases were first confirmed in Sana'a city and then spread to almost all governorates except Socotra Island. Continued efforts are being made by the World Health Organization and international partners to contain the epidemic through improving water, sanitation and hygiene, setting up diarrhea treatment centers, and improving the population's awareness about the disease. The provision of clean water and adequate sanitation is imperative as an effective long-term solution to prevent the further spread of this epidemic. Cholera vaccination campaigns should also be conducted as a preventive measure.

PMID: 29557331 [PubMed - indexed for MEDLINE]

Emerging/re-emerging viral diseases & new viruses on the Indian horizon.

August 15, 2019
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Emerging/re-emerging viral diseases & new viruses on the Indian horizon.

Indian J Med Res. 2019 Apr;149(4):447-467

Authors: Mourya DT, Yadav PD, Ullas PT, Bhardwaj SD, Sahay RR, Chadha MS, Shete AM, Jadhav S, Gupta N, Gangakhedkar RR, Khasnobis P, Singh SK

Abstract
Infectious diseases remain as the major causes of human and animal morbidity and mortality leading to significant healthcare expenditure in India. The country has experienced the outbreaks and epidemics of many infectious diseases. However, enormous successes have been obtained against the control of major epidemic diseases, such as malaria, plague, leprosy and cholera, in the past. The country's vast terrains of extreme geo-climatic differences and uneven population distribution present unique patterns of distribution of viral diseases. Dynamic interplays of biological, socio-cultural and ecological factors, together with novel aspects of human-animal interphase, pose additional challenges with respect to the emergence of infectious diseases. The important challenges faced in the control and prevention of emerging and re-emerging infectious diseases range from understanding the impact of factors that are necessary for the emergence, to development of strengthened surveillance systems that can mitigate human suffering and death. In this article, the major emerging and re-emerging viral infections of public health importance have been reviewed that have already been included in the Integrated Disease Surveillance Programme.

PMID: 31411169 [PubMed - in process]

Responding to epidemics in large-scale humanitarian crises: a case study of the cholera response in Yemen, 2016-2018.

August 14, 2019

Responding to epidemics in large-scale humanitarian crises: a case study of the cholera response in Yemen, 2016-2018.

BMJ Glob Health. 2019;4(4):e001709

Authors: Spiegel P, Ratnayake R, Hellman N, Ververs M, Ngwa M, Wise PH, Lantagne D

Abstract
Background: Large epidemics frequently emerge in conflict-affected states. We examined the cholera response during the humanitarian crisis in Yemen to inform control strategies.
Methods: We conducted interviews with practitioners and advisors on preparedness; surveillance; laboratory; case management; malnutrition; water, sanitation and hygiene (WASH); vaccination; coordination and insecurity. We undertook a literature review of global and Yemen-specific cholera guidance, examined surveillance data from the first and second waves (28 September 2016-12 March 2018) and reviewed reports on airstrikes on water systems and health facilities (April 2015-December 2017). We used the Global Task Force on Cholera Control's framework to examine intervention strategies and thematic analysis to understand decision making.
Results: Yemen is water scarce, and repeated airstrikes damaged water systems, risking widespread infection. Since a cholera preparedness and response plan was absent, on detection, the humanitarian cluster system rapidly developed response plans. The initial plans did not prioritise key actions including community-directed WASH to reduce transmission, epidemiological analysis and laboratory monitoring. Coordination was not harmonised across the crisis-focused clusters and epidemic-focused incident management system. The health strategy was crisis focused and was centralised on functional health facilities, underemphasising less accessible areas. As vaccination was not incorporated into preparedness, consensus on its use remained slow. At the second wave peak, key actions including data management, community-directed WASH and oral rehydration and vaccination were scaled-up.
Conclusion: Despite endemicity and conflict, Yemen was not prepared for the epidemic. To contain outbreaks, conflict-affected states, humanitarian agencies, and donors must emphasise preparedness planning and community-directed responses.

PMID: 31406596 [PubMed]

A cholera outbreak caused by drinking contaminated river water, Bulambuli District, Eastern Uganda, March 2016.

August 14, 2019
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A cholera outbreak caused by drinking contaminated river water, Bulambuli District, Eastern Uganda, March 2016.

BMC Infect Dis. 2019 Jun 11;19(1):516

Authors: Okello PE, Bulage L, Riolexus AA, Kadobera D, Kwesiga B, Kajumbula H, Mulongo M, Namboozo EJ, Pimundu G, Ssewanyana I, Kiyaga C, Aisu S, Zhu BP

Abstract
BACKGROUND: A cholera outbreak started on 29 February in Bwikhonge Sub-county, Bulambuli District in Eastern Uganda. Local public health authorities implemented initial control measures. However, in late March, cases sharply increased in Bwikhonge Sub-county. We investigated the outbreak to determine its scope and mode of transmission, and to inform control measures.
METHODS: We defined a suspected case as sudden onset of watery diarrhea from 1 March 2016 onwards in a resident of Bulambuli District. A confirmed case was a suspected case with positive stool culture for V. cholerae. We conducted descriptive epidemiologic analysis of the cases to inform the hypothesis on mode of transmission. To test the hypothesis, we conducted a case-control study involving 100 suspected case-patients and 100 asymptomatic controls, individually-matched by residence village and age. We collected seven water samples for laboratory testing.
RESULTS: We identified 108 suspected cases (attack rate: 1.3%, 108/8404), including 7 confirmed cases. The case-control study revealed that 78% (78/100) of case-patients compared with 51% (51/100) of control-persons usually collected drinking water from the nearby Cheptui River (ORMH = 7.8, 95% CI = 2.7-22); conversely, 35% (35/100) of case-patients compared with 54% (54/100) of control-persons usually collected drinking water from borehole pumps (ORMH = 0.31, 95% CI = 0.13-0.65). The index case in Bwikhonge Sub-county had onset on 29 February but the outbreak had been on-going in the neighbouring sub-counties in the previous 3 months. V. cholera was isolated in 2 of the 7 river water samples collected from different locations.
CONCLUSIONS: We concluded that this cholera outbreak was caused by drinking contaminated water from Cheptui River. We recommended boiling and/or treating drinking water, improved sanitation, distribution of chlorine tablets to the affected villages, and as a long-term solution, construction of more borehole pumps. After implementing preventive measures, the number of cases declined and completely stopped after 6th April.

PMID: 31185939 [PubMed - indexed for MEDLINE]

Revisiting the Global Epidemiology of Cholera in Conjuction With the Genomics of Vibrio cholerae.

August 10, 2019
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Revisiting the Global Epidemiology of Cholera in Conjuction With the Genomics of Vibrio cholerae.

Front Public Health. 2019;7:203

Authors: Ramamurthy T, Mutreja A, Weill FX, Das B, Ghosh A, Nair GB

Abstract
Toxigenic Vibrio cholerae is responsible for 1.4 to 4.3 million cases with about 21,000-143,000 deaths per year. Dominance of O1 and O139 serogroups, classical and El tor biotypes, alterations in CTX phages and the pathogenicity Islands are some of the major features of V. cholerae isolates that are responsible for cholera epidemics. Whole-genome sequencing (WGS) based analyses of single-nucleotide polymorphisms (SNPs) and other infrequent genetic variants provide a robust phylogenetic framework. Recent studies on the global transmission of pandemic V. cholerae O1 strains have shown the existence of eight different phyletic lineages. In these, the classical and El Tor biotype strains were separated as two distinctly evolved lineages. The frequency of SNP accumulation and the temporal and geographical distribution supports the perception that the seventh cholera pandemic (7CP) has spread from the Bay of Bengal region in three independent but overlapping waves. The 2010 Haitian outbreak shared a common ancestor with South-Asian wave-3 strains. In West Africa and East/Southern Africa, cholera epidemics are caused by single expanded lineage, which has been introduced several times since 1970. The Latin American epidemics that occurred in 1991 and 2010 were the result of introductions of two 7CP sublineages. Sublineages representing wave-3 have caused huge outbreaks in Haiti and Yemen. The Ogawa-Inaba serotype switchover in several cholera epidemics are believed to be due to the involvement of certain selection mechanism(s) rather than due to random events. V. cholerae O139 serogroup is phylogenetically related to the 7CP El Tor, and almost all these isolates belonged to the multilocus sequence type-69. Additional phenotypic and genotypic information have been generated to understand the pathogenicity of classical and El Tor vibrios. Presence of integrative conjugative elements (ICE) with antibiotic resistance gene cassettes, clustered regularly interspaced short palindromic repeats-associated protein system and ctxAB promoter based ToxRS expression of cholera toxin (CT) separates classical and El Tor biotypes. With the availability of WGS information, several important applications including, molecular typing, antimicrobial resistance, new diagnostics, and vaccination strategies could be generated.

PMID: 31396501 [PubMed]

Epidemiology of cholera.

August 10, 2019
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Epidemiology of cholera.

Vaccine. 2019 Aug 05;:

Authors: Deen J, Mengel MA, Clemens JD

Abstract
Cholera is an ancient disease that remains a public health problem in many impoverished locations around the world. Seven pandemics of cholera have been recorded since the first pandemic in 1817, the last of which is on going. Overcrowding, poverty, insufficient water and sanitation facilities increase the risk for cholera outbreaks. The epidemiology of cholera in the areas in Asia, Africa and the Americas where the disease occurs continues to evolve.

PMID: 31395455 [PubMed - as supplied by publisher]

Randomization inference with general interference and censoring.

August 8, 2019
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Randomization inference with general interference and censoring.

Biometrics. 2019 Aug 07;:

Authors: Loh WW, Hudgens MG, Clemens JD, Ali M, Emch ME

Abstract
Interference occurs between individuals when the treatment (or exposure) of one individual affects the outcome of another individual. Previous work on causal inference methods in the presence of interference has focused on the setting where a priori it is assumed there is 'partial interference,' in the sense that individuals can be partitioned into groups wherein there is no interference between individuals in different groups. Bowers, Fredrickson, and Panagopoulos (2012) and Bowers, Fredrickson, and Aronow (2016) consider randomization-based inferential methods that allow for more general interference structures in the context of randomized experiments. In this paper, extensions of Bowers et al. which allow for failure time outcomes subject to right censoring are proposed. Permitting right censored outcomes is challenging because standard randomization-based tests of the null hypothesis of no treatment effect assume that whether an individual is censored does not depend on treatment. The proposed extension of Bowers et al. to allow for censoring entails adapting the method of Wang, Lagakos, and Gray (2010) for two sample survival comparisons in the presence of unequal censoring. The methods are examined via simulation studies and utilized to assess the effects of cholera vaccination in an individually-randomized trial of 73,000 children and women in Matlab, Bangladesh. This article is protected by copyright. All rights reserved.

PMID: 31388990 [PubMed - as supplied by publisher]

[Simplified Protocols for Cholera Diagnosis in the National Public Health Laboratory, Port-au-Prince, Haiti].

August 8, 2019
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[Simplified Protocols for Cholera Diagnosis in the National Public Health Laboratory, Port-au-Prince, Haiti].

Bull Soc Pathol Exot. 2018;111(3):156-160

Authors: Moise K, Henrys JH, Rebaudet S, Rossignol E, Boncy J, Raccurt C

Abstract
While the incidence of cholera is decreasing in Haiti, the time required to render stool culture results with antibiogram using the standard method practiced at the National Public Health Laboratory (LNSP) remains at an average of 80 hours. This delay can be further lengthened by the process of rendering the analysis reports to the sites of care which significantly delays the community responses to cholera. Through this study, we have aimed to assess the reliability of partial results. We have studied 250 stool samples that were analyzed between January and September 2017 at the LNSP by determining the specificity, positive predictive value and positive likelihood ratio of i) the identification of yellowish colonies and ii) the identification of yellowish colonies with a positive oxidase assay in comparison to the stool culture. Compared to the entire process, the identification of yellowish colonies showed a specificity of 56%, a positive predictive value of 69% and a positive likelihood ratio of 2.27. The identification of yellowish colonies with a positive oxidase assay showed a specificity of 77%, a positive predictive value of 81% and a positive likelihood ratio of 4.31. The communication of partial results at these steps would likely guide community interventions despite a relative decrease in reliability of the results.

PMID: 30793576 [PubMed - indexed for MEDLINE]

Emerging outbreaks associated with conflict and failing healthcare systems in the Middle East.

August 7, 2019
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Emerging outbreaks associated with conflict and failing healthcare systems in the Middle East.

Infect Control Hosp Epidemiol. 2018 10;39(10):1230-1236

Authors: Raad II, Chaftari AM, Dib RW, Graviss EA, Hachem R

Abstract
The escalating conflicts in the Middle East have been associated with the rapid collapse of the existing healthcare systems in affected countries. As millions of refugees flee their countries, they become vulnerable and exposed to communicable diseases that easily grow into epidemic crises. Here, we describe infectious disease epidemics that have been associated with conflicts in the Middle East, including cholera, poliomyelitis, measles, cutaneous leishmaniasis, and diphtheria, that call for appropriate preventive measures. Local ongoing wars and failing healthcare systems have resulted in regional and global health threats that warrant international medical interventions.

PMID: 30099975 [PubMed - indexed for MEDLINE]

Formative research for the design of a scalable mobile health program water, sanitation, and hygiene: CHoBI7 mobile health program.

August 2, 2019
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Formative research for the design of a scalable mobile health program water, sanitation, and hygiene: CHoBI7 mobile health program.

BMC Public Health. 2019 Jul 31;19(1):1028

Authors: George CM, Zohura F, Teman A, Thomas E, Hasan T, Rana S, Parvin T, Sack DA, Bhuyian SI, Labrique A, Masud J, Winch P, Leontsini E, Zeller K, Begum F, Khan AH, Tahmina S, Munum F, Monira S, Alam M

Abstract
BACKGROUND: The Cholera-Hospital-Based-Intervention-for-7-Days (CHoBI7) is a handwashing with soap and water treatment intervention program delivered by a health promoter bedside in a health facility and through home visits to diarrhea patients and their household members during the 7 days after admission to a health facility. In a randomized controlled trial among cholera patient households in Bangladesh, the 7-day CHoBI7 program resulted in a significant reduction in cholera among household members of cholera patients and sustained improvements in drinking water quality and handwashing with soap practices 12 months post-intervention. In an effort to take this intervention to scale across Bangladesh in partnership with the Bangladesh Ministry of Health and Family Welfare, this study evaluates the feasibility and acceptability of mobile health (mHealth) programs as a low-cost, scalable approach for CHoBI7 program delivery.
METHODS: Formative research for the development of the CHoBI7 mHealth intervention included 40 semi-structured interviews, 4 mHealth workshops, 2 group discussions, and a pilot study of 52 households to assess the feasibility and acceptability of the developed mHealth program. Thematic analysis of the interviews and group discussions was conducted by two individuals separately based on emergent themes, and then themes were compared and discussed.
RESULTS: A theory- and evidence-based approach using qualitative research methods was implemented to design the CHoBI7 mHealth program. Semi-structured interviews with government stakeholders identified perceptions and preferences for scaling the CHoBI7 mHealth program. Group discussions and semi-structured interviews with diarrhea patients and their family members identified beneficiary perceptions of mHealth and preferences for CHoBI7 mHealth program delivery. mHealth workshops were conducted as an interactive approach to draft and refine mobile message content based on stakeholder preferences. The pilot findings indicate that the CHoBI7 mHealth program has high user acceptability and is feasible to deliver to diarrhea patients that present at health facilities for treatment in Bangladesh. Both text and voice messages were recommended for program delivery. Dr. Chobi, the sender of mHealth messages, was viewed as a credible source of information that could be shared with others.
CONCLUSION: This study presents a theory- and evidence-based approach that can be implemented for the development of future water, sanitation, and hygiene mHealth programs in low-resource settings.

PMID: 31366398 [PubMed - in process]

Cholera outbreak by Sea Gypsies in Sabah, Malaysia: A challenge in North Borneo.

August 1, 2019
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Cholera outbreak by Sea Gypsies in Sabah, Malaysia: A challenge in North Borneo.

Int J Infect Dis. 2019 Jun;83:83-85

Authors: Jikal M, Riduan T, Aarifin R, Jeffree MS, Ahmed K

Abstract
OBJECTIVES: In this study we investigated an outbreak of Vibrio cholera O1 Ogawa serotype, occurred during December 2014 in Kudat district, situated in Sabah state of the Malaysian part of Borneo.
METHODS: Active case detection and contact tracing were done at respective localities by house to house survey. Passive case detection was done among acute gastroenteritis patients attended at various health facilities. To determine the source, samples from food, water and environment were taken. A case control study was also done to determine the risk factors.
RESULTS: A total of 44 symptomatic and 34 asymptomatic cases from 19 localities were investigated. 39 cases were detected through passive case detection. Median age of cases was 23 years. All cases belonged to serogroup O1 and Ogawa serotype. The epidemiological investigation of time, place, and person identified that V. cholerae cross-transmission might have occurred in two fish markets and the fish-loading port. Circumstantial evidences indicated that cholera was possibly transmitted through contaminated sea foods.
CONCLUSIONS: We concluded that the life-style of Sea Gypsies is a challenge in cholera control; therefore vaccination might be an effective way to mitigate cholera in an outbreak prone area like Kudat.

PMID: 30986543 [PubMed - indexed for MEDLINE]

In silico characteristics for re-emerging possibility of Vibrio cholerae genotypes in Iran.

July 31, 2019
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In silico characteristics for re-emerging possibility of Vibrio cholerae genotypes in Iran.

New Microbes New Infect. 2019 Sep;31:100577

Authors: Hajia M, Sohrabi A

Abstract
Epidemic cholera has been registered several times within recent years in Iran. The dominant genotype was Ogawa until 2011, but this gradually changed to Inaba. However, in 2015, the re-appearance of a previous Ogawa genotype was detected by the Iranian CDC. This raised worries because no evidence was found for its origin abroad. The aim of the present study was to identify clearly the source of this outbreak. Pulsed field gel electrophoresis (PFGE) was used to compare the recently detected Vibrio cholerae strains with those isolated from 2011 to 2015. We selected one strain per PFGE pattern, and compared the distinct patterns. BioNumerics software was applied, which enables interpretation of phenotypic and genotypic differences. In total, we studied 33 V. cholerae Ogawa strains. Analysis showed that strains could be discriminated on the basis of annual clusters but with a similarity of more than 80%. The highest homology was observed among those isolated each year from 2011 to 2014. In contrast, strains isolated in 2015 also exhibited close correlation with each other but were located in distinct clusters. The analysis also proved genetic variations among some strains. All 2015 strains showed differences with regard to previous genotypes despite some similarities. The new genotypes were probably imported into Iran from neighbouring countries such as Iraq by travellers or contaminated food sources since 2015. However, more investigations are required to identify the exact source of the 2015 outbreak.

PMID: 31360526 [PubMed]

The social biography of antibiotic use in smallholder dairy farms in India.

July 31, 2019
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The social biography of antibiotic use in smallholder dairy farms in India.

Antimicrob Resist Infect Control. 2018;7:60

Authors: Chauhan AS, George MS, Chatterjee P, Lindahl J, Grace D, Kakkar M

Abstract
Background: Antimicrobial resistance (AMR) has been identified as one of the major threats to global health, food security and development today. While there has been considerable attention about the use and misuse of antibiotics amongst human populations in both research and policy environments, there is no definitive estimate of the extent of misuse of antibiotics in the veterinary sector and its contribution to AMR in humans. In this study, we explored the drivers ofirrational usage of verterinary antibiotics in the dairy farming sector in peri-urban India.
Methods and materials: The study was conducted in the peri-urban belts of Ludhiana, Guwahati and Bangalore. A total of 54 interviews (formal and non-formal) were carried out across these three sites. Theme guides were developed to explore different drivers of veterinary antimicrobial use. Data was audio recorded and transcribed. Analysis of the coded data set was carried out using AtlasTi. Version 7. Themes emerged inductively from the set of codes.
Results: Findings were presented based on concept of 'levels of analyses'. Emergent themes were categorised as individual, health systems, and policy level drivers. Low level of knowledge related to antibiotics among farmers, active informal service providers, direct marketing of drugs to the farmers and easily available antibiotics, dispensed without appropriate prescriptions contributed to easy access to antibiotics, and were identified to be the possible drivers contributing to the non-prescribed and self-administered use of antibiotics in the dairy farms.
Conclusions: Smallholding dairy farmers operated within very small margins of profits. The paucity of formal veterinary services at the community level, coupled with easy availability of antibiotics and the need to ensure profits and minimise losses, promoted non-prescribed antibiotic consumption. It is essential that these local drivers of irrational antibiotic use are understood in order to develop interventions and policies that seek to reduce antibiotic misuse.

PMID: 29744041 [PubMed - indexed for MEDLINE]

Molecular epidemiology and intercontinental spread of cholera.

July 28, 2019
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Molecular epidemiology and intercontinental spread of cholera.

Vaccine. 2019 Jul 22;:

Authors: Mutreja A, Dougan G

Abstract
Whole genome sequence analysis has revealed the phylogenetic structure of Vibrio cholerae and has shown that the current seventh pandemic is highly clonal, emerging from a single source. Such analysis has the potential to become a powerful public health tool as we build public sequence databases, and as the speed of sequencing and analysis increases. Examples of such studies, as applied to different settings of the disease cholera, are described and discussed.

PMID: 31345641 [PubMed - as supplied by publisher]

Global dynamics of an age-structured cholera model with multiple transmissions, saturation incidence and imperfect vaccination.

July 28, 2019
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Global dynamics of an age-structured cholera model with multiple transmissions, saturation incidence and imperfect vaccination.

J Biol Dyn. 2019 12;13(1):69-102

Authors: Lin J, Xu R, Tian X

Abstract
In this paper, an age-structured cholera model with multiple transmissions, saturation incidence and imperfect vaccination is proposed. In the model, we consider both the infection age of infected individuals and the biological age of Vibrio cholerae in the aquatic environment. Asymptotic smoothness is verified as a necessary argument. By analysing the characteristic equations, the local stability of disease-free and endemic steady states is established. By using Lyapunov functionals and LaSalle's invariance principle, it is proved that the global dynamics of the model can be completely determined by basic reproduction number. The study of optimal control helps us seek cost-effective solutions of time-dependent vaccination strategy against cholera outbreaks. Numerical simulations are carried out to illustrate the corresponding theoretical results.

PMID: 30696390 [PubMed - indexed for MEDLINE]

Individual and household exposures associated with cholera transmission in case-control studies: a systematic review.

July 26, 2019
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Individual and household exposures associated with cholera transmission in case-control studies: a systematic review.

Trop Med Int Health. 2019 Jul 25;:

Authors: Phelps MD, Simonsen L, Jensen PKM

Abstract
OBJECTIVE: Uncertainty persists regarding cholera transmission routes. We conducted a structured review of case-control studies on cholera transmission and provide a qualitative summary of reported exposures in order to inform public health efforts and future cholera research.
METHODS: We searched two electronic databases for published case-control studies that investigated risk factors for cholera, and included any publications that did not match our exclusion criteria. From the included studies, we grouped exposures using two parameters, whether transmission domain was public or domestic, and also on the vehicle of transmission. We extracted data on study location, method of case and control inclusion, type of statistical analysis performed, and which exposures were included. Additionally, two parallel subgroup analyses were performed. The first included the subgroup of all studies that used culture-confirmed cholera cases, and the second included the subgroup of all studies employing a multivariate analysis. In the second analysis we calculated the population attributable risk (PAR).
RESULTS: Our search yielded 2347 peer reviewed publications, of which 65 did not match our exclusion criteria, comprising 69 individual studies. Water-based exposures were investigated in 97% of these studies, of which 70% found a significant association with cholera infection. Food-based exposures were investigated in 75% of studies, of which 63% found a significant association with risk of cholera infection. Close personal contact with cholera cases was investigated in 30% of studies, of which 52% found a significant association with risk of cholera infection. Hygiene-related exposures were investigated in 51% of studies, of which 63% found a significant association with cholera transmission. Among studies that examined at least one exposure related to the domestic domain, 76% found a significant association with cholera infection, vs. 71% of studies investigating at least one public domain exposure. The subgroup analyses produced similar results.
CONCLUSIONS: Despite strong evidence for cholera transmission via foodborne-, hygiene-, waterborne-, and close personal contact-related pathways in both domestic and public domains, we found that non-waterborne-related factors are understudied. Future cholera case-control studies would benefit from investigating all transmission vehicles and transmission domains. This article is protected by copyright. All rights reserved.

PMID: 31343805 [PubMed - as supplied by publisher]

A comparison of Lyse-It to other cellular sample preparation, bacterial lysing, and DNA fragmentation technologies.

July 24, 2019
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A comparison of Lyse-It to other cellular sample preparation, bacterial lysing, and DNA fragmentation technologies.

PLoS One. 2019;14(7):e0220102

Authors: Santaus TM, Li S, Saha L, Chen WH, Bhagat S, Stine OC, Geddes CD

Abstract
The ability for safe and rapid pathogenic sample transportation and subsequent detection is an increasing challenge throughout the world. Herein, we describe and use bead-beating, vortex, sonication, 903 protein saver cards, and Lyse-It methods, aiming to inactivate Gram-positive and -negative bacteria with subsequent genome DNA (quantitative Polymerase Chain Reaction) qPCR detection. The basic concepts behind the four chosen technologies is their versatility, cost, and ease of use in developed and underdeveloped countries. The four methods target the testing of bacterial resilience, cellular extraction from general and complex media and subsequent DNA extraction for qPCR detection and amplification. These results demonstrate that conventional high temperature heating, 903 protein saver cards, and Lyse-It are all viable options for inactivating bacterial growth for safe shipping. Additionally, Lyse-It was found to be particularly useful as this technology can inactivate bacteria, extract cells from 903 protein saver cards, lyse bacterial cells, and additionally keep genomic DNA viable for qPCR detection.

PMID: 31335892 [PubMed - in process]

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