Recent Cholera Publications on PubMed

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cholera epidemiology; +12 new citations

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cholera epidemiology

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A prospective cohort study comparing household contact and water Vibrio cholerae isolates in households of cholera patients in rural Bangladesh.

November 28, 2018
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A prospective cohort study comparing household contact and water Vibrio cholerae isolates in households of cholera patients in rural Bangladesh.

PLoS Negl Trop Dis. 2018 07;12(7):e0006641

Authors: George CM, Hasan K, Monira S, Rahman Z, Saif-Ur-Rahman KM, Rashid MU, Zohura F, Parvin T, Islam Bhuyian MS, Mahmud MT, Li S, Perin J, Morgan C, Mustafiz M, Sack RB, Sack DA, Stine OC, Alam M

Abstract
BACKGROUND: Household contacts of cholera patients are at a 100 times higher risk of developing cholera than the general population. The objective of this study was to examine the incidence of V. cholerae infections among household contacts of cholera patients in a rural setting in Bangladesh, to identify risk factors for V. cholerae infections among this population, and to investigate transmission pathways of V. cholerae using multilocus variable-number tandem-repeat analysis (MLVA).
METHODOLOGY/PRINCIPAL FINDINGS: Stool from household contacts, source water and stored water samples were collected from cholera patient households on Day 1, 3, 5, and 7 after the presentation of the index patient at a health facility. Two hundred thirty clinical and water V. cholerae isolates were analyzed by MLVA. Thirty seven percent of households had at least one household contact with a V. cholerae infection. Thirteen percent of households had V. cholerae in their water source, and 27% had V. cholerae in stored household drinking water. Household contacts with V. cholerae in their water source had a significantly higher odds of symptomatic cholera (Odds Ratio (OR): 5.49, 95% Confidence Interval (CI): 1.07, 28.08). Contacts consuming street vended food had a significantly higher odds of a V. cholerae infection (OR: 9.45, 95% CI: 2.14, 41.72). Older age was significantly associated with a lower odds of a V. cholerae infection (OR: 0.96, 95% CI: 0.93, 0.99). Households with both water and clinical V. cholerae-positive samples all had isolates that were closely related by MLVA.
CONCLUSIONS/SIGNIFICANCE: These findings emphasize the need for interventions targeting water treatment and food hygiene to reduce V. cholerae infections.

PMID: 30052631 [PubMed - indexed for MEDLINE]

Biofilm formation and avian immune response following experimental acute and chronic avian cholera due to Pasteurella multocida.

November 21, 2018
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Biofilm formation and avian immune response following experimental acute and chronic avian cholera due to Pasteurella multocida.

Vet Microbiol. 2018 Aug;222:114-123

Authors: Petruzzi B, Dalloul RA, LeRoith T, Evans NP, Pierson FW, Inzana TJ

Abstract
Pasteurella multocida is the causative agent of avian cholera, an important economic and ecological disease that can present as a peracute, acute, chronic, or asymptomatic infection. Acute avian cholera is associated with encapsulated P. multocida, while chronic and asymptomatic cases of avian cholera may be associated with capsule-deficient P. multocida isolates. We hypothesize that biofilm formation is also associated with chronic and asymptomatic avian cholera. Experimental infections of chickens with encapsulated, biofilm-deficient P. multocida strain X73, proficient biofilm forming P. multocida strain X73ΔhyaD, and proficient biofilm forming clinical strains 775 and 756 showed that virulence was inversely correlated with biofilm formation. Biofilm-proficient isolates induced chronic avian cholera in the chicken host. Histopathological analysis was used to show that biofilm-proficient isolates induced little inflammation in the lungs, heart, and liver, while biofilm-deficient isolates induced greater inflammation and induced the recruitment of heterophil granulocytes. Putative biofilm matrix material and exopolysaccharide was detected in pulmonary tissue of chickens diagnosed with chronic avian cholera using scanning electron microscopy and a fluorescently-tagged lectin, respectively, supporting a role for biofilm in chronic avian cholera. P. multocida induced Th1 and Th17 immune responses during acute and chronic avian cholera, as determined by quantitative real-time PCR of splenic cytokine genes. Chickens that succumbed to acute avian cholera after experimental challenge with strain X73 had high levels of INF-γ, IL-1β, IL-6, IL-12A, IL-22, IL-17A, and IL-17RA expressed in the spleen compared to all other experimental groups. Birds infected with capsule-deficient strains had chronic infections lasting 7 days or longer, and had increased levels of IL-17RA, CCR6, and IL-16 compared to non-infected control chickens. However, specific antibody titers increased only transiently to capsule-deficient strains and were low, indicating that antibodies are less important in managing and clearing P. multocida infections.

PMID: 30080666 [PubMed - indexed for MEDLINE]

Oral cholera vaccine in cholera prevention and control, Malawi.

November 16, 2018
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Oral cholera vaccine in cholera prevention and control, Malawi.

Bull World Health Organ. 2018 Jun 01;96(6):428-435

Authors: M'bangombe M, Pezzoli L, Reeder B, Kabuluzi S, Msyamboza K, Masuku H, Ngwira B, Cavailler P, Grandesso F, Palomares A, Beck N, Shaffer A, MacDonald E, Senbete M, Lessler J, Moore SM, Azman AS

Abstract
Problem: With limited global supplies of oral cholera vaccine, countries need to identify priority areas for vaccination while longer-term solutions, such as water and sanitation infrastructure, are being developed.
Approach: In 2017, Malawi integrated oral cholera vaccine into its national cholera control plan. The process started with a desk review and analysis of previous surveillance and risk factor data. At a consultative meeting, researchers, national health and water officials and representatives from nongovernmental and international organizations reviewed the data and local epidemiological knowledge to determine priority districts for oral cholera vaccination. The final stage was preparation of an application to the global oral cholera vaccine stockpile for non-emergency use.
Local setting: Malawi collects annual data on cholera and most districts have reported cases at least once since the 1970s.
Relevant changes: The government's application for 3.2 million doses of vaccine to be provided over 20 months in 12 districts was accepted in April 2017. By April 2018, over 1 million doses had been administered in five districts. Continuing surveillance in districts showed that cholera outbreaks were notably absent in vaccinated high-risk areas, despite a national outbreak in 2017-2018.
Lessons learnt: Augmenting advanced mapping techniques with local information helped us extend priority areas beyond those identified as high-risk based on cholera incidence reported at the district level. Involvement of the water, sanitation and hygiene sectors is key to ensuring that short-term gains from cholera vaccine are backed by longer-term progress in reducing cholera transmission.

PMID: 29904226 [PubMed - indexed for MEDLINE]

AlmG, responsible for polymyxin resistance in pandemic Vibrio cholerae, is a glycyltransferase distantly related to lipid A late acyltransferases.

November 15, 2018
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AlmG, responsible for polymyxin resistance in pandemic Vibrio cholerae, is a glycyltransferase distantly related to lipid A late acyltransferases.

J Biol Chem. 2017 12 22;292(51):21205-21215

Authors: Henderson JC, Herrera CM, Trent MS

Abstract
Cationic antimicrobial peptides (CAMPs), such as polymyxins, are used as a last-line defense in treatment of many bacterial infections. However, some bacteria have developed resistance mechanisms to survive these compounds. Current pandemic O1 Vibrio cholerae biotype El Tor is resistant to polymyxins, whereas a previous pandemic strain of the biotype Classical is polymyxin-sensitive. The almEFG operon found in El Tor V. cholerae confers >100-fold resistance to antimicrobial peptides through aminoacylation of lipopolysaccharide (LPS), expected to decrease the negatively charged surface of the V. cholerae outer membrane. This Gram-negative system bears striking resemblance to a related Gram-positive cell-wall remodeling strategy that also promotes CAMP resistance. Mutants defective in AlmEF-dependent LPS modification exhibit reduced fitness in vivo Here, we present investigation of AlmG, the hitherto uncharacterized member of the AlmEFG pathway. Evidence for AlmG glycyl to lipid substrate transferase activity is demonstrated in vivo by heterologous expression of V. cholerae pathway enzymes in a specially engineered Escherichia coli strain. Development of a minimal keto-deoxyoctulosonate (Kdo)-lipid A domain in E. coli was necessary to facilitate chemical structure analysis and to produce a mimetic Kdo-lipid A domain AlmG substrate to that synthesized by V. cholerae. Our biochemical studies support a uniquely nuanced pathway of Gram-negative CAMPs resistance and provide a more detailed description of an enzyme of the pharmacologically relevant lysophosphospholipid acyltransferase (LPLAT) superfamily.

PMID: 29101229 [PubMed - indexed for MEDLINE]

Untangling the causes of the 2016-18 Cholera epidemic in Yemen.

November 8, 2018
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Untangling the causes of the 2016-18 Cholera epidemic in Yemen.

Lancet Glob Health. 2018 06;6(6):e600-e601

Authors: Gormley M

PMID: 29731399 [PubMed - indexed for MEDLINE]

Reviving Phage Therapy for the Treatment of Cholera.

November 6, 2018
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Reviving Phage Therapy for the Treatment of Cholera.

J Infect Dis. 2018 Nov 03;:

Authors: Bhandare S, Colom J, Baig A, Ritchie JM, Bukhari H, Shah MA, Sarkar BL, Su J, Wren B, Barrow P, Atterbury RJ

Abstract
Cholera remains a major risk in developing countries, particularly after natural or man-made disasters. Vibrio cholerae El Tor is the most important cause of these outbreaks, and is becoming increasingly resistant to antibiotics, so alternative therapies are urgently needed. In this study, a single bacteriophage, Phi_1, was used to control cholera prophylactically and therapeutically in an infant rabbit model. In both cases, phage-treated animals showed no clinical signs of disease, compared with 69% of untreated control animals. Bacterial counts in the intestines of phage-treated animals were reduced by up to 4 log10 colony-forming units/g. There was evidence of phage multiplication only in animals that received a V. cholerae challenge. No phage-resistant bacterial mutants were isolated from the animals, despite extensive searching. This is the first evidence that a single phage could be effective in the treatment of cholera, without detectable levels of resistance. Clinical trials in human patients should be considered.

PMID: 30395214 [PubMed - as supplied by publisher]

Detection of Uncommon Enteric Bacterial Pathogens from Acute Diarrheal Specimens using SYBR-Green Real Time PCR.

November 2, 2018
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Detection of Uncommon Enteric Bacterial Pathogens from Acute Diarrheal Specimens using SYBR-Green Real Time PCR.

Jpn J Infect Dis. 2018 Oct 31;:

Authors: Chowdhury G, Stine OC, Rajendran K, Mukhopadhyay AK, Okamoto K, Ramamurthy T

Abstract
Acute diarrheal disease is a major health problem and second most common cause of death in children under five years of age. Conventional diagnostic methods are laborious, time consuming and occasionally inaccurate. We examined SYBR-Green real-time PCR for the detection of ten uncommon bacterial pathogens using fecal specimens from acute diarrheal patients. In SYBR-Green real-time PCR, the products formed were identified based on melting point temperature (Tm) curve analysis and was validated with the respective reference strain. In a retrospective study, 1184 tested stool specimens by conventional culture methods were included. Enterotoxigenic Bacteriodes fragilis was detected more (6.7%) followed by enterotoxigenic Bacillus cereus (5.1%), Clostridium perfringens (3.9%) and Aeromonas hydrophila (3.8%). In the prospective study, A. hydrophila, S. aureus, and C. perfringens, were predominantly detected in >5 years age group by the real-time PCR. The real-time PCR assay is comprehensive, rapid, accurate and well suited for surveillance or diagnostic purpose for detection of uncommon bacterial pathogens and also helpful in initiating appropriate care and thereby reducing the risk of the patients.

PMID: 30381678 [PubMed - as supplied by publisher]

Mapping the burden of cholera in sub-Saharan Africa and implications for control: an analysis of data across geographical scales.

October 24, 2018
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Mapping the burden of cholera in sub-Saharan Africa and implications for control: an analysis of data across geographical scales.

Lancet. 2018 05 12;391(10133):1908-1915

Authors: Lessler J, Moore SM, Luquero FJ, McKay HS, Grais R, Henkens M, Mengel M, Dunoyer J, M'bangombe M, Lee EC, Djingarey MH, Sudre B, Bompangue D, Fraser RSM, Abubakar A, Perea W, Legros D, Azman AS

Abstract
BACKGROUND: Cholera remains a persistent health problem in sub-Saharan Africa and worldwide. Cholera can be controlled through appropriate water and sanitation, or by oral cholera vaccination, which provides transient (∼3 years) protection, although vaccine supplies remain scarce. We aimed to map cholera burden in sub-Saharan Africa and assess how geographical targeting could lead to more efficient interventions.
METHODS: We combined information on cholera incidence in sub-Saharan Africa (excluding Djibouti and Eritrea) from 2010 to 2016 from datasets from WHO, Médecins Sans Frontières, ProMED, ReliefWeb, ministries of health, and the scientific literature. We divided the study region into 20 km × 20 km grid cells and modelled annual cholera incidence in each grid cell assuming a Poisson process adjusted for covariates and spatially correlated random effects. We combined these findings with data on population distribution to estimate the number of people living in areas of high cholera incidence (>1 case per 1000 people per year). We further estimated the reduction in cholera incidence that could be achieved by targeting cholera prevention and control interventions at areas of high cholera incidence.
FINDINGS: We included 279 datasets covering 2283 locations in our analyses. In sub-Saharan Africa (excluding Djibouti and Eritrea), a mean of 141 918 cholera cases (95% credible interval [CrI] 141 538-146 505) were reported per year. 4·0% (95% CrI 1·7-16·8) of districts, home to 87·2 million people (95% CrI 60·3 million to 118·9 million), have high cholera incidence. By focusing on the highest incidence districts first, effective targeted interventions could eliminate 50% of the region's cholera by covering 35·3 million people (95% CrI 26·3 million to 62·0 million), which is less than 4% of the total population.
INTERPRETATION: Although cholera occurs throughout sub-Saharan Africa, its highest incidence is concentrated in a small proportion of the continent. Prioritising high-risk areas could substantially increase the efficiency of cholera control programmes.
FUNDING: The Bill & Melinda Gates Foundation.

PMID: 29502905 [PubMed - indexed for MEDLINE]

A randomized, observer-blinded, equivalence trial comparing two variations of Euvichol®, a bivalent killed whole-cell oral cholera vaccine, in healthy adults and children in the Philippines.

October 16, 2018
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A randomized, observer-blinded, equivalence trial comparing two variations of Euvichol®, a bivalent killed whole-cell oral cholera vaccine, in healthy adults and children in the Philippines.

Vaccine. 2018 07 05;36(29):4317-4324

Authors: Russo P, Ligsay AD, Olveda R, Choi SK, Kim DR, Park JY, Park JY, Syed KA, Dey A, Kim YH, Lee SH, Kim J, Chon Y, Digilio L, Kim CW, Excler JL

Abstract
BACKGROUND: To contribute to the global demand for oral cholera vaccine (OCV), the production of Euvichol® was scaled up with elimination of thimerosal. To demonstrate the equivalence of the variations, a study was carried out in the Philippines.
METHODS: Healthy male and female adults and children in Manila were randomized to receive two doses of Euvichol® two weeks apart from either the 100L (Comparator) or the 600L (Test) variation. Primary and secondary immunogenicity endpoints were respectively geometric mean titer (GMT) of vibriocidal antibodies (two weeks post second dose) and seroconversion rate (two weeks after each dose) against O1 Inaba, Ogawa, and O139 serogroups. The GMT of vibriocidal antibodies against O1 Inaba, Ogawa, and O139 two weeks post first dose was also measured. To show the equivalence of two variations of Euvichol®, the ratio of GMT and the difference of seroconversion rate between Test and Comparator vaccines were tested with equivalence margin of [0.5, 2.0] for GMT ratio and of 15% for seroconversion rate, respectively. Safety assessment included solicited reactogenicity within 6 days after each dose and unsolicited and serious adverse events.
RESULTS: A total of 442 participants were enrolled. For the overall population, equivalence between Test and Comparator was demonstrated for vibriocidal antibody response against O1 Inaba and Ogawa serotypes and O139 serogroup in both modified intention-to-treat (mITT) and per protocol analysis, since the 95% confidence intervals (CI) of GMT to any serotypes were within the lower and upper boundary [0.5, 2.0]. Seroconversion rates after two doses also showed equivalence for O1 Inaba, Ogawa, and O139. The vaccine was safe and well tolerated, similarly between the two groups.
CONCLUSION: The study results support the equivalence of the 600L Euvichol® to the 100L formulation in healthy children and adults. The 600L Euvichol® is safe and immunogenic in adults and children. ClinicalTrials.gov registration number: NCT02502331.

PMID: 29895500 [PubMed - indexed for MEDLINE]

Emergency deployment of oral cholera vaccine for the Rohingya in Bangladesh.

October 16, 2018
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Emergency deployment of oral cholera vaccine for the Rohingya in Bangladesh.

Lancet. 2018 05 12;391(10133):1877-1879

Authors: Qadri F, Azad AK, Flora MS, Khan AI, Islam MT, Nair GB, Singh PK, Clemens JD

PMID: 29781432 [PubMed - indexed for MEDLINE]

The challenges of cholera at the 2017 Hajj pilgrimage.

October 12, 2018
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The challenges of cholera at the 2017 Hajj pilgrimage.

Lancet Infect Dis. 2017 09;17(9):895-897

Authors: Zumla A, McCloskey B, Endericks T, Azhar EI, Petersen E

PMID: 28803813 [PubMed - indexed for MEDLINE]

A self-quenching-resistant carbon nanodot powder with multicolored solid-state fluorescence for ultra-fast staining of various representative bacterial species within one minute.

October 6, 2018
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A self-quenching-resistant carbon nanodot powder with multicolored solid-state fluorescence for ultra-fast staining of various representative bacterial species within one minute.

Nanoscale. 2016 Dec 01;8(47):19744-19753

Authors: Zhang Y, Li C, Fan Y, Wang C, Yang R, Liu X, Zhou L

Abstract
In this study, we prepared self-quenching-resistant solid-state fluorescent carbon nanodots (SFCDs) without any other solid matrices. The SFCDs were prepared using a one-step microwave synthesis method through precise control of the heating power and time. The resulting SFCD powder showed excitation-dependent emission behavior with a maximum fluorescence quantum yield of 40%. The multicolored SFCDs were successfully used as fluorescent agents for rapid staining of 14 representative bacterial species, including Gram-negative, Gram-positive, and acid-fast bacteria. Moreover, some pathogenic bacteria, including Bacillus anthracis (vegetative cells and endospores), Yersinia pestis, Vibrio cholera O1, Listeria monocytogenes, Neisseria meningitidis, and Klebsiella pneumoniae, could all be stained within just 1 min by the smear staining method without any incubation, which was also applicable by using the liquid incubation method. Moreover, excellent staining quality, superior resistance to photobleaching, high stability in solutions of different pH values, and low toxicity were also demonstrated.

PMID: 27874136 [PubMed - indexed for MEDLINE]

UNstoppable: How Advocates Persevered in the Fight for Justice for Haitian Cholera Victims.

October 4, 2018
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UNstoppable: How Advocates Persevered in the Fight for Justice for Haitian Cholera Victims.

Health Hum Rights. 2017 Jun;19(1):299-304

Authors: Houston A

PMID: 28630562 [PubMed - indexed for MEDLINE]

Cyclical cholera outbreaks in Ghana: filth, not myth.

October 3, 2018
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Cyclical cholera outbreaks in Ghana: filth, not myth.

Infect Dis Poverty. 2018 Jun 15;7(1):51

Authors: Mireku-Gyimah N, Apanga PA, Awoonor-Williams JK

Abstract
BACKGROUND: Ranked among the world's dirtiest countries, Ghana has poor environmental sanitation and hygiene, and a lack of potable water, all of which combined have been largely blamed as the underscoring reasons for cholera outbreaks. The country has concomitantly suffered seasonal cholera outbreaks that have impacted negatively on the population's health, as well as on the nation's economy. To prevent cyclical cholera outbreaks in Ghana, this commentary discusses the associated problems and makes recommendations to solve them.
MAIN BODY: This commentary aims to throw light on the menace of cholera in Ghana and the need to curb the recurrence of outbreaks and bouts of this epidemic. Response measures, challenges, and lessons learnt from the most recent cholera outbreak are critically assessed to determine how best this public health issue could be resolved. General and specific policy recommendations are identified in this regard.
CONCLUSION: To resolve this problem, there is a need for an oral cholera vaccine to be introduced. There is also a need to develop strategies and interventions relating to water, sanitation, and hygiene, to be initiated by the Ministry of Health, with component activities that are culturally tailored to Ghanaian communities. Policy change towards the prevention of outbreaks in Ghana is identified as another requisite.

PMID: 29903037 [PubMed - indexed for MEDLINE]

Treating cholera in severely malnourished children in the Horn of Africa and Yemen.

October 2, 2018
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Treating cholera in severely malnourished children in the Horn of Africa and Yemen.

Lancet. 2017 Oct 28;390(10106):1945-1946

Authors: Ververs M, Narra R

PMID: 28988791 [PubMed - indexed for MEDLINE]

Feasibility, coverage and cost of oral cholera vaccination conducted by icddr,b using the existing national immunization service delivery mechanism in rural setting Keraniganj, Bangladesh.

September 28, 2018
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Feasibility, coverage and cost of oral cholera vaccination conducted by icddr,b using the existing national immunization service delivery mechanism in rural setting Keraniganj, Bangladesh.

Hum Vaccin Immunother. 2018 Sep 27;:

Authors: Khan AI, Khan IA, Siddique SA, Rahman A, Islam MT, Bhuiya MAI, Saha NC, Biswas PK, Saha A, Chowdhury F, Qadri F

Abstract
BACKGROUND: Cholera is a considerable health burden in developing country settings including Bangladesh. The oral cholera vaccine (OCV) is a preventative tool to control the disease. The objective of this study was to describe whether the International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), could provide the OCV to rural communities using existing government infrastructure.
METHODS: The study was conducted in rural sub-district Keraniganj, 20 km from the capital city Dhaka. All listed participants one year and above in age (excluding pregnant women) were offered two doses of OCV at a 14 day interval. Existing government facilities were used to deliver and also maintain the cold chain required for the vaccine. All events related to vaccination were recorded at the 17 vaccination sites to evaluate the coverage and feasibility of OCV program.
RESULTS: A total of 29,029 individuals received the 1st dose (90% of target) and 26,611 individuals received the 2nd dose (83% of target and 92% of 1st dose individuals) of OCV. The highest vaccination coverage was in younger children (1-9 years) and the lowest was amongst 18-29-year age group. Somewhat better coverage was seen amongst the female participants than males (92% vs. 88% for the 1st dose and 93% vs. 90% for the 2nd dose). The cost of vaccine cost was calculated as US$1.00 per dose plus freight, insurance, and transportation and the total vaccine delivery cost was US$70,957.
CONCLUSION: This was a project undertaken using existing public health program resources to collect empirical evidence on the use of a mass OCV campaign in the rural setting. Mass vaccination with the OCV is feasible in the rural setting using existing governmental vaccine delivery systems in Bangladesh.

PMID: 30261152 [PubMed - as supplied by publisher]

Cholera.

September 28, 2018
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Cholera.

Lancet. 2017 Sep 23;390(10101):1539-1549

Authors: Clemens JD, Nair GB, Ahmed T, Qadri F, Holmgren J

Abstract
Cholera is an acute, watery diarrhoeal disease caused by Vibrio cholerae of the O1 or O139 serogroups. In the past two centuries, cholera has emerged and spread from the Ganges Delta six times and from Indonesia once to cause global pandemics. Rational approaches to the case management of cholera with oral and intravenous rehydration therapy have reduced the case fatality of cholera from more than 50% to much less than 1%. Despite improvements in water quality, sanitation, and hygiene, as well as in the clinical treatment of cholera, the disease is still estimated to cause about 100 000 deaths every year. Most deaths occur in cholera-endemic settings, and virtually all deaths occur in developing countries. Contemporary understanding of immune protection against cholera, which results from local intestinal immunity, has yielded safe and protective orally administered cholera vaccines that are now globally stockpiled for use in the control of both epidemic and endemic cholera.

PMID: 28302312 [PubMed - indexed for MEDLINE]

Cholera outbreak in the horn of Africa.

September 25, 2018
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Cholera outbreak in the horn of Africa.

Lancet. 2017 Jun 03;389(10085):2179

Authors: Green A

PMID: 28589885 [PubMed - indexed for MEDLINE]

Progress and Challenges in Using Oral Cholera Vaccines to Control Outbreaks: The Médecins Sans Frontières Experience.

September 22, 2018
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Progress and Challenges in Using Oral Cholera Vaccines to Control Outbreaks: The Médecins Sans Frontières Experience.

J Infect Dis. 2018 Sep 14;:

Authors: Ciglenecki I, Azman AS, Jamet C, Serafini M, Luquero FJ, Cabrol JC

Abstract
The use of oral cholera vaccine (OCV) has increased since 2011, when Shanchol, the first OCV suitable for large-scale use, became available. Médecins Sans Frontières considers OCVs an essential cholera outbreak control tool and has contributed to generating new evidence on OCV use in outbreaks. We showed that large-scale mass campaigns are feasible during outbreaks, documented high short-term effectiveness and showed that vaccines are likely safe in pregnancy. We found that a single-dose regimen has high short-term effectiveness, making rapid delivery of vaccine during outbreaks easier, especially given the on-going global vaccine shortage. Despite progress, OCV has still not been used widely in some of the largest recent outbreaks and thousands of cholera deaths are reported every year. While working towards improving our tools to protect those most at-risk of cholera, we must strive to use all available effective interventions in efficient ways, including OCV, to prevent avoidable deaths today.

PMID: 30239901 [PubMed - as supplied by publisher]

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