Recent Cholera Publications on PubMed

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Economic burden of cholera in Asia.

October 16, 2019
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Economic burden of cholera in Asia.

Vaccine. 2019 Oct 11;:

Authors: Mogasale V, Mogasale VV, Hsiao A

Abstract
BACKGROUND: The economic burden data can provide a basis to inform investments in cholera control and prevention activities. However, treatment costs and productivity loss due to cholera are not well studied.
METHODS: We included Asian countries that either reported cholera cases to the World Health Organization (WHO) in 2015 or were considered cholera endemic in 2015 global burden of disease study. Public health service delivery costs for hospitalization and outpatient costs, out-of-pocket costs to patients and households, and lost productivity were extracted from literature. A probabilistic multivariate sensitivity analysis was conducted for key outputs using Monte Carlo simulation. Scenario analyses were conducted using data from the WHO cholera reports and conservative and liberal disease burden estimates.
RESULTS: Our analysis included 14 Asian countries that were estimated to have a total of 850,000 cholera cases and 25,500 deaths in 2015 While, the WHO cholera report documented around 60,000 cholera cases and 28 deaths. We estimated around $20.2 million (I$74.4 million) in out-of-pocket expenditures, $8.5 million (I$30.1 million) in public sector costs, and $12.1 million (I$43.7 million) in lost productivity in 2015. Lost productivity due to premature deaths was estimated to be $985.7 million (I$3,638.6 million). Our scenario analyses excluding mortality costs showed that the economic burden ranged from 20.3% ($8.3 million) to 139.3% ($57.1 million) in high and low scenarios when compared to the base case scenario ($41 million) and was least at 10.1% ($4.1 million) when estimated based on cholera cases reported to WHO.
CONCLUSION: The economic burden of cholera in Asia provides a better understanding of financial offsets that can be achieved, and the value of investments on cholera control measures. With a clear understanding of the limitations of the underlying assumptions, the information may be used in economic evaluations and policy decisions.

PMID: 31611097 [PubMed - as supplied by publisher]

Characterization of Vibrio cholerae O1 isolates responsible for cholera outbreaks in Kenya between 1975 and 2017.

October 16, 2019
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Characterization of Vibrio cholerae O1 isolates responsible for cholera outbreaks in Kenya between 1975 and 2017.

Microbiol Immunol. 2019 Sep;63(9):350-358

Authors: Bundi M, Shah MM, Odoyo E, Kathiiko C, Wandera E, Miring'u G, Guyo S, Langat D, Morita K, Ichinose Y

Abstract
Kenya is endemic for cholera with different waves of outbreaks having been documented since 1971. In recent years, new variants of Vibrio cholerae O1 have emerged and have replaced most of the traditional El Tor biotype globally. These strains also appear to have increased virulence, and it is important to describe and document their phenotypic and genotypic traits. This study characterized 146 V. cholerae O1 isolates from cholera outbreaks that occurred in Kenya between 1975 and 2017. Our study reports that the 1975-1984 strains had typical classical or El Tor biotype characters. New variants of V. cholerae O1 having traits of both classical and El Tor biotypes were observed from 2007 with all strains isolated between 2015 and 2017 being sensitive to polymyxin B and carrying both classical and El Tor type ctxB. All strains were resistant to Phage IV and harbored rstR, rtxC, hlyA, rtxA and tcpA genes specific for El Tor biotype indicating that the strains had an El Tor backbone. Pulsed field gel electrophoresis (PFGE) genotyping differentiated the isolates into 14 pulsotypes. The clustering also corresponded with the year of isolation signifying that the cholera outbreaks occurred as separate waves of different genetic fingerprints exhibiting different genotypic and phenotypic characteristics. The emergence and prevalence of V. cholerae O1 strains carrying El Tor type and classical type ctxB in Kenya are reported. These strains have replaced the typical El Tor biotype in Kenya and are potentially more virulent and easily transmitted within the population.

PMID: 31407393 [PubMed - indexed for MEDLINE]

The Accuracy of the Patient Health Questionnaire-9 Algorithm for Screening to Detect Major Depression: An Individual Participant Data Meta-Analysis.

October 9, 2019
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The Accuracy of the Patient Health Questionnaire-9 Algorithm for Screening to Detect Major Depression: An Individual Participant Data Meta-Analysis.

Psychother Psychosom. 2019 Oct 08;:1-13

Authors: He C, Levis B, Riehm KE, Saadat N, Levis AW, Azar M, Rice DB, Krishnan A, Wu Y, Sun Y, Imran M, Boruff J, Cuijpers P, Gilbody S, Ioannidis JPA, Kloda LA, McMillan D, Patten SB, Shrier I, Ziegelstein RC, Akena DH, Arroll B, Ayalon L, Baradaran HR, Baron M, Beraldi A, Bombardier CH, Butterworth P, Carter G, Chagas MHN, Chan JCN, Cholera R, Clover K, Conwell Y, de Man-van Ginkel JM, Fann JR, Fischer FH, Fung D, Gelaye B, Goodyear-Smith F, Greeno CG, Hall BJ, Harrison PA, Härter M, Hegerl U, Hides L, Hobfoll SE, Hudson M, Hyphantis TN, Inagaki M, Ismail K, Jetté N, Khamseh ME, Kiely KM, Kwan Y, Lamers F, Liu SI, Lotrakul M, Loureiro SR, Löwe B, Marsh L, McGuire A, Mohd-Sidik S, Munhoz TN, Muramatsu K, Osório FL, Patel V, Pence BW, Persoons P, Picardi A, Reuter K, Rooney AG, da Silva Dos Santos IS, Shaaban J, Sidebottom A, Simning A, Stafford L, Sung S, Tan PLL, Turner A, van Weert HCPM, White J, Whooley MA, Winkley K, Yamada M, Thombs BD, Benedetti A

Abstract
BACKGROUND: Screening for major depression with the Patient Health Questionnaire-9 (PHQ-9) can be done using a cutoff or the PHQ-9 diagnostic algorithm. Many primary studies publish results for only one approach, and previous meta-analyses of the algorithm approach included only a subset of primary studies that collected data and could have published results.
OBJECTIVE: To use an individual participant data meta-analysis to evaluate the accuracy of two PHQ-9 diagnostic algorithms for detecting major depression and compare accuracy between the algorithms and the standard PHQ-9 cutoff score of ≥10.
METHODS: Medline, Medline In-Process and Other Non-Indexed Citations, PsycINFO, Web of Science (January 1, 2000, to February 7, 2015). Eligible studies that classified current major depression status using a validated diagnostic interview.
RESULTS: Data were included for 54 of 72 identified eligible studies (n participants = 16,688, n cases = 2,091). Among studies that used a semi-structured interview, pooled sensitivity and specificity (95% confidence interval) were 0.57 (0.49, 0.64) and 0.95 (0.94, 0.97) for the original algorithm and 0.61 (0.54, 0.68) and 0.95 (0.93, 0.96) for a modified algorithm. Algorithm sensitivity was 0.22-0.24 lower compared to fully structured interviews and 0.06-0.07 lower compared to the Mini International Neuropsychiatric Interview. Specificity was similar across reference standards. For PHQ-9 cutoff of ≥10 compared to semi-structured interviews, sensitivity and specificity (95% confidence interval) were 0.88 (0.82-0.92) and 0.86 (0.82-0.88).
CONCLUSIONS: The cutoff score approach appears to be a better option than a PHQ-9 algorithm for detecting major depression.

PMID: 31593971 [PubMed - as supplied by publisher]

Health Problems while Working as a Volunteer or Humanitarian Aid Worker in Post-Earthquake Nepal.

October 8, 2019
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Health Problems while Working as a Volunteer or Humanitarian Aid Worker in Post-Earthquake Nepal.

JNMA J Nepal Med Assoc. 2018 Mar-Apr;56(211):691-695

Authors: Bhandari D, Pandey P

Abstract
INTRODUCTION: Volunteers and humanitarian aid workers working in disaster struck areas of the world are a vulnerable group of travelers. Nepal saw an influx of these humanitarian aid workers following earthquakes in April and May 2015. This study was undertaken to find out the pre-travel preparation and to estimate the risk of disease while the volunteers were deployed in Nepal.
METHODS: This was a descriptive cross-sectional study conducted at CIWEC Hospital located in Kathmandu. A questionnaire was given to all volunteers and aid workers who arrived at the hospital for evaluation of health related problems and agreed to be part of the study.
RESULTS: Ninety-five volunteers were enrolled in the study. Among these, 65 (68%) were female and 30 (32%) were male. The immunizations received before travel were Hepatitis A 82 (86%), Hepatitis B 82 (86%), Typhoid 70 (73%), Rabies 38 (40%), Japanese Encephalitis 34 (36%), Influenza within last one year 23 (24%), measles 48 (51%), Cholera 34 (36%),Tetanus within 10 years 71 (75%) and Varicella 38 (40%). Forty-four (45%) of travelers carried medication for treatment of Traveler's Diarrhea (TD) which included Ciprofloxacin, Azithromycin, Loperamide and others like Metronidazole and Charcoal. The common illnesses encountered were gastrointestinal, skin problems , injury and musculoskeletal problems, respiratory problems, genitourinary problems, cardiovascular, psychological problems, syncope, and miscellaneous.
CONCLUSIONS: Traveler's Diarrhea and dermatological problems were the most common health related problems. Volunteers were not properly prepared for self-treatment and pre-travel preparation was sub-optimal. Important pre travel health advice will decrease the incidence of health problems in this group.

PMID: 30381767 [PubMed - indexed for MEDLINE]

Genetic diversity of toxigenic Vibrio cholerae O1 from Sabah, Malaysia 2015.

October 4, 2019
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Genetic diversity of toxigenic Vibrio cholerae O1 from Sabah, Malaysia 2015.

J Microbiol Immunol Infect. 2019 Aug;52(4):563-570

Authors: Zaw MT, Emran NA, Ibrahim MY, Suleiman M, Awang Mohd TA, Yusuff AS, Naing KS, Myint T, Jikal M, Salleh MA, Lin Z

Abstract
BACKGROUND: Cholera is an important health problem in Sabah, a Malaysian state in northern Borneo; however, Vibrio cholerae in Sabah have never been characterized. Since 2002, serogroup O1 strains having the traits of both classical and El Tor biotype, designated as atypical El Tor biotype, have been increasingly reported as the cause of cholera worldwide. These variants are believed to produce clinically more severe disease like classical strains.
PURPOSE: The purpose of this study is to investigate the genetic diversity of V.cholerae in Sabah and whether V.cholerae in Sabah belong to atypical El Tor biotype.
METHODS: ERIC-PCR, a DNA fingerprinting method for bacterial pathogens based on the enterobacterial repetitive intergenic consensus sequence, was used to study the genetic diversity of 65 clinical V.cholerae O1 isolates from 3 districts (Kudat, Beluran, Sandakan) in Sabah and one environmental isolate from coastal sea water in Kudat district. In addition, we studied the biotype-specific genetic traits in these isolates to establish their biotype.
RESULTS: Different fingerprint patterns were seen in isolates from these three districts but one of the patterns was seen in more than one district. Clinical isolates and environmental isolate have different patterns. In addition, Sabah isolates harbor genetic traits specific to both classical biotype (ctxB-1, rstRCla) and El Tor biotype (rstRET, rstC, tcpAET, rtxC, VC2346).
CONCLUSION: This study revealed that V.cholerae in Sabah were genetically diverse and were atypical El Tor strains. Fingerprint patterns of these isolates will be useful in tracing the origin of this pathogen in the future.

PMID: 29428381 [PubMed - indexed for MEDLINE]

Genetic characterization of group-A rotaviruses among children in eastern India during 2014-2016: Phylodynamics of co-circulating genotypes.

September 24, 2019
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Genetic characterization of group-A rotaviruses among children in eastern India during 2014-2016: Phylodynamics of co-circulating genotypes.

Vaccine. 2019 Sep 19;:

Authors: Nayak MK, Banerjee A, Sarkar R, Mitra S, Dutta K, Ganguly N, Ghosh C, Girish Kumar CP, Niyogi P, Panda S, Dutta S, Chawla-Sarkar M

Abstract
BACKGROUND: Group-A human rotaviruses (GARV) are among the major cause of childhood diarrhea worldwide. In lieu of monitoring the circulatory GARV strains and underscoring the burden of GARV related hospitalization, a systematic surveillance was conducted in three hospitals of eastern India. In this hospital-based diarrheal disease surveillance (2014-2016), GARV was the most common cause of acute infantile gastroenteritis. The strains were genotyped and characterized to understand their prevalence and phylodynamics prior to the introduction of vaccine in eastern India.
MATERIALS AND METHODS: A total of 3652 stool samples were screened from children (≤5 years) hospitalized with acute diarrhea during 2014-2016. Initial screening for VP6 antigen was done by ELISA. GARV positive samples were genotyped by multiplex semi-nested PCR and DNA sequencing and phylogenetic analyses were based on the capsid proteins VP4 and VP7.
RESULTS: Of 3652 samples, 1817 (49.8%) were GARV positive. G1, G2, G3 and G9 in conjunction with P[4], P[6]and P[8]genotypes were seen to co-circulate in the population. A sharp deflection from G1 to G3 occurred since 2016; upsurge of G9 strains was seen in alternate years, whereas G2 strains had a low frequency. All the circulating genotypes depicted a low phylogenetic relatedness to the vaccine strains. Differences in antigenic epitopes of VP4 and VP7 proteins in local strains were seen when compared to the vaccine strains. A significant difference in the degree of dehydration, duration of mean hospital stay and frequency of vomiting/24 h between GARV positive and negative children was evident.
CONCLUSION: The study provides a relevant set of base-line data on high burden of rotaviral gastroenteritis and the varied genotypic diversity among children prior to the introduction of GARV vaccine in this endemic region. Continuous monitoring during post-vaccination era will be required to assess the impact of vaccination in this region.

PMID: 31543416 [PubMed - as supplied by publisher]

Involvement of topoisomerase mutations and qnr and aac(6')Ib-cr genes in conferring quinolone resistance to clinical isolates of Vibrio and Shigella spp. from Kolkata, India (1998-2009).

September 24, 2019
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Involvement of topoisomerase mutations and qnr and aac(6')Ib-cr genes in conferring quinolone resistance to clinical isolates of Vibrio and Shigella spp. from Kolkata, India (1998-2009).

J Glob Antimicrob Resist. 2018 06;13:85-90

Authors: Vinothkumar K, Bhalara SR, Shah A, Ramamurthy T, Niyogi SK, Kumar GN, Bhardwaj AK

Abstract
OBJECTIVES: Quinolone antibiotics have been widely used to treat diarrhoeal diseases caused by bacterial agents such as those belonging to the genera Vibrio and Shigella. As these pathogens are accumulating quinolone resistance, treating infections caused by them has become complicated.
METHODS: In this study, Vibrio and Shigella spp. isolates obtained from diarrhoeal patients from Kolkata, India, over a period of 12 years (1998-2009) were analysed for quinolone resistance. A total of 27 Vibrio spp. (9 Vibrio cholerae, 11 Vibrio fluvialis and 7 Vibrio parahaemolyticus) and 10 Shigella spp. isolates (7 Shigella flexneri, 2 Shigella dysenteriae and 1 Shigella sonnei) showing reduced susceptibility to quinolones were studied to unravel the genetic factors responsible for quinolone resistance.
RESULTS: Antimicrobial susceptibility testing showed a wide spectrum and varying degree of resistance to different generations of quinolones. Genotypic characterisation revealed the involvement of GyrA(S83I) and ParC(S85L) mutations in V. cholerae and V. fluvialis, whereas Shigella spp. isolates showed the mutations S83L and/or D87N/Y in GyrA and S80I or E84K in ParC. Analysis of plasmid-mediated quinolone resistance genes showed that qnrVC5 was detected in three V. fluvialis isolates, aac(6')-Ib-cr in one V. fluvialis isolate and qnrS1 in a S. flexneri isolate.
CONCLUSIONS: These results emphasise that quinolone resistance is widespread and therefore quinolones should be used prudently. To the best of our knowledge, this is the first study where resistance to various generations of quinolones in Vibrio and Shigella spp. has been examined in terms of detailed genotype-phenotype correlation.

PMID: 29111483 [PubMed - indexed for MEDLINE]

Screening for dysglycaemia using anthropometric indices in an adult population in Oman.

September 23, 2019
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Screening for dysglycaemia using anthropometric indices in an adult population in Oman.

East Mediterr Health J. 2018 Jun 10;24(3):254-261

Authors: Ganguly SS, Sarkar K, Al-Adawi S, Al-Mahrezi AA

Abstract
Background: A previous community-based cross-sectional survey conducted in a semi-urban community revealed that 44% of people aged 18+ years manifest dysglycaemia, which appears to echo the national trend. There is lack of studies examining the role of anthropometric indices in people with dysglycaemia.
Aim: We explored the screening ability of anthropometric indices, body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), and waist-to-height ratio (WHtR) to detect dysglycaemia in the adult Omani population based on a community-based survey conducted in 2005. The potential of anthropometric indices to detect the presence of glycaemic disorder could aid in detection, prevention and health education.
Methods: A total of 480 male and 795 female subjects aged 18+ years were included in this study. The prevalence of dysglycaemia was analysed using the American Diabetic Association criteria. Logistic regression approach and Receiver- Operating Characteristic (ROC) curve analysis was performed.
Results: The analysis revealed that mean values of age, BMI, WC, WHR and WHtR increased significantly from normoglycemic to pre-diabetic and further to diabetic in both sexes (P<0.0001). Dysglycemia showed an increasing prevalence with age. WHtR showed the highest sensitivity for detecting dysglycemia in all age groups compared to other anthropometric indices with sensitivity rate of 94.4% in ≥45 years, 88.6% in (25- 44) years and 45.6% in age group <25 years.
Conclusion: Among the anthropometric indices we investigated, WHtR was the best predictor of dysglycaemia among Omani adults aged > 25 years.

PMID: 29908020 [PubMed - indexed for MEDLINE]

Edward Ballard and the Practice of Epidemiology in the 19th-Century United Kingdom.

September 18, 2019
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Edward Ballard and the Practice of Epidemiology in the 19th-Century United Kingdom.

Am J Public Health. 2018 12;108(12):1632-1638

Authors: Steere-Williams J

Abstract
This article recovers the history of Victorian epidemiology through the career of British physician Edward Ballard (1820-1897). Ballard's career provides a useful window into the practices of epidemiology in the 19th century because he held notable public health posts as medical officer of health for Islington and inspector at the Medical Department of the Local Government Board. By the time of his death, in 1897, he typified the transition toward professional epidemiology. In exploring some of the most important environmental and health-related problems in preventive medicine in the 19th century, Ballard was part of a group of influential epidemiologists who studied infectious disease. In particular, he was noted for his research into typhoid fever and industrial health. Yet Ballard's career has largely been forgotten. In this article, I explore Ballard's work as a window into the everyday practices of Victorian epidemiology and suggest that the process of professionalizing epidemiology in the 20th century was about forgetting epidemiology's Victorian past as much as it was about championing it.

PMID: 30359106 [PubMed - indexed for MEDLINE]

Responding to Cholera in Haiti: Implications for the National Plan to Eliminate Cholera by 2022.

September 18, 2019
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Responding to Cholera in Haiti: Implications for the National Plan to Eliminate Cholera by 2022.

J Infect Dis. 2018 10 15;218(suppl_3):S167-S170

Authors: Guillaume Y, Ternier R, Vissieres K, Casseus A, Chery MJ, Ivers LC

PMID: 30239937 [PubMed - indexed for MEDLINE]

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

September 18, 2019
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Progress and Challenges in Using Oral Cholera Vaccines to Control Outbreaks: The Médecins Sans Frontières Experience.

J Infect Dis. 2018 10 15;218(suppl_3):S165-S166

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 - indexed for MEDLINE]

Household Water Treatment and Cholera Control.

September 18, 2019
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Household Water Treatment and Cholera Control.

J Infect Dis. 2018 10 15;218(suppl_3):S147-S153

Authors: Lantagne D, Yates T

Abstract
Water, sanitation, and hygiene are one part of a cholera control strategy. Household water treatment (HWT) in particular has been shown to improve the microbiological quality of stored water and reduce the disease burden. We conducted a systematic review of published and gray literature to determine the outcomes and impacts of HWT in preventing cholera specifically. Fourteen manuscripts with 18 evaluations of HWT interventions in cholera were identified. Overall, a moderate quality of evidence suggests that HWT interventions reduce the burden of disease in cholera outbreaks and the risk of disease transmission. Appropriate training for users and community health worker follow-up are necessary for use. Barriers to uptake include taste and odor concerns, and facilitators include prior exposure, ease of use, and links to preexisting development programming. Further research on local barriers and facilitators, HWT filters, scaling up existing development programs, program sustainability, integrating HWT and oral cholera vaccine, and monitoring in low-access emergencies is recommended.

PMID: 30215739 [PubMed - indexed for MEDLINE]

A Multisectoral Emergency Response Approach to a Cholera Outbreak in Zambia: October 2017-February 2018.

September 18, 2019
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A Multisectoral Emergency Response Approach to a Cholera Outbreak in Zambia: October 2017-February 2018.

J Infect Dis. 2018 10 15;218(suppl_3):S181-S183

Authors: Kapata N, Sinyange N, Mazaba ML, Musonda K, Hamoonga R, Kapina M, Zyambo K, Malambo W, Yard E, Riggs M, Narra R, Murphy J, Brunkard J, Azman AS, Monze N, Malama K, Mulwanda J, Mukonka VM

PMID: 30215738 [PubMed - indexed for MEDLINE]

Micro-Hotspots of Risk in Urban Cholera Epidemics.

September 18, 2019
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Micro-Hotspots of Risk in Urban Cholera Epidemics.

J Infect Dis. 2018 08 24;218(7):1164-1168

Authors: Azman AS, Luquero FJ, Salje H, Mbaïbardoum NN, Adalbert N, Ali M, Bertuzzo E, Finger F, Toure B, Massing LA, Ramazani R, Saga B, Allan M, Olson D, Leglise J, Porten K, Lessler J

Abstract
Targeted interventions have been delivered to neighbors of cholera cases in major epidemic responses globally despite limited evidence for the impact of such targeting. Using data from urban epidemics in Chad and Democratic Republic of the Congo, we estimate the extent of spatiotemporal zones of increased cholera risk around cases. In both cities, we found zones of increased risk of at least 200 meters during the 5 days immediately after case presentation to a clinic. Risk was highest for those living closest to cases and diminished in time and space similarly across settings. These results provide a rational basis for rapidly delivering targeting interventions.

PMID: 29757428 [PubMed - indexed for MEDLINE]