Recent Cholera Publications on PubMed

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Tube Well Use as Protection Against Rotavirus Infection During the Monsoons in an Urban Setting.

November 29, 2019
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Tube Well Use as Protection Against Rotavirus Infection During the Monsoons in an Urban Setting.

J Infect Dis. 2019 Nov 28;:

Authors: Martinez PP, Mahmud AS, Yunus M, Faruque ASG, Ahmed T, Pascual M, Buckee CO

Abstract
Rotavirus, a diarrheal pathogen spread via fecal-oral transmission, is typically characterized by a winter incidence peak in most countries. Unlike for cholera and other waterborne infections, the role of sanitation and socioeconomic factors on the spatial variation of rotavirus seasonality remains unclear. In the current study, we analyzed their association with rotavirus seasonality, specifically the odds of monsoon cases, across 46 locations from 2001 to 2012 in Dhaka. Drinking water from tube wells, compared to other sources, has a clear protective effect against cases during the monsoon, when flooding and water contamination are more likely. This finding supports a significant environmental component of transmission.

PMID: 31776559 [PubMed - as supplied by publisher]

Potential pathogenicity and antibiotic resistance of aquatic Vibrio isolates from freshwater in Slovakia.

November 28, 2019
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Potential pathogenicity and antibiotic resistance of aquatic Vibrio isolates from freshwater in Slovakia.

Folia Microbiol (Praha). 2019 Nov 26;:

Authors: Valáriková J, Korcová J, Ziburová J, Rosinský J, Čížová A, Bieliková S, Sojka M, Farkaš P

Abstract
This study aimed to evaluate the potential pathogenicity and antibiotic resistance of 31 environmental Vibrio isolates obtained from surface water in southern and eastern Slovakia. Isolates were identified as Vibrio cholerae non-O1/non-O139 and Vibrio metschnikovii by biochemical tests, MALDI biotyping, and 16S RNA gene sequencing. Analysis of the susceptibility to 13 antibacterial agents showed susceptibility of all isolates to ciprofloxacin, trimethoprim/sulfamethoxazole, chloramphenicol, gentamicin, imipenem, tetracyclin, and doxycycline. We recorded high rates of resistance to β-lactams and streptomycin. Investigation of antibiotic resistance showed five different antibiotic profiles with resistance to antibacterials from three classes, but no multidrug resistance was observed. The investigation of the pathogenic potential of V. cholerae isolates showed that neither the cholera toxin coding gene ctxA nor the genes zot (zonula occludens toxin), ace (accessory cholera toxin), and tcpA (toxin-coregulated pilus) were present in any of 31 isolated samples. Gene ompU (outer membrane protein) was confirmed in 80% and central regulatory protein-coding gene toxR in 71% of V. cholerae isolates, respectively. A high prevalence of the hemolysin coding gene hlyA in all V. cholerae was observed. The data point toward the importance of systematic monitoring and comparative studies of potentially pathogenic vibrios in European countries.

PMID: 31773555 [PubMed - as supplied by publisher]

Changing Molecular Epidemiology of Vibrio cholerae Outbreaks in Shanghai, China.

November 28, 2019
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Changing Molecular Epidemiology of Vibrio cholerae Outbreaks in Shanghai, China.

mSystems. 2019 Nov 26;4(6):

Authors: Hu D, Yin Z, Yuan C, Yang P, Qian C, Wei Y, Zhang S, Wang Y, Yuan J, Wang M, Reeves PR, Tu L, Chen M, Huang D, Liu B

Abstract
The 7th cholera pandemic began in 1961 in Sulawesi, Indonesia, and then spread around the world in at least three waves. However, the lack of genome sequences for Vibrio cholerae strains under long-term surveillance in East Asia, especially in China, has restricted our understanding of the dynamics of the intracountry and intercountry evolution and transmission of the 7th-pandemic clones. In this study, we obtained the genome sequences of 60 V. cholerae strains isolated in Shanghai, the largest port in the world and the largest city in China, from 1961 to 2011. Our whole-genome-based phylogeny of 7th-pandemic strains revealed that all but one fell into five "stages," most of which are single clades and share independent ancestors. Each stage dominated in succession for a period, with little overlap between them. In addition, two near-identical Shanghai strains belonging to a pre-7th-pandemic precursor and 4 nontoxigenic O1/O139 strains attributed to independent recombination events at the O-antigen loci were present. The major lineages of the 7th pandemic in Shanghai appeared to be closely related to V. cholerae strains isolated from South or Southeast Asia. Stage succession was consistently related to changes in society and human activity, implying that human-caused niche change may play a vital role in the cholera dynamics in Shanghai.IMPORTANCE V. cholerae is the causative agent of cholera, a life-threatening disease characterized by severe, watery diarrhea. The 7th pandemic started in Indonesia in 1961 and spread globally, currently infecting 1.3 million to 4 million people annually. Here, we applied whole-genome sequencing to analyze a long-term collection of V. cholerae clinical strains to reveal the phylogenetic background and evolutionary dynamics of the 7th pandemic in Shanghai, which had undergone breathtakingly rapid development in the last half-century. All but one of the Shanghai 7th-pandemic strains fell into five "stages" that were dominant in Shanghai and appeared to be closely related to 7th-pandemic strains of South or Southeast Asia. Our findings extended the understanding of the dynamics of the evolution and transmission of the 7th-pandemic clones in East Asia and the relationship between social changes and cholera epidemiology.

PMID: 31771974 [PubMed]

Cholera prevention and control in refugee settings: Successes and continued challenges.

November 28, 2019
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Cholera prevention and control in refugee settings: Successes and continued challenges.

PLoS Negl Trop Dis. 2019 06;13(6):e0007347

Authors: Shannon K, Hast M, Azman AS, Legros D, McKay H, Lessler J

PMID: 31220084 [PubMed - indexed for MEDLINE]

Determinants of linear growth faltering among children with moderate-to-severe diarrhea in the Global Enteric Multicenter Study.

November 27, 2019
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Determinants of linear growth faltering among children with moderate-to-severe diarrhea in the Global Enteric Multicenter Study.

BMC Med. 2019 Nov 25;17(1):214

Authors: Brander RL, Pavlinac PB, Walson JL, John-Stewart GC, Weaver MR, Faruque ASG, Zaidi AKM, Sur D, Sow SO, Hossain MJ, Alonso PL, Breiman RF, Nasrin D, Nataro JP, Levine MM, Kotloff KL

Abstract
BACKGROUND: Moderate-to-severe diarrhea (MSD) in the first 2 years of life can impair linear growth. We sought to determine risk factors for linear growth faltering and to build a clinical prediction tool to identify children most likely to experience growth faltering following an episode of MSD.
METHODS: Using data from the Global Enteric Multicenter Study of children 0-23 months old presenting with MSD in Africa and Asia, we performed log-binomial regression to determine clinical and sociodemographic factors associated with severe linear growth faltering (loss of ≥ 0.5 length-for-age z-score [LAZ]). Linear regression was used to estimate associations with ΔLAZ. A clinical prediction tool was developed using backward elimination of potential variables, and Akaike Information Criterion to select the best fit model.
RESULTS: Of the 5902 included children, mean age was 10 months and 43.2% were female. Over the 50-90-day follow-up period, 24.2% of children had severe linear growth faltering and the mean ΔLAZ over follow-up was - 0.17 (standard deviation [SD] 0.54). After adjustment for age, baseline LAZ, and site, several factors were associated with decline in LAZ: young age, acute malnutrition, hospitalization at presentation, non-dysenteric diarrhea, unimproved sanitation, lower wealth, fever, co-morbidity, or an IMCI danger sign. Compared to children 12-23 months old, those 0-6 months were more likely to experience severe linear growth faltering (adjusted prevalence ratio [aPR] 1.97 [95% CI 1.70, 2.28]), as were children 6-12 months of age (aPR 1.72 [95% CI 1.51, 1.95]). A prediction model that included age, wasting, stunting, presentation with fever, and presentation with an IMCI danger sign had an area under the ROC (AUC) of 0.67 (95% CI 0.64, 0.69). Risk scores ranged from 0 to 37, and a cut-off of 21 maximized sensitivity (60.7%) and specificity (63.5%).
CONCLUSION: Younger age, acute malnutrition, MSD severity, and sociodemographic factors were associated with short-term linear growth deterioration following MSD. Data routinely obtained at MSD may be useful to predict children at risk for growth deterioration who would benefit from interventions.

PMID: 31767012 [PubMed - in process]

Immune responses to O-specific polysaccharide (OSP) in North American adults infected with Vibrio cholerae O1 Inaba.

November 20, 2019
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Immune responses to O-specific polysaccharide (OSP) in North American adults infected with Vibrio cholerae O1 Inaba.

PLoS Negl Trop Dis. 2019 Nov;13(11):e0007874

Authors: Hossain M, Islam K, Kelly M, Mayo Smith LM, Charles RC, Weil AA, Bhuiyan TR, Kováč P, Xu P, Calderwood SB, Simon JK, Chen WH, Lock M, Lyon CE, Kirkpatrick BD, Cohen M, Levine MM, Gurwith M, Leung DT, Azman AS, Harris JB, Qadri F, Ryan ET

Abstract
BACKGROUND: Antibodies targeting O-specific polysaccharide (OSP) of Vibrio cholerae may protect against cholera; however, little is known about this immune response in infected immunologically naïve humans.
METHODOLOGY: We measured serum anti-OSP antibodies in adult North American volunteers experimentally infected with V. cholerae O1 Inaba El Tor N16961. We also measured vibriocidal and anti-cholera toxin B subunit (CtxB) antibodies and compared responses to those in matched cholera patients in Dhaka, Bangladesh, an area endemic for cholera.
PRINCIPAL FINDINGS: We found prominent anti-OSP antibody responses following initial cholera infection: these responses were largely IgM and IgA, and highest to infecting serotype with significant cross-serotype reactivity. The anti-OSP responses peaked 10 days after infection and remained elevated over baseline for ≥ 6 months, correlated with vibriocidal responses, and may have been blunted in blood group O individuals (IgA anti-OSP). We found significant differences in immune responses between naïve and endemic zone cohorts, presumably reflecting previous exposure in the latter.
CONCLUSIONS: Our results define immune responses to O-specific polysaccharide in immunologically naive humans with cholera, find that they are largely IgM and IgA, may be blunted in blood group O individuals, and differ in a number of significant ways from responses in previously humans. These differences may explain in part varying degrees of protective efficacy afforded by cholera vaccination between these two populations.
TRIAL REGISTRATION NUMBER: ClinicalTrials.gov NCT01895855.

PMID: 31743334 [PubMed - in process]

Cleanliness: Success in Water Borne Diseases.

November 20, 2019
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Cleanliness: Success in Water Borne Diseases.

Indian J Med Res. 2019 01;149(Suppl):S105-S109

Authors: Debnath F, Deb AK, Sinha A, Chatterjee P, Dutta S

PMID: 31070186 [PubMed - indexed for MEDLINE]

Modeling the 2016-2017 Yemen cholera outbreak with the impact of limited medical resources.

November 19, 2019
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Modeling the 2016-2017 Yemen cholera outbreak with the impact of limited medical resources.

J Theor Biol. 2018 08 14;451:80-85

Authors: He D, Wang X, Gao D, Wang J

Abstract
We present a mathematical model to investigate the transmission dynamics of the 2016-2017 Yemen cholera outbreak. Our model describes the interaction between the human hosts and the pathogenic bacteria, under the impact of limited medical resources. We fit our model to Yemen epidemic data published by the World Health Organization, at both the country and regional levels. We find that the Yemen cholera outbreak is shaped by the interplay of environmental, socioeconomic, and climatic factors. Our results suggest that improvement of the public health system and strategic implementation of control measures with respect to time and location are key to future cholera prevention and intervention in Yemen.

PMID: 29727633 [PubMed - indexed for MEDLINE]

Corrigendum to: Cholera outbreak during a scientific conference at a Nairobi hotel, Kenya 2017.

November 16, 2019
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Corrigendum to: Cholera outbreak during a scientific conference at a Nairobi hotel, Kenya 2017.

J Public Health (Oxf). 2019 Nov 15;:

Authors: Mwenda V, Niyomwungere A, Oyugi E, Githuku J, Obonyo M, Gura Z

PMID: 31728506 [PubMed - as supplied by publisher]

Health facility preparedness for cholera outbreak response in four cholera-prone districts in Cameroon: a cross sectional study.

November 16, 2019
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Health facility preparedness for cholera outbreak response in four cholera-prone districts in Cameroon: a cross sectional study.

BMC Health Serv Res. 2019 Jul 08;19(1):458

Authors: Ateudjieu J, Yakum MN, Goura AP, Nafack SS, Chebe AN, Azakoh JN, Chukuwchindun BA, Bayiha EJ, Kangmo C, Tachegno GVB, Bissek AZK

Abstract
BACKGROUND: The risk of cholera outbreak remains high in Cameroon. This is because of the persistent cholera outbreaks in neighboring countries coupled with the poor hygiene and sanitation conditions in Cameroon. The objective of this study was to assess the readiness of health facilities to respond to cholera outbreak in four cholera-prone districts in Cameroon.
METHODOLOGY: A cross-sectional study was conducted targeting all health facilities in four health districts, labeled as cholera hotspots in Cameroon in August 2016. Data collection was done by interview with a questionnaire and by observation regarding the availability of resources and materials for surveillance and case management, access to water, hygiene, and sanitation. Data analysis was descriptive with STATA 11.
PRINCIPAL FINDINGS: A total of 134 health facilities were evaluated, most of which (108/134[81%]) were urban facilities. The preparedness regarding surveillance was limited with 13 (50%) health facilities in the Far North and 22(20%) in the Littoral having cholera case definition guide. ORS for Case management was present in 8(31%) health facilities in the Far North and in 94(87%) facilities in the littoral. Less than half of the health facilities had a hand washing protocol and 7(5.1%) did not have any source of drinking water or relied on unimproved sources like lake. A total of 4(3.0%) health facilities, all in the Far North region, did not have a toilet.
CONCLUSIONS: The level of preparedness of health facilities in Cameroon for cholera outbreak response presents a lot of weaknesses. These are present in terms of lack of basic surveillance and case management materials and resources, low access to WaSH. If not addressed now, these facilities might not be able to play their role in case there is an outbreak and might even turn to be transmission milieus.

PMID: 31286934 [PubMed - indexed for MEDLINE]

Seasonal influence, enteropathogenic microbial load and diarrhoeal enigma in the Gangetic Delta, India: Present scenario and health implications.

November 15, 2019
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Seasonal influence, enteropathogenic microbial load and diarrhoeal enigma in the Gangetic Delta, India: Present scenario and health implications.

J Infect Public Health. 2019 Jul - Aug;12(4):540-548

Authors: Saha S, Halder M, Mookerjee S, Palit A

Abstract
BACKGROUND: Environmental diarrheagenic enteropathogens, effect of surrounding attributes and disease dynamicity remains far from being conclusively explored. Population flux, poor sanitation and hygienic practice poses potential health threat in diarrhoea endemic tropical countries like India. We aim to identify environmental attributes, seasonality of water-borne enteropathogens and health risk assessment off the river Ganges.
METHODS: A yearlong sampling data generated from three sites on either sides of the River was analysed and implications have been reported. Immediately after sample collection, physico chemical and bacterial indices were measured at the sampling site and laboratory respectively, followed by further statistical analysis of the findings.
RESULTS: Annual variation of physico-chemical indices viz., temperature 18°C-36°C, pH 7.49-8.67, conductivity 215-468μS/cm and turbidity 25.6-593 NTU was recorded in the riverine water samples. High temperature and turbidity were recorded in the summer and monsoon at all sites. High bacterial dispersion has been positively correlated with turbidity and temperature variation (P<0.01; P<0.1) as we report TBC 103-105CFU/ml, TCC 103-104CFU/ml and CVC 4-212CFU/ml, with higher distribution in the monsoon and reverse in the winter. This suggests that the bacterial pool proliferates at higher temperature whereas turbidity enhances their survival providing the substratum for the bacterial pool. CVC could be positively correlated with conductivity which implies that ionic content of water augments the Vibrio load. Adaptive capability of Vibrios to sustain in very low saline riverine setting seems to be assisted by turbid water coupled with nutrient rich organic matter.
CONCLUSION: Our present work establishes the interplay of seasonal variants on the dynamicity of enteropathogenic bacteria in flowing aquatic ecosystem. It also categorises the existing microbial threats in the Ganga River to help monitor the conventional as well as emerging diarrhoeal pathogens to reduce diarrheal recurrences.

PMID: 30792073 [PubMed - indexed for MEDLINE]

Reviving Phage Therapy for the Treatment of Cholera.

November 13, 2019
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Reviving Phage Therapy for the Treatment of Cholera.

J Infect Dis. 2019 02 15;219(5):786-794

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 - indexed for MEDLINE]

Seasonal Pattern of Pathogenic V. cholerae and V. paraheamolyticus in Surface Water of Dhaka, Bangladesh.

November 9, 2019
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Seasonal Pattern of Pathogenic V. cholerae and V. paraheamolyticus in Surface Water of Dhaka, Bangladesh.

Mymensingh Med J. 2019 Oct;28(4):872-880

Authors: Kabir A, Khaleque M, Akhter H, Begum A

Abstract
V. cholerae and V. parahaemolyticus are responsible for majority of the Vibrio-related infections world wide. In this observational study, we selected three important river and pondsites of Dhaka city, Bangladesh to observe the presence of pathogenic V. cholerae, and V. parahaemolyticus. Surface water samples were collected from July 2013 to April 2014. Identification of V. cholerae was confirmed by the presence of ompW gene by PCR. Vibrio cholerae was found in the unique dual peak (March to May and September to November) patternin Mirpur-1 Mazar pond and Abdullahpur bridge river site, like many other studies reported earlier in Dhaka with only one exception of finding V. cholerae in the month of July 2013 in Mirpur-1 Mazar pond. A single peak was found from September to November in Mirpur-1 river sites. The ctxB positive non- O1 V. cholerae has also been reported. The presence of ctxB gene was observed by MAMA PCR. The O1 and O139 serogroups were confirmed by O1rfb and O139 rfb genes in PCR. Both classical and El-Tor biotypes were observed in this one year round study. V. paraheamolyticus was confirmed by the presence of ToxRVP gene and all the strains were negative for tdh pathogenic gene by PCR. This study observed for the first time the seasonal pattern of V. parahaemolyticus in water bodies in Bangladesh showing a peak from February to April in all three sampling sites and another additional peak which span from August to September in Mirpur-1 Mazar pond, Dhaka, Bangladesh.

PMID: 31599254 [PubMed - indexed for MEDLINE]

Antibiotic resistance in Vibrio cholerae El Tor strains isolated during cholera complications in Siberia and the Far East of Russia.

November 7, 2019
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Antibiotic resistance in Vibrio cholerae El Tor strains isolated during cholera complications in Siberia and the Far East of Russia.

Infect Genet Evol. 2019 Nov 02;:104096

Authors: Gladkikh AS, Feranchuk SI, Ponomareva AS, Bochalgin NO, Mironova LV

Abstract
Currently, the spread of antimicrobial resistance (AMR) is a global trend and poses a severe threat to public health. The causative agent of cholera, an extremely virulent disease with pandemic expansion, becomes more and more resistant to a wider range of drugs with every coming year. The Vibrio cholerae genome is highly flexible and adaptive; the acquisition of the SXT mobile element with a cluster of antibiotic resistance genes on it has marked a new stage in the adaptive evolution of the pathogen. The territory of Siberia and Russian Far East is free of cholera; however, in the 1970s and 1990s a number of infection importation cases and acute outbreaks associated with the cholera importation were reported. The aim of this study was to describe the phenotypic characteristics and genetic determinants of AMR in V. cholerae strains isolated during epidemic complications in Siberia and the Far East of Russia, as well as to clarify the origin of the strains. The present research comprises analysis of nine V. cholerae El Tor strains isolated from patients and water sources during epidemic complications in Siberia and the Russian Far East in the 1990s. Here, we compared the phenotypic manifestations of antibiotic resistance among strains, harbored the resistance patterns in genomes; we also determined the structure, the type of SXT elements, and the mobilome profile based on the accepted classification. We identified that strains that caused outbreaks in Vladivostok and Yuzhno-Sakhalinsk in 1999 had ICEVchCHN4210 type SXT element with deletion of some loci. The research shows that the integration of the core genome, the SNP analysis and the analysis of mobilome, associated with antibiotic resistance, is necessary to understand the cholera epidemiology, it also helps to establish the origin of the strains. The study of resistance determinants features allowed to make a conclusion about the heterogeneity of V. cholerae strains that were isolated during outbreaks in Vladivostok and Yuzhno-Sakhalinsk in 1999.

PMID: 31689544 [PubMed - as supplied by publisher]

Herd protection of unvaccinated adults by oral cholera vaccines in rural Bangladesh.

November 7, 2019
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Herd protection of unvaccinated adults by oral cholera vaccines in rural Bangladesh.

Int Health. 2019 05 01;11(3):229-234

Authors: Ali M, Kim P, Zaman K, Clemens J

Abstract
BACKGROUND: Past research has suggested that the most cost-effective approach to using oral cholera vaccines (OCVs) to control endemic cholera may be to target only children <15 y of age. However, the assumption that vaccination of children with OCVs protects unvaccinated adults has never been tested.
METHODS: We reanalyzed the data of an OCV trial in Bangladesh in which children 2-15 y of age and women >15 y of age were allocated to OCV or placebo and assessed herd protection by relating the risk of cholera in each nonvaccinated adult (>15 y) to OCV coverage (OCVC) of residents residing in virtual clusters within 500 m of the residence of that unvaccinated adult.
RESULTS: The risk of cholera in unvaccinated adults decreased by 14% with each 10% increase of OCVC of all targeted age groups (95% 7 to 21%, p=0.0004). Also, the risk of cholera in unvaccinated adults decreased by 13% with each 10% increase in OCVC of children 2-15 y of age (95% CI 6 to 20%, p=0.0007). A high correlation between levels of OCVC of children and adult females precluded an assessment of the herd protection of unvaccinated adults by vaccinating children <16 y of age, independent of concomitant vaccination of adult women.
CONCLUSIONS: Unvaccinated adults benefitted from herd protection conferred by OCVs in this trial. Vaccination of children may be sufficient to confer this protection, but this possibility needs to be evaluated in further studies.

PMID: 30496408 [PubMed - indexed for MEDLINE]

Cholera: ending a 50-year pandemic.

November 7, 2019
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Cholera: ending a 50-year pandemic.

Lancet. 2017 10 07;390(10103):1623

Authors: The Lancet

PMID: 29131781 [PubMed - indexed for MEDLINE]

Immunogenicity and Protection From a Single Dose of Internationally Available Killed Oral Cholera Vaccine: A Systematic Review and Metaanalysis.

November 5, 2019
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Immunogenicity and Protection From a Single Dose of Internationally Available Killed Oral Cholera Vaccine: A Systematic Review and Metaanalysis.

Clin Infect Dis. 2018 06 01;66(12):1960-1971

Authors: Lopez AL, Deen J, Azman AS, Luquero FJ, Kanungo S, Dutta S, von Seidlein L, Sack DA

Abstract
In addition to improved water supply and sanitation, the 2-dose killed oral cholera vaccine (OCV) is an important tool for the prevention and control of cholera. We aimed to document the immunogenicity and protection (efficacy and effectiveness) conferred by a single OCV dose against cholera. The metaanalysis showed that an estimated 73% and 77% of individuals seroconverted to the Ogawa and Inaba serotypes, respectively, after an OCV first dose. The estimates of single-dose vaccine protection from available studies are 87% at 2 months decreasing to 33% at 2 years. Current immunologic and clinical data suggest that protection conferred by a single dose of killed OCV may be sufficient to reduce short-term risk in outbreaks or other high-risk settings, which may be especially useful when vaccine supply is limited. However, until more data suggest otherwise, a second dose should be given as soon as circumstances allow to ensure robust protection.

PMID: 29177437 [PubMed - indexed for MEDLINE]

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

November 1, 2019
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Formative research for the design of a scalable water, sanitation, and hygiene mobile health program: CHoBI7 mobile health program

BMC Public Health. 2019 07 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 - indexed for MEDLINE]

Epidemiology and antibiotic susceptibility of Vibrio cholerae associated with the 2017 outbreak in Kasese district, Uganda.

October 31, 2019
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Epidemiology and antibiotic susceptibility of Vibrio cholerae associated with the 2017 outbreak in Kasese district, Uganda.

BMC Public Health. 2019 Oct 29;19(1):1405

Authors: Iramiot JS, Rwego IB, Kansiime C, Asiimwe BB

Abstract
BACKGROUND: Uganda is among the 51 countries where cholera outbreaks are common with epidemics occurring predominantly along the western border with Democratic Republic of Congo (DRC), Kampala city slums, Busia district which is a border town with Western Kenya, Mbale district and the Karamoja Sub-region. This report summarizes findings from the epidemiologic investigation, which aimed at identifying the mode of transmission and antibiotic susceptibility patterns of the Vibrio cholerae isolated in Kasese district, Uganda.
METHODS: A descriptive cross-sectional study was carried out between 2017 and 2018 to describe the epidemiology of the cholera epidemic in Kasese district, Uganda. Rectal swabs were collected from 69 suspected case-persons and cultured on Thiosulphate-Citrate-Bile-Salts Sucrose (TCBS™; SEIKEN Japan) agar and incubated at 37 °C for 18-24 h. The isolates were serotyped with polyvalent 01 antiserum and monovalent serotype Inaba and Ogawa antisera (Denka Seiken, Tokyo, Japan) to determine which serotype was responsible for the outbreak. Antimicrobial susceptibility testing was performed using the Kirby-Bauer disk diffusion method on Mueller-Hinton agar. A list of discharged patients was obtained from the isolation units of Bwera hospital and Kagando hospital and the individuals were followed to the community where they live. Questionnaires were administered to a total of 75 participants who were either the cases or relatives to the case. GPS points of the homes of the cases and pictures of potential source infection were also taken and cases were mapped.
RESULTS: A total of 222 cases were recorded in the Kasese District outbreak between the month of September 2017 and January 2018 with the case fatality rate (CFR) of 1.4%. Children below the age of 14 years contributed the biggest proportion of the cases (70%) and out of these, 33% were aged below 5 years. Culture isolated 69 V. cholerae 01 serotype Inaba from the total of 71 samples. Salmonella typhi was Isolated from the other two samples which were negative for V. cholerae. Antibiotic susceptibility using Kirby-Bauer disc diffusion method was done on isolates from 69 participants and showed 100% resistance to Ampicillin and over 50% were resistant to trimethoprim/Sulfamethoxazole whereas gentamicin showed 100% susceptibility. Environmental assessment revealed rampant cases of open defecation.
CONCLUSION: Though we did not culture water to confirm contamination with Vibrio cholerae, we hypothesize that the cholera epidemic in Kasese 2017 was sparked off by consumption of contaminated water following the heavy floods that washed away latrines into water sources in Bwera, Isango and Nakiyumbu sub-counties. V. cholerae was also highly resistant to the commonly used antibiotics.

PMID: 31664972 [PubMed - in process]

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