Detection of Vibrio cholerae O1 and O139 in environmental waters of rural Bangladesh: a flow-cytometry-based field trial.

Presence of Vibrio cholerae serogroups O1 and O139 in the waters of the rural area of Matlab, Bangladesh, was investigated with quantitative measurements performed with a portable flow cytometer. The relevance of this work relates to the testing of a field-adapted measurement protocol that might prove useful for cholera epidemic surveillance and for validation of mathematical models. Water samples were collected from different water bodies that constitute the hydrological system of the region, a well-known endemic area for cholera. Water was retrieved from ponds, river waters, and irrigation canals during an inter-epidemic time period. Each sample was filtered and analysed with a flow cytometer for a fast determination of V. cholerae cells contained in those environments. More specifically, samples were treated with O1- and O139-specific antibodies, which allowed precise flow-cytometry-based concentration measurements. Both serogroups were present in the environmental waters with a consistent dominance of V. cholerae O1. These results extend earlier studies where V. cholerae O1 and O139 were mostly detected during times of cholera epidemics using standard culturing techniques. Furthermore, our results confirm that an important fraction of the ponds' host populations of V. cholerae are able to self-sustain even when cholera cases are scarce. Those contaminated ponds may constitute a natural reservoir for cholera endemicity in the Matlab region. Correlations of V. cholerae concentrations with environmental factors and the spatial distribution of V. cholerae populations are also discussed.

The role of aquatic reservoir fluctuations in long-term cholera patterns.

We propose and analyze an important extension of standard cholera epidemiological models, explicitly accounting for fluctuations of water availability to the human community under study. The seasonality of water input in the reservoir drives the variation of concentration of Vibrio cholerae. Two compartments are added to the Susceptible-Infected-Bacteria model. First, the recovered individuals, which, over many seasons, lose their immunity to the disease and replenish the Susceptible group. Second, the water volume of the reservoir, which determines bacterial dilution and, consequently, the probability of contracting cholera by ingesting contaminated water. By forcing the model with a seasonally varying hydrologic input, we obtain simulations that can be compared to available data for various regions of the World characterized by different hydrological and epidemiological regimes. The model is shown to satisfactorily reproduce important characteristics of disease insurgence and long-term persistence. Using bifurcation analysis of nonlinear systems, we also explore how different degrees of seasonality and values of the basic reproductive number can change the expected long-term epidemiological time series. We find that there exist parametric conditions where the model shows chaotic patterns - i.e. high unpredictability especially in the amplitude of prevalence peaks - which very much resemble actual data on long-term cholera insurgence.

Modelling cholera epidemics: the role of waterways, human mobility and sanitation.

We investigate the role of human mobility as a driver for long-range spreading of cholera infections, which primarily propagate through hydrologically controlled ecological corridors. Our aim is to build a spatially explicit model of a disease epidemic, which is relevant to both social and scientific issues. We present a two-layer network model that accounts for the interplay between epidemiological dynamics, hydrological transport and long-distance dissemination of the pathogen Vibrio cholerae owing to host movement, described here by means of a gravity-model approach. We test our model against epidemiological data recorded during the extensive cholera outbreak occurred in the KwaZulu-Natal province of South Africa during 2000-2001. We show that long-range human movement is fundamental in quantifying otherwise unexplained inter-catchment transport of V. cholerae, thus playing a key role in the formation of regional patterns of cholera epidemics. We also show quantitatively how heterogeneously distributed drinking water supplies and sanitation conditions may affect large-scale cholera transmission, and analyse the effects of different sanitation policies.