Excess mortality in northern Haiti during the 2010 cholera epidemic.

In the course of infectious disease outbreaks, barriers to accessing health care can contribute to preventable mortality. According to the Ministry of Health of Haiti (Ministère de la Santé Publique et de la Population [MSPP]), the 2010 cholera epidemic caused 7,936 deaths from October 2010 to December 2012 in Haiti alone. We seek to quantify the excess mortality attributable to patients not seeking care during the cholera outbreak in the Nord Department in 2010-2012. Using data from a community-based retrospective survey conducted by Doctors Without Borders (Médecins Sans Frontières [MSF]) in Northern Haiti, we used logistic regression to examine the association between healthcare utilization and fatality among household members with watery diarrhea in the Communes of Borgne, Pilate, Plaisance, and Port-Margot in the Nord Department. We found that failing to seek care resulted in a 5-fold increase in the case fatality ratio among infected individuals (26%) versus those who sought care (5%). Common concerns noted for why care was not sought included travel distance to treatment centers, not attributing watery diarrhea episodes to cholera, and being unsure where to seek health care for their watery diarrhea episodes within their Communes. In conclusion, addressing transportation and information needs could increase healthcare utilization and reduce lives lost during an outbreak.

A commensal-encoded genotoxin drives restriction of Vibrio cholerae colonization and host gut microbiome remodeling.

SignificanceIn a polymicrobial battlefield where different species compete for nutrients and colonization niches, antimicrobial compounds are the sword and shield of commensal microbes in competition with invading pathogens and each other. The identification of an Escherichia coli-produced genotoxin, colibactin, and its specific targeted killing of enteric pathogens and commensals, including Vibrio cholerae and Bacteroides fragilis, sheds light on our understanding of intermicrobial interactions in the mammalian gut. Our findings elucidate the mechanisms through which genotoxins shape microbial communities and provide a platform for probing the larger role of enteric multibacterial interactions regarding infection and disease outcomes.

Quantification of Vibrio cholerae cholix exotoxin by sandwich bead-ELISA.

Introduction. Cholix toxin (ChxA) is an ADP-ribosylating exotoxin produced by Vibrio cholerae. However, to date, there is no quantitative assay available for ChxA, which makes it difficult to detect and estimate the level of ChxA produced by V. cholerae.Hypothesis/Gap Statement. It is important to develop a reliable and specific quantitative assay to measure the production level of ChxA, which will help us to understand the role of ChxA in V. cholerae pathogenesis.Aim. The aim of this study was to develop a bead-based sandwich ELISA (bead-ELISA) for the quantification of ChxA and to evaluate the importance of ChxA in the pathogenesis of V. cholerae infection.Methodology. Anti-rChxA was raised in New Zealand white rabbits, and Fab-horse radish peroxidase conjugate was prepared by the maleimide method to use in the bead-ELISA. This anti-ChxA bead-ELISA was applied to quantify the ChxA produced by various V. cholerae strains. The production of ChxA was examined in different growth media such as alkaline peptone water (APW), Luria-Bertani broth and AKI. Finally, the assay was evaluated using a mouse lethality assay with representative V. cholerae strains categorized as low to high ChxA-producers based on anti-ChxA bead-ELISA.Results. A sensitive bead-ELISA assay, which can quantify from 0.6 to 60 ng ml-1 of ChxA, was developed. ChxA was mostly detected in the extracellular cell-free supernatant and its production level varied from 1.2 ng ml-1 to 1.6 µg ml-1. The highest ChxA production was observed when V. cholerae strains were cultured in LB broth, but not in APW or AKI medium. The ChxA-producer V. cholerae strains showed 20-80 % lethality and only the high ChxA II-producer was statistically more lethal than a non-ChxA-producer, in the mice model assay. ChxA I and II production levels were not well correlated with mice lethality, and this could be due to the heterogeneity of the strains tested.Conclusion. ChxA I to III was produced mostly extracellularly at various levels depending on strains and culture conditions. The bead-ELISA developed in this study is useful for the detection and quantification of ChxA in V. cholerae strains.

Refugee Settlements and Cholera Risks in Uganda, 2016-2019.

During 2016 to 2019, cholera outbreaks were reported commonly to the Ministry of Health from refugee settlements. To further understand the risks cholera posed to refugees, a review of surveillance data on cholera in Uganda for the period 2016-2019 was carried out. During this 4-year period, there were seven such outbreaks with 1,495 cases and 30 deaths in five refugee settlements and one refugee reception center. Most deaths occurred early in the outbreak, often in the settlements or before arrival at a treatment center rather than after arrival at a treatment center. During the different years, these outbreaks occurred during different times of the year but simultaneously in settlements that were geographically separated and affected all ages and genders. Some outbreaks spread to the local populations within Uganda. Cholera control prevention measures are currently being implemented; however, additional measures are needed to reduce the risk of cholera among refugees including oral cholera vaccination and a water, sanitation and hygiene package during the refugee registration process. A standardized protocol is needed to quickly conduct case-control studies to generate information to guide future cholera outbreak prevention in refugees and the host population.

The cholera risk assessment in Kano State, Nigeria: A historical review, mapping of hotspots and evaluation of contextual factors.

Nigeria is endemic for cholera since 1970, and Kano State report outbreaks annually with high case fatality ratios ranging from 4.98%/2010 to 5.10%/2018 over the last decade. However, interventions focused on cholera prevention and control have been hampered by a lack of understanding of hotspot Local Government Areas (LGAs) that trigger and sustain yearly outbreaks. The goal of this study was to identify and categorize cholera hotspots in Kano State to inform a national plan for disease control and elimination in the State. We obtained LGA level confirmed and suspected cholera data from 2010 to 2019 from the Nigeria Centre for Disease Control (NCDC) and Kano State Ministry of Health. Data on inland waterbodies and population numbers were obtained from online sources and NCDC, respectively. Clusters (hotspots) were identified using SaTScan through a retrospective analysis of the data for the ten-year period using a Poisson discrete space-time scan statistic. We also used a method newly proposed by the Global Task Force on Cholera Control (GTFCC) to identify and rank hotspots based on two epidemiological indicators including mean annual incidence per 100 000 population of reported cases and the persistence of cholera for the study period. In the ten-year period, 16,461 cholera cases were reported with a case fatality ratio of 3.32% and a mean annual incidence rate of 13.4 cases per 100 000 population. Between 2010 and 2019, the most severe cholera exacerbations occurred in 2014 and 2018 with annual incidence rates of 58.01 and 21.52 cases per 100 000 inhabitants, respectively. Compared to 2017, reported cases and deaths increased by 214.56% and 406.67% in 2018. The geographic distribution of outbreaks revealed considerable spatial heterogeneity with the widest in 2014. Space-time clustering analysis identified 18 out of 44 LGAs as high risk for cholera (hotspots) involving both urban and rural LGAs. Cholera clustered around water bodies, and the relative risk of having cholera inside the hotspot LGA were 1.02 to 3.30 times higher than elsewhere in the State. A total of 4,894,144 inhabitants were in these hotspots LGAs. Of these, six LGAs with a total population of 1.665 million had a relative risk greater than 2 compared to the state as a whole. The SaTScan (statistical) and GTFCC methods were in agreement in hotspots identification. This study identified cholera hotspots LGAs in Kano State from 2010-2019. Hotspots appeared in both urban and rural settings. Focusing control strategies on these hotspots will facilitate control and eliminate cholera from the State.

Expression in Saccharomyces boulardii of recombinant Toxin-coregulated pilus A subunit (TcpA) of Vibrio cholerae O1

Cholera is endemic in over 50 countries with an estimated mortality of 100,000-120,000. Vaccination is considered the complementary key to prevent and control cholera; therefore, alternative vaccine preparations are needed. Toxin Co-regulated Pilus is part of the toxR virulence regulon, which is necessary for colonization in the intestinal mucosa. In order to express Vibrio cholerae TcpA protein in Saccharomyces boulardii, the expression plasmid pYES2 was constructed by inserting tcpA gene isolated from local Vibrio cholerae Eltor Inaba isolates. The new construct was transferred into Saccharomyces boulardii cells and the expression of tcpA gene was induced from the GAL1 promoter by adding galactose to the medium. The SDS-PAGE and Western blot analysis showed the presence of TcpA in yeast. These results showed that Saccharomyces boulardii is a promising host to express Vibrio cholerae toxin TcpA as the first step in attempt to produce an oral Vibrio cholerae vaccine(AU)

El cólera es endémico en más de 50 países. Se estima una mortalidad entre 100.000 - 120.000 debido a esta enfermedad. La vacunación se considera una medida complementaria para prevenir y controlar el cólera, por lo tanto, se necesitan preparaciones vacunales alternativas a las existentes. El Pili corregulado con la toxina, es parte del regulón de virulencia toxR, y es necesario para la colonización en la mucosa intestinal. Para expresar la proteína tcpA de Vibrio cholerae en Saccharomyces boulardii, se construyó el plásmido de expresión pYES2 insertando el gen tcpA obtenido a partir de aislamientos locales de Vibrio cholerae El Tor Inaba. La nueva construcción se transfirió a las células de Saccharomyces boulardii y se indujo la expresión del gen tcpA a partir del promotor GAL1 mediante la adición de galactosa al medio. El análisis mediante SDS-PAGE y Western blot demostró la presencia de TcpA en levaduras. Los resultados demostraron que Saccharomyces boulardii es un hospedero prometedor para expresar el gen tcpA de Vibrio cholerae como el primer paso en el intento de producir una vacuna oral contra Vibrio cholerae(AU)

Demographic and social context of deaths during the 1854 cholera outbreak in Soho, London: a reappraisal of Dr John Snow's investigation.

Deaths from cholera in Soho, London (late July to end of September 1854) exposed the epidemiology of the disease and demonstrated applied geospatial analysis by highlighting the shortest path principle followed by local residents when they obtained drinking water from a contaminated pump. The present investigation explores if households and individuals with different demographic and socio-economic characteristics were more or less likely to obtain their water from the pump and succumb to the disease. It combines information from the 1851 Population Census and topographic databases with the digital deaths and water pump data to reveal the risk of exposure and the mortality rate were greater for certain occupations, age groups and people living at high residential density irrespective of proximity to the contaminated water pump.

Cholera deaths in Soho, London, 1854: Risk Terrain Modeling for epidemiological investigations.

Risk Terrain Modeling (RTM) is a spatial analysis technique used to diagnose environmental conditions that lead to hazardous outcomes. Originally developed for applications to violent crime analysis, RTM is utilized here to analyze Dr. John Snow's data from the 1854 cholera outbreak in London to demonstrate its potential value to contemporary epidemiological investigations. Dr. Snow saved countless lives when he traced the source of the cholera outbreak to a specific water pump through inductive reasoning, which he communicated through maps and spatial evidence. His methods have since inspired several fields of scientific inquiry. Informed by the extant research on RTM, we speculated that it could have helped test Dr. Snow's hypothesis about cholera and empirically identified the sole source of contaminated well water. We learned that it could and, although it was not available to Dr. Snow in the 1800s, we discuss RTM's implications for present-day research and practice as it relates to the analysis, prevention and treatment of cholera and other public health threats around the world.

Risk and Protective Factors for Cholera Deaths during an Urban Outbreak-Lusaka, Zambia, 2017-2018.

The Republic of Zambia declared a cholera outbreak in Lusaka, the capital, on October 6, 2017. By mid-December, 20 of 661 reported cases had died (case fatality rate 3%), prompting the CDC and the Zambian Ministry of Health through the Zambia National Public Health Institute to investigate risk factors for cholera mortality. We conducted a study of cases (cholera deaths from October 2017 to January 2018) matched by age-group and onset date to controls (persons admitted to a cholera treatment center [CTC] and discharged alive). A questionnaire was administered to each survivor (or relative) and to a family member of each decedent. We used univariable exact conditional logistic regression to calculate matched odds ratios (mORs) and 95% CIs. In the analysis, 38 decedents and 76 survivors were included. Median ages for decedents and survivors were 38 (range: 0.5-95) and 25 (range: 1-82) years, respectively. Patients aged > 55 years and those who did not complete primary school had higher odds of being decedents (matched odds ratio [mOR] 6.3, 95% CI: 1.2-63.0, P = 0.03; mOR 8.6, 95% CI: 1.8-81.7, P < 0.01, respectively). Patients who received immediate oral rehydration solution (ORS) at the CTC had lower odds of dying than those who did not receive immediate ORS (mOR 0.1, 95% CI: 0.0-0.6, P = 0.02). Cholera prevention and outbreak response should include efforts focused on ensuring access to timely, appropriate care for older adults and less educated populations at home and in health facilities.

Identifying and quantifying the factors associated with cholera-related death during the 2018 outbreak in Nigeria.

INTRODUCTION: cholera outbreaks in Nigeria are often associated with high case fatality rates; however, there is a dearth of evidence on context-specific factors associated with the trend. This study therefore aimed to identify and quantify the factors associated with cholera-related deaths in Nigeria. METHODS: using a cross-sectional design, we analysed surveillance data from all the States that reported cholera cases during the 2018 outbreak, and defined cholera-related death as death of an individual classified as having cholera according to the Nigeria Centre for Disease Control case definition. Factors associated with cholera-related death were assessed using multivariable logistic regression and findings presented as adjusted odds ratios (ORs) with 95% Confidence Intervals (95% CIs). RESULTS: between January 1 and November 19, 2018, 41,394 cholera cases were reported across 20 States, including 815 cholera-related deaths. In the adjusted multivariable model, older age, male gender, living in peri-urban areas or in flooded states, infection during the rainy season, and delay in seeking health care by >2 days were positively associated with cholera-related death; whereas living in urban areas, hospitalisation in the course of illness, and presentation to a secondary hospital were negatively associated with cholera-related death. CONCLUSION: cholera-related deaths during the 2018 outbreak in Nigeria appeared to be driven by multiple factors, which further reemphasises the importance of adopting a multisectoral approach to the design and implementation of context-specific interventions in Nigeria.

Descriptive epidemiology of cholera outbreak in Nigeria, January-November, 2018: implications for the global roadmap strategy.

BACKGROUND: The cholera outbreak in 2018 in Nigeria reaffirms its public health threat to the country. Evidence on the current epidemiology of cholera required for the design and implementation of appropriate interventions towards attaining the global roadmap strategic goals for cholera elimination however seems lacking. Thus, this study aimed at addressing this gap by describing the epidemiology of the 2018 cholera outbreak in Nigeria. METHODS: This was a retrospective analysis of surveillance data collected between January 1st and November 19th, 2018. A cholera case was defined as an individual aged 2 years or older presenting with acute watery diarrhoea and severe dehydration or dying from acute watery diarrhoea. Descriptive analyses were performed and presented with respect to person, time and place using appropriate statistics. RESULTS: There were 43,996 cholera cases and 836 cholera deaths across 20 states in Nigeria during the outbreak period, with an attack rate (AR) of 127.43/100,000 population and a case fatality rate (CFR) of 1.90%. Individuals aged 15 years or older (47.76%) were the most affected age group, but the proportion of affected males and females was about the same (49.00 and 51.00% respectively). The outbreak was characterised by four distinct epidemic waves, with higher number of deaths recorded in the third and fourth waves. States from the north-west and north-east regions of the country recorded the highest ARs while those from the north-central recorded the highest CFRs. CONCLUSION: The severity and wide-geographical distribution of cholera cases and deaths during the 2018 outbreak are indicative of an elevated burden, which was more notable in the northern region of the country. Overall, the findings reaffirm the strategic role of a multi-sectoral approach in the design and implementation of public health interventions aimed at preventing and controlling cholera in Nigeria.

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

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

RésuméContexte: Le choléra est endémique en Afrique subsaharienne, en particulier dans les zones touchées par des catastrophes naturelles et des conflits humains. Le nord-est du Nigéria traverse une crise sanitaire en raison de la destruction d'équipements essentiels tels que des infrastructures de santé, des installations sanitaires, des réserves d'eau et des ressources humaines par les insurgés de Boko Haram. En 2017, une épidémie de choléra est survenue dans cinq zones de gouvernement local (LGA) accueillant des personnes déplacées. Le Centre nigérian pour le contrôle des maladies, l'Organisation mondiale de la santé, Médecins sans frontières internationaux et plusieurs autres organisations ont plaidé en faveur du contrôle de la maladie. Un centre d'opération d'urgence (EOC) établi par le ministère de la Santé de l'État (SMoH ) a ensuite coordonné la réponse à l'épidémie. Méthodes: Nous avons effectué une analyse rétrospective des données extraites de la liste de lignes utilisée par le SMoH pour enquêter sur les épidémies. Nous avons évalué l'épidémie par heure, lieu et personne. Le taux d'attaque par LGA et de l' âge - le taux de létalité spécifique (CFR) a été calculé sur la base des cas avec des dossiers complets pour l' âge, le sexe, le lieu de résidence, la date d'apparition des symptômes, et le résultat de la maladie. Résultats: Un total de 5889 cas de choléra ont été signalés par cinq LGA avec un taux d'attaque global de 395.3/100,000 personnes. Parmi les 4956 cas dont les résultats ont été documentés, le taux de létalité global était de 0,87%, avec une valeur variant entre 0% et 6,98% par la LGA. L'âge - CFR spécifique était le plus élevé parmi les personnes âgées de ≥60 ans (1,92%) et moins parmi les 20-29 ans à 0,3% âgés. La courbe épidémiologique a révélé deux pics qui coïncidaient avec des périodes de fortes pluies et d'inondations. Conclusion: cette étude fait état de la plus grande épidémie jamais enregistrée dans l' époque du choléra dans cinq LGA de l' État de Borno. L'épidémie était concentrée dans les collectivités locales touchées le plus durement par les activités destructrices des insurgés et s'était ensuite étendue aux collectivités locales voisines. Le faible taux de CFR enregistré dans cette épidémie de choléra a été atteint grâce à une détection, une notification et une réponse rapides, grâce aux efforts coordonnés du COU, mis en place par le SMOH, qui a harmonisé la réponse à la flambée. Mots-clés: Taux de mortalité, choléra, insurrection, nord-est du Nigéria, épidémie.

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

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-1ß, 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.

Aproximación a la mortalidad atribuible al Cólera-Morbo Asiático en Plasencia en 1834 a través de los registros parroquiales / Approaching the mortality attributable to cholera-Naughty Asian in Plasencia in 1834 through the parish registers / Aproximando-se da mortalidade atribuível à cólera-impertinente asiático em Plasencia em 1834 através dos registros paroquiais

Objetivo: El presente trabajo tiene como objetivo realizar un acercamiento a la mortalidad atribuible al cólera de 1834 en Plasencia a partir de la mortalidad absoluta. Método: Se trata de una investigación que se diseña como un estudio descriptivo, transversal y retrospectivo. Utilizando como fuente principal los registros sacramentales de defunción de las cinco parroquias existentes en el siglo XIX en la localidad, se realiza un análisis demográfico. Resultados: Podemos decir que el cólera fue el causante de un aumento en el número de enfermos y muertos, con datos interesantes a destacar como: la puesta de manifiesto de desigualdades sociales, su selectividad social y urbanística, sobremortalidad femenina etc. Conclusiones: Teniendo claro que partimos de una revisión indirecta, conocidas y minimizadas otras variables, como el hambre por malas cosechas (imposibles de aislar), el aumento de la mortalidad en esos meses debía obedecer entonces a alguna causa extraordinaria que coexistiera, y esa era la enfermedad del cólera

Objective: The objective of this study is to estimate the mortality rate attributable to cholera in 1834 in Plasencia, based on absolute mortality.Method: This is an investigation that is designed as a descriptive, cross-sectional and retrospective study. Using as the main source the sacramental records of death of the five parishes in the nineteenth century in the locality, a demographic analysis is carried out. Results: We can say that cholera was the cause of an increase in the number of sick and dead, with interesting data to highlight such as: the manifestation of social inequalities, social and urban selectivity, female overmortality, etc. Conclusions: It is clear that we started with an indirect review, known and minimized other variables, such as hunger for bad harvests (impossible to isolate), the increase in mortality in those months should then obey some extraordinary cause that coexisted, and that era The disease of cholera

Objetivo: Este estudo tem como objetivo fazer uma abordagem para a mortalidade atribuível à cólera em Plasencia 1834 da mortalidade absoluta. Método: Trata-se de uma investigação que é concebido como um estudo descritivo, transversal e retrospectivo. Utilizando como principal fonte sacramentais registros de morte dos cinco existentes no século XIX, nas paróquias da cidade, uma análise demográfica é realizada. Resultados: Podemos dizer que a cólera era a causa de um aumento no número de doentes e mortos, com dados interessantes a emergir como os que fazem as desigualdades se manifestam sociais, seletividade social e urbana, oexcesso de mortalidade femininaetc. Conclusões: Dado claro que começamos apartir de uma avaliação indireta, conhecidos eminimizados outras variáveis, como a fome porcolheitas pobres (impossível isolar), aumento damortalidade nesses meses seria, então, devido aalgumas causas extraordinárias coexistir, e queera doença de cólera

Cholera: under diagnosis and differentiation from other diarrhoeal diseases.

BACKGROUND: Globally 1.4 billion people are at risk from cholera in countries where the disease is endemic, with an estimated 2.8 million cases annually. The disease is significantly under reported due to economic, social and political disincentives as well as poor laboratory resources and epidemiological surveillance in those regions. In addition, identification of cholera from other diarrhoeal causes is often difficult due to shared pathology and symptoms with few reported cases in travellers from Northern Europe. METHODS: A search of PubMed and Ovid Medline for publications on cholera diagnosis from 2010 through 2017 was conducted. Search terms included were cholera, Rapid Diagnostic Test (RDT), multiplex PCR and diagnosis of diarrhoea. Studies were included if they are published in English, French or Spanish. RESULTS: An increase of RDT study publications for diarrhoeal disease and attempted test validations were seen over the publication period. RDTs were noted as having varied selectivity and specificity, as well as associated costs and local resource requirements that can prohibit their use. CONCLUSIONS: Despite opportunities to employ RDTs with high selectivity and specificity in epidemic areas, or in remote locations without access to health services, such tests are limited to surveillance use. This may represent a missed opportunity to discover the true global presence of Vibrio cholerae and its role in all cause diarrhoeal disease in underdeveloped countries and in travellers to those areas. The wider applicability of RDTs may also represent an opportunity in the wider management of traveller's diarrhoea.

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

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

Anti-Vibriocholerae IgY Antibody Inhibits Mortality in Suckling Mice Model.

BACKGROUND: Regarding to the importance of cholera in Iran and the potential advantages of egg yolk antibody (IgY) for immunotherapy, the aim of this study was to produce IgY antibody against V. cholerae Lipopolysaccharide (LPS) and determine its potential for V. cholerae treatment. METHODS: LPS was prepared, and the Anti-V. cholerae LPS IgY was purified from egg yolk and serially diluted in phosphate-buffered saline (PBS), mixed with V. cholerae and then gavaged into several groups of suckling mice. RESULTS: The yield of Anti-LPS IgY extraction was 40 mg/Egg yolk. The results demonstrated that up to approximately 75 ng of IgY can detect specifically V. cholerae. The lowest protective dose of anti-V. cholerae LPS IgY was 2.5 µg. CONCLUSIONS: The produced anti-Vibrio LPS specific IgY showed a good reactivity with its specific antigen and it may use as a complimentary oral immunotherapy for cholera disease.

Cholera Epidemics of the Past Offer New Insights Into an Old Enemy.

Background: Although cholera is considered the quintessential long-cycle waterborne disease, studies have emphasized the existence of short-cycle (food, household) transmission. We investigated singular Danish cholera epidemics (in 1853) to elucidate epidemiological parameters and modes of spread. Methods: Using time series data from cities with different water systems, we estimated the intrinsic transmissibility (R0). Accessing cause-specific mortality data, we studied clinical severity and age-specific impact. From physicians' narratives we established transmission chains and estimated serial intervals. Results: Epidemics were seeded by travelers from cholera-affected cities; initial transmission chains involving household members and caretakers ensued. Cholera killed 3.4%-8.9% of the populations, with highest mortality among seniors (16%) and lowest in children (2.7%). Transmissibility (R0) was 1.7-2.6 and the serial interval was estimated at 3.7 days (95% confidence interval, 2.9-4.7 days). The case fatality ratio (CFR) was high (54%-68%); using R0 we computed an adjusted CFR of 4%-5%. Conclusions: Short-cycle transmission was likely critical to early secondary transmission in historic Danish towns. The outbreaks resembled the contemporary Haiti outbreak with respect to transmissibility, age patterns, and CFR, suggesting a role for broader hygiene/sanitation interventions to control contemporary outbreaks.

Cholera Mortality during Urban Epidemic, Dar es Salaam, Tanzania, August 16, 2015-January 16, 20161.

In 2015, a cholera epidemic occurred in Tanzania; most cases and deaths occurred in Dar es Salaam early in the outbreak. We evaluated cholera mortality through passive surveillance, burial permits, and interviews conducted with decedents' caretakers. Active case finding identified 101 suspected cholera deaths. Routine surveillance had captured only 48 (48%) of all cholera deaths, and burial permit assessments captured the remainder. We interviewed caregivers of 56 decedents to assess cholera management behaviors. Of 51 decedents receiving home care, 5 (10%) used oral rehydration solution after becoming ill. Caregivers reported that 51 (93%) of 55 decedents with known time of death sought care before death; 16 (29%) of 55 delayed seeking care for >6 h. Of the 33 (59%) community decedents, 20 (61%) were said to have been discharged from a health facility before death. Appropriate and early management of cholera cases can reduce the number of cholera deaths.