Cholera at the beginning of the XXI century. Prognosis

The worldwide epidemiological situation in cholera El Tor at the beginning of this century is presented; among its characteristic features are continued extensive epidemics and outbreaks in African and Asian countries with cases of import of this infection to other continents. Outbreaks caused by a new variant of the infective agent of cholera, Vibrio cholerae O139, are still registered at limited territories in the countries of South-East Asia. In some CIS countries (Azerbaijan, Kazakhstan and Russia) unstable situation in cholera is still preserved due to cases of infection import mainly from Asian countries, as well as to the isolation of epidemically insignificant haemolysin-positive and haemolysin-negative V. cholerae O1 and O139, containing no ctx and tcpA genes, from surface water reservoirs and other environmental objects. In Russia prognosis for cholera is still unfavorable.     

Cholera in the Far East of Russia. Communication 2. Epidemiological characteristics of the outbreak of cholera El tor in Iuzhno-Sakhalinsk

The outbreak of cholera eltor in Yuzhno-Sakhalinsk has been analyzed. The fact of the import of this infection from China and its transmission mainly by the water route due to the intensive contamination of environmental objects has been substantiated. The effective purification decontamination of sewage water plays decisive role on the system of anticholera measures. The conclusion on the necessity of increasing the effectiveness of measures for the sanitary protection of the territory has been made.     

The characteristics of a cholera outbreak in Pushkino District, the Azerbaijan SSR

The outbreak of cholera in the Pushkino District of the Azerbaijan SSR, caused by the penetration of Vibrio cholerae into the water of the irrigation system, is described. Altogether 2 cholera patients and 39 Vibrio carriers were detected. The etiological agent of this infection was V. cholerae eltor, serovar Ogawa, with typical phenotype characteristics. From all patients and 37 carriers virulent strains and from 2 carriers faintly virulent strains were isolated. In this outbreak family foci were clearly observed, but the transmission of infection through everyday contacts was practically of no importance. The foci with multiple cases were formed due to the action of one transmission factor: contaminated water.     

Evolution of the epidemiology of cholera

The problems of the evolution of cholera at the stages of its pandemic spread are described. A short characterization of endemic zones in the countries of Asia, Africa and Latin America, stipulating the preservation of infection and the appearance of periodic epidemics in the world, is presented. Special attention is paid to the genesis of epidemic outbreaks in endemic and introduced foci of cholera, differing in the specific features of their formation and the accumulation of the epidemic variant of the infective agent in aqueous habitat. The role of the ecosystem of surface water reservoirs in the prolonged survival of cholera vibrios is evaluated. The necessity of the detailed study of the mechanisms and forms of existence of serogroup 0139 vibrio in open water reservoirs is substantiated. In the system of epidemiological surveillance on cholera the microbiological monitoring of environmental objects assumes the leading importance.     

Houseflies (M. domestica L.) as transmitters of the agent of cholera

The authors present the experimental results of study of the role played by domestic flies in the spread of cholera causative agents. It was found that cholera microbes survived on the external surface of flies for 5 to 7 days, and in the insect organism--in the course of their whole life. Cholera vibrios underwent no sharp changes in the organism of flies. By means of individual infection method and keeping of flies excluding a possibility. By means of individual infection method and keeping of flies excluding a possibility of repeated autoinfection it was revealed that cholera vibrios could multiply in the organism of domestic flies. The infected insects can discharge cholera vibrios for a long time into the external environment and contaminate food.     

Cholera in Kazan. Organization and implementation of cholera control interventions

Data on emergent epidemiological analysis of the cholera outbreak in Kazan are presented. A version of the cholera focus emergence was confirmed, namely water route of transmission as a result of bathing in a water reservoir where sewage waters had penetrated. The outbreak had local and acute character. The complex of cholera control interventions aimed at localization and liquidation of the focus proved to be effective.     

Conformations of higher gangliosides and their binding with cholera toxin - investigation by molecular modeling, molecular mechanics, and molecular dynamics

Molecular mechanics and molecular dynamics studies are performed to investigate the conformational preference of cell surface higher gangliosides (GT1A and GT1B) and their interaction with Cholera Toxin. The water mediated hydrogen bonding network exists between sugar residues in gangliosides. An integrated molecular modeling, molecular mechanics, and molecular dynamics calculation of cholera toxin complexed with GT1A and GT1B reveal that, the active site of cholera toxin can accommodate these higher gangliosides. Direct and water mediated hydrogen bonding interactions stabilize these binding modes and play an essential role in defining the order of specificity for different higher ganglioside towards cholera toxin. This study identifies that the binding site of cholera toxin is shallow and can accommodate a maximum of two NeuNAc residues. The NeuNAc binding site of cholera toxin may be crucial for the design of inhibitors that can prevent the infection of cholera.     

Household Transmission of Vibrio cholerae in Bangladesh

Background

Vibrio cholerae infections cluster in households. This study''s objective was to quantify the relative contribution of direct, within-household exposure (for example, via contamination of household food, water, or surfaces) to endemic cholera transmission. Quantifying the relative contribution of direct exposure is important for planning effective prevention and control measures.

Methodology/Principal Findings

Symptom histories and multiple blood and fecal specimens were prospectively collected from household members of hospital-ascertained cholera cases in Bangladesh from 2001–2006. We estimated the probabilities of cholera transmission through 1) direct exposure within the household and 2) contact with community-based sources of infection. The natural history of cholera infection and covariate effects on transmission were considered. Significant direct transmission (p-value<0.0001) occurred among 1414 members of 364 households. Fecal shedding of O1 El Tor Ogawa was associated with a 4.9% (95% confidence interval: 0.9%–22.8%) risk of infection among household contacts through direct exposure during an 11-day infectious period (mean length). The estimated 11-day risk of O1 El Tor Ogawa infection through exposure to community-based sources was 2.5% (0.8%–8.0%). The corresponding estimated risks for O1 El Tor Inaba and O139 infection were 3.7% (0.7%–16.6%) and 8.2% (2.1%–27.1%) through direct exposure, and 3.4% (1.7%–6.7%) and 2.0% (0.5%–7.3%) through community-based exposure. Children under 5 years-old were at elevated risk of infection. Limitations of the study may have led to an underestimation of the true risk of cholera infection. For instance, available covariate data may have incompletely characterized levels of pre-existing immunity to cholera infection. Transmission via direct exposure occurring outside of the household was not considered.

Conclusions

Direct exposure contributes substantially to endemic transmission of symptomatic cholera in an urban setting. We provide the first estimate of the transmissibility of endemic cholera within prospectively-followed members of households. The role of direct transmission must be considered when planning cholera control activities.     

Role of neuraminidase from cholera vibrions in the pathogenesis of experimental cholera]

A study was made of a possible effect of neuraminidase of cholera vibrios on cholera pathogenesis. It was shown that in intraintestinal injection of cholera vibrios of the El Tor biotype to nursling rabbits neuraminidase could be revealed in their intestine 5 to 8 hours after the infection. Addition of neuraminidase to the weakly cholerogenic strain cholera vibrios intensified its cholerogenic action in infection of the animals. The antineuraminidase serum administered to the infected rabbits prevented clinical manifestations of experimental cholera, although it failed to always eliminate the cholerogenic syndrome (revealed during autopsy). At the same time neuraminidase did not influence the capacity of cholerogen to produce the cholerogenic syndrome. The authors consider that the action of the enzyme should occur at the early stages of the pathogenic process, and could be associated with creation of conditions for the attachement of cholera causative agent to the intestinal wall or for the action of their exotoxin.     

Sachet water consumption as a risk factor for cholera in urban settings: Findings from a case control study in Kinshasa,Democratic Republic of the Congo during the 2017–2018 outbreak

BackgroundBehavioural risk factors for cholera are well established in rural and semi-urban contexts, but not in densely populated mega-cities in Sub-Saharan Africa. In November 2017, a cholera epidemic occurred in Kinshasa, the Democratic Republic of the Congo, where no outbreak had been recorded for nearly a decade. During this outbreak, we investigated context-specific risk factors for cholera in an urban setting among a population that is not frequently exposed to cholera.Methodology/Principal findingsWe recruited 390 participants from three affected health zones of Kinshasa into a 1:1 matched case control study. Cases were identified from cholera treatment centre admission records, while controls were recruited from the vicinity of the cases’ place of residence. We used standardized case report forms for the collection of socio-demographic and behavioural risk factors. We used augmented backward elimination in a conditional logistic regression model to identify risk factors.The consumption of sachet water was strongly associated with the risk of being a cholera case (p-value 0.019), which increased with increasing frequency of consumption from rarely (OR 2.2, 95% CI 0.9–5.2) to often (OR 4.0, 95% CI 1.6–9.9) to very often (OR 4.1, 95% CI 1.0–16.7). Overall, more than 80% of all participants reported consumption of this type of drinking water. The risk factors funeral attendance and contact with someone suffering from diarrhoea showed a p-value of 0.09 and 0.08, respectively. No socio-demographic characteristics were associated with the risk of cholera.Conclusions/SignificanceDrinking water consumption from sachets, which are sold informally on the streets in most Sub-Saharan African cities, are an overlooked route of infection in urban cholera outbreaks. Outbreak response measures need to acknowledge context-specific risk factors to remain a valuable tool in the efforts to achieve national and regional targets to reduce the burden of cholera in Sub-Saharan Africa.     

Correlations of daily activity with avian cholera mortality among wildfowl.

We tested the hypothesis that wildfowl activities can influence the risk of avian cholera (Pasteurella multocida infection) for susceptible birds at Centerville, Humboldt County, California (USA). Avian cholera mortality characteristics from past epizootics were correlated with variations in flock size, habitat use and 11 feeding and nonfeeding behaviors among six empirically defined groups of wildfowl: American coots (Fulica americana), tundra swans (Cygnus columbianus), American wigeon (Anas americana), northern pintails (A. acuta), northern shovelers (A. clypeata)/mallards (A. platyrhynchos), and teal (A. discors, A. crecca, A. cyanoptera). The position of these wildfowl groups in past mortality sequences was directly correlated with mean flock size, time spent on land, and time spent grazing on land or in shallow water. We propose that variations in bird density, habitat use and frequency of grazing may serve as predisposing factors to avian cholera among wildfowl.     

Conformations of Higher Gangliosides and Their Binding with Cholera Toxin—Investigation by Molecular Modeling,Molecular Mechanics,and Molecular Dynamics

Abstract

Molecular mechanics and molecular dynamics studies are performed to investigate the conformational preference of cell surface higher gangliosides (GT1A and GT1B) and their interaction with Cholera Toxin. The water mediated hydrogen bonding network exists between sugar residues in gangliosides. An integrated molecular modeling, molecular mechanics, and molecular dynamics calculation of cholera toxin complexed with GT1A and GT1B reveal that, the active site of cholera toxin can accommodate these higher gangliosides. Direct and water mediated hydrogen bonding interactions stabilize these binding modes and play an essential role in defining the order of specificity for different higher ganglioside towards cholera toxin. This study identifies that the binding site of cholera toxin is shallow and can accommodate a maximum of two NeuNAc residues. The NeuNAc binding site of cholera toxin may be crucial for the design of inhibitors that can prevent the infection of cholera.     

Comparative evaluation of the functional activity of different immunoglobulin classes in cholera]

The immunological activity of specific immunoglobulins in different forms of cholera infection was studied with the use of the indirect immunofluorescent method. The forms of cholera infection were shown to be related to the physico-chemical spectrum of antibodies: patients with the pronounced clinical symptoms of cholera produced serum IgM, including antigen -- antibody complex, more actively and in a greater amount; patients with faintly pronounced and asymptomatic infection produce highly active IgG. The competitive action of immunoglobulins of different classes in their simultaneous reaction with O antigen of Vibrio cholerae is shown. The mechanism of the competitive action of different immunoglobulin classes is supposed to play some role in the process of the sanation (with highly active IgM) or detoxication (with highly active IgG) of the organism.     

Epidemiology of Cholera in the Philippines

Background

Despite being a cholera-endemic country, data on cholera in the Philippines remain sparse. Knowing the areas where cholera is known to occur and the factors that lead to its occurrence will assist in planning preventive measures and disaster mitigation.

Methods

Using sentinel surveillance data, PubMed and ProMED searches covering information from 2008–2013 and event-based surveillance reports from 2010–2013, we assessed the epidemiology of cholera in the Philippines. Using spatial log regression, we assessed the role of water, sanitation and population density on the incidence of cholera.

Results and Discussion

We identified 12 articles from ProMED and none from PubMed that reported on cholera in the Philippines from 2008 to 2013. Data from ProMed and surveillance revealed 42,071 suspected and confirmed cholera cases reported from 2008 to 2013, among which only 5,006 were confirmed. 38 (47%) of 81 provinces and metropolitan regions reported at least one confirmed case of cholera and 32 (40%) reported at least one suspected case. The overall case fatality ratio in sentinel sites was 0.62%, but was 2% in outbreaks. All age groups were affected. Using both confirmed and suspected cholera cases, the average annual incidence in 2010–2013 was 9.1 per 100,000 population. Poor access to improved sanitation was consistently associated with higher cholera incidence. Paradoxically, access to improved water sources was associated with higher cholera incidence using both suspected and confirmed cholera data sources. This finding may have been due to the breakdown in the infrastructure and non-chlorination of water supplies, emphasizing the need to maintain public water systems.

Conclusion

Our findings confirm that cholera affects a large proportion of the provinces in the country. Identifying areas most at risk for cholera will support the development and implementation of policies to minimize the morbidity and mortality due to this disease.     

Epizootiology of avian cholera in wildfowl

Pasteurella multocida, the cause of avian cholera, has naturally infected over 100 species of free-living birds. Among wild birds, avian cholera has its greatest impact on North American wildfowl. Epizootics usually are explosive in onset and may involve thousands of birds. The disease has been reported in every month of the year among wildfowl. Disproportionate mortality, with some species suffering proportionately greater mortality than others, has been a common feature of this disease. Presence of animal organic matter plays a significant role in the survival of P. multocida. There are conflicting reports or a lack of information on the role of host sex, age, body size, other physical features, genetic variation or behavioral differences, as predisposing factors to infection by P. multocida. There also are ambiguities on the relationship between season, precipitation, temperature, nutritional stress, water quality, other microorganisms, and environmental contaminants, and the occurrence of avian cholera in wildfowl. Two competing hypotheses for the year-round reservoir of wildfowl strains of P. multocida are ambient soil or water of enzootic sites, and carrier animals; most current evidence favors the role of carrier animals. Transmission most likely occurs by ingestion of contaminated water, inhalation of bacteria-rich aerosols, or both. While many techniques have been proposed to prevent or control avian cholera, none have been rigorously tested to determine their effectiveness.     

Water Supply Interruptions and Suspected Cholera Incidence: A Time-Series Regression in the Democratic Republic of the Congo

Background

The eastern provinces of the Democratic Republic of the Congo have been identified as endemic areas for cholera transmission, and despite continuous control efforts, they continue to experience regular cholera outbreaks that occasionally spread to the rest of the country. In a region where access to improved water sources is particularly poor, the question of which improvements in water access should be prioritized to address cholera transmission remains unresolved. This study aimed at investigating the temporal association between water supply interruptions and Cholera Treatment Centre (CTC) admissions in a medium-sized town.

Methods and Findings

Time-series patterns of daily incidence of suspected cholera cases admitted to the Cholera Treatment Centre in Uvira in South Kivu Province between 2009 and 2014 were examined in relation to the daily variations in volume of water supplied by the town water treatment plant. Quasi-poisson regression and distributed lag nonlinear models up to 12 d were used, adjusting for daily precipitation rates, day of the week, and seasonal variations. A total of 5,745 patients over 5 y of age with acute watery diarrhoea symptoms were admitted to the CTC over the study period of 1,946 d. Following a day without tap water supply, the suspected cholera incidence rate increased on average by 155% over the next 12 d, corresponding to a rate ratio of 2.55 (95% CI: 1.54–4.24), compared to the incidence experienced after a day with optimal production (defined as the 95th percentile—4,794 m³). Suspected cholera cases attributable to a suboptimal tap water supply reached 23.2% of total admissions (95% CI 11.4%–33.2%). Although generally reporting less admissions to the CTC, neighbourhoods with a higher consumption of tap water were more affected by water supply interruptions, with a rate ratio of 3.71 (95% CI: 1.91–7.20) and an attributable fraction of cases of 31.4% (95% CI: 17.3%–42.5%). The analysis did not suggest any association between levels of residual chlorine in the water fed to the distribution network and suspected cholera incidence. Laboratory confirmation of cholera was not available for this analysis.

Conclusions

A clear association is observed between reduced availability of tap water and increased incidence of suspected cholera in the entire town of Uvira in Eastern Democratic Republic of the Congo. Even though access to piped water supplies is low in Uvira, improving the reliability of tap water supply may substantially reduce the incidence of suspected cholera, in particular in neighbourhoods having a higher access to tap water. These results argue in favour of water supply investments that focus on the delivery of a reliable and sustainable water supply, and not only on point-of-use water quality improvements, as is often seen during cholera outbreaks.     

Characterization of Vibrio cholerae cultures isolated in foci of cholera in the city of Kazan

During the period of the registered outbreak of cholera in 2001 in Kazan 171 V. cholerae cultures were isolated in the focus of the infection (from patients, carriers and 7 environmental objects). The use of the basic and additional tests, including the polymerase chain reaction, made it possible to establish the circulation of V. cholerae, phagovar 15, in the focus of the infection. The strain isolated from the water reservoir Azino-1 in Kazan was identical in its properties to the epidemically dangerous strains isolated from patients. On the whole, the data obtained in the identification of the strains showed that the cultures isolated from patients, vibrio-carriers and environmental objects were identical.     

Detection of L forms of Vibrio cholerae in the water of open water reservoirs

L-forms of cholera vibrios were isolated from the river water for the first time. The presence of L-forms in water permitted to suppose that such variants served as one of the forms of cholera causative agent preservation in the external medium.     

Epidemiological patterns of the import and spread of El Tor cholera]

The paper is a response to the paper by A. K. Akiev published in 1974 in the "Journal of Microbiology Epidemiology and Immunobiology": "Concerning the Epidemiology of El Tor cholera Abroad". The opinion of the author concerning the origin of El Tor infection in 1970, the sources of infection, and the factors of its transmission is critisized. Literature data and personal observations explaining the regularities of importation and spread of El Tor cholera as an intestinal infection are presented; these data are against the view of Akiev on El Tor cholera as a disease with a natural nidality caused by freely living vibrios.     

ELISA检测技术在猪瘟诊断中的应用

猪瘟是危害养猪业发展的重要传染病,给养猪业带来巨大的经济损失。对此,猪场迫切需要及时诊断猪瘟和定期检疫猪瘟。只有研究出快速、灵敏、准确、便捷的实验室诊断方法,才有助于清除猪瘟亚临床感染猪,更有效地控制和扑灭猪瘟。ELISA检测方法是近年来研究和应用较多的检测方法,其在猪瘟的诊断上已广泛研究开发,并且取得了较好的检测效果。