Table Of ContentCurrent Topics in Microbiology and Immunology
G. Balakrish Nair
Yoshifumi Takeda Editors
Cholera Outbreaks
Current Topics in Microbiology
and Immunology
Volume 379
Serieseditors
KlausAktories
MedizinischeFakultät,InstitutfürExperimentelleundKlinischePharmakologieundToxikologie,Abt.IAlbert-
Ludwigs-UniversitätFreiburg,Albertstr.25,79104Freiburg,Germany
RichardW.Compans
DepartmentofMicrobiologyandImmunology,EmoryUniversity,1518CliftonRoad,CNR5005,Atlanta,GA30322,
USA
MaxD.Cooper
DepartmentofPathologyandLaboratoryMedicine,GeorgiaResearchAlliance,EmoryUniversity,1462
CliftonRoad,Atlanta,GA30322,USA
JorgeE.Galan
BoyerCtr.forMolecularMedicine,SchoolofMedicine,YaleUniversity,295CongressAvenue,room343,
NewHaven,CT06536-0812,USA
YuriY.Gleba
ICONGeneticsAG,BiozentrumHalle,Weinbergweg22,06120Halle,Germany
TasukuHonjo
FacultyofMedicine,DepartmentofMedicalChemistry,KyotoUniversity,Sakyo-ku,Yoshida,Kyoto606-8501,
Japan
YoshihiroKawaoka
SchoolofVeterinaryMedicine,UniversityofWisconsin-Madison,2015LindenDrive,Madison,WI53706,USA
BernardMalissen
Centred’ImmunologiedeMarseille-Luminy,ParcScientifiquedeLuminy,Case906,13288MarseilleCedex9,
France
MichaelB.A.Oldstone
DepartmentofImmunologyandMicrobialScience,TheScrippsResearchInstitute,10550NorthTorreyPinesRoad,
LaJolla,CA92037,USA
RinoRappuoli
NovartisVaccines,ViaFiorentina1,Siena53100,Italy
PeterK.Vogt
DepartmentofMolecularandExperimentalMedicine,TheScrippsResearchInstitute,10550NorthTorreyPines
Road,BCC-239,LaJolla,CA92037,USA
HonoraryEditor:HilaryKoprowski(deceased)
FormerlyatBiotechnologyFoundation,Inc.,Ardmore,PA,USA
For furthervolumes:
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G. Balakrish Nair Yoshifumi Takeda
•
Editors
Cholera Outbreaks
Responsible Series Editor: Klaus Aktories
123
Editors
G.BalakrishNair Yoshifumi Takeda
Translational Health Science National InstituteofInfectious Diseases
andTechnology Institute Tokyo
Gurgaon, Haryana Japan
India
ISSN 0070-217X ISSN 2196-9965 (electronic)
ISBN 978-3-642-55403-2 ISBN 978-3-642-55404-9 (eBook)
DOI 10.1007/978-3-642-55404-9
Springer Heidelberg NewYork Dordrecht London
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Preface
As we place our thoughts together to write the Preface of this book on ‘‘Cholera
Outbreaks,’’ we are constantly reminded through all forms of media of the
impending outbreak of cholera in Sudan. The country is in the midst of armed
conflict resulting in the formation of temporary camps of thousands of displaced
people living in poor sanitary conditions and overcrowding; the perfect recipe to
initiateanoutbreakofcholera.TheWorldHealthOrganizationhasdippedintothe
newly launched stockpile of cholera vaccine and is creating history of sorts in
attemptingtopreempttheoutbreakbyvaccinatingpeopleinthesecampsusingthe
WHO prequalified bivalent oral cholera vaccine. In many ways this is not ‘‘new’’
news, instead this is news that is retold with remarkable regularity with the only
difference being that the name of the country differs each time. Cholera has been
exceptionally pervasive during the past three decades, particularly since the
beginning of this millennium. The Sudan outbreak was preceded by the Haiti
outbreak,whichstupefiedtheworldjustbyitsscale,itsenormity,andthedisputes
thataroseinitswake.Cholerahasthispenchantofbeingintheforefrontofnews.
Whatremainsacontinuingenigma,however,isthatweallowittohappentime
and again despite the enormous body of knowledge on the pathogen Vibrio
cholerae and on the disease cholera. Yet we are unable to accurately predict and
preempt outbreaks of cholera. The complete genome sequence of more than 150
strainsofVibriocholeraeareavailableininternationaldatabases,whichhavebeen
thoroughlyanalyzed,explored,teased,andinterpreted,weknowtheepidemiology
of the disease through decades of painstaking work; the ecology of the pathogen
and the impact of climate change has been thoroughly investigated. We are also
aware of simple ways to treat the disease. However, we have not been able to
decipher the reason for the ferocious spread of the pathogen during outbreaks of
choleranorhavewebeenabletopredictaccuratelywhereanoutbreakwilloccur.
Ironically, what is most predictable about cholera is its unpredictability.
The genesis of this book is the reaction to a lecture on cholera at the 85th
AnnualMeetingofJapaneseSocietyofBacteriologyheldinNagasakifromMarch
27 to 29, 2012. Professor Dr. Klaus Aktories of the Albert-Ludwigs-Universitat
Freiburg was in the audience. The lecture evoked his interest and he requested us
whetherwe wouldbe interested toedit avolume on Cholera inthe series Current
Topics in Microbiology and Immunology. We accepted the offer and are grateful
v
vi Preface
toProfessorAktoriesforhavinginitiatedourthoughtstoeditthisbook.Wechose
thetopicofcholeraoutbreaksasthethemebecausewefeltthatthereisahiatusin
information in the area of cholera outbreaks. Besides,for those who have worked
on cholera and were involved in cholera outbreaks in any capacity, it is a life-
changing experience.
Thebookstartswithachapteroncholeraoutbreaksinthetimeswhenclassical
biotype of Vibrio cholerae O1, acknowledged as the more virulent biotype, pre-
vailed. To bring about the contrast between biotypes in relation to cholera out-
breaks,‘‘CholeraOutbreaksintheElTorBiotypeEraandtheImpactoftheNewEl
TorVariants’’focusesontheElTorbiotypeanditsrecentvariantsincludingO139,
thealteredElTorandthehybridElTor,allofwhichareatestimonytothesubtle
changestakingplaceintherapidlyevolvinggenomeofElTorVibriocholerae.We
havethenfocusedonanoverviewofoutbreaksofcholerainIndia,SoutheastAsia,
Africa, and America to give a continent-wise flavor. There is increasing evidence
that the incidence of cholera and the factors that cause cholera outbreaks vary
betweenAsiaandAfrica.AnanalysisofahugeoutbreakofcholerainHaitiin‘‘The
CholeraOutbreakinHaiti:WhereandHowdiditBegin?’’providesaninsightinto
howanoutbreakofcholeracanoverwhelmacountryandthecontroversiesthatit
can generate. The role lytic phages play in modulating cholera epidemics and
enhance Vibrio cholerae evolution through a bactericidal selection process is
highlighted in ‘‘Role of Phages in the Epidemiology of Cholera’’. The fate of
circulating clones of Vibrio cholerae during cholera outbreaks including genetic
changes as a result of mutations or acquisition of new genetic sequences is dis-
cussed in detail in ‘‘Circulation and Transmission of Clones of Vibrio cholerae
During Cholera Outbreaks’’. Of late, there has been concerted efforts to use
mathematical models to synthesize knowledge on cholera into a quantitative
framework with an effort to predict and manage cholera, which is discussed in
‘‘ModellingCholeraOutbreaks.’’Thepasttwodecadeshaveseenaquantumleapin
Genomicsciencesand‘‘GenomicScienceinUnderstandingCholeraOutbreaksand
EvolutionofVibriocholeraeasaHumanPathogen’’collatesthisinformationand
extols how this information could be useful from a cholera control viewpoint or
fromthewayclonesofthepathogenspreadacrosstheglobe.TheprecisionofSNP
analysis across the whole genome in tracking the spread of the clones of the
pathogenishighlightedingreatdetail.Thelastchapteranalyzescircumstancesof
when the available cholera vaccines can beused tointerruptcholera outbreaks.
We hope the information provided by domain experts will give you a com-
prehensive overview on cholera outbreaks and their consequences. It is also in a
way to remind the readership that cholera is not an antiquated disease; it is still
very much there and will be there in places where hygiene and sanitation is
compromised.Puttingthisbooktogetherhasbeenadelightfulassignment.Weare
indebted to all the authors and coauthors of the 11 chapters for their cooperation
and for all the effort to prepare the chapter. Without their contribution, this book
would not exist. We applaud their expertise and acknowledge their efforts.
Finally, the book is a celebration of collaboration between the two Editors for
morethanthreedecades—acollaborationbondedbyresearchoncholera.The30-
Preface vii
plus years have been humbling and a learning experience. Cholera continues to
persistanddevastateespeciallyamongthemarginalizedsectionoftheworld.Itis
like a fire that cannot be put off.
G. Balakrish Nair
Yoshifumi Takeda
Contents
Cholera Outbreaks in the Classical Biotype Era. . . . . . . . . . . . . . . . . 1
A. K. Siddique and Richard Cash
Cholera Outbreaks in the El Tor Biotype Era and the Impact
of the New El Tor Variants. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
Asish K. Mukhopadhyay, Yoshifumi Takeda and G. Balakrish Nair
Cholera Outbreaks in India. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49
Thandavarayan Ramamurthy and Naresh C. Sharma
Cholera Outbreaks in South-East Asia. . . . . . . . . . . . . . . . . . . . . . . . 87
Kaushik Bharati and S. K. Bhattacharya
Cholera Outbreaks in Africa. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117
Martin A. Mengel, Isabelle Delrieu, Leonard Heyerdahl
and Bradford D. Gessner
The Cholera Outbreak in Haiti: Where and how did it begin? . . . . . . 145
Daniele Lantagne, G. Balakrish Nair, Claudio F. Lanata
and Alejandro Cravioto
Role of Phages in the Epidemiology of Cholera . . . . . . . . . . . . . . . . . 165
Shah M. Faruque
Circulation and Transmission of Clones of Vibrio cholerae
During Cholera Outbreaks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 181
O. Colin Stine and J. Glenn Morris Jr.
ix
x Contents
Modeling Cholera Outbreaks. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 195
Dennis L. Chao, Ira M. Longini Jr. and J. Glenn Morris Jr.
Genomic Science in Understanding Cholera Outbreaks
and Evolution of Vibrio cholerae as a Human Pathogen . . . . . . . . . . . 211
William P. Robins and John J. Mekalanos
When, How, and Where can Oral Cholera Vaccines
be Used to Interrupt Cholera Outbreaks? . . . . . . . . . . . . . . . . . . . . . 231
John Clemens and Jan Holmgren
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 259
Cholera Outbreaks in the Classical
Biotype Era
A. K. Siddique and Richard Cash
Abstract In the Indian subcontinent description of a disease resembling cholera
has been mentioned in Sushruta Samita, estimated to have been written between
*400 and 500 BC. It is however not clear whether the disease known today as
cholera caused by Vibrio cholerae O1 is the evolutionary progression of the
ancient disease. The modern history of cholera began in 1817 when an explosive
epidemicbrokeoutintheGangesRiverDeltaregionofBengal.Thiswasthefirst
of the seven recorded cholera pandemics that affected nearly the entire world and
causedhundredsofthousandsofdeaths.Thebacteriumresponsibleforthishuman
diseasewasfirstrecognisedduringthefifthpandemicandwasnamedV.cholerae
whichwasgroupedasO1,andwasfurtherdifferentiatedintoClassicalandElTor
biotypes.Itisnowknownthatthefifthandthesixthpandemicswerecausedbythe
V.choleraeO1oftheClassicalbiotypeandtheseventhbytheElTorbiotype.The
ElTorbiotypeofV.cholerae,whichoriginatedinIndonesiaandshortlythereafter
begantospreadintheearly1960s.Withinthespanof50 yearstheElTorbiotype
had invaded nearly the entire world, completely displacing the Classical biotype
fromallthecountriesexceptBangladesh.Whatpromptedtheearlierpandemicsto
begin is not clearly understood, nor do we know how and why they ended. The
successoftheseventhpandemiccloneoverthepre-existingsixthpandemicstrain
remains largely an unsolved mystery. Why classical biotype eventually disap-
peared from the world remains to be explained. For nearly three decades
(1963–1991) during the seventh pandemic, cholera in Bangladesh has recorded a
A.K.Siddique(&)
ICDDR,B,68.ShahedTajuddinAhamedSarani,Mohakhali,Dhaka1212,Bangladesh
e-mail:[email protected]
R.Cash
DepartmentofGlobalHealthandPopulation,HarvardSchoolofPublicHealth,
665HuntingtonAvenue,Boston,MA02138,USA
e-mail:[email protected];richard.cash@phfi.org
PublicHealthFoundationofIndia,PHDChambers,AugustKrantiMarg,
NewDelhi110016,India
CurrentTopicsinMicrobiologyandImmunology(2014)379:1–16 1
DOI:10.1007/82_2013_361
(cid:2)Springer-VerlagBerlinHeidelberg2013
PublishedOnline:25December2013
