1
|
Narendrakumar L, Jaikumar VS, Chandrika SK, Thomas S. Epidemiological and pathogenic characteristics of Haitian variant V. cholerae circulating in India over a decade (2000-2018). Microb Pathog 2020; 149:104538. [PMID: 32987116 DOI: 10.1016/j.micpath.2020.104538] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 09/19/2020] [Accepted: 09/21/2020] [Indexed: 10/23/2022]
Abstract
Vibrio cholerae, causative agent of the water-borne disease cholera still threatens a large proportion of world's population. The major biotypes of the pathogen are classical and El Tor. There have been recent reports of variant V. cholerae strains circulating around the world. In the present study, the epidemiological status of V. cholerae strains circulating in the country over a decade was assessed. Also, a comprehensive analysis of the difference in pathogenicity between the different biotypes of V. cholerae strains was evaluated both in-vitro and in-vivo. The amount of CT produced by different biotypes of V. cholerae strains were analyzed by GM1 ELISA and the probable reasons for the difference in toxin production was discussed. MLST analysis grouped the isolates into a single Sequence Type (ST 69) whereas PFGE analysis clustered the isolates into ten different pulsotypes revealing molecular diversity. The circulating strains were identified to produce cholera toxin and CT mRNA intermediate to the classical and prototype El Tor strains. Also, the circulating strains were identified to possess four ToxR binding sequences. In-vivo pathogenicity analysis by rabbit ileal loop fluid accumulation assay revealed the Haitian variant strains to be more hyperemic than the prototype strains.
Collapse
Affiliation(s)
- Lekshmi Narendrakumar
- Cholera and Biofilm Research Laboratory, Rajiv Gandhi Centre for Biotechnology, Thiruvananthapuram, 695 014, Kerala, India
| | - Vishnu S Jaikumar
- Animal Research Facility, Rajiv Gandhi Centre for Biotechnology, Thiruvananthapuram, 695 014, Kerala, India
| | - Sivakumar K Chandrika
- Distributed Information Sub-Centre, Rajiv Gandhi Centre for Biotechnology, Thiruvananthapuram, 695 014, Kerala, India
| | - Sabu Thomas
- Cholera and Biofilm Research Laboratory, Rajiv Gandhi Centre for Biotechnology, Thiruvananthapuram, 695 014, Kerala, India.
| |
Collapse
|
2
|
Connor BA, Dawood R, Riddle MS, Hamer DH. Cholera in travellers: a systematic review. J Travel Med 2019; 26:5651069. [PMID: 31804684 PMCID: PMC6927393 DOI: 10.1093/jtm/taz085] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 10/25/2019] [Accepted: 11/06/2019] [Indexed: 01/02/2023]
Abstract
Exposure to cholera is a risk for individuals and groups travelling to endemic areas, and the bacteria can be imported to cholera-free countries by returning travellers. This systematic review of the literature describes the circumstances in which cholera infection can occur in travellers and considers the possible value of the cholera vaccine for prevention in travellers. PubMed and EMBASE were searched for case reports of cholera or diarrhoea among travellers, with date limits of 1 January 1990-30 April 2018. Search results were screened to exclude the following articles: diarrhoea not caused by cholera, cholera in animals, intentional cholera infection in humans, non-English articles and publications on epidemics that did not report clinical details of individual cases and publications of cases pre-dating 1990. Articles were reviewed through descriptive analytic methods and information summarized. We identified 156 cases of cholera imported as a consequence of travel, and these were reviewed for type of traveller, source country, serogroup of cholera, treatment and outcomes. The case reports retrieved in the search did not report consistent levels of detail, making it difficult to synthesize data across reports and draw firm conclusions from the data. This clinical review sheds light on the paucity of actionable published data regarding the risk of cholera in travellers and identifies a number of gaps that should drive additional effort. Further information is needed to better inform evidence-based disease prevention strategies, including vaccination for travellers visiting areas of cholera risk. Modifications to current vaccination recommendations to include or exclude current or additional traveller populations may be considered as additional risk data become available. The protocol for this systematic review is registered with PROSPERO (registration number: 122797).
Collapse
Affiliation(s)
- Bradley A Connor
- Weill Cornell Medical College and the New York Center for Travel and Tropical Medicine, New York, NY, USA
| | | | - Mark S Riddle
- University of Nevada, Reno School of Medicine, Reno, NV, 89557, USA
| | - Davidson H Hamer
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA.,Section of Infectious Diseases, Department of Medicine, Boston Medical Center, Boston, MA, USA
| |
Collapse
|
3
|
Wilburn J, O'Connor C, Walsh AL, Morgan D. Identifying potential emerging threats through epidemic intelligence activities-looking for the needle in the haystack? Int J Infect Dis 2019; 89:146-153. [PMID: 31629079 PMCID: PMC7110621 DOI: 10.1016/j.ijid.2019.10.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 10/06/2019] [Accepted: 10/11/2019] [Indexed: 11/26/2022] Open
Abstract
The manual epidemic intelligence system was quick and accurate. All significant alerts were identified first through unofficial sources. The system was adaptable and allowed for monitoring of events as they evolved.
Background Epidemic intelligence (EI) for emerging infections is the process of identifying key information on emerging infectious diseases and specific incidents. Automated web-based infectious disease surveillance technologies are available; however, human input is still needed to review, validate, and interpret these sources. In this study, entries captured by Public Health England’s (PHE) manual event-based EI system were examined to inform future intelligence gathering activities. Methods A descriptive analysis of unique events captured in a database between 2013 and 2017 was conducted. The top five diseases in terms of the number of entries were described in depth to determine the effectiveness of PHE’s EI surveillance system compared to other sources. Results Between 2013 and 2017, a total of 22 847 unique entries were added to the database. The top three initial and definitive information sources varied considerably by disease. Ebola entries dominated the database, making up 23.7% of the total, followed by Zika (11.8%), Middle East respiratory syndrome (6.7%), cholera (5.5%), and yellow fever and undiagnosed morbidity (both 3.3%). Initial reports of major outbreaks due to the top five disease agents were picked up through the manual system prior to being publicly reported by official sources. Conclusions PHE’s manual EI process quickly and accurately detected global public health threats at the earliest stages and allowed for monitoring of events as they evolved.
Collapse
Affiliation(s)
- Jennifer Wilburn
- Public Health England, 61 Colindale Avenue, Colindale, NW9 5EQ, United Kingdom.
| | - Catherine O'Connor
- Public Health England, 61 Colindale Avenue, Colindale, NW9 5EQ, United Kingdom
| | - Amanda L Walsh
- Public Health England, 61 Colindale Avenue, Colindale, NW9 5EQ, United Kingdom
| | - Dilys Morgan
- Public Health England, 61 Colindale Avenue, Colindale, NW9 5EQ, United Kingdom
| |
Collapse
|
4
|
Araj R, Alqasrawi S, Samy S, Alwahdanee G, Wadi J, Mofleh J, Alsanouri T. Preventing Emerging and Re-emerging Infections in the Eastern Mediterranean Region: Gaps, Challenges, and Priorities. JMIR Public Health Surveill 2019; 5:e14348. [PMID: 31599734 PMCID: PMC6811772 DOI: 10.2196/14348] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Revised: 05/27/2019] [Accepted: 07/04/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The Eastern Mediterranean Public Health Network, supported by the Biosecurity Engagement Program, contributed significantly to strengthening the preparedness and response to the emerging and re-emerging infections in the region. OBJECTIVE This study aimed to determine the gaps, challenges, and priorities for preventing the emerging and re-emerging infections, with a focus on biosafety and biosecurity in four countries of the region, namely, Egypt, Iraq, Jordan, and Morocco. METHODS A total of two different methods were used to determine the gaps and priorities for preventing the emerging and re-emerging infections. The first method was a rapid assessment for the preparedness and response to the emerging and re-emerging infections in four countries of the region, with a focus on biosafety and biosecurity. The second method was a face-to-face round table meeting of the participating teams for two days, where the teams from all countries presented their countries' profiles, findings, priorities, and gaps based on the countries' assessments. RESULTS The assessment and meeting resulted in several priorities and recommendations for each of the countries in the areas of legislation and coordination, biosafety and biosecurity, surveillance and human resources, case management and response, infection control and prevention, and risk communication and laboratory capacity. CONCLUSIONS Many recommendations were relatively consistent throughout, including improving communication or building collaborations to improve the overall health of the country.
Collapse
Affiliation(s)
- Rawan Araj
- Global Health Development/Eastern Mediterranean Public Health Network, Amman, Jordan
| | | | | | | | - Jamal Wadi
- The Medical School, University of Jordan, Amman, Jordan
| | - Jawad Mofleh
- Global Health Development/Eastern Mediterranean Public Health Network, Amman, Jordan
| | - Tarek Alsanouri
- Global Health Development/Eastern Mediterranean Public Health Network, Amman, Jordan
| |
Collapse
|
5
|
Samanta P, Saha RN, Chowdhury G, Naha A, Sarkar S, Dutta S, Nandy RK, Okamoto K, Mukhopadhyay AK. Dissemination of newly emerged polymyxin B sensitive Vibrio cholerae O1 containing Haitian-like genetic traits in different parts of India. J Med Microbiol 2018; 67:1326-1333. [PMID: 29927375 DOI: 10.1099/jmm.0.000783] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
PURPOSE Two natural epidemic biotypes of Vibrio cholerae O1, classical and El Tor, exhibit different patterns of sensitivity against the antimicrobial peptide polymyxin B. This difference in sensitivity has been one of the major markers in biotype classification system for several decades. A recent report regarding the emergence of polymyxin B-sensitive El Tor V. cholerae O1 in Kolkata has motivated us to track the spread of the strains containing this important trait, along with Haitian-like genetic content, in different parts of India. METHODOLOGY We have collected 260 clinical V. cholerae O1 strains from 12 states in India and screened them for polymyxin B susceptibility. Genetic characterization was also performed to study the tcpA, ctxB and rtxA genotypes by allele-specific polymerase chain reaction (PCR) and nucleotide sequencing. RESULTS Interestingly, 88.85 % of the isolates were found to be sensitive to polymyxin B. All of the states, with the exception of Assam, had polymyxin B-sensitive V. cholerae strains and complete replacement with this strain was found in eight of the states. However, from 2016 onwards, all the strains tested showed sensitivity to polymyxin B. Allele-specific PCR and sequencing confirmed that all strains possessed Haitian-like genetic traits. CONCLUSION Polymyxin B-sensitive strains have begun to spread throughout India and may lead to the revision of the biotype classification. The dissemination of these new variant strains needs to be carefully monitored in different endemic populations through active holistic surveillance to understand their clinical and epidemiological consequences.
Collapse
Affiliation(s)
- Prosenjit Samanta
- 1Division of Bacteriology, National Institute of Cholera and Enteric Diseases, Kolkata 700010, India
| | - Rudra Narayan Saha
- 1Division of Bacteriology, National Institute of Cholera and Enteric Diseases, Kolkata 700010, India
| | - Goutam Chowdhury
- 1Division of Bacteriology, National Institute of Cholera and Enteric Diseases, Kolkata 700010, India
| | - Arindam Naha
- 1Division of Bacteriology, National Institute of Cholera and Enteric Diseases, Kolkata 700010, India
| | - Sounak Sarkar
- 1Division of Bacteriology, National Institute of Cholera and Enteric Diseases, Kolkata 700010, India
| | - Shanta Dutta
- 1Division of Bacteriology, National Institute of Cholera and Enteric Diseases, Kolkata 700010, India
| | - Ranjan Kumar Nandy
- 1Division of Bacteriology, National Institute of Cholera and Enteric Diseases, Kolkata 700010, India
| | - Keinosuke Okamoto
- 2Collaborative Research Center of Okayama University for Infectious Diseases in India, Kolkata 700010, India
| | - Asish Kumar Mukhopadhyay
- 1Division of Bacteriology, National Institute of Cholera and Enteric Diseases, Kolkata 700010, India
| |
Collapse
|
6
|
Buliva E, Elhakim M, Tran Minh NN, Elkholy A, Mala P, Abubakar A, Malik SMMR. Emerging and Reemerging Diseases in the World Health Organization (WHO) Eastern Mediterranean Region-Progress, Challenges, and WHO Initiatives. Front Public Health 2017; 5:276. [PMID: 29098145 PMCID: PMC5653925 DOI: 10.3389/fpubh.2017.00276] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 09/27/2017] [Indexed: 11/22/2022] Open
Abstract
The Eastern Mediterranean Region (EMR) of the World Health Organization (WHO) continues to be a hotspot for emerging and reemerging infectious diseases and the need to prevent, detect, and respond to any infectious diseases that pose a threat to global health security remains a priority. Many risk factors contribute in the emergence and rapid spread of epidemic diseases in the Region including acute and protracted humanitarian emergencies, resulting in fragile health systems, increased population mobility, rapid urbanization, climate change, weak surveillance and limited laboratory diagnostic capacity, and increased human-animal interaction. In EMR, several infectious disease outbreaks were detected, investigated, and rapidly contained over the past 5 years including: yellow fever in Sudan, Middle East respiratory syndrome in Bahrain, Oman, Qatar, Saudi Arabia, United Arab Emirates, and Yemen, cholera in Iraq, avian influenza A (H5N1) infection in Egypt, and dengue fever in Yemen, Sudan, and Pakistan. Dengue fever remains an important public health concern, with at least eight countries in the region being endemic for the disease. The emergence of MERS-CoV in the region in 2012 and its continued transmission currently poses one of the greatest threats. In response to the growing frequency, duration, and scale of disease outbreaks, WHO has worked closely with member states in the areas of improving public health preparedness, surveillance systems, outbreak response, and addressing critical knowledge gaps. A Regional network for experts and technical institutions has been established to facilitate support for international outbreak response. Major challenges are faced as a result of protracted humanitarian crises in the region. Funding gaps, lack of integrated approaches, weak surveillance systems, and absence of comprehensive response plans are other areas of concern. Accelerated efforts are needed by Regional countries, with the continuous support of WHO, to build and maintain a resilient public health system for detection and response to all acute public health events.
Collapse
Affiliation(s)
- Evans Buliva
- Regional Office for the Eastern Mediterranean, World Health Organization, Cairo, Egypt
| | - Mohamed Elhakim
- Regional Office for the Eastern Mediterranean, World Health Organization, Cairo, Egypt
| | - Nhu Nguyen Tran Minh
- Regional Office for the Eastern Mediterranean, World Health Organization, Cairo, Egypt
| | - Amgad Elkholy
- Regional Office for the Eastern Mediterranean, World Health Organization, Cairo, Egypt
| | - Peter Mala
- Regional Office for the Eastern Mediterranean, World Health Organization, Cairo, Egypt
| | - Abdinasir Abubakar
- Regional Office for the Eastern Mediterranean, World Health Organization, Cairo, Egypt
| | | |
Collapse
|