-
PLoS Neglected Tropical Diseases Dec 2021Cholera is a major cause of mortality and morbidity in low-resource and humanitarian settings. It is transmitted by fecal-oral route, and the infection risk is higher to... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Cholera is a major cause of mortality and morbidity in low-resource and humanitarian settings. It is transmitted by fecal-oral route, and the infection risk is higher to those living in and near cholera cases. Rapid identification of cholera cases and implementation of measures to prevent subsequent transmission around cases may be an efficient strategy to reduce the size and scale of cholera outbreaks.
METHODOLOGY/PRINCIPLE FINDINGS
We investigated implementation of cholera case-area targeted interventions (CATIs) using systematic reviews and case studies. We identified 11 peer-reviewed and eight grey literature articles documenting CATIs and completed 30 key informant interviews in case studies in Democratic Republic of Congo, Haiti, Yemen, and Zimbabwe. We documented 15 outbreaks in 12 countries where CATIs were used. The team composition and the interventions varied, with water, sanitation, and hygiene interventions implemented more commonly than those of health. Alert systems triggering interventions were diverse ranging from suspected cholera cases to culture confirmed cases. Selection of high-risk households around the case household was inconsistent and ranged from only one case to approximately 100 surrounding households with different methods of selecting them. Coordination among actors and integration between sectors were consistently reported as challenging. Delays in sharing case information impeded rapid implementation of this approach, while evaluation of the effectiveness of interventions varied.
CONCLUSIONS/SIGNIFICANCE
CATIs appear effective in reducing cholera outbreaks, but there is limited and context specific evidence of their effectiveness in reducing the incidence of cholera cases and lack of guidance for their consistent implementation. We propose to 1) use uniform cholera case definitions considering a local capacity to trigger alert; 2) evaluate the effectiveness of individual or sets of interventions to interrupt cholera, and establish a set of evidence-based interventions; 3) establish criteria to select high-risk households; and 4) improve coordination and data sharing amongst actors and facilitate integration among sectors to strengthen CATI approaches in cholera outbreaks.
Topics: Cholera; Congo; Family Characteristics; Haiti; Humans; Hygiene; Retrospective Studies; Sanitation; Yemen; Zimbabwe
PubMed: 34919551
DOI: 10.1371/journal.pntd.0010042 -
Revista Espanola de Salud Publica Nov 2021The humanitarian response to a cholera outbreak in a complex international crisis requires guaranteeing minimum conditions so that normalcy can be restored. Basic... (Review)
Review
BACKGROUND
The humanitarian response to a cholera outbreak in a complex international crisis requires guaranteeing minimum conditions so that normalcy can be restored. Basic responses to a cholera outbreak include water and sanitation. The general objective of this systematic review was the analysis of the current evidence that addresses the effectiveness of different WASH measures to control cholera.
METHODS
A review and analysis of the literature available in the main databases (PubMed, WoS and Scopus) and in a specific meta-search engine for humanitarian aid was carried out (reliefweb.int). Based on the establishment of the PICO research question "", the identification of keywords and databases to carry out the searches, as well as a selection process based on the established eligibility criteria: being studies in both English and Spanish where the WASH intervention was clearly defined, studies where health outcomes of cholera were presented, or data related to the function and use of the WASH intervention, was established.
RESULTS
The initial search provided 17,185 documents susceptible of analysis that were screened using the search criteria, up to 22 references that were read in full text and the 11 that were finally analyzed. These were coded based on the measures set out in their protocols, on the interventions carried out in the improvement of water and its supply, the improvement of sanitation, the measures aimed at better hygiene and those that evaluated the complete WASH intervention.
CONCLUSIONS
All the measures offered positive results, their effectiveness was conditioned by the education of the beneficiaries, the simplicity of the activities and the involvement of local actors.
Topics: Cholera; Disease Outbreaks; Humans; Hygiene; Sanitation; Spain
PubMed: 34732687
DOI: No ID Found -
Annual Review of Microbiology Oct 2021Most bacteria are protected from environmental offenses by a cell wall consisting of strong yet elastic peptidoglycan. The cell wall is essential for preserving... (Review)
Review
Most bacteria are protected from environmental offenses by a cell wall consisting of strong yet elastic peptidoglycan. The cell wall is essential for preserving bacterial morphology and viability, and thus the enzymes involved in the production and turnover of peptidoglycan have become preferred targets for many of our most successful antibiotics. In the past decades, , the gram-negative pathogen causing the diarrheal disease cholera, has become a major model for understanding cell wall genetics, biochemistry, and physiology. More than 100 articles have shed light on novel cell wall genetic determinants, regulatory links, and adaptive mechanisms. Here we provide the first comprehensive review of 's cell wall biology and genetics. Special emphasis is placed on the similarities and differences with , the paradigm for understanding cell wall metabolism and chemical structure in gram-negative bacteria.
Topics: Biology; Cell Wall; Escherichia coli; Peptidoglycan; Vibrio cholerae
PubMed: 34623898
DOI: 10.1146/annurev-micro-040621-122027 -
Clinical Microbiology and Infection :... Feb 2022Cholera is an acute diarrheal disease caused by Vibrio cholerae O1 or O139. Cholera rapid diagnostic tests (RDTs) are widely used to screen for cholera cases. However,... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Cholera is an acute diarrheal disease caused by Vibrio cholerae O1 or O139. Cholera rapid diagnostic tests (RDTs) are widely used to screen for cholera cases. However, their accuracy has not been systematically reviewed.
OBJECTIVES
To evaluate the diagnostic accuracy of cholera RDTs.
METHODS
Systematic review and meta-analysis.
DATA SOURCES
Medline, EMBASE and Web of science through to November 2020; references of included studies and a technical guidance on cholera RDTs. This review is registered with PROSPERO (CRD42021233124).
STUDY ELIGIBILITY CRITERIA
Cross-sectional studies comparing the performance of cholera RDTs either to stool culture or PCR.
PARTICIPANTS
Individuals with clinically suspected cholera.
DATA EXTRACTION
Two authors independently extracted data and assessed the quality using Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) criteria.
RESULTS
Eighteen studies were included in the systematic review of which 17 were used for meta-analysis. Crystal VC was the most frequently used RDT (13 studies), followed by Cholkit and Institut Pasteur cholera dipstick (three studies each), SD Bioline (two studies), Artron (one study) and Smart (one study). Using direct testing (n = 12 627 specimens), the bivariate random-effects model yielded a pooled sensitivity and specificity of 91% (95% CI 87%-94%) and 80% (95% CI 74%-84%), respectively. However, through alkaline peptone water (APW) enrichment (n = 3403 specimens), the pooled sensitivity and specificity were 89% (95% CI 79%-95%) and 98% (95% CI 95%-99%), respectively.
CONCLUSION
Cholera RDTs, especially when enriched with APW, have moderate sensitivity and specificity. Although less useful for clinical management, the current generation of RDTs have clear utility for surveillance efforts if used in a principled manner. Enrichment of stool specimens in APW before using cholera RDTs reduces the possibility of obtaining false-positive results, despite the few cholera cases that go undetected. It is noteworthy that APW-enriched cholera RDTs are not necessarily rapid tests, and are not listed in the Global Task Force on Cholera Control/WHO target product profile.
Topics: Cholera; Cross-Sectional Studies; Humans; Reagent Kits, Diagnostic; Sensitivity and Specificity; Vibrio cholerae O1
PubMed: 34506946
DOI: 10.1016/j.cmi.2021.08.027 -
Environmental Science and Pollution... Dec 2021Infectious diarrhea (ID) is an intestinal infectious disease including cholera, typhoid and paratyphoid fever, bacterial and amebic dysentery, and other infectious... (Meta-Analysis)
Meta-Analysis
Infectious diarrhea (ID) is an intestinal infectious disease including cholera, typhoid and paratyphoid fever, bacterial and amebic dysentery, and other infectious diarrhea. There are many studies that have explored the relationship between ambient temperature and the spread of infectious diarrhea, but the results are inconsistent. It is necessary to systematically evaluate the impact of temperature on the incidence of ID. This study was based on the PRISMA statement to report this systematic review. We conducted literature searches from CNKI, VIP databases, CBM, PubMed, Web of Science, Cochrane Library, and other databases. The number registered in PROSPERO is CRD42021225472. After searching a total of 4915 articles in the database and references, 27 studies were included. The number of people involved exceeded 7.07 million. The overall result demonstrated when the temperature rises, the risk of infectious diarrhea increases significantly (RR=1.42, 95%CI: 1.07-1.88, RR=1.08, 95%CI: 1.03-1.14). Subgroup analysis found the effect of temperature on the bacillary dysentery group (RR=1.85, 95%CI: 1.48-2.30) and unclassified diarrhea groups (RR=1.18, 95%CI: 0.59-2.34). The result of the single-day effect subgroup analysis was similar to the result of the cumulative effect. And the sensitivity analysis proved that the results were robust. This systematic review and meta-analysis support that temperature will increase the risk of ID, which is helpful for ID prediction and early warning in the future.
Topics: Cholera; Diarrhea; Humans; Incidence; Temperature; Typhoid Fever
PubMed: 34268683
DOI: 10.1007/s11356-021-15395-z -
Scandinavian Journal of Gastroenterology Dec 2020Emergence of molecular methods to screen stools could provide a more complete picture of pathogens causing gastroenteritis, allowing to adequately treat patients... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
Emergence of molecular methods to screen stools could provide a more complete picture of pathogens causing gastroenteritis, allowing to adequately treat patients whenever required but, so far, no aggregate data have been released. Our objective was to report pathogens identified in patients suffering from gastroenteritis using a multiplex molecular array.
DESIGN
Medline and Embase were searched for original publications reporting pathogens identified with FilmArray GI panel in patients suffering from gastroenteritis. Proportions of pathogens were extracted and pooled using a model with random effects.
RESULTS
Fourteen studies (17,815 patients) were included in the analysis. Among the 7,071 patients (39.7%) with positive FilmArray, identified pathogens were (27.5%), (19.3%), (15.1%), (15%), (11.8%), (8.1%), (7.3%), (7.3%), (7.1%), (5.2%), (4.9%), (4%), (3.8%), (3.8%), (2.8%), (1.7%), O157 (1.1%), (1.1%), (0.7%), (0.5%), (0.3%) and (0.3%). When considering only studies with control group (microbiological examination of the stools performed by other methods), FilmArray identified at least one pathogen in 48.2% of patients versus 16.7% when using comparative diagnostic methods.
CONCLUSIONS
FilmArray GI panel was positive in 39.7% of patients suffering from gastroenteritis. This proportion has to be mitigated by the carriage rates of identified organisms. Ultimately, restricted ordering of molecular panels to those patients who might benefit from specific treatment could provide medical value by swift identification of the pathogen and more targeted therapy.
Topics: Cryptosporidiosis; Cryptosporidium; Diarrhea; Feces; Gastroenteritis; Giardia lamblia; Humans
PubMed: 33147077
DOI: 10.1080/00365521.2020.1839128 -
The Science of the Total Environment Nov 2020Non-cholera Vibrio bacteria are a major cause of foodborne illness in the United States. Raw oysters are commonly implicated in gastroenteritis caused by pathogenic...
BACKGROUND
Non-cholera Vibrio bacteria are a major cause of foodborne illness in the United States. Raw oysters are commonly implicated in gastroenteritis caused by pathogenic Vibrio parahaemolyticus. In response to outbreaks in 1997-1998, the US Food and Drug Administration developed a nation-wide quantitative microbial risk assessment (QMRA) of V. parahaemolyticus in raw oysters in 2005. The QMRA identified information gaps that new research may address. Incidence of sporadic V. parahaemolyticus illness has recently increased and, as oyster consumption increases and sea temperatures rise, V. parahaemolyticus outbreaks may become more frequent, posing health concerns. Updated and region-specific QMRAs will improve the accuracy and precision of risk of infection estimates.
OBJECTIVES
We identify research to support an updated QMRA of V. parahaemolyticus from oysters harvested in Chesapeake Bay and Puget Sound, focusing on observational and experimental research on post-harvest practices (PHPs) published from 2004 to 2019.
METHODS
A predefined search strategy was applied to PubMed, Embase, Scopus, Science.gov, NAL Agricola, and Google Scholar. Study eligibility criteria were defined using a population, intervention, comparator, and outcome statement. Reviewers independently coded abstracts for inclusion/exclusion using predefined criteria. Data were extracted and study quality and relevance evaluated based on published guidance for food safety risk assessments. Findings were synthesized using a weight of evidence approach.
RESULTS
Of 12,174 articles retrieved, 93 were included for full-text review. Twenty-seven studies were found to be high quality and high relevance, including studies on cold storage, high hydrostatic pressure, depuration, and disinfectant, and other PHPs. High hydrostatic pressure consistently emerged as the most effective PHP in reducing abundance of V. parahaemolyticus.
DISCUSSION
Limitations of the knowledge base and review approach involve the type and quantity of data reported. Future research should focus on PHPs for which few or no high quality and high relevance studies exist, such as irradiation and relaying.
Topics: Animals; Colony Count, Microbial; Food Contamination; Food Safety; Foodborne Diseases; Ostreidae; Seafood; Vibrio parahaemolyticus
PubMed: 32731065
DOI: 10.1016/j.scitotenv.2020.140795 -
Environmental Science and Pollution... Oct 2020Although the number of cholera infection decreased universally, climate change can potentially affect both incidence and prevalence rates of disease in endemic regions.... (Review)
Review
Although the number of cholera infection decreased universally, climate change can potentially affect both incidence and prevalence rates of disease in endemic regions. There is considerable consistent evidence, explaining the associations between cholera and climatic variables. However, it is essentially required to compare and interpret these relationships globally. The aim of the present study was to carry out a systematic review in order to identify and appraise the literature concerning the relationship between nonanthropogenic climatic variabilities such as extreme weather- and ocean-related variables and cholera infection rates. The systematic literature review of studies was conducted by using determined search terms via four major electronic databases (PubMed, Web of Science, Embase, and Scopus) according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) approach. This search focused on published articles in English-language up to December 31, 2018. A total of 43 full-text studies that met our criteria have been identified and included in our analysis. The reviewed studies demonstrated that cholera incidence is highly attributed to climatic variables, especially rainfall, temperature, sea surface temperature (SST) and El Niño Southern Oscillation (ENSO). The association between cholera incidence and climatic variables has been investigated by a variety of data analysis methodologies, most commonly time series analysis, generalized linear model (GLM), regression analysis, and spatial/GIS. The results of this study assist the policy-makers who provide the efforts for planning and prevention actions in the face of changing global climatic variables.
Topics: Cholera; Climate Change; El Nino-Southern Oscillation; Humans; Incidence; Prevalence
PubMed: 32661979
DOI: 10.1007/s11356-020-09992-7 -
Journal of Water and Health Apr 2020Cholera is a severe diarrhoeal disease affecting vulnerable communities. A long-term solution to cholera transmission is improved access to and uptake of water,... (Meta-Analysis)
Meta-Analysis
Cholera is a severe diarrhoeal disease affecting vulnerable communities. A long-term solution to cholera transmission is improved access to and uptake of water, sanitation and hygiene (WASH). Climate change threatens WASH. A systematic review and meta-analysis determined five overarching WASH factors incorporating 17 specific WASH factors associated with cholera transmission, focussing upon community cases. Eight WASH factors showed lower odds and six showed higher odds for cholera transmission. These results were combined with findings in the climate change and WASH literature, to propose a health impact pathway illustrating potential routes through which climate change dynamics (e.g. drought, flooding) impact on WASH and cholera transmission. A causal process diagram visualising links between climate change dynamics, WASH factors, and cholera transmission was developed. Climate change dynamics can potentially affect multiple WASH factors (e.g. drought-induced reductions in handwashing and rainwater use). Multiple climate change dynamics can influence WASH factors (e.g. flooding and sea-level rise affect piped water usage). The influence of climate change dynamics on WASH factors can be negative or positive for cholera transmission (e.g. drought could increase pathogen desiccation but reduce rainwater harvesting). Identifying risk pathways helps policymakers focus on cholera risk mitigation, now and in the future.
Topics: Causality; Cholera; Climate Change; Humans; Hygiene; Risk Factors; Sanitation; Water; Water Supply
PubMed: 32300088
DOI: 10.2166/wh.2020.088 -
BJOG : An International Journal of... Aug 2020Cholera has harmful effects on the fetus but safety data on the oral cholera vaccine in pregnant women are controversial. (Meta-Analysis)
Meta-Analysis
BACKGROUND
Cholera has harmful effects on the fetus but safety data on the oral cholera vaccine in pregnant women are controversial.
OBJECTIVES
We conducted the first meta-analysis of studies in pregnant women comparing the effect of oral cholera vaccination on pregnancy outcomes with unvaccinated women. Outcomes of interest were adverse pregnancy outcome, miscarriage, stillbirth, preterm delivery, low birthweight, abortion and malformation.
SEARCH STRATEGY
The search was run in MEDLINE/PubMed, SCOPUS and Embase databases from inception up to December 2019.
SELECTION CRITERIA
Inclusion criteria were: (1) studies that investigated the association between oral cholera vaccines and adverse pregnancy outcomes; (2) studies that reported outcomes with appropriate estimates; and (3) studies that contained an unvaccinated control group.
DATA COLLECTION AND ANALYSIS
A random-effects model (DerSimonian and Laird) was run to evaluate the overall treatment effect (relative risk, RR). The PRISMA statement was followed in reporting this meta-analysis.
MAIN RESULTS
Five studies included in meta-analysis with 5584 women (2920 exposed and 2664 not exposed). No significant increase in adverse pregnancy outcome (RR 1.03, 95% CI 0.79-1.34), miscarriage (RR 1.15, 95% CI 0.84-1.57) or stillbirth (RR 1.11, 95% CI 0.69-1.80) following cholera vaccine administration was found compared with control group. There was also no association with an increased risk of preterm delivery (RR 0.61, 95% CI 0.35-1.06) low birthweight (RR 0.84, 95% CI 0.56- 1.26), accidental abortion (RR 1.02, 95% CI 0.77-1.35) or malformation (RR 0.70, 95% CI 0.22-2.25).
CONCLUSIONS
This study shows no evidence of an association between oral cholera vaccination and adverse pregnancy outcomes. The findings do not rigorously exclude the possibility that the vaccine protocol may result in some degree of harm.
TWEETABLE ABSTRACT
There is no evidence of an association between oral cholera vaccination and adverse pregnancy outcomes. The findings do not rigorously exclude the possibility that the vaccine protocol may result in some degree of harm.
Topics: Abortion, Spontaneous; Case-Control Studies; Cholera; Cholera Vaccines; Congenital Abnormalities; Female; Humans; Infant, Low Birth Weight; Infant, Newborn; Mass Vaccination; Pregnancy; Pregnancy Outcome; Premature Birth; Stillbirth
PubMed: 32289871
DOI: 10.1111/1471-0528.16260