Cholera in the United States, 2001–2011: a reflection of patterns of global epidemiology and travel

Loharikar, Anagha; Newton, Anna E.; Stroika, Steven; Freeman, Molly M.; Greene, Katherine D.; Parsons, Michele B.; Bopp, Cheryl A.; Talkington, Deborah F.; Mintz, Eric D.; Mahon, Barbara E.

doi:10.1017/s0950268814001186

Cited by 31 publications

(17 citation statements)

References 33 publications

(40 reference statements)

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“…In many other outbreaks, the consumption of drinks and foods purchased from street vendors has been identified as an important risk factor [ 22 , 23 ]. Street food vendors represent a possible method of transmitting cholera throughout the population, as suggested by Loharikar et al [ 24 ]. Items sold by vendors are most likely to be contaminated through the environment and by poor handling.…”

Section: Discussionmentioning

confidence: 99%

A cholera outbreak in Alborz Province, Iran: a matched case-control study

et al. 2016

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OBJECTIVES:A total of 229 confirmed cholera cases were reported in Alborz Province during an outbreak that lasted from June 2011 to August 2011. This study aimed to identify potential sources of transmission in order to determine suitable interventions in similar outbreaks. In other words, the lessons learned from this retrospective study can be utilized to manage future similar outbreaks.METHODS:An age-matched and sex-matched case-control study was conducted during the outbreak. For each case, two control subjects were selected from the neighborhood. A case of cholera was defined as a bacteriologically confirmed case with signs and symptoms of cholera. This study was conducted from June 14, 2011 through August 23, 2011. The data were analyzed by calculating odds ratios (ORs) using the logistic regression method.RESULTS:In this outbreak, 229 confirmed cholera cases were diagnosed. The following risk factors were found to be associated with cholera: consumption of unrefrigerated leftover food (OR, 3.05; 95% confidence interval [CI], 1.72 to 5.41), consumption of vegetables and fruits in the previous three days (OR, 2.75; 95% CI, 1.95 to 3.89), and a history of traveling in the previous five days (OR, 5.31; 95% CI, 2.21 to 9.72).CONCLUSIONS:Consumption of vegetables and fruits has remained an unresolved risk factor in cholera outbreaks in Iran in recent years. In order to reduce the risk of cholera, sanitary standards for fruits and vegetables should be observed at all points from production to consumption, the population should be educated regarding hygienic food storage during outbreaks, and sanitary standards should be maintained when traveling during cholera outbreaks.

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Section: Discussionmentioning

confidence: 99%

A cholera outbreak in Alborz Province, Iran: a matched case-control study

et al. 2016

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“…For instance, a few cases of cholera acquired in the US are declared each year. These sporadic cholera cases are generally attributed to consumption of seafood gathered from the US Gulf coast ( Loharikar et al, 2015 ). Antibiotic resistance genes carried by SRIs are also troublesome for aquaculture as resistance genes can hinder the treatment of diseased fish and enter the food chain ( Osorio et al, 2008 ; Rodriguez-Blanco et al, 2012 ; Nonaka et al, 2014 ).…”

Section: Diversity and Prevalence Of Sris And Acpsmentioning

confidence: 99%

The extended regulatory networks of SXT/R391 integrative and conjugative elements and IncA/C conjugative plasmids

2015

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Nowadays, healthcare systems are challenged by a major worldwide drug resistance crisis caused by the massive and rapid dissemination of antibiotic resistance genes and associated emergence of multidrug resistant pathogenic bacteria, in both clinical and environmental settings. Conjugation is the main driving force of gene transfer among microorganisms. This mechanism of horizontal gene transfer mediates the translocation of large DNA fragments between two bacterial cells in direct contact. Integrative and conjugative elements (ICEs) of the SXT/R391 family (SRIs) and IncA/C conjugative plasmids (ACPs) are responsible for the dissemination of a broad spectrum of antibiotic resistance genes among diverse species of Enterobacteriaceae and Vibrionaceae. The biology, diversity, prevalence and distribution of these two families of conjugative elements have been the subject of extensive studies for the past 15 years. Recently, the transcriptional regulators that govern their dissemination through the expression of ICE- or plasmid-encoded transfer genes have been described. Unrelated repressors control the activation of conjugation by preventing the expression of two related master activator complexes in both types of elements, i.e., SetCD in SXT/R391 ICEs and AcaCD in IncA/C plasmids. Finally, in addition to activating ICE- or plasmid-borne genes, these master activators have been shown to specifically activate phylogenetically unrelated mobilizable genomic islands (MGIs) that also disseminate antibiotic resistance genes and other adaptive traits among a plethora of pathogens such as Vibrio cholerae and Salmonella enterica.

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“…In most of the case reports, cholera vaccination information was not provided, or the authors noted that the patient had not received cholera vaccination. Seven review articles were retrieved, 22–28 reviewing a total of 499 cases of imported cholera. Five of these articles covered 491 cases in the USA between 1965 and 2011, of which 342 were acquired outside the USA 22 , 23 , 25 , 26 , 28 .…”

Section: Resultsmentioning

confidence: 99%

Cholera in travellers: a systematic review

Connor

Dawood²,

Riddle

et al. 2019

Journal of Travel Medicine

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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).

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Cholera in the United States, 2001–2011: a reflection of patterns of global epidemiology and travel

Cited by 31 publications

References 33 publications

A cholera outbreak in Alborz Province, Iran: a matched case-control study

A cholera outbreak in Alborz Province, Iran: a matched case-control study

The extended regulatory networks of SXT/R391 integrative and conjugative elements and IncA/C conjugative plasmids

Cholera in travellers: a systematic review

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