Cholera Outbreaks in India

Abstract

Cholera is a global health problem as several thousands of cases and deaths occur each year. The unique epidemiologic attribute of the disease is its propensity to occur as outbreaks that may flare-up into epidemics, if not controlled. The causative bacterial pathogen Vibrio cholerae prevails in the environment and infects humans whenever there is a breakdown in the public health component. The Indian subcontinent is vulnerable to this disease due its vast coastlines with areas of poor sanitation, unsafe drinking water, and overcrowding. Recently, it was shown that climatic conditions also play a major role in the persistence and spread of cholera. Constant change in the biotypes and serotypes of V. cholerae are also important aspects that changes virulence and survival of the pathogen. Such continuous changes increase the infection ability of the pathogen affecting the susceptible population including the children. The short-term carrier status of V. cholerae has been studied well at community level and this facet significantly contributes to the recurrence of cholera. Several molecular tools recognized altering clonality of V. cholerae in relation with the advent of a serogroup or serotype. Rapid identification systems were formulated for the timely detection of the pathogen so as to identify and control the outbreak and institute proper treatment of the patients. The antimicrobials used in the past are no longer useful in the treatment of cholera as V. cholerae has acquired several mechanisms for multiple antimicrobial resistance. This upsurge in antimicrobial resistance directly influences the management of the disease. This chapter provides an overview of cholera prevalence in India, possible sources of infection, and molecular epidemiology along with antimicrobial resistance of V. cholerae.

Pandemics, pathogenicity and changing molecular epidemiology of cholera in the era of global warming

“…Sanitation facilities, provision of safe drinking water and good infrastructure for sewage treatment in industrialized nations has made cholera extremely rare. Outbreak studies done in Odisha, India found a clear relationship between sewage contaminated water and cholera epidemics [48]. Several field surveys in West Bengal and Gujrat revealed cholera outbreaks related to sewage leaks from municipality pipelines and local overpopulation [49–51].…”

Antimicrobial susceptibility profile of Vibrio cholerae strains isolated at a tertiary care medical centre in New Delhi, India

“…2,3 In addition, one or the other part of the country continues to endure outbreaks of this illness every year, especially during monsoon seasons. 4 Though, it is the fluid and electrolyte replacement that plays a critical role in management of cholera, antibiotic intervention may be warranted, particularly in severe cases. For the patient, it is beneficial since it reduces the intensity and duration of diarrheal disease and prevents any lethal complications.…”

Evaluation of Whole-Genome Sequencing for Identification and Typing of Vibrio cholerae

“…The isolates from U.K. travelers clustered geographically with those returning from India located on the same branch, and those reporting recent travel to Pakistan clustered on a separate branch. Further analysis based on single nucleotide polymorphisms in the core genome compared with a reference strain may be performed for outbreak detection and source attribution where the incidence of the current V. cholerae O1 El Tor pandemic lineage (ST69) is high (28,29).…”