Phage predation of Vibrio cholerae has recently been reported to be a factor that influences seasonal epidemics of cholera in Bangladesh.To understand more about this phenomenon, we studied the dynamics of the V. cholerae-phage interaction during a recent epidemic in Dhaka. Because the outbreak strain causing this epidemic was resistant to multiple antibiotics, including streptomycin, we used a selective medium containing streptomycin to monitor accurately the abundance of this strain in the environment. The changing prevalence in the environment of the epidemic V. cholerae O1 strain and a particular lytic cholera phage (JSF4) to which it was sensitive was measured every 48 -72 h for 17 weeks. We also monitored the incidence of phage excretion in stools of 387 cholera patients during the epidemic. The peak of the epidemic was preceded by high V. cholerae prevalence in the environment and was followed by high JSF4 phage levels as the epidemic ended. The buildup to the phage peak in the environment coincided with increasing excretion of the same phage in the stools of cholera patients. These results suggest that patients toward the end of the epidemic ingested both JSF4 phage and the outbreak V. cholerae strain. Host-mediated phage amplification during the cholera epidemic likely contributed to increased environmental phage abundance, decreased load of environmental V. cholerae and, hence, the collapse of the epidemic. Thus, in vivo phage amplification in patients and subsequent phage predation in the environment may explain the self-limiting nature of seasonal cholera epidemics in Bangladesh.Vibrio cholerae ͉ vibriophage T oxigenic strains of Vibrio cholerae belonging to the O1 and O139 serogroups cause cholera, a devastating diarrhea disease that occurs frequently as epidemics in many developing countries (1). Epidemics of cholera occur regularly in the Ganges Delta region of Bangladesh and India. In Bangladesh, outbreaks usually occur twice during a year, with the highest number of cases just after the monsoon and a somewhat smaller number of cholera cases during the spring. The occurrence of epidemics are known to coincide with increased prevalence of the causative V. cholerae strain in the aquatic environment (2). A variety of physical and biological parameters are likely to influence the survival and abundance of V. cholerae as a species in the environment, but these factors do not exclusively modulate the prevalence of toxigenic V. cholerae O1 and O139 strains. In contrast, bacterial viruses (phage or bacteriophage) in the environment have recently been found to inversely correlate with the abundance of toxigenic V. cholerae in water samples and the incidence rates of cholera (3). These data strongly suggest that phage predation in the environment likely influences the temporal dynamics of cholera epidemics. Phages also play a role in the emergence of pathogenic clones and may also be involved in territorialism between different strains of V. cholerae (3-5). For example, cholera toxin genes are transferred ...