From 1994 up to now, active measures in the prevention of cholera have been implementing in Thua Thien Hue province, by the proper investment for safe water supplying, waste treatment, sewage treatment, sanitary-food safety examination and control of chloride content in safe water system, close supervise and soon discovery of patients with cholera, quick and strict responding to the epidemic so that limiting and decreasing significantly the mortality.
Cholera ; prevention & control

Animals ; China ; epidemiology ; Cholera ; epidemiology ; prevention & control ; Environmental Monitoring ; Vibrio cholerae ; genetics ; isolation & purification

The safety, tolerability and immunogenicity of an oral cholera vaccine (OCV) was assessed in adult Korean male through an open-label, non-comparative clinical study. Two doses of vaccine with an interval of 2 weeks were given to 20 healthy subjects. A total of 7 adverse events occurred in 6 subjects. However, no clinically significant change was observed in electrocardiograms, vital signs, physical examinations, and clinical laboratory tests. The immunogenicity of OCV was evaluated by serum vibriocidal assay where anti-Vibrio cholerae O1 and O139 antibodies were measured at day 0, 14, and 28 of vaccine administration. The antibody titers ranged from < 2.5-5,120 for V. cholerae O1 Inaba, < 2.5-10,240 for V. cholerae O1 Ogawa and < 2.5-480 for V. cholerae O139. In addition, the fold increase in antibody titers ranged from 1-4,096 for O1 Inaba, 1-8,192 for O1 Ogawa, and 1-384 for O139. The seroconversion rate was 95% and 45% for O1 and O139 antibodies, respectively. Our study clearly shows that administration of two doses of OCV at a 2 week-interval increases an appropriate level of antibody titer in the serum of healthy Korean adult males (Clinical Trial Number, NCT01707537).
Administration, Oral ; Adult ; Antibodies, Bacterial/*blood/immunology ; Antibody Formation ; Cholera/*prevention & control ; Cholera Vaccines/adverse effects/*immunology ; Creatine Kinase/blood ; Humans ; Male ; Republic of Korea ; Toothache/etiology ; Vibrio cholerae O1/immunology

Cholera is a secretory diarrhoeal disease caused by infection with Vibrio cholerae, primarily the V. cholerae O1 El Tor biotype. There are approximately 2.9 million cases in 69 endemic countries annually, resulting in 95 000 deaths. Cholera is associated with poor infrastructure and lack of access to sanitation and clean drinking water. The current cholera epidemic in Yemen, linked to spread of V. cholerae O1 (Ogawa serotype), is associated with the ongoing war. This has devastated infrastructure and health services. The World Health Organization had estimated that 172 286 suspected cases arose between 27th April and 19th June 2017, including 1170 deaths. While there are three oral cholera vaccines prequalified by the World Health Organization, there are issues surrounding vaccination campaigns in conflict situations, exacerbated by external factors such as a global vaccine shortage. Major movements of people complicates surveillance and administration of double doses of vaccines. Cholera therapy mainly depends on rehydration, with use of antibiotics in more severe infections. Concerns have arisen about the rise of antibiotic resistance in cholera, due to mobile genetic elements. In this review, we give an overview of cholera epidemiology, virulence, antibiotic resistance, therapy and vaccines, in the light of the ongoing epidemic in Yemen.
Anti-Bacterial Agents ; therapeutic use ; Cholera ; drug therapy ; prevention & control ; Cholera Vaccines ; therapeutic use ; DNA, Bacterial ; genetics ; Disease Outbreaks ; Drug Resistance, Multiple, Bacterial ; Humans ; Microbial Sensitivity Tests ; Polymerase Chain Reaction ; Vibrio cholerae ; drug effects ; isolation & purification ; Virulence Factors ; genetics ; Yemen

OBJECTIVETo construct an operable strategic framework for cholera prevention and control which mobilized the advantages of local resources and adapted to social developments in Chengdu, and to evaluate its application effects.

METHODS(1) After analyzing the local epidemic data of cholera in Chengdu from 1994 to 2004, we determined the main problems of cholera prevention and control works as well as the efficiency and deficiency of employed measures, and then formed a basic strategic framework. (2) After 55 invited experts preliminarily scored the strategic framework, we selected 72 specific measures to establish a measure entry database, and then the importance and operability of each measure were scored by 17 core experts. (3) Finally, the effectiveness of this strategic framework was evaluated according to the analyzing results of infection control, health education and etiological monitoring.

RESULTS(1) The framework took government leadership as main scenario and the informatization as subordination scenario. Meanwhile, it focused on three points: the improvement of social environment, the completion of system and mechanisms for monitoring and early warning, and the enhancement of CDC response to public health emergencies. Total importance score and operability score of 35 specific measures included in this framework was 4.20 ± 0.86 and 4.09 ± 0.87, respectively. (2) Chengdu had maintained zero cholera incidence for five consecutive years from 2005 to 2009 since it gradually began to implement the strategic framework in 2002. There were 19 positive cholera cases detected by etiological monitoring and all of them were seafood or fishery products including soft-shelled turtles, silver carps and bullfrogs. The coverage rate and qualification rate of the training for grassroots cadres, grassroots medical workers, mobile cooks and their assistants was 98.14% (198 452/202 220) and 98.17% (194 820/198 452) in average, respectively. The qualification rate of the training for employees in food industry was over 96.00% (912 470/950 489). The average awareness rate of cholera prevention and cure knowledge in rural residents, grassroots cadres, grassroots medical workers, mobile cooks and their assistants was 93.87% (1653/1761) and the average formation rate of good hygiene habits was 70.58% (1243/1761).

CONCLUSIONA strategic framework suitable for cholera prevention and control in Chengdu has been successfully established in this study. The incidence rate of cholera has maintained zero in Chengdu for five consecutive years under incessant threatening conditions such as the occurrence of cholera cases from time to time in its surrounding areas and the continuous existence of Bacillus comma in seafood or fishery products that entered local markets. Therefore, it demonstrated a good application effects.

China ; epidemiology ; Cholera ; epidemiology ; prevention & control ; Communicable Disease Control ; organization & administration ; Health Education ; organization & administration ; Humans ; Outcome Assessment (Health Care) ; Public Health

Rhesus monkeys (5 in each group) were inoculated with recombinant fusion protein of cholera toxin B subunit and multi-valent epitopes of Plasmodium falciparum intranasal or intramuscular (i.m.). Immune-responses and protective effect were evaluated. The antibody titer (Geometry mean) against CTB reached 1:512 (intranasal) and 1:10000 (i.m.) 14 day after 3rd immunization, and antibodies against P. falciparum were also elucidated, the titers in i.m. group were also significantly higher than that in intranasal group. The monkeys were challenged with 1.25 x 10(8) sporozoites of P. cynomolgi, Patent infection was observed in all 5 monkeys in control group inoculated with PBS in 10 - 14 days after challenge. Patent infection was also observed in 5 animals inoculated via intranasal and 2 animals in intramuscular group 19th days after challenge, But the infection last only 4 days in 3 animals in intranasal group and 2 animals in intramuscular group. The results demonstrated that the vaccine candidate could induce protective immune-responses in rhesus monkey against the challenge of P. cynomolgi.
Animals ; Antibodies, Bacterial ; blood ; Antibodies, Protozoan ; blood ; Cholera Toxin ; genetics ; immunology ; Erythrocytes ; parasitology ; Macaca mulatta ; Malaria ; prevention & control ; veterinary ; Malaria Vaccines ; immunology ; Monkey Diseases ; prevention & control ; Plasmodium cynomolgi ; Plasmodium falciparum ; immunology ; Recombinant Fusion Proteins ; immunology ; Vaccines, Synthetic ; immunology

To avoid a future catastrophic event like the recent Middle East respiratory syndrome (MERS) outbreak, we must reform our health system based on an objective and thorough review of the outbreak. A little over a year after the outbreak, this paper aims to evaluate the current status of the government's effort to reform our health system across the three following areas: 1) infectious disease emergency preparedness and response; 2) an organized healthcare system for infectious diseases; and 3) hospital preparedness for healthcare-associated infections. In spite of the substantial organizational changes of the Korea Centers for Disease Control (CDC) responsible for infectious disease emergency preparedness and response, the Korea CDC has not shown significant improvement in its competence and organizational commitment in the face of recent infectious disease threats such as Zika virus and cholera. So far, the Korean government has not announced an implementation plan for establishing an organized healthcare system for infectious diseases. To reduce healthcare associated infections, the Korean government implemented major changes in the hospital infection control system, emergency medical service system, and enhanced nursing system. Because the most extensive reform occurred around reducing healthcare-associated infections in hospitals, we need to evaluate the impact of the entire reform effort in a near future. Because the effort to reform our health system remains ongoing, we also need to continue to observe the progress of reform to ensure the avoidance of a future catastrophic event like the recent MERS outbreak.
Centers for Disease Control and Prevention (U.S.) ; Cholera ; Civil Defense ; Communicable Diseases ; Coronavirus Infections ; Cross Infection ; Delivery of Health Care* ; Emergency Medical Services ; Health Care Reform* ; Korea ; Mental Competency ; Nursing ; Organizational Innovation ; Zika Virus

Corn, one of the most important forage crops worldwide, has proven to be a useful expression vehicle due to the availability of established transformation procedures for this well-studied plant. The exotoxin Apx, a major virulence factor, is recognized as a common antigen of Actinobacillus (A.) pleuropneumoniae, the causative agent of porcine pleuropneumonia. In this study, a cholera toxin B (CTB)-ApxIIA#5 fusion protein and full-size ApxIIA expressed in corn seed, as a subunit vaccine candidate, were observed to induce Apx-specific immune responses in mice. These results suggest that transgenic corn-derived ApxIIA and CTB-ApxIIA#5 proteins are potential vaccine candidates against A. pleuropneumoniae infection.
Actinobacillus Infections/microbiology/*prevention & control ; Actinobacillus pleuropneumoniae ; Animals ; Antigens, Bacterial/immunology ; Bacterial Proteins/*immunology ; Bacterial Vaccines/*immunology ; Cholera Toxin/*chemistry ; Female ; Hemolysin Proteins/*immunology ; Immunization, Secondary ; Mice ; Mice, Inbred ICR ; Plants, Genetically Modified ; Zea mays/*genetics

OBJECTIVETo track the source of infection regarding 4 Cholerae outbreaks in Anhui province in 2012 through the application of PulseNet China Database (PNCD).

METHODSCholerae virulence genes were amplified by PCR and typed by pulse field gel electrophoresis(PFGE). Results from electrophoresis were cluster-analyzed by BioNumericsV4.0 software and compared with PNCD.

RESULTSVirulence gene CT and TCP of the tested vibrio cholera showed both positive. Homology of the strains from four cholera outbreaks was more than 98%, based on the homologous and cluster analysis through enzyme digested PFGE electrophoresis. Those strains were highly homologous with the cholera epidemic strains identified in Hunan, Sichuan,Zhejiang, Shanghai and Hubei by PNCD, with the homology as 100% .

CONCLUSIONFour cholera outbreaks in Anhui province, 2012 were highly correlated with the outbreaks occurring in Hunan and Sichuan during the same time period, indicating that PNCD could effectively and quickly tracking down the source of infection on the cholera outbreaks and providing early warning of the situation.

Animals ; Bacterial Typing Techniques ; methods ; China ; epidemiology ; Cholera ; epidemiology ; prevention & control ; Cluster Analysis ; DNA, Bacterial ; Databases, Factual ; Electrophoresis, Gel, Pulsed-Field ; methods ; Humans ; Polymerase Chain Reaction ; Vibrio cholerae ; genetics

INTRODUCTIONWe carried out an epidemiological review of cholera in Singapore to determine its trends and the factors contributing to its occurrence.

MATERIALS AND METHODSEpidemiological data of all notified cases of cholera maintained by the Communicable Diseases Division, Ministry of Health, for the period 1992 to 2007 were collated and analysed. Case-control studies were carried out in outbreaks to determine the source of infection and mode of transmission. Linear patterns in age and ethnic distribution of cholera cases were assessed using chi2 test for trend.

RESULTSThere were a total of 210 cholera cases reported between 1992 and 2007. The incidence of cholera declined from 17 cases in 1992 to 7 cases in 2007. About a quarter of the cases were imported from endemic countries in the region. Between 76% and 95% of the reported cases were local residents. Four elderly patients with comorbidities and who sought medical treatment late died, giving a case-fatality rate of 1.9%. Vibrio cholerae 01, biotype El Tor, serotype Ogawa, accounted for 83.8% of the cases. The vehicles of transmission identified in outbreaks included raw fi sh, undercooked seafood and iced drinks cross-contaminated with raw seafood.

CONCLUSIONWith the high standard of environmental hygiene and sanitation, a comprehensive epidemiological surveillance system and licensing and control of food establishments, cholera could not gain a foothold in Singapore despite it being situated in an endemic region. However, health education of the public on the importance of personal and food hygiene is of paramount importance in preventing foodborne outbreaks. Physicians should also maintain a high level of suspicion of cholera in patients presenting with severe gastroenteritis, especially those with a recent travel history to endemic countries.

Adolescent ; Child ; Child, Preschool ; Cholera ; microbiology ; mortality ; Disease Outbreaks ; statistics & numerical data ; Female ; Foodborne Diseases ; epidemiology ; prevention & control ; Humans ; Incidence ; Infant ; Infant, Newborn ; Male ; Middle Aged ; Population Surveillance ; Singapore ; epidemiology ; Vibrio cholerae O1 ; isolation & purification ; Young Adult