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Recent Advances in Cholera Research

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Cholera is an acute diarrhoeal disease manifested by profuse watery diarrhoea, vomiting, and life-threatening dehydration which may lead to hypotension and acute renal failure. If not treated promptly and adequately by intravenous fluids, the patient may die. The disease is caused by Vibrio cholerae O1 Eltor. In 1884, Robert Koch, a German scientist, discovered the bacteria. Cholera can cause an asymptomatic infection, mild to moderate diarrhea, or even life-threatening severe diarrhoea. Cholera can also cause sporadic cases, epidemics, and pandemics. The current, or seventh pandemic, started in the Celebes Islands in Indonesia and spread to 102 countries across the globe. The disease is transmitted by the fecal-oral route. The relationship of occurrence of cholera with Helicobacter, gastric acidity, antacids, h-2 receptor blocker, partial gastrectomy, and Zinc are well established. The development of Oral Rehydration Salt Solution (ORS) was a landmark in the treatment of cholera and has saved the lives of millions of children worldwide.

In 1992, an unprecedented event occurred in the epidemiology of cholera when a novel strain of Vibrio cholerae O139 emerged, starting from Vellore and Kolkata, India and Dhaka, Bangladesh. Like O1 strains, this new strain also produces cholera toxin (CT). Clinically, O139 cholera is indistinguishable from that of O1 cholera. Scientists and epidemiologists working in the field thought that this was probably the beginning of another pandemic, which was later proved wrong when it was observed that this variety of cholera did not spread much except in the Gangetic Delta and a few other countries. The clinical picture of cholera is akin to the same of Enterotoxigenic E. coli. More recently a hybrid strain of Vibrio cholera has been identified

The major outbreaks of cholera most recently witnessed occurred in Haiti, Mozambique, Gibraltar, and Yemen. These outbreaks have been described carefully and the role of sanitation, population movement and, role of the Oral Cholera Vaccine have been documented. Bangladesh, India, and several other countries in the South-East Asia Region are hyper endemic for cholera and cause small to massive outbreaks due to poor environmental sanitation, overcrowding, and lack of good water supply. There have been tremendous improvements in vaccine manufacturing in South Korea, making them more accessible, more deliverable, and more affordable. The country requirement of vaccines has been developed and GAVI (Global Action for Vaccine Initiative) collects vaccines for its stock pile. There is also some interesting data on surveillance by various funders, which is needed in order to move forward and to find out where major gaps in prevention and treatment exist. The WaSH (water, sanitation, and hygiene) strategy also provides some important information to complement vaccines. The major aim of these initiatives is to make useful epidemiological information available for at-risk countries to be able to decide on protocols for introducing the cholera vaccine into their own areas.

Vaccination is an attractive disease prevention strategy. An injectable cholera vaccine was available for a time, but it was highly reactogenic and therefore its use was discontinued. Two oral cholera vaccines were also developed, but they are not frequently used, with the exception of use by travelers visiting cholera endemic areas. Recently, a heat-killed bivalent oral cholera vaccine was developed, which has been shown by community trials to protect about 66% of patients vaccinated for up to 5 years. The World Health Organization recommends that this vaccine should be used in situations where cholera is endemic and for controlling outbreaks. Ring vaccination may also be useful for controlling outbreaks. Vaccination, however, is no substitute for preventative measures such as sanitation, safe water, and hand washing, but should be a supplementary strategy. Research on different aspects of the disease should continue to mitigate the suffering of people affected by cholera. Chemoprophylaxis for cholera outbreaks has not been successful and is not recommended.

In this Research Topic, we welcome contributions on the following aspects of cholera research:

a) Bacteriology
b) Epidemiology
c) Clinical features & Treatment
d) Immunology & phage typing
e) Cholera outbreaks
e) Prevention
f) Cholera Vaccine
g) Anti-microbial resistance (AMR)


Keywords: cholera, dehydration, antibiotic, vaccine, prevention, immunity


Important Note: All contributions to this Research Topic must be within the scope of the section and journal to which they are submitted, as defined in their mission statements. Frontiers reserves the right to guide an out-of-scope manuscript to a more suitable section or journal at any stage of peer review.

Cholera is an acute diarrhoeal disease manifested by profuse watery diarrhoea, vomiting, and life-threatening dehydration which may lead to hypotension and acute renal failure. If not treated promptly and adequately by intravenous fluids, the patient may die. The disease is caused by Vibrio cholerae O1 Eltor. In 1884, Robert Koch, a German scientist, discovered the bacteria. Cholera can cause an asymptomatic infection, mild to moderate diarrhea, or even life-threatening severe diarrhoea. Cholera can also cause sporadic cases, epidemics, and pandemics. The current, or seventh pandemic, started in the Celebes Islands in Indonesia and spread to 102 countries across the globe. The disease is transmitted by the fecal-oral route. The relationship of occurrence of cholera with Helicobacter, gastric acidity, antacids, h-2 receptor blocker, partial gastrectomy, and Zinc are well established. The development of Oral Rehydration Salt Solution (ORS) was a landmark in the treatment of cholera and has saved the lives of millions of children worldwide.

In 1992, an unprecedented event occurred in the epidemiology of cholera when a novel strain of Vibrio cholerae O139 emerged, starting from Vellore and Kolkata, India and Dhaka, Bangladesh. Like O1 strains, this new strain also produces cholera toxin (CT). Clinically, O139 cholera is indistinguishable from that of O1 cholera. Scientists and epidemiologists working in the field thought that this was probably the beginning of another pandemic, which was later proved wrong when it was observed that this variety of cholera did not spread much except in the Gangetic Delta and a few other countries. The clinical picture of cholera is akin to the same of Enterotoxigenic E. coli. More recently a hybrid strain of Vibrio cholera has been identified

The major outbreaks of cholera most recently witnessed occurred in Haiti, Mozambique, Gibraltar, and Yemen. These outbreaks have been described carefully and the role of sanitation, population movement and, role of the Oral Cholera Vaccine have been documented. Bangladesh, India, and several other countries in the South-East Asia Region are hyper endemic for cholera and cause small to massive outbreaks due to poor environmental sanitation, overcrowding, and lack of good water supply. There have been tremendous improvements in vaccine manufacturing in South Korea, making them more accessible, more deliverable, and more affordable. The country requirement of vaccines has been developed and GAVI (Global Action for Vaccine Initiative) collects vaccines for its stock pile. There is also some interesting data on surveillance by various funders, which is needed in order to move forward and to find out where major gaps in prevention and treatment exist. The WaSH (water, sanitation, and hygiene) strategy also provides some important information to complement vaccines. The major aim of these initiatives is to make useful epidemiological information available for at-risk countries to be able to decide on protocols for introducing the cholera vaccine into their own areas.

Vaccination is an attractive disease prevention strategy. An injectable cholera vaccine was available for a time, but it was highly reactogenic and therefore its use was discontinued. Two oral cholera vaccines were also developed, but they are not frequently used, with the exception of use by travelers visiting cholera endemic areas. Recently, a heat-killed bivalent oral cholera vaccine was developed, which has been shown by community trials to protect about 66% of patients vaccinated for up to 5 years. The World Health Organization recommends that this vaccine should be used in situations where cholera is endemic and for controlling outbreaks. Ring vaccination may also be useful for controlling outbreaks. Vaccination, however, is no substitute for preventative measures such as sanitation, safe water, and hand washing, but should be a supplementary strategy. Research on different aspects of the disease should continue to mitigate the suffering of people affected by cholera. Chemoprophylaxis for cholera outbreaks has not been successful and is not recommended.

In this Research Topic, we welcome contributions on the following aspects of cholera research:

a) Bacteriology
b) Epidemiology
c) Clinical features & Treatment
d) Immunology & phage typing
e) Cholera outbreaks
e) Prevention
f) Cholera Vaccine
g) Anti-microbial resistance (AMR)


Keywords: cholera, dehydration, antibiotic, vaccine, prevention, immunity


Important Note: All contributions to this Research Topic must be within the scope of the section and journal to which they are submitted, as defined in their mission statements. Frontiers reserves the right to guide an out-of-scope manuscript to a more suitable section or journal at any stage of peer review.

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