CDC EID Press Summaries Update
Emerging Infectious Diseases Journal
Highlights: Emerging Infectious Diseases, Vol. 17, No. 11, (November 2011)
The articles of interest summarized below with the exception of Cholera in United States Associated with Epidemic in Hispaniola will appear in the November 2011 issue of Emerging Infectious Diseases, CDC’s monthly peer-reviewed public health journal. This issue will feature cholera. The articles are embargoed until October 12, 2011, at 12 p.m. EDT. Cholera in United States Associated with Epidemic in Hispaniolais available online at http://wwwnc.cdc.gov/eid.
Note: Not all articles published in EID represent work done by CDC scientists. In your stories, please clarify whether a study was conducted by CDC (“a CDC study”) or by another institution (“a study published by CDC”). The opinions expressed by authors contributing to EID do not necessarily reflect the opinions of CDC or the institutions with which the authors are affiliated.
1. Lessons Learned during Public Health Response to Cholera Epidemic in Haiti and the Dominican Republic, Jordan W. Tappero and Robert Tauxe As long as cholera exists anywhere in the world, those who live in areas with poor sanitation and drink untreated water are at risk. Such was the situation after the 2010 earthquake in Haiti, a country already plagued with poor health infrastructure and conditions. The massive public health response depended on the effectiveness of international cooperation, rapid disease rehydration treatment and reporting, training of health care providers, and public education campaigns. But access to clean water and sanitation remains a top priority.
2. Epidemic Cholera in a Crowded Urban Environment, Port-au-Prince, Haiti Stacie E. Dunkle et al. Cholera is a problem in areas where sanitation is poor and clean water is scarce. Such were the conditions in Port-au-Prince, Haiti, after the January 2010 earthquake destroyed the city’s vital water and sanitation infrastructure. By the time the cholera epidemic hit, more than one million people were living in camps or crowded slums, where poverty, poor nutrition, and inadequate water and sanitation were the norm. A recent study conducted in Port-au-Prince identified three actions that seemed to protect some people from cholera: disinfecting drinking water, washing hands, and eating a diverse diet. The protective effects of clean water and hand-washing are well known, but that of the diverse diet might reflect higher socioeconomic status (more access to a variety of foods) or higher nutritional content (and subsequent health benefits), which may have helped prevent people from getting sick.
3. Cholera in United States Associated with Epidemic in Hispaniola, Anna E. Newton, et al. Sometimes history really does repeat itself. In the 1990s, increases in cholera in Latin America led to increasing numbers of cases in the United States. So, when the Haiti cholera epidemic began in 2010, experts expected to see an uptick in U.S. cases. And they did. Since the Haiti epidemic began, 23 cases of imported cholera have been reported among those living in eight U.S. states—nearly four times the annual average in recent years. All but one patient had travelled to Haiti or the Dominican Republic, including nine who attended a wedding in the Dominican Republic. (The non-traveler ate contaminated seafood brought back from Haiti by a relative). Most of the 23 U.S. cholera patients had gone to Hispaniola to visit friends or relatives. Although the risk of spreading cholera to others in the United States is low, this study underscores the need to educate those visiting friends or relatives about steps they should take to prevent infection and importation of disease into the United States.
4. Comparative Genomics of Vibrio cholerae from Haiti, Asia, and Africa Aleisha R. Reimer et al. Sometimes, a key to controlling an epidemic is finding the source of the pathogen causing the epidemic—its ancestral history—so that public health officials can predict its behavior: How infectious is a given strain? How deadly? Is it resistant to drugs? Is it likely to mutate? Genetic comparison between the cholera strain from Haiti with strains from other countries linked it to India and Cameroon. This finding supports the likelihood that the Haiti strain was imported from outside the country, as opposed to emerging from local water. Historically, this strain has been hardy, potent, and drug resistant; its genetic characteristics indicate that it may easily spread and replace current strains in the Americas.
5. Drug-Resistance Mechanisms in Vibrio cholerae O1 Outbreak Strain, Haiti, 2010, Maria Sjölund-Karlsson et al. Drug-resistant cholera is a global health concern; infections with drug-resistant strains can be more difficult to treat. Although the main treatment for cholera is replacing the fluid lost through diarrhea, the volume and duration of diarrhea can be reduced with antibiotics. Resistance to antibiotics, however, has been emerging and has been found in the cholera strain that caused the outbreak in Haiti. A study of the genetic mechanisms behind this resistance showed that the Haiti strain carries several drug-resistance genes. Continued monitoring of resistance in the cholera bacteria in Haiti is necessary to know if further resistance develops and to guide antibiotic policy if it does.
6.Cholera: Modern Pandemic Disease of Ancient Lineage, J. Glenn Morris Cholera is a wily opponent. The cholera organism can live indefinitely in water and can survive in a changing environment by evolving genetically. And as it evolves, it is becoming more capable of causing severe disease. Recently, researchers found that the organism passed in diarrhea from an infected person is more capable of causing disease for several hours, during which time fast transmission from person to person can occur. Although the key to ultimate cholera control is good sanitation, prevention efforts should also focus on household transmission during the short period when it is more infectious.
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