J Korean Med Assoc.  2017 Feb;60(2):140-146. 10.5124/jkma.2017.60.2.140.

Epidemiology, management, and prevention of cholera

• Bae IG

• KMID: 2368924
• DOI: http://doi.org/10.5124/jkma.2017.60.2.140

Abstract

Cholera is an acute secretory form of diarrhea caused by a potent enterotoxin (cholera toxin) after ingestion of toxigenic Vibrio cholerae of the O1 or O139 serogroups. Although cholera is very common in Africa and Asia as a whole, the incidence of cholera has been very low in recent years in Korea. Dehydration and electrolyte abnormalities due to massive watery diarrhea can lead to death, and the mortality rates in untreated patients with severe cholera can exceed 70%. Effective rehydration therapy is the cornerstone of the management of patients with cholera and can reduce the mortality rate to less than 0.2%. Antibiotics reduce the volume and duration of diarrhea, but are recommended for patients with severe disease because of the rapid emergence and spread of multidrug-resistant V. cholerae across the globe. Two oral cholera vaccines are available, and the World Health Organization recommends that these oral vaccines be considered in integrated prevention programs in endemic countries at risk for outbreaks.

Keyword

Cholera; Vibrio cholerae; Cholera toxin; Cholera vaccines

MeSH Terms

Africa
Anti-Bacterial Agents
Asia
Cholera Toxin
Cholera Vaccines
Cholera*
Dehydration
Diarrhea
Disease Outbreaks
Eating
Enterotoxins
Epidemiology*
Fluid Therapy
Humans
Incidence
Korea
Mortality
Serogroup
Vaccines
Vibrio cholerae
World Health Organization
Anti-Bacterial Agents
Cholera Toxin
Cholera Vaccines
Enterotoxins
Vaccines

Figure

• 

  Figure 1 Countries reporting cholera death and imported cases in 2015. Reproduced from Wkly Epidemiol Rec 2016;91:433-440 [9].

Reference

1. Sack DA, Sack RB, Nair GB, Siddique AK. Cholera. Lancet. 2004; 363:223–233.

2. Safa A, Nair GB, Kong RY. Evolution of new variants of Vibrio cholerae O1. Trends Microbiol. 2010; 18:46–54.

3. World Health Organization. Cholera vaccines: a brief summary of the March 2010 position paper. Geneva: World Health Organization;2010.

4. Lee JW, Kim TS, Jung JW, Park SB, Lee HJ, Lee DG, Lee JN, Lee SH. A case of liver abscess and bacteremia caused by Vibrio cholerae non-O1. Korean J Gastroenterol. 2011; 58:350–352.

5. Longini IM Jr, Yunus M, Zaman K, Siddique AK, Sack RB, Nizam A. Epidemic and endemic cholera trends over a 33-year period in Bangladesh. J Infect Dis. 2002; 186:246–251.

6. Bik EM, Bunschoten AE, Gouw RD, Mooi FR. Genesis of the novel epidemic Vibrio cholerae O139 strain: evidence for horizontal transfer of genes involved in polysaccharide synthesis. EMBO J. 1995; 14:209–216.

7. Cassel D, Pfeuffer T. Mechanism of cholera toxin action: covalent modification of the guanyl nucleotide-binding protein of the adenylate cyclase system. Proc Natl Acad Sci U S A. 1978; 75:2669–2673.

8. Matson JS, Withey JH, DiRita VJ. Regulatory networks controlling Vibrio cholerae virulence gene expression. Infect Immun. 2007; 75:5542–5549.

9. Cholera, 2015. Wkly Epidemiol Rec. 2016; 91:433–440.

10. Korea Centers for Disease Control and Prevention. Prevention of cholera infection [Internet]. Cheonju: Korea Centers for Disease Control and Prevention;2012. cited 2017 Jan 10. Available from: http://www.cdc.go.kr/CDC/health/CdcKrHealth0101.jsp?menuIds=HOME001-MNU1132-MNU1147-MNU0746-MNU2426&fid=7958&cid=68953.

11. Ruiz-Moreno D, Pascual M, Emch M, Yunus M. Spatial clustering in the spatio-temporal dynamics of endemic cholera. BMC Infect Dis. 2010; 10:51.

12. Nelson EJ, Harris JB, Morris JG Jr, Calderwood SB, Camilli A. Cholera transmission: the host, pathogen and bacteriophage dynamic. Nat Rev Microbiol. 2009; 7:693–702.

13. Faruque SM, Biswas K, Udden SM, Ahmad QS, Sack DA, Nair GB, Mekalanos JJ. Transmissibility of cholera: in vivo-formed biofilms and their relationship to infectivity and persistence in the environment. Proc Natl Acad Sci U S A. 2006; 103:6350–6355.

14. Hartley DM, Morris JG Jr, Smith DL. Hyperinfectivity: a criti-cal element in the ability of V. cholerae to cause epidemics? PLoS Med. 2006; 3:e7.

15. Lindenbaum J, Greenough WB, Islam MR. Antibiotic therapy of cholera in children. Bull World Health Organ. 1967; 37:529–538.

16. World Health Organization. The treatment of diarrhea: a manual for physicians and other senior health workers [Internet]. Geneva: World Health Organization;2005. cited 2017 Feb 10. http://whqlibdoc.who.int/publications/2005/9241593180.pdf.

17. Hasan JA, Huq A, Tamplin ML, Siebeling RJ, Colwell RR. A novel kit for rapid detection of Vibrio cholerae O1. J Clin Microbiol. 1994; 32:249–252.

18. Harris JR, Cavallaro EC, de Nobrega AA, Dos S, Bopp C, Parsons MB, Djalo D, Fonseca FG, Ba U, Semedo A, Sobel J, Mintz ED. Field evaluation of crystal VC Rapid Dipstick test for cholera during a cholera outbreak in Guinea-Bissau. Trop Med Int Health. 2009; 14:1117–1121.

19. Global Task Force on Cholera Control. First steps for managing an outbreak of acute diarrhea [Internet]. Geneva: World Health Organization;2010. cited 2017 Feb 10. Available from: http://www.who.int/cholera/publications/firststeps/en/.

20. Nelson EJ, Nelson DS, Salam MA, Sack DA. Antibiotics for both moderate and severe cholera. N Engl J Med. 2011; 364:5–7.

21. Kim H, Jeon S, Kim J, Kim S, Lee DY. Genetic characteristics and relatedness of imported Vibrio cholerae O1 biotype El tor in Korea. Ann Clin Microbiol. 2013; 16:25–32.

22. Global Task Force on Cholera Control. Prevention and control of cholera outbreaks: WHO policy and recommendations [Internet]. Geneva: World Health Organization;2011. cited 2017 Feb 10. Available from: http://www.who.int/cholera/technical/prevention/control/en/.

23. Sur D, Lopez AL, Kanungo S, Paisley A, Manna B, Ali M, Niyogi SK, Park JK, Sarkar B, Puri MK, Kim DR, Deen JL, Holmgren J, Carbis R, Rao R, Nguyen TV, Donner A, Ganguly NK, Nair GB, Bhattacharya SK, Clemens JD. Efficacy and safety of a modified killed-whole-cell oral cholera vaccine in India: an interim analysis of a cluster-randomised, double-blind, placebo-controlled trial. Lancet. 2009; 374:1694–1702.

24. Cholera vaccines: WHO position paper. Wkly Epidemiol Rec. 2010; 85:117–128.

25. Clemens JD, Sack DA, Harris JR, Chakraborty J, Khan MR, Stanton BF, Ali M, Ahmed F, Yunus M, Kay BA. Impact of B subunit killed whole-cell and killed whole-cell-only oral vaccines against cholera upon treated diarrhoeal illness and mortality in an area endemic for cholera. Lancet. 1988; 1:1375–1379.