Abstract: Cholera still affects millions of people worldwide, especially in lower- and middle-income countries (LMICs). The Global Task Force on Cholera Control (GTFCC) has identified surveillance and oral cholera vaccines as two critical interventions to actualise the global roadmap goals-reduction of cholera-related deaths by 90% and decreasing the number of cholera endemic countries by half by 2030. Therefore, this study aimed to identify facilitators and barriers to implementing these two cholera interventions in LMIC settings.A scoping review using the methods presented by Arksey and O'Malley. The search strategy involved using key search terms (cholera, surveillance, epidemiology and vaccines) in three databases (PubMed, CINAHL and Web of Science) and reviewing the first ten pages of Google searches. The eligibility criteria of being conducted in LMICs, a timeline of 2011-2021 and documents only in English were applied. Thematic analysis was performed, and the findings were presented according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension.Thirty-six documents met the predefined inclusion criteria, covering 2011 to 2021. There were two themes identified regarding the implementation of surveillance: timeliness and reporting (1); and resources and laboratory capabilities (2). As for oral cholera vaccines, there were four themes identified: information and awareness (1); community acceptance and trusted community leaders (2); planning and coordination (3); and resources and logistics (4). Additionally, adequate resources, good planning and coordination were identified to be operating at the interface between surveillance and oral cholera vaccines.Findings suggest that adequate and sustainable resources are crucial for timely and accurate cholera surveillance and that oral cholera vaccine implementation would benefit from increased community awareness and engagement of community leaders.

Abstract: Cholera is an issue of major public health importance. It was first reported in Kenya in 1971, with the country experiencing outbreaks through the years, most recently in 2021. Factors associated with the outbreaks in Kenya include open defecation, population growth with inadequate expansion of safe drinking water and sanitation infrastructure, population movement from neighboring countries, crowded settings such as refugee camps coupled with massive displacement of persons, mass gathering events, and changes in rainfall patterns. The Ministry of Health, together with other ministries and partners, revised the national cholera control plan to a multisectoral cholera elimination plan that is aligned with the Global Roadmap for Ending Cholera. One of the key features in the revised plan is the identification of hotspots. The hotspot identification exercise followed guidance and tools provided by the Global Task Force on Cholera Control (GTFCC). Two epidemiological indicators were used to identify the sub-counties with the highest cholera burden: incidence per population and persistence. Additionally, two indicators were used to identify sub-counties with poor WASH coverage due to low proportions of households accessing improved water sources and improved sanitation facilities. The country reported over 25,000 cholera cases between 2015 and 2019. Of 290 sub-counties, 25 (8.6%) sub-counties were identified as a high epidemiological priority; 78 (26.9%) sub-counties were identified as high WASH priority; and 30 (10.3%) sub-counties were considered high priority based on a combination of epidemiological and WASH indicators. About 10% of the Kenyan population (4.89 million) is living in these 30-combination high-priority sub-counties. The novel method used to identify cholera hotspots in Kenya provides useful information to better target interventions in smaller geographical areas given resource constraints. Kenya plans to deploy oral cholera vaccines in addition to WASH interventions to the populations living in cholera hotspots as it targets cholera elimination by 2030.

Abstract: Introduction Discuss the impact of cholera infection on pregnant women, fetus, and neonates and review the safety of cholera vaccines in pregnancy. Methods This study was carried out as a narrative review during November 2022. A thorough literature review was conducted on the following databases: PubMed, Scopus, SciELO, CINAHL, Web of Science, and ScienceDirect. The following parameters were assessed from the included studies: type of cholera vaccine, cholera symptoms, cholera treatment, effect of cholera on pregnancy, effect of cholera treatment on pregnancy, effect of cholera vaccine on pregnancy, risk factors for fetuses and neonates, and prevention of cholera. The authors independently extracted data from the 24 included studies. Results Cholera infection is a serious threat on pregnancy as it could lead to increased stillbirths and neonatal death. Fetal death was shown to occur mainly in the third trimester as most of the pregnant women infected with cholera had spontaneous abortions even after controlling for other confounding variables such as maternal age, dehydration level, and vomiting. Neonatal death was attributed mainly to congenital malformations and low Apgar scores with no improvements. Besides, cholera vaccines have shown to be safe in pregnancy and have proven to lower fetal and neonatal malformations among vaccinated compared to nonvaccinated pregnant women. Conclusion This narrative summarizes the different complications due to cholera infection in pregnancy. It also reviews the safety of cholera vaccine administration in pregnant women.

Abstract: ABSTRACT. In 2017, the Global Task Force for Cholera Control (GTFCC) set a goal to eliminate cholera from ≥ 20 countries and to reduce cholera deaths by 90% by 2030. Many countries have included oral cholera vaccine (OCV) in their cholera control plans. We felt that a simple, user-friendly monitoring tool would be useful to guide national progress toward cholera elimination. We reviewed cholera surveillance data of Uganda from 2015 to 2021 by date and district. We defined a district as having eliminated cholera if cholera was not reported in that district for at least 4 years. We prepared maps to show districts with cholera, districts that had eliminated it, and districts that had eliminated it but then “relapsed.” These maps were compared with districts where OCV was used and the hotspot map recommended by the GTFCC. Between 2018 and 2021, OCV was administered in 16 districts previously identified as hotspots. In 2018, cholera was reported during at least one of the four previous years from 36 of the 146 districts of Uganda. This number decreased to 18 districts by 2021. Cholera was deemed “eliminated” from four of these 18 districts but then “relapsed.” The cholera elimination scorecard effectively demonstrated national progress toward cholera elimination and identified districts where additional resources are needed to achieve elimination by 2030. Identification of the districts that have eliminated cholera and those that have relapsed will assist the national programs to focus on addressing the factors that result in elimination or relapse of cholera.

Abstract: Cholera, which is caused by Vibrio cholerae, persists as a devastating acute diarrheal disease. Despite availability of information on socio-cultural, agent and hosts risk factors, the disease continues to claim lives of people in Tanzania. The present study explores spatial patterns of cholera cases during a 2015–16 outbreak in Mwanza, Tanzania using a geographical information system (GIS) to identify concentrations of cholera cases. This cross-sectional study was conducted in Ilemela and Nyamagana Districts, Mwanza City. The two-phase data collection included: 1) retrospectively reviewing and capturing 852 suspected cholera cases from clinical files during the outbreak between August, 2015, and April, 2016, and 2) mapping of residence of suspected and confirmed cholera cases using global positioning systems (GPS). A majority of cholera patients were from Ilemela District (546, 64.1%), were males (506, 59.4%) and their median age was 27 (19–36) years. Of the 452 (55.1%) laboratory tests, 352 (77.9%) were confirmed to have Vibrio cholerae infection. Seven patients (0.80%) died. Cholera cases clustered in certain areas of Mwanza City. Sangabuye, Bugogwa and Igoma Wards had the largest number of confirmed cholera cases, while Luchelele Ward had no reported cholera cases. Concentrations may reflect health-seeking behavior as much as disease distribution. Topographical terrain, untreated water, physical and built environment, and health-seeking behaviors play a role in cholera epidemic in Mwanza City. The spatial analysis suggests patterns of health-seeking behavior more than patterns of disease. Maps similar to those generated in this study would be an important future resource for identifying an impending cholera outbreak in real-time to coordinate community members, community leaders and health personnel for guiding targeted education, outreach, and interventions.

Abstract: Vibriocidal antibodies are currently the best characterised correlate of protection against cholera and are used to gauge immunogenicity in vaccine trials. Although other circulating antibody responses have been associated with a decreased risk of infection, the correlates of protection against cholera have not been comprehensively compared. We aimed to analyse antibody-mediated correlates of protection from both V cholerae infection and cholera-related diarrhoea.We conducted a systems serology study that analysed 58 serum antibody biomarkers as correlates of protection against V cholerae O1 infection or diarrhoea. We used serum samples from two cohorts: household contacts of people with confirmed cholera in Dhaka, Bangladesh, and cholera-naive volunteers who were recruited at three centres in the USA, vaccinated with a single dose of CVD 103-HgR live oral cholera vaccine, and then challenged with V cholerae O1 El Tor Inaba strain N16961. We measured antigen-specific immunoglobulin responses against antigens using a customised Luminex assay and used conditional random forest models to examine which baseline biomarkers were most important for classifying individuals who went on to develop infection versus those who remained uninfected or asymptomatic. V cholerae infection was defined as having a positive stool culture result on days 2-7 or day 30 after enrolment of the household's index cholera case and, in the vaccine challenge cohort, was the development of symptomatic diarrhoea (defined as two or more loose stools of ≥200 mL each, or a single loose stool of ≥300 mL over a 48-h period).In the household contact cohort (261 participants from 180 households), 20 (34%) of the 58 studied biomarkers were associated with protection against V cholerae infection. We identified serum antibody-dependent complement deposition targeting the O1 antigen as the most predictive correlate of protection from infection in the household contacts, whereas vibriocidal antibody titres ranked lower. A five-biomarker model predicted protection from V cholerae infection with a cross-validated area under the curve (cvAUC) of 79% (95% CI 73-85). This model also predicted protection against diarrhoea in unvaccinated volunteers challenged with V cholerae O1 after vaccination (n=67; area under the curve [AUC] 77%, 95% CI 64-90). Although a different five-biomarker model best predicted protection from the development of cholera diarrhoea in the challenged vaccinees (cvAUC 78%, 95% CI 66-91), this model did poorly at predicting protection against infection in the household contacts (AUC 60%, 52-67).Several biomarkers predict protection better than vibriocidal titres. A model based on protection against infection among household contacts was predictive of protection against both infection and diarrhoeal illness in challenged vaccinees, suggesting that models based on observed conditions in a cholera-endemic population might be more likely to identify broadly applicable correlates of protection than models trained on single experimental settings.National Institute of Allergy and Infectious Diseases and National Institute of Child Health and Human Development, National Institutes of Health.

Abstract: Background: Over 700,000 Myanmar nationals known as the ‘Rohingyas’ fled into Cox’s Bazar, Bangladesh, in late 2017. Due to this huge displacement into unhygienic areas, these people became vulnerable to communicable diseases including cholera. Assessing the risk, the Government of Bangladesh (GoB), with the help of the International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B) and other international partners, decided to take preventive measures, one of which is the execution of oral cholera vaccination (OCV) campaigns. This paper describes the implementation and delivery of OCV campaigns during humanitarian crises in Bangladesh. Methods: Seven rounds of OCV campaigns were conducted between October 2017 and December 2021. The OCV campaigns were conducted by applying different strategies. Results: Approximately 900,000 Rohingya Myanmar nationals (RMNs) and the host population (amounting to 528,297) received OCV across seven campaigns. In total, 4,661,187 doses of OCVs were administered, which included 765,499 doses for RMNs, and 895,688 doses for the host community. The vaccine was well accepted, and as a result, a high level of coverage was achieved, ranging from 87% to 108% in different campaigns. Conclusions: After successful pre-emptive campaigns in Cox’s Bazar humanitarian camps, no cholera outbreaks were detected either in the RMN or host communities.

Abstract: Shortages of cholera vaccine and an unexpected surge in outbreaks have brought the fight against cholera to its knees. JaneFeinmann asks why the sudden danger, when a highly effective vaccine has been available for more than 20 years?

Abstract: Cholera continues to inflict high rates of morbidity and mortality. Prompt identification of cholera cases facilitates rapid outbreak responses in the short term while providing reliable surveillance data to guide long-term policies and interventions. Microbiological stool culture, the current recognized gold standard for diagnosing cholera, has significant limitations. Rapid diagnostic tests (RDTs) represent promising alternatives for diagnosing cholera in areas with limited laboratory infrastructure. However, studies conducted with the current cholera RDTs demonstrated wide variations in sensitivity and specificity. To address this gap in the diagnosis of cholera, we developed a simple, rapid, and sensitive diagnostic assay, "Rapid LAMP based Diagnostic Test (RLDT)." With a novel, simple sample preparation method directly from the fecal samples along with lyophilized reaction strips and using established Loop-mediated Isothermal Amplification (LAMP) platform, cholera toxin gene (ctxA) and O1 (O1rfb) gene could be detected in less than an hour. Cholera RLDT assay is cold chain and electricity-free. To avoid any end-user bias, a battery-operated, handheld reader was used to read the RLDT results. The performance specifications of the cholera RLDT assay, including analytical sensitivity and specificity, were evaluated using direct fecal samples, dried fecal samples on filter paper, and environmental water samples spiked with cholera strain. The limit of detection (LOD) was ~104 CFU/gm of stool for both ctxA and O1 genes, corresponding to about 1 CFU of Vibrio cholerae per reaction within 40 minutes. The LOD was 10 bacteria per ml of environmental water when tested with RLDT directly, without enrichment. Being simple, RLDT has the potential to be applied in resource-poor endemic settings for rapid, sensitive, and reliable diagnosis of cholera.

Abstract: Introduction Cholera remains a significant public health concern in many parts of the world, particularly in areas with poor sanitation and hygiene. Bangladesh and other impoverished nations have been severely affected by cholera outbreaks, especially in areas with a high population density. In order to mitigate the spread of cholera, oral cholera vaccines (OCVs) are recommended as a prophylactic measure. In May 2018, 775,666 of the Forcibly Displaced Myanmar Nationals (FDMN) in the registered and makeshift camps and 103,605 of the residents in the host community received two doses of OCV ShancholTM in Cox's Bazar, Bangladesh, because the conditions in the area favored the transmission of cholera and other waterborne diseases. This study aimed to assess the coverage of OCV among the FDMN and the host community in Cox's Bazar. Methods In August 2018, we enrolled 4,240 respondents for this study following the “World Health Organization (WHO) Vaccination Coverage Cluster Surveys: Reference Manual (2018).” The coverage survey was conducted with three strata of the population: the host community from the Teknaf Upazila, the registered camp, and the makeshift camp from the Ukhia Upazila. We collected information regarding OCV coverage, demographic characteristics, and knowledge and behaviors of people toward the vaccine. The data were analyzed using descriptive statistics. Results According to our study, the overall OCV coverage was 85%, with 68% in the host community, 91% in the registered camp, and 98% in the makeshift camp. The lower coverage in the host community was due to residents unaware of the vaccination campaign, the unavailability of vaccines, and unaware where to go for vaccination. Discussion Our findings demonstrate that the OCV campaign in the FDMN camps was successful, reaching over 90% coverage, while coverage in the host community was much lower. In order to make sure that OCV vaccination efforts are reaching the target population and having the desired impact, our study emphasizes the need to inform the target population of when and where to get vaccinated.

Abstract: Introduction. Cholera is a diarrheal disease that causes dehydration and rapid death due to infection with bacterium Vibrio cholerae that develops in the colon. Cholera generally develops in countries with poor sanitation, poverty, and unavailability of clean water such as Africa and South Asian. One of the efforts to prevent cholera transmission to tourists who will visit the country can be conducted through vaccines. Method. This research was made to find out the development of cholera vaccine using the literature search method through PubMed, Elsevier, Google Scholar databases, and credible websites. Result and Analysis. From the results of several literature searches, there is a monovalent O1 serogroup vaccine that contains killed whole-cell bacteria such as Ducoral and live-attenuated bacteria, called Vaxchora. Discussion. In addition, there are bivalent vaccines O1 and O139 serogroups that contain whole-cell killed bacteria such as Shanchol, Euvichol, mORC-Vax, and Cholvax.

Abstract: Abstract The objective was to evaluate the knowledge, attitudes, and practices of the Lebanese population towards cholera and its vaccination. A cross-sectional study was conducted using a self-administered questionnaire among a sample of Lebanese residents. The questionnaire consisted of questions about the participants' demographics, knowledge, attitudes, and practice towards cholera and vaccination. The final sample size was 691 respondents. The proportion of female and male participants was 68.7% and 31.3%, respectively. The results showed that the majority had a good knowledge of cholera, with 97.4% identifying severe diarrhea as the main symptom. Young age, different governorate of residence, and higher education were associated with better knowledge. Most participants had positive attitude, which was correlated with being female and having children under the age of 5 in the same household. Regarding practices, the majority reported engaging in some form of cholera prevention, such as always cooking (90.8%) and washing (88.3%) food. Being older, female, and homemaker was associated with better practice. Most participants expressed good knowledge and a positive attitude towards the vaccine, with 55.5% indicating that they would surely be willing to be vaccinated if freely available. However, 14.2% participants rejected and expressed concerns about the vaccine. Higher cholera knowledge was significantly predictive of vaccination willingness (B = 0.091). In conclusion, this study has provided insights into the knowledge, attitudes, and practices of the Lebanese population towards cholera and its vaccination. The findings can be used to inform the development of public health interventions aimed at improving cholera prevention and control in Lebanon.

Abstract: Background: To help address the current shortage of vaccine, a WHO prequalified bivalent whole cell (WC) OCV, Euvichol-Plus was reformulated by reducing the number of components and inactivation methods. Methods: The phase 3, observer-blind, randomized, active-controlled trial was performed in healthy participants aged 1-40 years in Nepal.Eligible participants were enrolled to receive two doses of either Euvichol-S (Euvichol-Simplified, a process-optimized monovalent WC OCV containing two components) or an active control vaccine, ShancholTM (a bivalent WC OCV containing five components).The study objectives are to demonstrate non-inferiority of Euvichol-S compared to ShancholTM as measured by seroconversion rates of anti-V. cholerae O1 Inaba and anti-V. cholerae O1 Ogawa vibriocidal titer two weeks after second dose for all ages, to evaluate the safety of Euvichol-S in all ages and each age stratum and to show lot-to-lot consistency of Euvichol-S. Findings: A total of 2,529 healthy participants were enrolled.At two weeks after the second dose, the differences of seroconversion rates to V. cholerae O1 Inaba and O1 Ogawa were –0·01 [95% CI: –1·87, 1·85] and –1.54 [95% CI: –4·77, 1·68], respectively for all ages combined, confirming the non-inferiority of Euvichol-S compared to ShancholTM. Both Euvichol-S and ShancholTM were well tolerated and showed an acceptable safety profile.Lot-to-lot consistency among the three lots of Euvichol-S at two weeks after the second dose for both O1 Inaba and O1 Ogawa was demonstrated. Interpretation: A two‑dose vaccination regimen with Euvichol-S induces seroconversion rates and anti‑V. cholerae O1 Inaba and O1 Ogawa vibriocidal titers non‑inferior to those elicited by ShancholTM.Euvichol‑S is expected to help to reduce the gap between the current OCV shortage and the OCV demand to achieve the WHO goal for ending cholera by 2030.Trial Registration: ClinicalTrials.gov registration number: NCT04760236.Funding: This work was funded by the Bill & Melinda Gates Foundation, Seattle, WA [Funding number INV-001786].Declaration of Interest: The authors declare no potential conflicts of interest.Ethical Approval: Written informed consent was obtained from all adults and parents of participating children prior to trial participation as well as assent form from 7 to 17 years children. The trial protocol was approved by Nepal Health Research Council, four trial sites and IVI IRB.

Abstract: Background: Cholera affects several hundred thousand individuals worldwide each year. According to estimates, more than 20 million individuals in Ghana are at danger of contracting the illness. However, research from Asia and other continents continues to be a major source of information for understanding cholera epidemiology in Africa, particularly in its coastal nations. The purpose of the study was to evaluate Ghana's cholera epidemics each year. Methods: A thorough analysis of articles that have been published on cholera outbreaks worldwide and in Ghana. A thorough search was done in the databases of Science Direct, PubMed, and Google Scholar to retrieve and to review research works published on cholera. Results: Findings suggest cholera has been a significant public health issue for Ghana every year since the first case was reported in 1970. Greater Accra is the area with the most cholera cases each year, with Accra being the district with the most cases. Greater Accra alone reported 58.5% of all cholera cases in Ghana from 1998 to 2017. However, the least affected regions in Ghana are the Upper West, Northern, Upper East, and Volta region. The cause of these cholera outbreaks is subpar sanitation and contaminated water. Annual cholera outbreaks occur in Ghana, where more attention is needed. Multiple deaths have been caused by these epidemics. Conclusion: Improved sanitation and provision of adequate clean drinking water can help curb the incidence of cholera and its devastating effects on individuals and the country as a whole.

Abstract: Background: Cholera is a communicable acute bacterial infection caused by a gram-negative bacterium that is Vibrio Cholera. Worldwide, is estimated that an incidence of 1.3–4.0 millions of cholera infection, leading to 21,000–143,000 deaths annually. Prevention of cholera require a proactive approach rather than reactive, as it`s identified to be the best strategy to decrease the cholera spreading risk in given population or community. Recently WHO warned that, the cholera spreading risk in Syria is very high, which linked to drinking of untreated water and food contamination. Aim: we conducted this study with aiming to assess the level of knowledge, attitude and practice regarding risks of cholera infection, preventive measures and preparedness among community in Syria. Consequently, recommending suitable measures based on study results. Methods: An online cross-sectional study was conducted in Syria to assess knowledge, attitude, and practice regarding cholera and cholera vaccine among general population in Syria. The inclusion criteria for participation were Syrian nationality aged 18 or more, male or female, from all governorates of Syria, never have cholera previously, and were willing to participate. The questionnaire was consisting of four sections. The first section was about sociodemographic data. The second section evaluated respondents' self-reported knowledge on cholera and divided into two parts (2a: Knowledge on cholera, its prevention and treatment. 2b Knowledge on cholera vaccine). The third section evaluated respondents’ self-reported practice relating to cholera and its vaccine, this section divided into two parts (3a: Practice relating cholera and its treatment/management. 3b: Practice relating cholera vaccine. The fourth section inquired respondents’ attitude toward cholera and cholera vaccine. 52.9% thought that cholera outbreaks happen in summer seasons. Results: Among 1563 Syrian national participants, (n=982, 62.8%) were females, and (n=581, 37.2%) males. 60.9% of respondents did not recognize the cholera in the first place. Passing watery stool was the most recognized symptom of cholera with 50.3%, severe dehydration with 31.1%, and repeated vomiting with 10.3%. Lack of safe drinking water was recognized as the most common cause for cholera. Most respondents (54.1%) have chosen IV saline as the treatment of choice for cholera. 85.3% of respondents are with providing health care to the infectants in health centers. Conclusion: According to our findings, there is insufficient understanding of the cholera symptoms and risk factors. The need for better understanding of such common outbreaks is essential to counter them. Consequently, there is a greater need to increase cholera awareness and education programs on the disease's signs and symptoms and its risk factors.

Abstract: Teaser section. With the ongoing outbreaks of cholera in many countries globally, the risk to MG events cannot be overlooked. Cholera vaccine should be a tool used to vaccinate high-risk populations in countries where cholera epidemics continue, but the shortage of vaccines precludes its use emphasizing the need for increasing vaccine supplies.

Abstract: It is crucial for human health that the immune system of the gastrointestinal tract works effectively. Dietary modulation is one of the factors that regulate the immune response in the gut. This study aims to develop a safe human challenge model to study gastrointestinal inflammation and immune function. This study focuses on evaluating gut stimulation induced by the oral cholera vaccine in healthy people. In addition, this paper describes the study design for assessing the efficacy and safety of a probiotic lysate, identifying whether functional ingredients in food can modulate inflammatory response induced by oral cholera vaccine. Forty-six males aged 20 to 50 with healthy bowel habits will be randomly allocated to the placebo or intervention group. Participants will consume 1 capsule of probiotic lysate or placebo twice daily for 6 weeks, take oral cholera vaccines on visit 2 (day 15) and visit 5 (day 29). The level of fecal calprotectin, a marker of gut inflammation, will be the primary outcome. The changes of cholera toxin-specific antibody levels and local/systemic inflammatory responses will be evaluated in blood. The purpose of this study is to evaluate gut stimulation of the oral cholera vaccine and investigate the effect of a probiotic lysate on improving the mild inflammatory response induced by the vaccine or supporting the immune response in healthy subjects. Trial registration: * This trial is registered in the International Clinical Trials Registry Platform of WHO (ICTRP, registration number: KCT0002589).

Abstract: Cholera is a major public health issue in India, with outbreaks occurring frequently in many parts of the country. India has a long history of cholera outbreaks, and the country has experienced several devastating epidemics in the past. The disease is caused by the bacterium Vibrio cholerae and is transmitted through contaminated food and water. India has the highest burden of cholera in the world, with an estimated 675,188 cases and 10,582 deaths reported in 2019 alone.

Abstract: The introduction of the toxT-139F allele triggers the expression of TCP (toxin co-regulated pilus) and CT (cholera toxin) under simple laboratory culture conditions in most Vibrio cholerae strains. Such V. cholerae strains, especially strains that have been used in OCVs (oral cholera vaccines), can induce antibody responses against TCP in animal models. However, CT produced in these V. cholerae strains is secreted into the culture medium. In this study, V. cholerae strains that can express intracellular CTB under the control of the toxT-139F allele have been constructed for potential application in OCVs. First, we constructed a recombinant plasmid directly linking the ctxAB promoter to ctxB without ctxA and confirmed CTB expression from the plasmid in V. cholerae containing the toxT-139F allele. We constructed another recombinant plasmid to express NtrCTB, from which 14 internal amino acids—from the 7th to the 20th amino acid—of the leader peptide of CTB have been omitted, and we found that NtrCTB remained in the cells. Based on those results, we constructed V. cholerae strains in which chromosomal ctxAB is replaced by ntrctxB or ntrctxB-dimer. Both NtrCTB and NtrCTB-dimer remained in the bacterial cells, and 60% of the NtrCTB-dimer in the bacterial cells was maintained in a soluble form. To develop improved OCVs, these strains could be tested to see whether they induce immune responses against CTB in animal models.

Abstract: The oral cholera vaccine WC-rBS consists of 4 different inactivated strains of Vibrio cholerae (LPS source) admixed with recombinant cholera toxin B subunit. Because of its unique composition and anti-inflammatory properties reported for both CTB and low doses of LPS from other Gram-negative bacteria, we speculated that WC-rBS might have anti-inflammatory potential in a chronic autoimmune disease such as inflammatory bowel diseases. First in vitro endotoxin tolerance experiments showed the surprising WC-rBS potential in the modulation of inflammatory responses on both PBMCs and THP1 cells. WC-rBS was further evaluated in the Dextran Sodium Sulfate colitis mouse model. Administrated orally at different dosages, WC-rBS vaccine was safe and showed immunomodulatory properties when administered in a preventive mode (before and during the induction of DSS colitis) as well as in a curative mode (after colitis induction); with improvement of disease activity index (from 27 to 73%) and histological score (from 65 to 88%). Interestingly, the highest therapeutic effect of WC-rBS vaccine was observed with the lowest dosage, showing even better anti-inflammatory properties than mesalamine; an approved 5-aminosalicylic acid drug for treating IBD patients. In summary, this is the first time that a prophylactic medicine, safe and approved for prevention of an infectious disease, showed a benefit in an inflammatory bowel disease model, potentially offering a novel therapeutic modality for IBD patients.

Abstract: Natural and human-made disasters have contributed to the rise in cases.

Abstract: Cholera, an enteric disease caused by Vibrio cholera claims thousands of lives yearly. The disease is a disease of inequality that affect populations which have poor access to safe water and sanitation facilities. Zanzibar, an archipelago in the Indian ocean which is part of the United Republic of Tanzania has been affected by recurrent cholera outbreak for the past decades. A multi-sectoral and multi-year three pillar approach namely Enabling Environment, Prevention and Response, for the elimination of cholera were initiated by the stewardship of the government, engagement of the community and technical and financial support of partners. The approach has enabled Zanzibar to interrupt the recurrent cholera outbreak for the past five years. The analysis of evidences have proven that creating an enabling environment through multi-sectoral involvement, mobilizing communities, intensifying surveillance complemented by the traditional disease prevention and control interventions has resulted to interruption of cholera transmission in the country.

Abstract: Developing an effective and safe cholera vaccine is a global public heath necessity in the cholera epidemic. Vaccination compliance maybe a major concern with cholera vaccine due to some factors. Therefore, this study aims to evaluate the compliance, knowledge and effects of cholera vaccine in the Hill top Ndobo community in the littoral region Douala, Cameroon.  Methods: A cross sectional community-based survey was carried out at the Hill top Ndobo community in Douala. A semistructured questionnaire was used to collect data after authorization was granted. The data collected was coded, analyzed using statistical package for the social sciences (SPSS) version 23 then presented on tables and figures. The statistical significance was set p < 0.05.  Results: A total of 300 participants were recruited into the study, and it was revealed that, majority had a good knowledge about cholera (67.0%), the vaccine (57.7%) and the mode of transmission (55.5%). 14.0% of the total population had received the vaccine at the time of sampling, and among those who didn’t received the vaccine, students (60.1%) significantly (p = 0.023) made up the population, and 95.0% of the study population attested that they were not comfortable taking the vaccine.  Conclusion: The population had a good knowledge about the cholera vaccine, but majority had not received the vaccine. A vaccination campaign at the Hill top Ndobo community in the littoral region Douala, Cameroon is recommended.