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Cholera Dynamics

This work aims to improve our understanding of Vibrio cholerae transmission to inform the design of better prevention and control programs

We study cholera transmission dynamics at multiple levels from individual-level data collected during cholera outbreaks to global incidence data, using a variety of methods including statistical and mechanistic models. Our work spans many disciplines and involves collaborators ranging from front-line public health workers to bench scientists. Our main bodies of current work are:

Global burden of cholera

Through working with multiple partners, including Médecins Sans Frontières (MSF), the World Health Organization (WHO), the United Nations High Commissioner for Refugees (UNHCR), and various Ministries of Health, we maintain a large database of cholera incidence and mortality that can accommodate surveillance data that comes in all shapes and sizes (for example, different case definitions, reporting intervals, and spatial scales). We have developed methods to integrate all of this data into a common statistical framework to better understand cholera burden and transmission dynamics worldwide and continue to work on making it more robust. On this site you can access parts of the database that are publicly available and browse meta-data for the entire repository in addition to accessing maps and other resources used by this project. We are very interested in seeing these data and our estimates used for making public health decisions and learning more about the epidemiology of cholera so please get in touch if you would like to collaborate.

Estimates of effectiveness and impact of interventions

We work on trying to better estimate the effectiveness and impact of cholera interventions, including cholera vaccine. This work ranges from developing new statistical methods to estimate intervention effectiveness from observational studies to retrospective case studies of outbreaks. Other global work, including consultations with GAVI, includes estimating the potential impact of large scale rollout of vaccination globally. This work is conducted in collaboration with multiple partners, including the Global Task Force for Cholera Control, Epicentre, Médecins Sans Frontières and GAVI.

Real-time and Strategic Modeling to Inform Outbreak Response

We work closely with those on the frontline of cholera epidemics including ministries of health, Global Task Force for Cholera Control members, Médecins Sans Frontières and others to analyse data in on-going cholera outbreaks to assess risk, often capitalizing on data from our cholera incidence repository, characterize key properties of transmission (e.g., modes of transmission, reproductive number) and to make short-term forcasts of the epidemic trajectory.

Serologic Methods

In collaboration with icddr,b, University of Utah, University of Florida and Harvard University, we are working to better characterize the kinetics of the human antibody response to infection by Vibrio cholerae and to exposure to (killed) oral cholera vaccine. Our ultimate aim is to develop new statistical methods and tools to allow us to use cross-sectional serologic samples to identify recent cholera infections, thus providing a new approach to understanding cholera transmission, independent of biases of clinic-based passive surveillance systems.

Maps and data

Browse and download data and maps on the world-wide distribution of cholera incidence and risk.

Access Resources

Principal Investigator

Justin Lessler Associate Professor

Andrew Azman Assistant Scientist

Updates #cholera

6 months 3 hours ago

Great work on #cholera serology by @andrewazman @GlobalGutHealth and @JustinLessler, with coverage in the @Telegraph https://t.co/JMrHvbgG8O
1 year 6 days ago

RT @andrewazman: Interesting new data in @LancetGH showing the effectiveness of #cholera #vaccine over four years in Haiti by… https://t.co/YmHRVv2oiz
1 year 2 months ago

RT @GlobalGutHealth: Excited that we just received @NIAIDNews R01 on #cholera #serosurveillance - collaboration w/ @andrewazman… https://t.co/d3hAsN6Yz3
1 year 4 months ago

RT @SecGTFCC: #SDG6 commits the world to ensuring that everyone has access to safe water by 2030. Target #cholera hotspots to rea… https://t.co/7RFTKl0JWP
1 year 5 months ago

Want to come work on interesting and impactful #cholera projects like this one? We are hiring a postdoc!… https://t.co/e4707eF9ok
1 year 5 months ago

RT @andrewazman: Mapping the burden of #cholera in @TheLancet a result of years of collaborative work with @MSFsci, @WHO,… https://t.co/h2WeE66pIK
1 year 5 months ago

RT @andrewazman: The potential impact of case-area targeted interventions in response to #cholera outbreaks from @JHIDDynamics,… https://t.co/VcHmM0VM18
1 year 8 months ago

Congratulations @Ymax . We look forward to having you join us working on #cholera https://t.co/4ZahqGpQJc
1 year 9 months ago

RT @KateGrabowski: Congrats to my colleague @andrewazman on launching the #plos #cholera channel. Awesome work! @JHIDDynamics… https://t.co/6NcmBkt74g
2 years 3 weeks ago

Come work in our group on #cholera dynamics. Looking for a postdoc to help us expand our work to SE Asia. https://t.co/BgmdJSR7zB
2 years 1 month ago

Congratulations to @QifangB, @andrewazman et al. on this important review #cholera vaccine performance https://t.co/pFfAUdc6dL
2 years 10 months ago

Congrats to @andrewazman on his paper on single dose use of OCV in outbreak response in @LancetGH . https://t.co/00N2kbyCDX #cholera

Resources

16 Apr 2018

Rate Raster

Mean annual cholera incidence rate (cases per population) in sub-Saharan Africa between 2010 and 2016.

16 Apr 2018

Cases Raster

Mean annual cholera incidence in sub-Saharan Africa between 2010 and 2016.

Funders

The Bill and Melinda Gates Foundation

Johns Hopkins Center for Global Health

Collaborators

World Health Organization

UNICEF

University of Utah

The African Cholera Surveillance Network (Africhol)

Princeton University

icddr,b

Médecins Sans Frontières (MSF) International

Publications

Protection against cholera from killed whole-cell oral cholera vaccines: a systematic review and meta-analysis.

Bi Q, Ferraras E, Pezzoli L, Legros D, Ivers LC, Date K, Qadri F, Digilio L, Sack DA, Ali M, Lessler J, Luquero FJ, Azman AS.

Lancet Infect Dis, 2017: 10.1016/S1473-3099(17)30359-6

Cholera outbreak in Yemen.

von Seidlein L, Sack D, Azman AS, Ivers LC, Lopez AL, Deen JL.

Lancet Gastroenterol Hepatol., 2017: 2(11): 777, 10.1016/S2468-1253(17)30287-X

Effectiveness of one dose of oral cholera vaccine in response to an outbreak: a case-cohort study.

Azman AS, Parker LA, Rumunu J, Tadesse F, Grandesso F, Deng LL, Lino RL, Bior BK, Lasuba M, Page AL, Ontweka L, Llosa AE, Cohuet S, Pezzoli L, Sodjinou DV, Abubakar A, Debes AK, Mpairwe AM, Wamala JF, Jamet C, Lessler J, Sack DA, Quilici ML, Ciglenecki I, Luquero FJ.

Lancet Glob Health, 2016: 4(11): e856–e863, 10.1016/S2214-109X(16)30211-X

Cholera Rapid Test with Enrichment Step Has Diagnostic Performance Equivalent to Culture.

Ontweka LN, Deng LO, Rauzier J, Debes AK, Tadesse F, Parker LA, Wamala JF, Bior BK, Lasuba M, But AB, Grandesso F, Jamet C, Cohuet S, Ciglenecki I, Serafini M, Sack DA, Quilici ML, Azman AS, Luquero FJ, Page AL.

PLoS One, 2016: 11 (12): e0168257, 10.1371/journal.pone.0168257

Immune Responses to an Oral Cholera Vaccine in Internally Displaced Persons in South Sudan.

Iyer AS, Bouhenia M, Rumunu J, Abubakar A, Gruninger RJ, Pita J, Lino RL, Deng LL, Wamala JF, Ryan ET, Martin S, Legros D, Lessler J, Sack DA, Luquero FJ, Leung DT, Azman AS.

Scientific Reports, 2016: 6: 35742, 10.1038/srep35742.

Comparison of inferred relatedness based on multilocus variable-number tandem-repeat analysis and whole genome sequencing of Vibrio cholerae O1.

Rashid MU, Almeida M, Azman AS, Lindsay BR, Sack DA, Colwell RR, Huq A, Morris JG Jr, Alam M, Stine OC.

FEMS Microbiol Lett, 2016: 363: 10.1093/femsle/fnw116

Correction: The Impact of a One-Dose versus Two-Dose Oral Cholera Vaccine Regimen in Outbreak Settings: A Modeling Study.

Azman AS, Luquero FJ, Ciglenecki I, Grais RF, Sack DA, Lessler J.

PLoS Med, 2016: 13: e1001989, 10.1371/journal.pmed.1001989

Safe water, sanitation, hygiene, and a cholera vaccine.

Azman AS, Ivers LC, Legros D, Luquero FJ, Mintz ED.

Lancet, 2016: 387: 28, 10.1016/S0140-6736(15)01294-5

Pages