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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

8 months 2 weeks ago

Fantastic work by @Ymax and colleagues discussing #cholera control in Haiti through vaccination campaigns, featurin… https://t.co/SSv8RdMFBg
1 year 3 months ago

RT @Ymax: My recent paper was featured in the @PLOS #cholera channel. Check it out! https://t.co/EuPAhEqytG
1 year 4 months ago

New paper from @Ymax on the potential impact of geographic targeting of #cholera #vaccine in Africa. With a lot of… https://t.co/ls3OcTqdQc
1 year 4 months ago

RT @Ymax: Serosurvey says: 19% #cholera seroincidence in the past year in Bangladesh @andrewazman @JHIDDynamics #TropMed2019 https://t.co/kbbcUBnVPd
1 year 4 months ago

RT @Ymax: New whole genome sequences from Malawi added to the global #cholera tree #wgs @shirleewohl @JHIDDynamics https://t.co/LooBaXlDi5
1 year 4 months ago

RT @Ymax: First high resolution maps of #cholera and acute watery #diarrhea in Bangladesh @TaraHegde @JHIDDynamics @icddr_b… https://t.co/3Vir4LcrGo
1 year 4 months ago

RT @Ymax: Can dose-response curves to #cholera explain differences in #vaccine protection in endemic and epidemic settings?… https://t.co/m9YxKHDDPh
1 year 4 months ago

RT @Ymax: What do #cholera outbreaks in sub-Saharan Africa look like? #TropMed19 @FhhVP0qx1W9U04l @JHIDDynamics https://t.co/T1cVPBVvYy
1 year 5 months ago

RT @ParasitologyELS: Understanding #cholera dynamics for public health. Justin Lessler @JustinLessler @JHIDDynamics plenary lecture at… https://t.co/9l1fjZ0br2
1 year 6 months ago

Old technology meets new at the #cholera MinION sequencing workshop in Nigeria. @JustinLessler @andrewazman… https://t.co/W7Q6HW3k9L
2 years 1 month ago

Great work on #cholera serology by @andrewazman @GlobalGutHealth and @JustinLessler, with coverage in the @Telegraph https://t.co/JMrHvbgG8O
2 years 8 months ago

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

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

Oral cholera vaccine in cholera prevention and control, Malawi.

M'bangombe M, Pezzoli L, Reeder B, Kabuluzi S, Msyamboza K, Masuku H, Ngwira B, Cavailler P, Grandesso F, Palomares A, Beck N, Shaffer A, MacDonald E, Senbete M, Lessler J, Moore SM, Azman AS.

Bull World Health Organ, 2018: 96: 428-435, 10.2471/BLT.17.207175

The Epidemiology of Cholera in Zanzibar: Implications for the Zanzibar Comprehensive Cholera Elimination Plan

Bi Q, Abdalla FM, Masauni S, Reyburn R, Msambazi M, Deglise C, von Seidlein L, Deen J, Jiddawi MS, Olson D, Nemes I, Taib JA, Lessler J, Andemichael GR, Azman AS

J Infect Dis, 2018: 218(suppl_3): S173-S180, 10.1093/infdis/jiy500

27 Feb 2018

The potential impact of case-area targeted interventions in response to cholera outbreaks: A modeling study

Finger F, Bertuzzo E, Luquero FJ, Naibei N, Touré B, Allan M, Porten K, Lessler J, Rinaldo A, Azman AS

PLoS Med, 2018: 15(2): e1002509, 10.1371/journal.pmed.1002509

Micro-hotspots of Risk in Urban Cholera Epidemics.

Azman A, Luquero Alcalde FJ, Salje H, Naibei N, Adalbert N, Ali M, Bertuzzo E, Finger F, Toure B, Massing LA, Ramazani R, Cardon A, Saga B, Allan M, Olson D, Leglise J, Porten K, Lessler J.

J Infect Dis, 2018: 10.1093/infdis/jiy283

Dried Blood Spots for Measuring Vibrio cholerae-specific Immune Responses.

Iyer AS, Azman AS, Bouhenia M, Deng LO, Anderson CP, Graves M, Kováč P, Xu P, Ryan ET, Harris JB, Sack DA, Luquero FJ, Leung DT.

PLoS Negl Trop Dis, 2018: 12(1): e0006196, 10.1371/journal.pntd.0006196

Adapting to the global shortage of cholera vaccines: targeted single dose cholera vaccine in response to an outbreak in South Sudan.

Parker LA, Rumunu J, Jamet C, Kenyi Y, Lino RL, Wamala JF, Mpairwe AM, Ciglenecki I, Luquero FJ, Azman AS, Cabrol JC.

Lancet Infect Dis, 2017: 10.1016/S1473-3099(16)30472-8

Safety of a killed oral cholera vaccine (Shanchol) in pregnant women in Malawi: an observational cohort study.

Ali M, Nelson A, Luquero FJ, Azman AS, Debes AK, M’bang’ombe MM, Seyama L, Kachale E, Zuze K, Malichi D, Zulu F, Msyamboza KP, Kabuluzi S, Sack DA.

Lancet Infect Dis, 2017: 10.1016/ S1473-3099(16)30523-0

El Niño and the shifting geography of cholera in Africa.

Moore SM, Azman AS, Zaitchik BF, Mintz ED, Brunkard J, Legros D, Hill A, McKay H, Luquero FJ, Olson D, Lessler J.

Proc Natl Acad Sci U S A, 2017: 114(17): 4436-41, 10.1073/pnas.1617218114

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