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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

1 month 4 days ago

RT @andrewazman: Seeking a study coordinator to help manage new project in eastern DRC on impact of #cholera #vaccines on clinical d… https://t.co/lXtTaDTEvh
3 months 1 week ago

RT @andrewazman: Results from this multi-country effort to understand #cholera now published in @eLife. Great work @ekeeme,… https://t.co/vy2iS5K6Ay
1 year 1 month ago

Fantastic work by @Ymax and colleagues discussing #cholera control in Haiti through vaccination campaigns, featurin… https://t.co/SSv8RdMFBg
1 year 8 months ago

RT @Ymax: My recent paper was featured in the @PLOS #cholera channel. Check it out! https://t.co/EuPAhEqytG
1 year 9 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 10 months ago

RT @Ymax: Serosurvey says: 19% #cholera seroincidence in the past year in Bangladesh @andrewazman @JHIDDynamics #TropMed2019 https://t.co/kbbcUBnVPd
1 year 10 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 10 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 10 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 10 months ago

RT @Ymax: What do #cholera outbreaks in sub-Saharan Africa look like? #TropMed19 @FhhVP0qx1W9U04l @JHIDDynamics https://t.co/T1cVPBVvYy
1 year 10 months ago

RT @ParasitologyELS: Understanding #cholera dynamics for public health. Justin Lessler @JustinLessler @JHIDDynamics plenary lecture at… https://t.co/9l1fjZ0br2
1 year 11 months ago

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

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

Reactive vaccination in the presence of disease hotspots.

Azman AS, Lessler J.

Proc Biol Sci, 2015: 282: 20141341, 10.1098/rspb.2014.1341

Optimal allocation of the limited oral cholera vaccine supply between endemic and epidemic settings.

Moore SM, Lessler J.

J R Soc Interface, 2015: 12: 20150703, 10.1098/rsif.2015.0703

Genetic variation of Vibrio cholerae during outbreaks, Bangladesh, 2010-2011.

Rashed SM, Azman AS, Alam M, Li S, Sack DA, Morris JG Jr, Longini I, Siddique AK, Iqbal A, Huq A, Colwell RR, Sack RB, Stine OC.

Emerg Infect Dis, 2014: 20: 54-60, 10.3201/eid2001.130796

Epidemic risk from cholera introductions into Mexico.

Moore SM, Shannon KL, Zelaya CE, Azman AS, Lessler J.

PLoS Curr, 2014: 6: 10.1371/currents.outbreaks.c04478c7fbd9854ef6ba923cc81eb799

The incubation period of cholera: a systematic review.

Azman AS, Rudolph KE, Cummings DA, Lessler J.

J Infect, 2013: 66: 432-8, 10.1016/j.jinf.2012.11.013

Urban cholera transmission hotspots and their implications for reactive vaccination: evidence from Bissau city, Guinea bissau.

Azman AS, Luquero FJ, Rodrigues A, Palma PP, Grais RF, Banga CN, Grenfell BT, Lessler J.

PLoS Negl Trop Dis, 2012: 6: e1901, 10.1371/journal.pntd.0001901

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