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6 : Cholera and : New Challenges from a Once and Future Pathogen

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Abstract:

Cholera is a severe diarrheal illness caused by several strains of that produce a powerful enterotoxin. Effective treatment for cholera is now well established and inexpensive. is a comma-shaped gram-negative halophilic rod that swims with rapid darting movements, propelled by a single polar flagellum. As a pathogen, toxigenic has remarkable host specificity. Studies of the molecular taxonomy of epidemic suggest that the sixth and seventh pandemics were caused by independently derived clones. In the current pandemic, several mechanisms have been documented by which can be introduced into new geographic areas. The first and perhaps the most important is via a person who travels while harboring an incubating infection. Food-borne transmission is an important component of many epidemics and has been the predominant mode of transmission in some. Moist grains eaten without reheating or acidification are a common vehicle as can grow rapidly on rice, lentils, or other cooked grains. Epidemic cholera can be controlled by reducing the risk of sustained transmission following introduction. In the developed world, this control was achieved by the engineered separation of the human fecal stream from water and food streams. The search for better cholera vaccines has yielded a substantially improved understanding of virulence mechanisms and of the nature of a protective immune response.

Citation: Tauxe R, Barrett T. 1998. Cholera and : New Challenges from a Once and Future Pathogen, p 125-144. In Scheld W, Craig W, Hughes J (ed), Emerging Infections 2. ASM Press, Washington, DC. doi: 10.1128/9781555816957.ch6

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Pulsed-Field Gel Electrophoresis
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Vibrio cholerae
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Figure 1

Spread of the seventh global pandemic of cholera, indicating the advancing edge of the epidemic at successive points in time.

Citation: Tauxe R, Barrett T. 1998. Cholera and : New Challenges from a Once and Future Pathogen, p 125-144. In Scheld W, Craig W, Hughes J (ed), Emerging Infections 2. ASM Press, Washington, DC. doi: 10.1128/9781555816957.ch6
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Image of Figure 2
Figure 2

Number of countries reporting cholera to the World Health Organization, 1951 to 1996. Data are rrom the World Health Organization.

Citation: Tauxe R, Barrett T. 1998. Cholera and : New Challenges from a Once and Future Pathogen, p 125-144. In Scheld W, Craig W, Hughes J (ed), Emerging Infections 2. ASM Press, Washington, DC. doi: 10.1128/9781555816957.ch6
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Image of Figure 3
Figure 3

Reported incidence of cholera, by country, 1996. Data are from the World Health Organization.

Citation: Tauxe R, Barrett T. 1998. Cholera and : New Challenges from a Once and Future Pathogen, p 125-144. In Scheld W, Craig W, Hughes J (ed), Emerging Infections 2. ASM Press, Washington, DC. doi: 10.1128/9781555816957.ch6
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Figure 4

Global distribution of PFGE types of toxigenic O1 as of 1992 (from reference ). Nontoxigenic types are not shown.

Citation: Tauxe R, Barrett T. 1998. Cholera and : New Challenges from a Once and Future Pathogen, p 125-144. In Scheld W, Craig W, Hughes J (ed), Emerging Infections 2. ASM Press, Washington, DC. doi: 10.1128/9781555816957.ch6
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Tables

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Table 1

Cholera pandemics since 1817

Citation: Tauxe R, Barrett T. 1998. Cholera and : New Challenges from a Once and Future Pathogen, p 125-144. In Scheld W, Craig W, Hughes J (ed), Emerging Infections 2. ASM Press, Washington, DC. doi: 10.1128/9781555816957.ch6
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Table 2

Reported cases and case fatality ratios by continent in 1996

Citation: Tauxe R, Barrett T. 1998. Cholera and : New Challenges from a Once and Future Pathogen, p 125-144. In Scheld W, Craig W, Hughes J (ed), Emerging Infections 2. ASM Press, Washington, DC. doi: 10.1128/9781555816957.ch6

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