Las epidemias de cólera en Argentina. Breve reseña histórica / The cholera epidemics in Argentina. Brief historical review

El cólera es una toxoinfección alimentaria ocasionada por la ingesta de agua y alimentos contaminados por el Vibrio cholerae. Es una de las enfermedades más antiguas de la humanidad y las primeras descripciones corresponden a Hipócrates. La primera epidemia documentada, sucedió en la India en 1817 y se extendió a Turquía y a los países árabes. En nuestro país, el primer brote ocurrió en 1856 en la ciudad de Bahía Blanca, asociada a la llegada de navíos con enfermos y a las deficientes condiciones sanitarias de la ciudad. Los sucesivos brotes se acompañaron de una alta mortalidad, a tal punto que el Dr. José María Penna señaló que costó más vidas a la nación que la guerra con Paraguay. En el presente artículo se analizan los sucesivos brotes de cólera en nuestro país

Cholera is a food poisoning caused by the ingestion of food and water contaminated by Vibrio cholerae. It is one of the oldest diseases of humanity and the first descriptions correspond to Hippocrates. The first documented epidemic occurred in India in 1817 and spread to Turkey and the Arab countries. In our country, the first outbreak occurred in 1856 in the city of Bahía Blanca, associated with the arrival of ships with patients and poor sanitary conditions in the city. The successive outbreaks were accompanied by high mortality, to the point that Dr. José María Penna pointed out that it cost the nation more lives than the war with Paraguay. This article analyzes the successive outbreaks of cholera in our country

Etiological and epidemiological characteristics of Vibrio cholerae in Beijing, 2015-2021 / 中华流行病学杂志

Objective: To analyze the etiological and epidemiological characteristics of Vibrio cholerae in Beijing during 2015-2021 and provide evidence for the prevention and control of cholera. Methods: The V. cholerae strains isolated in Beijing during 2015-2021 were analyzed by serotyping and virulence genes detection. Pulsed field gel electrophoresis (PFGE) was performed for the molecular typing of the strains. Based on the collected epidemiological and clinical data of cholera cases,the epidemiological characteristics of cholera were analyzed by descriptive epidemiology method. Results: A total of 76 Vibrio cholerae O1 strains were isolated in Beijing during 2015-2021, including 61 strains from human, 10 strains from environment and 5 strains from seafood. The 76 strains consisted of 68 Ogawa strains and 8 Inaba strains. Six Ogawa strains isolated from sporadic cases carried ctxAB. After NotⅠ digestion, 76 strains were divided into 33 PFGE patterns. From 2015 to 2021, a total of 38 cholera epidemics were reported in Beijing, most of them were sporadic ones, accounting for 92.11% (35/38). A total of 45 cases were reported, and the cases occurred during June-September accounted for 97.78% (44/45). Cholera cases occurred in 9 districts of Beijing, and the cases reported in Chaoyang district accounted for 42.22% (19/45) and in Changping district accounted for 31.11% (14/45). The age of the cholera cases ranged from 19 to 63 years. Except for one case with unknown clinical symptoms, 44 cases had diarrhea symptoms with 84.09% (37/44) of the cases reporting diarrhea (3-9 times/day), followed by yellow watery stool (95.45%, 42/44), abdominal pain (68.18%, 30/44), nausea and vomiting (40.91%, 18/44) and fever (36.36%, 16/44). Conclusion: Vibrio cholerae strains isolated in Beijing during 2015-2021 were mainly O1 serotype Ogawa,most of which were non-toxigenic. The PFGE of the strains varied. Cholera epidemics occurred in 9 districts of Beijing, but most were sporadic ones with incidence peak during June-September.

Principales pandemias en la historia de la humanidad / Major pandemics in the history of mankind

Introducción: Se describen las principales pandemias en la historia de la humanidad desde a.n.e. hasta la más reciente causada por el coronavirus SARS-CoV-2. Objetivo: Examinar las principales pandemias en la historia de la humanidad y su repercusión en la salud pública, ámbito social y perspectivas de la actual pandemia de la COVID-19 en el desarrollo de la sociedad. Métodos: Se revisaron las publicaciones sobre el tema en español e inglés en bases de datos de PubMed, Google Scholar, SciELO y Latindex desde el 2000 hasta al 25 de mayo 2020. Resultados: Se describen los aspectos más sobresalientes de las epidemias causadas por viruela, peste bubónica, cólera, VIH/sida. gripes y la actual producida por el coronavirus SARS-CoV-2, atendiendo a su aparición, duración en años, fallecidos, localización mundial, países más afectados e impacto en la sociedad y ámbito sanitario. Se exponen las perspectivas sociales determinadas por la pandemia de la COVID-19. Conclusiones: Se examinan los rasgos sobresalientes, en especial las pérdidas de vidas humanas en las principales pandemias que han azotado a la humanidad, desde a.n.e. hasta la más reciente causada por el coronavirus SARS-CoV-2. La sociedad en su momento actual se enfrenta a incertidumbres y retos sociales, económicos, culturales, éticos, sanitarios y existenciales, provenientes de las implicaciones que está teniendo la pandemia de la COVID-19, lo que determinará consecuencias para la salud y la vida humana. Esta pandemia es mucho más que una crisis sanitaria(AU)

Introduction: This work describes the major pandemics in the history of mankind from B.C. until the most recent caused by the coronavirus SARS-CoV-2. Objective: To examine the major pandemics in the history of mankind and their impact on public health, social scopes and prospects of the current pandemic of COVID-19 in the development of mankind. Methods: There were reviewed publications on the subject in Spanish and English in databases of PubMed, Google Scholar, SciELO and Latindex from 2000 to 25 May, 2020. Results: There is a description of the most important aspects of epidemics caused by smallpox, bubonic plague, cholera, HIV/AIDS, influenzas and the current one produced by the coronavirus SARS-CoV-2, on the basis of their onsets, duration in years, amount of deceased, world location, most affected countries and impact on society and the health field. The social perspectives determined by the pandemic of COVID-19 are presented. Conclusions: There was an study on the outstanding features, especially the loss of human lives in the major pandemics that have plagued mankind, from B.C. until the most recent caused by the coronavirus SARS-CoV-2. The global society at present time is facing uncertainties and challenges of social, economic, cultural, ethical, health and existential kind coming from the implications caused by the COVID-19 pandemic, which will determine consequences for human health and life. This pandemic is much more than a health crisis(AU)

Caracterización clínica-epidemiológica según la edad de pacientes diagnosticados con cólera / Clinic-epidemiological description according to the age of patients diagnosed with cholera

Introducción: Se estima que 1,4 billones de personas están en riesgo de infectarse por cólera y la mitad de los fallecidos son menores de 5 años. Objetivo: Caracterizar clínica y epidemiológicamente a los pacientes afectados por vibrión colérico según la edad de los enfermos y el tiempo que medió entre la aparición de los síntomas de la enfermedad y la asistencia al Sistema Nacional de Salud. Métodos: Estudio clínico, epidemiológico, descriptivo y prospectivo desde 2013-2017 a los pacientes que se les confirmó por coprocultivo el V. cholerae como causa de enfermedad diarreica aguda en el hospital pediátrico de Centro Habana. Se analizaron variables cualitativas y cuantitativas. Resultados: Se registraron 115 niños mayores de 5 años y 44 menores de 5 años afectados por el cólera. El 54,7 por ciento del total de pacientes estudiados estuvo en la zona afectada, el 94,3 por ciento presentó deposiciones líquidas, el 18,2 por ciento con aspecto de agua de arroz, el 7,5 por ciento con olor a pescado, el 47,2 por ciento presentó vómitos, el 6,9 por ciento fiebre y el 12,8 por ciento dolor abdominal. El valor de la mediana del tiempo que medio entre la aparición de los síntomas y la asistencia al médico fue de 24 horas. Conclusiones: Los pacientes más afectados son los mayores de 5 años y los que más tardíamente acudieron al Sistema Nacional de Salud. En todos predomina la procedencia de la zona afectada, las deposiciones líquidas y los vómitos(AU)

Introduction: It is estimated that 1.4 billion people are at risk of being infected by cholera and half of them are children under 5 years old. Objective: To describe clinically and epidemiologically the patients affected by Vibrio cholerae according to their age and the time passed from the onset of symptoms of disease to their attendance to the National Health System. Methods: Clinical, epidemiological, descriptive and prospective study from 2013 to 2017 in patients with confirmed V. cholerae by stool culture as a cause of acute diarrheal disease in the Pediatric Hospital of Centro Habana municipality.Qualitative and quantitative variables were analyzed. Results: There was a record of 115 children over 5 years and 44 children under 5 years affected by cholera. The 54.7percent of the total number of patients studied was in the affected area, 94.3 percent presented liquid stool, 18.2 percent of those looked like rice water, 7.5 percent with fishy smell; 47.2 percent of the patients presented vomiting, and 6.9 percent fever and 12.8 percent abdominal pain. The value of the mean time between the onset of symptoms and the assistance to the physician was of 24 hours. Conclusions: Most affected patients and that attended late to the National Health System were the ones over 5 years. In all predominated coming from the affected area, liquid stools and vomiting(AU)

Representaciones, discursos y prácticas profilácticas durante la epidemia de cólera (1886-1887, Mendoza, Argentina) / Prophylactic representations, discourses and practices during the cholera epidemic (1886-1887, Mendoza, Argentina)

Resumen El artículo busca indagar en los proyectos de disciplinamiento sancionados por el Estado de la provincia de Mendoza (Argentina) durante la epidemia de cólera ocurrida en el verano de 1886 y 1887. Si bien los planes tenían como finalidad mejorar el estado sanitario de toda la población y de la ciudad, apuntaron y se aplicaron con mayor intensidad sobre los sectores populares y sus espacios. Esto se debió a las ideas y representaciones que en torno de la enfermedad y la muerte construyó el grupo dirigente durante estos periodos.

Abstract The article takes a look into the disciplinary projects approved by the authorities in the province of Mendoza (Argentina) during the cholera epidemic that took place during the summer of 1886-1887. Although the projects were intended to ameliorate the sanitary conditions of the whole of the population, these were focused and applied more intensively on the underprivileged sectors and their areas of inhabitance. This follows the ideas and representations created by the State regarding the illness and its death during this period.

Bacteremia por Vibrio cholerae NO-O1/NO-O139 en un paciente cirrótico: Primer reporte de caso en el Perú y revisión de la literatura / Vibrio cholerae NO-O1/NO-O139 bacteremia in a cirrhotic patient: First case report in Peru and literatura review

Vibrio cholerae serogrupo NO-O1/NO-O139 (VCNO) es causa infrecuente de gastroenteritis. Sin embargo, se le asocia a infección extra-intestinal severa en huéspedes inmunocomprometidos, y entre ellas, la bacteremia en pacientes con cirrosis hepática es digna de mención. A continuación, presentamos el caso de una mujer de 58 años, con el diagnóstico de cirrosis hepática de fondo, que desarrolló progresivamente choque séptico, disfunción orgánica múltiple y desenlace fatal al cuarto día de su admisión. Los resultados obtenidos post mortem, de los hemocultivos previamente tomados, aislaron bacilos gram negativos compatibles con Vibrio cholerae. Posteriormente, se identificó el serogrupo NO-O1/NO-O139, a través de aglutinación en placa y PCR negativo para el gen ctxA. El antibiograma mostró susceptibilidad conservada a ampicilina, cloranfenicol, tetraciclina y ciprofloxacino, con resistencia al trimetoprim-sulfametoxazol. El presente caso, descrito en el Hospital Nacional Dos de Mayo, es hasta la fecha, el primer reporte de bacteremia VCNO en el Perú.

Non-O1, non-O139 Vibrio cholerae (NOVC) strains are an uncommon cause of gastroenteritis. However, they have been recently associated with severe extraintestinal infections in immunocompromised hosts. Among them, bacteremia in cirrhotic patients is noteworthy. We present the case of a 58-year-old woman with cirrhosis that developed septic shock, multiple organ failure and died four days after admission. Blood cultures yielded Gram-negative rods identified as Vibrio cholerae. Further serogrouping by slide agglutination and a negative PCR for ctxA gen confirmed the strain to be NOVC. Antimicrobial susceptibility testing showed sensitivity to ampicillin, chloramphenicol, tetracycline and ciprofloxacin; and resistance to trimethoprim-sulfamethoxazole. To the best of our knowledge, this is first report in Peru, described in the Hospital Nacional Dos de Mayo, of NOVC bacteremia.

Disease outbreaks in Eastern Mediterranean Region [EMR], January to June 2018

Since beginning of the year 2018, the WHO Eastern Mediterranean Region [EMR] has experienced ongoing and new outbreaks of emerging and re-emerging infectious disease in many countries. A number of these outbreaks are continuing from the previous year

Control de foco de un brote de Cólera. Matanzas 2014 / Control of Focus in front of a Bud of Cholera. Matanzas 2014

Se presenta un estudio de control de foco de un brote de cólera, mediante la técnica observacional del tipo serie de casos, en el mes de julio de 2014 en el Municipio Matanzas, donde se describe, según el método epidemiológico, la relación de los casos detectados con el caso índice; se analiza el problema detectado teniendo en cuenta el enfoque de riesgo del cólera. Se realiza una evolución clínico-epidemiológica de los casos detectados y se analizan las medidas de control de foco aplicadas. Se revisan tanto las historias clínicas individuales en el consultorio del médico de la familia, como las encuestas epidemiológicas y el expediente de control de foco en el departamento de Epidemiología (AU).

A study of control of focus of a bud of cholera is presented, by means of the observational technique of the type series of cases, in the month of July of 2014 in the Municipality Matanzas, where it is described, according to the epidemic method, the relationship of the cases detected with the index case; the detected problem is analyzed keeping in mind the focus of risk of the cholera. He/she is carried out a clinical-epidemic evolution of the detected cases and of the applied measures of focus control. They are revised the clinical histories so much in the clinic of the doctor of the family, as the epidemic surveys and the file of focus control in the department of epidemiology (AU).

Characterization of Vibrio cholerae isolates from 1976 to 2013 in Shandong Province, China

Abstract Cholera continues to be a serious public health issue in developing countries. We analyzed the epidemiological data of cholera from 1976 to 2013 in Shandong Province, an eastern coastal area of China. A total of 250 Vibrio cholerae isolates were selected for PCR analysis of virulence genes and pulsed-field gel electrophoresis (PFGE). The analysis of the virulence genes showed that the positive rates for tcpA and tcpI were the highest among strains from the southwest region, which had the highest incidence rate of cholera. Low positive rates for tcpA, tcpI and ctxAB among isolates from after 2000 may be an influencing factor contributing to the contemporary decline in cholera incidence rates. Spatiotemporal serotype shifts (Ogawa, Inaba, Ogawa, Inaba and O139) generally correlated with the variations in the PFGE patterns (PIV, PIIIc, PIa, PIIIb, PIIIa, PIb, and PII). O1 strains from different years or regions also had similar PFGE patterns, while O139 strains exclusively formed one cluster and differed from all other O1 strains. These data indicate that V. cholerae isolates in Shandong Province have continually undergone spatiotemporal changes. The serotype switching between Ogawa and Inaba originated from indigenous strains, while the emergence of serogroup O139 appeared to be unrelated to endemic V. cholerae O1 strains.

Snow's case revisited: new tool in geographic profiling of epidemiology

Abstract Geographic Profiling technique is used to find the origin of a series of crimes. The method was recently extended to other fields. One of the best renowned data in epidemiology is that by John Snow during an outburst of cholera in London. We wrote Python scripts to perform the analyses to apply the Geographic Profiling for individuating the starting origin of an infection by using the old Snow's data set. We modified the method by applying a weight to each point of the map where cases of cholera were reported. The weight was proportional to the number of cases in a given location.This modification of the Geographic Profiling method allowed to individuate in the map an area of maximum probability of the infection source, which was a few meters wide and including the historically known source of cholera, that is the "classical" water pump at Broad Street.The method appears to be a useful complement in order to individuate the source of epidemics when available data about the cases of the infections can be summarized on a map.

Tipificación molecular de aislados de vibrio cholerae O1 causantes de dos brotes de cólera en Venezuela / Molecular typing of vibrio cholerae O1 isolates causing two outbreaks of cholera in Venezuela

En Venezuela, en junio de 1996, se reportó que los casos de cólera eran causados por V. cholerae O1 serotipo Ogawa. A finales de 1998 se detectó un segundo brote de cólera causado por V. cholerae O1 serotipo Inaba resistente a la ampicilina y el trimetoprim-sulfametoxazol. Para estudiar las relaciones entre las cepas se examinaron veinticinco aislados de Vibrio cholerae O1 obtenidos desde 1996 a 2000 en Venezuela, para determinar la presencia de genes de virulencia y perfiles genómicos. Mediante la reacción en cadena de la polimerasa se determinó la presencia de genes de virulencia. Para determinar el perfil genómico de los aislamientos se utilizó ribotipificación y electroforesis en gel de campo pulsado (PFGE). Todos los aislados resultaron positivos para los genes ctxA, ctxB, zot y ace. El análisis RFLP de los genes RNAr mostró un único patrón de ribotipo V. El análisis de PFGE mostró una similitud de 91,5% independientemente del año o lugar de aislamiento, lo que indica la relación genómica entre los aislados. En conjunto, los datos sugieren que la cepa de V. cholerae O1 resistente a los antibióticos que apareció en 1998 surgió de la cepa epidémica anterior o de otro estrechamente relacionado con el clon anterior, con cambio de serotipo y ganancia de determinantes de resistencia a antibióticos. Es muy importante monitorear continuamente la aparición de la variantes porque mejorará la comprensión de la evolución de nuevos clones de V. cholerae

In Venezuela, cholera reported in June 1996 was caused by V. cholerae O1 serotype Ogawa. Second outbreak of cholera caused by V. cholerae O1 serotype Inaba, resistant to ampicillin and trimethoprim- Sulfamethoxazole, was notify at the end of 1998. Twenty-five isolates of Vibrio cholerae O1 obtained from 1996 to 2000 in Venezuela were examined to study the relationships between strains, presence of virulence genes and genomic profiles. Presence of virulence genes was detected by Polymerase Chain Reaction. Ribotyping and pulsed-field gel electrophoresis (PFGE) were used to determine the genomic profile of isolates. All isolates shown PCR product for ctxA, ctxB, zot and ace genes. RFLP analysis of rRNA gene showed one unique pattern from ribotype V. PFGE analysis revealed a similarity of 91.5%, regardless year or place of isolation, suggesting genomic relatedness among them. Overall, these data suggest that antibiotic resistant V. cholerae O1 El Tor strain that appeared in 1998 emerged from the previous epidemic strain or from another closely related to the previous clone. It is important the continuous monitor the emergence of variants because it will improve our understanding of the evolution of new clones V. cholerae

Emergency meeting on scaling up AWD/Cholera preparedness and response in EMR

An emergency sub-Regional meeting was co-hosted, for two days, by WHO and UNICEF in collaboration with the Ministry of Health of Lebanon, in Beirut from 8–9 July 2017, to discuss the ongo-ing Acute watery diarrhoea [AWD]/cholera outbreak in Somalia, Sudan and Yemen and the risk of spillover to neighboring countries, due to frequent movement of population fleeing countries affected by conflict and other reasons. A total of 51 participants representing six Regional Ministries of Health, WHO, UNICEF, and IFRC-MENA attended the meeting

Use of OCV in Iraq

In November 2015, Iraq successfully conducted its first ever mass vaccination campaign using Oral Cholera Vaccine [OCV] as part of the countries effort to prevent spread of an outbreak of cholera in northern part

Cholera elimination in the Eastern Mediterranean Region

Cholera continued to threaten public health and claim lives in the countries of Eastern Mediterranean Region [EMR]. During this year, a total of 49,519 suspected cases of cholera including 12 related deaths [CFR: 0.02%] were officially reported to WHO by three Member States in the EMR

As epidemias nas notícias em Portugal: cólera, peste, tifo, gripe e varíola, 1854-1918 / Epidemics in the news in Portugal: cholera, plague, typhus, influenza and smallpox, 1854-1918

Em períodos de crise sanitária grave como os de 1854-1856, 1899 e 1918, especialmente no Porto, onde cólera-morbo, peste bubónica, tifo exantemático, gripe pneumónica e varíola mataram percentagens elevadas da população, as imagens das epidemias na imprensa permitem-nos identificar os conhecimentos científicos num país considerado periférico, mas que dispunha de estudos e pessoal especializado no nível dos mais avançados da época. Uma base de dados de 6.700 notícias, artigos e anúncios revela-nos o conhecimento médico e farmacêutico da segunda metade do século XIX e início do XX, o modo como era transmitido e divulgado ao público e as soluções apresentadas pelas autoridades sanitárias. Um fator foi sempre salientado nas notícias e anúncios: a higiene.

In severe health crisis like those of 1854-1856, 1899 and 1918, especially in Porto, where cholera morbus, the bubonic plague, typhus fever, pneumonic influenza and smallpox killed high percentages of the population, the images of the epidemics in the press enable us to identify the scientific knowledge in a country considered peripheral, but which had studies and personnel specialized at the most advanced levels for the time. A database of 6,700 news items and announcements reveals the medical and pharmaceutical knowledge of the second half of the nineteenth and early twentieth centuries, the way it was transmitted and disclosed to the public and the solutions offered by the health authorities. Hygiene was consistently highlighted in the news and announcements.

Strategic framework for cholera control

A recent initiative to develop strategic framework for prevention and control of cholera in the Eastern Mediterranean Region [EMR] of WHO has been kicked off. The aim of this framework is to prevent and eliminate the risk of cholera from the region as an acute public health problem

La promoción y prevención de salud es la piedra angular para erradicar el cólera en el primer nivel de atención / Prevention and promotion is the cornerstone in the effort to erradicate cholera in primary care

Introducción:el Cholera morbus ha acompañado a la humanidad desde tiempos inmemoriales. Existen antecedentes en China, India y la Grecia clásica. Sin embargo, sólo se registran datos a partir de 1817 cuando se documenta la primera pandemia surgida en Asia y que se extendió a Turquía y los países árabes. Desde entonces se han sucedió ocho episodios pandémicos de cólera en el mundo. Objetivo: comunicar a la comunidad científica sobre la situación epidemiológica ocurrida en el mes de julio de 2012 en la provincia de Granma, de las medidas de promoción y prevención de salud que se desarrollaron en el primer nivel de atención para el cuadro diarreico causado por el Vibrio cholerae. Estas medidas las implementaron los equipos básicos de salud en el territorio con la participación intersectorial, lo que redunda en la adopción de estilos de vida saludables por parte de la población en general. Conclusión: primaron las actividades de saneamiento ambiental para disminuir la propagación de la enfermedad, complementadas con sugerencias a la comunidad médica sobre la importancia de la vigilancia epidemiológica ante eventuales reemergentes similares.

Introduction.Cholera has accompanied mankind since time immemorial with historical records from China, India and ancient Greece. However, registers are available only since 1817, when the first documented pandemic emerged in Asia and spread to Turkey and Arab countries. Since then, eight episodes of cholera pandemic have occurred in the world. Objective. To inform the scientific community about the epidemiological situation in the province of Granma, Cuba, at the cross-sectional period of July 2012 and the prevention and health promotion measures that were introduced in the first level of care for cases of diarrhea caused by Vibrio cholerae. These measures were implemented in the territory with an intersectoral approach, resulting in the adoption of healthy lifestyles by the general population. Conclusion. Basic sanitation activities were undertaken to slow the spread of the disease, complemented by suggestions to the medical community about the importance of epidemiological surveillance to detect reemergence.