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On the origin of the strain of Vibrio cholerae Cholera in Haiti

A study published last December 9 the site of the New England Journal of Medicine reports the results of investigations carried out on the genome of Vibrio cholerae isolates obtained during the outbreak currently underway on the island of Hispaniola (includes Haiti and the Dominican Republic).

Researchers compared the genomes of these strains with that of other strains isolated in various parts of the world.
E 'was found a close relationship between the island of Haiti and variant strains of V. cholerae El Tor 01 identified in Bangladesh in 2002 and 2008. The authors conclude that the epidemic in Haiti is probably the result of the introduction through human activities, of a strain of vibrio choleric from a geographically distant.

As you know, many Haitians have impeached the Nepalese soldiers sent to the country after the earthquake, according to a UN mandate. In fact, while it is true that the strain of V.cholerae working in Haiti is of South Asian, no one can tell from which country it comes from that area and how it got in ' island of Hispaniola. In fact the island after the earthquake, has come to staff from many organizations around the world and has not said that it is possible to trace the source of the infection.

In fact, instead of looking for the infector, it would be important to establish procedures
to prevent such incidents could happen again.
could be made an example of screening between
people coming from areas endemic for cholera when they are sent to the scene of a natural disaster, or presumptively could be given to those subject an antibiotic which V. cholerae is sensitive.

This study demonstrates once again the crucial role in the epidemiological context, technologies that allow genome analysis of bacteria and viruses responsible for epidemics.
Il testo integrale dell'articolo è disponibile nel sito web del NEJM:

Chin CS, Sorenson J, Harris JB, Robins WP, Charles RC, Jean-Charles RR, et al. The Origin of the Haitian Cholera Outbreak Strain. N Engl J Med. 2010 Dec 9.

doi 10.1056/NEJMoa1012928
http://www.nejm.org/doi/full/10.1056/NEJMoa1012928

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the if life gives you snow, make a snowman. Tivoli
in snowy, wet shoes. We worked Coast mini carrots and love snowmen.

I can admit that last picture did not I take photos, I just left took pictures while I was (unsuccessfully) tried to paste my nose snowman

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CHRISTMAS GIFTS! POLYMER CLAY

Offi ... some I forgot to photograph them ... but they are gifts for people close to me ... I will have the opportunity to do so!
I leave you with the overview ...

a mirror to my cousin who is a beautician

but this is a plate for my sister

this is a streghina, with the magnet behind ... a gift for an English friend who loves me as witches!
some bag holder and now I've got a number of aunts: one with Mucchetti, one with chicken and one with a canine theme ...

then, another magnet for a friend named Janete (is his first!)

these are a a little gift on request, my best friend recently asked me some earrings in the shape of toilet paper ... (and yes, a somewhat strange request ...); why I suggested my imagination

Finally a gift for my friend the breeder, as you can imagine Border Collie ( http://www.sunborder.com/ ) ... I am the proud mother of a dog of his breeding!

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At the start of the winter came the permanent rain and with the rain came the cholera. But it was checked and in the end only seven thousand died of it in the army.

Ernest Hemingway, A Farewell to Arms [A Farewell to Arms], 1929

With these simple words, Hemingway is able to convey to the reader a sense of hints at the anguish when a cholera epidemic among the Italian soldiers during the First World War, obviously a result of poor living conditions in the trenches. The final budget is "only seven thousand dead," thanks to the control measures taken.

Even in our age cholera returns periodically to the fore but, unlike what happened in the past, outbreaks occur regularly in developing countries, especially after catastrophic events such as the recent earthquake in Haiti.

The causative agent, Vibrio cholerae, is not really a single entity , but is present in different forms between them that affect their ability or inability to produce toxin, to cause epidemics and to respond to the only vaccine currently available.

The following table shows the main characteristics and classification of Vibrio cholerae (1).

                                                                      Serogroup
;	01	0139	Other: non-01, non-0139
E 'capable of producing the cholera toxin (CT)?	yes	yes	no
E 'can cause epidemics?	yes	yes	not (only sporadic cases)
Split into serotypes based on O antigen	2 serotypes: Ogawa and Inaba	no	no

Some strains of serogroups 01 and 0139 do not produce toxin cholera and therefore are not able to cause epidemics.

Vibrio cholerae is also divided into two biotypes: classical and El Tor . The first is virtually gone (the last case dates back to mid-90s and occurred in Bangladesh). The ongoing pandemic (ie the seventh pandemic) is due to biotype El Tor and includes both serotypes Inaba and Ogawa. There is also a variant, recently identified, which has characteristics of both biotypes.

The cholera toxin (CT) is at the heart of all the pathogenetic sequence of cholera :

V. cholerae is ingested exceeds the gastric acid barrier, colonize the small intestine, where it begins to produce enterotoxin (CT), consisting of a protein that is composed of two subunits:

- The A subunit is responsible for the clinical picture: by stimulating the enzyme adenylate cyclase, produces a hypersecretion of water and electrolytes that determine the profuse diarrhea characteristic of cholera and the resulting dehydration of the patient;

- subunit B, with which the CT binds to intestinal epithelial cells.

The only currently available vaccine (WC-RBS, trade name Dukoral) consists of two components (1):

- the subunit B recombinant cholera toxin, or that portion of the CT, as we have seen, allows the toxin to bind to the same epithelial cells of the small intestine;

- strains killed V. cholerae 01 belonging to both serotypes (Inaba and Ogawa) and both biotypes (El Tor and classical).

not contain the A subunit, the vaccine has no enterotoxic activity typical of cholera toxin.

What is the efficacy of the RBS-WC vaccine (Dukoral)?

The effectiveness was variable depending on the characteristics of the population studied, age and duration of follow-up period and can reach up to 86% (1-6).

The vaccine is not effective against the emerging 0139 serogroup of V. cholerae, until now responsible for outbreaks in limited areas of Asia.

The vaccine can also be effective in the prevention of enteritis by E. enterotoxigenic E. coli (ETEC): fact, the B subunit of CT contained in Dukoral is structurally, functionally and immunologically similar to heat-labile toxin produced by Escherichia enterotoxigenic E. coli, in turn, involved in 30-60% of cases traveler's diarrhea (7).

What is the risk of cholera in travelers?

The risk of cholera in travelers amounted to 0.2 casi/100.000 , with wide variations depending on the area visited (8).

In the course of an epidemic was estimated risk of casi/100.000 for 44 months (9).

Such data could be underestimated, because some cases of cholera shows atypical symptoms, clinically indistinguishable from the common traveler's diarrhea.

E 'observed an incidence of 5/100.000 in Japanese travelers (8), but this observation requires further confirmation in other subpopulations travelers.

The incidence in Japan may be higher for three reasons:

- the surveillance of cholera in Japan is better (return to conduct systematic screening);

- the Japanese are more likely to consume fish and raw seafood, behavior that increases the risk of cholera;

- among the Japanese is higher than the prevalence of atrophic gastritis, and this is obviously a risk factor.

In conclusion
travelers, while direct in endemic areas, but within the normal tourist routes, and observe the recommended precautions related to the consumption of food and water, have little or no risk of cholera. Vaccination is recommended for adventure travel or "alternative" and all situations where it is not expected to reach a sufficient level of food safety, especially when it comes to extended stays.

Bibliography

1. Tacket CO, Sack DA. Cholera vaccines. In: In Plotkin SA, Orenstein WA, Offit PA, eds. Vaccines. Philadelphia, PA : Saunders Elsevier, 2008.

2. van Loon FP, Clemens JD, Chakraborty J, et al: Field trial of inactivated oral cholera vaccines in Bangladesh : results from 5 years of follow-up. Vaccine   1996; 14:162-166.

3. Clemens JD, Sack DA, Harris JR, et al: Field trial of oral cholera vaccines in Bangladesh . Lancet   1986; 2:124-127.

4. Sanchez JL, Vasquez B, Begue RE, et al: Protective efficacy of oral whole-cell/recombinant-B-subunit cholera vaccine in Peruvian military recruits. Lancet   1994; 344:1273-1276.

5. Taylor DN, Cárdenas V, Sanchez JL, et al: Two-year study of the protective efficacy of the oral whole cell plus recombinant B subunit cholera vaccine in Peru . J Infect Dis   2000; 181:1667-1673.

6. Lucas ME, Deen JL, von Seidlein L, et al: Effectiveness of mass oral cholera vaccination in Beira , Mozambique . N Engl J Med   2005; 352:757-767.

7. R. Steffen, F. Castelli, H. Dieter Nothdurft, L. Rombo and J.N. Zuckerman, Vaccination against enterotoxigenic Escherichia coli, a cause of travelers’ diarrhea, J Travel Med 2005;12:102–107.

8. Wittlinger F, Steffen R, Watanabe H and Handszuh H. Risk of cholera among Western and Japanese travelers. Journal of Travel Medicine 1995;2:154-158.

9. Taylor DN, Rizzo J, Meza R, Perez J and Watts D. Cholera among Americans living in Peru . Clinical Infectious Diseases 1996;22:1108-1109.