Vibrio Cholera Michelle Ross, Kristin Roman, Risa Siegel

Cholera: Introduction Transmitted to humans via contaminated food and water 1 of 3 diseases requiring WHO notification Part of normal flora of brackish water and estuaries associated with algal blooms (plankton), which are influenced by the temperature of the water. 8 http://www.cobblestoneconcepts.com/ucgis2summer/chow//chow.htm - lots of pictures Human beings are also one of the reservoirs of the pathogenic form of Vibrio cholerae.”8

Cholera: A Historical Perspective 500-400 BC Sanskrit writings describe a dehydrating diarrhea-like death first observed on the Indian subcontinent Sushruta Samhita (an ancient text) mentions “visuchika, an intestinal disease which closely resembles cholera” PICTURE: Fig. 1. Historical distribution of endemic cholera in South Asia. The level of endemicity (calculated as the average incidence during the 15 healthiest years between 1901 and 1945) is shown by the variation in the density of dots (from 17).

Cholera: A Historical Perspective 500 BC Hippocrates and Areatus of Capdadocia mention cholera-like disease in their medical writings 900 AD Rhazes, Islamic physician, describes cholera-like illness referring to it as heyda (Arabic) PICTURE: Hippocrates Hippocrates/Aretaus of Capdadocia Dehydrating diarrhea2 Indicates presence of cholera-like disease on European continent before 1817 outbreak

Cholera: A Historical Perspective 1563 first recorded cholera epidemic 1643 used term “trousse-galant” and “flux de ventre” to describe severe diarrheal illness 1649 sporadic but very severe form of cholera 1563: Garcia del Huerto (Portuguese physician) in Goa, India described cholera epidemic2 1643: Van der Heyden (Belgian physician) utilized terminology to describe severe diarrheal illness 1649: “Rivirerus of Montpellier, France wrote of a sporadic, extremely severe form of cholera plaguing the town

Cholera: A Historical Perspective 1658 Brazil – cholera-like illness 1665 Ghent - cholera-like illness 1781 division of Bengal troops infected heading to Calcutta 1787-1796 Outbreak in Vellore and Arcot (1787-1789) -> Ganjam (1790) -> Malabar and Coromandel (1796) 1781 - Outbreak spread through Calcutta -> Sylhet -> Hardwar1 “. . . first outbreak to occur following British occupation of India took place in 1781 among a division of Bengal troops headed towards Calcutta.” 1

Historical Perspective: First Pandemic 1817-1820 First Major Cholera Pandemic spread out of India to Europe and the Americas spread from India -> Middle East (reaching Turkey and Persia) -> Far East (Singapore, Japan, and Philippines) PICTURE: Title: 'Hoping for the Spread of Cholera', c 1840-1850. Caption: 'Hoping for the Spread of Cholera', c 1840-1850. Lithograph featuring a caricature of an undertaker in hat and tailcoat, gleefully rubbing his hands in anticipation of increased business from a cholera epidemic. He is seen looking down at a paper reporting recent deaths. The first major cholera epidemic struck England in 1831, and was initially attributed to 'miasma' (foul vapours in the atmosphere). However, observations made by John Snow (1813-1858) during the epidemics of 1848 and 1854 established the role of polluted water in the spread of the disease. had unusual virulence1 disease was new to the area -> thought it was a new disease

Historical Perspective: Second Pandemic 1829-1851 entered US through NY and New Orleans -> proceeded through entire country Moscow chemist – administer IV fluids to cholera patients Research supported by Lancet; not commonly accepted until end of 19th century PICTURE: Title: 'Cholera Preventive Costume', March 1832. Caption: 'Cholera Preventive Costume', March 1832. Coloured lithograph published by T McClean of Haymarket, London, during a cholera epidemic and showing a caricature of man wearing a bulky costume made of useless preventatives, including india rubber, a face mask and juniper berries. The satirical commentary below also recommends the dragging of a small cart containing further items and concludes that 'by exactly following these directions you may be certain that the cholera...will attack you the first.' Printed by Meifred, Lemercier & Co, lithographers, London. There are two speculated sources for the second pandemic: 1 - speculated to have started in Astrakhan (part of the former Soviet Union) 1 2 – speculated to have started in India -> Afghanistan -> Persia -> Orenburg, Astrakhan1

Historical Perspective: Third Pandemic PICTURE: cartoon showing skeleton pumping water at public water pump 1852-1859 1853 rampant throughout Middle East, Northern Europe, and North and Central America

Historical Perspective: Identification 1854 Filippo Pacini identified curved or comma shaped bacterium which he called Vibrio cholerae examined intestinal mucosa of patients following cholera death during Asiatic cholera pandemic of 1846-1863 PICTURE: He published a paper in 1854 entitled, "Microscopical observations and pathological deductions on cholera" in which he described the organism and its relation to the disease. His microscopic slides of the organism were clearly labeled, identifying the date and nature of his investigations (see figure). “He correctly described the disease as a massive loss of fluid and electrolytes due to the local action of the vibrio on the intestinal mucosa, and recommended in extreme cases the intravenous injection of 10 gram of sodium chloride in a liter of water - - later found to be very effective.”3

Historical Perspective: Snow 1854 John Snow hypothesized water as primary reservoir for transmission Broad Street pump incident 56 deaths in 2 days PICTURE: It offers his views on cholera and other epidemic diseases that were troublesome during the mid-1800s. The writings illustrate his manner of epidemiologic thinking, and how he used available clinical and population-based evidence to address the potential etiology of selected infectious diseases.