Cholera has historically occurred in periodic epidemics, with the most severe epidemics limited to a few countries, namely Bangladesh, India, and countries in Africa and South America. During the past three decades, however, this disease has occurred in geographical areas from which it had seemingly disappeared almost a century ago (35). Including these new appearances, epidemics have been reported in over 75 countries in South America, Africa, and Asia during the past decade (38). In addition, each year sporadic cases are reported in other countries around the world (38).Interestingly, cholera is one of the few bacterial diseases known for its pandemicity, and until 1992, all epidemics of cholera were caused by Vibrio cholerae serogroup O1. In the latter part of 1992, a newly recognized O139 serogroup was isolated in areas surrounding the Bay of Bengal and was linked to major epidemics, first in Madras on the eastern coast of India and then in the southern part of Bangladesh. Later it was detected in neighboring countries and has continued to persist in that geographic region (6, 28).In 1992 in Bangladesh during a 12-week period, there were approximately 220,000 cases of cholera caused by serotype O139, with over 8,000 deaths, more deaths than in all of Latin America that same year (31,35). Cholera is known to be a disease with a high mortality (Ϸ60% if untreated); with adequate treatment (intravenous and oral rehydration therapy, supplemented with appropriate antibiotics) the mortality drops to Ͻ1.0% (5, 26). The large numbers of deaths indicate that adequate therapy was not available to the many persons who died (6,35).In the recent history of cholera, most major epidemics originated in coastal regions, including both the South American epidemic that began in the coastal regions of Peru, spreading to 21 countries, including Mexico, and the new O139 outbreak in India and Bangladesh. In Dhaka City and a rural area of Bangladesh, Matlab, cholera occurs year-round, with a distinct pattern of two peaks of disease, one in the spring and the other in the fall (16,30).The presence of V. cholerae O1 year-round via its commensal association with plankton was established by Colwell and coworkers using direct detection methods (17). It is still not certain what triggers the continuing seasonal epidemics of cholera in Bangladesh and what determines the persistence and multiplication of V. cholerae O1 and O139 in the choleraendemic regions of the world. However, coexistence of V. cholerae O1 and O139 serogroups in association with plankton has

Five tube-wells in Matlab, Bangladesh, were selected for analysis of selected biophysicochemical parameters. The results showed that all tube-well water samples contained zooplankton and bacteria. Results for some of the parameters were outside the accepted limits recommended by the World Health Organization for drinking water. It is concluded that water from tube-wells should be treated if used as drinking water.

Recently, a new strain of cholera, Vibrio cholerae O139, has emerged as an epidemic strain, but there is little information about its environmental reservoir. The present investigation was aimed to determine the role of cyanobacteria in the persistence of V. cholerae O139 in microcosms. An environmental isolate of V. cholerae O139 and three cyanobacteria (Anabaena sp., Nostoc sp., and Hapalosiphon sp.) were used in this study. Survival of culturable V. cholerae O139 in microcosms was monitored using taurocholate-tellurite gelatin agar medium. Viable but nonculturable V. cholerae O139 were detected using a fluorescent antibody technique. Vibrio cholerae O139 could be isolated for up to 12 days in a culturable form in association with cyanobacteria but could not be isolated in the culturable form after 2 days from control water without cyanobacteria. The viable but nonculturable V. cholerae O139 could be detected in association with cyanobacteria for up to 15 months. These results, therefore, suggest that cyanobacteria can act as a long-term reservoir of V. cholerae O139 in an aquatic environment.

Coastal areas in South Asian countries are particularly vulnerable to elevated water salinity. Drinking water salinity has been found to be associated with cardiovascular diseases (CVD), diarrhea, and abdominal pain. Our study aimed to find if excess drinking water salinity was associated with increased hospital visits with an array of health effects in coastal sub-districts of Bangladesh. A cross-sectional study was conducted with 157 participants from three coastal sub-districts. A face-to-face interview was conducted to collect salinity exposure and hospital visit data. Water samples were collected from both drinking and other household water sources for the measurement of salinity and total dissolved solids (TDS). CVD, diarrhea, and abdominal pain related hospital visits were found to be significantly associated with high water salinity and TDS. Households exposed to high salinity demonstrated a higher frequency of hospital visits than the low salinity-exposed households. People exposed to high salinity seemed to lack awareness regarding salinity-inducing health effects. Water salinity is a public health concern that will continue to rise due to climate change. Therefore, raising awareness about the health risks of water salinity is essential for the government to frame policies and mitigation strategies to control this emerging threat.

Mucinase is a soluble haemagglutinin protease, which may be important for the survival of Vibrio cholerae in association with mucilaginous blue-green algae (cyanobacteria). A comparative survival study was carried out with an Anabaena sp. and a wild-type V. cholerae O1 strain hap+ gene (haemagglutinin-protease), together with its isogenic mutant hap (hap-deleted gene). A simple spread plate technique was followed to count culturable V. cholerae O1 on taurocholate tellurite gelatin agar plate. The fluorescent antibody technique of Kogure et al. (1979) was used for the microscopical viable count of V. cholerae O1. Polymerase chain reaction (PCR) and Southern blot hybridization were carried out to detect a lower number of viable but nonculturable (VBNC) V. cholerae O1 from the laboratory-based experiments. The wild and mutant V. cholerae O1 strains survived in culturable form for 22 and 10 days. respectively, in association with the Anabaena sp., with the difference being statistically significant (P < 0.01). The fluorescent antibody technique, PCR, and hybridization results also showed that the wild strain survived better in the VBNC state than did the mutant VBNC strain in association with an Anabaena sp. These results indicate that the enzyme mucinase may play an important role in the association and long-term survival of V. cholerae O1 with a mucilaginous blue-green alga, Anabaena sp.