This ecologic research suggests that high poverty level, low urbanization, and southern location are the most important predictors of endemic cholera in Mexican states. It is hypothesized that the natural environment of the coastal plains in southern states may also play a significant role in cholera incidence. Poor communities residing in the southern, predominantly rural, coastal states should be prioritized when it comes to investing in safe water supply facilities, adequate excreta disposal systems and cholera surveillance.

The endemic and seasonal nature of cholera depends upon the survival of Vibrio cholerae 01 in a viable but not necessarily culturable state in ecologic niches in aquatic environments during interepidemic periods. To understand the ecology of V. cholerae it is necessary to know which aquatic ecosystems can harbor it and thus contribute to the endemic presence of cholera in Latin America. This article summarizes knowledge about the ecology of V. cholerae 01, specifically, the abiotic and biotic factors that are relevant to the microbe's survival in aquatic environments. This pathogen finds favorable conditions in waters characterized by moderate salinity, high nutrient content, warm temperature, neutral or slightly alkaline pH, and the presence of aquatic macrophytes, phytoplankton, zooplankton, fish, mollusks, and crustaceans. These ecologic conditions are typical of estuaries and coastal swamps, and toxigenic V. cholerae 01 is now considered an autochthonous member of the microbial flora of these environments. The microorganism has also shown the ability to colonize freshwater ecosystems in its viable but not necessarily culturable form, if organic or inorganic substrates that favor its survival are available. ABSTRACTVibrio cholerae serogroup 01 consists of the classic and El Tor biotypes, the latter of which is responsible for the seventh cholera pandemic, which is now in progress. These two biotypes comprise the Inaba, Ogawa, and Hikojima serotypes. Epidemic cholera is caused by strains of V. cholerae that produce enterotoxin; strains that do not produce the toxin are identified as nonepidemic, although they may cause diarrhea. Vibrios that do not agglutinate serogroup 01 antiserum,

La ecología de

The danger that cholera is becoming endemic in Latin America makes it imperative to know the geographic location of aquatic environments where ecological conditions favor long-term survival of the toxigenic Vibrio cholerae O1 El Tor biotype, and such aquatic environments should be sampled to determine if they harbor this microorganism. For efficient and effective sampling, it would be useful to know what kinds of waters are ecologically suitable for the survival of this pathogen during periods between epidemics, and where these bodies of water are located. This paper presents the hypothesis that toxigenic V. cholerae O1's ability to survive in surface freshwaters tends to be inversely related to the altitude above sea level of these freshwaters.

ObjectiveDescribe how the Georgia Department of Public Health (DPH) used data from its State Electronic Notifiable Disease Surveillance System (SendSS) Syndromic Surveillance (SS) module for early detection of an outbreak of salmonellosis in Camden County, Georgia.IntroductionEvidence about the value of syndromic surveillance data for outbreak detection is limited (1). In July 2018, a salmonellosis outbreak occurred following a family reunion of 300 persons held in Camden County, Georgia, where one meal was served on 7/27/2018 and on 7/28/2018.MethodsSendSS-SS and SAS were used for cluster detection of Emergency Department (ED) patients with similar Chief Complaint (CC), Triage Notes (TN), or Discharge Diagnoses (DDx) by facility, time of ED visit, and zip code / county of residence. A SAS-based free-text query related to food poisoning in the CC and DDx fields was also performed on a daily basis. County- and hospital-specific charting of the Diarrhea syndrome was also conducted in SendSS-SS, whereas county- and zip code-specific charting of the same syndrome were done in both SendSS-SS and SAS (2).ResultsOn Sunday July 29th, 2018, three children and three adults were seen within 18 hours at the ED of Hospital A in Camden County, Georgia. All patients complained of diarrhea, vomiting, and food poisoning, after a large family reunion that had been held the day before. This early cluster was detected by the SAS-based free-text query of ‘food poisoning’ and the SAS-based cluster detection tool for patients with Diarrhea syndrome. The District Epidemiologists (DE) in the Coastal Health District were notified on Monday, July 30th, 2018. One-year high daily spikes of the Diarrhea syndrome occurred from July 29th to July 31st, 2018 in a local hospital ED (Fig 1), Camden County, and zip code 31548. Two HIPAA-compliant line lists with a total of 27 patients seen at EDs were emailed to the DEs to support active case finding. No further spikes of the Diarrhea syndrome were detected in Camden County during the 2-week period after the 3-day spike.ConclusionsSyndromic surveillance was a useful surveillance tool for early detection of a salmonellosis outbreak, helping with the active search for outbreak cases, tracking the peak of the outbreak, and assuring that no further spikes were occurring.References1.R Hopkins, C Tong, H Burkom, et al. A Practitioner-Driven Research Agenda for Syndromic Surveillance. Public Health Reports 2017; 132(Supplement1): 116S-126S.2. G Zhang, A Llau, J Suarez, E O'Connell, E Rico, R Borroto, F Leguen. Using ESSENCE to Track a Gastrointestinal Outbreak in a Homeless Shelter in Miami-Dade County, 2008. Advances in Disease Surveillance. 2008; 5:139.