Combating cholera by building predictive capabilities for pathogenic Vibrio cholerae in Yemen

Abstract

Cholera remains a global public health threat in regions where social vulnerabilities intersect with climate and weather processes that impact infectious Vibrio cholerae. While access to safe drinking water and sanitation facilities limit cholera outbreaks, sheer cost of building such infrastructure limits the ability to safeguard the population. Here, using Yemen as an example where cholera outbreak was reported in 2016, we show how predictive abilities for forecasting risk, employing sociodemographical, microbiological, and climate information of cholera, can aid in combating disease outbreak. An epidemiological analysis using Bradford Hill Criteria was employed in near-real-time to understand a predictive model’s outputs and cholera cases in Yemen. We note that the model predicted cholera risk at least four weeks in advance for all governorates of Yemen with overall 72% accuracy (varies with the year). We argue the development of anticipatory decision-making frameworks for climate modulated diseases to design intervention activities and limit exposure of pathogens preemptively.

Public Health Implications of Cholera- a Water Sanitation and Hygiene (WASH) Related Infectious Disease in the Era of Climate Change: The Nigeria Experience

“…Also, the investigated variables on the perceptions of the respondents regarding climate change predisposing factors exhibited significant correlation with the risks of cholera infection. The observations in these regards are not unexpected as they are in agreement with the results of many researchers elsewhere [8,49,51,52]. High levels of health literacy lead to observance of the WASH practices which greatly reduces the chances of the pathogens getting to humans to initiate infection.…”

“…The majority perceived that climate change afflicted people with different diseases including WASH related diseases. The perception on the effects of climate on transmission of diseases has been corroborated in several studies [20,48,49,50]. Fallouts of climate change includes variations in temperature, extreme variations in rainfall, flooding, drought among others.…”

“…High temperatures are likely to lead to proliferation of pathogens and vectors, while high rain may result in flooding and associated disruption of water infrastructure as well as contamination of water sources with waste water and sewage. Low rainfall may cause water scarcity resulting in concentration of pathogens, scarcity of water and drought which hinders compliance to WASH practices [20,50,49].…”

Environmental Factors Influencing Occurrence of Vibrio parahaemolyticus and Vibrio vulnificus

“…For example, the risk of cholera can now be predicted at the scale of available satellite observation and favorable environmental conditions ( 62 , 63 ). The model was employed to assess the risk of cholera in Ukraine ( 24 ) and Yemen ( 64 ), countries suffering damaged or severely crippled civil infrastructure, following which the human population is at risk of health disasters. It is important to note that both cholera and vibriosis have various routes of environmental transmission, primarily attributed to the ability of V. cholerae to thrive in freshwater through its salinity requirements ( 14 ) and association with a variety of hosts with chitinous exoskeletons ( 6 , 52 ).…”

Collaborative Efforts and Strategies for Cholera Outbreak Control in Garissa County, Kenya: Implementation of Water Quality Monitoring Interventions

“…Cholera cases were first reported in Kenya in 1971, and the country has since experienced recurring outbreaks [8]. The occurrence of cholera has been linked to climate changes, including El Niño events [9] [10]. A study by [11] analyzed incidence data at the country level and projected that Kenya, as part of East Africa, would likely face more cholera outbreaks in the near future due to El Niño events.…”