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The effect of climate change on cholera disease: The road ahead using artificial neural network
Zahra Asadgol | Hamed Mohammadi | Majid Kermani | Alireza Badirzadeh | Mitra Gholami
Date of Publication:
Climate change has been described to raise outbreaks of water-born infectious diseases and increases public health concerns. This study aimed at finding out these impacts on cholera infections by using Artificial Neural Networks (ANNs) from 2021 to 2050. Daily data for cholera infection cases in Qom city, which is located in the center of Iran, were analyzed from 1998 to 2016. To determine the best lag time and combination of inputs, Gamma Test was applied. General circulation model outputs were utilized to project future climate pattern under two scenarios of Representative Concentration Pathway (RCP2.6 and RCP8.5). Statistical downscaling was done to produce high-resolution synthetic time series weather dataset. ANNs were applied for simulating the impact of climate change on cholera. The observed climate variables including maximum and minimum temperatures and precipitation were tagged as predictors in ANNs. Cholera cases were considered as the target outcome variable. Projected future (2020–2050) climate in previous step was carried out to assess future cholera incidence. A seasonal trend in cholera infection was seen. Our results elucidated that the best lag time was 21 days. According to the results of downscaling tool, future climate in the study area by 2050 will be warmer and wetter. Simulation of cholera cases indicated that there is a clear trend of increasing cholera cases under the worst scenario (RCP8.5) by the year 2050 and the highest cholera cases observe in warmer months. The precipitation was recognized as the most effective input variable by sensitivity analysis. We observed a significant correlation between low precipitation and cholera infection. There is a strong evidence to show that cholera disease is correlated with environment variables, as low precipitation and high temperatures in warmer months could provide the swifter bacterial replication. These conditions in Iran, especially in the central parts, may raise the cholera infection rates. Furthermore, ANNs is an executive tool to simulate the impact of climate change on cholera to estimate the future trend of cholera incidence for adopting protective measures in endemic areas.
In silico characteristics for re-emerging possibility of Vibrio cholerae genotypes in Iran
M. Hajia | A. Sohrabi
Date of Publication:
New Microbes and New Infections
Epidemic cholera has been registered several times within recent years in Iran. The dominant genotype was Ogawa until 2011, but this gradually changed to Inaba. However, in 2015, the re-appearance of a previous Ogawa genotype was detected by the Iranian CDC. This raised worries because no evidence was found for its origin abroad. The aim of the present study was to identify clearly the source of this outbreak. Pulsed field gel electrophoresis (PFGE) was used to compare the recently detected Vibrio cholerae strains with those isolated from 2011 to 2015. We selected one strain per PFGE pattern, and compared the distinct patterns. In total, we studied 33 V. cholerae Ogawa strains. Analysis showed that strains could be discriminated on the basis of annual clusters but with a similarity of more than 80%. The highest homology was observed among those isolated each year from 2011 to 2014. In contrast, strains isolated in 2015 also exhibited close correlation with each other but were located in distinct clusters. The analysis also proved genetic variations among some strains. All 2015 strains showed differences with regard to previous genotypes despite some similarities. The new genotypes were probably imported into Iran from neighbouring countries such as Iraq by travellers or contaminated food sources since 2015. However, more investigations are required to identify the exact source of the 2015 outbreak.
A systematic review and meta-analysis on the epidemiology of antibiotic resistance of Vibrio cholerae in Iran
A Yousefi | H Vaez | A Sahebkar | F Khademi
Date of Publication:
Cholera, an acute diarrheal disease caused by Vibrio cholerae (V. cholerae), is an endemic disease and a major public health problem in Iran. Antibiotic therapy can decrease duration of the disease, transmission of infection and contamination of the environment. Considering different pattern of V. cholerae antibiotic resistance around the world, the aim of the current systematic review and meta-analysis was to evaluate the prevalence of antibiotic resistance of V. cholerae in Iran.
A systematic review of the literature was performed using related keywords in the electronic national and international databases. Up to July 31, 2018, 27 eligible papers were included in our meta-analysis based on the defined inclusion criteria.
V. cholerae O1 was the most prevalent strain isolated in Iran and exhibited a high resistance rate against numerous antibiotics including chloramphenicol (33.6%), oxytetracycline (40.2%), trimethoprim/ sulphamethoxazole (86%), tetracycline (34.5%), furazolidone (69.8%), streptomycin (93.8%), polymyxin (80.7%), ampicillin (32.1%), nalidixic acid (88.9%), kanamycin (29%) and amoxicillin (30.5%). According to the meta-analysis results, antibiotic therapy with ciprofloxacin, doxycycline, erythromycin, gentamicin, azithromycin, cefixime and cefepime could be effective for the treatment of severe cases of cholera in Iran.
A cholera outbreak in Alborz Province, Iran: a matched case-control study
Ghobad Moradi | Mohammad Aziz Rasouli | Parvin Mohammadi | Elham Elahi | Hojatollah Barati
Date of Publication:
Epidemiology and Health
A total of 229 confirmed cholera cases were reported in Alborz Province during an outbreak that lasted from June 2011 to August 2011. This study aimed to identify potential sources of transmission in order to determine suitable interventions in similar outbreaks. In other words, the lessons learned from this retrospective study can be utilized to manage future similar outbreaks. In this outbreak, 229 confirmed cholera cases were diagnosed. The following risk factors were found to be associated with cholera: consumption of unrefrigerated leftover food (OR, 3.05; 95% confidence interval [CI], 1.72 to 5.41), consumption of vegetables and fruits in the previous three days (OR, 2.75; 95% CI, 1.95 to 3.89), and a history of traveling in the previous five days (OR, 5.31; 95% CI, 2.21 to 9.72). In conclusion, consumption of vegetables and fruits has remained an unresolved risk factor in cholera outbreaks in Iran in recent years. To reduce the risk of cholera, sanitary standards for fruits and vegetables should be observed at all points from production to consumption, the population should be educated regarding hygienic food storage during outbreaks, and sanitary standards should be maintained when traveling during cholera outbreaks.
Epidemiologic and Drug Resistance Pattern of Vibrio cholerae O1 Biotype El Tor, Serotype Ogawa, in the 2011 Cholera Outbreak, in Alborz Province, Iran
Hojatolah Barati | Ghobad Moradi | Mohammad Aziz Rasouli | Parvin Mohammadi
Date of Publication:
Jundishapur Journal of Microbiology
This study aimed to assess the epidemiological aspects and drug resistance pattern of Vibrio cholerae O1, biotype El Tor, serotype Ogawa, in cholera outbreak, in Alborz province in Iran, during 2011.
This is a cross-sectional study, which reviews a cholera epidemic that occurred in Iran. A total of 9844 specimens were taken from suspected cases, among diarrheal patients, via rectal swabs. The specimens were placed in Cary-Blair transport medium and sent to laboratory. Samples were enriched, in alkaline peptone water, and isolated on thiosulphate-citrate-bile salt-sucrose agar. From the 244 confirmed cases, 239 cases underwent antibiogram test, via disk diffusion method and based on national committee for clinical laboratory standards (NCCLS) instructions. The standard Escherichia coli ATCC 25922 was used for antibiogram quality control and, eventually, all results were interpreted and reported using NCCLS standard table.
In total, until October 22, 2011, which was announced as the end of outbreak, 9844 samples were taken from diarrheal patients. Regarding the type of V. cholerae, 244 El Tor biotype positive cases were reported. The case fatality rate was 1.3%. The mean age of patients was 37.8 years and the highest incidence rate occurred in the age group 21 - 30 years. After conducting antibiotic susceptibility test in the 244 V. cholerae, biotype El Tor, serotype Ogawa, it was found that ciprofloxacin had the highest level of antibiotic susceptibility (99.6%) and the highest level of antibiotic resistance was observed in co-trimoxazole (95.4%).
The results of our study show that the resistances to doxycycline and tetracycline, which are mentioned in multiple resources, as the most common antibiotic drugs for treating cholera, are increasing.