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{{Cholera}}
{{Cholera}}
{{CMG}}; '''Associate Editors-In-Chief:''' [[Priyamvada Singh|Priyamvada Singh, MBBS]] [mailto:psingh13579@gmail.com]; {{SaraM}}
{{CMG}}; '''Associate Editors-In-Chief:''' [[Priyamvada Singh|Priyamvada Singh, MBBS]] [mailto:psingh13579@gmail.com], {{SaraM}}


==Overview==
==Overview==
Certain factors have been found to be associated with an increased risks of Cholera. Among these decreased immunity, decreased gastric pH, certain blood groups (Blood group O are most prone, blood group AB is least prone), and genetics are the commonest associated. The greatest risk occurs in over-populated communities and refugee settings characterized by poor sanitation, unsafe drinking-water, increased person-to-person transmission.<ref name="pmid4014172">{{cite journal| author=Glass RI, Holmgren J, Haley CE, Khan MR, Svennerholm AM, Stoll BJ et al.| title=Predisposition for cholera of individuals with O blood group. Possible evolutionary significance. | journal=Am J Epidemiol | year= 1985 | volume= 121 | issue= 6 | pages= 791-6 | pmid=4014172 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4014172  }} </ref><ref name="pmid10892490">{{cite journal| author=Rabbani GH, Greenough WB| title=Food as a vehicle of transmission of cholera. | journal=J Diarrhoeal Dis Res | year= 1999 | volume= 17 | issue= 1 | pages= 1-9 | pmid=10892490 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10892490  }} </ref><ref name="pmid19212328">{{cite journal| author=Larocque RC, Sabeti P, Duggal P, Chowdhury F, Khan AI, Lebrun LM et al.| title=A variant in long palate, lung and nasal epithelium clone 1 is associated with cholera in a Bangladeshi population. | journal=Genes Immun | year= 2009 | volume= 10 | issue= 3 | pages= 267-72 | pmid=19212328 | doi=10.1038/gene.2009.2 | pmc=2672110 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19212328  }} </ref><ref name=Cholera-outbreak> World Health Organization. Assessing the Outbreak response and improving preparedness (2004) http://apps.who.int/iris/bitstream/10665/43017/1/WHO_CDS_CPE_ZFk_2004.4_eng.pdf</ref>
Certain factors have been found to be associated with an increased risk of contracting cholera. Among these decreased immunity, decreased gastric pH, certain blood groups (patients with [[ABO blood group system|blood group O]] are most prone, while patients with [[ABO blood group system|blood group AB]] are least prone), and genetics are the most commonly associated factors. The greatest risk occurs in over-populated communities and refugee settings characterized by poor sanitation, unsafe drinking water, and increased person-to-person transmission.<ref name="pmid4014172">{{cite journal| author=Glass RI, Holmgren J, Haley CE, Khan MR, Svennerholm AM, Stoll BJ et al.| title=Predisposition for cholera of individuals with O blood group. Possible evolutionary significance. | journal=Am J Epidemiol | year= 1985 | volume= 121 | issue= 6 | pages= 791-6 | pmid=4014172 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4014172  }} </ref><ref name="pmid10892490">{{cite journal| author=Rabbani GH, Greenough WB| title=Food as a vehicle of transmission of cholera. | journal=J Diarrhoeal Dis Res | year= 1999 | volume= 17 | issue= 1 | pages= 1-9 | pmid=10892490 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10892490  }} </ref><ref name="pmid19212328">{{cite journal| author=Larocque RC, Sabeti P, Duggal P, Chowdhury F, Khan AI, Lebrun LM et al.| title=A variant in long palate, lung and nasal epithelium clone 1 is associated with cholera in a Bangladeshi population. | journal=Genes Immun | year= 2009 | volume= 10 | issue= 3 | pages= 267-72 | pmid=19212328 | doi=10.1038/gene.2009.2 | pmc=2672110 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19212328  }} </ref><ref name=Cholera-outbreak> World Health Organization. Assessing the Outbreak response and improving preparedness (2004) http://apps.who.int/iris/bitstream/10665/43017/1/WHO_CDS_CPE_ZFk_2004.4_eng.pdf</ref>
 
==Risk Factors==
==Risk Factors==
*Foodborne cholera outbreaks risk factors may include:<ref name="pmid22099118">{{cite journal| author=O'Connor KA, Cartwright E, Loharikar A, Routh J, Gaines J, Fouché MD et al.| title=Risk factors early in the 2010 cholera epidemic, Haiti. | journal=Emerg Infect Dis | year= 2011 | volume= 17 | issue= 11 | pages= 2136-8 | pmid=22099118 | doi=10.3201/eid1711.110810 | pmc=3310583 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22099118  }} </ref><ref name="pmid10892490">{{cite journal| author=Rabbani GH, Greenough WB| title=Food as a vehicle of transmission of cholera. | journal=J Diarrhoeal Dis Res | year= 1999 | volume= 17 | issue= 1 | pages= 1-9 | pmid=10892490 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10892490  }} </ref>
===Contaminated Sources===
**Consumption of contaminated water
Risk factors for foodborne cholera may include:<ref name="pmid22099118">{{cite journal| author=O'Connor KA, Cartwright E, Loharikar A, Routh J, Gaines J, Fouché MD et al.| title=Risk factors early in the 2010 cholera epidemic, Haiti. | journal=Emerg Infect Dis | year= 2011 | volume= 17 | issue= 11 | pages= 2136-8 | pmid=22099118 | doi=10.3201/eid1711.110810 | pmc=3310583 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22099118  }} </ref><ref name="pmid10892490">{{cite journal| author=Rabbani GH, Greenough WB| title=Food as a vehicle of transmission of cholera. | journal=J Diarrhoeal Dis Res | year= 1999 | volume= 17 | issue= 1 | pages= 1-9 | pmid=10892490 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10892490  }} </ref>
**Consumption of rice products
*Consumption of contaminated water
**Consumption specific vegetables or fruits
*Consumption of rice products
*Sporadic cholera risk factors include:
*Consumption of specific vegetables or fruits
**Consumption of undercooked shellfish
Risk factors for sporadic cholera include:
*The greatest risk occurs in over-populated communities (massive displacement of IDPs or refugees) which many is caused by:<ref name=Cholera-outbreak> World Health Organization. Assessing the Outbreak response and improving preparedness (2004) http://apps.who.int/iris/bitstream/10665/43017/1/WHO_CDS_CPE_ZFk_2004.4_eng.pdf</ref>  
*Consumption of under-cooked shellfish
**Poor sanitation
 
**Unsafe drinking-water
===Overcrowding and Displacement===
**Increased person-to-person transmission
The greatest risk of developing cholera is present in over-populated communities affected by massive displacement and overcrowding, commonly due to natural disasters or political/economical instability (e.g., earthquakes, hurricanes, refugee camps) by means of:<ref name=Cholera-outbreak> World Health Organization. Assessing the Outbreak response and improving preparedness (2004) http://apps.who.int/iris/bitstream/10665/43017/1/WHO_CDS_CPE_ZFk_2004.4_eng.pdf</ref>  
===Blood Group===
*Poor sanitation
* Recent [[epidemiology|epidemiologic research]] suggests that an individual's susceptibility to cholera (and other [[diarrhea]]l infections) is affected by their [[blood type]]. Those with [[type O blood]] are the most susceptible, while those with [[type AB]] are the most resistant. Between these two extremes are the A and B blood types, with type A being more resistant than type B.<ref name=Swerdlow_1994>{{cite journal |author=Swerdlow D, Mintz E, Rodriguez M, Tejada E, Ocampo C, Espejo L, Barrett T, Petzelt J, Bean N, Seminario L |title=Severe life-threatening cholera associated with blood group O in Peru: implications for the Latin American epidemic |journal=J Infect Dis |volume=170 |issue=2 |pages=468-72 |year=1994 |id=PMID 8035040}}</ref><ref name=Harris_2005>{{cite journal |author=Harris J, Khan A, LaRocque R, Dorer D, Chowdhury F, Faruque A, Sack D, Ryan E, Qadri F, Calderwood S |title=Blood group, immunity, and risk of infection with ''Vibrio cholerae'' in an area of endemicity |journal=Infect Immun |volume=73 |issue=11 |pages=7422-7 |year=2005 |pmid=16239542}}</ref>
*Unsafe drinking water
*Increased person-to-person transmission
 
===Other Risk Factors===
====Blood Group====
Recent [[epidemiology|epidemiologic research]] suggests that an individual's susceptibility to cholera (and other [[diarrhea]]l infections) is affected by his/her [[blood type]]. Those with [[type O blood]] are the most susceptible, while those with [[type AB]] are the most resistant. Between these two extremes are the A and B blood types, with type A being more resistant than type B.<ref name=Swerdlow_1994>{{cite journal |author=Swerdlow D, Mintz E, Rodriguez M, Tejada E, Ocampo C, Espejo L, Barrett T, Petzelt J, Bean N, Seminario L |title=Severe life-threatening cholera associated with blood group O in Peru: implications for the Latin American epidemic |journal=J Infect Dis |volume=170 |issue=2 |pages=468-72 |year=1994 |id=PMID 8035040}}</ref><ref name=Harris_2005>{{cite journal |author=Harris J, Khan A, LaRocque R, Dorer D, Chowdhury F, Faruque A, Sack D, Ryan E, Qadri F, Calderwood S |title=Blood group, immunity, and risk of infection with ''Vibrio cholerae'' in an area of endemicity |journal=Infect Immun |volume=73 |issue=11 |pages=7422-7 |year=2005 |pmid=16239542}}</ref>


===Genetics===
====Genetics====
**Variants in the innate immunity protein BPIFB1 (LPLUNC1) are associated with susceptibility to choler<ref name="pmid19212328">{{cite journal| author=Larocque RC, Sabeti P, Duggal P, Chowdhury F, Khan AI, Lebrun LM et al.| title=A variant in long palate, lung and nasal epithelium clone 1 is associated with cholera in a Bangladeshi population. | journal=Genes Immun | year= 2009 | volume= 10 | issue= 3 | pages= 267-72 | pmid=19212328 | doi=10.1038/gene.2009.2 | pmc=2672110 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19212328  }} </ref>
*Variants in the innate immunity protein BPIFB1 (LPLUNC1) are associated with susceptibility to cholera.<ref name="pmid19212328">{{cite journal| author=Larocque RC, Sabeti P, Duggal P, Chowdhury F, Khan AI, Lebrun LM et al.| title=A variant in long palate, lung and nasal epithelium clone 1 is associated with cholera in a Bangladeshi population. | journal=Genes Immun | year= 2009 | volume= 10 | issue= 3 | pages= 267-72 | pmid=19212328 | doi=10.1038/gene.2009.2 | pmc=2672110 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19212328  }} </ref>
* It has also been hypothesized that the [[cystic fibrosis]] genetic [[mutation]] has been maintained in humans due to a selective advantage: [[heterozygous]] carriers of the mutation (who are thus not affected by cystic fibrosis) are more resistant to ''V. cholerae'' infections.<ref name=Bertranpetit_1996>{{cite journal |author=Bertranpetit J, Calafell F |title=Genetic and geographical variability in cystic fibrosis: evolutionary considerations |journal=Ciba Found Symp |volume=197 |issue= |pages=97-114; discussion 114-8 |year=1996 |pmid=8827370}}</ref> In this model, the genetic deficiency in the [[cystic fibrosis transmembrane conductance regulator]] channel proteins interferes with bacteria binding to the [[gastrointestinal]] epithelium, thus reducing the effects of an infection.
*It has also been hypothesized that the [[cystic fibrosis]] genetic [[mutation]] has been maintained in humans due to a selective advantage: [[heterozygous]] carriers of the [[mutation]] (who are thus not affected by [[cystic fibrosis]]) are more resistant to ''V. cholerae'' infections.<ref name=Bertranpetit_1996>{{cite journal |author=Bertranpetit J, Calafell F |title=Genetic and geographical variability in cystic fibrosis: evolutionary considerations |journal=Ciba Found Symp |volume=197 |issue= |pages=97-114; discussion 114-8 |year=1996 |pmid=8827370}}</ref> In this model, the genetic deficiency in the [[cystic fibrosis transmembrane conductance regulator]] channel proteins interferes with bacteria binding to the [[gastrointestinal]] [[epithelium]], thus reducing the effects of an infection.
===Decreased Gastric Acidity===
 
====Decreased Gastric Acidity====
* Use of [[antacid]]s
* Use of [[antacid]]s
===Decreased Immunity===
====Decreased Immunity====
* [[Malnutrition|Malnourished]] patients
* [[Malnutrition|Malnourished]] patients
===Hypochlorhydria ===
====Hypochlorhydria====
*Retinol deficiency
*[[Retinol]] deficiency


==References==
== References ==
{{Reflist|2}}
{{Reflist|2}}
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editors-In-Chief: Priyamvada Singh, MBBS [2], Sara Mehrsefat, M.D. [3]

Overview

Certain factors have been found to be associated with an increased risk of contracting cholera. Among these decreased immunity, decreased gastric pH, certain blood groups (patients with blood group O are most prone, while patients with blood group AB are least prone), and genetics are the most commonly associated factors. The greatest risk occurs in over-populated communities and refugee settings characterized by poor sanitation, unsafe drinking water, and increased person-to-person transmission.[1][2][3][4]

Risk Factors

Contaminated Sources

Risk factors for foodborne cholera may include:[5][2]

  • Consumption of contaminated water
  • Consumption of rice products
  • Consumption of specific vegetables or fruits

Risk factors for sporadic cholera include:

  • Consumption of under-cooked shellfish

Overcrowding and Displacement

The greatest risk of developing cholera is present in over-populated communities affected by massive displacement and overcrowding, commonly due to natural disasters or political/economical instability (e.g., earthquakes, hurricanes, refugee camps) by means of:[4]

  • Poor sanitation
  • Unsafe drinking water
  • Increased person-to-person transmission

Other Risk Factors

Blood Group

Recent epidemiologic research suggests that an individual's susceptibility to cholera (and other diarrheal infections) is affected by his/her blood type. Those with type O blood are the most susceptible, while those with type AB are the most resistant. Between these two extremes are the A and B blood types, with type A being more resistant than type B.[6][7]

Genetics

Decreased Gastric Acidity

Decreased Immunity

Hypochlorhydria

References

  1. ↑ Glass RI, Holmgren J, Haley CE, Khan MR, Svennerholm AM, Stoll BJ; et al. (1985). "Predisposition for cholera of individuals with O blood group. Possible evolutionary significance". Am J Epidemiol. 121 (6): 791–6. PMID 4014172.
  2. ↑ 2.0 2.1 Rabbani GH, Greenough WB (1999). "Food as a vehicle of transmission of cholera". J Diarrhoeal Dis Res. 17 (1): 1–9. PMID 10892490.
  3. ↑ 3.0 3.1 Larocque RC, Sabeti P, Duggal P, Chowdhury F, Khan AI, Lebrun LM; et al. (2009). "A variant in long palate, lung and nasal epithelium clone 1 is associated with cholera in a Bangladeshi population". Genes Immun. 10 (3): 267–72. doi:10.1038/gene.2009.2. PMC 2672110. PMID 19212328.
  4. ↑ 4.0 4.1 World Health Organization. Assessing the Outbreak response and improving preparedness (2004) http://apps.who.int/iris/bitstream/10665/43017/1/WHO_CDS_CPE_ZFk_2004.4_eng.pdf
  5. ↑ O'Connor KA, Cartwright E, Loharikar A, Routh J, Gaines J, Fouché MD; et al. (2011). "Risk factors early in the 2010 cholera epidemic, Haiti". Emerg Infect Dis. 17 (11): 2136–8. doi:10.3201/eid1711.110810. PMC 3310583. PMID 22099118.
  6. ↑ Swerdlow D, Mintz E, Rodriguez M, Tejada E, Ocampo C, Espejo L, Barrett T, Petzelt J, Bean N, Seminario L (1994). "Severe life-threatening cholera associated with blood group O in Peru: implications for the Latin American epidemic". J Infect Dis. 170 (2): 468–72. PMID 8035040.
  7. ↑ Harris J, Khan A, LaRocque R, Dorer D, Chowdhury F, Faruque A, Sack D, Ryan E, Qadri F, Calderwood S (2005). "Blood group, immunity, and risk of infection with Vibrio cholerae in an area of endemicity". Infect Immun. 73 (11): 7422–7. PMID 16239542.
  8. ↑ Bertranpetit J, Calafell F (1996). "Genetic and geographical variability in cystic fibrosis: evolutionary considerations". Ciba Found Symp. 197: 97–114, discussion 114-8. PMID 8827370.


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