Reinforcing cholera intervention through prediction-aided prevention.

Perspectives With the ever-expanding geographic reach and disease burden of the current cholera pandemic, as well as alarming fatality rates in newly affected regions, it is apparent that global cholera prevention strategies are failing. 1 The established treatment methods – oral rehydration, antibiotics, enhanced water and sanitation infrastructure and vaccination – have performed well in selected local and regional settings. These measures are yet to be implemented on a global scale due to economic, logistic or other practical constraints. 2–4 However, the disease burden could be significantly reduced if these preventive measures could be deployed ahead of time with an early warning system before an outbreak hits a particular region. The existence of an environmental reservoir of Vibrio cholerae, the caus-ative agent of the disease, is well established. 5 Recent findings demonstrate the strong potential to predict impending cholera outbreaks using satellite remote monitoring of coastal and terrestrial ecosystems that harbour V. cholerae. For example, data on stream flows from the major rivers of the Bengal Delta and satellite-derived plankton abundance from coastal areas in the Bay of Bengal correlate with more than 80% of the cholera prevalence in Bangladesh. 5 Such predictive capability could allow the use of an operational climate-based cholera warning system that would help identify vulnerable populations up to a few months in advance. Such a system would require minimal instrumentation and operating costs, yet allow for the timely implementation of preventive measures to contain the spread of outbreaks. With the recent and devastating return of cholera to the Caribbean region, there has been a tremendous interest in the effectiveness of interventions since the Haitian outbreak. Vaccination appears to be the predominant response, with a call for health authorities to incorporate it into existing intervention methods to reduce infection rates and minimize future epidemics. 1,4 With an increasing disease burden in endemic regions and high fatality rates in newly affected regions, there is a need to examine the efficacy of existing strategies and to explore the use of predictive technology to implement proactive intervention measures. Are existing cholera intervention techniques effective in reducing the disease burden? Most cholera epidemiology , transmission, propagation and intervention literature are heavily influenced by long-term data sets generated by the International Center for Diarrhoeal Disease Research (ICDDR,B) in Bangladesh, where the disease is endemic. A closer look at the past 30 years (1980–2010) of surveillance data reveals some important trends of …