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Cholera in the 21st century

Charles, Richelle C.a,b; Ryan, Edward T.a,b,c

Current Opinion in Infectious Diseases: October 2011 - Volume 24 - Issue 5 - p 472–477
doi: 10.1097/QCO.0b013e32834a88af
Gastrointestinal infections: Edited by Nicholas J. Beeching and A. Clinton White

Purpose of review This review will focus on recent advances in our understanding of biologic and environmental factors that shape current cholera outbreaks, advances in our understanding of host–pathogen interactions during cholera, and recent evolution of current treatment and cholera prevention strategies.

Recent findings New research studies have improved our understanding of a number of dynamic factors that shape the ecology of Vibrio cholerae and influence its transmission, including the role of lytic bacteriophage, biofilm formation, a hyperinfectious state of human-passaged V. cholerae, and the impact of severe weather events. Provision of safe water and improved sanitation continue to be the mainstays of preventing cholera transmission; however, the role of cholera vaccination as a control measure in both endemic and epidemic settings is evolving. Recent advances in our understanding of long-lived protective immunity after natural infection may aid in the global efforts to control cholera.

Summary Improved understanding of factors associated with protective immunity and dynamic factors associated with cholera outbreaks may lead to improved control and prevention strategies for cholera.

aDivision of Infectious Diseases, Massachusetts General Hospital

bDepartment of Medicine, Harvard Medical School

cDepartment of Immunology and Infectious Diseases, Harvard School of Public Health, Boston, Massachusetts, USA

Correspondence to Edward T. Ryan, MD, Division of Infectious Diseases, Massachusetts General Hospital, Jackson 504, 55 Fruit Street, Boston, MA 02114, USATel: +1 617 726 3812; fax: +1 617 726 7416; e-mail:

© 2011 Lippincott Williams & Wilkins, Inc.