Cholera is an ancient disease that has shown a remarkable ability to persist and spread in the modern world. On October 21, 2010, isolation of toxigenic Vibrio cholerae O1 from patients living along the Artibonite River was confirmed by the National Laboratory of Public Health of the Ministry of Public Health and Population (MSPP) in Haiti, the first cholera cases identified in Haiti in over 100 years. PFGE, VNTR, and sequence data subsequently demonstrated the essentially clonal relationship among strains, consistent with a point-source introduction of the microorganism. As of August 15, 2015, Haiti has reported a total of 746,469 cholera cases, with 427,841 hospitalizations and 8,985 deaths. After passage of the initial epidemic waves, the disease has moved into a chronic, endemic pattern, with periodic outbreaks associated with the rainy season and/or localized flooding; however, disease burden remains substantial, with 10,328 cholera cases, 8,124 hospitalizations, and 106 deaths reported in the first three months of 2015 alone. Cholera in Haiti, while a public health disaster, also represents a unique ?natural experiment,? where an epidemic has been caused by a single clone introduced onto an island: we have a complete characterization of the initial clone, and know exactly when and where it was introduced, permitting accurate assessments to be made of environmental persistence, transmission, and evolution of the microorganism. Our group from University of Florida has been involved in NIH-funded studies of cholera in a rural area of Haiti west of Port-au-Prince. However, to provide the data necessary for control of the disease in Haiti, we need comparable data from Port-au-Prince, where 1/3 of the Haitian population lives. While most work to date on cholera has been in rural settings, in Bangladesh and India, problems with the disease are increasingly centered in periurban slums/shantytowns in the global mega-cities, sites for which transmission data are limited. The current proposal, written in collaboration with GHESKIO (an organization which has been providing medical and public health services in the periurban slums of Port-au-Prince for over 30 years), seeks to make use of the unique situation in Haiti to address global issues relevant to cholera transmission in urban/periurban slum areas.
Specific Aims i nclude the following:
Specific Aim 1 : Establishment of systematic environmental surveillance for V. cholerae O1 in periurban slum areas of Port-au-Prince, and identification of risk factors for presence of the microorganism;
Specific Aim 2 : Characterization and identification of risk factors for household cholera transmission, including determination of rates of asymptomatic infection within households;
and Specific Aim 3 : Application of phylodynamic techniques to assess ongoing evolutionary changes in clinical and environmental V. cholerae O1 strains, and characterization of the evolutionary forces (such as vaccination) driving cholera epidemic waves.

Public Health Relevance

Building on the strong existing community-based health care organization established by GEISKIO Haiti to deal with cholera in peri-urban slum areas of Port-au-Prince, combined with the cholera research expertise and Haiti experience of investigators at the University of Florida, we are proposing to further explore transmission dynamics of cholera within an urban setting. Key topic areas will include identification of environmental reservoirs for toxigenic V. cholerae O1, assessment of household transmission within urban areas, and evolutionary changes within the microorganism, particularly in communities that have received cholera vaccine.

National Institute of Health (NIH)
National Institute of Allergy and Infectious Diseases (NIAID)
Research Project (R01)
Project #
Application #
Study Section
Special Emphasis Panel (ZRG1)
Program Officer
Hall, Robert H
Project Start
Project End
Budget Start
Budget End
Support Year
Fiscal Year
Total Cost
Indirect Cost
University of Florida
Internal Medicine/Medicine
Schools of Medicine
United States
Zip Code
White, Sarah K; Mavian, Carla; Elbadry, Maha A et al. (2018) Detection and phylogenetic characterization of arbovirus dual-infections among persons during a chikungunya fever outbreak, Haiti 2014. PLoS Negl Trop Dis 12:e0006505
Blohm, Gabriela M; Lednicky, John A; White, Sarah K et al. (2018) Madariaga Virus: Identification of a Lineage III Strain in a Venezuelan Child With Acute Undifferentiated Febrile Illness, in the Setting of a Possible Equine Epizootic. Clin Infect Dis 67:619-621
White, Sarah K; Lednicky, John A; Okech, Bernard A et al. (2018) Spondweni Virus in Field-Caught Culex quinquefasciatus Mosquitoes, Haiti, 2016. Emerg Infect Dis 24:1765-1767
Ball, Jacob D; Elbadry, Maha A; Telisma, Taina et al. (2018) Clinical and Epidemiologic Patterns of Chikungunya Virus Infection and Coincident Arboviral Disease in a School Cohort in Haiti, 2014-2015. Clin Infect Dis :
White, Sarah Keller; Mavian, Carla; Salemi, Marco et al. (2018) A new ""American"" subgroup of African-lineage Chikungunya virus detected in and isolated from mosquitoes collected in Haiti, 2016. PLoS One 13:e0196857
Iovine, Nicole M; Lednicky, John; Cherabuddi, Kartikeya et al. (2017) Coinfection With Zika and Dengue-2 Viruses in a Traveler Returning From Haiti, 2016: Clinical Presentation and Genetic Analysis. Clin Infect Dis 64:72-75
Mavian, Carla; Rife, Brittany D; Dollar, James Jarad et al. (2017) Emergence of recombinant Mayaro virus strains from the Amazon basin. Sci Rep 7:8718
Blohm, Gabriela M; Lednicky, John A; Márquez, Marilianna et al. (2017) Complete Genome Sequences of Identical Zika virus Isolates in a Nursing Mother and Her Infant. Genome Announc 5:
White, Sarah K; Iovine, Nicole M; Nickels, L Connor et al. (2017) Complete Genome Sequence of Dengue virus Type 2 from a Resident of North-Central Florida with Locally Transmitted Dengue Fever. Genome Announc 5:
Beau De Rochars, Valery Madsen; Lednicky, John; White, Sarah et al. (2017) Isolation of Coronavirus NL63 from Blood from Children in Rural Haiti: Phylogenetic Similarities with Recent Isolates from Malaysia. Am J Trop Med Hyg 96:144-147

Showing the most recent 10 out of 16 publications