Abstract
In the current study, a comprehensive, data driven, mathematical model for cholera transmission in Haiti is presented. Along with the inclusion of short cycle human-to-human transmission and long cycle human-to-environment and environment-to-human transmission, this novel dynamic model incorporates both the reported cholera incidence and remote sensing data from the Ouest Department of Haiti between 2010 to 2014. The model has separate compartments for infectious individuals that include different levels of infectivity to reflect the distribution of symptomatic and asymptomatic cases in the population. The environmental compartment, which serves as a source of exposure to toxigenic V. cholerae, is also modeled separately based on the biology of causative bacterium, the shedding of V. cholerae O1 by humans into the environment, as well as the effects of precipitation and water temperature on the concentration and survival of V. cholerae in aquatic reservoirs. Although the number of reported cholera cases has declined compared to the initial outbreak in 2010, the increase in the number of susceptible population members and the presence of toxigenic V. cholerae in the environment estimated by the model indicate that without further improvements to drinking water and sanitation infrastructures, intermittent cholera outbreaks are likely to continue in Haiti.
Highlights
After a massive earthquake struck the island nation of Haiti in 2010, the introduction of an altered El Tor biotype of Vibrio cholerae O1 has led to one of the largest cholera outbreaks in recent history [1] [2] [3]
Based on the model-fitted trend and the observed incidence, there is evidence that after an initial period of intense transmission, the cholera epidemic in Haiti stabilized during the third year of the outbreak and became endemic
The model estimates indicate that the proportion of the population susceptible to infection is increasing and that the presence of toxigenic V. cholerae in the environment remains a potential source of new infections
Summary
After a massive earthquake struck the island nation of Haiti in 2010, the introduction of an altered El Tor biotype of Vibrio cholerae O1 has led to one of the largest cholera outbreaks in recent history [1] [2] [3]. In endemic countries, this assumption is often likely to be false; where V. cholerae O1 is able to persist and multiply in the environment in response to an influx of nutrients into surface waters after rainfall events or increases in water temperature leading to recurrent outbreaks after interepidemic periods where very few cases were reported [13] Since both water temperature and rainfall have been associated with increased isolation frequency of toxigenic V. cholerae O1 in Haiti [6], a dynamic cholera transmission model was created with the additional mechanism by which the environmental compartment responds to factors such as precipitation and surface water temperature that increase the concentration of the organism in the aquatic environment. These extra parameters will assist in the understanding of the underlying processes of cholera transmission in Haiti and allow for more accurate prediction of the potential for future outbreaks
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