#Cholera #epidemics of the past offer new insights into an old enemy (J Infect Dis., abstract)

[Source: Journal of Infectious Diseases, full page: (LINK). Abstract, edited.]

Cholera epidemics of the past offer new insights into an old enemy

Matthew Phelps, Mads Linnet Perner,  Virginia E Pitzer, Viggo Andreasen, Peter K M Jensen, Lone Simonsen

The Journal of Infectious Diseases, jix602, https://doi.org/10.1093/infdis/jix602

Published: 20 November 2017 – Received: 04 September 2017

Citation: Matthew Phelps, Mads Linnet Perner, Virginia E Pitzer, Viggo Andreasen, Peter K M Jensen, Lone Simonsen; Cholera epidemics of the past offer new insights into an old enemy, The Journal of Infectious Diseases, , jix602, https://doi.org/10.1093/infdis/jix602

© 2017 Oxford University Press




Although cholera is considered the quintessential long-cycle waterborne disease, studies have emphasized the existence of short-cycle (food, household) transmission. We investigated singular Danish cholera epidemics (1853) to elucidate epidemiological parameters and modes of spread.


Using time series data from cities with different water systems, we estimated the intrinsic transmissibility (R0). Accessing cause-specific mortality data we studied clinical severity, age-specific impact. From physicians’ narratives we established transmission chains and estimated serial intervals.


Epidemics were seeded by travelers from cholera-affected cities; initial transmission chains involving household members and caretakers ensued. Cholera killed 3.4-8.9% of the populations, with highest mortality among seniors (16%) and lowest in children (2.7%). Transmissibility (R0) was 1.7-2.6 and the serial interval was estimated at 3.7 days (95% CI: 2.9 – 4.7). The case fatality ratio (CFR) was high (54%-68%); using R0 we computed an adjusted CFR of 4-5%.


Short-cycle transmission was likely critical to early secondary transmission in historic Danish towns. The outbreaks resembled the contemporary Haiti outbreak with respect to transmissibility, age patterns and CFR, suggesting a role for broader hygiene/sanitation interventions to control contemporary outbreaks.

Issue Section: Major Article

© The Author 2017. Published by Oxford University Press for the Infectious Diseases Society of America.

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Keywords: Cholera.


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Giuseppe Michieli

I am an Italian blogger, active since 2005 with main focus on emerging infectious diseases such as avian influenza, SARS, antibiotics resistance, and many other global Health issues. Other fields of interest are: climate change, global warming, geological and biological sciences. My activity consists mainly in collection and analysis of news, public services updates, confronting sources and making decision about what are the 'signals' of an impending crisis (an outbreak, for example). When a signal is detected, I follow traces during the entire course of an event. I started in 2005 my blog ''A TIME'S MEMORY'', now with more than 40,000 posts and 3 millions of web interactions. Subsequently I added an Italian Language blog, then discontinued because of very low traffic and interest. I contributed for seven years to a public forum (FluTrackers.com) in the midst of the Ebola epidemic in West Africa in 2014, I left the site to continue alone my data tracking job.