CHOLERA MORPHOLOGY- the cholera vibrio is a short,curved,cylindrical rod. The cells are typically comma shaped. In stained films of mucous flakes from acute cholera cases the vibrio are seen arranged in parallel rows, fish in stream appearance. CULTURAL CHARACTERISTIC- the cholera vibrio is strongly aerobic,growth being scanty and slow anaerobically. It grow within the temperature range of 16-40degree celcius. Growth is better in an alkaline medium the range of ph being 6.4-9.6. it grows well on ordinary media. On nutrient agar, after, overnight growth, colonies are moist, translucent,round discs, about 1-2mm in diameter,with a distinctive odour. On macconkey agar,the colonies are colourless at first but become reddish on prolonged incubation due to the late fermentation of lactose. On blood agar, colonies are initially surrounded by a zone of greening which later becomes clear due to hemodigestion. A number of special media have been employed for the cultivation of cholera vibrio. The may be classified as follow; HOLDING OR TRANSPORT MEDIA: 1 Venkatraman-ramakrishnan medium: A simple modified form of this medium is prepared by dissolving 20 g crude sea salt and 5 g Peptone in one litre of distilled water and adjusting the pH to 8.6-8.8. It is dispensed in screw-capped bottles in 10-15 ml amounts. About 1-3 ml stool is to be added to each bottle. In this medium vibrio’s do not multiply, but remain viable for several weeks. 2 Cary-Blair Transport Medium: is a simple, semi-solid, non-nutritive medium used for the collection and preservation of microbiological specimens. The minimal nutrients in the medium facilitate the survival of organisms without multiplication. The semisolid consistency provides ease of transport, and the prepared medium can be stored for up to 1 year after preparation at room temperature. Cary-Blair Transport Medium is a modification of Stuart’s Medium . CLASSIFICATION: a serological classification was introduduced bu gardner and venkatraman in 1935. Cholera vibrios and biochemically similar vibrios, possessing a commom flagellar(H)antigen were classified as group A vibrios, and rest as groupB vibrios comprising a heterogeneous collection.

1. PRESENTED BY
-SHRADDHA DUBEY

2.  EPIDEMIOLOGY[epi=among, derm=people,
logy=study]
 The study of distribution and determinants of
health related state or event in a specific
population and application of this study to
control health problem.
 The [3Ds]- disease frequency.
Distrubtion,determinants
AGENT
HOST ENVIORNMENT

3.  Causative agent
vibrio cholerae.
 First isolated by
koch in 1883.
 “fish in stream”.
 It is gram negative
and strongly
aerobic.
 Transmission- fecal
oral route

4.  Thiosulphate citrate
bile salt sucrose
agar.
 Alkaline peptone
water.
 Macconkey agar.
 Venkkatraman-
ramkrishnan
medium.
 Cary-blair medium.
 Abdominal pain with
burning.
 Pain often increases
with empty stomach
 Poor appetite
 Weight loss
 Vomiting
 Blood in stool
 Indigestion
 Heat burn
 nausea

6.  Cholera,a rapid lethal dehydrating diarrheal
disease killed millions of people in 19th
century.
 1817-1923 in all 7 pandemic happened.
 India was thought to be the “HOMELAND”
where cholera originated.
 John snow- cholera was spread by drinking
water that was contaminated with fecal
waste.
 Koch-identified cholera vibrio.
 The first six pandemic -01 clasical biotype.
 The 7th pandemic- E1tor.

7.  Cholera was
endemic every year
in bengal.
 It was most terrible
of all indian cholera
epedemic.
 Bengal-south east
asia-the middle
east-europe-eastern
africa.
 Through trade
route.

8.  Bengal-russia-
europe-america-
egypt(twice).
 Epidemic claimed
1,50,000 lives.
 Death-3000 daily.
 Egypt is connected
by sea,land,air.
 Becoming the
meeting center of
east and west

9.  It is also known
as”Great britain
pandemic”.
 1853-1854 london
claimed 10,000 lives
23,000 death.
 It was consider
highest fatalities in
19th century-among
asia, europe,
africa,N.america.
 Decine of case-
remove the pump
handle.

10.  The 4th and 5th pandemic are generally considerd
to have been less severe that the previous .
 4th pandemic- bengal – middle east –europe-
africa-N.america.
 3000/9000 pilgrims fell victim to the disease.
 5th pandemic-bengal-asia-africa-S.america-
france-germany
 Russia – 200000 lives between 1893-94
 Japan -90000 lives between 1887-1889
 Hamburg -1.5% population perished.
 Last quarter of 19th century- widespread
infection in china and japan.

11.  Especially lethal in india-arabia-N.africa
 34,000 perished-egypt-3 months.
 Mecca “relay station”-27 epedemic -1900-
1930.
 Russia -5000000 death
 Pandemic failed to reach america and only
caused small outbreak western europe.

12.  The 7th pandemic was the 1st recognized to
be caused by E1tor biotype V.cholarae 01.
 Orginated – celebs island, Indonesia and
affected more countries and continent than
the previous six pandemics
 The 7th V. cholera E1tor is typified with less
sever diarrhea, low case fertility rate and
high % of asymptomatic cases.
 In 1991-peru-it was absent from 100years.
 Colombia –brazil-central america-mexio
 By 2005- 120 countries.

14.  Zimbabwe-[2008-2009]-S.africa-affected 95%
of country -96,700 cases-4,200 death.
 Haiti-[2010-2019]-catastropic earthquake-
332000[2010]-4000[2011]-4[2019].
 Somalia [2017-2019]-protracted crisis-7800
cases,1159 death[2017]-1041cases
1death[2019]-5342 cases ,29 deaths[2020]-
inaba
 yemen[2017-2020]-airstrike-1.2 million cases
2,500 died-58%children-V.cholera serotype
ogwa -759,464-1163 death[2018-2019]-
229887,73 death[2020]

16.  https://www.npr.org/sections/thetwo-way/2017/12/21/572544447/a-hideous-
milestone-in-the-21st-century-cholera-
 Ending Cholera: A Global Roadmap to
2030https://www.who.int/cholera/publications/archive/en//
 https://www.cdc.gov/cholera/haiti/index.html
 https://www.britannica.com/science/cholera/The-seventh-pandemic-in-the-21st-
century
 https://apps.who.int/iris/bitstream/handle/10665/41711/WHO_MONO_43;jsessioni
d=A7B6F4B3B2079B314B6423EC67338B82?sequence=1
 https://www.unicef.org/media/88321/file/2021-HAC-Yemen.pdf
 Section of epidermilogy and state medicine-sage publication on june 21,2016
 A Re-Look at Cholera Pandemics from Early Times to now in the Current Era of
Epidemiology Set Alert Journal of Disaster Research ; Vol 16, No 1, 2021 ; PP: 110-
117 Peer Reviewed