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Researchers Fight Cholera With Computer Forecasting

Just as the rainy season is driving a new surge of choleracases in Haiti, a new computational model could forecast where outbreaks are likely to occur. 

Researchers at Ohio State University are working with the Centers for Disease Control and Prevention (CDC) on the project, in the hopes of targeting anti-cholera efforts where they are most needed in the earthquake-ravaged country. 

Just back from a 10-day trip to the Artibonite Valley in Haiti, Ohio State researcher Marisa Eisenberg described the model's early results at the Ecological Society of America annual meeting in Austin. 

One question was whether the deadly disease is spreading primarily through contaminated environmental water or through human contact - for example, through contaminated food. That knowledge would enable the CDC and relief agencies to focus limited resources on counteracting one means of transmission or the other. 

"According to our preliminary findings, it's both," said Eisenberg, who is a postdoctoral fellow in the Mathematical Biosciences Institute at Ohio State. "We can't neglect either source of transmission." 

As they continue to process the data, the researchers hope to identify typical patterns of cholera outbreaks, and identify "hotspots" - regions that are key to controlling the spread of the disease. 

The CDC approached computer modelers about the problem in November 2010. Among them was Eisenberg's collaborator, Joseph Tien, professor of mathematics at Ohio State, who had previously identified patterns in data from the 19th Century cholera epidemics in London. 

The resulting study, which he and Eisenberg published with Canadian collaborators in the Annals of Internal Medicine in May 2011, revealed the disease's cyclical nature: When a new strain of cholera invades a country, the epidemic typically starts with an initial wave of cases in the fall, then erupts into much larger outbreaks the following summer. 

That pattern has thus far held true for Haiti. 

"Before the earthquake, cholera hadn't been reported in Haiti in decades, so we're in new territory as far as what the disease will do there in the coming months and years," Tien said. "There are lots of different factors to consider -- environmental conditions affecting the ability of the cholera bacteria to persist in water bodies, variation in water quality and sanitation in different locales, infection-derived immunity, seasonal drivers such as rainfall. We're hoping to use mathematics to help piece the puzzle together." 

Cholera is a bacterial infection of the intestines that causes vomiting and severediarrhea. Without help, victims die of dehydration. According to the CDC, an estimated 3-5 million cases and 100,000 deaths occur around the world every year due to cholera. 

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