V2global Spread of Cholera - Stamped Doc

[00.
05] I have with me here Daryl, who's going to tell us about his research into the
transmission of cholera. So, Daryl, I thought cholera was a disease of the past, is it still a
problem now? So, you're right in that cholera has been a scourge since at least the
1800s. So six pandemics of cholera, we're currently in the seventh pandemic started in
1960. It's the worst pandemics we've seen of cholera yet, the current situation in
Yemen, where the epidemic is quickly reaching 1 million people absolutely is a reminder
that cholera has a strong foothold in the modern world.
[00.43] So, how does cholera spread? So, cholera is the classic example of a waterborne
disease, so faecal contamination of water sources, and people get this by ingesting the
water contaminated with the real cholera or food that's been prepared with
contaminated water. And so are there typing schemes available that allow people to
track how cholera spreads. Yeah, so, historically, we've used serotyping of the O-antigen
and the presence of the cholera toxin which is actually anaphase. Other typing
techniques that we've used our PFG or ribotyping, but really what happened with the
use of all of these techniques is that there was a lot of confusion as to what was actually
going on at a global level within cholera epidemiology. And so what the whole genome
sequencing has allowed us to do is actually unify all of these things into something that
makes sense, like a cohesive framework for us to understand how cholera is moving
across the globe and whether or not epidemics, say in Africa or Latin America are
actually connected to one another.
[01:45] OK, so in the course, already we've heard about John Snow how he managed to
track transmission of cholera around London using epidemiology, why do we need these
tightly schemes or genomics and those kind of things you've just described. No
discussion of cholera can be complete without John Snow. And it was just absolutely
incredible what he was able to do in London at the time, I think it was 1854. But really
what we're able to do now with molecular techniques and especially with whole
genome sequencing is just have such a better picture of what's happening with cholera.
So, in London, he was able to track the individual cases around the Broad Street Pump,
but now we're looking at how cholera affects individuals, to households, to
communities, all the way to how cholera is spreading across a city. So, really being able
to link up who or where, perhaps cholera is moving and then even to a larger scale
across continents and globally.
[02:48] And so how is your research using genomics, how has that helped you learn
about how cholera is spreading over these large distances? Yes, what we've been able
to do is focus on the two regions most affected by cholera, historically. So that's been
Africa, which is currently the continent that has the highest burden of disease for
cholera and Latin America. And so what we've really done is sequenced a lot of samples
from both of these areas, including with additional samples from Asia and really piecing
together the puzzle of how cholera is moving across the globe. So what we've been able
to show is that cholera enters into Africa at least 11 times since the 1970s, all from
strains originating in Asia. And also in Latin America, we've been able to show that
again, introductions of pandemic strains of cholera into Latin America were responsible
for some of the largest epidemics we've seen, such as in Haiti in 2010, and in Peru in
1991.
[03:51] OK, so specifically how are these importations happening, is it via people or is it
via water? Yeah, that's a great question actually. So we do believe that it's through
human-to-human movement, primarily. Some say that large transport could happen
through the releasing of ship water into different ports, but really this is mediated all by
human movement. Yeah, and you wouldn't have been able to get that from
epidemiology alone, you need the typing data to answer that. Absolutely, so through
whole genome sequencing, we were able to use snips to draw a really robust
phylogeny's, which allow us to then make robust inferences on how cholera has moved
throughout the globe with really high resolution. Thank you very much, Daryl. Thanks
Josie.

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