# Epidemiology and Ecology of Cholera in Africa

> **NIH NIH R01** · JOHNS HOPKINS UNIVERSITY · 2024 · $737,666

## Abstract

The long-term goal is the elimination of cholera in Africa by identifying patterns of transmission that will
enable endemic African countries reduce the number of districts with cholera by stopping transmission within
and between districts. This goal is consistent with the goal of the Global Task Force for Cholera Control to
“eliminate” cholera from > 20 countries by 2030. Using innovative surveillance, molecular and GIS methods,
the study will conduct detailed molecular epidemiological studies in Nigeria, and Uganda to detect the spread
of specific V. cholerae (Vc) genetic lineages and vibriophage and will monitor the impact of interventions
intended to prevent cholera’s spread. By stopping cholera’s transmission within a country, the country will
reduce the number of districts with cholera; thereby, creating a “cholera elimination scorecard” with which to
monitor progress toward national elimination.
 This application builds on evidence from our initial RO1 study of cholera in Africa showing that cholera
lineages “spread to” rather than “emerge from” endemic areas, and strategies to control cholera need to adapt
to this new understanding. Many Sub-Saharan African countries are “endemic” since they regularly report
cholera cases; however, most outbreaks are short (few weeks), are limited to a few districts or subdistricts and
are caused by genetic lineages that move through an area and then die out. Because water, sanitation and
hygiene (WASH) is poor, these areas remain susceptible when a new genetic lineage is introduced.
 To improve the effectiveness of an elimination strategy, improved surveillance is needed to detect
outbreaks quickly to intervene and prevent outward transmission. Rapid molecular surveillance is now possible
with rapid diagnostic tests (RDTs) able to immediately identify cases while also providing DNA samples for
PCR confirmation and molecular characterization using MLVA. Stools will also be cultured to create a
repository of Vc strains, and feces will be spotted on filter paper and dried. The dried fecal samples (DFS) can
be stored indefinitely without refrigeration, are easily transported, are not biohazardous, and can be used to
detect Vc and vibriophage. Sewage samples will be collected to detect Vc and phage during and between
outbreaks to further characterize transmission of genetic lineages and phage. By combining intensive
surveillance, molecular epidemiology, and rapid evaluation of case GIS coordinates, quickly identified patterns
of cholera transmission should improve targeted interventions (vaccine and WASH).
 The project uses innovative new technologies developed during the initial RO1 grant applicable to
conditions in developing countries. These include evaluation of RDTs that allow results from RDTs to declare
an outbreak as well as be used for molecular studies, rapid detection of Vc using a new simplified LAMP assay
(termed RLDT), genotyping (MLVA) from DFS and RDTs, d) whole genome sequencing (WGS) from is...

## Key facts

- **NIH application ID:** 10814271
- **Project number:** 5R01AI123422-07
- **Recipient organization:** JOHNS HOPKINS UNIVERSITY
- **Principal Investigator:** Amanda Kay Debes
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $737,666
- **Award type:** 5
- **Project period:** 2017-04-01 → 2028-02-29

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10814271

## Citation

> US National Institutes of Health, RePORTER application 10814271, Epidemiology and Ecology of Cholera in Africa (5R01AI123422-07). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/10814271. Licensed CC0.

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