# Recurrence of Cholera in Haiti: Exploration of Contributing Factors and Intervention Strategies

> **NIH NIH R01** · UNIVERSITY OF FLORIDA · 2024 · $773,680

## Abstract

PROJECT SUMMARY/ABSTRACT
 Cholera continues to be a major cause of global morbidity and mortality, with continuing spread into
new areas and recurrences in areas thought to be free of cholera, driven by draught, flood, war, mass
population movements, and the associated breakdown of public health infrastructure. Haiti was the site of a
major cholera epidemic beginning in 2010, with over 820,000 reported cases and close to 10,000 deaths. No
clinical cases from this initial epidemic were reported after February 2019, and in 2022 it was announced that
cholera had been “eliminated” from Haiti. However, on September 25, 2022, cholera cases were again
identified, with 64,618 suspect cholera cases and 60,171 hospitalizations subsequently reported.
 In collaboration with GHESKIO, Haiti’s leading medical research institute, we have sequenced Vibrio
cholerae strains isolated from patients infected during the “new” 2022/2023 epidemic. Our genetic analysis
indicates that the epidemic strain originated from an “older” Haitian V. cholerae serogroup Ogawa strain that
had been circulating at sub-epidemic levels in the aquatic environment, rather than from more recent clinical
serogroup Inaba isolates or from strains introduced from outside of the country. These findings raise critically
important (and controversial) questions about the impact of strain and ecologic factors on persistence of
environmental foci of V. cholerae; factors influencing spread of epidemic disease within the Haitian population;
and best approaches to long-term cholera prevention, in Haiti and similar settings globally.
 Haiti provides a unique environment in which to address questions related to cholera: it is on an island,
with an initial epidemic caused by introduction of a single well characterized strain in 2010. Since 2010 we
have established a strong infrastructure in Haiti for cholera research with excellent local collaborators and have
built extensive environmental and clinical databases. The current study focuses on understanding factors
driving re-emergence of the disease after three years of quiescence, including use of causal Artificial
Intelligence (AI) to see if it is possible to model/predict the occurrence of future epidemic waves.
Specific Aim 1: Identify strain characteristics and ecologic factors that influence evolution, virulence, and
survival of V. cholerae O1 in environmental reservoirs, through environmental studies and evolutionary-
informed laboratory microcosm model systems.
Specific Aim 2: Monitor levels of exposure/immunity to V. cholerae O1 in communities and case cohorts to
determine rates of infection in the population and monitor waning of immune responses.
Specific Aim 3: Assess phylogeographic and phylodynamic patterns driving evolution of V. cholerae from
clinical and environmental sources.
Specific Aim 4: Develop a causal AI approach to predict the occurrence of future epidemic waves and
estimate effectiveness of interventions.

## Key facts

- **NIH application ID:** 10979581
- **Project number:** 2R01AI126357-06A1
- **Recipient organization:** UNIVERSITY OF FLORIDA
- **Principal Investigator:** John Glenn Morris
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $773,680
- **Award type:** 2
- **Project period:** 2016-07-01 → 2029-03-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10979581

## Citation

> US National Institutes of Health, RePORTER application 10979581, Recurrence of Cholera in Haiti: Exploration of Contributing Factors and Intervention Strategies (2R01AI126357-06A1). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10979581. Licensed CC0.

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