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

Award Number: R01AI126357
ORGANIZATION: NATIONAL INSTITUTE OF ALLERGY & INFECTIOUS DISEASES
OPDIV: NIH
AWARD CLASS: DISCRETIONARY
AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)

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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.


Issue Date FY	Funding FY	Legal Entity Name	Legal Entity Address	Legal Entity City	Legal Entity State	Legal Entity Zip Code	Legal Entity COUNTY	Legal Entity COUNTRY	Assistance Listing	Award Code	Budget Year	Action Date	Action Type	Action Amount

Issue Date FY: 2025 ( Subtotal = $0 )
2025	2024	UNIVERSITY OF FLORIDA	1523 UNION RD RM 207	GAINESVILLE	FL	32611	ALACHUA	USA	Allergy and Infectious Diseases Research	000	6	10/16/2024	COMPETING CONTINUATION	$0
														Subtotal = $0

Issue Date FY: 2024 ( Subtotal = $773,680 )
2024	2024	UNIVERSITY OF FLORIDA	1523 UNION RD RM 207	GAINESVILLE	FL	32611	ALACHUA	USA	Allergy and Infectious Diseases Research	000	6	5/24/2024	COMPETING CONTINUATION	$697,626
2024	2024	UNIVERSITY OF FLORIDA	1523 UNION RD RM 207	GAINESVILLE	FL	32611	ALACHUA	USA	Allergy and Infectious Diseases Research	001	6	9/3/2024	COMPETING CONTINUATION	$76,054
														Subtotal = $773,680

Issue Date FY: 2023 ( Subtotal = -$5,004 )
2023	2020	UNIVERSITY OF FLORIDA	1523 UNION RD RM 207	GAINESVILLE	FL	32611	ALACHUA	USA	Allergy and Infectious Diseases Research	000	5	8/7/2023	NON-COMPETING CONTINUATION	-$5,004
														Subtotal = -$5,004

Issue Date FY: 2020 ( Subtotal = $654,992 )
2020	2020	UNIVERSITY OF FLORIDA	1523 UNION RD RM 207	GAINESVILLE	FL	32611	ALACHUA	USA	Allergy and Infectious Diseases Research	000	5	6/9/2020	NON-COMPETING CONTINUATION	$654,992
														Subtotal = $654,992

Issue Date FY: 2019 ( Subtotal = $1,093,897 )
2019	2019	UNIVERSITY OF FLORIDA	1523 UNION RD RM 207	GAINESVILLE	FL	32611	ALACHUA	USA	Allergy and Infectious Diseases Research	000	4	7/2/2019	NON-COMPETING CONTINUATION	$1,093,897
														Subtotal = $1,093,897

Issue Date FY: 2018 ( Subtotal = $1,093,920 )
2018	2018	UNIVERSITY OF FLORIDA	1523 UNION RD RM 207	GAINESVILLE	FL	32611	ALACHUA	USA	Allergy and Infectious Diseases Research	000	3	6/21/2018	NON-COMPETING CONTINUATION	$1,093,920
														Subtotal = $1,093,920

Issue Date FY: 2017 ( Subtotal = $1,093,883 )
2017	2017	UNIVERSITY OF FLORIDA	207 GRINTER HALL	GAINESVILLE	FL	32611	ALACHUA	USA	Allergy and Infectious Diseases Research	000	2	6/29/2017	NON-COMPETING CONTINUATION	$1,093,883
														Subtotal = $1,093,883

Issue Date FY: 2016 ( Subtotal = $1,134,286 )
2016	2016	UNIVERSITY OF FLORIDA	PO BOX 113001, 302 TIGERT HALL	GAINESVILLE	FL	32611	ALACHUA	USA	Allergy and Infectious Diseases Research	001	1	8/12/2016	NEW	$442,085
2016	2016	UNIVERSITY OF FLORIDA	PO BOX 113001, 302 TIGERT HALL	GAINESVILLE	FL	32611	ALACHUA	USA	Allergy and Infectious Diseases Research	000	1	7/1/2016	NEW	$692,201
														Subtotal = $1,134,286

Grand Total All Awards = $5,839,654

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

Award Number: R01AI126357

ORGANIZATION: NATIONAL INSTITUTE OF ALLERGY & INFECTIOUS DISEASES

OPDIV: NIH

AWARD CLASS: DISCRETIONARY

AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)

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