Pathways Of Dispersal for Cholera And Solution Tools (PODCAST)

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Cholera is a waterborne epidemic disease in humans. It is a major public health threat, affecting 1.3 to 4 million people each year worldwide, with 21,000 to 143,000 reported fatalities. Outbreaks are caused by the bacterial pathogen Vibrio cholerae, found in many coastal, estuarine, and brackish waters around the world. The origin of the current pandemic of cholera was a single population of pathogens in the north-eastern Indian Ocean basin, which spread globally, in several transmission events. Transmission pathways include direct human-to-human infection, and human-environment interactions, including ingestion of contaminated water, aggravated by emerging antimicrobial resistance through release of antibiotics into the environment. Vibrio pathogens are found as free-floating forms or attached to living (plankton) and non-living (sediment) hosts. They flourish under warm temperature, moderate salinity and turbidity. The major environmental reservoirs of Vibrios, their connectivity, how they might be affected by climate variability and the associated impact on human health remain largely unknown. There is a clear imperative to reduce human risk from cholera bacteria to meet Global Goals related to 3-human health, 6-water quality, 13-climate and 14-life under water. Focusing on the northern Indian Ocean, currently a hotbed of outbreaks of cholera and related diseases, the PODCAST project will pinpoint the impact of large-scale oceanic and climatic processes on the transmission dynamics of cholera (Goals 6, 13, 14) and their impact on public health (Goal 3). Scientists from India, Japan and the UK will work collaboratively to: 1) identify environmental reservoirs of Vibrio cholerae as well as possible advective transport via ocean currents and long-distance transmission routes for cholera outbreaks; 2) characterise the influence of climate perturbations on cholera outbreaks and environmental transmission routes; 3) build an epidemiological model integrating environmental and human-to-human transmission routes; and 4) produce forecasts for cholera outbreaks in coastal regions. The research will be developed in consultation with end-users, including local communities relying on water resources for livelihoods, income generation and recreation; governments; health services; intergovernmental agencies; and policy makers for whom we will provide tools and Vibrio disease risk map products that will support evidence-based policy decisions and actions to achieve Global Goals.The work will be organised in four Work Packages. WP1 (Abdulaziz-India; Sathyendranath-UK) will generate new in situ observations of biophysical variables (including Vibrio pathogens and antibiotics) at selected sites in open-ocean and coastal locations; and process satellite data (ocean-colour, salinity, altimeter and temperature) over entire northern Indian Ocean. WP2 (Platt-UK; Clark-UK; Nonaka-Japan), focussing on models and using data from WP1, will develop an epidemiological model including components of human-to-human and environmental transmission routes of cholera outbreaks; a particle-tracking model to study sources and connectivity between environmental reservoirs of Vibrios; and a climate-variability model to generate past and future indices of large-scale patterns of climate variability. WP3 (Racault-UK), based on the influence of environmental conditions, regional circulation and climate variability on risks of outbreaks at coastal locations in the northern Indian Ocean (WP 2), will focus on producing a cholera-outbreak prediction system for coastal regions of the northern Indian Ocean. The user-engagement, policy information and practice interventions will be addressed in WP4 (Menon-India; George-India) in which we will engage with local communities, policy-makers, and intergovernmental agencies (WHO, IPCC) to identify needs, assess benefits, best practices and uptake of results from PODCAST to reduce risks of Vibrio diseases to public health.