title: Relationship between Distinct African Cholera Epidemics Revealed via MLVA Haplotyping of 337 Vibrio cholerae Isolates.
abstract: BACKGROUND
  Since cholera appeared in Africa during the 1970s, cases have been reported on the continent every year. In Sub-Saharan Africa, cholera outbreaks primarily cluster at certain hotspots including the African Great Lakes Region and West Africa.
  
  
  RESULTS
  In this study, we applied MLVA (Multi-Locus Variable Number Tandem Repeat Analysis) typing of 337 Vibrio cholerae isolates from recent cholera epidemics in the Democratic Republic of the Congo (DRC), Zambia, Guinea and Togo. We aimed to assess the relationship between outbreaks. Applying this method, we identified 89 unique MLVA haplotypes across our isolate collection. MLVA typing revealed the short-term divergence and microevolution of these Vibrio cholerae populations to provide insight into the dynamics of cholera outbreaks in each country. Our analyses also revealed strong geographical clustering. Isolates from the African Great Lakes Region (DRC and Zambia) formed a closely related group, while West African isolates (Togo and Guinea) constituted a separate cluster. At a country-level scale our analyses revealed several distinct MLVA groups, most notably DRC 2011/2012, DRC 2009, Zambia 2012 and Guinea 2012. We also found that certain MLVA types collected in the DRC persisted in the country for several years, occasionally giving rise to expansive epidemics. Finally, we found that the six environmental isolates in our panel were unrelated to the epidemic isolates.
  
  
  CONCLUSIONS
  To effectively combat the disease, it is critical to understand the mechanisms of cholera emergence and diffusion in a region-specific manner. Overall, these findings demonstrate the relationship between distinct epidemics in West Africa and the African Great Lakes Region. This study also highlights the importance of monitoring and analyzing Vibrio cholerae isolates.
authors.affiliation: Department of Parasitology and Mycology, Assistance Publique-Hôpitaux de Marseille/Aix-Marseille University, UMR MD3, Marseille, France.
authors.forename: Sandra
authors.initials: S
authors.lastname: Moore
authors.affiliation: Institut National de Recherche Biomédicale, Ministry of Public Health, Kinshasa, Democratic Republic of the Congo.
authors.forename: Berthe
authors.initials: B
authors.lastname: Miwanda
authors.affiliation: Department of Bacteriology, National Institute of Hygiene, Lomé, Togo.
authors.forename: Adodo Yao
authors.initials: AY
authors.lastname: Sadji
authors.affiliation: Hôpital d'Instruction des Armées Laveran, Marseille, France.
authors.forename: Hélène
authors.initials: H
authors.lastname: Thefenne
authors.affiliation: Department of Parasitology and Mycology, Assistance Publique-Hôpitaux de Marseille/Aix-Marseille University, UMR MD3, Marseille, France.
authors.forename: Fakhri
authors.initials: F
authors.lastname: Jeddi
authors.affiliation: Department of Parasitology and Mycology, Assistance Publique-Hôpitaux de Marseille/Aix-Marseille University, UMR MD3, Marseille, France.
authors.forename: Stanislas
authors.initials: S
authors.lastname: Rebaudet
authors.affiliation: Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium.
authors.forename: Hilde
authors.initials: H
authors.lastname: de Boeck
authors.affiliation: Department of Bacteriology, National Institute of Hygiene, Lomé, Togo.
authors.forename: Bawimodom
authors.initials: B
authors.lastname: Bidjada
authors.affiliation: Hôpital d'Instruction des Armées Laveran, Marseille, France.
authors.forename: Jean-Jacques
authors.initials: JJ
authors.lastname: Depina
authors.affiliation: Institut National de Recherche Biomédicale, Ministry of Public Health, Kinshasa, Democratic Republic of the Congo; Department of Microbiology, Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of the Congo; Laboratoire Chrono-Environnement, UMR 6249, CNRS, University of Franche-Comte, Besançon, France.
authors.forename: Didier
authors.initials: D
authors.lastname: Bompangue
authors.affiliation: Ministry of Health, Kinshasa, Democratic Republic of the Congo.
authors.forename: Aaron Aruna
authors.initials: AA
authors.lastname: Abedi
authors.affiliation: Institut National de Santé Publique, Conakry, Republic of Guinea.
authors.forename: Lamine
authors.initials: L
authors.lastname: Koivogui
authors.affiliation: Division Prévention et Lutte contre la Maladie, Ministère de la Santé Publique et de l'Hygiène Publique, Conakry, Republic of Guinea.
authors.forename: Sakoba
authors.initials: S
authors.lastname: Keita
authors.affiliation: Hôpital d'Instruction des Armées Laveran, Marseille, France.
authors.forename: Eric
authors.initials: E
authors.lastname: Garnotel
authors.affiliation: Royal Museum for Central Africa, Tervuren, Belgium.
authors.forename: Pierre-Denis
authors.initials: PD
authors.lastname: Plisnier
authors.affiliation: Clinical Research Department, Nice University Hospital, Nice, France.
authors.forename: Raymond
authors.initials: R
authors.lastname: Ruimy
authors.affiliation: Pathogen Genomics, Wellcome Trust Sanger Institute, Hinxton, Cambridge, United Kingdom; London School of Hygiene & Tropical Medicine, London, United Kingdom.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Thomson
authors.affiliation: Institut National de Recherche Biomédicale, Ministry of Public Health, Kinshasa, Democratic Republic of the Congo; Department of Microbiology, Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of the Congo.
authors.forename: Jean-Jacques
authors.initials: JJ
authors.lastname: Muyembe
authors.affiliation: Department of Parasitology and Mycology, Assistance Publique-Hôpitaux de Marseille/Aix-Marseille University, UMR MD3, Marseille, France.
authors.forename: Renaud
authors.initials: R
authors.lastname: Piarroux
mesh_terms: D017954:Africa South of the Sahara / Q000453:epidemiology; D002771:Cholera / Q000453:epidemiology* / Q000382:microbiology*; D016000:Cluster Analysis; D017931:DNA Primers / Q000235:genetics; D058872:Epidemics / Q000266:history*; D019143:Evolution, Molecular; D005787:Gene Frequency; D005828:Genetics, Population; D006239:Haplotypes / Q000235:genetics*; D049673:History, 20th Century; D049674:History, 21st Century; D006801:Humans; D018598:Minisatellite Repeats / Q000235:genetics; D010802:Phylogeny; D058974:Phylogeography; D016133:Polymerase Chain Reaction; D014734:Vibrio cholerae / Q000235:genetics*
chemical_list: D017931:DNA Primers