Population Vulnerability to Biannual Cholera Outbreaks and Associated Macro-Scale Drivers in the Bengal Delta

Ali Shafqat Akanda Department of Civil and Environmental Engineering, University of Rhode Island, Kingston, Rhode Island; Civil and Environmental Engineering, West Virginia University, Morgantown, West Virginia; Department of Civil and Environmental Engineering, and Water Diplomacy, Fletcher School of Law and Diplomacy, Tufts University, Medford, Massachusetts; Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland; International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh; Center for Bioinformatics and Computational Biology, and Maryland Pathogen Research Institute, University of Maryland, College Park, Maryland

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Antarpreet S. Jutla Department of Civil and Environmental Engineering, University of Rhode Island, Kingston, Rhode Island; Civil and Environmental Engineering, West Virginia University, Morgantown, West Virginia; Department of Civil and Environmental Engineering, and Water Diplomacy, Fletcher School of Law and Diplomacy, Tufts University, Medford, Massachusetts; Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland; International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh; Center for Bioinformatics and Computational Biology, and Maryland Pathogen Research Institute, University of Maryland, College Park, Maryland

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David M. Gute Department of Civil and Environmental Engineering, University of Rhode Island, Kingston, Rhode Island; Civil and Environmental Engineering, West Virginia University, Morgantown, West Virginia; Department of Civil and Environmental Engineering, and Water Diplomacy, Fletcher School of Law and Diplomacy, Tufts University, Medford, Massachusetts; Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland; International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh; Center for Bioinformatics and Computational Biology, and Maryland Pathogen Research Institute, University of Maryland, College Park, Maryland

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R. Bradley Sack Department of Civil and Environmental Engineering, University of Rhode Island, Kingston, Rhode Island; Civil and Environmental Engineering, West Virginia University, Morgantown, West Virginia; Department of Civil and Environmental Engineering, and Water Diplomacy, Fletcher School of Law and Diplomacy, Tufts University, Medford, Massachusetts; Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland; International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh; Center for Bioinformatics and Computational Biology, and Maryland Pathogen Research Institute, University of Maryland, College Park, Maryland

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Munirul Alam Department of Civil and Environmental Engineering, University of Rhode Island, Kingston, Rhode Island; Civil and Environmental Engineering, West Virginia University, Morgantown, West Virginia; Department of Civil and Environmental Engineering, and Water Diplomacy, Fletcher School of Law and Diplomacy, Tufts University, Medford, Massachusetts; Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland; International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh; Center for Bioinformatics and Computational Biology, and Maryland Pathogen Research Institute, University of Maryland, College Park, Maryland

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Anwar Huq Department of Civil and Environmental Engineering, University of Rhode Island, Kingston, Rhode Island; Civil and Environmental Engineering, West Virginia University, Morgantown, West Virginia; Department of Civil and Environmental Engineering, and Water Diplomacy, Fletcher School of Law and Diplomacy, Tufts University, Medford, Massachusetts; Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland; International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh; Center for Bioinformatics and Computational Biology, and Maryland Pathogen Research Institute, University of Maryland, College Park, Maryland

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Rita R. Colwell Department of Civil and Environmental Engineering, University of Rhode Island, Kingston, Rhode Island; Civil and Environmental Engineering, West Virginia University, Morgantown, West Virginia; Department of Civil and Environmental Engineering, and Water Diplomacy, Fletcher School of Law and Diplomacy, Tufts University, Medford, Massachusetts; Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland; International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh; Center for Bioinformatics and Computational Biology, and Maryland Pathogen Research Institute, University of Maryland, College Park, Maryland

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Shafiqul Islam Department of Civil and Environmental Engineering, University of Rhode Island, Kingston, Rhode Island; Civil and Environmental Engineering, West Virginia University, Morgantown, West Virginia; Department of Civil and Environmental Engineering, and Water Diplomacy, Fletcher School of Law and Diplomacy, Tufts University, Medford, Massachusetts; Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland; International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh; Center for Bioinformatics and Computational Biology, and Maryland Pathogen Research Institute, University of Maryland, College Park, Maryland

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The highly populated floodplains of the Bengal Delta have a long history of endemic and epidemic cholera outbreaks, both coastal and inland. Previous studies have not addressed the spatio-temporal dynamics of population vulnerability related to the influence of underlying large-scale processes. We analyzed spatial and temporal variability of cholera incidence across six surveillance sites in the Bengal Delta and their association with regional hydroclimatic and environmental drivers. More specifically, we use salinity and flood inundation modeling across the vulnerable districts of Bangladesh to test earlier proposed hypotheses on the role of these environmental variables. Our results show strong influence of seasonal and interannual variability in estuarine salinity on spring outbreaks and inland flooding on fall outbreaks. A large segment of the population in the Bengal Delta floodplains remain vulnerable to these biannual cholera transmission mechanisms that provide ecologic and environmental conditions for outbreaks over large geographic regions.

Author Notes

* Address correspondence to Shafiqul Islam, Department of Civil and Environmental Engineering, Tufts University, 200 College Avenue, 311 Anderson Hall, Medford, MA 02155. E-mail: shafiqul.islam@tufts.edu

Financial support: This study was supported, in part, by a research challenge grant (1RC1TW008587-01) from the National Institutes of Health under the American Recovery and Reinvestment Act (2009). Rural cholera incidence data collection was supported by National Institutes of Health grant RO1-A13912901 as well as by grants from the US National Science Foundation (NSF 0809783 and NSF 0741600).

Authors' addresses: Ali Shafqat Akanda, Department of Civil and Environmental Engineering, University of Rhode Island, Kingston, RI, E-mail: akanda@egr.uri.edu. David M. Gute, and Shafiqul Islam, Department of Civil and Environmental Engineering, Tufts University, Medford, MA, E-mail: david.gute@tufts.edu, shafiqul.islam@tufts.edu. Antarpreet S. Jutla, Department of Civil and Environmental Engineering, West Virginia University, Morgantown, WV, E-mail: asjutla@mail.wvu.edu. Anwar Huq, and Rita R. Colwell, Biomolecular Sciences Building, University of Maryland, College Park, MD, E-mail: huqanwar@gmail.com, rcolwell@umd.edu. R. Bradley Sack, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, E-mail: rsack@jhsph.edu. Munirul Alam, Centre for Food and Waterborne Diseases, International Centre for Diarrhoeal Disease Research, Mohakhali, Dhaka 1212, Bangladesh, E-mail: munirul@icddrb.org.

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