Multifaceted epidemic preparedness against cholera outbreak by One Health approach and genomic surveillance

Many developing countries in Africa and Asia are hotspots and endemic for cholera. Over the past five years, these countries have had steady rises in the incidence of cholera, with case fatality ratios continuously exceeding the WHO recommendation of 1 %. Despite this, there aren't many non-outbreak investigations that try to check for Vibrio cholerae in asymptomatic individuals who could act as reservoirs and vectors of transmission. We address the fundamental causes of global cholera transmission following a systematic review of available literature with a focus on the ecological and epidemiological drivers in developing countries. Apart from the established risk for cholera outbreaks, we postulated that the detection of V. cholerae in terrestrial animals could serve as an additional pathway (zoonosis) for cholera transmission. Based on the well-documented detection of V. cholerae in environmental and human samples as well as animal samples, we recommend that epidemic preparedness for cholera should be based on an integrated "One Health" approach following genomic surveillance. Thus, we strongly recommend that long-term, multisectoral, multidisciplinary methods be employed to develop evidence-based, context-specific, and innovative strategies for preventing cholera outbreaks.