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PLoS One. 2020 Mar 12;15(3):e0229837. doi: 10.1371/journal.pone.0229837. eCollection 2020.

Direct transmission via households informs models of disease and intervention dynamics in cholera.

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Department of Ecology and Evolutionary Biology, Brown University, Providence, RI, United States of America.
Department of Mathematics, Florida State University, Tallahassee, FL, United States of America.
Burnett School of Biomedical Sciences, University of Central Florida, Orlando, FL, United States of America.
National Center for Integrated Coastal Research, University of Central Florida, Orlando, FL, United States of America.


While several basic properties of cholera outbreaks are common to most settings-the pathophysiology of the disease, the waterborne nature of transmission, and others-recent findings suggest that transmission within households may play a larger role in cholera outbreaks than previously appreciated. Important features of cholera outbreaks have long been effectively modeled with mathematical and computational approaches, but little is known about how variation in direct transmission via households may influence epidemic dynamics. In this study, we construct a mathematical model of cholera that incorporates transmission within and between households. We observe that variation in the magnitude of household transmission changes multiple features of disease dynamics, including the severity and duration of outbreaks. Strikingly, we observe that household transmission influences the effectiveness of possible public health interventions (e.g. water treatment, antibiotics, vaccines). We find that vaccine interventions are more effective than water treatment or antibiotic administration when direct household transmission is present. Summarizing, we position these results within the landscape of existing models of cholera, and speculate on its implications for epidemiology and public health.

Conflict of interest statement

The authors have declared that no competing interests exist.

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