cholera
Enable an agent to recognise suspected cholera, assess illness and transmission states, and support evidence-based care escalation and public-health response.
Research draft, second pass
A second pass drafted this model: the structure a model of this thing needs, and what is known about it in the world. The line under this one says how the second half was obtained - researched against sources, or recalled without web access, in which case nothing here was read anywhere and every claim is a lead to verify. Unreviewed either way.
recalled by Codex without web access - no source was read
Researched by: Codex
Purpose and description
Enable an agent to recognise suspected cholera, assess illness and transmission states, and support evidence-based care escalation and public-health response.
Cholera is an acute intestinal infection caused by cholera-toxin-producing Vibrio cholerae, usually acquired through contaminated water or food, that can cause profuse watery diarrhoea and rapidly fatal dehydration.
It can be Classify an episode against an explicit cholera case definition and explain missing evidence.; Flag urgent clinical review from recorded dehydration and deterioration assessments.; Track stool-testing requests and reconcile provisional classifications with laboratory results.; Construct time-and-place clusters while preserving uncertainty in exposure attribution.; Identify gaps in access to cholera care, safe water, sanitation and vaccination.; Prepare surveillance summaries and response options for review by authorised health personnel..
Distinguishing features
Record organism identification, serogroup and toxigenicity separately: detecting V. cholerae alone does not establish epidemic cholera. [CDC clinical detection](https://www.cdc.gov/cholera/php/laboratories/cholera-clinical-detection.html)
Acute watery diarrhoea supports suspicion but does not uniquely distinguish cholera from other enteric infections. [CDC diagnosis](https://www.cdc.gov/cholera/hcp/case-definition/index.html)
A positive rapid diagnostic test supplies outbreak-warning evidence rather than definitive individual confirmation; retain culture or PCR evidence separately. [CDC diagnosis](https://www.cdc.gov/cholera/hcp/case-definition/index.html)
Distinguish symptomatic disease from asymptomatic infection; absence of severe diarrhoea does not establish absence of infection. [WHO cholera fact sheet](https://www.who.int/news-room/fact-sheets/detail/cholera)
Record the outbreak context and case-definition version because surveillance criteria change with context. [CDC case definitions](https://www.cdc.gov/cholera/hcp/case-definition/index.html)
Scope
+ Cholera-specific disease identity and boundaries with other diarrhoeal illnesses
+ Suspected and confirmed episodes, diagnostic evidence and classification changes
+ Fluid-loss severity, care urgency and episode outcomes
+ Exposure pathways and evidence linking cases to transmission
+ Cholera surveillance, prevention and response evaluation
- Vibrio cholerae taxonomy and organism biology beyond disease-relevant attributes
- Other causes of acute watery diarrhoea and non-cholera vibriosis
- General dehydration management outside a cholera episode
- Engineering specifications for water and sanitation infrastructure
- Vaccine manufacturing, pharmaceutical formulation and general immunisation systems
Characteristics
- Clinical presentation
- Asymptomatic infection; acute watery diarrhoea; other presentation; unknown Separates infection evidence from observed illness.
- Surveillance classification
- Classification under a named, dated jurisdictional definition, with pending and excluded states Makes counts interpretable when definitions or outbreak context change.
- Pathogen evidence
- Method and result; O1/O139/other/unresolved serogroup; toxigenicity detected/not detected/not tested Prevents unsupported confirmation from a generic organism result.
- Dehydration assessment
- No, some or severe dehydration under a named clinical protocol; unassessed; assessment time Supports care urgency and reassessment.
- Fluid balance observations
- Intake and measured losses in mL per stated interval; weight in kg; measurement or estimation method Makes continuing losses and response to care visible.
- Episode timing
- Dated exposure interval, symptom onset, presentation, specimen collection and treatment initiation; elapsed hours Supports exposure investigation and identifies care delays.
- Exposure linkage
- Links to water, food, households, travel or clusters, each with evidence and confidence Separates plausible transmission hypotheses from demonstrated links.
- Episode outcome
- Ongoing care; recovered; transferred; died; lost to follow-up; unknown Supports follow-up and avoids treating missing outcomes as recovery.
- Cholera vaccination history
- Product, dose dates, documentation source and applicable schedule Supports prevention assessment without assuming vaccination excludes cholera.
- Population burden
- Cases and deaths by classification, place and interval; incidence and case-fatality proportion with explicit denominators Allows comparison while exposing reporting and ascertainment differences.
Also called
Where this came from
wikidata · CC0 1.0
Also registered as vr.tr.cholera
Drafted structure
Bundle to layer to finding to question, as the second pass will find it: 6 bundles · 11 layers · 20 findings · 36 questions.
Cholera identity and confirmation Establish what qualifies as cholera and how each episode is supported.
Watery diarrhoea, organism detection and confirmed cholera are different evidential states.
Disease boundary
Separate the disease concept from its pathogen and neighbouring syndromes.
Etiological membership
Record whether evidence supports toxigenic O1/O139 infection or a neighbouring Vibrio-associated illness.
- What evidence identifies the organism, serogroup and toxigenicity independently? definition
- Does this record concern symptomatic cholera, asymptomatic infection or a different Vibrio-associated illness? boundary
Diagnostic evidence
Preserve specimen, assay and interpretation provenance.
Confirmation chain
Connect each interpretation to specimen timing, test method, laboratory report and unresolved limitations.
- When was the stool specimen collected relative to symptom onset and antimicrobial exposure? provenance
- Which culture, PCR or rapid-test results are available, and what does each actually establish? measurement
- What additional testing or review is needed to resolve discordant or incomplete results? action
Fluid loss and care Represent the evolving clinical episode and its response to care.
Cholera can cause rapidly dangerous dehydration; rehydration should not await laboratory confirmation. [WHO](https://www.who.int/news-room/fact-sheets/detail/cholera), [CDC](https://www.cdc.gov/cholera/hcp/case-definition/index.html)
Dehydration trajectory
Track dated observations of losses, hydration and deterioration.
Time-sensitive severity
Treat severity as a repeated assessment rather than a fixed episode label.
- Which observed signs support the recorded dehydration category under the selected protocol? measurement
- How have stool losses, vomiting, intake and hydration changed since the previous assessment? measurement
- Does the current assessment require immediate escalation under the applicable clinical protocol? action
Care and response
Link delivered care to reassessment and disposition.
Rehydration and adjuncts
Record rehydration delivery, clinician-directed adjuncts and observed response without embedding a universal prescription.
- What fluids were actually delivered, by which route and over what interval? measurement
- Which protocol and patient factors support any antimicrobial decision, and what susceptibility evidence was considered? provenance
- What reassessment supports continuing care, transfer or discharge? action
Exposure and transmission Connect episodes to plausible ingestion exposures and local transmission.
Cholera spreads through contaminated food or water, making exposure pathways central to investigation. [WHO cholera fact sheet](https://www.who.int/news-room/fact-sheets/detail/cholera)
Exposure reconstruction
Reconstruct dated food, water and travel histories.
Candidate exposure pathways
Keep alternative exposure explanations visible and attach evidence to each.
- Which drinking-water sources, foods and travel locations occurred within the investigation's stated exposure window? provenance
- What evidence supports each candidate exposure beyond its proximity to a case? boundary
Cluster linkage
Assess connections among cases, shared exposures and environmental findings.
Transmission attribution
Distinguish shared-source hypotheses, possible onward spread and unrelated introductions.
- Which onset dates and shared exposures support grouping these episodes together? measurement
- How do laboratory typing and environmental results strengthen or weaken the proposed linkage? boundary
- Which targeted investigation would best distinguish the remaining transmission explanations? action
Surveillance and outbreak state Translate episode evidence into traceable counts and outbreak assessments.
An agent must preserve how cholera classifications and denominators were produced before interpreting trends.
Case counting
Apply a versioned surveillance definition to a specified population and period.
Classification context
Keep surveillance classification distinct from clinical assessment and retain its revision history.
- Which authority, definition version and outbreak context governed this classification? provenance
- How are duplicate reports, transfers and subsequent laboratory reclassifications reconciled? measurement
Outbreak interpretation
Interpret cholera signals alongside testing coverage and reporting limitations.
Signal and ascertainment
Record the evidence supporting an alert or outbreak-state change and the uncertainty in reported burden.
- What local criteria and evidence support an alert, declaration or closure, and who made that determination? provenance
- Could changes in testing, reporting delays or access to care explain the apparent trend? boundary
- Which cases, deaths, population denominator and time interval underlie each reported rate? measurement
Prevention and response reach Connect cholera-control measures to identified exposure and service gaps.
Cholera control combines water, sanitation, hygiene, vaccination, surveillance and accessible treatment. [WHO cholera fact sheet](https://www.who.int/news-room/fact-sheets/detail/cholera)
Exposure interruption
Assess whether measures reach the suspected transmission pathways.
Water, sanitation and hygiene response
Link proposed and implemented measures to specific cholera exposure hypotheses.
- Which implicated water, food or faecal-contamination pathway does each measure address? action
- What observations verify that affected households can obtain and consistently use the intended protection? measurement
Vaccination and care access
Evaluate whether preventive and clinical services reach the affected population.
Oral cholera vaccine reach
Record campaign eligibility, delivery and coverage against the policy applicable at the time.
- Which dated policy specifies the vaccine product, eligible population and dose schedule? provenance
- What denominator and dose records support coverage estimates, and which groups were missed? measurement
Timely care reach
Identify barriers between diarrhoea onset, rehydration access and clinical care.
- Where do travel time, cost, supply shortages or communication barriers delay access to cholera care? measurement
- Which service change addresses the documented delay, and how will its effect be assessed? action
Evidence and external alignment What the world already says about this thing, gathered so the model can be checked against it.
A model that cannot be lined up against existing standards, identifiers and practice cannot be adopted by anyone who already uses them.
Reported evidence
Findings from the breadth pass, kept separate from the structural claims.
Check these first
Recalled without web access and unsourced; every item is a lead to verify.
- This describes the infectious disease sense; the supplied ACT.ACT domain assignment warrants review.
- The listed kinds classify established epidemic-associated organisms; serogroup, biotype, and toxin production are distinct properties.
- Recalled information only; current surveillance definitions, regulatory requirements, and regional strain distributions should be checked.
- Which of these check these first hold for the sense of cholera this model covers, and on what evidence? provenance
Kinds and varieties
Recalled without web access and unsourced; every item is a lead to verify.
- Cholera caused by V. cholerae O1, classical biotype
- Cholera caused by V. cholerae O1, El Tor biotype
- Cholera caused by V. cholerae O139
- Which of these kinds and varieties hold for the sense of cholera this model covers, and on what evidence? provenance
Identifiers and schemes
Recalled without web access and unsourced; every item is a lead to verify.
- ICD-10 - A00 - Cholera; subcategories distinguish classical-biotype infection, El Tor infection, and unspecified cholera.
- Which of these identifiers and schemes hold for the sense of cholera this model covers, and on what evidence? provenance
Standards and regulation
Recalled without web access and unsourced; every item is a lead to verify.
- World Health Organization guidance on cholera surveillance, prevention, and clinical management.
- World Health Organization International Health Regulations (2005): cholera events are assessed using the Annex 2 decision instrument to determine international notification requirements.
- Which of these standards and regulation hold for the sense of cholera this model covers, and on what evidence? provenance
Real-world use
Recalled without web access and unsourced; every item is a lead to verify.
- Clinical recognition and management of acute watery diarrhoea and dehydration.
- Laboratory confirmation and outbreak surveillance.
- Planning safe-water, sanitation, and hygiene interventions.
- Planning oral cholera vaccination campaigns.
- Which of these real-world use hold for the sense of cholera this model covers, and on what evidence? provenance
Typical measurements
Recalled without web access and unsourced; every item is a lead to verify.
- Incubation period - Approximately 12-120 - hours
- Outbreak case-fatality ratio with appropriate treatment - Expected to remain below 1 - %
- Which of these typical measurements hold for the sense of cholera this model covers, and on what evidence? provenance
Failure modes and hazards
Recalled without web access and unsourced; every item is a lead to verify.
- Rapid fluid and electrolyte loss can cause hypovolaemic shock, kidney injury, and death.
- Delayed or inadequate rehydration greatly increases mortality.
- Contaminated water and inadequate sanitation can sustain large outbreaks.
- Mild or asymptomatic infections can escape surveillance while contributing to transmission.
- Antimicrobial resistance can reduce the effectiveness of antibiotic treatment.
- Which of these failure modes and hazards hold for the sense of cholera this model covers, and on what evidence? provenance
Regional variation
Recalled without web access and unsourced; every item is a lead to verify.
- Cholera occurs in both endemic settings and episodic outbreaks; risk depends strongly on access to safe water and sanitation.
- Conflict, displacement, and disrupted water infrastructure can increase outbreak risk.
- O1 has a broad geographic distribution; O139 has historically been associated mainly with Asia.
- Which of these regional variation hold for the sense of cholera this model covers, and on what evidence? provenance
Neighbouring kinds and how to tell them apart
Recalled without web access and unsourced; every item is a lead to verify.
- Vibrio cholerae - The bacterial species is the organism; cholera is a disease caused by particular toxigenic strains.
- Acute watery diarrhoea - This is a clinical syndrome with multiple possible causes; cholera specifies an infectious cause.
- Dysentery - Dysentery involves inflammatory diarrhoea with visible blood; cholera typically causes watery, non-bloody diarrhoea.
- Non-cholera vibriosis - Other Vibrio infections can cause gastrointestinal, wound, or bloodstream disease without constituting epidemic cholera.
- Which of these neighbouring kinds and how to tell them apart hold for the sense of cholera this model covers, and on what evidence? provenance
What the second pass must settle
- Does an existing Vercy disease or world model already own cholera, and should this registry entry link to it instead of receiving a separate publication?
- How should the inherited ACT / ACT.ACT placement connect to biological disease and public-health concepts without changing registry identity?
- Which jurisdictional case definitions and outbreak declaration or closure criteria should the completed model operationalise?
- How should asymptomatic toxigenic O1/O139 infection be represented relative to symptomatic cholera episodes and surveillance counts?
- Which locally applicable clinical, antimicrobial-susceptibility and oral-vaccine policies must be researched before the model can support operational decisions?