MICROBIOLOGY CONFERENCE


Holy moly! A case of domestically acquired cholera Dr Claire Jenkins, Deputy Head of the Gastrointestinal Bacteria Reference Unit (GBRU), UKHSA, gave a presentation that consisted of two case studies that served to highlight the increase in cholera case notifications worldwide and in Europe and the importance of surveillance of Vibrio cholerae in the UK.


Case 1


In February 2026, the UKHSA press office received a call from a tabloid newspaper journalist advising that they were aware of an elderly man who had died in a hospital in the Midlands from cholera. The patient had not been abroad and the journalist wanted to issue an alert to the public as this was the first death from cholera in 125 years.


The Health Protection Team


investigated and identified an 87-year- old male whose blood culture and stool specimens had grown what was identified as V. cholerae in the local trust laboratory, and sent subsequently to the GBRU at Colindale. There was no clear exposure or travel abroad but he had recently eaten a Chinese takeaway, and Environmental Health Officers were investigating. Infection Prevention Control had been


provided to the trust, and the family and the local Director of Public Health had been made aware. An Incident Management Team meeting had been arranged for the same day. The V. cholerae isolate had been


cultured in the local trust laboratory using thiosulphate citrate bile salt sucrose (TCBS) and identified by MALDI from the patient’s blood culture and faeces, and at GBRU identified by a real-time multiplex PCR that targets the toxR gene, which was positive. Other targets include ctxA which encodes cholera toxin, O1 (serogroup O1) and O139 (serogroup O139), all of which were negative thus indicating a non- toxigenic strain. The journalist worked with UKHSA


to responsibly publish the article in the tabloid newspaper and included an ‘information box’ describing the symptoms of cholera and historical information on the first cholera epidemic in 1831 in Britain originating in the Sunderland docks and imported from Asia which killed 32,000 people. In 1848, 52,000 people lost their lives and in 1854 the discovery of an outbreak in Soho sourced to a water pump on Broad Street by the legendary physician John Snow. Snow’s waterborne discovery led to fundamental changes in the water and sewage systems of London and beyond.


Conference delegates enjoyed an eclectic scientific programme.


Case 2


John Snow’s discovery initiated major investment in public health including the sewage systems still in place today. By the turn of the century cholera was no longer endemic in Britain and to date there have not been any domestically acquired cases for over 125 years. In February 2025, a V. cholerae


serogroup 01 toxin-positive case was identified in a 36-year-old male with no travel history; however, he had drunk holy water brought back from Ethiopia. An outbreak of cholera has been ongoing in Ethiopia since 2022 with 58,381 cases and 726 deaths. In February 2025, the European Civil Protection and Humanitarian Aid Operations (ECHO) reported a resurgence in the Amhara region due to armed conflict causing access issues for humanitarian aid workers and medical staff. The source of the outbreak was


contaminated water from a holy well in Bermel Giorgis, which atracts pilgrims from across the country and beyond to drink and bathe in the holy water, believing it has the power to cure illness and exorcise demons. On 25 February 2025 UKHSA picked up an alert via the EpiPulse posted by scientists at the Robert Koch Institute reporting three cases of domestically acquired cholera in Germany. The link to consumption of water from the holy well in Bermel Giorgis was identified, and isolates from the faecal samples of all three patients were identical to the UK-identified strain establishing a microbiological link. All cases were treated and all recovered. A rapid communication was issued in Eurosurveillance, and the case was published in The Times. The World Health Organization


(WHO) reported the increase in cholera cases and the association with religious festivals and water from holy wells. The well was closed and guidelines issued for preventative measures in the country,


including improved access to wash facilities, sanitation and hygiene as well as community engagement with religious leaders and communication of the risks to pilgrims. The National Travel Health Network and Centre advertised and highlighted the risk along with preventative advice including cholera vaccination if eligible. Since 2022 notification of cases


of V. cholerae has increased globally, are becoming more widespread and the size of outbreaks increasing. This is compounded by the impact of the COVID-19 pandemic, increased burden on medical facilities, deterioration of public health infrastructure and access


to wash facilities. Climate change extreme weather events trigger new outbreaks and worsen existing ones, and emergence of antimicrobial resistance hinders treatment and case management. The European Centre for Disease


Prevention & Control (ECDC) reported a 10-fold increase in the number of imported cholera cases in Europe in 2022 compared to 2021. Most strains were susceptible to first- and second-line treatments, but MDR strains are emerging. Surveillance of V. cholerae in the UK identifies an average of fifty-one cases per year, 27% of which are toxigenic. The number of non-toxigenic cases has continued to rise since 2022. Children <10 years old and the elderly are most susceptible to infection, and travel was reported in 92.9% of cases, principally to India, Pakistan, and Kenya. The UK Standards for Microbiology


Investigations for Gastroenteritis recommend testing faecal specimens for V. cholerae in patients reporting recent travel to countries where cholera is endemic, with suspected cholera or those reporting epidemiological links to outbreaks caused by the consumption of contaminated seafood. Additional exposure risks including wild swimming and shellfish consumption as V. cholerae O1 is endemic in the UK and non-01 serogroups have been detected in UK rivers and coastal waters. There is a Food Standards Agency funded shellfish survey planned for 2026 as shellfish are not regularly screened by the industry. In conclusion, Dr Jenkins summarised


her presentation with the major take home messages and a picture of the John Snow Public House in Soho which has a replica water pump outside the premises.


Mycoplasma pneumoniae: atypical in many ways Dr Michael Beeton’s presentation on ‘Mycoplasma pneumoniae: atypical in


August 2026 WWW.PATHOLOGYINPRACTICE.COM 23


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