Vibrio cholerae is a Gram-negative, comma-shaped bacterium. The bacterium's natural habitat is brackish or saltwater where they attach themselves to the chitin-containing shells of crabs and other shellfish; some strains of V. cholerae cause the disease cholera, which can be derived from the consumption of undercooked or raw marine life species. V. cholerae has a flagellum at one cell pole as well as pili. V. cholerae can undergo fermentative metabolism. When ingested, V. cholerae can cause diarrhea and vomiting in a host within several hours to 2–3 days of ingestion. V. cholerae was first isolated as the cause of cholera by Italian anatomist Filippo Pacini in 1854, but his discovery was not known until Robert Koch, working independently 30 years publicized the knowledge and the means of fighting the disease. V. cholerae is a motile, comma shaped, gram-negative rod. Initial isolates are curved, whereas they can appear as straight rods upon laboratory culturing; the bacterium has a flagellum at one cell pole as well as pili.

The Vibrios tolerate alkaline media that kill most intestinal commensals, but they are sensitive to acid. V. cholerae is a facultative anaerobe, can undergo respiratory and fermentative metabolism. It measures 0.3 micron in diameter and 1.3 micron in length with average swimming velocity of around 75.4 +/- 9.4 microns/sec. V. cholerae pathogenicity genes code for proteins directly or indirectly involved in the virulence of the bacteria. During infection, V. cholerae secretes cholera toxin, a protein that causes profuse, watery diarrhea. This cholera toxin contains 5 B subunits that plays a role in attaching to the intestinal epithelial cells and 1 A subunit that plays a role in toxin activity. Colonization of the small intestine requires the toxin coregulated pilus, a thin, filamentous appendage on the surface of bacterial cells; the V. cholerae particle in the intestinal lumen uses fimbraie to attach to the intestinal mucosa, not invading the mucosa. After doing so it secretes cholerae toxin causing its symptoms.

This increases cyclic AMP or cAMP by binding to adenylyl cyclase activating the GS pathway which leads to efflux of water and sodium into the intestinal lumen causing watery stools or rice watery stools. V. cholerae can cause syndromes ranging from asymptomatic to cholera gravis. In endemic areas, 75% of cases are asymptomatic, 20% are mild to moderate, 2-5% are severe forms such as cholera gravis. Symptoms include abrupt onset of watery diarrhea, occasional vomiting, abdominal cramps. Dehydration ensues, with symptoms and signs such as thirst, dry mucous membranes, decreased skin turgor, sunken eyes, weak or absent radial pulse, tachypnea, hoarse voice, cramps, kidney failure, somnolence and death. Death due to dehydration can occur in a few hours to days in untreated children; the disease is particularly dangerous for pregnant women and their fetuses during late pregnancy, as it may cause premature labor and fetal death. In a study done by the Centers for Disease Control in Haiti, they found that women who were pregnant and contracted the disease, 16% of 900 women had fetal death.

Risk factors for these deaths include: third trimester, younger maternal age, severe dehydration, vomiting Dehydration poses the biggest health risk to pregnant women in countries that there are high rates of cholera. In cases of cholera gravis involving severe dehydration, up to 60% of patients can die; the disease lasts 4–6 days. Worldwide, diarrhoeal disease, caused by cholera and many other pathogens, is the second-leading cause of death for children under the age of 5 and at least 120,000 deaths are estimated to be caused by cholera each year. In 2002, the WHO deemed that the case fatality ratio for cholera was about 3.95%. Cholera is an illness that derives from the bacteria, V. cholerae. This bacteria infects the intestine where it causes diarrhea; this bacteria, V. cholerae can be spread by drinking contaminated water. This illness is spread through humans making skin contact with contaminated water from human feces; when it comes to symptoms, not everyone with Cholera will experience symptoms but it averages about 1 in 10 people with Cholera will experience symptoms.

Some symptoms include: watery diarrhea, rapid heart rate, loss of skin elasticity, low blood pressure and muscle cramps. This illness can get as serious are possible coma. If this illness is treated fast enough, the people infected can be cured and there is no chance of this illness reoccurring unless they are re-exposed to the bacteria. V. cholerae has an epidemic occurrence. In countries where the disease has been for the past three years and the cases confirmed are local transmission is considered to be "endemic."" Alternatively, an outbreak is declared when the occurrence of disease exceeds the normal occurrence for any given time or location. Epidemics can last several days or over a span of years. Additionally, countries that have an occurrence of an epidemic can be endemic; the longest standing V. chloerae epidemic was recorded in Yemen. Yemen had two outbreaks, the first occurred between September 2016 and April 2017, the second began in April 2017 and was considered to be resolved in 2019.

The epidemic in Yemen took over 2,500 lives and impacted over 1 million people of Yemen More outbreaks have occurred in Africa, the Americas, Haiti. When visiting areas with epidemic chol

Michèle Kahn Spike is an American lawyer and lecturer. She graduated from Boston University School of Law in 1976 and became a member of the Bar of the State of New York in 1977, concentrating in international corporate law. From the late 1980s until 2011, she lived in Florence, Italy together with her husband, noted art historian John Spike. Since fall 2012 she has been teaching at the Marshall-Wythe School of Law at the College of William & Mary, she was appointed as Visiting Professor of the Practice of Law in 2017, she is known for her biography of Matilda of Tuscany, Tuscan Countess: The Life and Extraordinary Times of Matilda of Canossa, published to favorable reviews in 2004. She collaborated with John Spike on his study of Caravaggio and Mattia Preti. Spike has been a member of the Bar of the State of New York since 1977 and during those 40 years engaged in the practice of international corporate law. In the spring of 2015, in honor of the 900th anniversary of the death of Matilda of Canossa, Spike curated the exhibition, Matilda of Canossa and the Origins of the Renaissance, for the Muscarelle Museum of Art in coordination with the Marshall-Wythe School of Law at the College of William and Mary.

The catalogue for that exhibition was published by the Muscarelle Museum of Art. In 2015, Spike published, An Illustrated Guide to the ‘One Hundred Churches’ of Matilda of Canossa, Countess of Tuscany. In 2016 in honor of the 900th anniversary of the death of the Countess, she curated the exhibition, Matilda di Canossa La donna che mutò il corso della stori / Matilda of Canossa the Woman who Changed the Course of History for the Casa Buonarroti in Florence; the catalogue, available in Italian and in English, was published by Florence. As a member of the Standing Commission on Anglican and International Peace with Justice Concerns of the Episcopal Church 2003-2009, Spike participated in delegations to Palestine and Israel as well as to United Nations conferences in New York City and Amman, Jordan. Since 2005, Spike has been Chancellor to the Bishop of the Convocation of Episcopal Churches in Europe, she most lectured on the Rule of Law at the Jerusalem Peacebuilders Camp in Brattleboro, Vermont

Shamsheer Vayalil Parambath is an Indian radiologist and businessman. He is the founder and managing director of VPS Healthcare Group, the vice chairman and managing director of Amanat Holdings, a healthcare and education investment company; as of June 2019, Vayalil has a net worth of US$1.4 billion. Vayalil was born on 11 January 1977 in Kozhikode, India, his parents are Mariyam Barakkool. After his schooling, he pursued a MBBS at Kasturba Medical College, Manipal obtained his MD in radiology from Sri Ramachandra Medical College and Research Institute, Chennai, he did his radiology fellowship at Boston. Vayalil was a radiologist for 12 months at Sheikh Khalifa Medical City, Abu Dhabi, UAE. In 2007, he opened his first hospital – LLH Hospital in Abu Dhabi. Over the next twelve years, his company VPS Healthcare started 23 hospitals in four countries with over 125 medical centres and about 13,000 employees in the Middle East and India. Vayalil is a member of the UAE Medical Council, a board member of the Abu Dhabi University, a member of the advisory committee of the University of Sharjah College of Medicine.

He is a former director of Kannur International Airport Ltd, a member of the Kerala NRI Commission, a commission with quasi-judicial powers set up in Kerala to protect the rights and properties of non-resident Indians from Kerala. Vayalil is a member of "The Giving Pledge", he pledged to donate half his wealth for philanthropy. VPS Healthcare donated emergency healthcare equipment worth Rs 1.75 crores when Nipah viral infection was diagnosed in Kerala in 2018. Vayalil pledged to donate Dh 26 million to Kerala after the monsoon floods in August 2018, he was honoured at an event hosted by United Nations in New York for his philanthropy. He was recognised for the community welfare initiatives, which include the'1000 Free Heart Surgeries' initiative for the underprivileged, launched as a tribute to Mohammed bin Zayed Al Nahyan; as part of the initiative, people from around the world, from babies to a 70-year-old, have undergone cardiac surgeries. Vayalil made donations to the UAE Red Crescent for Syrian refugees and to the Indian Prime Minister's National Relief Fund for flood-hit Jammu and Kashmir.

He extended his support to the kin of the victims of the Mangaluru plane crash in May 2010. He offered jobs and educational assistance to the families of the victims and many of the people that took up jobs at VPS Healthcare continue to work with the company today. In April 2014, Vayalil filed a petition in the Supreme Court of India in connection with non-resident Indian voting rights. Voters have to travel to their constituency to vote; the Court directed the Election Commission of India to explore the possibility for NRIs to cast their vote from their place of residence. In October 2014, the Commission submitted its report to the Court, recommending that NRIs be permitted to vote by proxy and e-postal ballot. On 9 August 2018, the Representation of the People Bill 2017, enabling the facility of proxy voting to overseas Indians, was passed by the Lok Sabha, was awaiting introduction in the upper house of the Indian Parliament, the Rajya Sabha. 2014 – Pravasi Bharatiya Samman for his role in developing a healthcare business in the United Arab Emirates and for promoting UAE-India ties 2014 – Received an honorary Doctorate from Aligarh Muslim University Vayalil is married to Shabeena, the eldest daughter of fellow billionaire M. A. Yusuff Ali.

They have four children. Media related to Shamsheer Vayalil at Wikimedia Commons