In mid-1800s London, an anesthesiologist named John Snow conducted a series of field investigations that have earned him the title the “father of field epidemiology.” Snow conducted studies of cholera outbreaks and discovered the cause of disease and prevented its recurrence. In 1854, there was a cholera epidemic in the Golden Square neighborhood of London. He began his investigation by determining where in the area people with cholera lived and worked. He marked each residence on a map. Because Snow believed that water was a source of infection for cholera, he marked the location of water pumps on his map, then looked for a relationship between the distribution of households with cases of cholera and the location of pumps. Even with no knowledge of the existence of microorganisms, Snow demonstrated through epidemiologic studies that water could serve as a vehicle for transmitting cholera and that epidemiologic information could be used to direct prompt and appropriate public health action as recourse and prevention.

In the 1880s, Dr. Robert Koch discovered cholera bacteria, traveling from Germany to Egypt and India during outbreaks. They confirmed the bacteria during autopsies and concluded it was linked to infected water supplies. Koch also discovered that people infected with cholera were protected from it afterwards.

In 1885, Spanish doctor Jaime Ferran, who studied under Louis Pasteur (Koch’s rival), created the first cholera vaccine from working with live bacteria. He did a mass vaccination (50,000 people) during an outbreak in Spain.

Two scientists, Sawtschenko and Sabolotny, experimented with a killed cholera bacteria “broth” in 1893, which prevented cholera but was impractical because it required many doses.

Dr. Pittman was active with SEATO and traveled to the cholera research laboratory in Dacca, East Pakistan (now Bangladesh). For five years she was the SEATO Cholera Research Project director at the NIH. Pittman helped design the laboratory, the equipment, and the research that would take place at SEATO. With Pittman leading the team their findings demonstrated that the effectiveness of a cholera vaccination directly relates to its potency assay. This research project also verified the importance of IV restorative fluids in treatment procedures for victims of cholera. Today SEATO has been replaced by the International Center for Diarrhoeal Disease Research, Bangladesh.

The 1980s and 1990s brought increased research and understanding of the complexity of the cholera bacteria, leading to many more vaccines around the world. Trials around the world expanded knowledge on the theory of herd immunity or herd protection. Vaxchora, approved by the FDA in 2016 and the vaccine currently in use, is a single-dose vaccine taken before traveling to at-risk areas.