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Iona Twaddell looks at the science of the waterborne disease cholera There are an estimated 3-5 million cases of cholera, a disease caused by the bacterium Vibrio cholera, each year. It is passed on through drinking water that has been contaminated with faeces from someone infected with the bacteria. Cholera causes vomiting and diarrhoea, leading to severe dehydration.

This case study centers on an active teaching game that simulates a cholera outbreak among five villages along a river, similar to the Haitian outbreak of 2010. By enacting the behaviors of fictional villagers, students learn how trade, travel, sanitation practices and geographic location contribute to the spread of diarrheal disease. Documenting various contamination events of village water supplies allows students to trace the progression of the disease and illustrates how adequate sanitation facilities provide protection against the bacteria Vibrio cholera. Originally designed for an undergraduate upper-division biology course focusing on the epidemiology of diseases, the simulation is also appropriate for microbiology and public health courses, as well as lower division undergraduate biology courses and high school. Biology or epidemiology components of the case study can be highlighted depending on the emphasis of the course being taught. The game can be completed within a 45- to 60-minute class period. Playing cards are available from the Supplemental Materials tab; detailed instructions are found in the teaching notes.

NPR's Jason Beaubien explains cholera, a deadly disease spread through water contaminated with sewage, in under two minutes.

This flipped case study is suited for general education undergraduate level biology. Students prepare ahead of time for class by viewing a video created by the authors that reviews the basics of nutrition and digestion; in class, students then engage in three activities to further explore aspects of the video's content using specific and concrete examples of diverse foods. During the first part of the case study, students learn information about balanced diets, nutrition and the digestive system. Students apply their knowledge on how food passes through the digestive tract, and how absorption and breakdown of nutrients occur by explaining and presenting the process based on assigned food items. Students are then asked to further apply their knowledge when presented with two scenarios ("mini-cases"), one involving gastric bypass surgery and the other the effects of cholera.