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Disease Along the River: A Case Study and Cholera Outbreak Game


Andrea C. Nicholas
Department of Neurobiology and Behavior
University of California, Irvine
Isabella Villano

San Joaquin High School


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.


  • Provide examples of human behaviors that promote the spread of diarrheal diseases.
  • Understand how adequate sanitation protects against, and compromised sanitation facilitates, cholera outbreaks.
  • Recognize how agriculture and human-livestock interactions contribute to the spread of cholera.
  • Appreciate how geographic factors can influence the spread of cholera in humans.
  • Understand the role of waterways in the spread of human disease.
  • Describe how trade and travel influence the spread of direct contact diseases.


Cholera; Vibrio cholera; diarrheal disease; diarrhea; dysentery; waterborne disease; infectious disease; outbreak; bacteria; waste disposal; sanitation; disease spread; contamination; Haiti

Topical Areas

Regulatory issues

Educational Level

High school, Undergraduate lower division, Undergraduate upper division



Type / Methods

Analysis (Issues), Discussion, Role-Play



Subject Headings

Biology (General)  |   Epidemiology  |   Medicine (General)  |   Microbiology  |   Public Health  |   Science (General)  |   Science Education  |  

Date Posted


Teaching Notes

Case teaching notes are password-protected and access to them is limited to paid subscribed instructors. To become a paid subscriber, begin the process by registering.

Teaching notes are intended to help teachers select and adopt a case. They typically include a summary of the case, teaching objectives, information about the intended audience, details about how the case may be taught, and a list of references and resources.

Supplemental Materials

The file below contains optional playing cards and printing instructions.

  Playing Cards


Lynette Jackson
Leigh High School
San Jose
I have been doing this activity for over 4 years. Instead of beads, I purchased different colors of card stock and cut them into 1 in x 1 in squares. Every villager is a different color. It works out very nicely. I store the colored squares in an envelope labeled with the villager's number and the envelope also contains their game cards. The students love this activity!