This study develops the novel SVAITRS-B model, unifying deterministic and stochastic frameworks to capture cholera dynamics with vaccination, asymptomatic carriers, and environmental pathways. We demonstrate analytically that person-to-person transmission exhibits backward bifurcation, while environmental transmission follows classical forward bifurcation-establishing distinct elimination thresholds that explain disease persistence even when the basic reproduction number ℛ 0 D falls below one. Stochastic simulations reveal that human-contact transmission generates 30% greater outbreak variability than environmental routes, highlighting its role in unpredictable epidemics. Environmental transmission, however, dominates long-term endemicity, contributing 68% to ℛ 0 D . We identify critical hysteresis effects governed by vaccine efficacy ( f V ) and bacterial shedding ( ξ A , ξ I ), and uncover a logarithmic sensitivity of bacterial concentration to sanitation-indicating that standard intervention targets may underestimate effort by 15–20%. These results provide a mathematical foundation for dual-pathway control strategies, combining human-focused interventions with environmental management. Our accompanying computational toolkit enables scenario testing for public health planning, though field validation of spatial heterogeneity remains essential for localized application.
Welu et al. (Thu,) studied this question.