Cholera outbreak continues in Yemen

Yemen has been experiencing a cholera outbreak that started in early August 2016. As of 1 February, 2017, a cumulative number of 18, 848 suspected Cholera cases including 97 associated deaths [case fatality rate 0.86%] have been reported from 157 districts in 15 governorates

Cholera Outbreak in Somalia

Somalia has been experiencing recurring outbreaks of cholera in the last few years. The current cholera outbreak started in November 2016 and is still ongoing. Since the beginning of the outbreak in early 2016, a cumulative total of 20 684 cases including 689 deaths have been reported so far [CFR=3.2%] from the country

A community-wide cholera outbreak caused by drinking unsafe water: Kasese District, Western Uganda, February ­July 2015

Introduction: Kasese District is prone to cholera outbreaks and this was its third outbreak in 15 years. In May 2015, Kasese District reported a cholera outbreak that had lasted 3 months and caused >100 infections. A team from Ministry of Health set out to support the local response team in identifying the mode of transmission and informing control measures.Methods: we defined a suspected case as onset of acute watery diarrhoea from 1st February 2015 onward; a confirmed case was a suspect case with Vibrio cholerae cultured from a stool sample. We reviewed medical records for case finding and conducted a case-control study to compare the exposures of 49 confirmed cases with those of 201 asymptomatic controls, matched by village and age group. We conducted environmental assessments and tested water samples for faecal contamination.Results: we identified 183 suspected cases including 61 confirmed cases (serotype inaba) and 2 deaths from February to July. The outbreak occurred in 80 villages and affected all age groups; the highest attack rate occurred in persons aged 5-14 years (4.1/10,000). Stratified epidemic curves showed that the outbreak started in Bwera Sub-county bordering the Democratic Republic of Congo, and spread eastward. 94% (46/49) of cases compared with 75% (152/201) of controls drank water without boiling or treatment (ORM-H = 5.9; 95%CI = 1.6-22). The main water sources, public piped water (consumed by 39% of cases and 38% of controls) and stream water (consumed by 29% of cases and 24% controls), both had high levels of E. coli, a marker of faecal contamination. Environmental assessment revealed evidence of open defaecation along the streams. No food items were significantly associated with illness.Conclusion: drinking unsafe water contaminated by feces caused this outbreak. We recommended rigorous disposal of patients' feces, chlorination of piped water, and drinking boiled or treated water. The outbreak stopped 6 weeks after initiating implementation of these control measures

Prevalence of cholera risk factors between migrant Haitians and Dominicans in the Dominican Republic / Prevalencia de los factores de riesgo de cólera entre los inmigrantes haitianos y los dominicanos en la República Dominicana

OBJECTIVE: To determine whether cholera risk factor prevalence in the Dominican Republic can be explained by nationality, independent of other factors, given the vulnerability of many Haitians in the country and the need for targeted prevention. METHODS: A cross-sectional, observational household survey (103 Haitian and 260 Dominican) was completed in 18 communities in July 2012. The survey included modules for demographics, knowledge, socioeconomic status, and access to adequate water, sanitation, and hygiene (WASH) infrastructure. Logistic regression assessed differential access to WASH infrastructure and Poisson regression assessed differences in cholera knowledge, controlling for potential confounders. RESULTS: Dominican and Haitian households differed on demographic characteristics. Haitians had lower educational attainment, socioeconomic status, and less knowledge of cholera than Dominicans (adjusted odds ratio [aOR] = 0.66; 95% confidence interval [95%CI] = 0.55-0.81). Access to improved drinking water was low for both groups, but particularly low among rural Haitians (aOR = 0.21; 95%CI: 0.04-1.01). No differences were found in access to sanitation after adjusting for sociodemographic confounders (aOR = 1.00; 95%CI: 0.57-1.76). CONCLUSIONS: Urban/rural geography and socioeconomic status play a larger role in cholera risk factor prevalence than nationality, indicating that Haitians' perceived vulnerability to cholera is confounded by contextual factors. Understanding the social dynamics that lead to cholera risk can inform control strategies, leading to better targeting and the possibility of eliminating cholera from the island.

OBJETIVO: Determinar si la prevalencia de los factores de riesgo de cólera en la República Dominicana puede explicarse por la nacionalidad, independiente de otros factores, dada la vulnerabilidad de muchos habitantes haitianos que viven en el país y la necesidad de actividades de prevención orientadas. MÉTODOS: En julio del 2012, se llevó a cabo una encuesta domiciliaria transversal y de observación (103 hogares haitianos y 260 hogares dominicanos) en 18 comunidades. La encuesta incluía módulos sobre características demográficas, conocimientos, nivel socioeconómico y acceso a una infraestructura adecuada de agua, saneamiento e higiene (WASH). Mediante regresión logística, se evaluaron las diferencias de acceso a una infraestructura de WASH y, mediante regresión de Poisson, se evaluaron las diferencias en materia de conocimientos sobre el cólera, con control de los potenciales factores de confusión. RESULTADOS: Los hogares dominicanos y haitianos diferían en cuanto a características demográficas. Los segundos mostraban un nivel educativo inferior, una peor situación socioeconómica y menores conocimientos sobre el cólera que los hogares dominicanos (razón de posibilidades ajustada [ORa] = 0,66; intervalo de confianza de 95% [IC95%] = 0,55-0,81). El acceso a agua potable mejorada fue bajo en ambos grupos pero particularmente entre los hogares haitianos rurales (ORa = 0,21; IC95%: 0,04-1,01). No se observaron diferencias en cuanto al acceso al saneamiento después de ajustar para los factores de confusión sociodemográficos (ORa = 1,00; IC95%: 0,57-1,76). CONCLUSIONES: La geografía urbana o rural y el nivel socioeconómico repercuten más ampliamente en la prevalencia de los factores de riesgo de cólera que la nacionalidad, lo que indica que la vulnerabilidad percibida de los habitantes haitianos al cólera se confunde por factores contextuales. La comprensión de la dinámica social que conduce al riesgo de cólera puede servir de base a las estrategias de control, y llevar a una mejor orientación de las iniciativas y a la posibilidad de eliminar el cólera de la isla.

Descripción de las experiencias de las brigadas de control de vectores durante la epidemia de cólera en Haití / Experiences of the vector control brigades during the cholera epidemics in Haiti

Introducción: el cólera es una de las enfermedades infecciosas más antiguas que ocasiona epidemias y pandemias de gran magnitud, sobre todo en territorios donde el consumo de agua es de mala calidad, saneamiento ambiental deficiente y hacinamiento permanente. Objetivo: describir las experiencias de los trabajadores de vectores en el control de la epidemia de cólera en Haití. Métodos: se detallaron las tareas desarrolladas por el personal de vectores en las viviendas, en los centros de tratamientos del cólera y unidades de tratamiento del cólera atendidos por cubanos durante la epidemia desde octubre de 2010 hasta marzo de 2011. Resultados: las actividades realizadas consistieron en la preparación de soluciones desinfectante para la limpieza podal y el lavado de manos; el tratamiento de agua de consumo y uso domésticos utilizando diferentes formulaciones comerciales de cloro y tabletas de Aquatab, Polintest instachlor y Sany Tabs. Otras labores incluyeron la desinfección concurrente en ropas y excretas de pacientes, desinfección terminal y disposición y desinfección final de residuales líquidos y sólidos, así como su apoyo en pesquisas activas en la búsqueda de casos en comunas de difícil acceso y actividades de control vectorial principalmente sobre Musca domestica. Conclusiones: por primera vez se describen las experiencias de este personal de salud en el control de una epidemia de cólera, que contribuyeron junto a la labor de médicos, enfermeras y personal en general a la disminución de casos de la enfermedad en Haití, a la protección de los colaboradores cubanos y la no introducción de esta enfermedad en Cuba

Introduction: cholera is one of the oldest infectious diseases causing huge epidemics and pandemics, mainly in territories where poor-quality water consumption, deficient environmental sanitation and permanent crowding prevail. Objective: to describe the experiences gained by the vector control workers during the cholera epidemics in Haiti. Methods: details were offered about the tasks of the vector control staff in houses, cholera treatment centers and units served by Cubans during the cholera epidemics from October 2010 to March 2011. Results: the activities included preparation of disinfectant solutions for the podal cleaning and the handwashing; the treatment of drinking water and of domestic use waters through several conventional formulations of chlorine and Aquatab, Polintest instachlor and Sany Tabs tablets. Other tasks comprised concurrent disinfection in clothes and feces from patients, terminal disinfection and disposal, and final disinfection of liquid and solid wastes, as well as support to active screening for the search of positive cases in remote communes and vector control actions mainly on Musca domestica. Conclusions: for the first time, the experiences of this health staffs in the control of a cholera epidemics is described in detail; their work, together with that of physicians, nurses and other health professionals, contributed to the general reduction of cholera in Haiti, to the protection of the Cuban cooperators and to the non-introduction of this disease in Cuba

Factores ambientales vinculados con la aparición y dispersión de las epidemias de Vibrio en América del Sur / Environmental drivers of emergence and spreading of Vibrio epidemics in South America

El Vibrio cholerae y el V. parahaemolyticus son las principales especies de Vibrio que ocasionan infecciones en seres humanos. Las infecciones causadas por estos dos patógenos están teniendo una creciente importancia debido a su imparable expansión a nivel mundial. En el presente artículo se resumen los aspectos ecológicos asociados con la llegada y dispersión de las epidemias por V. parahaemolyticus y V. cholera en Perú desde una perspectiva sudamericana. De igual forma, se discute las similitudes en la aparición del cólera en 1991 y las infecciones por V. parahaemolyticus en 1997 en Perú, que sirvieron como experimentos únicos para analizar la relación entre las epidemias de Vibrio y los cambios en el medio ambiente. Estas dos radiaciones epidémicas constituyen unos claros ejemplos que apoyan la teoría de la dispersión oceánica de vibrios patógenos y permiten identificar a los episodios de El Niño como un mecanismo potencial de transmisión de enfermedades a través del océano.

Vibrio cholerae and V. parahaemolyticus are the two Vibrio species with a major impact on human health. Diseases caused by both pathogens are acquiring increasing relevance due to their expansion at global scale. In this paper, we resume the ecological aspects associated with the arrival and spreading of infections caused by V. parahaemolyticus and V. cholerae in Peru from a South American perspective. Moreover, we discuss the similarities in the emergence in Peru of cholera cases in 1991 and V. parahaemolyticus infections in 1997. These constituted exceptional experiments to evaluate the relationships between the Vibrio epidemics and changes in the environment. The epidemic radiations of V. cholerae and V. parahaemolyticus constitute to clear examples supporting the oceanic dispersion of pathogenic vibrios and have enabled the identification of El Niño events as a potential mechanism for the spreading of diseases through the ocean.

Coping with Cholera: the Importance of Coordinated Planning

Cholera epidemics in Zimbabwe; Haiti; and Nigeria have grabbed worldwide headlines in the last couple of years as beleagured health agencies battled to contain a rising tide of patients. Is this resurgence a pathological issue; or simply the consequence of poor public health provision? Superficially there should be little excuse for the epidemics of the size we have witnessed recently (more than 1500 died in the outbreak in Nigeria in 2010); cholera is not a mystery illness; and measures to contain an outbreak are known. But the logistics can be daunting and if health systems are weak; they can quickly become overwhelmed. Can one prepare? Of course. and in fact it is a must. As with all infectious diseases; lessons from one campaign will educate and illuminate actions for another. Hospitals and communities should be undertaking regular risk assessments; and providing quality training and resources to enable swift and decisive action the moment a problem is identified. Until the 1980s most outbreaks were managed at the local level using the best available common sense. Apart from in the most densely populated areas; this was largely successful. Slowly; public health experts started comparing notes and the compilation of guidelines for the control of cholera outbreaks started to emerge with epidemiologists from WHO helping to `join up the dots' between experiences in different continents and countries

Retractación en: Historia del cólera en el Perú en 1991 / Retracted of: History of cholera in Peru in 1991

El cólera es una enfermedad infecciosa aguda, que su sola mención asusta. Hasta el siglo XIX, el cólera existía únicamente en Asia y en la India, posteriormente se extendió siguiendo las rutas comerciales por casi todo el mundo causando 6 pandemias desde 1817 a 1923. Posteriormente volvió a limitarse a regiones del Sudeste de Asia. Salvo una epidemia aislada ocurrida en 1947 en Egipto. El cólera hace su aparición en América del Sur a fines del mes de enero de 1991, en Chancay - Perú, extendiéndose rápidamente a otras ciudades como Chimbote, Piura, Callao, Lima y posteriormente a casi todos los departamentos en la Costa, Sierra y Selva del Perú y luego a casi todo América. A pesar de las dificultades económicas, laborales, logísticas, etc, la epidemia de 1991 en el Perú fue adecuadamente manejada, controlada y la letalidad fue una de las más bajas del mundo. En América ha resurgido el 2010 el cólera en Haití, por ello debemos estar siempre alertas. Este trabajo tiene como objetivo presentar las condiciones económicas y sanitarias a su ingreso al Perú, curso de la epidemia, manejo y lecciones aprendidas.

Cholera is an acute infectious disease, its mere mention scary. Until the nineteenth century, cholera was only in Asia and India, then spread along trade routes by almost 6 causing worldwide pandemics from 1817 to 1923. Later again limited to regions of Southeast Asia. Except for isolated epidemics occurred in 1947 in Egypt. The cholera made its appearance in South America in late January 1991, Chancay - Perú, spreading rapidly to other cities like Chimbote, Piura, Callao, Lima and then to almost every department in the Costa, Sierra y Selva Peru and then to almost every American. Despite economic difficulties, labor, logistics, etc. The 1991 epidemic in Peru was handled properly controlled and lethality was one of the lowest in the world. In 2010, America has emerged cholera in Haiti, so we must be alert. This paper aims to present the economic and health conditions to enter Perú, epidemic, management and lessons learned.

[ cholera outbreak investigation in Karaj district in 2008]

However outbreaks of cholera are not very common in central area of Iran, in 2008 district health authority reported a cluster of diarrhea cases. We investigated this cluster to identify the etiological agent, source of transmission and propose control measures. We defined a case of diarrhea as occurrence of > or =3 loose/watery stools a day among the residents of Karaj. Fifty four [54] cases were identified in health care centers and 106 healthy individuals as control. We conducted a gender- and age-matched case-control study to identify risk factors. Vibrio cholerae El Tor O1 Inaba was isolated from all cases rectal swabs. during cholera epidemic outbreak in 2007, 54 cases of stool-culture were vibrio cholera, serotype Inaba positive. Using industrial-ice and fruits and vegetables were significantly associated with the illness [OR 4.4 and 3.3 respectively]. This outbreak was due to a contaminated industrial-ice and contaminated vegetables and fruits and V. cholera 01 Inaba was possibly the causative organism. Therefore more prevention program and observation methods should be considered

Cholera in Iraq

During the period between 14th of September, 2007 and 13th of January, 2008 a total of 4,697 laboratory-confirmed cases of cholera were reported from 46 districts in eleven provinces of Iraq [Kirkuk, Sulaimaniyah, Erbil, Dahuk, Tikrit, Ninewa, Baghdad, Basra, Wasit, Anbarand Diyala]. Twenty-four of these cases were fatal [CFR = 0.51%.]. V. Cholerae biotype Inaba was isolated in 99% of all samples tested. The outbreak was first reported from Kirkuk, Sulaimaniyah and Erbil provinces in the Northern part of the Country. The three provinces account for 98% [4,520] of the total reported cases of cholera in the Country. However, in the last few weeks the number of cases has been slowly coming down in these three provinces. In the last six weeks, most of the cases were reported from the capital city, Baghdad. Contaminated water was identified as the commonest vehicle of transmission of this outbreak. In response to the outbreak, Ministry of Health, Iraq, with the support of WHO Country and Regional offices and in collaboration with other partners have put in place control measures to contain the spread of the outbreak

Cholera outbreak in southern Sudan

During the later part of May 2008, an outbreak of cholera was confirmed at Magwi county of Eastern Equatoria state, one of the 10 states of southern Sudan. The laboratory test done on stool samples at the AMREF laboratory in Kenya isolated Vibrio cholerae 01 serotype Ogawa as the causative pathogen for this outbreak. The Ministry of Health of southern Sudan reported a total number of 181 suspected cases of cholera including 18 deaths [CFR:10%] between 28 April to 17 May 2008. Most of the cases are clustered around three payams of Magwi county– Magwi Center, Pajok and Owinyikibul. The source of infection for this current outbreak has been presumed to be contaminated water and environmental risk factors like use of river water contaminated with human waste, poor sanitation in the affected areas have been identified as the main reason for propagation of this outbreak

Is cholera outbreak related to climate factors? report of seven year study from 21th March 1998-to 21th March 2004 in Iran

Cholera is a main food and water borne diseases world wide. This study was conducted to in order to find out is there any relation between Cholera outbreak and climate factors. The number of cholera infection during seven years [1998-2004] compared with the same year climate data. In addition the epidemiology of infection was surveyed in order to find out the possible link. The results of this study indicated that with decreasing or increasing from minimum or maximum range of temperature the outbreaks is dropped down sharply. The humidity around 50% is also prepared the best condition for the outbreak too. Cholera outbreaks could be related with many climate factors. Some factors including moderate temperature [25°C] and humidity increase the risk of epidemic conditions. However the rainfall above 294 mm in the rain seasons and high temperature above 49.6 in hot seasons are the major factors which could be related to cholera epidemic

Riesgo de transmisión del cólera a través de pescados, mariscos y hortalizas: síntesis de evidencia / Cholera transmission risk through seafood and vegetables: evidence synthesis

La presente revisión responde a una solicitud de la División de Rectoría y Regulación del Ministerio de Salud, y tiene por objetivo evaluar, a través de una revisión sistemática de la literatura, el rol de la ingesta de mariscos, pescados y hortalizas crudas, en la transmisión del cólera. La solicitud tiene su origen en la detección reciente del Vibrio cholerae 01 en una muestra de agua obtenida desde una estación de vigilancia ambiental ubicada en el Río Maipo, y en incertidumbres respecto a la importancia de la transmisión de la infección a través de los alimentos, por las implicancias que ello tiene desde el punto de vista regulatorio y económico. Las preguntas específicas que se plantea resolver la presente evaluación son las siguientes: ¿Cuál es la mejor evidencia disponible de que la ingesta de alimentos contaminados constituye un mecanismo de transmisión del cólera? Si dicha evidencia es concluyente: ¿Qué alimentos han estado asociados preferentemente en la transmisión? ¿Qué magnitud puede alcanzar la transmisión por alimentos en el curso de un brote de cólera, y bajo qué condiciones del entorno?.

Cólera no Brasil: a sétima pandemia / Cholera in Brazil: the seventh pandemy

Neste trabalho, composto de quatro artigos, discutimos a instalação e propagação da sétima pandemia de cólera no Brasil, seu determinantes, formas de transmissão e impacto sobre a população.