BackgroundCholera has caused 7 global pandemics, including the current one which has been ongoing since 1961. A systematic review of risk factors for symptomatic cholera infection has not been previously published.MethodsIn accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we performed a systematic review and meta-analysis of individual and household risk factors for symptomatic cholera infection.ResultsWe identified 110 studies eligible for inclusion in qualitative synthesis. Factors associated with symptomatic cholera that were eligible for meta-analysis included education less than secondary level (summary odds ratio [SOR], 2.64; 95% confidence interval [CI], 1.41–4.92; I2 = 8%), unimproved water source (SOR, 3.48; 95% CI, 2.18–5.54; I2 = 77%), open container water storage (SOR, 2.03; 95% CI, 1.09–3.76; I2 = 62%), consumption of food outside the home (SOR, 2.76; 95% CI, 1.62–4.69; I2 = 64%), household contact with cholera (SOR, 2.91; 95% CI, 1.62–5.25; I2 = 89%), water treatment (SOR, 0.37; 95% CI, .21–.63; I2 = 74%), and handwashing (SOR, 0.29; 95% CI, .20–.43; I2 = 37%). Other notable associations with symptomatic infection included income/wealth, blood group, gastric acidity, infant breastfeeding status, and human immunodeficiency virus infection.ConclusionsWe identified potential risk factors for symptomatic cholera infection including environmental characteristics, socioeconomic factors, and intrinsic patient factors. Ultimately, a combination of interventional approaches targeting various groups with risk-adapted intensities may prove to be the optimal strategy for cholera control.

BackgroundCholera has caused seven global pandemics, including the current one which has been ongoing since 1961. A systematic review of risk factors for symptomatic cholera infection has not been previously published.MethodsIn accordance with PRISMA guidelines, we performed a systematic review and meta-analysis of individual and household risk factors for symptomatic cholera infection.ResultsWe identified 110 studies eligible for inclusion in qualitative synthesis. Factors associated with symptomatic cholera that were eligible for meta-analysis included education less than secondary level (summary OR 2.64, 95% CI 1.41–4.92, I2 = 8%), unimproved water source (summary OR 4.78, 95% CI 3.02–7.57, I2 = 49%), open container water storage (summary OR 2.51, 95% CI 1.57–4.01, I2 = 33%), consumption of food outside the home (summary OR 5.02, 95% CI 2.34–10.76, I2 = 61%), household contact with cholera (summary OR 3.99, 95% CI 2.03–7.87, I2 = 89%), water treatment (summary OR 0.22, 95% CI 0.13–0.36, I2 = 37%), and handwashing (summary OR 0.17, 95% CI 0.10–0.30, I2 = 37%). Other notable associations with symptomatic infection included income/wealth, blood group, gastric acidity, infant breastfeeding status, and HIV infection.ConclusionWe identified potential risk factors for symptomatic cholera infection including environmental characteristics, socioeconomic factors, and intrinsic patient factors. Ultimately, a combination of interventional approaches targeting various groups with risk-adapted intensities may prove to be the optimal strategy for cholera control.Disclosures All authors: No reported disclosures.

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