Cholera Epidemic Associated with Consumption of Unsafe Drinking Water and Street-Vended Water—Eastern Freetown, Sierra Leone, 2012

Abstract

Abstract. During 2012, Sierra Leone experienced a cholera epidemic with 22,815 reported cases and 296 deaths. We conducted a matched case-control study to assess risk factors, enrolling 49 cases and 98 controls. Stool specimens were analyzed by culture, polymerase chain reaction (PCR), and pulsed-field gel electrophoresis (PFGE). Conditional logistic regression found that consuming unsafe water (matched odds ratio [mOR]: 3.4; 95% confidence interval [CI]: 1.1, 11.0), street-vended water (mOR: 9.4; 95% CI: 2.0, 43.7), and crab (mOR: 3.3; 95% CI: 1.03, 10.6) were significant risk factors for cholera infection. Of 30 stool specimens, 13 (43%) showed PCR evidence of toxigenic Vibrio cholerae O1. Six specimens yielded isolates of V. cholerae O1, El Tor; PFGE identified a pattern previously observed in seven countries. We recommended ensuring the quality of improved water sources, promoting household chlorination, and educating street vendors on water handling practices.

Prevention and control of cholera with household and community water, sanitation and hygiene (WASH) interventions: A scoping review of current international guidelines

“…contaminated water in lakes and rivers, or a faecal-contaminated environment) [25]: this is known as the environment-to-human transmission pathway [26,27]. Infection with V. cholerae can also occur between infected and susceptible individuals [28,29], from consuming contaminated food [30][31][32][33][34][35][36][37] or water at the point of use (POU) [37][38][39][40][41][42][43] that has been contaminated by a cholera case or through caring for existing cholera cases, particularly among household contacts of a case [28]: this is known as the human-to-human transmission pathway. During outbreaks, recurrent environment-to-human reinfection of the population may also occur through ingestion of V. cholerae through contaminated environmental point sources, due to sustained contamination of the environment by symptomatic and asymptomatic cholera cases [25,44,45].…”

Factors Determining Water Treatment Behavior for the Prevention of Cholera in Chad

“…15 The role of unsafe water as a risk factor and the effectiveness of water treatment have also been shown in the context of cholera epidemics. 18,19 In their spatial analysis of risk factors, Sasaki and others 11 describe the risk for infection with cholera as a result of individual hygiene behaviors in addition to environmental circumstances. In this sense, the application and continued usage of point-of-use water treatment technologies directly rely on the end user's behavior, wherever necessary infrastructural or environmental factors are given.…”

Characterization of Vibrio cholerae Strains Isolated from the Nigerian Cholera Outbreak in 2010

“…Our findings highlight the need for the accurate diagnosis of V. cholerae during cholera epidemics to guide the implementation of appropriate life-saving interventions. This scenario has been reported during cholera outbreaks in many countries where cholera is endemic, such as Bangladesh, Tanzania, and Sierra Leone (27,28,29), and currently during the ongoing outbreak in Tanzania (WHO).…”