Epidemic Cholera in a Crowded Urban Environment, Port-au-Prince, Haiti

Dunkle, Stacie E.; Mba‐Jonas, Adamma; Loharikar, Anagha; Fouché, Bernadette; Peck, Mireille; Ayers, Tracy; Archer, W. Roodly; Rochars, Valery Madsen Beau De; Bender, Thomas John; Moffett, Daphne B.; Tappero, Jordan W.; Dahourou, George; Roels, Thierry H.; Quick, Robert

doi:10.3201/eid1711.110772

Cited by 53 publications

(72 citation statements)

References 12 publications

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“…Handwashing with soap and water protects against cholera [16], and may become increasingly important during outbreaks as cholera contamination becomes widespread and disease dissemination is through multiple vehicles [17]. In our study, reporting the presence of soap for handwashing in the home was associated with protection against cholera (aOR 0.41; 95%CI 0.19, 0.87).…”

Section: Discussionmentioning

confidence: 67%

“…cholerae by in vivo vibriolytic action of the phage and/or nonculturability induced as a host response [26]. Similar to previous studies that have relied on a high positive predictive value of the clinical case definition during cholera outbreaks [4,5,17,27-30], we did not exclude cases on microbiological confirmation of non-cholera aetiologies. The estimates of sensitivity and specificity of the POC test had wide confidence intervals due to a small sample size, however interpretation remained feasible.…”

Section: Discussionmentioning

confidence: 99%

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Cholera risk factors, Papua New Guinea, 2010

Rosewell

Addy²,

Komnapi³

et al. 2012

BMC Infect Dis

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BackgroundCholera is newly emergent in Papua New Guinea but may soon become endemic. Identifying the risk factors for cholera provides evidence for targeted prevention and control measures.MethodsWe conducted a hospital-based case–control study to identify cholera risk factors. Using stool culture as the standard, we evaluated a cholera point of care test in the field.Results176 participants were recruited: 54 cases and 122 controls. Independent risk factors for cholera were: being over 20 years of age (aOR 2.5; 95%CI 1.1, 5.4), defecating in the open air (or river) (aOR 4.5; 95% CI 1.4, 14.4) and knowing someone who travelled to a cholera affected area (aOR 4.1; 95%CI 1.6, 10.7); while the availability of soap for handwashing at home was protective (aOR 0.41; 95%CI 0.19, 0.87). Those reporting access to a piped water distribution system in the home were twice as likely to report the availability of soap for handwashing. The sensitivity and specificity of the rapid test were 72% (95% CI 47–90) and 71% (95%CI 44–90%).ConclusionsImproving population access to the piped water distribution system and sanitation will likely reduce transmission by enabling enhanced hygiene and limiting the contamination of water sources. The One step V. cholerae O1/O139 Antigen Test is of limited utility for clinical decision making in a hospital setting with access to traditional laboratory methods. Settlement dwellers and mobile populations of all age groups should be targeted for interventions in Papua New Guinea.

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Section: Discussionmentioning

confidence: 67%

Section: Discussionmentioning

confidence: 99%

Cholera risk factors, Papua New Guinea, 2010

Rosewell

Addy²,

Komnapi³

et al. 2012

BMC Infect Dis

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“…Most patients treated at the CTC live in crowded conditions with limited access to sanitation where drinking water sources included purchased water bags, bottled or filtered water, piped water and water delivered by tanker trucks 12. The GHESKIO camp for IDP established after the earthquake had a population of ∼5,000 during the time of this observation.…”

Section: Methodsmentioning

confidence: 99%

Predictors of Disease Severity in Patients Admitted to a Cholera Treatment Center in Urban Haiti

Valcin¹,

Sévère²,

Riché³

et al. 2013

The American Society of Tropical Medicine and Hygiene

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Cholera, previously unrecognized in Haiti, spread through the country in the fall of 2010. An analysis was performed to understand the epidemiological characteristics, clinical management, and risk factors for disease severity in a population seen at the GHESKIO Cholera Treatment Center in Port-au-Prince. A comprehensive review of the medical records of patients admitted during the period of October 28, 2010–July 10, 2011 was conducted. Disease severity on admission was directly correlated with older age, more prolonged length of stay, and presentation during the two epidemic waves seen in the observation period. Although there was a high seroprevalence of human immunodeficiency virus (HIV), severity of cholera was not greater with HIV infection. This study documents the correlation of cholera waves with rainfall and its reduction in settings with improved sanitary conditions and potable water when newly introduced cholera affects all ages equally so that interventions must be directed throughout the population.

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“…Copper, iron, selenium and zinc are all known to confer function in both innate and adaptive immune systems, with copper also impacting intestinal immune barriers [20]. A history of prior cholera infection has been identified as a risk factor for outbreaks of thiamine deficiency among prisoners [21], and food diversity has recently been shown to be protective against cholera in the ongoing outbreak in Haiti [22]. In our study, it would appear these outbreaks were concurrent and that symptomatic cholera infection did not cause the micronutrient deficiencies among the cases of peripheral neuropathy, as the majority (88%) of cases did not report an episode of diarrhoea in the previous three months.…”

Section: Discussionmentioning

confidence: 99%

Concurrent Outbreaks of Cholera and Peripheral Neuropathy Associated with High Mortality among Persons Internally Displaced by a Volcanic Eruption

Rosewell

Clark²,

Mabong³

et al. 2013

PLoS ONE

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BackgroundIn October 2004, Manam Island volcano in Papua New Guinea erupted, causing over 10 000 villagers to flee to internally displaced person (IDP) camps, including 550 from Dugulaba village. Following violence over land access in March 2010, the IDPs fled the camps, and four months later concurrent outbreaks of acute watery diarrhea and unusual neurological complaints were reported in this population.Materials and MethodsA retrospective case-control study was conducted to identify the risk factors for peripheral neuropathy. Rectal swabs were collected from cases of acute watery diarrhea. Hair and serum metals and metalloids were analyzed by Inductively Coupled Plasma-Mass Spectrometry (ICP-MS).ResultsThere were 17 deaths among the 550 village inhabitants during the outbreak period at a crude mortality rate 21-fold that of a humanitarian crisis. Vibrio cholerae O1 El Tor Ogawa was confirmed among the population. Access to community-level rehydration was crucial to mortality. Peripheral neuropathy was diagnosed among cases with neurological symptoms. A balanced diet was significantly protective against neuropathy. A dose-response relationship was seen between peripheral neuropathy and a decreasing number of micronutrient- rich foods in the diet. Deficiencies in copper, iron, selenium and zinc were identified among the cases of peripheral neuropathy.ConclusionsCholera likely caused the mostly preventable excess mortality. Peripheral neuropathy was not caused by cholera, but cholera may worsen existing nutritional deficiencies. The peripheral neuropathy was likely caused by complex micronutrient deficiencies linked to non-diversified diets that potentially increased the vulnerability of this population, however a new zinc-associated neuropathy could not be ruled out. Reoccurrence can be prevented by addressing the root cause of displacement and ensuring access to arable land and timely resettlement.

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Epidemic Cholera in a Crowded Urban Environment, Port-au-Prince, Haiti

Cited by 53 publications

References 12 publications

Cholera risk factors, Papua New Guinea, 2010

Cholera risk factors, Papua New Guinea, 2010

Predictors of Disease Severity in Patients Admitted to a Cholera Treatment Center in Urban Haiti

Concurrent Outbreaks of Cholera and Peripheral Neuropathy Associated with High Mortality among Persons Internally Displaced by a Volcanic Eruption

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