Impact of Rapid Urbanization on the Rates of Infection by Vibrio cholerae O1 and Enterotoxigenic Escherichia coli in Dhaka, Bangladesh

Abstract

BackgroundIn Bangladesh, increases in cholera epidemics are being documented with a greater incidence and severity. The aim of this prospective study was to identify the prevalence and importance of V. cholerae O1 and enterotoxigenic Escherichia coli (ETEC) as causal agents of severe diarrhea in a high diarrhea prone urban area in Dhaka city.MethodologySystematic surveillance was carried out on all diarrheal patients admitted from Mirpur between March 2008 to February 2010 at the ICDDR, B hospital. Stool or rectal swabs were collected from every third diarrheal patient for microbiological evaluation.Principal FindingsOf diarrheal patients attending the hospital from Mirpur, 41% suffered from severe dehydration with 39% requiring intravenous rehydration therapy. More diarrheal patients were above five years of age (64%) than those below five years of age (36%). About 60% of the patients above five years of age had severe dehydration compared with only 9% of patients under five years of age. The most prevalent pathogen isolated was Vibrio cholerae O1 (23%) followed by ETEC (11%). About 8% of cholera infection was seen in infants with the youngest children being one month of age while in the case of ETEC the rate was 11%. Of the isolated ETEC strains, the enterotoxin type were almost equally distributed; ST accounted for 31% of strains; LT/ST for 38% and LT for 31%.Conclusion V. cholerae O1 is the major bacterial pathogen and a cause of severe cholera disease in 23% of patients from Mirpur. This represents a socioeconomic group that best reflects the major areas of high cholera burden in the country. Vaccines that can target such high risk groups in the country and the region will hopefully be able to reduce the disease morbidity and the transmission of pathogens that impact the life and health of people.

Enterotoxigenic Escherichia coli associated with childhood diarrhoea in Colombia, South America

“…Several countries in the world report ETEC as the most common cause of diarrhoea among all E. coli intestinal pathotypes, among them Bangladesh, Egypt and Mexico [36][37][38]. In addition, ETEC is known to be the most frequent cause of traveller's diarrhoea [39][40][41]. In other countries in Latin America, however, ETEC may not be as frequent as in Colombia.…”

Diarrhoeal Diseases in Developing Countries: A Situational Analysis

“…Of the isolated ETEC strains, the enterotoxin type were almost equally distributed; ST accounted for 31% of strains; LT/ST for 38% and LT for 31%. 18 During the dry season, acute watery diarrhoea is the most common type of diarrhoea in children under five years in a study in Tanzania and overall, bacteria and viruses contributed equally accounting for 33.2% and 32.2% of all the cases, respectively. 23 Of the estimated 165 million cases of Shigella diarrhoea that occur annually, 99% occur in developing countries out of which 69% of episodes occur in children under five years of age.…”

“…About 60% of the patients above five years of age had severe dehydration compared with only 9% of patients under five years of age. 18 Egypt study reported that in order of contribution to risk prediction, household meat consumption, mother's age at the time of birth of the child, child's age, and father's illiteracy were significant factors, while Ethiopia study found that well source of water and acute respiratory infections (ARI) in the previous two weeks were found to be significantly associated with occurrence of diarrhoeal disease in the logistic regression analysis. 9,11 Another study found that use of cover material during drinking water transportation, faeces seen around the pit-hole and bottle feeding were the only significant variables on multivariate analysis.…”

Uptake during an oral cholera vaccine pilot demonstration program, Odisha, India

“…[1][2][3][4] The World Health Organization (WHO) has recommended the preemptive use of oral cholera vaccines (OCV) with vulnerable populations in endemic settings as well as reactive implementation during epidemics. [5][6][7] Implementation of OCV campaigns in these settings is considered an opportunity to decrease morbidity and prevent the loss of thousands of lives.…”