Outbreak of Cholera in Tilathi VDC Saptari Nepal

Yadav, Deepak; Tamrakar, Dipesh; Baral, Ratna; Jha, Pramod; Gautam, Sanjay S.; Pokharel, PK

doi:10.3126/kumj.v10i4.10992

Cited by 9 publications

(11 citation statements)

References 8 publications

(8 reference statements)

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“…Contrary to this, adult populations of age group 20–30 years were highly infected accounting for 8.7% as compared to all other aged groups (3.4%) in our context (p = 0.018). The studies by Kansakar et al [ 22 ] and Yadav et al [ 32 ] found similar results in which most of the infected patients were adults aged 20 to 29 years and 15 to 29 years respectively. The greater incidence of infections in these groups was found because of their food habits outside the home including consumption of street food.…”

Section: Discussionmentioning

confidence: 57%

Multidrug resistant Vibrio cholerae O1 from clinical and environmental samples in Kathmandu city

Shrestha¹,

Adhikari²,

Maharjan³

et al. 2015

BMC Infect Dis

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BackgroundCholera, an infectious disease caused by Vibrio cholerae, is a major public health problem and is a particularly burden in developing countries including Nepal. Although the recent worldwide outbreaks of cholera have been due to V. cholerae El Tor, the classical biotypes are still predominant in Nepal. Serogroup O1 of the V. cholerae classical biotype was the primary cause of a cholera outbreak in Kathmandu in 2012. Thus, this study was designed to know serotypes and biotypes of V. cholerae strains causing recent outbreak with reference to drug resistant patterns. Moreover, we also report the toxigenic strains of V. cholerae from both environmental and clinical specimens by detecting the ctx gene.MethodsTwenty four V. cholerae (n = 22 from stool samples and n = 2 from water samples) isolated in this study were subjected to Serotyping and biotyping following the standard protocols as described previously. All of the isolates were tested for antimicrobial susceptibility patterns using the modified Kirby-Bauer disk diffusion method as recommended by CLSI guidelines. The screening of the ctx genes (ctxA2-B gene) were performed by PCR method using a pair of primers; C2F (5′-AGGTGTAAAATTCCTTGACGA-3′) and C2R (5′-TCCTCAGGGTATCCTTCATC-3′) to identify the toxigenic strains of V. cholerae.ResultsAmong twenty four V. cholerae isolates, 91.7% were clinical and 8.3% were from water samples. Higher rate of V. cholerae infection was found among adults of aged group 20–30 years. All isolates were serogroups O1 of the V. cholerae classical biotype and sub serotype, Ogawa. All isolates were resistant to ampicillin, nalidixic acid and cotrimoxazole. 90.9% were resistant to erythromycin however, tetracycline was found to be the most effective drug for the isolates. All isolates were multidrug resistant (MDR) and possessed a ctx gene of approximately 400 base pairs indicating the toxigenic strains.ConclusionHundred percent strains of V. cholerae were MDR possessing a ctx gene. It suggests that toxigenic strains be identified and proper antibiotic susceptibility testing be conducted. This will allow effective empirical therapy to be used to treat and control cholera.

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Section: Discussionmentioning

confidence: 57%

Multidrug resistant Vibrio cholerae O1 from clinical and environmental samples in Kathmandu city

Shrestha¹,

Adhikari²,

Maharjan³

et al. 2015

BMC Infect Dis

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“…However, despite the presence of EWARS in nearly 80% of the outbreaks examined, the median delay to response was 10 days. Where EWARS was used successfully to link early detection with a preliminary and robust response, for example in Afghanistan (2010-1), Nepal (2011-6), and Northern Nigeria (2018), a timely response was judged to be dependent on adequate and trained human resources (e.g., district-level rapid response teams or local health facility staff capable of multidisciplinary investigation and a generic response [63,162]), and the ability to mount at least a preliminary response moving forward independent of laboratory confirmation [52,75,100,101,139,161,171]. For example, investigation and response were integrated in Afghanistan (2010) where a local NGO was trained rapidly to carry out a comprehensive community response, as they had more access to the area than health authorities in an insecure area [52].…”

Section: Discussionmentioning

confidence: 99%

“…In Somalia, faster response in insecure urban areas using EWARS in 2016 and 2018 can be compared to a lack of a comprehensive early response during ongoing transmission over 2 months in 2008 (14-and 19-day delays versus 2-month delay, ID 54-56). Nepal's EWARS facilitated rapid detection and response to clusters from 2011 onwards (total delays 6-9 days, ID 42-44) [75,130,162]. In 2016, RDT capacity was added at health facilities to enable better discrimination between alerts of cholera or diarrhea due to other pathogens [161].…”

Section: Factors Associated With Delaysmentioning

confidence: 99%

Early detection of cholera epidemics to support control in fragile states: estimation of delays and potential epidemic sizes

Ratnayake

Finger²,

Edmunds

et al. 2020

BMC Med

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Background Cholera epidemics continue to challenge disease control, particularly in fragile and conflict-affected states. Rapid detection and response to small cholera clusters is key for efficient control before an epidemic propagates. To understand the capacity for early response in fragile states, we investigated delays in outbreak detection, investigation, response, and laboratory confirmation, and we estimated epidemic sizes. We assessed predictors of delays, and annual changes in response time. Methods We compiled a list of cholera outbreaks in fragile and conflict-affected states from 2008 to 2019. We searched for peer-reviewed articles and epidemiological reports. We evaluated delays from the dates of symptom onset of the primary case, and the earliest dates of outbreak detection, investigation, response, and confirmation. Information on how the outbreak was alerted was summarized. A branching process model was used to estimate epidemic size at each delay. Regression models were used to investigate the association between predictors and delays to response. Results Seventy-six outbreaks from 34 countries were included. Median delays spanned 1–2 weeks: from symptom onset of the primary case to presentation at the health facility (5 days, IQR 5–5), detection (5 days, IQR 5–6), investigation (7 days, IQR 5.8–13.3), response (10 days, IQR 7–18), and confirmation (11 days, IQR 7–16). In the model simulation, the median delay to response (10 days) with 3 seed cases led to a median epidemic size of 12 cases (upper range, 47) and 8% of outbreaks ≥ 20 cases (increasing to 32% with a 30-day delay to response). Increased outbreak size at detection (10 seed cases) and a 10-day median delay to response resulted in an epidemic size of 34 cases (upper range 67 cases) and < 1% of outbreaks < 20 cases. We estimated an annual global decrease in delay to response of 5.2% (95% CI 0.5–9.6, p = 0.03). Outbreaks signaled by immediate alerts were associated with a reduction in delay to response of 39.3% (95% CI 5.7–61.0, p = 0.03). Conclusions From 2008 to 2019, median delays from symptom onset of the primary case to case presentation and to response were 5 days and 10 days, respectively. Our model simulations suggest that depending on the outbreak size (3 versus 10 seed cases), in 8 to 99% of scenarios, a 10-day delay to response would result in large clusters that would be difficult to contain. Improving the delay to response involves rethinking the integration at local levels of event-based detection, rapid diagnostic testing for cluster validation, and integrated alert, investigation, and response.

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“…Other studies have documented youthful populations as the most affected age group. 10,14,15 In direct contrast to this, other studies have reported children and elderly people mostly affected by cholera. 16,17 About 37.2% (123/331) of the collected stool samples and rectal swabs from various health facilities in the metropolis were confirmed positive for cholera.…”

Section: Discussionmentioning

confidence: 88%

Protracted cholera outbreak in the Central Region, Ghana, 2016

Issahaku

Asiedu-Bekoe

Kwashie

et al. 2020

gmj

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Objective: On 24th October 2016, the Central Regional Health Directorate received report of a suspected cholera outbreak in the Cape Coast Metropolis (CCM). We investigated to confirm the diagnosis, identify risk factors and implement control measures.Design: We used a descriptive study followed by 1:2 unmatched case-control study.Data source: We reviewed medical records, conducted active case search and contact tracing, interviewed case-patients and their contacts and conducted environmental assessment. Case-patients' stool samples were tested with point of care test kits (SD Bioline Cholera Ag 01/0139) and sent to the Cape Coast Teaching Hospital Laboratory for confirmation.Main outcomes: Cause of outbreak, risk factors associated with spread of outbreakResults: Vibrio cholerae serotype Ogawa caused the outbreak. There was no mortality. Of 704 case-patients, 371(52.7%) were males and 55(7.8%) were aged under-five years. The median age was 23 years (interquartile range: 16-32 years). About a third 248(35.2%) of the case patients were aged 15-24 years. The University of Cape Coast subdistrict was the epicenter with 341(48.44%) cases. Compared to controls, cholera case-patients were more likely to have visited Cholera Treatment Centers (CTC) (aOR=12.1, 95%CI: 1.5-101.3), drank pipe-borne water (aOR=11.7, 95%CI: 3.3-41.8), or drank street-vended sachet water (aOR=11.0, 95%CI: 3.7-32.9). Open defecation and broken sewage pipes were observed in the epicenter.Conclusion: Vibrio cholerae serotype Ogawa caused the CCM cholera outbreak mostly affecting the youth. Visiting CTC was a major risk factor. Prompt case-management, contact tracing, health education, restricting access to CTC and implementing water sanitation and hygiene activities helped in the control.Keywords: Cholera outbreak, Vibrio cholerae serotype Ogawa, Cholera treatment center, Water sanitation and hygiene, Cape Coast MetropolisFunding: This work was supported by Ghana Field Epidemiology and Laboratory Training Program (GFELTP), University of Ghana

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Outbreak of Cholera in Tilathi VDC Saptari Nepal

Cited by 9 publications

References 8 publications

Multidrug resistant Vibrio cholerae O1 from clinical and environmental samples in Kathmandu city

Multidrug resistant Vibrio cholerae O1 from clinical and environmental samples in Kathmandu city

Early detection of cholera epidemics to support control in fragile states: estimation of delays and potential epidemic sizes

Protracted cholera outbreak in the Central Region, Ghana, 2016

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