First do no harm: making oral rehydration solution safer in a cholera epidemic.
Oral rehydration solution (ORS) is lifesaving therapy for cholera and pediatric diarrhea. During a cholera epidemic in Guinea-Bissau, we evaluated the microbiologic quality of ORS prepared at a hospital and tested a simple intervention using special vessels for disinfecting tap water with bleach and for preparing, storing, and dispensing ORS. Few coliform bacteria and Escherichia coli were recovered from tap water; however, pre-intervention ORS contained numerous bacteria including E. coli and toxigenic Vibrio cholerae O1. In contrast, ORS samples from intervention vessels had few or no coliform bacteria, no E. coli, and no V. cholerae. Mean pre-intervention counts of coliform bacteria (3.4 x 10(7) colony-forming units [cfu]/100 ml) and E. coli (6.2 x 10(3) cfu) decreased significantly during the intervention period to 3.6 x 10(2) cfu and 0 cfu, respectively (P < 0.001). This simple system using bleach disinfectant and special storage vessels prevents bacterial contamination of ORS and reduces the risk of nosocomial transmission of cholera and other enteric pathogens.
Foodborne and Diarrheal Diseases Branch, Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
N A
NA
Daniels
S L
SL
Simons
A
A
Rodrigues
G
G
Gunnlaugsson
T S
TS
Forster
J G
JG
Wells
L
L
Hutwagner
R V
RV
Tauxe
E D
ED
Mintz
D000372:Agglutination Tests; D002771:Cholera / Q000453:epidemiology / Q000517:prevention & control / Q000628:therapy*; D015169:Colony Count, Microbial; D003428:Cross Infection / Q000517:prevention & control; D003967:Diarrhea / Q000453:epidemiology / Q000517:prevention & control / Q000628:therapy; D004196:Disease Outbreaks; D004926:Escherichia coli / Q000302:isolation & purification; D005440:Fluid Therapy / Q000379:methods*; D006169:Guinea-Bissau / Q000453:epidemiology; D006801:Humans; D015532:Rehydration Solutions / Q000592:standards*; D014734:Vibrio cholerae / Q000302:isolation & purification / Q000472:pathogenicity*; D014871:Water Microbiology
D015532:Rehydration Solutions