title: Epidemiological and laboratory investigations of outbreaks of diarrhoea in rural South India: implications for control of disease.
abstract: Two epidemics of acute, watery diarrhoea in villages in North Arcot district, India, were investigated. The attack rates were 10.03 and 15.53 per 100 population, the median duration was 5 days and enteric pathogens were present in 56.8% and 60.3% of specimens from the two villages, but no predominant pathogen was identified. Examination of stools from a 20% age-stratified random sample of the population of one of the villages after the epidemic found 22.9% of asymptomatic subjects excreted bacterial enteric pathogens. Despite the high background of enteric pathogen carriage, the isolation rates for shigellae, enteropathogenic Escherichia coli and Shiga-toxin producing E. coli were significantly higher (P < 0.001, P < 0.02, P < 0.05) during the epidemic. The epidemics may have been caused by faecal contamination of well water following rain. Point-of-use techniques for water disinfection may be most effective for preventing such outbreaks, but further research into the development of appropriate technology is required.
authors.affiliation: Department of Gastrointestinal Sciences, Christian Medical College and Hospital, Vellore, India.
authors.forename: G
authors.initials: G
authors.lastname: Kang
authors.forename: B S
authors.initials: BS
authors.lastname: Ramakrishna
authors.forename: J
authors.initials: J
authors.lastname: Daniel
authors.forename: M
authors.initials: M
authors.lastname: Mathan
authors.forename: V I
authors.initials: VI
authors.lastname: Mathan
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D003967:Diarrhea / Q000453:epidemiology* / Q000382:microbiology / Q000469:parasitology; D004196:Disease Outbreaks; D004812:Epidemiologic Methods; D005243:Feces / Q000382:microbiology; D005260:Female; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D012424:Rural Population; D014871:Water Microbiology