title: An Outbreak of Vibrio cholerae O1 infections on Ebeye Island, Republic of the Marshall Islands, associated with use of an adequately chlorinated water source.
abstract: In December 2000, physicians in the Republic of the Marshall Islands reported the first known outbreak of Vibrio cholerae O1 infection (biotype El Tor, serotype Ogawa) from this country. In a matched case-control study on Ebeye Island, patients with cholera (n=53) had greater odds than persons without cholera (n=104) to have drunk adequately chlorinated water collected from a US military installation on neighboring Kwajalein Island and transported back to Ebeye (matched odds ratio [MOR], 8.0; P=.01). Transporting or storing drinking water in a water cooler with a spout and a tight-fitting lid was associated with reduced odds of illness (MOR, 0.24; P<.01), as was drinking bottled water (MOR, 0.08; P<.01), boiled water (MOR, 0.47; P=.02), or water flavored with powdered drink mixes (MOR, 0.18; P<.01). No cases of cholera were reported among Kwajalein residents. This outbreak highlights the critical importance of handling and storing drinking water safely, especially during outbreaks of gastrointestinal illness.
authors.affiliation: Epidemic Intelligence Service, Division of Applied Public Health Training, Epidemiology Program Office, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA. zbn5@cdc.gov
authors.forename: Mark E
authors.initials: ME
authors.lastname: Beatty
authors.forename: Tom
authors.initials: T
authors.lastname: Jack
authors.forename: Sumathi
authors.initials: S
authors.lastname: Sivapalasingam
authors.forename: Sandra S
authors.initials: SS
authors.lastname: Yao
authors.forename: Irene
authors.initials: I
authors.lastname: Paul
authors.forename: Bill
authors.initials: B
authors.lastname: Bibb
authors.forename: Kathy D
authors.initials: KD
authors.lastname: Greene
authors.forename: Kristy
authors.initials: K
authors.lastname: Kubota
authors.forename: Eric D
authors.initials: ED
authors.lastname: Mintz
authors.forename: John T
authors.initials: JT
authors.lastname: Brooks
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D002713:Chlorine / Q000494:pharmacology; D002771:Cholera / Q000453:epidemiology*; D004196:Disease Outbreaks; D005260:Female; D006801:Humans; D006875:Hydrotherapy; D008297:Male; D008849:Micronesia / Q000453:epidemiology; D008875:Middle Aged; D014734:Vibrio cholerae / Q000187:drug effects; D014881:Water Supply
chemical_list: D002713:Chlorine