title: Cholera outbreak in districts around Lake Chilwa, Malawi: lessons learned.
abstract: BACKGROUND
  Cholera is endemic in Malawi with seasonal outbreaks during the wet season. People living around Lake Chilwa rely on the lake for their water supply. From May 2009 to May 2010, a cholera outbreak occurred in fishing communities around Lake Chilwa. This paper describes the outbreak response and lessons learned for prevention and management of future outbreaks.
  
  
  METHODS
  Starting in January 2010, Médecins Sans Frontières (MSF) helped District Health Management Teams (DHMTs) to distribute educational materials, water disinfectant and hygiene supplies, and oral rehydration solution (ORS) in fishing communities. MSF also supported case management by mentoring health workers and providing equipment and supplies.
  
  
  RESULTS
  A total of 1,171 cholera cases and 21 deaths were reported in the districts around the lake, with cases also being reported on the Mozambican side of the lake. The attack rate was highest among people living on or around the lake, particularly among fishermen. Samples of lake water had high turbidity conducive to the propagation of Vibrio cholerae.
  
  
  CONCLUSIONS
  A number of practical measures could be taken to prevent future outbreaks and to manage outbreaks more effectively. These measures should address surveillance, environmental management, outbreak preparedness, and case management.
authors: Médecins Sans Frontières, Thyolo, Malawi.
authors: Amin
authors: A
authors: Khonje
authors: Carol Ann
authors: CA
authors: Metcalf
authors: Emma
authors: E
authors: Diggle
authors: Dudley
authors: D
authors: Mlozowa
authors: Chandiwira
authors: C
authors: Jere
authors: Ann
authors: A
authors: Akesson
authors: Tom
authors: T
authors: Corbet
authors: Zachariah
authors: Z
authors: Chimanga
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D002771:Cholera / Q000453:epidemiology* / Q000517:prevention & control; D003140:Communicable Disease Control / Q000379:methods*; D004196:Disease Outbreaks; D005260:Female; D006801:Humans; D060106:Lakes; D008295:Malawi / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance; D012307:Risk Factors; D011795:Surveys and Questionnaires; D014734:Vibrio cholerae; D055815:Young Adult
references: Trans R Soc Trop Med Hyg. 2002 Jan-Feb;96(1):39-40
references: 11925988
references: Vaccine. 2006 May 29;24(22):4890-5
references: 16298025
references: J Appl Microbiol. 2004;97(1):225-31
references: 15186460
references: Epidemiol Infect. 1997 Jun;118(3):207-14
references: 9207730
references: N Engl J Med. 2005 Feb 24;352(8):757-67
references: 15728808
references: Proc Natl Acad Sci U S A. 2008 Nov 18;105(46):17676-81
references: 19001267
references: N Engl J Med. 2011 Jan 6;364(1):5-7
references: 21142691
references: PLoS Negl Trop Dis. 2008 Feb 20;2(2):e173
references: 18299707
references: Bull World Health Organ. 2006 Jan;84(1):28-35
references: 16501712
references: Wkly Epidemiol Rec. 2010 Mar 26;85(13):117-28
references: 20349546
references: J Water Health. 2007 Sep;5(3):367-74
references: 17878551
references: Lancet. 1997 Apr 5;349(9057):981-5
references: 9100624
references: Clin Infect Dis. 2011 Jun;52(11):1343-9
references: 21498389
references: Am J Trop Med Hyg. 1999 Feb;60(2):271-6
references: 10072150
references: PLoS Negl Trop Dis. 2009;3(5):e436
references: 19436726
references: BMJ. 2005 Sep 3;331(7515):478
references: 16046440
references: BMJ. 2007 Apr 14;334(7597):782
references: 17353208