Cholera epidemic associated with consumption of unsafe drinking water and street-vended water--Eastern Freetown, Sierra Leone, 2012.
During 2012, Sierra Leone experienced a cholera epidemic with 22,815 reported cases and 296 deaths. We conducted a matched case-control study to assess risk factors, enrolling 49 cases and 98 controls. Stool specimens were analyzed by culture, polymerase chain reaction (PCR), and pulsed-field gel electrophoresis (PFGE). Conditional logistic regression found that consuming unsafe water (matched odds ratio [mOR]: 3.4; 95% confidence interval [CI]: 1.1, 11.0), street-vended water (mOR: 9.4; 95% CI: 2.0, 43.7), and crab (mOR: 3.3; 95% CI: 1.03, 10.6) were significant risk factors for cholera infection. Of 30 stool specimens, 13 (43%) showed PCR evidence of toxigenic Vibrio cholerae O1. Six specimens yielded isolates of V. cholerae O1, El Tor; PFGE identified a pattern previously observed in seven countries. We recommended ensuring the quality of improved water sources, promoting household chlorination, and educating street vendors on water handling practices.
Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Disease Control and Prevention, Sierra Leone Ministry of Health and Sanitation, Freetown, Sierra Leone; WHO Representative Office, Sierra Leone World Health Organization Country Office, Freetown, Sierra Leone; Environmental Microbiology Laboratory, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh.
Von D
VD
Nguyen
Nandini
N
Sreenivasan
Eugene
E
Lam
Tracy
T
Ayers
David
D
Kargbo
Foday
F
Dafae
Amara
A
Jambai
Wondimagegnehu
W
Alemu
Abdul
A
Kamara
M Sirajul
MS
Islam
Steven
S
Stroika
Cheryl
C
Bopp
Robert
R
Quick
Eric D
ED
Mintz
Joan M
JM
Brunkard
D000293:Adolescent; D000328:Adult; D000368:Aged; D000818:Animals; D003386:Brachyura / Q000382:microbiology*; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D002771:Cholera / Q000453:epidemiology* / Q000382:microbiology; D060766:Drinking Water / Q000382:microbiology*; D004435:Eating; D058872:Epidemics; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D012307:Risk Factors; D012758:Shellfish / Q000382:microbiology*; D012807:Sierra Leone / Q000453:epidemiology; D014734:Vibrio cholerae / Q000235:genetics / Q000302:isolation & purification*; D014881:Water Supply; D055815:Young Adult
D060766:Drinking Water