title: A cholera outbreak in Alborz Province, Iran: a matched case-control study.
abstract: OBJECTIVE
  A total of 229 confirmed cholera cases were reported in Alborz Province during an outbreak that lasted from June 2011 to August 2011. This study aimed to identify potential sources of transmission in order to determine suitable interventions in similar outbreaks. In other words, the lessons learned from this retrospective study can be utilized to manage future similar outbreaks.
  
  
  METHODS
  An age-matched and sex-matched case-control study was conducted during the outbreak. For each case, two control subjects were selected from the neighborhood. A case of cholera was defined as a bacteriologically confirmed case with signs and symptoms of cholera. This study was conducted from June 14, 2011 through August 23, 2011. The data were analyzed by calculating odds ratios (ORs) using the logistic regression method.
  
  
  RESULTS
  In this outbreak, 229 confirmed cholera cases were diagnosed. The following risk factors were found to be associated with cholera: consumption of unrefrigerated leftover food (OR, 3.05; 95% confidence interval [CI], 1.72 to 5.41), consumption of vegetables and fruits in the previous three days (OR, 2.75; 95% CI, 1.95 to 3.89), and a history of traveling in the previous five days (OR, 5.31; 95% CI, 2.21 to 9.72).
  
  
  CONCLUSIONS
  Consumption of vegetables and fruits has remained an unresolved risk factor in cholera outbreaks in Iran in recent years. In order to reduce the risk of cholera, sanitary standards for fruits and vegetables should be observed at all points from production to consumption, the population should be educated regarding hygienic food storage during outbreaks, and sanitary standards should be maintained when traveling during cholera outbreaks.
authors.affiliation: Social Determinants of Health Research Center, Kurdistan University of Medical Sciences, Sanandaj, Iran.
authors.forename: Ghobad
authors.initials: G
authors.lastname: Moradi
authors.affiliation: Department of Epidemiology and Biostatistics, Kurdistan University of Medical Sciences, Sanandaj, Iran.
authors.forename: Mohammad Aziz
authors.initials: MA
authors.lastname: Rasouli
authors.affiliation: Department of Nursing and Midwifery, Sanandaj Branch, Islamic Azad University, Sanandaj, Iran.
authors.forename: Parvin
authors.initials: P
authors.lastname: Mohammadi
authors.affiliation: Health Education and Health Promotion, School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
authors.forename: Elham
authors.initials: E
authors.lastname: Elahi
authors.affiliation: Health Department, Alborz University of Medical Sciences, Karaj, Iran.
authors.forename: Hojatollah
authors.initials: H
authors.lastname: Barati
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D002771:Cholera / Q000453:epidemiology*; D004196:Disease Outbreaks; D005260:Female; D006801:Humans; D007223:Infant; D007492:Iran / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult
keywords: Case-control studies; Cholera; Disease outbreaks; Iran