Contaminated stream water causes cholera in a village of hilly area -Kalahandi, Eastern India, 2009

Background: In August, 2009 a cluster of diarrhoea cases was reported in a rural hilly village of Kalahandi, Orissa, Eastern India. We investigated the cluster to identify risk factors and propose recommendations.

Methods: We searched door-to-door for case-patients with three or more loose stools within 24-hours with or without vomiting and dehydration since 11 August in a resident of the village. We described the outbreak by time, place and person. We compared the case-patients with controls for the frequency of water consumption practices. We calculated odds ratio (OR), confidence intervals (CI) and population attributable fractions (PAF). We collected rectal swabs for laboratory confirmation.

Results: We identified 27 cases, with two deaths (Attack rate: 52%, case-fatality: 7.4%). The attack rate was highest among 35-44 years (10/13, 77%) and female (17/29, 59%). Starting from 11 August, cases peaked on 15 August and after that no case was reported. We isolated Vibrio cholerae O1 from six of the eight rectal swabs. Of the 27case-patients, 23 consumed stream water (85%) as compared to 52% of the 25 controls (OR: 5.3, 95% CI: 1.2-24.8, PAF: 68%). On 31 July, the initial case-patients from a hilly area above the affected village washed their soiled clothes in the stream that runs down.

Conclusions: Stream water was contaminated by the washing of soiled clothes by the primary cases from another area above the affected village was responsible for the outbreak. We recommended to (1) restrict the use of stream water (2) adopt household safe-water practices (3) use tube well water. 

Author (s): 

Dasmohapatra S, Manickam P, Murhekar MV

Presenter (s): 
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