Outbreak of V. cholera in a rural area of Punjab, Pakistan-August 2009

Background: On August 14, 2009, District Health Authorities were informed about an increased number of acute watery diarrhea (AWD) cases in a village of Arifwala tehsil with two deaths. A team was sent to investigate the outbreak, confirm the diagnosis, identify the risk factors and recommend control measures.

Method: The outbreak investigation was carried out from 15th to 18th August, 2009. The case definition used was any person residing in this village having three or more loose stools in 24 hours from 14th to 16th August, 2009. Water and stool samples were collected.

Results: A total 175 AWD patients were reported at the health facility; 89 (51%) were male and the mean age was 10 years (range: 23days-75 years). Along with diarrhea, other common symptoms were fever (n= 46, 27%), abdominal pain (n= 46, 27%) and vomiting (n= 26, 15%). Children under 5 years were the most affected group (n=92, 52.6%). V. cholera was isolated from one out of three stool samples during the investigation. Fourteen water samples were collected from households and main sources; 12 were found to be contaminated and unsafe for human consumption due to fecal contamination.

Conclusion and Recommendations: Presence of fecal contamination in water samples indicates the mixing of sewage and drinking water and is likely the cause of the outbreak. Oral rehydration therapy, water chlorination, disconnecting the municipal water supply, use of boiled water and a health education campaign helped control the outbreak from August 18, 2009, onward. Based on the findings, Tehsil Municipal Administration Arifwala allocated about 2 million Rupees for improvement of the sewage system and a safe drinking water supply.

For more information, email the presenter at: drabbasch@hotmail.com

Author (s): 

Rana Imtiaz Ahmed, Jamil Ahmed Ansari, Rana Jawad Asghar

Presenter (s): 
Dr. Mohammad Abbas
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