Cholera outbreak associated with drinking contaminated river water in Panyimur and Parombo sub-counties: Nebbi district, Uganda, March 2017
Accepted: 9 May 2022
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Introduction: On 10thFebruary 2017, Uganda Ministry of Health was notified of a suspected cholera outbreak in Nebbi district. The district experienced numerous cholera outbreaks with the latest in 2016. We investigated to determine the scope, mode of transmission, and exposures.
Methods: We defined a suspected case as sudden onset of acute watery diarrhoea in a resident (>5 years) from Parombo or Panyimur subcounties in Nebbi district, during 1 January-9 March 2017. A confirmed case was a suspected case with culture-confirmed Vibrio cholerae from stool. We conducted descriptive epidemiology of case-persons to inform hypothesis generation and a case-control study involving 67 case-persons and 134 control-persons to test the hypothesis.
Results: We identified 222 suspected case-persons; samples from two yielded Vibrio cholerae O139. Three case-persons died (CFR=1.4%). The epidemic curve indicated a point-source outbreak. Among 67 cases, 40 (60%) drank river water, compared with 56 (42%) of 134 controls (OR 2.2, 95% CI: 1.2- 4.1). Visual assessment revealed that river water had high turbidity and we observed mass open defecation.
Conclusion: This outbreak affected two sub-counties and was associated with drinking contaminated river water. We recommended treating drinking water by the community members and health education on drinking water safety and proper waste disposal in the communities. And for long term, the district water department should increase the number and functionality of boreholes or piped water in the communities.
WHO. Weekly Epideniological Record, Cholera 2016 [Internet]. Switzerland; 2017 Sep [cited 2017 Sep 28] p. 16. Report No.: Number 36. Available from: http://apps.who.int/iris/bitstream/10665/258910/1/WER9236.pdf?ua=1
David L Heymann. Control of Communicable Diseases manual [Internet]. Vol. 20th Edition. Washington: American Public Health Association; 2015 [cited 2017 Sep 14]. Available from: https://www.amazon.com/Control-Communicable-Diseases-Manual-Heymann/dp/087553189X
WHO. Cholera [Internet]. Geneva; 2017 [cited 2017 Sep 14]. (Organisation WH, editor. Fact sheet). Available from: http://www.who.int/mediacentre/factsheets/fs107/en/
WHO. Western Pacific Region (WPRO) | Cholera [Internet]. WPRO. 2012 [cited 2017 Sep 28]. Available from: http://www.wpro.who.int/mediacentre/factsheets/fs_28082012_Cholera/en/
Nsagha DS, Atashili J, Fon PN,et al. Assessing the risk factors of cholera epidemic in the Buea Health District of Cameroon. BMC Public Health [Internet]. 2015 Nov 14 [cited 2017 Sep 14];15(1):1128. Available from: https://doi.org/10.1186/s12889-015-2485-8
Bwire G, Malimbo M, Makumbi I, et al. Cholera Surveillance in Uganda: An Analysis of Notifications for the Years 2007–2011. J Infect Dis [Internet]. 2013 Nov 1;208(suppl_1):S78–85. Available from: http://dx.doi.org/10.1093/infdis/jit203
WHO. Prevention and control of cholera outbreaks: WHO policy and recommendations [Internet]. Geneva; 2017 [cited 2017 Sep 14]. (Organisation WH, editor. Global Task Force on Cholera Control). Available from: http://www.who.int/cholera/technical/prevention/control/en/
Ali M, Nelson A R, Lopez A L, Sack D A. Updated Global Burden of Cholera in Endemic Countries. PLOS Neglected Tropical Diseases. PLoS Negl Trop Dis [Internet]. 2015 [cited 2017 Sep 14];9(6)(e0003832.). Available from: http://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0003832
Andrawa M, Anguzu P, Anguaku A, et al. Risk factors for repeated cholera outbreak in Arua municipal council, north-western Uganda. Int J Infect Dis [Internet]. 2010 Mar 1 [cited 2017 Sep 28];14:e65. Available from: http://www.ijidonline.com/article/S1201-9712(10)01673-5/abstract
Cummings MJ, Wamala JF, Eyura M, et al. A cholera outbreak among semi-nomadic pastoralists in northeastern Uganda: epidemiology and interventions. Epidemiol Infect. 2012 Aug;140(8):1376–85.
WHO. WHO report on Global surveillance of epidemic prone infectious diseases [Internet]. Geneva; 2017 [cited 2017 Sep 28]. (Emergencies preparedness, response). Available from: http://www.who.int/csr/resources/publications/surveillance/WHO_CDS_CSR_ISR_2000_1/en/
Bwire G, Mugagga M, Brian M, et al. The Burden of Cholera in Uganda. PLoS Negl Trop Dis [Internet]. 2013 [cited 2017 Sep 14]; Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3855006/
Bwire G, Malimbo M, Makumbi I, et al. Cholera Surveillance in Uganda: An Analysis of Notifications for the Years 2007–2011. J Infect Dis [Internet]. 2013 Nov 1 [cited 2017 Sep 15];208(suppl_1):S78–85. Available from: https://academic.oup.com/jid/article/208/suppl_1/S78/833490/Cholera-Surveillance-in-Uganda-An-Analysis-of
UBOS. The National Population and Housing Census 2014 [Internet]. Kampala, Uganda: Uganda Bureau of Statistics: Kampala; 2014 [cited 2017 Sep 15] p. 105. Available from: http://www.ubos.org/onlinefiles/uploads/ubos/NPHC/NPHC%202014%20FINAL%20RESULTS%20REPORT.pdf
Uganda Bureau of Statistics U. National Population and Housing Census 2014. Area Specific Profiles. Nebbi District [Internet]. Kampala, Uganda; 2017 p. 75. Available from: http://www.ubos.org/onlinefiles/uploads/ubos/2014CensusProfiles/NEBBI.pdf
Borahagal ro, Giheung gu, Yongin si, Gyeonggi do. Bioline SD Cholera Ag O1/O139 (44FK30). In: One Step Vibrio Cholerae O1/O139 Antigen Test in Human fecal specimen [Internet]. Republic of Korea: Standard Diagnostics, Inc; 2015 [cited 2017 Sep 26]. Available from: http://www.ctr.com.mx/img_prod/cholera_i.pdf
Kwesiga B, Pande G, Ario AR, et al. A prolonged, community-wide cholera outbreak associated with drinking water contaminated by sewage in Kasese District, western Uganda. BMC Public Health [Internet]. 2017 Jul 18 [cited 2017 Sep 15];18:30. Available from: https://doi.org/10.1186/s12889-017-4589-9
O’Connor KA, Cartwright E, Loharikar A, et al. Risk Factors Early in the 2010 Cholera Epidemic, Haiti. Emerg Infect Dis [Internet]. 2011 Nov [cited 2017 Sep 15];17(11):2136–8. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3310583/
Bwire G, Mwesawina M, Baluku Y, et al. Cross-Border Cholera Outbreaks in Sub-Saharan Africa, the Mystery behind the Silent Illness: What Needs to Be Done? PLOS ONE [Internet]. 2016 Jun 3 [cited 2017 Sep 16];11(6):e0156674. Available from: http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0156674
Luquero FJ, Sack DA. Effectiveness of oral cholera vaccine in Haiti. Lancet Glob Health [Internet]. 2015 Mar 1 [cited 2017 Sep 29];3(3):e120–1. Available from: http://thelancet.com/journals/langlo/article/PIIS2214-109X(15)70015-X/abstract
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