Tag Archives: cholera

Bacterial contamination of drinking water and health, Egypt

Ouf SA, Yehia RS, Ouf AS, Abdul-Rahim RF. Bacterial contamination and health risks of drinking water from the municipal non-government managed water treatment plants. Environmental monitoring and assessment. 2018 Oct 29;190(11):685. doi: 10.1007/s10661-018-7054-z.

Water quality and bacterial contamination from 18 drinking water municipal plants in three locations at Giza governorate were investigated. The average total count of bacteria detected after four stages of treatments in the investigated plants was 32 CFU/1 mL compared to 2330 cfu/mL for raw water, with a reduction percentage of 98.6. Although there is a relatively high removal percent of bacterial contamination from the water sources, however, several bacterial pathogens were identified in the produced water prepared for drinking including Enterococcus faecalis, Escherichia coli, Pseudomonas aeruginosa, and Shigella spp. After 3 days of water incubation at 30 °C, the amount of bacterial endotoxins ranged from 77 to 137 ng/mL in the water produced from the municipal plants compared to 621-1260 ng/mL for untreated water. The main diseases reported from patients attending different clinics and hospitals during summer 2014 at the surveyed locations and assuredly due to drinking water from these plants indicated that diarrheas and gastroenteritis due to E. coli and Campylobacter jejuni constituted 65.7% of the total patients followed by bacillary dysentery or shigellosis due to Shigella spp. (7.9%) and cholera due to Vibrio cholera (7.2%). There was an increase in serum aspartate aminotransferase (AST), alanine aminotransferase (ALT), and alkaline phosphatase (ALP) as well as urea and creatinine values of guinea pigs consuming water produced from the non-governmental plants for 6 months indicating remarkable liver and kidney damages. Histological sections of liver and kidney from the tested animal revealed liver having ballooning degeneration of hepatocytes and distortion and fragmentation of the nuclei, while the section of the kidney showed irregularly distributed wrinkled cells, degenerated Bowman’s capsule, congested blood vessels, and inflammatory cells.

Cholera Outbreak from Contaminated Lake Water, Uganda

Oguttu DW, Okullo A, Bwire G, Nsubuga P, Ario AR. Cholera outbreak caused by drinking lake water contaminated with human faeces in Kaiso Village, Hoima District, Western Uganda, October 2015. Infect Dis Poverty. 2017 Oct 10;6(1):146. doi: 10.1186/s40249-017-0359-2.

BACKGROUND: On 12 October 2015, a cholera outbreak involving 65 cases and two deaths was reported in a fishing village in Hoima District, Western Uganda. Despite initial response by the local health department, the outbreak persisted. We conducted an investigation to identify the source and mode of transmission, and recommend evidence-led interventions to control and prevent cholera outbreaks in this area.

METHODS: We defined a suspected case as the onset of acute watery diarrhoea from 1 October to 2 November 2015 in a resident of Kaiso Village. A confirmed case was a suspected case who had Vibrio cholerae isolated from stool. We found cases by record review and active community case finding. We performed descriptive epidemiologic analysis for hypothesis generation. In an unmatched case-control study, we compared exposure histories of 61 cases and 126 controls randomly selected among asymptomatic village residents. We also conducted an environmental assessment and obtained meteorological data from a weather station.

RESULTS: We identified 122 suspected cases, of which six were culture-confirmed, 47 were confirmed positive with a rapid diagnostic test and two died. The two deceased cases had onset of the disease on 2 October and 10 October, respectively. Heavy rainfall occurred on 7-11 October; a point-source outbreak occurred on 12-15 October, followed by continuous community transmission for two weeks. Village residents usually collected drinking water from three lakeshore points – A, B and C: 9.8% (6/61) of case-persons and 31% (39/126) of control-persons were found to usually use point A, 21% (13/61) of case-persons and 37% (46/126) of control-persons were found to usually use point B (OR = 1.8, 95% CI: 0.64-5.3), and 69% (42/61) of case-persons and 33% (41/126) of control-persons were found to usually use point C (OR = 6.7; 95% CI: 2.5-17) for water collection. All case-persons (61/61) and 93% (117/126) of control-persons reportedly never treated/boiled drinking water (OR = ∞, 95% CI Fisher: 1.0 – ∞). The village’s piped water system had been vandalised and open defecation was common due to a lack of latrines. The lake water was found to be contiminated due to a gully channel that washed the faeces into the lake at point C.

CONCLUSIONS: This outbreak was likely caused by drinking lake water contaminated by faeces from a gully channel. We recommend treatment of drinking water, fixing the vandalised piped-water system and constructing latrines.

V. cholerae can survive in the river systems, Bangladesh

Grant SL, Tamason CC, Hoque BA, Jensen PK. Drinking cholera: salinity levels and palatability of drinking water in coastal Bangladesh. Trop Med Int Health. 2015 Apr;20(4):455-61. doi: 10.1111/tmi.12455. 

OBJECTIVES: To measure the salinity levels of common water sources in coastal Bangladesh and explore perceptions of water palatability among the local population to investigate the plausibility of linking cholera outbreaks in Bangladesh with ingestion of saline-rich cholera-infected river water.

METHODS: Hundred participants took part in a taste-testing experiment of water with varying levels of salinity. Salinity measurements were taken of both drinking and non-drinking water sources. Informal group discussions were conducted to gain an in-depth understanding of water sources and water uses.

RESULTS: Salinity levels of non-drinking water sources suggest that the conditions for Vibrio cholerae survival exist 7-8 days within the local aquatic environment. However, 96% of participants in the taste-testing experiment reported that they would never drink water with salinity levels that would be conducive to V. cholerae survival. Furthermore, salinity levels of participant’s drinking water sources were all well below the levels required for optimal survival of V. cholerae. Respondents explained that they preferred less salty and more aesthetically pleasing drinking water.

CONCLUSION: Theoretically, V. cholerae can survive in the river systems in Bangladesh; however, water sources which have been contaminated with river water are avoided as potential drinking water sources. Furthermore, there are no physical connecting points between the river system and drinking water sources among the study population, indicating that the primary driver for cholera cases in Bangladesh is likely not through the contamination of saline-rich river water into drinking water sources.

Cholera Outbreak in Vietnam from Unsafe Water

Nguyen TV, Pham QD, Do QK, Diep TT, Phan HC, Ho TV, Do HT, Phan LT, Tran HN. Cholera returns to southern Vietnam in an outbreak associated with consuming unsafe water through iced tea: A matched case-control study. PLoS neglected tropical diseases. 2017 Apr 13;11(4):e0005490. doi: 10.1371/journal.pntd.0005490.

BACKGROUND: After more than a decade of steadily declining notifications, the number of reported cholera cases has recently increased in Vietnam. We conducted a matched case-control study to investigate transmission of cholera during an outbreak in Ben Tre, southern Vietnam, and to explore the associated risk factors.

METHODOLOGY/PRINCIPAL FINDINGS: Sixty of 71 diarrheal patients confirmed to be infected with cholera by culture and diagnosed between May 9 and August 3, 2010 in Ben Tre were consecutively recruited as case-patients. Case-patients were matched 1:4 to controls by commune, sex, and 5-year age group. Risk factors for cholera were examined by multivariable conditional logistic regression. In addition, environmental samples from villages containing case-patients were taken to identify contamination of food and water sources. The regression indicated that drinking iced tea (adjusted odds ratio (aOR) = 8.40, 95% confidence interval (CI): 1.84-39.25), not always boiling drinking water (aOR = 2.62, 95% CI: 1.03-6.67), having the main source of water for use being close to a toilet (aOR = 4.36, 95% CI: 1.37-13.88), living with people who had acute diarrhea (aOR = 13.72, 95% CI: 2.77-67.97), and little or no education (aOR = 4.89, 95% CI: 1.18-20.19) were significantly associated with increased risk of cholera. In contrast, drinking stored rainwater (aOR = 0.17, 95% CI: 0.04-0.63), eating cooked seafood (aOR = 0.27, 95% CI: 0.10-0.73), and eating steamed vegetables (aOR = 0.22, 95% CI: 0.07-0.70) were protective against cholera. Vibrio cholerae O1 Ogawa carrying ctxA was found in two of twenty-five river water samples and one of six wastewater samples.

CONCLUSIONS/SIGNIFICANCE: The magnitude of the cholera outbreak in Ben Tre was lower than in other similar settings. This investigation identified several risk factors and underscored the importance of continued responses targeting cholera prevention in southern Vietnam. The association between drinking iced tea and cholera and the spread of V. cholerae O1, altered El Tor strains warrant further research. These findings might be affected by a number of limitations due to the inability to capture asymptomatic or mildly symptomatic infections, the possible underreporting of personal unhygienic behaviors, and the purposive selection of environmental samples.

Cholera Remains a Public Health Issue in Africa

Pena ES, Kakaiuml CG, Bompangueacute D, Toureacute K. Cholera: Evolution of Epidemiological Situation in four French-speaking African Countries from 2004 to 2013. West African Journal of Medicine. 2014 Oct-Dec;33(4):245-51.

BACKGROUND: The Initiative against Diarrheal and Enteric Diseases in Africa and Asia (IDEA) was launched to play a significant and sustainable role in the understanding, prevention and control of enteric diseases. Its initial focus is on cholera, a disease responsible for large-scale epidemics resulting in high morbidity and mortality rates.

STUDY DESIGN: We present an update on the evolution of cholera from 2004 to 2013 based on data provided by experts from four IDEA African countries: Benin, Cameroon, the Democratic Republic of Congo and Mali.

RESULTS: Cholera has been responsible for severe epidemics with high fatality rates in Africa over the recent years. The 2013 data are the most recent data on cholera available for the four countries. While some signs of improvement are visible, not all countries have experienced a declining trend in the occurrence of the disease.

CONCLUSION: Cholera remains a public health issue in Africa with a risk of potential recurrent outbreaks. The multifactorial nature of the disease requires a multi-sectorial approach combining several complementary operational strategies. The most critical challenges include achieving a more consistent and reliable reporting of cases and a better appraisal of the real burden of the disease through a better cholera case definition. Ongoing efforts must be supported and renewed to provide improved and sustained access to safe drinking water and sanitation and raise disease awareness further. Investing in operational research for a better understanding of the spatio-temporal dynamics of cholera will also help adapt the control strategies against the disease.

Sierra Leone tackles cholera outbreak…

“Dr. Konteh re-echoed government policy relating to cholera and said, “Cholera treatment is FREE in all government health facilities and cholera treatment centers (e.g. Macauley Street, Connaught Hospital, Wellington, 34 Military Hospital, Newton and Mabela) in Freetown, the capital and other Hospitals through- out the Country.” click here for the full article….

Contaminated water suspected in Dominican Republic cholera cases…

“Suspected cases of cholera continue to increase at hospitals in the northern Dominican province of Santiago, where at least 550 people have been treated in the past nine days for acute diarrhea.”

Click here for news article…