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Cholera in Indonesia: Epidemiologic Studies of Transmission in Aceh Province^*

Roger I. Glass, A. R. M. A. Alim, Abu Eusof, John D. Snyder, Burhanuddin Jusuf, Syarifuddin Anwar, Zainal Bakri, Cut Helmi^|| AND Bambang Winardi^**

The International Centre for Diarrhoeal Disease Research, Bangladesh
The Provincial Health Services, Daerah Istimewa Aceh, Banda Aceh, Indonesia
The Directorate of Health, Kabupaten Pidie, Sigli, Indonesia
The^|| Sigli Hospital, Sigli, Indonesia
^** The National Diarrheal Disease Program, Ministry of Health, Jakarta, Indonesia

To determine the modes of transmission of cholera in the regency of Pidie, Indonesia, and to consider strategies for its control, we set up a laboratory to identify Vibrio cholerae 01 from patients with severe diarrhea in all government clinics in the regency and questioned culture-positive cases and neighborhood controls about possible exposures to V. cholerae 01. Between 12 July and 15 August 1982, 63 of 138 suspected cholera cases were confirmed by the laboratory; 53 of these patients were seen and followed up. We were unable to identify a single, indisputable mode of transmission for cholera which was amenable to immediate control. Nonetheless, a number of factors, including exposure to water from the Tiro-Sigli River and consumption of ice, were associated with disease. Other findings bring into question the value of current practices of chlorinating dugwells and disinfecting homes with Lysol® during a cholera outbreak. The case-control approach to investigating the mode of transmision of cholera has distinct limitations when applied in endemic setting where there may not be a single predominant vehicle of transmission, or where the vehicle such as river water is used by all and is only periodically contaminated.

Accepted for publication March 16, 1984.

^* Dr. Glass was on assignment from the Centers for Disease Control, Atlanta. Dr. Snyder is currently with the Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts.

Address reprint requests to: Dr. R. I. Glass, Laboratory of Infectious Diseases, NIAID, NIH, Building 7, Room 100, Bethesda, Maryland 20205.