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Rapid Spread of Vibrio cholerae O1 Throughout Kenya, 2005

Between January and June 2005, 5 distinct cholera outbreaks occurred in Kenya. Overall, 990 cases and 25 deaths (2.5%) were reported. Four outbreaks occurred in towns along major highways, and 1 occurred in a refugee camp near the Sudanese border, accessible to Nairobi by daily flights. Matched case–control studies from 2 outbreaks showed that failure to treat drinking water and storing drinking water in wide-mouthed containers were significantly associated with disease. Isolates from all 5 outbreaks were Vibrio cholerae O1, Inaba serotype, and had genetically similar PFGE patterns of SfiI-digested chromosomal DNA. Linkage of the outbreak locations by major transportation routes, their temporal proximity, and similar PFGE patterns of isolates suggests the outbreaks might have been linked epidemiologically, showing the speed and distance of cholera spread in countries like Kenya with pockets of susceptible populations connected by modern transportation. Prevention measures remain implementation of point-of-use safe water systems and case finding and referral.

Received September 5, 2007. Accepted for publication December 4, 2007.

Acknowledgments: We thank members of the following organizations for their important work on this outbreak: John Mwihia, Abdikher Dahiye, Lali William Zira, and Patrick Nguku of the Field Epidemiology and Training Program; Joseph Njau of the Kenyan Ministry of Health; Joe Oundo, John Kiiru, Suleiman Saidi, and Jane Muyodi of the Kenya Medical Research Institute (KEMRI); Mohammed Qassim of UNHCR; Benjamin Ochieng, Alvin Schultz, and Heather Burke of the International Emerging Infections Program, CDC–Kenya; Michele Parsons, Kara Cooper, and Cheryl Bopp, Foodborne and Diarrheal Diseases Branch, CDC, Atlanta, GA, USA.

This investigation was funded by core funding of the International Emerging Infections Program, CDC–Kenya, The Field Epidemiology and Laboratory Training Program, Global Emerging Infections Program, U.S. Army Medical Research Unit–Kenya, and the Kenya Ministry of Health.

Disclaimer: This information is distributed solely for the purpose of pre-dissemination peer review under applicable information quality guidelines. It has not been formally disseminated by the Centers for Disease Control and Prevention. It does not represent and should not be construed to represent any agency determination or policy.

This material has been reviewed by the Walter Reed Army Institute of Research. There is no objection to its presentation and or publication.

The opinions or assertions contained herein are the private views of the authors, and are not to be construed as official or as reflecting true views of the Department of the Army or Department of Defense.

^* Address correspondence to Daniel R. Feikin, CDC, Unit 64112, APO, AE 09831 (U.S. Postal Service), or CDC/KEMRI, PO Box 1578, Across from Kisian Station, Kisumu, Kenya. E-mail: dfeikin{at}ke.cdc.gov

Authors’ addresses: Isaac Mugoya, Tura Galgalo, Jared Omollo, and Christopher Tetteh, Field Epidemiology and Laboratory Training Program, CDC/KEMRI, Mbagathi Way, Off Mbagathi Road, Nairobi, Kenya, Telephone: +254-721203157, Fax: +254-572022981, E-mail: ikmugoya{at}gmail.com, tisword{at}yahoo.com (T.G.), TettehC{at}sa.cdc.gov, and jaredom2000{at}yahoo.com. Robert Breiman, IEIP, CDC/KEMRI, Mbagathi Way, Off Mbagathi Road, Nairobi, Kenya, Telephone: +254-722205248, Fax: +254-572022981, E-mail: rbreiman{at}ke.cdc.gov. Samuel Kariuki, Centre for Microbiologic Research, KEMRI, Kenyatta Hospital, Nairobi, Kenya, Telephone: +254-722232467, E-mail: skariuki{at}kemri.org. Charles Njuguna, Jackson Njoroge, Rosalia Kalani, and Charles Nzioka, Disease Outbreak Management Unit, Afya House, Nairobi, Kenya, Telephone: +254-733753541, E-mail: njugunack{at}yahoo.co.uk, DOMU{at}africaonline.co.ke. Sheryl Bedno, Walter Reed Army Institute of Research, Washington, DC, E-mail: Sheryl.Bedno{at}amedd.army.mil. Daniel Feikin, CDC, Unit 64112, APO, AE 09831 (U.S. Postal Service), Telephone: +254-7222-00075, Fax: +254-572022981, E-mail: dfeikin{at}ke.cdc.gov.

Reprint requests: Daniel Feikin, CDC, Unit 64112, APO, AE 09831 (U.S. Postal Service), Telephone: +254-7222-00075, Fax: +254-572022981, E-mail: dfeikin{at}ke.cdc.gov.

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