1921
Volume 96, Issue 6
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645

Abstract

Abstract

Household contacts of cholera patients are at a 100 times higher risk of a infection than the general population. To examine risk factors for infections and investigate intervention strategies among this population, we followed household contacts of cholera patients for the 1-week high-risk period after the index patient obtained care. This study was nested within a randomized controlled trial of the Cholera-Hospital-Based-Intervention-for-7-days (CHoBI7), a handwashing with soap and water treatment intervention in Dhaka, Bangladesh. Rectal swab results were available from 320 household contacts of cholera patients at five time points over a 1-week period. Fecal and water samples were analyzed for by bacterial culture. All analyses were stratified by study arm. Within the intervention arm, stored household drinking water with a median free chlorine concentration below 0.5 mg/L was associated with a three times higher odds of a cholera infection (odds ratio [OR]: 3.0; 95% confidence interval [CI]: 1.32, 6.63). In the control arm, having in stored water was associated with a significantly higher odds of a symptomatic cholera infection (OR: 8.66; 95% CI: 2.11, 35.48). No association was found between observed handwashing with soap at food and stool-related events and infections. Stored household drinking water with detectable and chlorine concentrations below the World Health Organization guideline were found to be important risk factors for cholera infection among household contacts of cholera patients. These findings emphasize the need for water treatment interventions targeting this high risk population.

Loading

Article metrics loading...

/content/journals/10.4269/ajtmh.16-0871
2017-06-07
2018-11-16
Loading full text...

Full text loading...

/deliver/fulltext/14761645/96/6/1382.html?itemId=/content/journals/10.4269/ajtmh.16-0871&mimeType=html&fmt=ahah

References

  1. Zuckerman JN, Rombo L, Fisch A, , 2007. The true burden and risk of cholera: implications for prevention and control. Lancet Infect Dis 7: 521530.[Crossref]
  2. Weil AA, Khan AI, Chowdhury F, Larocque RC, Faruque AS, Ryan ET, Calderwood SB, Qadri F, Harris JB, , 2009. Clinical outcomes in household contacts of patients with cholera in Bangladesh. Clin Infect Dis 49: 14731479.[Crossref]
  3. Sinclair GS, Mphahlele M, Duvenhage H, Nichol R, Whitehorn A, Kustner HG, , 1982. Determination of the mode of transmission of cholera in Lebowa. An epidemiological investigation. S Afr Med J 62: 753755.
  4. Acosta CJ, Galindo CM, Kimario J, Senkoro K, Urassa H, Casals C, Corachán M, Eseko N, Tanner M, Mshinda H, Lwilla F, Vila J, Alonso PL, , 2001. Cholera outbreak in southern Tanzania: risk factors and patterns of transmission. Emerg Infect Dis 7 (Suppl): 583587.[Crossref]
  5. Hughes JM, Boyce JM, Levine RJ, Khan M, Aziz KM, Huq MI, Curlin GT, , 1982. Epidemiology of eltor cholera in rural Bangladesh: importance of surface water in transmission. Bull World Health Organ 60: 395404.
  6. Swerdlow DL, Malenga G, Begkoyian G, Nyangulu D, Toole M, Waldman RJ, Puhr DN, Tauxe RV, , 1997. Epidemic cholera among refugees in Malawi, Africa: treatment and transmission. Epidemiol Infect 118: 207214.[Crossref]
  7. Holmberg SD, Harris JR, Kay DE, Hargrett NT, Parker RD, Kansou N, Rao NU, Blake PA, , 1984. Foodborne transmission of cholera in Micronesian households. Lancet 1: 325328.[Crossref]
  8. Hutin Y, Luby S, Paquet C, , 2003. A large cholera outbreak in Kano City, Nigeria: the importance of hand washing with soap and the danger of street-vended water. J Water Health 1: 4552.
  9. Harris JB, LaRocque RC, Chowdhury F, Khan AI, Logvinenko T, Faruque AS, Ryan ET, Qadri F, Calderwood SB, , 2008. Susceptibility to Vibrio cholerae infection in a cohort of household contacts of patients with cholera in Bangladesh. PLoS Negl Trop Dis 2: e221.[Crossref]
  10. Spira WM, Khan MU, Saeed YA, Sattar MA, , 1980. Microbiological surveillance of intra-neighbourhood E1 Tor cholera transmission in rural Bangladesh. Bull World Health Organ 58: 731740.
  11. Mosley WH, Ahmad S, Benenson AS, Ahmed A, , 1968. The relationship of vibriocidal antibody titre to susceptibility to cholera in family contacts of cholera patients. Bull World Health Organ 38: 777785.
  12. Glass RI, Svennerholm AM, Khan MR, Huda S, Huq MI, Holmgren J, , 1985. Seroepidemiological studies of El Tor cholera in Bangladesh: association of serum antibody levels with protection. J Infect Dis 151: 236242.[Crossref]
  13. George CM, Monira S, Sack DA, Rashid MU, Saif-Ur-Rahman KM, Mahmud T, Rahman Z, Mustafiz M, Bhuyian SI, Winch PJ, Leontsini E, Perin J, Begum F, Zohura F, Biswas S, Parvin T, Zhang X, Jung D, Sack RB, Alam M, , 2016. Randomized controlled trial of hospital-based hygiene and water treatment intervention (CHoBI7) to reduce cholera. Emerg Infect Dis 22: 233241.[Crossref]
  14. George CM, Jung DS, Saif-Ur-Rahman KM, Monira S, Sack DA, Rashid M, Mahmud MT, Mustafiz M, Rahman Z, Bhuyian SI, Winch PJ, Leontsini E, Perin J, Begum F, Zohura F, Biswas S, Parvin T, Sack RB, Alam M, , 2016. Sustained uptake of a hospital-based handwashing with soap and water treatment intervention (cholera-hospital-based intervention for 7 days [CHoBI7]): a randomized controlled trial. Am J Trop Med Hyg 94: 428436.[Crossref]
  15. Saif-Ur-Rahman KM, Parvin T, Bhuyian SI, Zohura F, Begum F, Rashid M, Biswas SK, Sack D, Sack RB, Monira S, Alam M, Shaly NJ, George CM, , 2016. Promotion of cholera awareness among households of cholera patients: a randomized controlled trial of the CHoBI7 intervention. Am J Trop Med Hyg 95: 12921298.[Crossref]
  16. Bhuiyan NA, Qadri F, Faruque AS, Malek MA, Salam MA, Nato F, Fournier JM, Chanteau S, Sack DA, Balakrish Nair G, , 2003. Use of dipsticks for rapid diagnosis of cholera caused by Vibrio cholerae O1 and O139 from rectal swabs. J Clin Microbiol 41: 39393941.[Crossref]
  17. Nato F, Boutonnier A, Rajerison M, Grosjean P, Dartevelle S, Guénolé A, Bhuiyan NA, Sack DA, Nair GB, Fournier JM, Chanteau S, , 2003. One-step immunochromatographic dipstick tests for rapid detection of Vibrio cholerae O1 and O139 in stool samples. Clin Diagn Lab Immunol 10: 476478.
  18. Page AL, Alberti KP, Mondonge V, Rauzier J, Quilici ML, Guerin PJ, , 2012. Evaluation of a rapid test for the diagnosis of cholera in the absence of a gold standard. PLoS One 7: e37360.[Crossref]
  19. Harris JR, Cavallaro EC, de Nobrega AA, Dos S, Barrado JC, Bopp C, Parsons MB, Djalo D, Fonseca FG, Ba U, Semedo A, Sobel J, Mintz ED, , 2009. Field evaluation of crystal VC Rapid Dipstick test for cholera during a cholera outbreak in Guinea-Bissau. Trop Med Int Health 14: 11171121.[Crossref]
  20. WHO, 2008. Guidelines for Drinking-Water Quality, Third Edition incorporating the First and Second Addenda-Volume 1 Recommendations. Available at: www.who.int/water_sanitation_health/dwq/fulltext.pdf. Accessed. Geneva, Switzerland: WHO.
  21. Liang KY, Zeger S, , 1986. Longitudinal data analysis using generalized linear models. Biometrika 73: 1322.[Crossref]
  22. Rashid MU, George CM, Monira S, Mahmud T, Rahman Z, Mustafiz M, Saif-Ur-Rahman KM, Parvin T, Bhuyian SI, Zohura F, Begum F, Biswas SK, Akhter S, Zhang X, Sack D, Sack RB, Alam M, , 2016. Chlorination of household drinking water among cholera patients' households to prevent transmission of toxigenic Vibrio cholerae in Dhaka City: CHoBI7 trial. Am J Trop Med Hyg 95: 12991304.[Crossref]
  23. World Health Organization, 1996. Chlorine in Drinking-Water: Background Document for Development of WHO Guidelines for Drinking-water Quality, 2nd edition. Rep no WHO/SDE/WSH/03 04/45. Geneva, Switzerland: WHO.
  24. Glass RI, Becker S, Huq MI, Stoll BJ, Khan MU, Merson MH, Lee JV, Black RE, , 1982. Endemic cholera in rural Bangladesh, 1966–1980. Am J Epidemiol 116: 959970.[Crossref]
  25. St Louis ME, Porter JD, Helal A, Drame K, Hargrett-Bean N, Wells JG, Tauxe RV, , 1990. Epidemic cholera in west Africa: the role of food handling and high-risk foods. Am J Epidemiol 131: 719728.[Crossref]
  26. Pickering AJ, Julian TR, Mamuya S, Boehm AB, Davis J, , 2011. Bacterial hand contamination among Tanzanian mothers varies temporally and following household activities. Trop Med Int Health 16: 233239.[Crossref]
http://instance.metastore.ingenta.com/content/journals/10.4269/ajtmh.16-0871
Loading
/content/journals/10.4269/ajtmh.16-0871
Loading

Data & Media loading...

  • Received : 04 Nov 2016
  • Accepted : 06 Feb 2017

Most Cited This Month

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error