Volume 78, Issue 3
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645


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 O1, Inaba serotype, and had genetically similar PFGE patterns of I-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.


Article metrics loading...

The graphs shown below represent data from March 2017
Loading full text...

Full text loading...



  1. Goodgame RW, Greenough WB, 1975. Cholera in Africa: a message for the West. Ann Intern Med 82 : 101–106. [Google Scholar]
  2. WHO, 2005. Cholera 2004. Wkly Epidemiol Rec 31 : 261–268. [Google Scholar]
  3. Centers for Disease Control, 1991. Cholera—Peru. MMWR 40 : 108–109. [Google Scholar]
  4. Tauxe RV, Mintz ED, Quick RE, 1995. Epidemic cholera in the new world: translating field epidemiology into new prevention strategies. Emerg Infect Dis 1 : 141–146. [Google Scholar]
  5. Acosta JC, 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 3): 583–587. [Google Scholar]
  6. Shapiro RL, Muga RO, Adcock PM, Phillips-Howard PA, Hawley WA, Waiyaki P, Nahlen BL, Slutsker L, 1999. Transmission of epidemic Vibrio cholerae O1 in rural western Kenya associated with drinking water from Lake Victoria: an environmental reservoir for cholera? Am J Trop Med Hyg 60 : 271–276. [Google Scholar]
  7. Hutin Y, Luby S, Paquet C, 2003. A large cholera outbreak in Kano City, Nigeria: importance of hand washing with soap and the danger of street-vended water. J Water Health 1 : 45–52. [Google Scholar]
  8. 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 : 207–214. [Google Scholar]
  9. Tauxe RV, Holberg SD, Dodin A, Wells JV, Blake PA, 1988. Epidemic cholera in Mali: high mortality and multiple routes of transmission in a famine area. Epidemiol Infect 100 : 279–289. [Google Scholar]
  10. 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 : 719–728. [Google Scholar]
  11. Sinclair GS, Mphalele M, Duvenhage H, Nichol R, Whitehorn A, Kustner HG, 1982. Determination of mode of transmission of cholera in Lebowa. An epidemiological investigation. S Afr Med J 62 : 753–755. [Google Scholar]
  12. Gunnlaugsson G, Einarsdottir J, Angulo FJ, Mentambanar SA, Passa A, Tauxe RV, 1998. Funerals during the 1994 cholera epidemic in Guinea-Bissau, West Africa: the need for disinfection of bodies of persons dying of cholera. Epidemiol Infect 120 : 7–15. [Google Scholar]
  13. Birmingham ME, Lee LA, Ndayimirije N, Nkurikiye S, Hersh BS, Wells JG, Deming MS, 1997. Epidemic cholera in Burundi: patterns of transmission in the Great Rift Valley lake region. Lancet 349 : 981–985. [Google Scholar]
  14. Dubois AE, Sinkala M, Kalluri P, Makasa-Chikoya M, Quick RE, 2006. Epidemic cholera in urban Zambia: hand soap and dried fish as protective factors. Epidemiol Infect 134 : 1226–1230. [Google Scholar]
  15. Siddique AK, Salam A, Islam MS, Akram K, Majumdar RN, Zaman K, Fronczak N, Laston S, 1995. Why treatment centres failed to prevent cholera deaths among Rwandan refugees in Goma, Zaire. Lancet 345 : 359–361. [Google Scholar]
  16. Reller ME, Mong YJM, Hoekstra RM, Quick RE, 2001. Cholera prevention with traditional and novel water treatment methods: an outbreak investigation in Fort-Dauphin, Madagascar. Am J Public Health 91 : 1608–1610. [Google Scholar]
  17. Centers for Disease Control and Prevention, 1999. Laboratory Methods for the Diagnosis of Epidemic Dysentery and Cholera. WHO/CDS/CSR/EDC/99.8. Atlanta, GA: Centers for Disease Control and Prevention.
  18. National Committee for Clinical Laboratory Standards, 2002. Performance Standards for Antimicrobial Susceptibility Testing; 12th Informational Supplement. Approved Standard M100-S12. Wayne, PA: National Committee for Clinical Laboratory Standards.
  19. Cooper KLF, Luey CKY, Bird M, Terajima J, Nair GB, Kam KM, Arakawa E, Safa A, Cheung D, Law C, Watanabe H, Kubota K, Swaminathan B, Ribot EM, 2006. Development and validation of a PulseNet standardized pulsed-field gel electrophoresis protocol for subtyping of Vibrio cholerae. Food-borne Pathog Dis 3 : 51–58. [Google Scholar]
  20. Tenover FC, Arbeit RD, Goering RV, Mickelson PA, Murray BE, Pershing DH, Swaminathan B, 1995. Interpreting chromosomal DNA restriction patterns produced by pulsed-field gel electrophoresis: criteria for bacterial strain typing. J Clin Microbiol 33 : 2233–2239. [Google Scholar]
  21. World Health Organization, 2003. Global Task Force on Cholera Control. Available at: www.who.int/csr/diseases/cholera. Accessed December 27, 2005.
  22. Mbugua GG, Muthami LN, Mutura CW, 1995. Epidemiology of HIV infection among long distance truck drivers in Kenya. East Afr Med J 72 : 515–518. [Google Scholar]
  23. Cameron DN, Khambaty FM, Wachsmuth IK, Tauxe RV, Barrett TJ, 1994. Molecular characterization of Vibrio cholerae O1 strains by pulsed-field gel electrophoresis. J Clin Micro 32 : 1685–1690. [Google Scholar]
  24. Kumar L, Kubota K, Bopp C, Slutsker L, Mintz E, Brooks J, Greene K, Wells J, 2001. Characterization of Vibrio cholerae O1 isolates from Kenya by PFGE. American Society of Microbiology Conference. 101st American Society For Microbiology (ASM) General Meeting, Orlando, FL.
  25. Mintz ED, Reiff FM, Tauxe RV, 1995. Safe water treatment and storage in the home: a practical approach to prevent water-borne diseases. JAMA 273 : 948–953. [Google Scholar]
  26. Swerdlow DL, Mintz ED, Rodriguez M, Tejada E, Ocampo C, Espejo L, Barrett BJ, Petzelt J, Bean NH, Seminario L, 1992. Waterborne transmission of epidemic cholera in Trujillo, Peru: lessons for a continent at risk. Lancet 340 : 28–33. [Google Scholar]
  27. Quick RE, Venezel LV, Gonzalez O, Mintz ED, Highsmith AK, Espanda A, Damian E, Bean NH, De Hannover EH, Tauxe RV, 1996. Narrow-mouthed water storage vessels and in situ chlorination in a Bolivian community: a simple method to improve drinking water quality. Am J Trop Med Hyg 54 : 511–516. [Google Scholar]

Data & Media loading...

  • Received : 05 Sep 2007
  • Accepted : 04 Dec 2007

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