Epidemic Cholera in the Amazon: The Challenge of Preventing Death

Robert E. Quick Division of Field Epidemiology, Epidemiology Program Office, Centers for Disease Control and Prevention, Programa de Epidemiologia del Campo, Ministerio de Salud, Enteric Diseases Branch, Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, Peru

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Rodolfo Vargas Division of Field Epidemiology, Epidemiology Program Office, Centers for Disease Control and Prevention, Programa de Epidemiologia del Campo, Ministerio de Salud, Enteric Diseases Branch, Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, Peru

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Dafne Moreno Division of Field Epidemiology, Epidemiology Program Office, Centers for Disease Control and Prevention, Programa de Epidemiologia del Campo, Ministerio de Salud, Enteric Diseases Branch, Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, Peru

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Oscar Mujica Division of Field Epidemiology, Epidemiology Program Office, Centers for Disease Control and Prevention, Programa de Epidemiologia del Campo, Ministerio de Salud, Enteric Diseases Branch, Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, Peru

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Luis Beingolea Division of Field Epidemiology, Epidemiology Program Office, Centers for Disease Control and Prevention, Programa de Epidemiologia del Campo, Ministerio de Salud, Enteric Diseases Branch, Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, Peru

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Ana Maria Palacios Division of Field Epidemiology, Epidemiology Program Office, Centers for Disease Control and Prevention, Programa de Epidemiologia del Campo, Ministerio de Salud, Enteric Diseases Branch, Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, Peru

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Luis Seminario Division of Field Epidemiology, Epidemiology Program Office, Centers for Disease Control and Prevention, Programa de Epidemiologia del Campo, Ministerio de Salud, Enteric Diseases Branch, Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, Peru

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Robert V. Tauxe Division of Field Epidemiology, Epidemiology Program Office, Centers for Disease Control and Prevention, Programa de Epidemiologia del Campo, Ministerio de Salud, Enteric Diseases Branch, Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, Peru

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DOI:
https://doi.org/10.4269/ajtmh.1993.48.597
Volume/Issue:
Volume 48: Issue 5
Page(s):
597–602
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Epidemic cholera struck Peru in January 1991, and spread rapidly. The national cholera case-fatality rate (CFR) was less than 1% in the first six months of the epidemic, but in some rural areas, the CFR exceeded 10%. We investigated cholera mortality in the rural Amazon region, an area with a CFR of 6.3%. We conducted a case-control study, comparing 29 decedents with 61 survivors of recent cholera-like diarrheal illness in 12 villages with a combined CFR of 13.5%. Of 29 decedents, 28 (96%) died in the village or en route to a health facility. Death occurred within 36 hours of illness onset for 83% of the decedents. In 11 (92%) villages, the first or second recognized case was fatal. Death was associated with receiving treatment only at home (odds ratio indeterminate; 95% confidence interval 3.5, indeterminate). Treatment with oral rehydration salts (ORS) was not protective against death for patients who received treatment only at home. Treatment with homemade sugar-salt solution (SSS) was also not protective; fewer than one-third of respondents knew the correct SSS recipe. Most decedents experienced multiple barriers to health care. Cholera victims died rapidly and early in village outbreaks, and few patients had access to health care. Provision of threatened villages with ORS supplies and education in their use before cholera strikes is essential to reducing cholera mortality in this region.

Author Notes

Copyright:
Copyright © 1993 by The American Society of Tropical Medicine and Hygiene 1993
Published Online:
May 1993
Cover The American Journal of Tropical Medicine and Hygiene
The American Journal of Tropical Medicine and Hygiene
Print ISSN:
0002-9637
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