High Mortality in a Cholera Outbreak in Western Kenya after Post-Election Violence in 2008

O-Tipo Shikanga Field Epidemiology and Laboratory Training Program–Kenya, Centers for Disease Control and Prevention, Nairobi, Kenya

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David Mutonga Field Epidemiology and Laboratory Training Program–Kenya, Centers for Disease Control and Prevention, Nairobi, Kenya

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Mohammed Abade Field Epidemiology and Laboratory Training Program–Kenya, Centers for Disease Control and Prevention, Nairobi, Kenya

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Samuel Amwayi Field Epidemiology and Laboratory Training Program–Kenya, Centers for Disease Control and Prevention, Nairobi, Kenya

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Maurice Ope Field Epidemiology and Laboratory Training Program–Kenya, Centers for Disease Control and Prevention, Nairobi, Kenya

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Hillary Limo Field Epidemiology and Laboratory Training Program–Kenya, Centers for Disease Control and Prevention, Nairobi, Kenya

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Eric D. Mintz Field Epidemiology and Laboratory Training Program–Kenya, Centers for Disease Control and Prevention, Nairobi, Kenya

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Robert E. Quick Field Epidemiology and Laboratory Training Program–Kenya, Centers for Disease Control and Prevention, Nairobi, Kenya

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Robert F. Breiman Field Epidemiology and Laboratory Training Program–Kenya, Centers for Disease Control and Prevention, Nairobi, Kenya

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Daniel R. Feikin Field Epidemiology and Laboratory Training Program–Kenya, Centers for Disease Control and Prevention, Nairobi, Kenya

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In 2008, a cholera outbreak with unusually high mortality occurred in western Kenya during civil unrest after disputed presidential elections. Through active case finding, we found a 200% increase in fatal cases and a 37% increase in surviving cases over passively reported cases; the case-fatality ratio increased from 5.5% to 11.4%. In conditional logistic regression of a matched case-control study of fatal versus non-fatal cholera infection, home antibiotic treatment (odds ratio [OR] 0.049; 95% CI: < 0.001–0.43), hospitalization (OR, 0.066; 95% CI, 0.001–0.54), treatment in government-operated health facilities (OR, 0.15; 95% CI, 0.015–0.73), and receiving education about cholera by health workers (OR, 0.19; 95% CI, 0.018–0.96) were protective against death. Among 13 hospitalized fatal cases, chart review showed inadequate intravenous and oral hydration and substantial staff and supply shortages at the time of admission. Cholera mortality was under-reported and very high, in part because of factors exacerbated by widespread post-election violence.

Author Notes

Reprint requests: Daniel R. Feikin, KEMRI/CDC, PO Box 1578, Kisumu, Kenya, E-mail: dfeikin@ke.cdc.gov.
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