Cholera Epidemic Associated with Consumption of Unsafe Drinking Water and Street-Vended Water—Eastern Freetown, Sierra Leone, 2012

Von D. Nguyen Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Disease Control and Prevention, Sierra Leone Ministry of Health and Sanitation, Freetown, Sierra Leone; WHO Representative Office, Sierra Leone World Health Organization Country Office, Freetown, Sierra Leone; Environmental Microbiology Laboratory, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh

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Nandini Sreenivasan Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Disease Control and Prevention, Sierra Leone Ministry of Health and Sanitation, Freetown, Sierra Leone; WHO Representative Office, Sierra Leone World Health Organization Country Office, Freetown, Sierra Leone; Environmental Microbiology Laboratory, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh

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Eugene Lam Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Disease Control and Prevention, Sierra Leone Ministry of Health and Sanitation, Freetown, Sierra Leone; WHO Representative Office, Sierra Leone World Health Organization Country Office, Freetown, Sierra Leone; Environmental Microbiology Laboratory, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh

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Tracy Ayers Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Disease Control and Prevention, Sierra Leone Ministry of Health and Sanitation, Freetown, Sierra Leone; WHO Representative Office, Sierra Leone World Health Organization Country Office, Freetown, Sierra Leone; Environmental Microbiology Laboratory, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh

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David Kargbo Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Disease Control and Prevention, Sierra Leone Ministry of Health and Sanitation, Freetown, Sierra Leone; WHO Representative Office, Sierra Leone World Health Organization Country Office, Freetown, Sierra Leone; Environmental Microbiology Laboratory, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh

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Foday Dafae Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Disease Control and Prevention, Sierra Leone Ministry of Health and Sanitation, Freetown, Sierra Leone; WHO Representative Office, Sierra Leone World Health Organization Country Office, Freetown, Sierra Leone; Environmental Microbiology Laboratory, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh

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Amara Jambai Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Disease Control and Prevention, Sierra Leone Ministry of Health and Sanitation, Freetown, Sierra Leone; WHO Representative Office, Sierra Leone World Health Organization Country Office, Freetown, Sierra Leone; Environmental Microbiology Laboratory, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh

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Wondimagegnehu Alemu Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Disease Control and Prevention, Sierra Leone Ministry of Health and Sanitation, Freetown, Sierra Leone; WHO Representative Office, Sierra Leone World Health Organization Country Office, Freetown, Sierra Leone; Environmental Microbiology Laboratory, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh

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Abdul Kamara Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Disease Control and Prevention, Sierra Leone Ministry of Health and Sanitation, Freetown, Sierra Leone; WHO Representative Office, Sierra Leone World Health Organization Country Office, Freetown, Sierra Leone; Environmental Microbiology Laboratory, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh

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M. Sirajul Islam Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Disease Control and Prevention, Sierra Leone Ministry of Health and Sanitation, Freetown, Sierra Leone; WHO Representative Office, Sierra Leone World Health Organization Country Office, Freetown, Sierra Leone; Environmental Microbiology Laboratory, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh

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Steven Stroika Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Disease Control and Prevention, Sierra Leone Ministry of Health and Sanitation, Freetown, Sierra Leone; WHO Representative Office, Sierra Leone World Health Organization Country Office, Freetown, Sierra Leone; Environmental Microbiology Laboratory, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh

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Cheryl Bopp Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Disease Control and Prevention, Sierra Leone Ministry of Health and Sanitation, Freetown, Sierra Leone; WHO Representative Office, Sierra Leone World Health Organization Country Office, Freetown, Sierra Leone; Environmental Microbiology Laboratory, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh

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Robert Quick Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Disease Control and Prevention, Sierra Leone Ministry of Health and Sanitation, Freetown, Sierra Leone; WHO Representative Office, Sierra Leone World Health Organization Country Office, Freetown, Sierra Leone; Environmental Microbiology Laboratory, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh

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Eric D. Mintz Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Disease Control and Prevention, Sierra Leone Ministry of Health and Sanitation, Freetown, Sierra Leone; WHO Representative Office, Sierra Leone World Health Organization Country Office, Freetown, Sierra Leone; Environmental Microbiology Laboratory, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh

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Joan M. Brunkard Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Disease Control and Prevention, Sierra Leone Ministry of Health and Sanitation, Freetown, Sierra Leone; WHO Representative Office, Sierra Leone World Health Organization Country Office, Freetown, Sierra Leone; Environmental Microbiology Laboratory, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh

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During 2012, Sierra Leone experienced a cholera epidemic with 22,815 reported cases and 296 deaths. We conducted a matched case-control study to assess risk factors, enrolling 49 cases and 98 controls. Stool specimens were analyzed by culture, polymerase chain reaction (PCR), and pulsed-field gel electrophoresis (PFGE). Conditional logistic regression found that consuming unsafe water (matched odds ratio [mOR]: 3.4; 95% confidence interval [CI]: 1.1, 11.0), street-vended water (mOR: 9.4; 95% CI: 2.0, 43.7), and crab (mOR: 3.3; 95% CI: 1.03, 10.6) were significant risk factors for cholera infection. Of 30 stool specimens, 13 (43%) showed PCR evidence of toxigenic Vibrio cholerae O1. Six specimens yielded isolates of V. cholerae O1, El Tor; PFGE identified a pattern previously observed in seven countries. We recommended ensuring the quality of improved water sources, promoting household chlorination, and educating street vendors on water handling practices.

Author Notes

* Address correspondence to Von D. Nguyen, Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd. NE, MS - A38, Atlanta, GA 30333. E-mail: dly1@cdc.gov

Financial support: Financial support was provided by the CDC Global Disease Detection Operations Center Outbreak Response Contingency Fund.

Authors' addresses: Von D. Nguyen, Nandini Sreenivasan, Tracy Ayers, Steven Stroika, Cheryl Bopp, Robert Quick, Eric D. Mintz, and Joan M. Brunkard, Division of Foodborne, Waterborne, and Environmental Diseases (DFWED), Centers for Disease Control and Prevention (CDC), Atlanta, GA, E-mails: dly1@cdc.gov, vii2@cdc.gov, eyk6@cdc.gov, fru3@cdc.gov, cab4@cdc.gov, rxq1@cdc.gov, edm1@cdc.gov, and feu4@cdc.gov. Eugene Lam, Global Immunization Division, CDC, Atlanta, GA, E-mail: vif4@cdc.gov. David Kargbo, Foday Dafae, Amara Jambai, and Abdul Kamara, Disease Control and Prevention, Sierra Leone Ministry of Health and Sanitation, Freetown, Sierra Leone, E-mails: dkkargbo@yahoo.com, fodaydafae@yahoo.co.uk, amarajambai@yahoo.com, and abdulatkamara@gmail.com. Wondimagegnehu Alemu, WHO Representative, Uganda World Health Organization Country Office, Kololo, Kampala, Uganda, E-mail: alemuw@ug.afro.who.int. M. Sirajul Islam, Environmental Microbiology Laboratory, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh, E-mail: sislam@icddrb.org.

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