• 1.

    Gaffga NH, Tauxe RV, Mintz ED, 2007. Cholera: a new homeland in Africa? Am J Trop Med Hyg 77: 705713.

  • 2.

    World Health Organization, 2007. Cholera, 2006. Wkly Epidemiol Rec 82: 273284.

  • 3.

    World Health Organization, 2008. Cholera, 2007. Wkly Epidemiol Rec 83: 269283.

  • 4.

    World Health Organization, 2009. Cholera: global surveillance summary. Wkly Epidemiol Rec 84: 309324.

  • 5.

    World Health Organization, 2010. Cholera, 2009. Wkly Epidemiol Rec 85: 293308.

  • 6.

    World Health Organization, 2013. Cholera, 2012. Wkly Epidemiol Rec 88: 321336.

  • 7.

    Griffith DC, Kelly-Hope LA, Miller MA, 2006. Review of reported cholera outbreaks worldwide, 1995–2005. Am J Trop Med Hyg 75: 973977.

  • 8.

    The World Bank Sierra Leone Data Portal, 2013. Available at: http://data.worldbank.org/country/sierra-leone. Accessed November 22, 2013.

    • Search Google Scholar
    • Export Citation
  • 9.

    Koroma DS, Turay AB, Moigua MB, 2006. Sierra Leone 2004 Population and Housing Census: Analytical Report on Population Projection for Sierra Leone, 2527.

    • Search Google Scholar
    • Export Citation
  • 10.

    WHO UNICEF Joint Monitoring Programme (JMP) for Water Supply and Sanitation, 2013. Types of Drinking-Water Sources and Sanitation. Available at: http://www.wssinfo.org/definitions-methods/watsan-categories/. Accessed April 24, 2013.

    • Search Google Scholar
    • Export Citation
  • 11.

    Gunnlaugsson G, Einarsdottir J, Angulo FJ, Metambanar 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: 715.

    • Search Google Scholar
    • Export Citation
  • 12.

    Shapiro RL, Otieno MR, Adcock PM, Phillips-Howard PA, Hawley WA, Kumar L, 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: 271276.

    • Search Google Scholar
    • Export Citation
  • 13.

    Swerdlow DL, Mintz ED, Rodriguez M, Tejada E, Ocampo C, Espejo L, Greene KD, Saldana W, Seminario L, Tauxe RV, Wells JG, Bean NH, Ries AA, Pollack M, Vertiz B, Blake PA, 1992. Waterborne transmission of epidemic cholera in Trujillo, Peru: lessons for a continent at risk. Lancet 340: 2833.

    • Search Google Scholar
    • Export Citation
  • 14.

    Centers for Disease control and Prevention, 1999. Laboratory methods for the diagnosis of epidemic dysentery and cholera, Atlanta: The Centers. Available at: http://www.cdc.gov/cholera/pdf/Laboratory-Methods-for-the-Diagnosis-of-Epidemic-Dysentery-and-Cholera.pdf. Accessed July 10, 2013.

    • Search Google Scholar
    • Export Citation
  • 15.

    Talkington D, Bopp C, Tarr C, Parsons MB, Dahourou G, Freeman M, Joyce K, Turnsek M, Garrett N, Humphrys M, Gomez G, Stroika S, Boncy J, Ochieng B, Oundo J, Klena J, Smith A, Keddy K, Gerner-Smidt P, 2011. Characterization of toxigenic Vibrio cholerae from Haiti, 2010–2011. Emerg Infect Dis 17: 21222129.

    • Search Google Scholar
    • Export Citation
  • 16.

    Cooper KL, Luey CK, Bird M, Terajima J, Nair GB, Kam KM, Arakawa E, Safa A, Cheung DT, Law CP, Watanabe H, Kubota K, Swaminathan B, Ribot EM, 2006. Development and validation of a PulseNet standardized pulsed-field gel electrophoresis protocol for subtyping Vibrio cholerae. Foodborne Pathog Dis 3: 5158.

    • Search Google Scholar
    • Export Citation
  • 17.

    Rebaudet S, Sudre B, Faucher B, Piarroux R, 2013. Environmental determinants of cholera outbreaks in Inland Africa: a systematic review of main transmission foci and propogation routes. J Infect Dis 208 (Suppl 1): S98S106.

    • Search Google Scholar
    • Export Citation
  • 18.

    WHO/UNICEF Joint Monitoring Programme (JMP) for Water Supply and Sanitation Data & Estimates, 2010. Available at: http://www.wssinfo.org/data-estimates/table/. Accessed November 23, 2013.

  • 19.

    WHO/UNICEF Joint Water Supply and Sanitation Monitoring Programme, 2010. Progress on sanitation and drinking water: 2010 update. Geneva and New York: World Health Organization. Available at: http://www.unicef.org/media/files/JMP-2010Final.pdf. Accessed April 26, 2013.

    • Search Google Scholar
    • Export Citation
  • 20.

    Onda K, Lobuglio J, Bartram J, 2012. Global access to safe water: accounting for water quality and the resulting impact on MDG progress. Int J Environ Res Public Health 9: 880894.

    • Search Google Scholar
    • Export Citation
  • 21.

    Bhunia R, Ramakrishnan R, Hutin Y, Gupte MD, 2006. Cholera outbreak secondary to contaminated pipe water in an urban area, West Bengal, India. Indian J Gastroenterol 28: 6264.

    • Search Google Scholar
    • Export Citation
  • 22.

    Lantangne DS, Clasen TF, 2012. Use of household water treatment and safe storage methods in acute emergency response: case study results from Nepal, Indonesia, Kenya, and Haiti. Environ Sci Technol 46: 1135211360.

    • Search Google Scholar
    • Export Citation
  • 23.

    Lantange D, 2012. Point-of-Use water treatment in emergency response. Waterlines, 31.

  • 24.

    Koo D, Aragon A, Moscoso V, Gudiel M, Bietti L, Carrillo N, Chojoj J, Gordillo B, Cano F, Cameron DN, Wells JG, Bean NH, Tauxe RV, 1996. Epidemic cholera in Guatemala, 1993: transmission of a newly introduced epidemic strain by street vendors. Epidemiol Infect 116: 121126.

    • Search Google Scholar
    • Export Citation
  • 25.

    Islam MA, Mondol AS, Azmi IJ, de Boer E, Beumer RR, Zwietering MH, Heuvelink AE, Talukder KA, 2010. Occurrence and characterization of Shiga toxin-producing Escherichia coli in raw meat, raw milk, and street vended juices in Bangladesh. Foodborne Pathog Dis 7: 13811385.

    • Search Google Scholar
    • Export Citation
  • 26.

    Dione MM, Ieven M, Garin B, Marcotty T, Geerts S, 2009. Prevalence and antimicrobial resistance of Salmonella isolated from broiler farms, chicken carcasses, and street-vended restaurants in Casamance, Senegal. J Food Prot 72: 24232427.

    • Search Google Scholar
    • Export Citation
  • 27.

    El-Shenawy M, El-Shenawy, Manes J, Soriano JM, 2011. Listeria spp. in street-vended ready-to-eat foods. Interdiscip Perspect Infect Dis 2011. Available at: http://www.hindawi.com/journals/ipid/2011/968031/. Accessed May 9, 2013.

    • Search Google Scholar
    • Export Citation
  • 28.

    Sobel J, Mahon B, Mendoza CE, Passaro D, Cano F, Baier K, Racioppi F, Hutwagner L, Mintz E, 1998. Reduction of fecal contamination of street-vended beverages in Guatemala by a simple system for water purification and storage, hand washing, and beverage storage. Am J Trop Med Hyg 59: 380387.

    • Search Google Scholar
    • Export Citation
  • 29.

    Blake PA, Allegra DT, Snyder JD, Barrett TJ, McFarland L, Caraway CT, Feeley JC, Craig JP, Lee JV, Puhr ND, Feldman RA, 1980. Cholera–a possible endemic focus in the United States. N Engl J Med 302: 305309.

    • Search Google Scholar
    • Export Citation
  • 30.

    Weber JT, Mintz ED, Canizares R, Semiglia A, Gomez I, Sempertegui R, Davila A, Greene KD, Puhr ND, Cameron DN, Tenover FC, Barrett TJ, Bean NH, Ivey C, Tauxe RV, Blake PA, 1994. Epidemic cholera in Ecuador: multidrug-resistance and transmission by water and seafood. Epidemiol Infect 112: 111.

    • Search Google Scholar
    • Export Citation
  • 31.

    Quick RE, Thompson BL, Zuniga A, Dominguez G, De Brizuela EL, De Palma O, Almeida S, Valencia A, Ries AA, Bean NH, Blake PA, 1995. Epidemic cholera in rural El Salvador: risk factors in a region covered by a cholera prevention campaign. Epidemiol Infect 114: 249255.

    • Search Google Scholar
    • Export Citation

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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

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  • 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

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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