• 1.

    Zuckerman JN, Rombo L, Fisch A, 2007. The true burden and risk of cholera: implications for prevention and control. Lancet Infect Dis 7: 521530.

    • Search Google Scholar
    • Export Citation
  • 2.

    Ryan ET, Dhar U, Khan WA, Salam MA, Faruque AS, Fuchs GJ, Calderwood SB, Bennish ML, 2000. Mortality, morbidity, and microbiology of endemic cholera among hospitalized patients in Dhaka, Bangladesh. Am J Trop Med Hyg 63: 1220.

    • Search Google Scholar
    • Export Citation
  • 3.

    Weil AA, Khan AI, Chowdhury F, Larocque RC, Faruque AS, Ryan ET, Calderwood SB, Qadri F, Harris JB, 2009. Clinical outcomes in household contacts of patients with cholera in Bangladesh. Clin Infect Dis 49: 14731479.

    • Search Google Scholar
    • Export Citation
  • 4.

    Mosley WH, Ahmad S, Benenson AS, Ahmed A, 1968. The relationship of vibriocidal antibody titre to susceptibility to cholera in family contacts of cholera patients. Bull World Health Organ 38: 777785.

    • Search Google Scholar
    • Export Citation
  • 5.

    Larocque RC, Sabeti P, Duggal P, Chowdhury F, Khan AI, Lebrun LM, Harris JB, Ryan ET, Qadri F, Calderwood SB, 2009. A variant in long palate, lung and nasal epithelium clone 1 is associated with cholera in a Bangladeshi population. Genes Immun 10: 267272.

    • Search Google Scholar
    • Export Citation
  • 6.

    Harris JB, Larocque RC, Chowdhury F, Khan AI, Logvinenko T, Faruque AS, Ryan ET, Qadri F, Calderwood SB, 2008. Susceptibility to Vibrio cholerae infection in a cohort of household contacts of patients with cholera in Bangladesh. PLoS Negl Trop Dis 2: e221.

    • Search Google Scholar
    • Export Citation
  • 7.

    Faruque AS, Mahalanabis D, Albert MJ, Hoque SS, 1994. Studies of infection with Vibrio cholerae O139 synonym Bengal in family contacts of index cases. Trans R Soc Trop Med Hyg 88: 439.

    • Search Google Scholar
    • Export Citation
  • 8.

    Yen CH, 1964. A recent study of cholera with reference to an outbreak in Taiwan in 1962. Bull World Health Organ 30: 811825.

  • 9.

    Patel SM, Rahman MA, Mohasin M, Riyadh MA, Leung DT, Alam MM, Chowdhury F, Khan AI, Weil AA, Aktar A, Nazim M, Larocque RC, Ryan ET, Calderwood SB, Qadri F, Harris JB, 2012. Memory B cell responses to Vibrio cholerae O1 lipopolysaccharide are associated with protection against infection from household contacts of patients with cholera in Bangladesh. Clin Vaccine Immunol 19: 842848.

    • Search Google Scholar
    • Export Citation
  • 10.

    Rahman M, Sack DA, Mahmood S, Hossain A, 1987. Rapid diagnosis of cholera by coagglutination test using 4-h fecal enrichment cultures. J Clin Microbiol 25: 22042206.

    • Search Google Scholar
    • Export Citation
  • 11.

    Qadri F, Azim T, Chowdhury A, Hossain J, Sack RB, Albert MJ, 1994. Production, characterization, and application of monoclonal antibodies to Vibrio cholerae O139 synonym Bengal. Clin Diagn Lab Immunol 1: 5154.

    • Search Google Scholar
    • Export Citation
  • 12.

    Qadri F, Wenneras C, Albert MJ, Hossain J, Mannoor K, Begum YA, Mohi G, Salam MA, Sack RB, Svennerholm AM, 1997. Comparison of immune responses in patients infected with Vibrio cholerae O139 and O1. Infect Immun 65: 35713576.

    • Search Google Scholar
    • Export Citation
  • 13.

    Saha D, Karim MM, Khan WA, Ahmed S, Salam MA, Bennish ML, 2006. Single-dose azithromycin for the treatment of cholera in adults. N Engl J Med 354: 24522462.

    • Search Google Scholar
    • Export Citation
  • 14.

    Faruque AS, Alam K, Malek MA, Khan MG, Ahmed S, Saha D, Khan WA, Nair GB, Salam MA, Luby SP, Sack DA, 2007. Emergence of multidrug-resistant strain of Vibrio cholerae O1 in Bangladesh and reversal of their susceptibility to tetracycline after two years. J Health Popul Nutr 25: 241243.

    • Search Google Scholar
    • Export Citation
  • 15.

    Rashed SM, Mannan SB, Johura FT, Islam MT, Sadique A, Watanabe H, Sack RB, Huq A, Colwell RR, Cravioto A, Alam M, 2012. Genetic characteristics of drug-resistant Vibrio cholerae O1 causing endemic cholera in Dhaka, 2006–2011. J Med Microbiol 61: 17361745.

    • Search Google Scholar
    • Export Citation
  • 16.

    Clements ML, Levine MM, Young CR, Black RE, Lim YL, Robins-Browne RM, Craig JP, 1982. Magnitude, kinetics, and duration of vibriocidal antibody responses in North Americans after ingestion of Vibrio cholerae. J Infect Dis 145: 465473.

    • Search Google Scholar
    • Export Citation
  • 17.

    World Health Organization, 1997. World Health Organization Database on Child Growth and Malnutrition. Geneva: World Health Organization Programme of Nutrition.

    • Search Google Scholar
    • Export Citation
  • 18.

    1995. Physical status: the use and interpretation of anthropometry. Report of a WHO Expert Committee. World Health Organ Tech Rep Ser 854: 1452.

    • Search Google Scholar
    • Export Citation
  • 19.

    Palmer DL, Koster FT, Alam AK, Islam MR, 1976. Nutritional status: a determinant of severity of diarrhea in patients with cholera. J Infect Dis 134: 814.

    • Search Google Scholar
    • Export Citation
  • 20.

    Monira S, Alam NH, Suau A, Magne F, Nair GB, Karmakar PC, Rahman M, Pochart P, Desjeux JF, 2009. Time course of bacterial diversity in stool samples of malnourished children with cholera receiving treatment. J Pediatr Gastroenterol Nutr 48: 571578.

    • Search Google Scholar
    • Export Citation
  • 21.

    Harris JB, Podolsky MJ, Bhuiyan TR, Chowdhury F, Khan AI, Larocque RC, Logvinenko T, Kendall J, Faruque AS, Nagler CR, Ryan ET, Qadri F, Calderwood SB, 2009. Immunologic responses to Vibrio cholerae in patients co-infected with intestinal parasites in Bangladesh. PLoS Negl Trop Dis 3: e403.

    • Search Google Scholar
    • Export Citation
  • 22.

    Utsalo SJ, Eko FO, Umoh F, Asindi AA, 1999. Faecal excretion of Vibrio cholerae during convalescence of cholera patients in Calabar, Nigeria. Eur J Epidemiol 15: 379381.

    • Search Google Scholar
    • Export Citation
  • 23.

    Larson CP, Saha UR, Islam R, Roy N, 2006. Childhood diarrhoea management practices in Bangladesh: private sector dominance and continued inequities in care. Int J Epidemiol 35: 14301439.

    • Search Google Scholar
    • Export Citation
  • 24.

    Lindenbaum J, Greenough WB, Islam MR, 1967. Antibiotic therapy of cholera. Bull World Health Organ 36: 871883.

  • 25.

    McCormack WM, Chowdhury AM, Jahangir N, Ahmed AB, Mosley WH, 1968. Tetracycline prophylaxis in families of cholera patients. Bull World Health Organ 38: 787792.

    • Search Google Scholar
    • Export Citation
  • 26.

    Echevarria J, Seas C, Carrillo C, Mostorino R, Ruiz R, Gotuzzo E, 1995. Efficacy and tolerability of ciprofloxacin prophylaxis in adult household contacts of patients with cholera. Clin Infect Dis 20: 14801484.

    • Search Google Scholar
    • Export Citation

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Bacterial Shedding in Household Contacts of Cholera Patients in Dhaka, Bangladesh

View More View Less
  • Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts; Department of Medicine, Department of Microbiology and Immunobiology, and Department of Pediatrics, Harvard Medical School, Boston, Massachusetts; Centre for Vaccine Sciences, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh; Department of Immunology and Infectious Diseases, Harvard School of Public Health, Boston, Massachusetts

Multiple Vibrio cholerae infections within the same household are common. Household contacts of patients with cholera were observed with daily clinical assessments and collection of rectal swab cultures for nine days after presentation of the index case. During the follow-up period, 71 (24%) of 294 household contacts developed a positive V. cholerae rectal swab, signifying bacterial shedding. The average length of bacterial shedding was 2.0 days (95% confidence interval 1.7–2.4). However, 16 (5%) of 294 contacts shed V. cholerae for ≥ 4 days. In a multivariate analysis, malnutrition was predictive of long-term shedding (odds ratio = 1.4, 95% confidence interval = 1.3–13, P = 0.02). High rates of V. cholerae infection and bacterial shedding among household contacts of cholera patients represent an opportunity for intervention to reduce V. cholerae transmission.

Author Notes

* Address correspondence to Jason B. Harris, Division of Infectious Diseases, Massachusetts General Hospital, 55 Fruit Street, Jackson 504, Boston, MA 02114. E-mail: jbharris@partners.org† Co-senior authors.

Financial support: This study was supported by grants from National Institutes of Health, including AI058935 (Edward T. Ryan and Stephen B. Calderwood), R03 AI063079 (Firdausi Qadri), R01AI03055 and R01 AI099243 (Jason B. Harris), and U01 AI077883 and AI106878 (Edward T. Ryan); a Training Grant in Vaccine Development and Public Health (TW005572) (Edward T. Ryan and Firdausi Qadri]; a Career Development Award (K08 AI089721 (Richelle C. Charles) and K08 AI100923 (Daniel T. Leung); a Fogarty International Clinical Research Scholars award (R24 TW007988 (Firdausi Qadri and Ashraful I. Khan) from the Fogarty International Center; the Swedish Agency for International Development and Cooperation (Firdausi Qadri), a Physician Scientist Early Career Award from the Howard Hughes Medical Institute (Regina C. LaRocque); a Postdoctoral Fellowship in Tropical Infectious Diseases from the American Society for Tropical Medicine and Hygiene-Burroughs Wellcome Fund (Daniel T. Leung); a Thrasher Research Fund Early Career Award (Daniel T. Leung); and a Partners Healthcare Center of Expertise in Global and Humanitarian Health Travel Grant (Ana A. Weil).

Authors' addresses: Ana A. Weil, Regina C. LaRocque, Richelle C. Charles, Edward T. Ryan, Stephen B. Calderwood, and Jason B. Harris, Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, E-mails: aweil@partners.org, rclarocque@partners.org, rccharles@partners.org, etryan@partners.org, scalderwood@partners.org, and jbharris@partners.org. Yasmin Begum, Fahima Chowdhury, Ashraful I. Khan, Firdausi Qadri, Centre for Vaccine Sciences, International Centre for Diarrhoeal Disease Research, Bangladesh, Mohakhali, Dhaka, Banglasdesh, E-mails: yasmin@icddrb.org, fchowdhury@icddrb.org, ashrafk@icddrb.org, and fqadri@icddrb.org. Daniel T. Leung, Division of Infectious Diseases, University of Utah, Salt lake City, UT, E-mail: Daniel.Leung@utah.edu.

Save