- Abstract
- Background
- Methods
- Laboratory experiments to determine the bactericidal concentrations of free chlorine to inactivate V. cholerae O1 and O139.
- Preparation of bacterial stock culture.
- Preparation of different concentrations of chlorine solution.
- Experiments to inactivate 105 CFU/mL of V. cholerae O1 and O139 cells using 10 chlorine stock solutions.
- Laboratory experiments to determine the free chlorine concentrations over a 24-hour period after the use of a chlorine tablet in DWASA water.
- Field trial to determine the efficacy of chlorine tablets for the inactivation of V. cholerae.
- Ethics approval and consent.
- Laboratory experiments to determine the bactericidal concentrations of free chlorine to inactivate V. cholerae O1 and O139.
- Results
- Discussion
- Conclusions
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Chlorination of Household Drinking Water Among Cholera Patients' Households to Prevent Transmission of Toxigenic Vibrio cholerae in Dhaka, Bangladesh: CHoBI7 Trial
Abstract
Household members of cholera patients are at a 100 times higher risk of cholera infections than the general population because of shared contaminated drinking water sources and secondary transmission through poor household hygiene practices. In this study, we investigated the bactericidal concentration of free chlorine required to inactivate Vibrio cholerae in household drinking water in Dhaka, Bangladesh. In laboratory experiments, we found that the concentrations of free chlorine required to inactivate 105 colony-forming units (CFU)/mL of V. cholerae serogroups O1 and O139 were 0.1 mg/L and 0.2 mg/L, respectively. The concentration of free chlorine generated by a single chlorine tablet (sodium dichloroisocyanurate [33 mg]) after a 30-minute reaction time in a 10-L sealed vessel containing Dhaka city municipal supply water was 1.8 mg/L; and the concentration declined to 0.26 mg/L after 24 hours. In field measurements, water collected from 165 households enrolled in a randomized controlled trial (RCT) of a chlorine and handwashing with soap intervention (Cholera-Hospital-Based-Intervention-for-7-Days [CHoBI7]), we observed significantly higher free chlorine concentrations in the 82 intervention arm households (mean = 1.12 mg/L, standard deviation [SD] = 0.52, range = 0.07–2.6 mg/L) compared with the 83 control households (0.017 mg/L, SD = 0.01, range = 0–0.06 mg/L) (P < 0.001) during spot check visits. These findings suggest that point-of-use chlorine tablets present an effective approach to inactivate V. cholerae from drinking water in households of cholera patients in Dhaka city. This result is consistent with the findings from the RCT of CHoBI7 which found that this intervention led to a significant reduction in symptomatic cholera infections among household members of cholera patients and no stored drinking water samples with detectable V. cholerae.
Author Notes
Financial support: This research was supported by the Center for Global Health at Johns Hopkins University and the National Institute of Allergy and Infectious Diseases, National Institutes of Health. icddr,b thanks the governments of Australia, Bangladesh, Canada, Sweden, and United Kingdom for providing core/unrestricted support.
Authors' addresses: Mahamud-ur Rashid, Shirajum Monira, Md. Toslim Mahmud, Zillur Rahman, Munshi Mustafiz, K. M. Saif-Ur-Rahman, Tahmina Parvin, Sazzadul Islam Bhuyian, Fatema Zohura, Farzana Begum, Shwapon Kumar Biswas, Shamima Akhter, and Munirul Alam, International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh, E-mails: mahamudur@icddrb.org, smonira@icddrb.org, palashmahmud@ymail.com, zillur.rahman@icddrb.org, rimonstate@gmail.com, su.rahman@icddrb.org, tparvin@icddrb.org, sazzadul.islam@icddrb.org, fzohura@icddrb.org, farzanab@icddrb.org, drskbiswas2004@yahoo.com, shamima.akhter@icddrb.org, and munirul@icddrb.org. Christine Marie George, Xiaotong Zhang, David Sack, and R. Bradley Sack, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, E-mails: cmgeorge@jhsph.edu, xzhang75@jhmi.edu, dsack1@jhu.edu, and rsack1@jhu.edu.