Risk Factors for Household Transmission of Vibrio cholerae in Dhaka, Bangladesh (CHoBI7 Trial)

Vanessa Burrowes Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.

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Jamie Perin Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.

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Shirajum Monira Department of International Health, International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.

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David A. Sack Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.

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Mahamud-ur Rashid Center for Communicable Diseases, International Center for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.

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Toslim Mahamud Center for Communicable Diseases, International Center for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.

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Zillur Rahman Center for Communicable Diseases, International Center for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.

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Munshi Mustafiz Center for Communicable Diseases, International Center for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.

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Sazzadul I. Bhuyian Center for Communicable Diseases, International Center for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.

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Farzana Begum Center for Communicable Diseases, International Center for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.

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Fatema Zohura Center for Communicable Diseases, International Center for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.

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Shwapon Biswas Center for Communicable Diseases, International Center for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.

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Tahmina Parvin Center for Communicable Diseases, International Center for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.

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Tasdik Hasan Center for Communicable Diseases, International Center for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.

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Xiaotong Zhang Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.

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Bradley R. Sack Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.

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K. M. Saif-Ur-Rahman Center for Communicable Diseases, International Center for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.

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Munirul Alam Center for Communicable Diseases, International Center for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.

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Christine Marie George Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.

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Household contacts of cholera patients are at a 100 times higher risk of a Vibrio cholerae infection than the general population. To examine risk factors for V. cholerae infections and investigate intervention strategies among this population, we followed household contacts of cholera patients for the 1-week high-risk period after the index patient obtained care. This study was nested within a randomized controlled trial of the Cholera-Hospital-Based-Intervention-for-7-days (CHoBI7), a handwashing with soap and water treatment intervention in Dhaka, Bangladesh. Rectal swab results were available from 320 household contacts of cholera patients at five time points over a 1-week period. Fecal and water samples were analyzed for V. cholerae by bacterial culture. All analyses were stratified by study arm. Within the intervention arm, stored household drinking water with a median free chlorine concentration below 0.5 mg/L was associated with a three times higher odds of a cholera infection (odds ratio [OR]: 3.0; 95% confidence interval [CI]: 1.32, 6.63). In the control arm, having V. cholerae in stored water was associated with a significantly higher odds of a symptomatic cholera infection (OR: 8.66; 95% CI: 2.11, 35.48). No association was found between observed handwashing with soap at food and stool-related events and V. cholerae infections. Stored household drinking water with detectable V. cholerae and chlorine concentrations below the World Health Organization guideline were found to be important risk factors for cholera infection among household contacts of cholera patients. These findings emphasize the need for water treatment interventions targeting this high risk population.

Author Notes

* Address correspondence to Christine Marie George, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205. E-mail: cgeorg19@jhu.edu

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, the Rangpur Medical College Hospital, and icddr,b. Thanks to the governments of Australia, Bangladesh, Canada, Sweden, and United Kingdom for providing core/unrestricted support.

Authors' addresses: Vanessa Burrowes, Jamie Perin, David A. Sack, Xiaotong Zhang, Bradley R. Sack, and Christine M. George, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, E-mails: vburrow1@jhmi.edu, jperin@jhu.edu, dsack@jhsph.edu, xzhang75@jhmi.edu, rsack@jhsph.edu, and cgeorg19@jhu.edu. Shirajum Monira, Department of International Health, International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh, E-mail: smonira@icddrb.org. Mahamud-ur Rashid, Toslim Mahamud, Munshi Mustafiz, Shwapon Biswas, and Tasdik Hasan, Center for Communicable Diseases, International Center for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh, E-mails: palash1898@gmail.com, palashmahmud@ymail.com, rimonstate@gmail.com, drskbiswas2004@yahoo.com, and tasdik@icddrb.org. Zillur Rahman, Sazzadul I. Bhuyian, Farzana Begum, Fatema Zohura, K. M. Saif-Ur-Rahman, and Munirul Alam, CDC–International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh, E-mails: zillur.rahman@icddrb.org, sazzadul.islam@icddrb.org, farzanab@icddrb.org, fzohura@icddrb.org, su.rahman@icddrb.org, and munirul@icddrb.org. Tahmina Parvin, Centre for Nutrition and Food Security (CNFS), International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh, E-mail: tparvin@icddrb.org.

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