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An outbreak of cholera associated with an unprotected well in Parbatia, Orissa, Eastern India.

Das A, Manickam P, Hutin Y, Pal BB, Chhotray GP, Kar SK, Gupte MD - J Health Popul Nutr (2009)

Bottom Line: Vibrio cholerae El Tor O1, serotype Ogawa was isolated from four of six rectal swabs.The water from the public well was associated with the outbreak (matched odds ratio: 12; 95% confidence interval 1.2-44.1).On the basis of these conclusions, access to the well was barred immediately, and it was protected.

View Article: PubMed Central - PubMed

Affiliation: National Institute of Epidemiology (ICMR), Chennai, Tamil Nadu, India.

ABSTRACT
In November 2003, an outbreak (41 cases; attack rate-4.3%; no deaths) of severe diarrhoea was reported from a village in Orissa, eastern India. Thirteen of these cases were hospitalized. A matched case-control study was conducted to identify the possible exposure variables. Since all wells were heavily chlorinated immediately after the outbreak, water samples were not tested. The cases were managed symptomatically. Descriptive epidemiology suggested clustering of cases around one public well. Vibrio cholerae El Tor O1, serotype Ogawa was isolated from four of six rectal swabs. The water from the public well was associated with the outbreak (matched odds ratio: 12; 95% confidence interval 1.2-44.1). On the basis of these conclusions, access to the well was barred immediately, and it was protected. This investigation highlighted the broader use of field epidemiology methods to implement public-health actions guided by epidemiologic data to control a cholera epidemic.

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Cases of acute diarrhoea by date of onset, Parbatia, Orissa, India, November 2003
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Figure 1: Cases of acute diarrhoea by date of onset, Parbatia, Orissa, India, November 2003

Mentions: Females had a slightly higher attack rate. There was an initial case on 10 November, followed by a rapid increase in the number of cases leading to a peak on 15 November and a progressive subsequent decrease, and the last case was on 21 November (Fig. 1). This led to suspect a common source of the outbreak, although the second part of the epidemic curve could have been stretched because of secondary person-to-person transmission. Of the 40 case-patients, 24 (60%) were clustered around an unprotected well located close to the residence of the index case-patient (Fig. 2). Hypothesis-generating interviews with this index case-patient indicated that this person fell sick and soiled his clothes with diarrhoea. Thus, he left his house (shown with a triangle on the map) and crossed the road to wash his soiled clothes in the unprotected well (Fig. 2). Thus, we generated the hypothesis that the source of the outbreak could have been drinking water from the contaminated well.


An outbreak of cholera associated with an unprotected well in Parbatia, Orissa, Eastern India.

Das A, Manickam P, Hutin Y, Pal BB, Chhotray GP, Kar SK, Gupte MD - J Health Popul Nutr (2009)

Cases of acute diarrhoea by date of onset, Parbatia, Orissa, India, November 2003
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2928086&req=5

Figure 1: Cases of acute diarrhoea by date of onset, Parbatia, Orissa, India, November 2003
Mentions: Females had a slightly higher attack rate. There was an initial case on 10 November, followed by a rapid increase in the number of cases leading to a peak on 15 November and a progressive subsequent decrease, and the last case was on 21 November (Fig. 1). This led to suspect a common source of the outbreak, although the second part of the epidemic curve could have been stretched because of secondary person-to-person transmission. Of the 40 case-patients, 24 (60%) were clustered around an unprotected well located close to the residence of the index case-patient (Fig. 2). Hypothesis-generating interviews with this index case-patient indicated that this person fell sick and soiled his clothes with diarrhoea. Thus, he left his house (shown with a triangle on the map) and crossed the road to wash his soiled clothes in the unprotected well (Fig. 2). Thus, we generated the hypothesis that the source of the outbreak could have been drinking water from the contaminated well.

Bottom Line: Vibrio cholerae El Tor O1, serotype Ogawa was isolated from four of six rectal swabs.The water from the public well was associated with the outbreak (matched odds ratio: 12; 95% confidence interval 1.2-44.1).On the basis of these conclusions, access to the well was barred immediately, and it was protected.

View Article: PubMed Central - PubMed

Affiliation: National Institute of Epidemiology (ICMR), Chennai, Tamil Nadu, India.

ABSTRACT
In November 2003, an outbreak (41 cases; attack rate-4.3%; no deaths) of severe diarrhoea was reported from a village in Orissa, eastern India. Thirteen of these cases were hospitalized. A matched case-control study was conducted to identify the possible exposure variables. Since all wells were heavily chlorinated immediately after the outbreak, water samples were not tested. The cases were managed symptomatically. Descriptive epidemiology suggested clustering of cases around one public well. Vibrio cholerae El Tor O1, serotype Ogawa was isolated from four of six rectal swabs. The water from the public well was associated with the outbreak (matched odds ratio: 12; 95% confidence interval 1.2-44.1). On the basis of these conclusions, access to the well was barred immediately, and it was protected. This investigation highlighted the broader use of field epidemiology methods to implement public-health actions guided by epidemiologic data to control a cholera epidemic.

Show MeSH
Related in: MedlinePlus