Abstract
BackgroundIn May 2015, a cholera outbreak that had lasted 3 months and infected over 100 people was reported in Kasese District, Uganda, where multiple cholera outbreaks had occurred previously. We conducted an investigation to identify the mode of transmission to guide control measures.MethodsWe defined a suspected case as onset of acute watery diarrhoea from 1 February 2015 onwards in a Kasese resident. A confirmed case was a suspected case with Vibrio cholerae O1 El Tor, serotype Inaba cultured from a stool sample. We reviewed medical records to find cases. We conducted a case-control study to compare exposures among confirmed case-persons and asymptomatic controls, matched by village and age-group. We conducted environmental assessments. We tested water samples from the most affected area for total coliforms using the Most Probable Number (MPN) method.ResultsWe identified 183 suspected cases including 61 confirmed cases of Vibrio cholerae 01; serotype Inaba, with onset between February and July 2015. 2 case-persons died of cholera. The outbreak occurred in 80 villages and affected all age groups; the highest attack rate occurred in the 5–14 year age group (4.1/10,000). The outbreak started in Bwera Sub-County bordering the Democratic Republic of Congo and spread eastward through sustained community transmission. The first case-persons were involved in cross-border trading. The case-control study, which involved 49 confirmed cases and 201 controls, showed that 94% (46/49) of case-persons compared with 79% (160/201) of control-persons drank water without boiling or treatment (ORM-H=4.8, 95% CI: 1.3–18). Water collected from the two main sources, i.e., public pipes (consumed by 39% of case-persons and 38% of control-persons) or streams (consumed by 29% of case-persons and 24% control-persons) had high coliform counts, a marker of faecal contamination. Environmental assessment revealed evidence of open defecation along the streams. No food items were significantly associated with illness.ConclusionsThis prolonged, community-wide cholera outbreak was associated with drinking water contaminated by faecal matter and cross-border trading. We recommended rigorous disposal of patients’ faeces, chlorination of piped water, and boiling or treatment of drinking water. The outbreak stopped 6 weeks after these recommendations were implemented.
Highlights
In May 2015, a cholera outbreak that had lasted 3 months and infected over 100 people was reported in Kasese District, Uganda, where multiple cholera outbreaks had occurred previously
In resource-limited settings, the Crystal VC® dipstick rapid test can be used to alert public health officials of a possible cholera outbreak [2]. This dipstick rapid test has suboptimal sensitivity and specificity; faecal specimens tested positive for V. cholerae using this Rapid Diagnostic Test (RDT) should be confirmed using the traditional culture-based methods [2]
We reviewed data in the Health Management Information System, an electronic health data reporting system managed by Ministry of Health (MoH), on cholera cases reported in the area [9]
Summary
In May 2015, a cholera outbreak that had lasted 3 months and infected over 100 people was reported in Kasese District, Uganda, where multiple cholera outbreaks had occurred previously. Cholera is caused by toxigenic Vibrio cholerae serogroup O1 and O139. In resource-limited settings, the Crystal VC® dipstick rapid test can be used to alert public health officials of a possible cholera outbreak [2]. This dipstick rapid test has suboptimal sensitivity and specificity; faecal specimens tested positive for V. cholerae using this Rapid Diagnostic Test (RDT) should be confirmed using the traditional culture-based methods [2]
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