Abstract
IntroductionIn 2009 and 2010, more than 6,000 cholera cases were recorded during these outbreaks with more than 80% of cases recorded in Lusaka province. After a five-year break, in 2016 an outbreak occurred in Lusaka, causing more than 1,000 cases of cholera. This study will strengthen the epidemiological information on the changing characteristics of the cholera outbreaks, for treatment, prevention and control of the disease.MethodsThis was a laboratory-based descriptive cross-sectional study conducted at the University Teaching Hospital in Lusaka, Zambia. A total of 83 V. cholerae O1 isolates were characterised by biochemical testing, serotyping, antimicrobial susceptibility testing, and macrorestriction analysis using Pulsed-Field Gel Electrophoresis.ResultsMacrorestriction analysis of the isolates demonstrated high genetic diversity among the isolates with 16 different patterns. The largest pattern comprised 9 isolates while the smallest one had 1 isolate. 2009 and 2010 isolates were highly resistant to nalidixic acid and cotrimoxazole, but highly sensitive to azithromycin and ampicillin. Of the fifty-two isolates from the 2016 cholera outbreak, 90% (47) were sensitive to cotrimoxazole, 94% (49) to tetracycline, and 98% (51) to azithromycin, while 98% (51) were resistant to nalidixic acid and 31(60%) to ampicillin.Conclusionmacrorestriction analysis demonstrated high genetic diversity among the V. cholerae O1 strains, suggesting that these isolates were probably not from a similar source. This study also revealed the emergence of multidrug resistance among the 2016 V. cholerae outbreak isolates but were susceptible to cotrimoxazole, tetracycline, and azithromycin, which can be used for treatment of the cholera cases.
Highlights
Cholera is an enteric disease of immense public health concern, causing an estimated 2.8 million cases with 91,000 deaths globally every year [1]
Data in this study demonstrate that the 2009, 2010 and 2016 cholera outbreaks were caused by V. cholerae serogroup O1, with the Ogawa serotype being the predominant serotype
The strains that caused the 2009 cholera outbreak emerged during the 2010 outbreak but new strains of the bacteria emerged during the 2016 outbreak as evidenced by the macrorestriction and antimicrobial resistance (AMR) patterns
Summary
Cholera is an enteric disease of immense public health concern, causing an estimated 2.8 million cases with 91,000 deaths globally every year [1]. It is an acute disease characterised by severe watery diarrhoea caused by toxigenic Vibrio cholerae strains belonging to serogroups O1 and O139 [2]. No further outbreak was reported on the continent after the 1893-1894 outbreak in the Senegambia region until the seventh pandemic reached the continent in 1970 [6] This pandemic caused massive outbreaks in Africa resulting in more than 400,000 cases with a high mortality rate [7]. This study sought to describe the phenotypic characteristics of V. cholerae O1 strains isolated from Lusaka during these three cholera outbreaks through serotyping and antibiotic susceptibility testing, and their genetic diversity by macrorestriction analysis using Pulsed-Field Gel Electrophoresis (PFGE)
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