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Abstract
BackgroundThere is not much information on the differences in clinical, epidemiological and spatial characteristics of diarrhea due to V. cholerae and V. parahaemolyticus from non-coastal areas. We investigated the differences in clinical, epidemiological and spatial characteristics of the two Vibrio species in the urban slums of Kolkata, India.MethodsThe data of a cluster randomized cholera vaccine trial were used. We restricted the analysis to clusters assigned to placebo. Survival analysis of the time to the first episode was used to analyze risk factors for V. parahaemolyticus diarrhea or cholera. A spatial scan test was used to identify high risk areas for cholera and for V. parahaemolyticus diarrhea.ResultsIn total, 54,519 people from the placebo clusters were assembled. The incidence of cholera (1.30/1000/year) was significantly higher than that of V. parahaemolyticus diarrhea (0.63/1000/year). Cholera incidence was inversely related to age, whereas the risk of V. parahaemolyticus diarrhea was age-independent. The seasonality of diarrhea due to the two Vibrio species was similar. Cholera was distinguished by a higher frequency of severe dehydration, and V. parahaemolyticus diarrhea was by abdominal pain. Hindus and those who live in household not using boiled or treated water were more likely to have V. parahaemolyticus diarrhea. Young age, low socioeconomic status, and living closer to a project healthcare facility were associated with an increased risk for cholera. The high risk area for cholera differed from the high risk area for V. parahaemolyticus diarrhea.ConclusionWe report coexistence of the two vibrios in the slums of Kolkata. The two etiologies of diarrhea had a similar seasonality but had distinguishing clinical features. The risk factors and the high risk areas for the two diseases differ from one another suggesting different modes of transmission of these two pathogens.
Highlights
There is not much information on the differences in clinical, epidemiological and spatial characteristics of diarrhea due to V. cholerae and V. parahaemolyticus from non-coastal areas. This paper describes these characteristics in the urban slums of, a non-coastal area, Kolkata, India, where a cohort of population was under uniform surveillance for diarrhea
All episodes of cholera were due to V. cholerae O1, El Tor biotype
Cholera incidence was higher in younger age groups, but the incidence of V. parahaemolyticus diarrhea showed slight increase with age (Table 1)
Summary
There is not much information on the differences in clinical, epidemiological and spatial characteristics of diarrhea due to V. cholerae and V. parahaemolyticus from non-coastal areas. We investigated the differences in clinical, epidemiological and spatial characteristics of the two Vibrio species in the urban slums of Kolkata, India. Vibrio parahaemolyticus diarrhea and cholera diarrhea (due to Vibrio cholerae O1 and less commonly V. cholerae O139) are both public health concerns. V. parahaemolyticus is a halophilic etiologic agent of diarrheal disease, having an ability to produce outbreaks of gastroenteritis [1]. V. parahaemolyticus of specific serotypes were associated with the outbreaks in several parts of the world with the earliest cases being All group. V. parahaemolyticus Diarrhea No of episodes (incidence rate/1000/year). Cholera No of episodes (incidence rate/1000/year)
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