Abstract
Household spraying is a commonly implemented, yet an under-researched, cholera response intervention where a response team sprays surfaces in cholera patients’ houses with chlorine. We conducted mixed-methods evaluations of three household spraying programs in the Democratic Republic of Congo and Haiti, including 18 key informant interviews, 14 household surveys and observations, and 418 surface samples collected before spraying, 30 minutes and 24 hours after spraying. The surfaces consistently most contaminated with Vibrio cholerae were food preparation areas, near the patient’s bed and the latrine. Effectiveness varied between programs, with statistically significant reductions in V. cholerae concentrations 30 minutes after spraying in two programs. Surface contamination after 24 hours was variable between households and programs. Program challenges included difficulty locating households, transportation and funding limitations, and reaching households quickly after case presentation (disinfection occurred 2–6 days after reported cholera onset). Program advantages included the concurrent deployment of hygiene promotion activities. Further research is indicated on perception, recontamination, cost-effectiveness, viable but nonculturable V. cholerae, and epidemiological coverage. We recommend that, if spraying is implemented, spraying agents should: disinfect surfaces systematically until wet using 0.2/2.0% chlorine solution, including kitchen spaces, patients’ beds, and latrines; arrive at households quickly; and, concurrently deploy hygiene promotion activities.
Highlights
Infection with toxigenic Vibrio cholerae O1/O139 bacteria can cause profuse watery stool and vomiting and, if untreated, can result in severe dehydration and death within hours [1,2]
Household spraying is an outbreak response activity where the houses of cholera patients are disinfected by spraying chlorine to interrupt cholera transmission within households
Effectiveness evaluations of household spraying in cholera outbreaks awarded to DSL, Ref. 28374), by the Swiss National Science Foundation
Summary
Infection with toxigenic Vibrio cholerae O1/O139 bacteria can cause profuse watery stool and vomiting and, if untreated, can result in severe dehydration and death within hours [1,2]. In 2018, 34 countries reported cholera [10] and the global cholera burden is estimated to 2.9 million cases and 95,000 deaths per year [11]. Individuals living within 50 meters of a cholera case are 23–56 times as likely to contract cholera as those further away [15]; person-to-person transmission has been estimated to account for 41–95% of transmission in modelling studies [15,16,17,18] and, mean infection risks of 3.7–8.2% were associated with fecal shedding of V. cholerae among household contacts of cases, compared to infection risks of 2.0–3.4% from community water sources over 11 days [19]. Among the potential cholera transmission pathways, it is plausible that contaminated surfaces or objects (“fomites”) contribute to transmission, for household contacts of cholera cases
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