Randomized Controlled Trial of Hospital-Based Hygiene and Water Treatment Intervention (CHoBI7) to Reduce Cholera.

Christine Marie George,Tahmina Parvin,Toslim Mahmud,Shirajum Monira,Munshi Mustafiz,Peter J Winch,David A Sack,Shwapon Biswas,Danielle Jung,Munirul Alam,Zillur Rahman,Jamie Perin,Sazzadul Islam Bhuyian,R Bradley Sack,Elli Leontsini,Farzana Begum,Fatema Zohura,Xiaolin Zhang ,Mohammad Junaebur Rashid ,K M Saif‐Ur‐Rahman

doi:10.3201/eid2202.151175

Abstract

The risk for cholera infection is >100 times higher for household contacts of cholera patients during the week after the index patient seeks hospital care than it is for the general population. To initiate a standard of care for this high-risk population, we developed Cholera-Hospital-Based-Intervention-for-7-Days (CHoBI7), which promotes hand washing with soap and treatment of water. To test CHoBI7, we conducted a randomized controlled trial among 219 intervention household contacts of 82 cholera patients and 220 control contacts of 83 cholera patients in Dhaka, Bangladesh, during 2013-2014. Intervention contacts had significantly fewer symptomatic Vibrio cholerae infections than did control contacts and 47% fewer overall V. cholerae infections. Intervention households had no stored drinking water with V. cholerae and 14 times higher odds of hand washing with soap at key events during structured observation on surveillance days 5, 6, or 7. CHoBI7 presents a promising approach for controlling cholera among highly susceptible household contacts of cholera patients.

Highlights

Severe cholera without adequate rehydration kills up to half of affected persons [1]
The time that patients and their accompanying family members spend at a health facility during a severe diarrheal episode provides an opportunity for health providers to communicate information about water sanitation and hygiene (WASH) behavior change when perceived severity of diarrheal disease and perceived benefits of water treatment and hand washing with soap are likely to be highest [14]
Only a few studies have evaluated the effects of health facility–based WASH interventions, and none have evaluated the effects of these interventions in reducing enteric infections among household contacts of hospitalized diarrhea patients [15,16,17,18,19,20,21,22]

Summary

Introduction

Severe cholera without adequate rehydration kills up to half of affected persons [1]. Studies have identified multiple risk factors for Vibrio cholerae infection, such as drinking street-vended water, placing one’s hands into stored household water, lack of drinking water treatment, eating food prepared by a recently ill food handler, and not washing hands with soap before eating food [3,4,5,6,7,8]. These findings suggest that cholera is transmitted through contaminated water and poor hygiene practices. In comparison with the standard message given to cholera patients at hospital discharge on ORS, CHoBI7 would significantly reduce cholera infections and increase hand washing with soap and treatment of water among highly susceptible household contacts of cholera patients

Objectives

Methods

Results

Conclusion