Abstract

BackgroundCholera outbreaks are a continuing problem in Bangladesh, and the timely detection of an outbreak is important for reducing morbidity and mortality. In Matlab, the ongoing Health and Demographic Surveillance System (HDSS) data records symptoms of diarrhea in children under the age of 5 years at the community level. Cholera surveillance in Matlab currently uses hospital-based data.ObjectiveThe objective of this study is to determine whether increases in cholera in Matlab can be detected earlier by using HDSS diarrhea symptom data in a syndromic surveillance analysis, when compared to hospital admissions for cholera.MethodsHDSS diarrhea symptom data and hospital admissions for cholera in children under 5 years of age over a 2-year period were analyzed with the syndromic surveillance statistical program EARS (Early Aberration Reporting System). Dates when significant increases in either symptoms or cholera cases occurred were compared to one another.ResultsThe analysis revealed that there were 43 days over 16 months when the cholera cases or diarrhea symptoms increased significantly. There were 8 months when both data sets detected days with significant increases. In 5 of the 8 months, increases in diarrheal symptoms occurred before increases of cholera cases. The increases in symptoms occurred between 1 and 15 days before the increases in cholera cases.ConclusionsThe results suggest that the HDSS survey data may be able to detect an increase in cholera before an increase in hospital admissions is seen. However, there was no direct link between diarrheal symptom increases and cholera cases, and this, as well as other methodological weaknesses, should be taken into consideration.

Highlights

  • The World Health Organization estimates that up to 3Á5 million cholera cases and between 100,000 and 120,000 cholera deaths occur globally each year, with the highest burden in children under 5 years of age (1Á3)

  • The objective of this study was to determine whether increases in cholera in Matlab could be detected earlier by using Health and Demographic Surveillance System (HDSS) diarrhea symptom data in a syndromic surveillance analysis, when compared to hospital admissions for cholera

  • Cholera was identified in just over 30% (174 patients) of the admissions tested for a pathogen, with the majority seen during the second year of the study period

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Summary

Introduction

The World Health Organization estimates that up to 3Á5 million cholera cases and between 100,000 and 120,000 cholera deaths occur globally each year, with the highest burden in children under 5 years of age (1Á3). In Matlab, the ongoing Health and Demographic Surveillance System (HDSS) data records symptoms of diarrhea in children under the age of 5 years at the community level. Objective: The objective of this study is to determine whether increases in cholera in Matlab can be detected earlier by using HDSS diarrhea symptom data in a syndromic surveillance analysis, when compared to hospital admissions for cholera. Methods: HDSS diarrhea symptom data and hospital admissions for cholera in children under 5 years of age over a 2-year period were analyzed with the syndromic surveillance statistical program EARS (Early Aberration Reporting System). Conclusions: The results suggest that the HDSS survey data may be able to detect an increase in cholera before an increase in hospital admissions is seen. There was no direct link between diarrheal symptom increases and cholera cases, and this, as well as other methodological weaknesses, should be taken into consideration

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