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      Risk Factors for Sustained Cholera Transmission, Juba County, South Sudan, 2014

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          Abstract

          We conducted a case–control study to identify risk factors for the 2014 cholera outbreak in Juba County, South Sudan. Illness was associated with traveling or eating away from home; treating drinking water and receiving oral cholera vaccination were protective. Oral cholera vaccination should be used to complement cholera prevention efforts.

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          Use of Vibrio cholerae vaccine in an outbreak in Guinea.

          Francisco Luquero, Lise Grout, Iza Ciglenecki … (2014)
          The use of vaccines to prevent and control cholera is currently under debate. Shanchol is one of the two oral cholera vaccines prequalified by the World Health Organization; however, its effectiveness under field conditions and the protection it confers in the first months after administration remain unknown. The main objective of this study was to estimate the short-term effectiveness of two doses of Shanchol used as a part of the integrated response to a cholera outbreak in Africa. We conducted a matched case-control study in Guinea between May 20 and October 19, 2012. Suspected cholera cases were confirmed by means of a rapid test, and controls were selected among neighbors of the same age and sex as the case patients. The odds of vaccination were compared between case patients and controls in bivariate and adjusted conditional logistic-regression models. Vaccine effectiveness was calculated as (1-odds ratio)×100. Between June 8 and October 19, 2012, we enrolled 40 case patients and 160 controls in the study for the primary analysis. After adjustment for potentially confounding variables, vaccination with two complete doses was associated with significant protection against cholera (effectiveness, 86.6%; 95% confidence interval, 56.7 to 95.8; P=0.001). In this study, Shanchol was effective when used in response to a cholera outbreak in Guinea. This study provides evidence supporting the addition of vaccination as part of the response to an outbreak. It also supports the ongoing efforts to establish a cholera vaccine stockpile for emergency use, which would enhance outbreak prevention and control strategies. (Funded by Médecins sans Frontières.).
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            A cholera outbreak among semi-nomadic pastoralists in northeastern Uganda: epidemiology and interventions.

            Mariana Mayer, Doyle Cummings, L Lukwago … (2012)
            In sub-Saharan Africa, many nomadic pastoralists have begun to settle in permanent communities as a result of long-term water, food, and civil insecurity. Little is known about the epidemiology of cholera in these emerging semi-nomadic populations. We report the results of a case-control study conducted during a cholera outbreak among semi-nomadic pastoralists in the Karamoja sub-region of northeastern Uganda in 2010. Data from 99 cases and 99 controls were analysed. In multivariate analyses, risk factors identified were: residing in the same household as another cholera case [adjusted odds ratio (aOR) 6·67, 95% confidence interval (CI) 2·83-15·70], eating roadside food (aOR 2·91, 95% CI 1·24-6·81), not disposing of children's faeces in a latrine (aOR 15·76, 95% CI 1·54-161·25), not treating drinking water with chlorine (aOR 3·86, 95% CI 1·63-9·14), female gender (aOR 2·43, 95% CI 1·09-5·43), and childhood age (10-17 years) (aOR 7·14, 95% CI 1·97-25·83). This is the first epidemiological study of cholera reported from a setting of semi-nomadic pastoralism in sub-Saharan Africa. Public health interventions among semi-nomadic pastoralists should include a two-faceted approach to cholera prevention: intensive health education programmes to address behaviours inherited from insecure nomadic lifestyles, as well as improvements in water and sanitation infrastructure. The utilization of community-based village health teams provides an important method of implementing such activities.
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              Risk factors for cholera transmission in Haiti during inter-peak periods: insights to improve current control strategies from two case-control studies.

              F Grandesso, Keith M Allan, P S J Jean-Simon … (2014)
              Two community-based density case-control studies were performed to assess risk factors for cholera transmission during inter-peak periods of the ongoing epidemic in two Haitian urban settings, Gonaives and Carrefour. The strongest associations were: close contact with cholera patients (sharing latrines, visiting cholera patients, helping someone with diarrhoea), eating food from street vendors and washing dishes with untreated water. Protective factors were: drinking chlorinated water, receiving prevention messages via television, church or training sessions, and high household socioeconomic level. These findings suggest that, in addition to contaminated water, factors related to direct and indirect inter-human contact play an important role in cholera transmission during inter-peak periods. In order to reduce cholera transmission in Haiti intensive preventive measures such as hygiene promotion and awareness campaigns should be implemented during inter-peak lulls, when prevention activities are typically scaled back.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Emerg Infect Dis
                Journal ID (iso-abbrev): Emerging Infect. Dis
                Journal ID (publisher-id): EID
                Title: Emerging Infectious Diseases
                Publisher: Centers for Disease Control and Prevention
                ISSN (Print): 1080-6040
                ISSN (Electronic): 1080-6059
                Publication date (Print): October 2015
                Volume: 21
                Issue: 10
                Pages: 1849-1852
                Affiliations
                [1]Ministry of Health, Juba, South Sudan (T.T.A. Ujjiga, J.J.H. Mogga, T.O. Othwonh, P. Nyimol, R. Lul, R.L. Lako, J. Rumunu);
                [2]World Health Organization, Juba (J.F. Wamala, D. Mutonga, A. Kone-Coulibaly, M.A. Shaikh, A.M. Mpairwe, A. Abdinasir, M.A. Abdi, Z. Yoti, O. Olushayo)
                Author notes
                Address for correspondence: Joseph F. Wamala, World Health Organization Country Office, Juba, South Sudan; email: j_wamala@ 123456yahoo.com
                Article
                Publisher ID: 14-2051
                DOI: 10.3201/eid2110.142051
                PMC ID: 4593433
                PubMed ID: 26402715
                SO-VID: 84ecca99-754e-4092-b243-95788e989165
                History
                Categories
                Subject: Dispatch
                Subject: Dispatch
                Subject: Risk Factors for Sustained Cholera Transmission, Juba County, South Sudan, 2014

                ScienceOpen disciplines: Infectious disease & Microbiology
                Keywords: cholera,risk factors,matched case-control study,zoonoses,south sudan,transmission,sub-saharan africa,epidemic,water sanitation,environmental factors,vaccine,diarrheal disease,enteric infections,vibrio cholerae
                Data availability:
                ScienceOpen disciplines: Infectious disease & Microbiology
                Keywords: cholera, risk factors, matched case-control study, zoonoses, south sudan, transmission, sub-saharan africa, epidemic, water sanitation, environmental factors, vaccine, diarrheal disease, enteric infections, vibrio cholerae

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