Outbreak of Cholera in Vea-Gunga, Upper East Region, Ghana, 2015: Interfamilial and household-level transmission
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Abstract
Abstract
Background: Cholera is an acute infectious illness with profuse watery diarrhoea caused by toxigenic Vibrio cholerae serogroup O1 or O139. An estimated 1.4–4.3 million cases and 28000-142000 deaths occur yearly. In 2014, the Upper East Region (UER) of Ghana recorded 289 cholera cases with case-fatality of 3.1%.
On June 28, 2015, Bongo-District Hospital prompted the Bongo-District Health Directorate of a cholera outbreak at Vea-Gunga, in the Bongo District (BD), UER. We investigated to verify the diagnosis, determine the magnitude, identify etiological agent, source of infection and recommend control measures.
Methods: We perform a descriptive study. A suspected cholera case-patient was a person having acute watery diarrhoea with or without vomiting at Vea-Gunga from June1to July 20, 2015. Data was obtained by record review, interview with stakeholders and active case-finding from health facilities and communities. Stool from case-patients were taken for laboratory diagnosis and the environment was assessed. Data was analysed by person, place and time with Epi-info-version-3.5.1.
Results: Of 933 community members, 13 were affected and 69.2% (9/13) were females. The overall attack rate was 1.4% (13/933) and case-fatality 15.4% (2/13). The median and intra-quartile-range age of case-patients was 28.5 (1-50) years old. Sex-specific attack rates were 0.9% (4/447) and 1.6% (9/486) for males and females respectively. Almost all 85% (11/13) of affected cases-patients were close family members of the primary case, living on the same compound. Vibrio cholerae serotype ogawa was isolated from stool samples. We observed inadequate and unsafe water supply coupled with pollution of Vea-Dam.
Conclusions: Vibrio cholerae serotype ogawa caused the Vea-Gunga cholera-outbreak. Children and females were mostly affected. The probable sources of infection were person-to-person, contamination of drinking water or food. Boiling or chlorination of water, hand washing with soap and water were initiated and this played a significant role in controlling the outbreak.Article Details
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References
1. 1. Seas C GE. Vibrio cholerae. In: Mandell GL, Bennett JE, Dolin R, eds. Principles and Practice of Infectious Diseases. USA: Churchill Livingston; 2000: 2266 –2272.; 2000. 2266 –2272 p.
2. Outbreak news. Severe acute watery diarrhoea with cases positive for Vibrio cholerae. Viet NamWkly Epidemiol Rec. 2008;83(18):157–8.
3. WHO Report [Internet]. 2016. Available from: http://www.who.int/wer
4. WHO. Global Health Observatory (GHO), Reported cholera case fatality rate; Situation and trends. WHO, Geneva. 2010;
5. Annual report Bongo District, Upper East Region, Ghana. 2015.
6. Sack DA, Sack RB, Nair GB SA. “Cholera.” Lancet. 2004;363(9404):223–33.
7. Breban R. Role of environmental persistence in pathogen transmission : a mathematical modeling approach. 2013;535–46.
8. Eisenberg MC, Robertson SL TJ. Identifiability and estimation of multiple transmission pathways in cholera and waterborne disease. J Theor Biol. :324:84-102.
9. Sack RB, Siddique AK, Longini IM, Nizam A, Islam MS, Morris JG, et al. A 4-Year Study of the Epidemiology of Vibrio cholerae in Four Rural Areas of Bangladesh. 2003;21205:96–101.
10. Ali M, Emch M, von Seidlein L, Yunus M S DA. Herd immunity conferred by killed oral cholera vaccines in Bangladesh: a reanalysis. Lancet. 2005;(366):44–49.
11. Ghana Statistical Service [Internet]. 2010. Available from: www.statsghana.gov.gh
12. Shears P. Recent developments in cholera. Curr Opin Infect Dis. 2001;(14):553–558.
13. Goh KT, Teo SH, Lam S LM. Person-to-person transmission of cholera in a psychiatric hospital. J Infect. 20(3):193–200.
14. Lasch, E.E., Abed, Y., Marcus, O., Shbeir, M., El Alem, A., Ali Hassan N 1984. C in G in 1981: Epidemiological characteristics of an outbreak. Tranactions R Soc Trop Med Hyg. 1984;78(4):554–7.
15. Al S et. Epidemiology of Vibrio cholerae O139 with Special Reference to Intrafamilial Transmission in Calcutta. J lnfection. 1994;(31):45–7.
16. Al S et. Waterborne transmission of epidemic cholera in Trujillo, Peru: lessons for a continent at risk. Lancet. 1992;340(8810):28–33.
17. Shahid, N.S., Samadi, A.R., Khan, M.U., and Huq MI. Classical vs El Tor cholera: a prospective family study of a concurrent outbreak. J Diarrheal Dis Res. 1984;2(2):7378.
18. St. Louis ME, Porter JD HA. Epidemic cholera in West Africa: the role of food handling and high-risk foods. Am J Epidemiol. 1990;131:719–28.
19. Estrada-Garcia, T, and Mintz E. Cholera: Foodborne transmission and its prevention. Eur J Epidemiol. 1996;12(5):461–9.
20. Holmberg SD, Harris JR K DE. Foodborne transmission of cholera in Micronesian households. Lancet. 1984;i:325–8.
21. Sugimoto JD, Koepke AA, Kenah EE, Halloran ME, Chowdhury F, Khan AI, et al. Household Transmission of Vibrio cholerae in Bangladesh. 2014;8(11).
22. Tauxe RV, Holmberg SD, Dodin A, Wells JG BP. Epidemic cholera in Mali: high mortality and multiple routes of transmission in a famine area. Epidemiol Infect. 1988;100:279–89.
23. Gunnlaugsson G1, Einarsdóttir J, Angulo FJ, Mentambanar SA, Passa A TR. Funerals during the 1994 cholera epidemic in Guinea-Bissau, West Africa: the need for disinfection of bodies of persons dying of cholera. Epidemiol Infect. 1998;120 1(1):7–15.
24. Mandomando I, Espasa M VX. Antimicrobial resistance of Vibrio cholerae O1 serotype Ogawa isolated in Manhica District Hospital, southern Mozambique. J Antimicrob Chemother. 2007;60:662–4.
25. Opintan JA, Newman MJ, Nsiah-poodoh OA, Okeke IN. Vibrio cholerae O1 from Accra , Ghana carrying a class 2 integron and the SXT element. 2008;(August):929–33.
26. Opare JKL, Ohuabunwo C, Afari E, Wurapa F, Sackey SO. Outbreak Of Cholera in the East Akim Municipality of Ghana Following Unhygienic Practices By Small-Scale Gold Miners, Ghana Medical Journal, November 2010. 2012;(September 2010).
27. Dzotsi E, Odoom JK, Opare JKL, Davies-teye BBK. Outbreak of Cholera , Greater Accra Region, 2016;9 (August 2014):1–12.
28. Harri AA. Cholera: Lessons from Haiti and Beyond. Curr Infect Dis Rep. 2012;14(1):pp 1–8.
29. Siddique AK, Salam A, Islam MS, Akram K, Majumdar RN, Zaman K, Fronczak N LS. Why treatment centres failed to prevent cholera deaths among Rwandan refugees in Goma, Zaire. Lancet. 345(8946):359–61.