Author:
SWERDLOW D. L.,MALENGA G.,BEGKOYIAN G.,NYANGULU D.,TOOLE M.,WALDMAN R. J.,PUHR D. N. D.,TAUXE R. V.
Abstract
Between 23 August and 15 December 1990 an epidemic of cholera affected
Mozambican
refugees in Malawi causing 1931 cases (attack rate=2·4%); 86% of
patients had arrived in
Malawi <3 months before illness onset. There were 68 deaths
(case-fatality rate=3·5%);
most deaths (63%) occurred within 24 h of hospital admission which may
have indicated
delayed presentation to health facilities and inadequate early rehydration.
Mortality was higher
in children <4 years old and febrile deaths may have been associated with
prolonged IV use.
Significant risk factors for illness (P<0·05) in two
case-control studies included drinking river
water (odds ratio [OR]=3·0); placing hands into stored
household drinking water (OR=6·0);
and among those without adequate firewood to reheat food, eating
leftover cooked peas (OR=8·0). Toxigenic V. cholerae O1,
serotype Inaba, was isolated from patients and stored household
water. The rapidity with which newly arrived refugees became infected
precluded effective use
of a cholera vaccine to prevent cases unless vaccination had occurred
immediately upon camp
arrival. Improved access to treatment and care of paediatric patients,
and increased use of oral
rehydration therapy, could decrease mortality. Preventing future cholera
outbreaks in Africa
will depend on interrupting both waterborne and foodborne transmission
of this pathogen.
Publisher
Cambridge University Press (CUP)
Subject
Infectious Diseases,Epidemiology
Cited by
79 articles.
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