Cholera Outbreak Linked with Lack of Safe Water Supply Following a Tropical Cyclone in Pondicherry, India, 2012
Cholera Outbreak Linked with Lack of Safe Water Supply Following a Tropical Cyclone in Pondicherry, India, 2012
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2012 年印度本地治里发生热带气旋后，霍乱爆发与缺乏安全供水有关
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发表时间：
2015
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影响因子：
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通讯作者：
Vasna Joshua
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作者：
T. Fredrick;M. Ponnaiah;M. Murhekar;Y. Jayaraman;J. K. David;Selvaraj Vadivoo;Vasna Joshua
摘要2012年1月7日，在一场严重的气旋风暴之后，印度南部本地治里的两个地方报告了一组急性腹泻病例。我们调查了疫情，以确定原因并建议控制措施。我们将一例病例定义为2012年1月6日至18日期间受影响地区的居民每天出现三次以上稀便伴或不伴呕吐的腹泻。我们使用主动（上门调查）和刺激被动（基于健康设施）监测来识别病例。我们按时间、地点和人物描述了疫情的爆发。我们比较了病例患者与最多三个对照组，这些对照组没有任何明显的腹泻体征和症状，并且在年龄、性别和邻居方面相匹配。我们计算了匹配比值比（莫尔）、95%置信区间（CI）和人群归因分数（PAF）。我们采集了直肠拭子和水样进行实验室诊断，并检测了水样的微生物质量。我们在8，367名居民中确定了921例病例和1例死亡（发病率：11%，病死率：0.1%）。50岁及以上人群（14%）和女性（12%）的发病率最高。疫情于1月6日开始，9日达到高峰，并持续到1月14日。病例集中在供水系统的两个主要泄漏点。16份粪便样本中有9份检出霍乱弧菌O 1 Ogawa。我们发现，公共分配系统的水消费（莫尔=37，95% CI 4.9-285，PAF：97%），饮用生水（莫尔=35，95% CI 4.5-269，PAF：97%），以及两个或多个家庭使用的公共厕所（莫尔=2.7，95% CI 1.3-5.6）与霍乱独立相关。流行病学证据表明，这次暴发是由于在飓风期间摄入了雨水后被排水污染的水。我们建议修复供水管道，清理下水道，洗手，喝开水。
ABSTRACT In the aftermath of a severe cyclonic storm on 7 January 2012, a cluster of acute diarrhoea cases was reported from two localities in Pondicherry, Southern India. We investigated the outbreak to identify causes and recommend control measures. We defined a case as occurrence of diarrhoea of more than three loose stools per day with or without vomiting in a resident of affected areas during 6-18 January 2012. We used active (door-to-door survey) and stimulated passive (healthy facility-based) surveillance to identify cases. We described the outbreak by time, place, and person. We compared the case-patients with up to three controls without any apparent signs and symptoms of diarrhoea and matched for age, gender, and neighbourhood. We calculated matched odds ratio (MOR), 95% confidence intervals (CI), and population attributable fractions (PAF). We collected rectal swabs and water samples for laboratory diagnosis and tested water samples for microbiological quality. We identified 921 cases and one death among 8,367 residents (attack rate: 11%, case-fatality: 0.1%). The attack rate was the highest among persons of 50 years and above (14%) and females (12%). The outbreak started on 6 January and peaked on the 9th and lasted till 14 January. Cases were clustered around two major leakages in water supply system. Nine of the 16 stool samples yielded V. cholerae O1 Ogawa. We identified that consumption of water from the public distribution system (MOR=37, 95% CI 4.9-285, PAF: 97%), drinking unboiled water (MOR=35, 95% CI 4.5-269, PAF: 97%), and a common latrine used by two or more households (MOR=2.7, 95% CI 1.3-5.6) were independently associated with cholera. Epidemiological evidence suggested that this outbreak was due to ingestion of water contaminated by drainage following rains during cyclone. We recommended repair of the water supply lines, cleaning-up of the drains, handwashing, and drinking of boiled water.