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Venkat A, Falconi TMA, Cruz M, Hartwick MA, Anandan S, Kumar N, Ward H, Veeraraghavan B, Naumova EN. Spatiotemporal Patterns of Cholera Hospitalization in Vellore, India. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E4257. [PMID: 31684018 PMCID: PMC6862112 DOI: 10.3390/ijerph16214257] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Revised: 10/24/2019] [Accepted: 10/31/2019] [Indexed: 11/25/2022]
Abstract
Systematically collected hospitalization records provide valuable insight into disease patterns and support comprehensive national infectious disease surveillance networks. Hospitalization records detailing patient's place of residence (PoR) can be utilized to better understand a hospital's case load and strengthen surveillance among mobile populations. This study examined geographic patterns of patients treated for cholera at a major hospital in south India. We abstracted 1401 laboratory-confirmed cases of cholera between 2000-2014 from logbooks and electronic health records (EHRs) maintained by the Christian Medical College (CMC) in Vellore, Tamil Nadu, India. We constructed spatial trend models and identified two distinct clusters of patient residence-one around Vellore (836 records (61.2%)) and one in Bengal (294 records (21.5%)). We further characterized differences in peak timing and disease trend among these clusters to identify differences in cholera exposure among local and visiting populations. We found that the two clusters differ by their patient profiles, with patients in the Bengal cluster being most likely older males traveling to Vellore. Both clusters show well-aligned seasonal peaks in mid-July, only one week apart, with similar downward trend and proportion of predominant O1 serotype. Large hospitals can thus harness EHRs for surveillance by utilizing patients' PoRs to study disease patterns among resident and visitor populations.
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Affiliation(s)
- Aishwarya Venkat
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA 02111, USA.
| | | | - Melissa Cruz
- Sackler School of Graduate Biomedical Sciences, Tufts University, Boston, MA 02111, USA.
| | - Meghan A Hartwick
- School of Marine Science and Ocean Engineering, University of New Hampshire, Durham, NH 03824, USA.
| | - Shalini Anandan
- Christian Medical College, Vellore, Tamil Nadu 632004, India.
| | - Naveen Kumar
- Christian Medical College, Vellore, Tamil Nadu 632004, India.
| | - Honorine Ward
- Sackler School of Graduate Biomedical Sciences, Tufts University, Boston, MA 02111, USA.
- Christian Medical College, Vellore, Tamil Nadu 632004, India.
- Tufts Medical Center, Boston, MA 02111, USA.
| | | | - Elena N Naumova
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA 02111, USA.
- Christian Medical College, Vellore, Tamil Nadu 632004, India.
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Islam MT, Khan AI, Sayeed MA, Amin J, Islam K, Alam N, Sultana N, Jahan N, Rashid MM, Khan ZH, Zion MI, Afrad MH, Siddique SA, Khanam F, Begum YA, Islam MS, Qadri F. Field evaluation of a locally produced rapid diagnostic test for early detection of cholera in Bangladesh. PLoS Negl Trop Dis 2019; 13:e0007124. [PMID: 30703097 PMCID: PMC6372204 DOI: 10.1371/journal.pntd.0007124] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 02/12/2019] [Accepted: 01/03/2019] [Indexed: 11/18/2022] Open
Abstract
Background Cholera remains a substantial health burden in Asia and Africa particularly in resource poor settings. The standard procedures to identify the etiological organism V. cholerae are isolation from microbiological culture from stool as well as Polymerase Chain Reaction (PCR). Both the processes are highly lab oriented, labor extensive, time consuming, and expensive. In an effort to control for outbreaks and epidemics; an effective, convenient, quick and relatively less expensive detection method is imperative, without compromising the sensitivity and specificity that exists at present. The objective of this component of the study was to evaluate the effectiveness of a locally produced rapid diagnostic test (RDT) for cholera diagnosis. Methods In Bangladesh, nationwide cholera surveillance is ongoing in 22 hospitals covering all 8 divisions of the country since June, 2016. In the surveillance, stool samples have been collected from patients presenting to hospitals with acute watery diarrhea. Crystal VCTM (Span diagnostics, India) and Cholkit (locally produced RDT) have been used to detect V. cholerae from stool samples. Samples have also been sent to the main laboratory at icddr,b where the culture based isolation is routinely performed. All the tests were carried out for both direct and enriched stool samples. RDT sensitivity and specificity were calculated using stool culture as the gold standard. Results A total of 7720 samples were tested. Among these, 5865 samples were solely tested with Crystal VC and 1355 samples with Cholkit whereas 381 samples were tested with both the RDTs. In comparison with culture, direct testing with Crystal VC showed a sensitivity of 72% (95% CI: 50.6% to 87.9%) and specificity of 86.8% (95% CI: 82.8% to 90.1%). After enrichment the sensitivity and specificity was 68% (95% CI: 46.5% to 85.1%) and 97.5% (95% CI: 95.3% to 98.8%) respectively. The direct Cholkit test showed sensitivity of 76% (95% CI: 54.9% to 90.6%) and specificity of 90.2% (95% CI: 86.6% to 93.1%). Conclusion This evaluation has demonstrated that the sensitivity and specificity of Cholkit is similar to the commercially available test, Crystal VC when used in field settings for detecting V. cholerae from stool specimens. The findings from this study suggest that the Cholkit could be a possible alternative for cholera endemic regions where V. cholerae O1 is the major causative organism causing cholera. Cholera still remains a burning public health issue in the developing world. Microbiological culture is the gold standard method for cholera diagnosis. However, it requires well equipped laboratories and 24–72 hours’ time for the isolation of pathogens, which may not be feasible for hard to reach areas and during epidemics or seasonal outbreaks. For the effective control of disease outbreaks, detection methods should be both quick and easy without sacrificing specificity and sensitivity. Rapid diagnostic test for cholera could be a potential alternative for early detection of the disease. Addressing this issue in our study, we report the performance of a rapid diagnostic test (RDT), Cholkit for the diagnosis of cholera cases using stool obtained in field settings and the assessment of its performance with those of microbial culture and Crystal VC assay, a commercially available dipstick.
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Affiliation(s)
- Md. Taufiqul Islam
- International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Ashraful Islam Khan
- International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Md. Abu Sayeed
- International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Jakia Amin
- Incepta Pharmaceuticals Ltd., Dhaka, Bangladesh
| | - Kamrul Islam
- International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Nur Alam
- Incepta Pharmaceuticals Ltd., Dhaka, Bangladesh
| | | | - Noor Jahan
- Incepta Pharmaceuticals Ltd., Dhaka, Bangladesh
| | - Md. Mahbubur Rashid
- International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Zahid Hasan Khan
- International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Mazharul Islam Zion
- International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Mokibul Hassan Afrad
- International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Shah Alam Siddique
- International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Farhana Khanam
- International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Yasmin Ara Begum
- International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Muhammad Shariful Islam
- International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Firdausi Qadri
- International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
- * E-mail:
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Khan AI, Khan IA, Siddique SA, Rahman A, Islam MT, Bhuiya MAI, Saha NC, Biswas PK, Saha A, Chowdhury F, Qadri F. Feasibility, coverage and cost of oral cholera vaccination conducted by icddr,b using the existing national immunization service delivery mechanism in rural setting Keraniganj, Bangladesh. Hum Vaccin Immunother 2018; 15:1302-1309. [PMID: 30261152 PMCID: PMC6663147 DOI: 10.1080/21645515.2018.1528833] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Background: Cholera is a considerable health burden in developing country settings including Bangladesh. The oral cholera vaccine (OCV) is a preventative tool to control the disease. The objective of this study was to describe whether the International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), could provide the OCV to rural communities using existing government infrastructure. Methods: The study was conducted in rural sub-district Keraniganj, 20 km from the capital city Dhaka. All listed participants one year and above in age (excluding pregnant women) were offered two doses of OCV at a 14 day interval. Existing government facilities were used to deliver and also maintain the cold chain required for the vaccine. All events related to vaccination were recorded at the 17 vaccination sites to evaluate the coverage and feasibility of OCV program. Results: A total of 29,029 individuals received the 1st dose (90% of target) and 26,611 individuals received the 2nd dose (83% of target and 92% of 1st dose individuals) of OCV. The highest vaccination coverage was in younger children (1–9 years) and the lowest was amongst 18–29-year age group. Somewhat better coverage was seen amongst the female participants than males (92% vs. 88% for the 1st dose and 93% vs. 90% for the 2nd dose). The cost of vaccine cost was calculated as US$1.00 per dose plus freight, insurance, and transportation and the total vaccine delivery cost was US$70,957. Conclusion: This was a project undertaken using existing public health program resources to collect empirical evidence on the use of a mass OCV campaign in the rural setting. Mass vaccination with the OCV is feasible in the rural setting using existing governmental vaccine delivery systems in Bangladesh.
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Affiliation(s)
- Ashraful Islam Khan
- a Infectious Diseases Division , International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) , Dhaka , Bangladesh
| | - Iqbal Ansary Khan
- b Medical Social Science , Institute of Epidemiology, Disease Control and Research (IEDCR) , Dhaka , Bangladesh
| | - Shah Alam Siddique
- a Infectious Diseases Division , International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) , Dhaka , Bangladesh
| | - Anisur Rahman
- a Infectious Diseases Division , International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) , Dhaka , Bangladesh
| | - Md Taufiqul Islam
- a Infectious Diseases Division , International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) , Dhaka , Bangladesh
| | - Md Amirul Islam Bhuiya
- a Infectious Diseases Division , International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) , Dhaka , Bangladesh
| | - Nirod Chandra Saha
- a Infectious Diseases Division , International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) , Dhaka , Bangladesh
| | - Prasanta Kumar Biswas
- a Infectious Diseases Division , International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) , Dhaka , Bangladesh
| | - Amit Saha
- a Infectious Diseases Division , International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) , Dhaka , Bangladesh
| | - Fahima Chowdhury
- a Infectious Diseases Division , International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) , Dhaka , Bangladesh
| | - Firdausi Qadri
- a Infectious Diseases Division , International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) , Dhaka , Bangladesh
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Pal BB, Nayak SR, Khuntia HK. Epidemiology and Antibiogram Profile of Vibrio cholerae Isolates between 2004-2013 from Odisha, India. Jpn J Infect Dis 2017; 71:99-103. [PMID: 29279443 DOI: 10.7883/yoken.jjid.2017.193] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Cholera is an acute diarrheal disease caused by Vibrio cholerae serogroups O1 and O139, which are known to cause epidemics of cholera in Odisha. The present study was intended to document the antibiotic resistance pattern among clinical isolates of both serogroups of V. cholerae (O1 and O139) isolated during 2004-2013. Nine-hundred nine isolates of V. cholerae were included in this study and were identified by standard procedures. An antibiotic sensitivity test was performed by the disc diffusion method. The seasonality of cholera in this region indicated that there was one peak in the rainy season only. The number of cholera cases started increasing from July and declined starting from the month of October onward. The adult age group of patients was the worst affected among all age groups of patients. The 2 different serogroups of V. cholerae (O1 and O139) showed different prevalence rates (%) of resistance to all the antibiotics in each year. Serogroup O1 showed uniformly high resistance to co-trimoxazole, furazolidone, and nalidixic acid throughout the study. Chloramphenicol encountered resistance only during 2009, but the strains were sensitive in the other years. The emergence of multiple drug-resistant V. cholerae strains may significantly influence the control of future outbreaks and epidemics of cholera in this region.
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