1
|
Akel M, Sakr F, Haddad C, Hajj A, Sacre H, Zeenny RM, Safwan J, Salameh P. Knowledge, Attitude, and Practices of the General Population toward the Old-New Outbreak of Cholera in a Developing Country. Trop Med Infect Dis 2023; 8:tropicalmed8040236. [PMID: 37104361 PMCID: PMC10144007 DOI: 10.3390/tropicalmed8040236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 04/14/2023] [Accepted: 04/17/2023] [Indexed: 04/28/2023] Open
Abstract
Background: In October 2022, the first case of cholera since 1993 was recorded in Lebanon. This study aimed to develop and validate a tool to explore the knowledge, attitudes, and practices (KAP) toward cholera infection and its prevention among the general population in Lebanon and identify the associated factors related to the KAP assessment to guide prevention and awareness strategies. The nation's already precarious healthcare system might become overwhelmed by the response to the cholera outbreak. Therefore, evaluating the level of cholera-related KAP among the Lebanese population is crucial since it directly affects the disease's treatment, control, and prevention. Methods: This online cross-sectional study was carried out between October and November 2022 during the cholera outbreak in Lebanon. Snowball sampling was used to recruit 448 adults living in Lebanon. Results: The suggested KAP scales had adequate structural and convergent validity and were internally consistent. The disease knowledge was inversely associated with the reluctance to receive educational information (β = -1.58) and cigarette smoking (β = -1.31) but positively associated with the female gender (β = 1.74) and awareness of vaccine availability and efficacy (β = 1.34). For attitude, healthcare professionals were less frightened than others (β = 2.69). Better practices were related to better knowledge (β = 0.43), while inadequate practices were associated with getting information from social media (β = -2.47). Conclusions: This study could identify notable gaps in the knowledge, attitudes, and practices, which varied according to participant characteristics. Cholera incidence can be reduced by improved community education and training, increased access to safe water, sanitation, and hygiene amenities, and changes in behavior. These findings warrant additional actions by public health stakeholders and governmental authorities to promote better practices and curb disease transmission.
Collapse
Affiliation(s)
- Marwan Akel
- School of Pharmacy, Lebanese International University, Beirut P.O. Box 146404, Lebanon
- INSPECT-LB (Institut National de Santé Publique, d'Épidémiologie Clinique et de Toxicologie-Liban), Beirut P.O. Box 12109, Lebanon
- School of Education, Lebanese International University, Beirut P.O. Box 146404, Lebanon
| | - Fouad Sakr
- School of Pharmacy, Lebanese International University, Beirut P.O. Box 146404, Lebanon
- INSPECT-LB (Institut National de Santé Publique, d'Épidémiologie Clinique et de Toxicologie-Liban), Beirut P.O. Box 12109, Lebanon
- UMR U955 INSERM, Institut Mondor de Recherche Biomédicale, Université Paris-Est Créteil, 94010 Créteil, France
- École Doctorale Sciences de la Vie et de la Santé, Université Paris-Est Créteil, 94010 Créteil, France
| | - Chadia Haddad
- INSPECT-LB (Institut National de Santé Publique, d'Épidémiologie Clinique et de Toxicologie-Liban), Beirut P.O. Box 12109, Lebanon
- School of Medicine, Lebanese American University, Byblos P.O. Box 13-5053, Lebanon
- Research Department, Psychiatric Hospital of the Cross, Jall Eddib P.O. Box 60096, Lebanon
| | - Aline Hajj
- INSPECT-LB (Institut National de Santé Publique, d'Épidémiologie Clinique et de Toxicologie-Liban), Beirut P.O. Box 12109, Lebanon
- Faculté de Pharmacie, Université Laval, Québec G1V 0A6, Canada
- Oncology Division, CHU de Québec Université Laval Research Center, Québec G1S 4L8, Canada
- Laboratoire de Pharmacologie, Pharmacie Clinique et Contrôle de Qualité des Médicament, Faculté de Pharmacie, Université Saint-Joseph de Beyrouth, Beirut P.O. Box 1107-2180, Lebanon
| | - Hala Sacre
- INSPECT-LB (Institut National de Santé Publique, d'Épidémiologie Clinique et de Toxicologie-Liban), Beirut P.O. Box 12109, Lebanon
- Drug Information Center, Order of Pharmacists of Lebanon, Beirut P.O. Box 11-2807, Lebanon
| | - Rony M Zeenny
- INSPECT-LB (Institut National de Santé Publique, d'Épidémiologie Clinique et de Toxicologie-Liban), Beirut P.O. Box 12109, Lebanon
- Department of Pharmacy, American University of Beirut Medical Center, Beirut P.O. Box 11-0236, Lebanon
| | - Jihan Safwan
- School of Pharmacy, Lebanese International University, Beirut P.O. Box 146404, Lebanon
- INSPECT-LB (Institut National de Santé Publique, d'Épidémiologie Clinique et de Toxicologie-Liban), Beirut P.O. Box 12109, Lebanon
| | - Pascale Salameh
- INSPECT-LB (Institut National de Santé Publique, d'Épidémiologie Clinique et de Toxicologie-Liban), Beirut P.O. Box 12109, Lebanon
- School of Medicine, Lebanese American University, Byblos P.O. Box 13-5053, Lebanon
- Faculty of Pharmacy, Lebanese University, Hadath P.O. Box 6573-14, Lebanon
- Department of Primary Care and Population Health, University of Nicosia Medical School, Nicosia 2417, Cyprus
| |
Collapse
|
2
|
Murray GR, Rutland J. Prioritizing public health? Factors affecting the issuance of stay-at-home orders in response to COVID-19 in Africa. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000112. [PMID: 36962142 PMCID: PMC10021525 DOI: 10.1371/journal.pgph.0000112] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 11/18/2021] [Indexed: 11/19/2022]
Abstract
COVID-19 has sickened and killed millions of people globally. Conventional non-pharmaceutical interventions, particularly stay-at-home orders (SAHOs), though effective for limiting the spread of disease have significantly disrupted social and economic systems. The effects also have been dramatic in Africa, where many states are already vulnerable due to their developmental status. This study is designed to test hypotheses derived from the public health policymaking literature regarding the roles played by medical and political factors as well as social, economic, and external factors in African countries' issuance of SAHOs in response to the early stages of the COVID-19 pandemic. Using event history analysis, this study analyzed these five common factors related to public health policy to determine their impact on African states' varying decisions regarding the issuance of SAHOs. The results of this analysis suggest that medical factors significantly influenced decisions as did factors external to the states, while the role of political factors was limited. Social and economic factors played no discernible role. Overall, this study suggests how African leaders prioritized competing factors in the early stages of a public health crisis.
Collapse
Affiliation(s)
- Gregg R. Murray
- Department of Social Sciences, Political Science, Center for Bioethics and Health Policy, Augusta University, Augusta, Georgia, United States of America
| | - Joshua Rutland
- Department of Social Sciences, MAISS, Augusta University, Augusta, Georgia, United States of America
| |
Collapse
|
3
|
Major Stressors Favoring Cholera Trigger and Dissemination in Guinea-Bissau (West Africa). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111296. [PMID: 34769812 PMCID: PMC8583644 DOI: 10.3390/ijerph182111296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 10/15/2021] [Accepted: 10/23/2021] [Indexed: 11/17/2022]
Abstract
Cholera remains a heavy burden worldwide, especially in Sub-Saharan African countries, which account for the majority of the reported cases on the continent. In this study, a 27-year retrospective analysis of cholera epidemics in Guinea-Bissau was performed in order to highlight major stressors fueling the trigger and dissemination of the disease. Although the role of environmental factors did not always have the same degree of importance for the onset of epidemics, a cholera seasonal pattern was clearly perceived, with most of the reported cases occurring during the wet season. The generated theoretical hypothesis indicated rainfall above climatological average, associated with a lack of WASH (water, sanitation and hygiene) infrastructure, and the occurrence of concomitant epidemics in neighboring countries as the key indicators for optimal conditions for cholera to thrive in Guinea-Bissau. Warmer air temperature, the increase in sea surface temperature, and the decrease in salinity in the coastal areas may also contribute to the emergence and/or aggravation of cholera events. Prediction of the conditions favorable for cholera growth and identification of risk pathways will allow the timely allocation of resources, and support the development of alert tools and mitigation strategies.
Collapse
|
4
|
Smith AM, Weill FX, Njamkepo E, Ngomane HM, Ramalwa N, Sekwadi P, Thomas J. Emergence of Vibrio cholerae O1 Sequence Type 75, South Africa, 2018-2020. Emerg Infect Dis 2021; 27:2927-2931. [PMID: 34670657 PMCID: PMC8544974 DOI: 10.3201/eid2711.211144] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
We describe the molecular epidemiology of cholera in South Africa during 2018-2020. Vibrio cholerae O1 sequence type (ST) 75 recently emerged and became more prevalent than the V. cholerae O1 biotype El Tor pandemic clone. ST75 isolates were found across large spatial and temporal distances, suggesting local ST75 spread.
Collapse
|
5
|
Abstract
PURPOSE OF REVIEW This review describes the basic epidemiologic, clinical, and microbiologic aspects of cholera, highlights new developments within these areas, and presents strategies for applying currently available tools and knowledge more effectively. RECENT FINDINGS From 1990 to 2016, the reported global burden of cholera fluctuated between 74,000 and 595,000 cases per year; however, modeling estimates suggest the real burden is between 1.3 and 4.0 million cases and 95,000 deaths yearly. In 2018, the World Health Assembly endorsed a new initiative to reduce cholera deaths by 90% and eliminate local cholera transmission in 20 countries by 2030. New tools, including localized GIS mapping, climate modeling, whole genome sequencing, oral vaccines, rapid diagnostic tests, and new applications of water, sanitation, and hygiene interventions, could support this goal. Challenges include a high proportion of fragile states among cholera-endemic countries, urbanization, climate change, and the need for cholera treatment guidelines for pregnant women and malnourished children. SUMMARY Reducing cholera morbidity and mortality depends on real-time surveillance, outbreak detection and response; timely access to appropriate case management and cholera vaccines; and provision of safe water, sanitation, and hygiene.
Collapse
Affiliation(s)
- William Davis
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road, Mailstop H24-9, Atlanta, GA 30329, USA
| | - Rupa Narra
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road, Mailstop H24-9, Atlanta, GA 30329, USA
| | - Eric D. Mintz
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road, Mailstop H24-9, Atlanta, GA 30329, USA
| |
Collapse
|
6
|
Sinyange N, Brunkard JM, Kapata N, Mazaba ML, Musonda KG, Hamoonga R, Kapina M, Kapaya F, Mutale L, Kateule E, Nanzaluka F, Zulu J, Musyani CL, Winstead AV, Davis WW, N’cho HS, Mulambya NL, Sakubita P, Chewe O, Nyimbili S, Onwuekwe EV, Adrien N, Blackstock AJ, Brown TW, Derado G, Garrett N, Kim S, Hubbard S, Kahler AM, Malambo W, Mintz E, Murphy J, Narra R, Rao GG, Riggs MA, Weber N, Yard E, Zyambo KD, Bakyaita N, Monze N, Malama K, Mulwanda J, Mukonka VM. Cholera Epidemic - Lusaka, Zambia, October 2017-May 2018. MMWR-MORBIDITY AND MORTALITY WEEKLY REPORT 2018; 67:556-559. [PMID: 29771877 PMCID: PMC6048949 DOI: 10.15585/mmwr.mm6719a5] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
|
7
|
Mintz E. Taking aim at cholera. Lancet 2018; 391:1868-1870. [PMID: 29502906 DOI: 10.1016/s0140-6736(18)30543-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 12/11/2017] [Indexed: 10/17/2022]
Affiliation(s)
- Eric Mintz
- Waterborne Diseases Prevention Branch, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA.
| |
Collapse
|
8
|
Diaconu K, Falconer J, O’May F, Jimenez M, Matragrano J, Njanpop-Lafourcade B, Ager A. Cholera diagnosis in human stool and detection in water: protocol for a systematic review of available technologies. Syst Rev 2018; 7:29. [PMID: 29458416 PMCID: PMC5819268 DOI: 10.1186/s13643-018-0679-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 01/11/2018] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Cholera is a highly infectious diarrheal disease spread via fecal contamination of water and food sources; it is endemic in parts of Africa and Asia and recent outbreaks have been reported in Haiti, the Zambia and Democratic Republic of the Congo. If left untreated, the disease can be fatal in less than 24 h and result in case fatality ratios of 30-50%. Cholera disproportionately affects those living in areas with poor access to water and sanitation: the long-term public health response is focused on improving water and hygiene facilities and access. Short-term measures for infection prevention and control, and disease characterization and surveillance, are impaired by diagnostic delays: culture methods are slow and rely on the availability of infrastructure and specialist equipment. Rapid diagnostic tests have shown promise under field conditions and further innovations in this area have been proposed. METHODS This paper is the protocol for a systematic review focused on identifying current technologies and methods used for cholera diagnosis in stool, and detection in water. We will synthesize and appraise information on product technical specifications, accuracy and design features in order to inform infection prevention and control and innovation development. Embase, MEDLINE, CINAHL, Proquest, IndMed and the WHO and Campbell libraries will be searched. We will include studies reporting on field evaluations, including within-study comparisons against a reference standard, and laboratory evaluations reporting on product validation against field stool or water samples. We will extract data according to protocol and attempt meta-analyses if appropriate given data availability and quality. DISCUSSION The systematic review builds on a previous scoping review in this field and expands upon this by synthesising data on both product technical characteristics and design features. The review will be of particular value to stakeholders engaged in diagnostic procurement and manufacturers interested in developing cholera or diarrheal disease diagnostics. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42016048428 .
Collapse
Affiliation(s)
- Karin Diaconu
- Institute for Global Health and Development, Queen Margaret University - Edinburgh, Musselburgh, EH21 6UU Scotland
| | - Jennifer Falconer
- Institute for Global Health and Development, Queen Margaret University - Edinburgh, Musselburgh, EH21 6UU Scotland
| | - Fiona O’May
- Institute for Global Health and Development, Queen Margaret University - Edinburgh, Musselburgh, EH21 6UU Scotland
| | - Miguel Jimenez
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139 USA
| | - Joe Matragrano
- Columbia University, 116th St & Broadway, New York, NY 10027 USA
| | | | - Alastair Ager
- Institute for Global Health and Development, Queen Margaret University - Edinburgh, Musselburgh, EH21 6UU Scotland
- Mailman School of Public Health, 116th St & Broadway, New York, NY 10027 USA
| |
Collapse
|
9
|
Bwire G, Ali M, Sack DA, Nakinsige A, Naigaga M, Debes AK, Ngwa MC, Brooks WA, Garimoi Orach C. Identifying cholera "hotspots" in Uganda: An analysis of cholera surveillance data from 2011 to 2016. PLoS Negl Trop Dis 2017; 11:e0006118. [PMID: 29284003 PMCID: PMC5746206 DOI: 10.1371/journal.pntd.0006118] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 11/17/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Despite advance in science and technology for prevention, detection and treatment of cholera, this infectious disease remains a major public health problem in many countries in sub-Saharan Africa, Uganda inclusive. The aim of this study was to identify cholera hotspots in Uganda to guide the development of a roadmap for prevention, control and elimination of cholera in the country. METHODOLOGY/PRINCIPLE FINDINGS We obtained district level confirmed cholera outbreak data from 2011 to 2016 from the Ministry of Health, Uganda. Population and rainfall data were obtained from the Uganda Bureau of Statistics, and water, sanitation and hygiene data from the Ministry of Water and Environment. A spatial scan test was performed to identify the significantly high risk clusters. Cholera hotspots were defined as districts whose center fell within a significantly high risk cluster or where a significantly high risk cluster was completely superimposed onto a district. A zero-inflated negative binomial regression model was employed to identify the district level risk factors for cholera. In total 11,030 cases of cholera were reported during the 6-year period. 37(33%) of 112 districts reported cholera outbreaks in one of the six years, and 20 (18%) districts experienced cholera at least twice in those years. We identified 22 districts as high risk for cholera, of which 13 were near a border of Democratic Republic of Congo (DRC), while 9 districts were near a border of Kenya. The relative risk of having cholera inside the high-risk districts (hotspots) were 2 to 22 times higher than elsewhere in the country. In total, 7 million people were within cholera hotspots. The negative binomial component of the ZINB model shows people living near a lake or the Nile river were at increased risk for cholera (incidence rate ratio, IRR = 0.98, 95% CI: 0.97 to 0.99, p < .01); people living near the border of DRC/Kenya or higher incidence rate in the neighboring districts were increased risk for cholera in a district (IRR = 0.99, 95% CI: 0.98 to 1.00, p = .02 and IRR = 1.02, 95% CI: 1.01 to 1.03, p < .01, respectively). The zero inflated component of the ZINB model yielded shorter distance to Kenya or DRC border, higher incidence rate in the neighboring districts, and higher annual rainfall in the district were associated with the risk of having cholera in the district. CONCLUSIONS/SIGNIFICANCE The study identified cholera hotspots during the period 2011-2016. The people located near the international borders, internationally shared lakes and river Nile were at higher risk for cholera outbreaks than elsewhere in the country. Targeting cholera interventions to these locations could prevent and ultimately eliminate cholera in Uganda.
Collapse
Affiliation(s)
- Godfrey Bwire
- Department of Community Health, Uganda Ministry of Health, Kampala, Uganda
| | - Mohammad Ali
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - David A. Sack
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Anne Nakinsige
- Department of National Disease Control, Uganda Ministry of Health, Kampala, Uganda
| | - Martha Naigaga
- Department of Environmental Health, Uganda Ministry of Water and Environment, Kampala, Uganda
| | - Amanda K. Debes
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Moise C. Ngwa
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - W. Abdullah Brooks
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Christopher Garimoi Orach
- Department of Community and Behavioural Sciences, College of Health Sciences, Makerere University, Kampala, Uganda
| |
Collapse
|
10
|
Ohene SA, Klenyuie W, Sarpeh M. Assessment of the response to cholera outbreaks in two districts in Ghana. Infect Dis Poverty 2016; 5:99. [PMID: 27802834 PMCID: PMC5090876 DOI: 10.1186/s40249-016-0192-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Accepted: 08/31/2016] [Indexed: 11/28/2022] Open
Abstract
Background Despite recurring outbreaks of cholera in Ghana, very little has been reported on assessments of outbreak response activities undertaken in affected areas. This study assessed the response activities undertaken in two districts, Akatsi District in Volta Region and Komenda-Edina-Eguafo-Abirem (KEEA) Municipal in Central Region during the 2012 cholera epidemic in Ghana. Methods We conducted a retrospective assessment of the events, strengths and weaknesses of the cholera outbreak response activities in the two districts making use of the WHO cholera evaluation tool. Information sources included surveillance and facility records, reports and interviews with relevant health personnel involved in the outbreak response from both district health directorates and health facilities. We collected data on age, sex, area of residence, date of reporting to health facility of cholera cases, district population data and information on the outbreak response activities and performed descriptive analyses of the outbreak data by person, time and place. Results The cholera outbreak in Akatsi was explosive with a high attack rate (AR) of 374/100,000 and case fatality rate (CFR) of 1.2 % while that in KEEA was on a relatively smaller scale AR of 23/100,000 but with a high case fatality rate of 18.8 %. For both districts, we identified multiple strengths in the response to the outbreak including timely notification of the district health officials which triggered prompt investigation of the suspected outbreak facilitating confirmation of cholera and initiation of public health response activities. Others were coordination of the activities by multi-sectoral committees, instituting water, sanitation and hygiene measures and appropriate case management at health facilities. We also found areas that needed improvement in both districts including incomplete surveillance data, sub-optimal community based surveillance considering the late reporting and the deaths in the community and the inadequate community knowledge about cholera preventive measures. Conclusion The assessment of the cholera outbreak response in the two districts highlighted strengths in the epidemic control activities. There was however need to strengthen preparedness especially in the area of improving community surveillance and awareness about cholera prevention and the importance of seeking prompt treatment in health facilities in the event of an outbreak. Electronic supplementary material The online version of this article (doi:10.1186/s40249-016-0192-z) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Sally-Ann Ohene
- World Health Organization Country Office, 29 Volta Street Airport, Airport Residential Area, PO Box MB 142, Accra, Ghana.
| | - Wisdom Klenyuie
- School of Public Health, College of Health Science, University of Ghana, Accra, Ghana
| | - Mark Sarpeh
- Komenda-Edina-Eguafo-Abirem Municipal Health Directorate, Central Region, Ghana
| |
Collapse
|
11
|
Sévère K, Anglade SB, Bertil C, Duncan A, Joseph P, Deroncenay A, Mabou MM, Ocheretina O, Reif L, Seo G, Pape JW, Fitzgerald DW. Clinical Features of Human Immunodeficiency Virus-Infected Patients Presenting with Cholera in Port-au-Prince, Haiti. Am J Trop Med Hyg 2016; 95:999-1003. [PMID: 27549637 DOI: 10.4269/ajtmh.16-0105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Accepted: 07/11/2016] [Indexed: 11/07/2022] Open
Abstract
Human immunodeficiency virus (HIV) infection has been postulated to alter the natural history of cholera, including increased susceptibility to infection, severity of illness, and chronic carriage of Vibrio cholerae Haiti has a generalized HIV epidemic with an adult HIV prevalence of 1.9% and recently suffered a cholera epidemic. We conducted a prospective study at the cholera treatment center (CTC) of GHESKIO in Haiti to characterize the coinfection. Adults admitted at the CTC for acute diarrhea were invited to participate in the study. Vital signs, frequency, and volume of stools and/or vomiting were monitored, and single-dose doxycycline was administered. After counseling, participants were screened for HIV by enzyme-linked immunosorbent assay and for cholera by culture. Of 729 adults admitted to the CTC, 99 (13.6%) had HIV infection, and 457 (63%) had culture-confirmed cholera. HIV prevalence was three times higher in patients without cholera (23%, 63/272) than in those with culture-confirmed cholera (7.9%, 36/457). HIV prevalence in patients with culture-confirmed cholera (7.9%) was four times higher than the adult prevalence in Port-au-Prince (1.9%). Of the 36 HIV-infected patients with cholera, 25 (69%) had moderate/severe dehydration versus 302/421 (72%) in the HIV negative. Of 30 HIV-infected patients with weekly stool cultures performed after discharge, 29 (97%) were negative at week 1. Of 50 HIV-negative patients with weekly stool cultures, 49 (98%) were negative at week 1. In countries with endemic HIV infection, clinicians should consider screening patients presenting with suspected cholera for HIV coinfection.
Collapse
Affiliation(s)
- Karine Sévère
- Groupe Haïtien Etude pour le Sarcome de Kaposi et les Infections Opportunistes (GHESKIO), Port-au-Prince, Haiti
| | - Stravinsky B Anglade
- Groupe Haïtien Etude pour le Sarcome de Kaposi et les Infections Opportunistes (GHESKIO), Port-au-Prince, Haiti
| | - Claudin Bertil
- Groupe Haïtien Etude pour le Sarcome de Kaposi et les Infections Opportunistes (GHESKIO), Port-au-Prince, Haiti
| | - Aynsley Duncan
- Center for Global Health, Weill Cornell Medical College, New York, New York
| | - Patrice Joseph
- Groupe Haïtien Etude pour le Sarcome de Kaposi et les Infections Opportunistes (GHESKIO), Port-au-Prince, Haiti
| | - Alexandra Deroncenay
- Groupe Haïtien Etude pour le Sarcome de Kaposi et les Infections Opportunistes (GHESKIO), Port-au-Prince, Haiti
| | - Marie M Mabou
- Groupe Haïtien Etude pour le Sarcome de Kaposi et les Infections Opportunistes (GHESKIO), Port-au-Prince, Haiti
| | - Oksana Ocheretina
- Center for Global Health, Weill Cornell Medical College, New York, New York
| | - Lindsey Reif
- Center for Global Health, Weill Cornell Medical College, New York, New York
| | - Grace Seo
- Center for Global Health, Weill Cornell Medical College, New York, New York.
| | - Jean W Pape
- Groupe Haïtien Etude pour le Sarcome de Kaposi et les Infections Opportunistes (GHESKIO), Port-au-Prince, Haiti.,Center for Global Health, Weill Cornell Medical College, New York, New York
| | | |
Collapse
|
12
|
Desai SN, Akalu Z, Teferi M, Manna B, Teshome S, Park JY, Yang JS, Kim DR, Kanungo S, Digilio L. Comparison of immune responses to a killed bivalent whole cell oral cholera vaccine between endemic and less endemic settings. Trop Med Int Health 2015; 21:194-201. [PMID: 26681205 DOI: 10.1111/tmi.12641] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Studies on safety, immunogenicity and efficacy of the killed, bivalent whole cell oral cholera vaccine (Shanchol) have been conducted in historically endemic settings of Asia. Recent cholera vaccination campaigns in Haiti and Guinea have also demonstrated favourable immunogenicity and effectiveness in nonendemic outbreak settings. We performed a secondary analysis, comparing immune responses of Shanchol from two randomised controlled trials performed in an endemic and a less endemic area (Addis Ababa) during a nonoutbreak setting. While Shanchol may offer some degree of immediate protection in primed populations living in cholera endemic areas, as well as being highly immunogenic in less endemic settings, understanding the characteristics of immune responses in each of these areas is vital in determining ideal dosing strategies that offer the greatest public health impact to populations from areas with varying degrees of cholera endemicity.
Collapse
Affiliation(s)
| | - Zenebe Akalu
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | | | - Byomkesh Manna
- National Institute of Cholera and Enteric Diseases, Kolkata, India
| | | | | | | | | | - Suman Kanungo
- National Institute of Cholera and Enteric Diseases, Kolkata, India
| | | |
Collapse
|
13
|
Bwire G, Malimbo M, Kagirita A, Makumbi I, Mintz E, Mengel MA, Orach CG. Nosocomial Cholera Outbreak in a Mental Hospital: Challenges and Lessons Learnt from Butabika National Referral Mental Hospital, Uganda. Am J Trop Med Hyg 2015; 93:534-8. [PMID: 26195468 PMCID: PMC4559692 DOI: 10.4269/ajtmh.14-0730] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Accepted: 05/12/2015] [Indexed: 11/07/2022] Open
Abstract
During the last four decades, Uganda has experienced repeated cholera outbreaks in communities; no cholera outbreaks have been reported in Ugandan health facilities. In October 2008, a unique cholera outbreak was confirmed in Butabika National Mental Referral Hospital (BNMRH), Uganda. This article describes actions taken to control the outbreak, challenges, and lessons learnt. We reviewed patient and hospital reports for clinical symptoms and signs, treatment and outcome, patient mental diagnosis, and challenges noted during management of patients and contacts. Out of 114 BNMRH patients on two affected wards, 18 cholera cases and five deaths were documented for an attack rate of 15.8% and a case fatality rate of 28%. Wards and surroundings were intensively disinfected and 96 contacts (psychiatric patients) in the affected wards received chemoprophylaxis with oral ciprofloxacin 500 mg twice daily until November 5, 2008. We documented a nosocomial cholera outbreak in BNMRH with a high case fatality of 28% compared with the national average of 2.4% for cholera outbreaks in communities. To avoid cholera outbreaks and potentially high mortality among patients in mental institutions, procedures for prompt diagnosis, treatment, disinfection, and prophylaxis are needed and preemptive use of oral cholera vaccines should be considered.
Collapse
Affiliation(s)
- Godfrey Bwire
- Control of Diarrheal Diseases Section, Ministry of Health, Kampala, Uganda; Epidemiological Surveillance Division, Ministry of Health, Kampala, Uganda; U.S. Centers for Disease Control and Prevention, Atlanta, Georgia; Central Public Health Laboratory, Kampala, Uganda; Agence de Médicine Préventive, Paris, France; Makerere University School of Public Health, Kampala, Uganda
| | - Mugagga Malimbo
- Control of Diarrheal Diseases Section, Ministry of Health, Kampala, Uganda; Epidemiological Surveillance Division, Ministry of Health, Kampala, Uganda; U.S. Centers for Disease Control and Prevention, Atlanta, Georgia; Central Public Health Laboratory, Kampala, Uganda; Agence de Médicine Préventive, Paris, France; Makerere University School of Public Health, Kampala, Uganda
| | - Atek Kagirita
- Control of Diarrheal Diseases Section, Ministry of Health, Kampala, Uganda; Epidemiological Surveillance Division, Ministry of Health, Kampala, Uganda; U.S. Centers for Disease Control and Prevention, Atlanta, Georgia; Central Public Health Laboratory, Kampala, Uganda; Agence de Médicine Préventive, Paris, France; Makerere University School of Public Health, Kampala, Uganda
| | - Issa Makumbi
- Control of Diarrheal Diseases Section, Ministry of Health, Kampala, Uganda; Epidemiological Surveillance Division, Ministry of Health, Kampala, Uganda; U.S. Centers for Disease Control and Prevention, Atlanta, Georgia; Central Public Health Laboratory, Kampala, Uganda; Agence de Médicine Préventive, Paris, France; Makerere University School of Public Health, Kampala, Uganda
| | - Eric Mintz
- Control of Diarrheal Diseases Section, Ministry of Health, Kampala, Uganda; Epidemiological Surveillance Division, Ministry of Health, Kampala, Uganda; U.S. Centers for Disease Control and Prevention, Atlanta, Georgia; Central Public Health Laboratory, Kampala, Uganda; Agence de Médicine Préventive, Paris, France; Makerere University School of Public Health, Kampala, Uganda
| | - Martin A Mengel
- Control of Diarrheal Diseases Section, Ministry of Health, Kampala, Uganda; Epidemiological Surveillance Division, Ministry of Health, Kampala, Uganda; U.S. Centers for Disease Control and Prevention, Atlanta, Georgia; Central Public Health Laboratory, Kampala, Uganda; Agence de Médicine Préventive, Paris, France; Makerere University School of Public Health, Kampala, Uganda
| | - Christopher Garimoi Orach
- Control of Diarrheal Diseases Section, Ministry of Health, Kampala, Uganda; Epidemiological Surveillance Division, Ministry of Health, Kampala, Uganda; U.S. Centers for Disease Control and Prevention, Atlanta, Georgia; Central Public Health Laboratory, Kampala, Uganda; Agence de Médicine Préventive, Paris, France; Makerere University School of Public Health, Kampala, Uganda
| |
Collapse
|
14
|
Desai SN, Akalu Z, Teshome S, Teferi M, Yamuah L, Kim DR, Yang JS, Hussein J, Park JY, Jang MS, Mesganaw C, Taye H, Beyene D, Bedru A, Singh AP, Wierzba TF, Aseffa A. A Randomized, Placebo-Controlled Trial Evaluating Safety and Immunogenicity of the Killed, Bivalent, Whole-Cell Oral Cholera Vaccine in Ethiopia. Am J Trop Med Hyg 2015; 93:527-533. [PMID: 26078323 PMCID: PMC4559691 DOI: 10.4269/ajtmh.14-0683] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Accepted: 03/22/2015] [Indexed: 11/07/2022] Open
Abstract
Killed whole-cell oral cholera vaccine (OCV) has been a key component of a comprehensive package including water and sanitation measures for recent cholera epidemics. The vaccine, given in a two-dose regimen, has been evaluated in a large number of human volunteers in India, Vietnam, and Bangladesh, where it has demonstrated safety, immunogenicity, and clinical efficacy. We conducted a double-blind randomized placebo-controlled trial in Ethiopia, where we evaluated the safety and immunogenicity of the vaccine in 216 healthy adults and children. OCV was found to be safe and elicited a robust immunological response against Vibrio cholerae O1, with 81% adults and 77% children demonstrating seroconversion 14 days after the second dose of vaccine. This is the first study to evaluate safety and immunogenicity of the vaccine in a population outside Asia using a placebo-controlled, double-blind, randomized study design.
Collapse
Affiliation(s)
- Sachin N. Desai
- *Address correspondence to Sachin N. Desai, International Vaccine Institute, SNU Research Park, San 4-8, Nakseongdae-dong, Gwanak-gu, Seoul, Korea 151-919. E-mail:
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
15
|
Mengel M, Mintz E, Nair GB, Gessner BD. Editorial committee introduction. J Infect Dis 2013; 208 Suppl 1:S1-3. [PMID: 24101637 DOI: 10.1093/infdis/jit403] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|