Outbreak investigation of cholera in a rural community, Rivers State Nigeria: an interventional epidemiological study

Authors

  • Golden Owhonda Luke Department of Public Health and Disease Control, College of Medical Sciences, Rivers State Ministry of Health, Port Harcourt, Rivers State, Nigeria https://orcid.org/0000-0002-8242-1508
  • Anwuri Luke Department of Community Medicine, College of Medical Sciences, Rivers State Ministry of Health, Port Harcourt, Rivers State, Nigeria
  • Bright O. Ogbondah Department of Community Medicine, College of Medical Sciences, Rivers State Ministry of Health, Port Harcourt, Rivers State, Nigeria
  • Ifeoma Nwadiuto Department of Public Health and Disease Control, College of Medical Sciences, Rivers State Ministry of Health, Port Harcourt, Rivers State, Nigeria
  • Victor Abikor Department of Public Health and Disease Control, College of Medical Sciences, Rivers State Ministry of Health, Port Harcourt, Rivers State, Nigeria
  • Emmanuel Owhondah Department of Public Health and Disease Control, College of Medical Sciences, Rivers State Ministry of Health, Port Harcourt, Rivers State, Nigeria

DOI:

https://doi.org/10.18203/2394-6040.ijcmph20230248

Keywords:

Outbreak investigation, Cholera, Rural, Community, Interventional, Epidemiological study

Abstract

Cholera is a potentially life-threatening public health menace caused by a gram-negative rod-shaped bacterium known as Vibrio cholerae. This study was an epidemiological investigation of the cholera outbreak in Degema local government area (LGA), Rivers State, Nigeria. An interventional epidemiological study was conducted in a rural community between December 2021 to February 2022. All suspected cases were identified using the World Health Organization (WHO) case definition of acute watery diarrhoea. The standard outbreak investigation procedures (active case search, case management, water sanitation, hygiene) were implemented. The cholera outbreak observed two waves within an at-risk population of 373,071 in the affected LGA. Of the 35 line-listed suspected cases (male-20 versus female-15), the highest frequency was observed among those aged 0-5 years. The index case was reported on the 3rd of December in the 47th week of 2021 and abated by the 49th week, while the 2nd wave began in the 1st week of 2022 and abated by the 6th week. The stool samples result revealed; six positives for RDT, while four samples were positive by microscopy. All patients received home-based treatment except for two cases that were managed at the healthcare facility. The attack and case fatality rates were 0.01, and 8% respectively. The Rivers State public health emergency operation centre deployed standard epidemiological interventions for the containment of acute watery diarrhoea (cholera) aimed at reducing morbidity and mortality; however, vaccines were not part of the response. The deployment of vaccines and provision of potable water will improve response outcomes.

References

Baker-Austin C, Oliver JD, Alam M, Ali A, Waldor MK, Qadri F, et al. Vibrio spp. infections. Nat Rev Dis Primer. 2018;4(1):19.

Bintsis T. Foodborne pathogens. AIMS Microbiol. 2017;3(3):529-63.

Igere BE, Okoh AI, Nwodo UU. Non‑serogroup O1/O139 agglutinable Vibrio cholerae: A phylogenetically and genealogically neglected yet emerging potential pathogen of clinical relevance. Arch Microbiol. 2022;204(323):28.

Jahan S. Significance, prevention and control of food-related diseases: Cholera epidemiology, prevention and control. London, United Kingdom: IntechOpen Limited. 2016:15.

Williams PCM and Berkley JA. Guidelines for the management of paediatric cholera infection: A systematic review of the evidence. Paediatr Int Child Health. 2018;38(1):S16-31.

Goswami S, Jha A, Sivan SP, Dambhare D, Gupta SS. An outbreak investigation of cholera outbreak in a slum area of urban Wardha, India: An interventional epidemiological study. J Fam Med Prim Care. 2019;8(3):1112-6.

Mokomane M, Kasvosve I, de Melo E, Pernica JM, Goldfarb DM. The global problem of childhood diarrhoeal diseases: Emerging strategies in prevention and management. Ther Adv Infect Dis. 2018;5(1):29-43.

Deen J, Mengel MA, Clemens JD. Epidemiology of cholera. Vaccine. 2020;38(1):31-40.

Ngwa MC, Wondimagegnehu A, Okudo I, Owili C, Ugochukwu U, Clement P, et al. The multi-sectorial emergency response to a cholera outbreak in internally displaced person camps in Borno State, Nigeria, 2017. BMJ Glob Health. 2020;5(1):12.

Shannon K, Hast M, Azman AS, Legros D, McKay H, Lessler J. Cholera prevention and control in refugee settings: Successes and continued challenges. PLoS Negl Trop Dis. 2019;13(6):11.

Pietroni MAC. Case management of cholera. Vaccine. 2020;38(1):105-9.

Ayenigbara IO, Ayenigbara GO, Adeleke RO. Contemporary Nigerian public health problem: prevention and surveillance are key to combating cholera. GMS Hyg Infect Control. 2019;14(16):8.

D’Mello-Guyett L, Gallandat K, Bergh RV den, Taylor D, Bulit G, Legros D, et al. Prevention and control of cholera with household and community water, sanitation and hygiene (WASH) interventions: A scoping review of current international guidelines. Plos One. 2020;15(1):26.

Kwasi-Do Ohene Opoku N, Afriyie C. The role of control measures and the environment in the transmission dynamics of cholera. Abstr Appl Anal. 2020;e2485979:16.

Wierzba TF. Oral cholera vaccines and their impact on the global burden of disease. Hum Vaccines Immunother. 2018;15(6):1294-301.

Desai SN, Cravioto A, Sur D, Kanungo S. Maximizing protection from the use of oral cholera vaccines in developing country settings. Hum Vaccines Immunother. 2014;10(6):1457-65.

World Health Organization (WHO). Manual for investigating suspected outbreaks of illnesses of possible chemical aetiology: Guidance for investigation and control. Geneva, Switzerland. 2021;120. Available at: https://apps.who.int/iris/rest/bitstreams/1356776/retrieve. Accessed on 24 October 2022.

Baltazar CS, Pezzoli L, Baloi LD, Luiz N, Chitio JE, Capitine I, et al. Conditions to eliminate cholera in Mozambique: The pathway for the development of the national cholera plan. Pan Afr Med J. 2022;42(279):8.

Das M, Singh H, Girish Kumar CP, John D, Panda S, Mehendale SM. Non-vaccine strategies for cholera prevention and control: India’s preparedness for the global roadmap. Vaccine. 2020;38(1):167-174.

Bengtsson L, Gaudart J, Lu X, Moore S, Wetter E, Sallah K, et al. Using mobile phone data to predict the spatial spread of cholera. Sci Rep. 2015;5(8923):5.

Abubakar I, Dalglish SL, Angell B, Sanuade O, Abimbola S, Adamu AL, et al. The Lancet Nigeria Commission: Investing in health and the future of the nation. The Lancet. 2022;399(10330):1155-200.

Christaki E, Dimitriou P, Pantavou K, Nikolopoulos GK. The impact of climate change on cholera: A review on the global status and future challenges. Atmosphere. 2020;11(5):11.

Ali M, Nelson AR, Lopez AL, Sack DA. Updated global burden of cholera in endemic countries. PLoS Negl Trop Dis. 2015;9(6):13.

World Health Organization (WHO). Cholera, 2020. Weekly Epidemiological Report. 2020;37(96):445-60.

Dan-Nwafor CC, Ogbonna U, Onyiah P, Gidado S, Adebobola B, Nguku P, et al. A cholera outbreak in a rural north central Nigerian community: An unmatched case-control study. BMC Public Health. 2019;19(112):7.

Sow AU, Haruna UA, Amos OA, Olajide EO, Amene T, Odususi OD, et al. Tackling cholera outbreak amidst COVID-19 pandemic in Nigeria: Challenges and recommendations. Public Health Rev. 2022;43(1604776):5.

Health Sector Nigeria. Outbreak preparedness response plan for cholera and diarrheal diseases in North East Nigeria. Bornu State: Bornu State Government. 2017:37. Available at: http://plateformecholera.info/attachments/article/486/4.%20Preparedness%20response%20plan%20for%20cholera%20and%20diarrheal%20diseases%20in%20NE%20Nigeria%2028.08.17.pdf. Accessed on 10 November 2022.

Elimian KO, Musah A, Mezue S, Oyebanji O, Yennan S, Jinadu A, et al. Descriptive epidemiology of cholera outbreak in Nigeria, January-November 2018: Implications for the global roadmap strategy. BMC Public Health. 2019;19(1264):11.

Elimian KO, Musah A, Ochu CL, Onwah SS, Oyebanji O, Yennan S, et al. Identifying and quantifying the factors associated with cholera-related death during the 2018 outbreak in Nigeria. Pan Afr Med J. 2020;37(368):13.

Elimian K, Onwah S, Musah A, Oyebanji O, Fall I, Yennan S, et al. What are the drivers of recurrent cholera transmission in Nigeria? Evidence from a scoping review. BMC Public Health. 2020;20(432):14.

Kanu N, Osinubi M, Nwadiuto I, Okeke C. Cholera outbreak in Andoni local government area, Rivers State, Nigeria; January 2015: The role of hand washing with soap. Niger J Med. 2018;27(2):140-7..

World Health Organization (WHO). Case management guidelines for acute watery diarrhoea/cholera. Geneva, Switzerland. 2022;19. Available at: https://shcc.org.pk/public-docs/Guidelines%20of%20Cholera%20Management.pdf. Accessed on 18 November 2022.

World Health Organization Global Task Force on Cholera Control (GTFCC). Cholera outbreak response field manual. 2019;140. Available at: https://www.gtfcc.org/wp-content/uploads/2020/04/gtfcc-cholera-outbreak-response-field-manual.pdf. Accessed on 18 November 2022.

Balajee SA, Salyer SJ, Greene-Cramer B, Sadek M, Mounts AW. The practice of event-based surveillance: concept and methods. Glob Secur Health Sci Policy. 2021;6(1):1-9.

Ganesan D, Gupta SS, Legros D. Cholera surveillance and estimation of the burden of cholera. Vaccine. 2020;38(10):13-7.

Faruque ASG, Khan AI, Nahar B, Islam SMR, Hossain MN, Abdullah SA, et al. Cholera outbreak in Forcibly Displaced Myanmar National (FDMN) from a small population segment in Cox’s Bazar, Bangladesh, 2019. PLoS Negl Trop Dis. 2021;15(9):14.

Ibrahim BS, Mohammed Y, Usman R, Okon UA, Katchy UI, Olufemi AA, et al. Outbreak of cholera at Dutsen-Abba Ward Zaria local government area, Kaduna State Nigeria 2015: the importance of hygienic practices. Int J Community Med Public Health. 2017;4(5):1473-8.

Endris AA, Addissie A, Ahmed M, Abagero A, Techane B, Tadesse M. Epidemiology of cholera outbreak and summary of the preparedness and response activities in Addis Ababa, Ethiopia, 2016. J Environ Public Health. 2022;4671719:13.

Challa JM, Getachew T, Debella A, Merid M, Atnafe G, Eyeberu A, et al. Inadequate hand washing, lack of clean drinking water and latrines as major determinants of cholera outbreak in Somali region, Ethiopia in 2019. Front Public Health. 2022;10(845057):11.

Zohura F, Bhuyian SI, Monira S, Begum F, Biswas SK, Parvin T, et al. Observed handwashing with soap practices among cholera patients and accompanying household members in a hospital setting (CHoBI7 Trial). Am J Trop Med Hyg. 2016;95(6):1314-8.

Galea J, Camilleri L. Epidemiological factors of cholera in Gozo, Malta in 1837. Malta Med Sch Gaz. 2020;4(1):56-68.

Suleiiman SY, Idris AS, Suleiman K, Abubakar A, Ruma MT, Haladu S, et al. A descriptive epidemiology of cholera outbreak in Katsina State, Nigeria, 2021. Int J Infect Dis. 2022;116(997):82.

Sigudu TT, Tint KS, Archer B. Epidemiological description of cholera outbreak in Mpumalanga Province, South Africa, December 2008-March 2009. South Afr J Infect Dis. 2015;30(4):125-8.

Sodjinou VD, Talisuna A, Braka F, Barboza P, Alberti K, Fortin A, et al. The 2021 cholera outbreak in West Africa: Epidemiology and public health implications. Arch Clin Biomed Res. 2022;6(2):296-307.

Ohene SA, Klenyuie W, Sarpeh M. Assessment of the response to cholera outbreaks in two districts in Ghana. Infect Dis Poverty. 2016;5(99):11.

World Health Organization (WHO). Weekly Bulletin: Communicable disease threat report. Geneva, Switzerland. 2022;13. Available at: https://www.ecdc.europa.eu/sites/default/files/documents/ECDC-Weekly-CDTR-w38.pdf. Accessed on 06 October 2022.

Torok M. Focus on field epidemiology. N C Inst Public Health. 2021;1(5):6.

Park SE, Jeon Y, Kang S, Gedefaw A, Hailu D, Yeshitela B, et al. Infectious disease control and management in Ethiopia: A case study of cholera. Front Public Health. 2022;10(870276):12.

Downloads

Published

2023-01-27

How to Cite

Luke, G. O., Anwuri Luke, Bright O. Ogbondah, Ifeoma Nwadiuto, Victor Abikor, & Emmanuel Owhondah. (2023). Outbreak investigation of cholera in a rural community, Rivers State Nigeria: an interventional epidemiological study. International Journal Of Community Medicine And Public Health, 10(2), 860–868. https://doi.org/10.18203/2394-6040.ijcmph20230248

Issue

Section

Review Articles