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Individual and Household Risk Factors for Symptomatic Cholera Infection: A Systematic Review and Meta-analysis
Aaron Richterman | Duarxy Rodcnel Sainvilien | Lauren Eberly | Louise C Ivers
Date of Publication:
The Journal of Infectious Diseases
Cholera has caused seven global pandemics, including the current one which has been ongoing since 1961. A systematic review of risk factors for symptomatic cholera infection has not been previously published. In accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we performed a systematic review and meta-analysis of individual and household risk factors for symptomatic cholera infection. We identified 110 studies eligible for inclusion in qualitative synthesis. Factors associated with symptomatic cholera that were eligible for meta-analysis included education less than secondary level (summary odds ratio [SOR], 2.64; 95% confi- dence interval [CI], 1.41–4.92; I2 = 8%), unimproved water source (SOR, 3.48; 95% CI, 2.18–5.54; I2 = 77%), open container water storage (SOR, 2.03; 95% CI, 1.09–3.76; I2 = 62%), consumption of food outside the home (SOR, 2.76; 95% CI, 1.62–4.69; I2 = 64%), household contact with cholera (SOR, 2.91; 95% CI, 1.62–5.25; I2 = 89%), water treatment (SOR, 0.37; 95% CI, .21–.63; I2 = 74%), and handwashing (SOR, 0.29; 95% CI, .20–.43; I2 = 37%). Other notable associations with symptomatic infection included income/wealth, blood group, gastric acidity, infant breastfeeding status, and human immunodeficiency virus infection. We identified potential risk factors for symptomatic cholera infection including environmental characteristics, socioeconomic factors, and intrinsic patient factors. Ultimately, a combination of interventional approaches targeting various groups with risk-adapted intensities may prove to be the optimal strategy for cholera control.
Epidemic cholera in urban Zambia: hand soap and dried fish as protective factors
A. E. Dubois | M. Sinkala | P. Kalluri | M. Makasa-Chikoya | R. E. Quick
Date of Publication:
Epidemiology and Infection
Between 28 November 2003 and 23 February 2004, 4343 cases and 154 deaths from cholera (case-fatality rate 3•5%) were reported in Lusaka, Zambia. A case-control study was conducted in February 2004 to assess potential transmission routes and prevention strategies. Consumption of raw vegetables was significantly associated with cholera [adjusted odds ratio (aOR) 4•7, 95% confidence interval (CI) 1•7–13, P=0•003). Consumption of a local sardine-like fish was protective (aOR 0•3, 95% CI 0•1–0•7, P=0•008). Hand soap was present in 90% of control homes and 58% of case homes. Observed hand soap was a strongly protective factor (aOR 0•1, 95% CI 0•04–0•4, P=0•001). No water source or treatment practice was significantly associated with cholera. This study documents the importance of foodborne transmission of cholera, illustrates the protective role of hand washing in an epidemic setting, and identifies a novel possible protective factor, a local fish, which warrants further research.