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Cholera outbreak associated with contaminated water sources in paddy fields, Mandla District, Madhya Pradesh, India
Biswa Prakash Dutta1, Nishant Kumar2, KC Meshram3, Rajesh Yadav4, Samir V Sodha5, Sonia Gupta6
1 India Epidemic Intelligence Service Officer, Epidemiology Division, National Centre for Disease Control, Delhi, India
2 Deputy Director, Integrated Disease Surveillance Program, National Centre for Disease Control, Delhi, India
3 Chief Medical and Health Officer Mandla, Department of Health and Family Welfare, Madhya Pradesh, India
4 Public Health Specialist, Division of Global Health Protection, Centers for Disease Control and Prevention, Delhi, India
5 Resident Advisor, India EIS Programme, Division of Global Health Protection, Centers for Disease Control and Prevention, Delhi, India
6 Additional Director, National Centre for Disease Control, Director General of Health Services, Delhi, India
Correspondence Address:
Biswa Prakash Dutta
HIG 2/76, Lane-4, Satyasai Enclave, Po- Khandagiri, Bhubaneswar, Odisha - 751 030
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/ijph.IJPH_1118_20
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Background: Mandla District in Madhya Pradesh, India, reported a suspected cholera outbreak from Ghughri subdistrict on August 18, 2016. Objective: We investigated to determine risk factors and recommend control and prevention measures. Methods: We defined a case as >3 loose stools in 24 h in a Ghughri resident between July 20 and August 19, 2016. We identified cases by passive surveillance in health facilities and by a house-to-house survey in 28 highly affected villages. We conducted a 1:2 unmatched case–control study, collected stool samples for culture, and tested water sources for fecal contamination. Results: We identified 628 cases (61% female) from 96 villages; the median age was 27 years (range: 1 month–76 years). Illnesses began 7 days after rainfall with 259 (41%) hospitalizations and 14 (2%) deaths in people from remote villages who died before reaching a health facility; 12 (86%) worked in paddy fields. Illness was associated with drinking well water within paddy fields (odds ratio [OR] = 4.0, 95% confidence interval [CI] = 1.4–8.0) and not washing hands with soap after defecation (OR = 6.1, CI = 1.7–21). Of 34 stool cultures, 11 (34%) tested positive for Vibrio cholerae O1 Ogawa. We observed open defecation in affected villages around paddy fields. Of 16 tested water sources in paddy fields, eight (50%) were protected, but 100% had fecal contamination. Conclusion: We recommended education regarding pit latrine sanitation and safe water, especially in paddy fields, provision of oral rehydration solution in remote villages, and chlorine tablets for point-of-use treatment of drinking water.
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