Household spraying is a commonly implemented, yet an under-researched, cholera response intervention where a response team sprays surfaces in cholera patients' houses with chlorine. We conducted mixed-methods evaluations of three household spraying programs in the Democratic Republic of Congo and Haiti, including 18 key informant interviews, 14 household surveys and observations, and 418 surface samples collected before spraying, 30 minutes and 24 hours after spraying. The surfaces consistently most contaminated with Vibrio cholerae were food preparation areas, near the patient's bed and the latrine. Effectiveness varied between programs, with statistically significant reductions in V. cholerae concentrations 30 minutes after spraying in two programs. Surface contamination after 24 hours was variable between households and programs. Program challenges included difficulty locating households, transportation and funding limitations, and reaching households quickly after case presentation (disinfection occurred 2-6 days after reported cholera onset). Program advantages included the concurrent deployment of hygiene promotion activities. Further research is indicated on perception, recontamination, cost-effectiveness, viable but nonculturable V. cholerae, and epidemiological coverage. We recommend that, if spraying is implemented, spraying agents should: disinfect surfaces systematically until wet using 0.2/2.0% chlorine solution, including kitchen spaces, patients' beds, and latrines; arrive at households quickly; and, concurrently deploy hygiene promotion activities.

Bucket chlorination, where chlorine is dosed directly into water collection containers, is a point-of-source water treatment intervention commonly implemented in cholera outbreaks. There is little previous data on chlorine efficacy against Vibrio cholerae in different waters and appropriate dosage regimes. We evaluated V. cholerae reduction and free chlorine residual (FCR) in waters with four turbidities (1/5/10/50 NTU), two total organic carbon (TOC) concentrations (0.4, 1 mg/L), and two dosing schemes (fixed-dose of 2 or 4 mg/L, variable-dose based on jar testing) treated with three chlorine types (HTH, NaOCl, NaDCC). We found that chlorine was efficacious at reducing V. cholerae by ≥2.75 to ≥3.63 log reduction value (LRV); variably dosed reactors were dosed higher, met ≥0.5 mg/L FCR at 30 min, and had higher LRVs (p=0.024) than fixed doses; and low TOC reactors had more samples ≥0.2 mg/L FRC at 4 h (p=0.007). Our results are conservative, as internationally recommended additives to create test water increased chlorine demand, highlighting the challenge of replicating field conditions in laboratory testing. Overall, we found that chlorine can efficaciously reduce V. cholerae; recommend further research on appropriate chlorine demand for test waters; and recommend establishing appropriate chlorine doses based on source water and taste/odor acceptability in bucket chlorination programs.