A hospital outbreak of cholera in Maputo, Mozambique

Abstract

We describe a hospital outbreak of cholera in a children's paediatric unit. The outbreak began explosively and continued for four months with spread from person to person within the diarrhoea isolation unit. Overcrowded and unhygienic conditions in this unit facilitated transmission. The organism was multiply drug-resistant, the same strain having been isolated in another outbreak in the paediatric unit seven months previously. A high case fatality rate of 30.0% was recorded in infants infected in hospital.

Nosocomial Cholera Outbreak in a Mental Hospital: Challenges and Lessons Learnt from Butabika National Referral Mental Hospital, Uganda

“…11 A high case fatality rate was also noted in the outbreak among psychiatric patients in Singapore (11%; 18 cases and two deaths) 19 and in an outbreak in a pediatric ward in Maputo, Mozambique (30%; 20 cases and six deaths). 18 In our investigation, the case fatality rate was higher among schizophrenic patients than among all other patients although this did not quite reach statistical significance.…”

“…[8][9][10][11][12] However, this investigation shows that hospitals in countries with endemic or epidemic cholera can also be a source of cholera outbreaks. A cholera outbreak was previously reported in a psychiatric hospital only once 19 (in Singapore) where, as in previously reported nosocomial cholera outbreaks, 18,20 transmission was attributed to "close person-to-person contact among individuals living in overcrowded unhygienic environments." The authors of one report noted that by person to-person transmission they mean "spread through close direct physical contact or indirectly through contaminated food, water, or fomites."…”

“…The first cholera case in 2010 in Haiti was reportedly traced in a 32-year-old man with mental illness who died in the community. 25 Given the high case fatality rate in our investigation and others, 18,19 persons with mental illness may be at higher risk for severe cholera and poor outcomes, and warrant special attention along with other vulnerable groups. This includes ensuring a hygienic in-hospital environment, access to safe drinking water and food, and inclusion in preventive oral cholera vaccination campaigns.…”

“…17 Though these infections are common globally, very few reports mention V. cholerae as the responsible pathogen for outbreaks recorded in hospitals. [18][19][20][21][22] Some reports documented high case fatality rates associated with these outbreaks, 17 yet little specific information is available to help health facilities prepare for and prevent nosocomial cholera transmission.…”

Epidemiologia da cólera em Moçambique no período de 1973-1992

“…Dentre as principais atividades que o Sistema Nacional de Saúde, em Moçambique, tem desenvolvido para a diminuição da taxa de letalidade, figuram: formação do pessoal de saúde no tratamento da desidratação grave; definição do caso de cólera; melhoramento da vigilância epidemiológia na identificação de surtos; produção e distribuição de normas de prevenção e tratamento da cólera; elaboração e ditribuição de "Kits" com os principais materiais necesários para o tratamento dos doentes; organização de comissões nacional, provinciais e distritais de luta contra a cólera com a participação intersetorial e a intregação com o programa nacional de controle das doenças diarréicas (CDD). Se é verdade que foi mencionada a resistência à tetraciclina, em baixa proporção in vitro, em algumas cidades do país 3,5 , esta não foi reportada in vivo, pelo que não é possível afirmar se esta exerceu papel determinante na propagação pelo país. Mas considerou-se que a mudança na definição de caso de cólera teve influência no aumento de casos e óbitos notificados durante os anos 1991 e 1992.…”