Cholera in Piura, Peru: A Modern Urban Epidemic

Abstract

In late January 1991, epidemic cholera appeared in Peru. Within 2 months, 7922 cases and 17 deaths occurred in Piura, a Peruvian city of 361,868. A hospital-based culture survey showed that 79%-86% of diarrhea cases were cholera. High vibriocidal antibody titers were detected in 34% of the asymptomatic population. A study of 50 case-patients and 100 matched controls demonstrated that cholera was associated with drinking unboiled water (odds ratio [OR], 3.9; 95% confidence interval [CI], 1.7-8.9), drinking beverages from street vendors (OR, 14.6; CI, 4.2-51.2), and eating food from street vendors (OR, 24.0; CI, 3.0-191). In a second study, patients were more likely than controls to consume beverages with ice (OR, 4.0; CI, 1.1-18.3). Ice was produced from municipal water. Municipal water samples revealed no or insufficient chlorination, and fecal coliform bacteria were detected in samples from 6 of 10 wells tested. With epidemic cholera spreading throughout Latin America, these findings emphasize the importance of safe municipal drinking water.

Epidemic cholera in Ecuador: multidrug–resistance and transmission by water and seafood

“…Such contamination could easily overwhelm the chlorine. Studies in Peru and Calcutta have suggested that boiling water before drinking and storing water in a narrow-mouthed, capped container decreases the risk of cholera transmission [7,8,[17][18][19]. Our investigation did not document the type of container used to store boiled water, but having boiled water in the house at the time of inspection was protective.…”

“…Public health officials had to decide on preventive measures based on knowledge of how cholera spread in previous epidemics and on anecdotal information. This investigation and parallel investigations in Peru provided the first information from controlled studies about the most important modes and vehicles of transmission for cholera in Latin America [7][8][9]. Identification of specific modes of cholera transmission allows control measures and education to be more focused and, presumably, more effective.…”

“…This risk was not found in Trujillo, Peru, because street vendors had been banned before the investigation began [8]. In Piura, Peru, however, consuming beverages from street vendors also was associated with cholera [7]. Street vendors and their customers can be taught methods to reduce contamination with V. cholerae 0 1, such as making beverages from boiled or treated water, serving beverages hot, cooling drinks with ice placed outside rather than in the beverage container, using lemon juice to decrease the pH of beverages to 4-5 or less, and washing glasses and utensils with soap and boiled or treated water.…”

“…Although seafood eaten raw may have played an important role in the early part of the epidemic in Peru, it was almost immediately suspect, and the public was warned by the Minister of Health against consuming seafood raw. The public complied, and subsequent case-control studies were unable to evaluate the role of seafood because few patients or controls were eating raw seafood when the studies were conducted [7,8].…”

Epidemiologia da cólera em Moçambique no período de 1973-1992

“…Começaram a aparecer novos poços em zonas de alta concentração de latrinas e sem nenhuma medida de proteção. Apesar de não ter sido possível realizar investigações epidemiológicas que ajudassem a identificar os fatores de risco na propagação da cólera devido a escassez de recursos, o inadequado abastecimento de água, em quantidade e qualidade, pode ter contribuído na propagação da cólera em Moçambique, fato também encontrado durante a epidemia no Peru, nos anos 1991 e 1992, a qual teve uma forte relação com a falta de tratamento de água canalizada e fontes de água contaminadas 7,9,10 .…”