Cholera: Overview of epidemiologic, therapeutic, and preventive issues learned from recent epidemics

Seas, Carlos; Gotuzzo, Eduardo

doi:10.1016/s1201-9712(96)90076-4

Cited by 22 publications

(10 citation statements)

References 51 publications

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“…5 Its spread was also facilitated by poor sanitary conditions and hygienic practices prevailing in low socioeconomic groups in Peruvian coastal cities at that time. 8,11 Clearly, a major limitation of this study is the lack of microbiological confirmation of the clinical diagnoses. It is possible that these cases of severe, dehydrating, watery diarrhea were due to causes other than V. cholerae O1.…”

Section: Resultsmentioning

confidence: 99%

“…DISCUSSION The largest epidemic of cholera during the last decade of the Twentieth Century occurred unexpectedly in Latin America in 1991. 8 Peru was the first country to report cases of cholera and also the country most severely affected by the epidemic, not only in terms of numbers (almost 300,000 cases during the first year of the epidemic, and approximately 45,000 cases per week during the first few weeks), but also in terms of the significant impact that the epidemic had on its impoverished economy. 8,9 Nine years later, the origin of the epidemic has yet to be determined.…”

Section: Resultsmentioning

confidence: 99%

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New insights on the emergence of cholera in Latin America during 1991: the Peruvian experience.

Seas¹,

Miranda²,

Gil³

et al. 2000

The American Journal of Tropical Medicine and Hygiene

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Abstract. After a century of absence, in late January 1991, Vibrio cholerae invaded the Western Hemisphere by way of Peru. Although a number of theories have been proposed, it is still not understood how that invasion took place. We reviewed the clinical records of persons attending hospital emergency departments in the major coastal cities of Peru from September through January of 1989/1990 and 1990/1991. We identified seven adults suffering from severe, watery diarrhea compatible with a clinical diagnosis of cholera during the four months preceding the cholera outbreak, but none during the previous year. The patients were scattered among five coastal cities along a 1,000 km coastline. We postulate that cholera vibrios, autochthonous to the aquatic environment, were present in multiple coastal locations, and resulted from environmental conditions that existed during an El Nino phenomenon. Once introduced into the coastal communities in concentrations large enough for human infection to occur, cholera spread by the well-known means of contaminated water and food.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

New insights on the emergence of cholera in Latin America during 1991: the Peruvian experience.

Seas¹,

Miranda²,

Gil³

et al. 2000

The American Journal of Tropical Medicine and Hygiene

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“…The infection rate for the continent was 521 cases per million people with a mortality rate per case of 1%. Peru was the most seriously affected country with almost 300,000 cases in the first year and 45,000 new cases per week in the first few weeks of the epidemic, which severely affected the economy of the country [15,16]. Fifteen years later, the origin of the epidemic remains unknown, although there are various hypotheses as to how cholera arrived and spread throughout Peru: (1) through the discharge of sewage water from the ships that came into port carrying passengers or crew who were asymptomatic and who had arrived from cholera-infected areas.…”

Section: Epidemiology Of Cholera In Americasmentioning

confidence: 99%

The Re-emergence of Cholera in the Americas

Delgado

Morales

Méndez

et al. 2010

Epidemiological and Molecular Aspects on Cholera

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In the history of cholera, seven cholera pandemics occurred during the nineteenth and twentieth centuries and five of these affected the American continent. Ships transporting European immigrants in the nineteenth century probably brought the disease to the American continent during the second pandemic. Between 1973 and 1991, infrequent indigenous cholera cases were reported in different parts of the USA including Louisiana, Florida, Georgia, Maryland, which have been linked to the Gulf Coast reservoir. In 1991, cholera resurfaced in Latin America accounting for 66% (396,536 cases) of all cholera cases reported worldwide that year. Unexpectedly, cholera re-emerged in Peru during early 1991 and quickly turned into an epidemic that extended to Bolivia, Brazil, Chile, Colombia, Ecuador, El Salvador, Guatemala, Honduras, Panama, Venezuela, and Mexico. During this time, several important environmental factors including El Niño were attributed to the increased incidence of cholera. During and after the cholera outbreaks in South America, intensive measures were taken that include epidemiological surveillance, setting up of a laboratory network, proper patient care, improvements in basic sanitation, and clean water supply systems. Such timely measures helped to control cholera and other diarrheal diseases. Several molecular techniques have allowed the study of clonal variations in Vibrio cholerae for the first time. Molecular tools helped in identifying the epidemiological links with import of cholera by travelers as well as of the environmental origin. Several serotypes of V. cholerae exist in costal environments and seroconversion may play an important role in the epidemiology of cholera.

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“…Epidemics of cholera have been associated with high morbidity and significant mortality ( 4 ). Mortality is reduced by prompt rehydration and access to health facilities ( 5 ).…”

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confidence: 99%

Characteristics and clinical management of patients admitted to cholera wards in a regional referral hospital during the 2012 epidemic in Sierra Leone

Blacklock

Sesay

Kamara

et al. 2015

Global Health Action

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Background and objectivesIn 2012, Sierra Leone suffered a nationwide cholera epidemic which affected the capital Freetown and also the provinces. This study aims to describe the characteristics and clinical management of patients admitted to cholera isolation wards of the main referral hospital in the Northern Province and compare management with standard guidelines.DesignAll available clinical records of patients from the cholera isolation wards were reviewed retrospectively. There was no active case finding. The following data were collected from the clinical records after patients had left the ward: date of admission, demographics, symptoms, dehydration status, diagnoses, tests and treatments given, length of stay, and outcomes.ResultsA total of 798 patients were admitted, of whom 443 (55.5%) were female. There were 18 deaths (2.3%). Assessment of dehydration status was recorded in 517 (64.8%) of clinical records. An alternative or additional diagnosis was made for 214 patients (26.8%). Intravenous (IV) fluids were prescribed to 767 patients (96.1%), including 95% of 141 patients who had documentation of being not severely dehydrated. A history of vomiting was documented in 92.1% of all patients. Oral rehydration solution (ORS) was given to 629 (78.8%) patients. Doxycycline was given to 380 (47.6%) patients, erythromycin to 34 (4.3%), and other antibiotics were used on 247 occasions. Zinc was given to 209 (26.2%).DiscussionThis retrospective study highlights the need for efforts to improve the quality of triage, adherence to clinical guidance, and record keeping.ConclusionsData collection and analysis of clinical practices during an epidemic situation would enable faster identification of those areas requiring intervention and improvement.

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Cholera: Overview of epidemiologic, therapeutic, and preventive issues learned from recent epidemics

Cited by 22 publications

References 51 publications

New insights on the emergence of cholera in Latin America during 1991: the Peruvian experience.

New insights on the emergence of cholera in Latin America during 1991: the Peruvian experience.

The Re-emergence of Cholera in the Americas

Characteristics and clinical management of patients admitted to cholera wards in a regional referral hospital during the 2012 epidemic in Sierra Leone

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