Person-to-person transmission of cholera in a psychiatric hospital

Heterogeneity in multiple transmission pathways: modelling the spread of cholera and other waterborne disease in networks with a common water source

“…Here, we refer to disease transmission through an environmental reservoir with long pathogen persistence as indirect/delayed transmission. This is in contrast with disease transmission through pathways with shorter pathogen lifetimes, for example through contamination of household water storage containers [35], food preparation [2,18,29], or direct person-person contact [15]. We refer to these latter pathways as direct/fast transmission.…”

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

“…[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."…”

“…23 It should be noted that although patients were under the care of health workers, which should result in a low case fatality rate, the case fatality rate was very high at 28% compared with a national average of 2.4% recorded over the same period for cholera outbreaks in communities. 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.…”

“…20 Our investigation suggests this was also the most likely means of transmission in BNMRH. Other reported nosocomial cholera outbreaks were attributed to inappropriate infection control, 19,22 and a previous study demonstrated the potential for nosocomial cholera transmission through improper preparation, storage, and dispensing of oral rehydration solution in cholera treatment centers or hospitals. 23 It should be noted that although patients were under the care of health workers, which should result in a low case fatality rate, the case fatality rate was very high at 28% compared with a national average of 2.4% recorded over the same period for cholera outbreaks in communities.…”

“…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.…”