A Massive Cholera Outbreak in Shaheed Benazir Abad, Sindh, Pakistan

Background: A team of Field Epidemiology and Laboratory Training fellows were deputed to investigate the cholera outbreak reported from Village Laiq Rahoo Taluka Daulat Pur of district Shaheed Benazir Abad on 14 June 2016 after reporting of 56 diarrheal cases from the district.

Methods: The study was conducted from 15-19 June 2016. A case was defined any person who has presented with 3 or more episodes of watery stools or vomiting since last day, with or without; fever, nausea, abdominal cramps, blood or mucous in stool. Active case search was conducted in village. A case control study was carried out preceded by descriptive study. Data was collected on pretested questionniare. Environmental assessment was done. Stool samples were sent to National Institute of Health, Islamabad.

Results: A total of 132 diarrheal cases were identified with Case Fatality Rate of 3%. Age range was 1 year to 60 years (Mean=18 years). Of all casaes males were 73 (56%). Population of village was 3308, so the overall attack rate was 4%. Commonly affected age group was 30-34 years with attack rate of 11% (22/206). Diarrhea n=132 (100%) and vomiting n=47 (45%) were leading symptoms among cases. Water source near the toilets < less than 10 feet> (OR: 11, 95% CI: 6-20, p: <0.001), Eating from common OR=7.3, 95% CI: 4.2-12.6, p<0.001) were the factors associated with outbreak. Vibrio Cholera was detected in 3 out of 5 stool samples and 4 out of 5 water samples revealed coliforms.

Conclusion: Diarrhea outbreak was likely due to close proximity of water and sewage sources. It is recommended that hand pump should be installed away from toilets.