Epidemiology and Infection

Short Report

Epidemic cholera in urban Zambia: hand soap and dried fish as protective factors

A. E. DUBOIS a1a2c1, M. SINKALA a3, P. KALLURI a1, M. MAKASA-CHIKOYA a3 and R. E. QUICK a1
a1 Foodborne and Diarrheal Diseases Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA
a2 Epidemic Intelligence Service, Epidemiology Program Office, Office of Workforce and Career Development, Centers for Disease Control and Prevention, Atlanta, GA, USA
a3 Lusaka District Health Management Team, Lusaka, Zambia

Article author query
dubois ae   [PubMed][Google Scholar] 
sinkala m   [PubMed][Google Scholar] 
kalluri p   [PubMed][Google Scholar] 
makasa-chikoya m   [PubMed][Google Scholar] 
quick re   [PubMed][Google Scholar] 


Between 28 November 2003 and 23 February 2004, 4343 cases and 154 deaths from cholera (case-fatality rate 3·5%) were reported in Lusaka, Zambia. A case-control study was conducted in February 2004 to assess potential transmission routes and prevention strategies. Consumption of raw vegetables was significantly associated with cholera [adjusted odds ratio (aOR) 4·7, 95% confidence interval (CI) 1·7–13, P=0·003). Consumption of a local sardine-like fish was protective (aOR 0·3, 95% CI 0·1–0·7, P=0·008). Hand soap was present in 90% of control homes and 58% of case homes. Observed hand soap was a strongly protective factor (aOR 0·1, 95% CI 0·04–0·4, P=0·001). No water source or treatment practice was significantly associated with cholera. This study documents the importance of foodborne transmission of cholera, illustrates the protective role of hand washing in an epidemic setting, and identifies a novel possible protective factor, a local fish, which warrants further research.

(Accepted February 8 2006)
(Published Online April 20 2006)

c1 Global AIDS Program Guyana, Centers for Disease Control and Prevention, 3170 Georgetown Place, Washington, DC 20521, USA. (Email: duboisa@gapcdcgy.org)