Epidemiology and Infection

Original Papers

Gastrointestinal infection

Risk factors for cholera transmission in Haiti during inter-peak periods: insights to improve current control strategies from two case-control studies

F. GRANDESSOa1 c1, M. ALLANa1, P. S. J. JEAN-SIMONa2, J. BONCYa3, A. BLAKEa1, R. PIERREa4, K. P. ALBERTIa1, A. MUNGERa2, G. ELDERa5, D. OLSONa5, K. PORTENa1 and F. J. LUQUEROa1

a1 Epicentre, Paris, France

a2 Médecins sans Frontières, Paris, France

a3 Laboratoire National de Santé Publique, Ministère de la Santé Publique et de la Population, Port-au-Prince, Haiti

a4 Direction Sanitaire de l'Artibonite, Gonaives, Haiti

a5 Médecins sans Frontières, New York, USA

SUMMARY

Two community-based density case-control studies were performed to assess risk factors for cholera transmission during inter-peak periods of the ongoing epidemic in two Haitian urban settings, Gonaives and Carrefour. The strongest associations were: close contact with cholera patients (sharing latrines, visiting cholera patients, helping someone with diarrhoea), eating food from street vendors and washing dishes with untreated water. Protective factors were: drinking chlorinated water, receiving prevention messages via television, church or training sessions, and high household socioeconomic level. These findings suggest that, in addition to contaminated water, factors related to direct and indirect inter-human contact play an important role in cholera transmission during inter-peak periods. In order to reduce cholera transmission in Haiti intensive preventive measures such as hygiene promotion and awareness campaigns should be implemented during inter-peak lulls, when prevention activities are typically scaled back.

(Received May 22 2013)

(Revised July 29 2013)

(Accepted September 11 2013)

(Online publication October 11 2013)

Key words

  • Cholera;
  • risk factors;
  • endemic;
  • epidemic;
  • Haiti;
  • prevention;
  • transmission;
  • Vibrio cholerae

Correspondence

c1 Author for correspondence: Mr F. Grandesso, Clinical Research Department, Epicentre, 8 rue Saint-Sabin, 75011 Paris, France. (Email: francesco.GRANDESSO@epicentre.msf.org)

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