1. A diarrheal epidemic occurred in coastal villages in eastern India following Cyclone Aila in 2009, including the village of Pakhirala.
2. In Pakhirala village, 91.2% of residents developed watery diarrhea within 6 weeks, with 26% experiencing moderate to severe cases. Nearby villages saw lower attack (70%) and severity (14%) rates.
3. Laboratory analysis found Vibrio fluvialis was the predominant pathogen in Pakhirala village samples, while Vibrio cholerae O1 was predominant in other villages, indicating V. fluvialis may have caused a more aggressive epidemic in Pakhirala.
Chikungunya as a Cause of Acute Febrile Illness in Southern Sri LankaYan'an Hou
This study investigated chikungunya virus (CHIKV) as a cause of acute febrile illness in southern Sri Lanka during a 2007 outbreak. Researchers enrolled 797 patients presenting with undifferentiated fever at a large hospital. Serology identified acute CHIKV infection in 3.5% of patients without acute dengue virus infection, and PCR/viral isolation confirmed 64.3% of these cases. Sequencing of CHIKV isolates showed they possessed the E1-226A residue and were closely related to contemporary Sri Lankan and Indian isolates. Except for more frequent and persistent musculoskeletal symptoms, acute CHIKV mimicked dengue and other febrile illnesses clinically. Only 1.
Current Status of Lymphatic Filariasis in Sarangarh Tehsil, District Raigarh,...iosrjce
Local knowledge about lymphatic filariasis (LF) and their cause in villages of sarangarh tehsil,
district Raigarh, C. G. Sarangarh tehsil is endemic for lymphatic filariasis. During July to November 2014, a
lymphatic filariasis survey was carried out in six randomly selected villages and muhallas of sarangarh tehsil.
Quantitative and qualitative methods were used for data collection. 202 individuals had disease manifestation of
Lf. Female (55.44%) were more infected than male (44.55%), over all disease rate was (.70%) in all. Out of 202
diseased individuals, 57 male had hydrocele (28.21%), 126 had infected lower legs (62.36%) and 19 had
infected upper arm (9.40%). Major causes of lymphatic filariasis is due to less awareness, unhygienic
condition and late prevention. The present survey indicate that lymphatic filariasis is one of the major problem of public health in surveyed area.
The views expressed in the presentations are that of the author and do not necessarily reflect the views of the Government of Canada. Presentations are shared in the original format received from the presenter.
Presentations given at the Conference to Develop a Federal Framework on Lyme Disease are the property of the author, unless otherwise cited. If you reference the author's work, you must give the author credit by naming the author and their work as well as the place and date it was presented.
For more information, contact the Lyme Disease Conference Secretariat at maladie_lyme_disease@phac-aspc.gc.ca
This document summarizes research investigating the source of Liberia's second Ebola virus disease flare-up in June-July 2015. Genomic sequencing revealed that the viruses causing this flare-up were nearly identical to each other and formed a distinct cluster within the Liberian outbreak lineage. Epidemiological evidence linked the flare-up to a previous Ebola virus disease cluster in nearby Barclay Farm in August-September 2014. Two virus genomes from deceased individuals in the earlier cluster differed by only one mutation from viruses in the 2015 flare-up, suggesting this second flare-up originated from reemergence of the virus from a persistently infected person rather than a new introduction.
January 2010 Selected Zoonotic Diseases Conference Call goa4
This document summarizes investigations into two cases of human rabies in the United States in 2009. The first case was in Virginia and involved a man who was exposed to rabies while traveling in India and later developed symptoms. Public health agencies conducted contact tracing of over 150 individuals. The second case involved a joint investigation by CDC, Indiana, and Kentucky into a man who died of rabies in Kentucky after possible bat exposure in Indiana. Both cases highlight the challenges of diagnosing and investigating human rabies cases.
The document summarizes ethical issues that arise in treating patients with Ebola virus disease. It discusses principles of medical ethics like utilitarianism and deontology. It describes the author's experience working in an Ebola treatment unit in Sierra Leone. Key issues discussed include health worker safety, patient selection and triage if resources become overwhelmed, experimental treatments, and stigmatization of survivors.
INFLUENCING FACTORS FOR CHOLERA AND DIARRHOEA WATER SANITATION AND HYGIENE IN...Thant Zin
This study explored factors influencing cholera and diarrhea in rural villages in Beluran District, Sabah, Malaysia. The study found lower than national averages for improved sanitation facilities (35.3-52.3% of households), lack of toilets (37-63% of households), and improved water supplies (52-60% of households). Water quality testing found E. coli present in 32-37% of household water samples, though V. cholerae was not isolated. Significant associations were found between occupation/sanitation facilities and house ownership/knowledge of oral rehydration solution preparation. Predictors of household water quality included having a toilet and improved toilet facilities. The study recommends improving water supplies, sanitation
This study isolated and evaluated antibiotic resistance patterns of fecal coliform bacteria from the Wudil River in Kano, Nigeria. Samples were collected from four sites along the river and analyzed physically, chemically, and microbiologically. Escherichia coli, Salmonella typhi, Proteus mirabilis, Enterobacter sp., and Klebsiella pneumoneae were isolated. Antibiotic sensitivity testing found that Gentamicin, Ciprofloxacin, Erythromycin, and Levofloxacin were 80-90% effective, while isolates were 100% resistant to Ampicillin and 80% resistant to Rifampicin. The river water poses health risks if used for drinking without treatment
Chikungunya as a Cause of Acute Febrile Illness in Southern Sri LankaYan'an Hou
This study investigated chikungunya virus (CHIKV) as a cause of acute febrile illness in southern Sri Lanka during a 2007 outbreak. Researchers enrolled 797 patients presenting with undifferentiated fever at a large hospital. Serology identified acute CHIKV infection in 3.5% of patients without acute dengue virus infection, and PCR/viral isolation confirmed 64.3% of these cases. Sequencing of CHIKV isolates showed they possessed the E1-226A residue and were closely related to contemporary Sri Lankan and Indian isolates. Except for more frequent and persistent musculoskeletal symptoms, acute CHIKV mimicked dengue and other febrile illnesses clinically. Only 1.
Current Status of Lymphatic Filariasis in Sarangarh Tehsil, District Raigarh,...iosrjce
Local knowledge about lymphatic filariasis (LF) and their cause in villages of sarangarh tehsil,
district Raigarh, C. G. Sarangarh tehsil is endemic for lymphatic filariasis. During July to November 2014, a
lymphatic filariasis survey was carried out in six randomly selected villages and muhallas of sarangarh tehsil.
Quantitative and qualitative methods were used for data collection. 202 individuals had disease manifestation of
Lf. Female (55.44%) were more infected than male (44.55%), over all disease rate was (.70%) in all. Out of 202
diseased individuals, 57 male had hydrocele (28.21%), 126 had infected lower legs (62.36%) and 19 had
infected upper arm (9.40%). Major causes of lymphatic filariasis is due to less awareness, unhygienic
condition and late prevention. The present survey indicate that lymphatic filariasis is one of the major problem of public health in surveyed area.
The views expressed in the presentations are that of the author and do not necessarily reflect the views of the Government of Canada. Presentations are shared in the original format received from the presenter.
Presentations given at the Conference to Develop a Federal Framework on Lyme Disease are the property of the author, unless otherwise cited. If you reference the author's work, you must give the author credit by naming the author and their work as well as the place and date it was presented.
For more information, contact the Lyme Disease Conference Secretariat at maladie_lyme_disease@phac-aspc.gc.ca
This document summarizes research investigating the source of Liberia's second Ebola virus disease flare-up in June-July 2015. Genomic sequencing revealed that the viruses causing this flare-up were nearly identical to each other and formed a distinct cluster within the Liberian outbreak lineage. Epidemiological evidence linked the flare-up to a previous Ebola virus disease cluster in nearby Barclay Farm in August-September 2014. Two virus genomes from deceased individuals in the earlier cluster differed by only one mutation from viruses in the 2015 flare-up, suggesting this second flare-up originated from reemergence of the virus from a persistently infected person rather than a new introduction.
January 2010 Selected Zoonotic Diseases Conference Call goa4
This document summarizes investigations into two cases of human rabies in the United States in 2009. The first case was in Virginia and involved a man who was exposed to rabies while traveling in India and later developed symptoms. Public health agencies conducted contact tracing of over 150 individuals. The second case involved a joint investigation by CDC, Indiana, and Kentucky into a man who died of rabies in Kentucky after possible bat exposure in Indiana. Both cases highlight the challenges of diagnosing and investigating human rabies cases.
The document summarizes ethical issues that arise in treating patients with Ebola virus disease. It discusses principles of medical ethics like utilitarianism and deontology. It describes the author's experience working in an Ebola treatment unit in Sierra Leone. Key issues discussed include health worker safety, patient selection and triage if resources become overwhelmed, experimental treatments, and stigmatization of survivors.
INFLUENCING FACTORS FOR CHOLERA AND DIARRHOEA WATER SANITATION AND HYGIENE IN...Thant Zin
This study explored factors influencing cholera and diarrhea in rural villages in Beluran District, Sabah, Malaysia. The study found lower than national averages for improved sanitation facilities (35.3-52.3% of households), lack of toilets (37-63% of households), and improved water supplies (52-60% of households). Water quality testing found E. coli present in 32-37% of household water samples, though V. cholerae was not isolated. Significant associations were found between occupation/sanitation facilities and house ownership/knowledge of oral rehydration solution preparation. Predictors of household water quality included having a toilet and improved toilet facilities. The study recommends improving water supplies, sanitation
This study isolated and evaluated antibiotic resistance patterns of fecal coliform bacteria from the Wudil River in Kano, Nigeria. Samples were collected from four sites along the river and analyzed physically, chemically, and microbiologically. Escherichia coli, Salmonella typhi, Proteus mirabilis, Enterobacter sp., and Klebsiella pneumoneae were isolated. Antibiotic sensitivity testing found that Gentamicin, Ciprofloxacin, Erythromycin, and Levofloxacin were 80-90% effective, while isolates were 100% resistant to Ampicillin and 80% resistant to Rifampicin. The river water poses health risks if used for drinking without treatment
Clinical profile of cholera cases in yavatmal district, maharashtraAlexander Decker
1) The document summarizes a study on cholera cases in Yavatmal District, Maharashtra between June-July 2012.
2) The study found that 13 of 377 cases of acute watery diarrhea were positive for cholera, all caused by the V. cholera 01 El Tor serotype Ogawa strain.
3) Nearly half of cases were children under 5 years old. Living conditions for all patients were poor and involved unsafe water sources, but all cases responded well to treatment.
Shigellosis and Socio-Demography of hospitalized Patients in Kano, North-West...inventionjournals
Aim: The aim of the study was to determine the prevalent of Shigellosis in relation to socio-demographic characteristics of hospitalized patients in Kano metropolis. Study design: The study is a descriptive cross-sectional study. Place and duration of study: One milliliter of venous blood was collected from each patient with some or all clinical features of Shigellosis that sign a consent form and transfer into EDTA bottles. If daily is unavoidable blood samples were stored at 4 0C. Samples were analyzed at the both laboratories of the authors. This work was carried out between May, 2012 and March, 2014. Methodology: The blood specimens were cultured in thioglycollate broth and sub-cultured onto deoxycholate citrate agar (DCA), Salmonella-Shigella agar (SSA) and brilliant Green agar (BGA) followed by confirmation of presumptive colonies using different biochemical tests and analytical profile index 20E. Serologic identification of Shigella was performed by slide agglutination test using polyvalent O and H Shigella antisera. Results: Although, the relationship between different age groups was not significantly associated (P < 0.05), patients under age bracket of 21-30 years were found to be more susceptible to Shigella infections with 13 representing 2.6% followed in that order by 11-20 years (6), , ≤10 -years (4) 31-40 years (3) and >40 years (2) age groups, representing 1.2%, 0.8%, 0.6% and 0.4% respectively. The frequency of shigellosis was highest in other patients (without occupation), patients with informal level of education, using tap water as sources of drinking water, with more than one of all clinical manifestations of Salmonella infections and patients on treatment. However, there was a significant difference between the rate of Salmonella infections and sociodemographic characteristics of patients studied (p<0.05).> 0.05) in males than the females’ patients. However, Shigella flexneri was the most common among patients followed by Shigella dysenteriae, Shigella boydii and Shigella sonnei in decreasing order. The frequency of shigellosis was highest in other patients (without occupation), patients with informal level of education, using tap water as sources of drinking water, with more than one of all clinical manifestations of Salmonella infections and patients on treatment.
Evaluation of factors that influence Reoccurrence of Cholera epidemics in Bwe...PUBLISHERJOURNAL
Cholera is an acute enteric infection characterised by sudden onset of profuse, painless watery diarrhoea and vomiting. Transmission of the disease is by faecal-oral route and from man to man via faecal contaminated water, ingestion of contaminated foods and drinks, and bottle feeding in infants. Globally, an estimated 1.4 to 4.3 million cholera cases and 28,000 to 142,000 cholera related deaths occur every year and the highest deaths rates occur in developing countries. The aim of this study was to explore the factors influencing reoccurrence of cholera outbreaks in Bwera hospital-Kasese district, Uganda. The study was a descriptive cross-sectional where quantitative strategy was applied on health workers and households within Bwera hospital. The study targeted 73 respondents; random sampling procedure was used. Three broad themes were based on to obtain results namely; sources of water for home use, environmental sanitation and the role of climate change. It emerged that water was mainly collected from unprotected sources using rudimentary methods and it was made safe by boiling. Hand washing was seen as a common practice done though occasionally. Generally solid wastes were poorly managed including human waste and reinforcing reforestation was seen as a remedy to avert effects of climate change. The commonest source of water for home consumption was from open water surfaces mainly rivers/streams. Boiling was seen as one of the commonest methods of making water safe for home consumption but the numbers of house hold that boils water are very few thereby making them prone to infection. Washing hands was the commonest practice especially before eating but still some children do ignore washing of their hands before eating if their caretakers are not around them; however, it was not consistently after visiting latrine. Poor waste disposal was seen present in the communities whereby bushes and river banks were seen as places where human waste is deposited.
Keywords: Cholera, Deaths, Households, Bwera hospital, contaminated Water.
This document summarizes a study that investigated fecal contamination of drinking water in urban slum households in Hyderabad, India. The study tested water samples at distribution points and from household storage containers to measure changes in water quality over time. It also conducted surveys of household water handling practices and hygiene. The results showed that while 92% of samples at supply points were adequately chlorinated, 36% of samples from household storage containers showed increased bacterial contamination. However, households with contaminated stored water did not significantly differ in demographics, water handling, hygiene, or sanitation from those without. This indicates that water quality deteriorates substantially between distribution and household storage, likely due to poor water handling and storage practices.
WCS's health programs work to save wildlife through scientific research, clinical care, and innovative solutions at the intersection of wildlife, domestic animal, and human health. They identified canine distemper virus as a threat to endangered Amur tigers in Russia, which has a population of only 400-500 individuals. Their molecular scientist helped train Russian colleagues to continue disease research. They also work globally on turtle conservation projects like headstarting Southern River terrapins in Cambodia and assessing turtle species in Chinese markets to advance ex situ conservation efforts.
Suitability of tube wells water for drinking at lalpur upazila in natore dist...Khulna University
The aim of the study was to observe the suitability of tube-wells water consumed by people of Lalpur upazila in Natore district for drinking purpose in comparison to standard of World Health Organization (WHO) and the standard of Bangladesh. In this study, it was tried to find out the physical and chemical conditions of the drinkable tube-wells water used in the studied region and to observe the presence or absence of total coliform & Escherichia coli bacteria.
Endemic Fluorosis and Occurrence Gastrointestinal Disorders in Prakasam Distr...IJEAB
This document summarizes a study on the prevalence of gastrointestinal disorders among populations in five villages in Prakasam District, Andhra Pradesh, India, an area affected by endemic fluorosis. An epidemiological survey found that nausea was reported in 22% of subjects, loss of appetite in 18%, and indigestion and vomiting in 12-14%. Histological analysis of rats exposed to sodium fluoride found damage to the intestinal mucosa and submucosa. The document discusses how fluoride exposure may cause gastrointestinal issues by disrupting enzyme activity and cellular respiration processes. The results indicate a relationship between high fluoride exposure through drinking water and a higher reported prevalence of gastrointestinal symptoms among villagers.
Isolation and Identification of Coliform Bacteria's from Drinking Water Sourc...iosrphr_editor
This document summarizes a study that analyzed drinking water samples from three cities (Mansehra, Abbottabad, and Haripur) in Hazara Division, Pakistan to identify coliform bacteria. A total of 90 water samples were collected and tested for the presence of four bacterial species: E. coli, P. aeruginosa, Salmonella, and H. pylori. The study found that 26.66% of samples contained E. coli, the most prevalent bacteria identified. Abbottabad had the highest number of samples containing coliform bacteria at 20%. The results indicate unsafe drinking water in the region and a need for improved water treatment and sanitation practices to reduce waterborne diseases.
Risk Factors Early in the 2010 Cholera Epidemic, Haiti.docxhealdkathaleen
Risk Factors Early
in the 2010 Cholera
Epidemic, Haiti
Katherine A. O’Connor, Emily Cartwright,
Anagha Loharikar, Janell Routh, Joanna Gaines,
Marie-Délivrance Bernadette Fouché,
Reginald Jean-Louis, Tracy Ayers,
Dawn Johnson, Jordan W. Tappero,
Thierry H. Roels, W. Roodly Archer,
Georges A. Dahourou, Eric Mintz, Robert Quick,
and Barbara E. Mahon
During the early weeks of the cholera outbreak that
began in Haiti in October 2010, we conducted a case–
control study to identify risk factors. Drinking treated water
was strongly protective against illness. Our results highlight
the effectiveness of safe water in cholera control.
On October 19, 2010, the Haitian Ministry of Public Health and Population (MSPP) was notifi ed of
increased cases of acute watery diarrhea resulting in death
among adults in Artibonite Department. Within 2 days,
MSPP’s Laboratoire National de la Santé Publique had
identifi ed toxigenic Vibrio cholerae O1, serotype Ogawa,
biotype El Tor in stool specimens (1). The fi rst reports of
illness consistent with cholera occurred on October 16,
and, by November 19, cholera had reached all 10 Haitian
administrative departments (2).
Because the fi rst cases were in persons who worked
near the Artibonite River, contaminated river water was
suspected as the initial source. In a proactive effort to
protect the population, MSPP rapidly implemented a
cholera prevention campaign that began on October 22,
2010, to discourage the population from drinking river
water, distribute water treatment products, and promote
water treatment, handwashing, sanitation, and safe food
preparation. To inform further prevention activities, we
conducted a case–control study during the second and
third weeks of the outbreak to identify risk factors for
symptomatic cholera.
The Study
This study was conducted in Artibonite Department
close to where the fi rst cases were identifi ed. On the
basis of detailed hypothesis-generating interviews with
patients and known risk factors associated with cholera
in other investigations in the Americas, we created a
questionnaire to assess multiple exposures, including
river and other water-related exposures, sanitation and
hygiene practices, foods, and other factors. We enrolled
and interviewed participants from October 31 through
November 13, 2010, with a 4-day break during November
5–8 because of Hurricane Tomas. To rapidly generate
relevant information to guide outbreak response, we set
a goal of enrolling 50 case-patients and 100 controls, a
sample size that, although limited, was in line with that of
previous successful emergency investigations.
Eligible case-patients were persons >5 years of age
who were hospitalized between October 22 and November
9 for acute watery diarrhea at the Médecins Sans
Frontières cholera treatment unit in Petite Rivière, a town
in a densely populated rural region near the Artibonite
River. Only case-patients with the fi rst case of ...
Initial Report on Increasing Incidence of Diarrhea Cases in Barangay Culamdan...No to mining in Palawan
HEALTH
Initial Report on Increasing Incidence of Diarrhea Cases in Barangay Culamdanum, Bataraza March 31, 2011
“Only when the last tree has died,
the last river has been poisoned
and the last fish has been caught,
only then will man realize that money cannot be eaten”
--- from a native Indian
Scrub typhus in a tertiary care hospital in the eastern part of OdishaApollo Hospitals
Our hospital, tertiary care hospital in the capital of the State of Odisha, had been witnessing pyrexia of unknown origin, associated with breathlessness, renal and liver impairment, which did not respond to high antibiotics like Carbapenems but to Doxycycline therefore, the present study was undertaken to identify whether scrub typhus is the aetiological agent and thereafter their characteristic features were further evaluated as an effort in supporting its diagnoses and treating patients accordingly.
ABSTRACT- Diarrhoea disease is one of the main reasons for absenteeism at work and school in developed and
developing countries, thereby contributing to economic losses. The explosion in the number of street food vendors
hawking ready-to-eat food is reported in every local government in Nigeria including Osun. Street foods are frequently
contaminated, thereby contributing to the number of food borne diseases. Individuals who presented to the clinics with
travelers’ disease symptoms (diarrhoea and vomiting) in the randomly selected clinics in Iwo, Osogbo, Ile-Ife and Ilesha
townships in Osun State were invited to participate in the survey. In the period of July-October 2015, 57 completed
questionnaires were collected and analyzed. Overall, 42.1% were males and 57.9% were females. About 22.8% of the
participants were <5>6 number of stools/24 h. The most frequently consumed foods identified were
moin-moin, amala/iyan, rice and satchet water. A strong correlation was found between having symptoms of travelers
disease and consumption of street vended foods (ρ (57) =0.357**, p<0.06). This study concludes that travelers’ disease
(diarrhea and vomiting) is persistent and has high prevalence in Osun State, Nigeria.
Key words- Travelers’ disease, Foodborne disease, Street- vended-foods, Osun State, Diarrhoea
Ethnomedical survey of herbs for the management of malaria in karnataka, indiaYounis I Munshi
This document describes an ethnomedical survey of plants used traditionally by healers in Karnataka, India to treat malaria. Researchers interviewed 24 healers and documented 31 plant species across 20 families used in herbal remedies. The most commonly used plant parts were leaves. Eight species had not been previously recorded for treating malaria. Traditional knowledge of malaria symptoms and herbal treatments is threatened by loss of culture. The survey aimed to document this indigenous knowledge and assess plant species for anti-malarial activity based on literature.
Introduction: Snake bite is considered to be one of the common, neglected and potential life-threatening public health issues in tropical and sub-tropical countries. According to World Health Organization (WHO), 4.5- 5.4 million people get bitten by snakes annually. Acute kidney injury is one of the major health issues due to snake envenomation and can be managed with appropriate dose of Anti-snake venom and other symptomatic approach. Methods: a prospective observational study, all the patients who were admitted to tertiary care hospital between October 2019 to September 2020 and developed Acute kidney injury were included. All the relevant data were collected from case reports and case sheets and patient interaction. Patients with the definitive history of renal disease, exposure to nephrotoxic drugs were excluded. All the statistical data were analyzed using descriptive statistics. Results: a total of 40 patients were included with a mean age of 40.07 (±10.01) years. This study shows a male predominance of 72.5% (n=29). The clinical manifestations like Cellulitis, local swelling, hypotension was commonly seen. Severe damage to kidney was seen in patients who received native medicine before admitting to hospital. Conclusion: this study concludes that acute kidney injury is one of the major causes of morbidity, there is need of education on snake envenomation and its treatment and first aid and effect of native medicine
This document provides an overview of fluorosis as a public health problem in India, specifically in West Bengal and the district of Bankura. It summarizes that fluorosis is caused by high fluoride levels in drinking water above 1 ppm, affecting over 62 million people across India. In West Bengal, the districts of Bankura, Birbhum, Purulia and Daxin Dinajpur have high levels of endemic fluorosis. The document then describes the types and symptoms of dental, skeletal, and non-skeletal fluorosis and outlines interventions including safe water supply, nutrition, medical treatment, and cooperation between health and public works departments.
This is a PPT which was spoken by Dr. J. Dinda , former CMOH , Bankura in the year 2012 in DH&FW advocacy meeting. Thanks to him for successful implementation of NPPCF at Bankura. Hi is no more with us unfortunately but his work regarding NPPCF is make him alive again.Till date i see you when i am in tense and remind you words to fight with the troubles and not to leave the station .......We are recruited for people who are in pain , to solve their problem and give them medical support .................Miss You a Lots .........Dibyendu Dutta
Mobile phone has been source of microorganisms that cause diseases of public health concerns. In a study, one-fi fth of cellular phones examined were found to harbor pathogenic bacteria indicating that these devices may serve as vehicles of transmission. Swab samples were collected aseptically from the phones of different handlers like motor bike riders, food vendors, meat sellers and nursing mothers. Bacteria isolation and identifi cation were carried out using pour plating technique with distinctive morphological and biochemical characteristics.The pathogenicity of the bacterial isolates was investigated through oral inoculation into albino rats. Eighty-eight (88) bacteria were isolated and selected based on their resistance to antibiotics for pathological study. Loss in weight was observed in some albino rat. Along with reduction in the packed cell volume, hemoglobin but raised white blood cell. Animal inoculated with Bacillus cereus showed meningitis like symptom after the first week of inoculation. Also, there were short and stunted villi; low crystal depth with necrotic
debris in the lumen. It has been observed that cell phones may harbor pathogenic bacteria and can subsequently plays role as fomite in the disease transmission. Therefore, the need to educate community phone handlers in the rural area becomes imperative.
This document summarizes a study on the socio-economic impacts of arsenic contamination in drinking water in Basti Rasul Pur, Rahim Yar Khan, Pakistan. Key findings include:
1) 77% of water samples tested were found to have unsafe levels of arsenic contamination.
2) 50% of people surveyed showed symptoms of arsenicosis (arsenic poisoning) and 60% of household earnings were being spent on medical treatment.
3) Widespread illiteracy meant the population was largely unaware of the health risks of drinking contaminated water.
There is a need for sustainable solutions to provide the affected community with safe drinking water and mitigate the severe health and socioeconomic impacts of arsenic
This study assessed the impact of municipal piped water in Old Dhaka, Bangladesh on public health. A survey of a local hospital found that approximately 40% of patients were admitted for water-borne diseases like diarrhea, typhoid, dysentery and hepatitis A. Children were the most vulnerable, comprising 70% of water-borne disease cases. Incidence rates were highest in the wet season and lowest in the dry season. However, all community respondents considered the piped water unsafe for drinking without treatment due to the risk of contamination.
Clinical profile of cholera cases in yavatmal district, maharashtraAlexander Decker
1) The document summarizes a study on cholera cases in Yavatmal District, Maharashtra between June-July 2012.
2) The study found that 13 of 377 cases of acute watery diarrhea were positive for cholera, all caused by the V. cholera 01 El Tor serotype Ogawa strain.
3) Nearly half of cases were children under 5 years old. Living conditions for all patients were poor and involved unsafe water sources, but all cases responded well to treatment.
Shigellosis and Socio-Demography of hospitalized Patients in Kano, North-West...inventionjournals
Aim: The aim of the study was to determine the prevalent of Shigellosis in relation to socio-demographic characteristics of hospitalized patients in Kano metropolis. Study design: The study is a descriptive cross-sectional study. Place and duration of study: One milliliter of venous blood was collected from each patient with some or all clinical features of Shigellosis that sign a consent form and transfer into EDTA bottles. If daily is unavoidable blood samples were stored at 4 0C. Samples were analyzed at the both laboratories of the authors. This work was carried out between May, 2012 and March, 2014. Methodology: The blood specimens were cultured in thioglycollate broth and sub-cultured onto deoxycholate citrate agar (DCA), Salmonella-Shigella agar (SSA) and brilliant Green agar (BGA) followed by confirmation of presumptive colonies using different biochemical tests and analytical profile index 20E. Serologic identification of Shigella was performed by slide agglutination test using polyvalent O and H Shigella antisera. Results: Although, the relationship between different age groups was not significantly associated (P < 0.05), patients under age bracket of 21-30 years were found to be more susceptible to Shigella infections with 13 representing 2.6% followed in that order by 11-20 years (6), , ≤10 -years (4) 31-40 years (3) and >40 years (2) age groups, representing 1.2%, 0.8%, 0.6% and 0.4% respectively. The frequency of shigellosis was highest in other patients (without occupation), patients with informal level of education, using tap water as sources of drinking water, with more than one of all clinical manifestations of Salmonella infections and patients on treatment. However, there was a significant difference between the rate of Salmonella infections and sociodemographic characteristics of patients studied (p<0.05).> 0.05) in males than the females’ patients. However, Shigella flexneri was the most common among patients followed by Shigella dysenteriae, Shigella boydii and Shigella sonnei in decreasing order. The frequency of shigellosis was highest in other patients (without occupation), patients with informal level of education, using tap water as sources of drinking water, with more than one of all clinical manifestations of Salmonella infections and patients on treatment.
Evaluation of factors that influence Reoccurrence of Cholera epidemics in Bwe...PUBLISHERJOURNAL
Cholera is an acute enteric infection characterised by sudden onset of profuse, painless watery diarrhoea and vomiting. Transmission of the disease is by faecal-oral route and from man to man via faecal contaminated water, ingestion of contaminated foods and drinks, and bottle feeding in infants. Globally, an estimated 1.4 to 4.3 million cholera cases and 28,000 to 142,000 cholera related deaths occur every year and the highest deaths rates occur in developing countries. The aim of this study was to explore the factors influencing reoccurrence of cholera outbreaks in Bwera hospital-Kasese district, Uganda. The study was a descriptive cross-sectional where quantitative strategy was applied on health workers and households within Bwera hospital. The study targeted 73 respondents; random sampling procedure was used. Three broad themes were based on to obtain results namely; sources of water for home use, environmental sanitation and the role of climate change. It emerged that water was mainly collected from unprotected sources using rudimentary methods and it was made safe by boiling. Hand washing was seen as a common practice done though occasionally. Generally solid wastes were poorly managed including human waste and reinforcing reforestation was seen as a remedy to avert effects of climate change. The commonest source of water for home consumption was from open water surfaces mainly rivers/streams. Boiling was seen as one of the commonest methods of making water safe for home consumption but the numbers of house hold that boils water are very few thereby making them prone to infection. Washing hands was the commonest practice especially before eating but still some children do ignore washing of their hands before eating if their caretakers are not around them; however, it was not consistently after visiting latrine. Poor waste disposal was seen present in the communities whereby bushes and river banks were seen as places where human waste is deposited.
Keywords: Cholera, Deaths, Households, Bwera hospital, contaminated Water.
This document summarizes a study that investigated fecal contamination of drinking water in urban slum households in Hyderabad, India. The study tested water samples at distribution points and from household storage containers to measure changes in water quality over time. It also conducted surveys of household water handling practices and hygiene. The results showed that while 92% of samples at supply points were adequately chlorinated, 36% of samples from household storage containers showed increased bacterial contamination. However, households with contaminated stored water did not significantly differ in demographics, water handling, hygiene, or sanitation from those without. This indicates that water quality deteriorates substantially between distribution and household storage, likely due to poor water handling and storage practices.
WCS's health programs work to save wildlife through scientific research, clinical care, and innovative solutions at the intersection of wildlife, domestic animal, and human health. They identified canine distemper virus as a threat to endangered Amur tigers in Russia, which has a population of only 400-500 individuals. Their molecular scientist helped train Russian colleagues to continue disease research. They also work globally on turtle conservation projects like headstarting Southern River terrapins in Cambodia and assessing turtle species in Chinese markets to advance ex situ conservation efforts.
Suitability of tube wells water for drinking at lalpur upazila in natore dist...Khulna University
The aim of the study was to observe the suitability of tube-wells water consumed by people of Lalpur upazila in Natore district for drinking purpose in comparison to standard of World Health Organization (WHO) and the standard of Bangladesh. In this study, it was tried to find out the physical and chemical conditions of the drinkable tube-wells water used in the studied region and to observe the presence or absence of total coliform & Escherichia coli bacteria.
Endemic Fluorosis and Occurrence Gastrointestinal Disorders in Prakasam Distr...IJEAB
This document summarizes a study on the prevalence of gastrointestinal disorders among populations in five villages in Prakasam District, Andhra Pradesh, India, an area affected by endemic fluorosis. An epidemiological survey found that nausea was reported in 22% of subjects, loss of appetite in 18%, and indigestion and vomiting in 12-14%. Histological analysis of rats exposed to sodium fluoride found damage to the intestinal mucosa and submucosa. The document discusses how fluoride exposure may cause gastrointestinal issues by disrupting enzyme activity and cellular respiration processes. The results indicate a relationship between high fluoride exposure through drinking water and a higher reported prevalence of gastrointestinal symptoms among villagers.
Isolation and Identification of Coliform Bacteria's from Drinking Water Sourc...iosrphr_editor
This document summarizes a study that analyzed drinking water samples from three cities (Mansehra, Abbottabad, and Haripur) in Hazara Division, Pakistan to identify coliform bacteria. A total of 90 water samples were collected and tested for the presence of four bacterial species: E. coli, P. aeruginosa, Salmonella, and H. pylori. The study found that 26.66% of samples contained E. coli, the most prevalent bacteria identified. Abbottabad had the highest number of samples containing coliform bacteria at 20%. The results indicate unsafe drinking water in the region and a need for improved water treatment and sanitation practices to reduce waterborne diseases.
Risk Factors Early in the 2010 Cholera Epidemic, Haiti.docxhealdkathaleen
Risk Factors Early
in the 2010 Cholera
Epidemic, Haiti
Katherine A. O’Connor, Emily Cartwright,
Anagha Loharikar, Janell Routh, Joanna Gaines,
Marie-Délivrance Bernadette Fouché,
Reginald Jean-Louis, Tracy Ayers,
Dawn Johnson, Jordan W. Tappero,
Thierry H. Roels, W. Roodly Archer,
Georges A. Dahourou, Eric Mintz, Robert Quick,
and Barbara E. Mahon
During the early weeks of the cholera outbreak that
began in Haiti in October 2010, we conducted a case–
control study to identify risk factors. Drinking treated water
was strongly protective against illness. Our results highlight
the effectiveness of safe water in cholera control.
On October 19, 2010, the Haitian Ministry of Public Health and Population (MSPP) was notifi ed of
increased cases of acute watery diarrhea resulting in death
among adults in Artibonite Department. Within 2 days,
MSPP’s Laboratoire National de la Santé Publique had
identifi ed toxigenic Vibrio cholerae O1, serotype Ogawa,
biotype El Tor in stool specimens (1). The fi rst reports of
illness consistent with cholera occurred on October 16,
and, by November 19, cholera had reached all 10 Haitian
administrative departments (2).
Because the fi rst cases were in persons who worked
near the Artibonite River, contaminated river water was
suspected as the initial source. In a proactive effort to
protect the population, MSPP rapidly implemented a
cholera prevention campaign that began on October 22,
2010, to discourage the population from drinking river
water, distribute water treatment products, and promote
water treatment, handwashing, sanitation, and safe food
preparation. To inform further prevention activities, we
conducted a case–control study during the second and
third weeks of the outbreak to identify risk factors for
symptomatic cholera.
The Study
This study was conducted in Artibonite Department
close to where the fi rst cases were identifi ed. On the
basis of detailed hypothesis-generating interviews with
patients and known risk factors associated with cholera
in other investigations in the Americas, we created a
questionnaire to assess multiple exposures, including
river and other water-related exposures, sanitation and
hygiene practices, foods, and other factors. We enrolled
and interviewed participants from October 31 through
November 13, 2010, with a 4-day break during November
5–8 because of Hurricane Tomas. To rapidly generate
relevant information to guide outbreak response, we set
a goal of enrolling 50 case-patients and 100 controls, a
sample size that, although limited, was in line with that of
previous successful emergency investigations.
Eligible case-patients were persons >5 years of age
who were hospitalized between October 22 and November
9 for acute watery diarrhea at the Médecins Sans
Frontières cholera treatment unit in Petite Rivière, a town
in a densely populated rural region near the Artibonite
River. Only case-patients with the fi rst case of ...
Initial Report on Increasing Incidence of Diarrhea Cases in Barangay Culamdan...No to mining in Palawan
HEALTH
Initial Report on Increasing Incidence of Diarrhea Cases in Barangay Culamdanum, Bataraza March 31, 2011
“Only when the last tree has died,
the last river has been poisoned
and the last fish has been caught,
only then will man realize that money cannot be eaten”
--- from a native Indian
Scrub typhus in a tertiary care hospital in the eastern part of OdishaApollo Hospitals
Our hospital, tertiary care hospital in the capital of the State of Odisha, had been witnessing pyrexia of unknown origin, associated with breathlessness, renal and liver impairment, which did not respond to high antibiotics like Carbapenems but to Doxycycline therefore, the present study was undertaken to identify whether scrub typhus is the aetiological agent and thereafter their characteristic features were further evaluated as an effort in supporting its diagnoses and treating patients accordingly.
ABSTRACT- Diarrhoea disease is one of the main reasons for absenteeism at work and school in developed and
developing countries, thereby contributing to economic losses. The explosion in the number of street food vendors
hawking ready-to-eat food is reported in every local government in Nigeria including Osun. Street foods are frequently
contaminated, thereby contributing to the number of food borne diseases. Individuals who presented to the clinics with
travelers’ disease symptoms (diarrhoea and vomiting) in the randomly selected clinics in Iwo, Osogbo, Ile-Ife and Ilesha
townships in Osun State were invited to participate in the survey. In the period of July-October 2015, 57 completed
questionnaires were collected and analyzed. Overall, 42.1% were males and 57.9% were females. About 22.8% of the
participants were <5>6 number of stools/24 h. The most frequently consumed foods identified were
moin-moin, amala/iyan, rice and satchet water. A strong correlation was found between having symptoms of travelers
disease and consumption of street vended foods (ρ (57) =0.357**, p<0.06). This study concludes that travelers’ disease
(diarrhea and vomiting) is persistent and has high prevalence in Osun State, Nigeria.
Key words- Travelers’ disease, Foodborne disease, Street- vended-foods, Osun State, Diarrhoea
Ethnomedical survey of herbs for the management of malaria in karnataka, indiaYounis I Munshi
This document describes an ethnomedical survey of plants used traditionally by healers in Karnataka, India to treat malaria. Researchers interviewed 24 healers and documented 31 plant species across 20 families used in herbal remedies. The most commonly used plant parts were leaves. Eight species had not been previously recorded for treating malaria. Traditional knowledge of malaria symptoms and herbal treatments is threatened by loss of culture. The survey aimed to document this indigenous knowledge and assess plant species for anti-malarial activity based on literature.
Introduction: Snake bite is considered to be one of the common, neglected and potential life-threatening public health issues in tropical and sub-tropical countries. According to World Health Organization (WHO), 4.5- 5.4 million people get bitten by snakes annually. Acute kidney injury is one of the major health issues due to snake envenomation and can be managed with appropriate dose of Anti-snake venom and other symptomatic approach. Methods: a prospective observational study, all the patients who were admitted to tertiary care hospital between October 2019 to September 2020 and developed Acute kidney injury were included. All the relevant data were collected from case reports and case sheets and patient interaction. Patients with the definitive history of renal disease, exposure to nephrotoxic drugs were excluded. All the statistical data were analyzed using descriptive statistics. Results: a total of 40 patients were included with a mean age of 40.07 (±10.01) years. This study shows a male predominance of 72.5% (n=29). The clinical manifestations like Cellulitis, local swelling, hypotension was commonly seen. Severe damage to kidney was seen in patients who received native medicine before admitting to hospital. Conclusion: this study concludes that acute kidney injury is one of the major causes of morbidity, there is need of education on snake envenomation and its treatment and first aid and effect of native medicine
This document provides an overview of fluorosis as a public health problem in India, specifically in West Bengal and the district of Bankura. It summarizes that fluorosis is caused by high fluoride levels in drinking water above 1 ppm, affecting over 62 million people across India. In West Bengal, the districts of Bankura, Birbhum, Purulia and Daxin Dinajpur have high levels of endemic fluorosis. The document then describes the types and symptoms of dental, skeletal, and non-skeletal fluorosis and outlines interventions including safe water supply, nutrition, medical treatment, and cooperation between health and public works departments.
This is a PPT which was spoken by Dr. J. Dinda , former CMOH , Bankura in the year 2012 in DH&FW advocacy meeting. Thanks to him for successful implementation of NPPCF at Bankura. Hi is no more with us unfortunately but his work regarding NPPCF is make him alive again.Till date i see you when i am in tense and remind you words to fight with the troubles and not to leave the station .......We are recruited for people who are in pain , to solve their problem and give them medical support .................Miss You a Lots .........Dibyendu Dutta
Mobile phone has been source of microorganisms that cause diseases of public health concerns. In a study, one-fi fth of cellular phones examined were found to harbor pathogenic bacteria indicating that these devices may serve as vehicles of transmission. Swab samples were collected aseptically from the phones of different handlers like motor bike riders, food vendors, meat sellers and nursing mothers. Bacteria isolation and identifi cation were carried out using pour plating technique with distinctive morphological and biochemical characteristics.The pathogenicity of the bacterial isolates was investigated through oral inoculation into albino rats. Eighty-eight (88) bacteria were isolated and selected based on their resistance to antibiotics for pathological study. Loss in weight was observed in some albino rat. Along with reduction in the packed cell volume, hemoglobin but raised white blood cell. Animal inoculated with Bacillus cereus showed meningitis like symptom after the first week of inoculation. Also, there were short and stunted villi; low crystal depth with necrotic
debris in the lumen. It has been observed that cell phones may harbor pathogenic bacteria and can subsequently plays role as fomite in the disease transmission. Therefore, the need to educate community phone handlers in the rural area becomes imperative.
This document summarizes a study on the socio-economic impacts of arsenic contamination in drinking water in Basti Rasul Pur, Rahim Yar Khan, Pakistan. Key findings include:
1) 77% of water samples tested were found to have unsafe levels of arsenic contamination.
2) 50% of people surveyed showed symptoms of arsenicosis (arsenic poisoning) and 60% of household earnings were being spent on medical treatment.
3) Widespread illiteracy meant the population was largely unaware of the health risks of drinking contaminated water.
There is a need for sustainable solutions to provide the affected community with safe drinking water and mitigate the severe health and socioeconomic impacts of arsenic
This study assessed the impact of municipal piped water in Old Dhaka, Bangladesh on public health. A survey of a local hospital found that approximately 40% of patients were admitted for water-borne diseases like diarrhea, typhoid, dysentery and hepatitis A. Children were the most vulnerable, comprising 70% of water-borne disease cases. Incidence rates were highest in the wet season and lowest in the dry season. However, all community respondents considered the piped water unsafe for drinking without treatment due to the risk of contamination.
2. Bhattacharjee S et al.Post-cyclone Vibrio fluvialis epidemic in India
JHPN312
er V. fluvialis could lead to an epidemic in coastal
regions, particularly following natural disasters,
such as flood which is common in these delta ar-
eas. An investigation was made to find out the out-
break-causing potentiality and epidemiology of V.
fluvialis in the Sundarbans following Aila.
MATERIALS AND METHODS
Study area
Villages across the Gosaba block of the Sundar-
bans were affected during the post-Aila diarrhoea
epidemic. Pakhirala village was one of the many af-
fected villages (Fig. 1).
One of the major attractions of this village is that
tourism in the Sundarbans is based on this village.
Of the 44,657 inhabitants in 80 villages of Gosaba
Fig. 1. Map of West Bengal showing Pakhirala village and other disaster-affected villages of Gosaba
block, Sundarbans area, 5 June–20 July 2009
SIKKIM BHUTAN
ASSAM
HIHAR
JHARKHAND
ORISSA
Bay of Bengal
BANGLADESH
AREA UNDER INVESTIGATION
FOREST AREA
Darjiling
Jalpaiguri
Koch Bihar
Dakshin
Dinajpur
PAKHIRALA
VILLAGE
RIVERS
TOURIST
ENTRY POINT
Maldah
Uttar
Dinajpur
Birbhum
Puruliya Bankura
Hugli
Haora Calcutta
(State Headquarter)
South 24
Parganas
Medinipur
(Midnapur)
Murshidabad
Nadia
Barddhaman
NEPAL
FOREST AREA
OTHER DISASTER
AFFECTED AREAS OF
GOSABA BLOCK
PHC HOSPITAL
block of the Sundarbans, 71% were reported to be
affected. All patients with features of moderate to
severe watery diarrhoea were attended and/or ad-
mitted to the nearby health facilities that included
primary or block health centres and private hos-
pitals run by non-governmental organizations
(NGOs). Admission registers of these health estab-
lishments were consulted to understand the epide-
miology of the outbreak.
Study population and sample collection
For the purpose of this study, ‘diarrhoea cases’ were
defined as those who passed three or more loose
or liquid stools per day, or more frequently than is
normal for the individual (1). Distinction among
‘mild’, ‘moderate’, and ‘severe’ diarrhoea was based
on degree of dehydration. Patients with no signs
or symptoms of dehydration were regarded as suf-
fering from mild diarrhoea. Patients were consid-
ered to be suffering from ‘moderate diarrhoea’ if
they showed the signs of sunken eyes, dry mouth,
increased thirst, restlessness or irritable behaviour,
and slow retraction of skin-pinch (1,2). Patients
were regarded as suffering from severe diarrhoea if
signs of severe dehydration were present, such as
drowsiness or unconsciousness, inability to drink,
weak and rapid radial pulse, low/undetectable
blood pressure, cool, moist extremities, and lack of
urine output (1,2).
A subset (n=100) of the affected people of Pakhirala
village was interviewed using a pretested question-
naire and examined clinically to understand their
morbidity profile. Following this, stool samples/rec-
tal swabs were collected in Cary-Blair media from
the affected people of this village and from other
villages. At Pakhirala village, stool samples/rec-
tal swabs were collected from patients visiting an
NGO-managed private hospital. Since this was the
only healthcare facility in the region, the affected
people from different parts of the village came here
for treatment.
3. Bhattacharjee S et al.Post-cyclone Vibrio fluvialis epidemic in India
Volume 28 | Number 4 | August 2010 313
Samples were collected from the eligible and will-
ing patients after obtaining verbal consent. In
the case of drowsy patients and children, consent
was obtained from the accompanying adults and
guardians. Stool samples were not collected from
patients belonging to the same household to en-
sure broader geographic distribution of the cases.
Addresses of the patients were also verified from
the hospital registers to ensure that they came
from different parts of the village and were not
clustered in the same neighbourhood. Care was
taken to collect specimens before the start of an-
tibiotics. Stool samples/rectal swabs were collected
in a similar way from patients visiting primary or
block health centres at the other affected villages.
Samples were transported to the laboratory of the
National Institute of Cholera & Enteric Diseases
(NICED), Kolkata, a World Health Organization
reference laboratory for cholera. However, due to
lack of facilities, only 37 stool samples (10 from the
affected people of Pakhirala village and 27 from the
people of other affected villages, such as Parasmani,
Rangabelia, Dayapur, Johar Colony, Sadhupur, and
Shantigachi) reached the laboratory on time for
bacteriological confirmation.
Of the 10 affected people from Pakhirala village,
four were aged less than 10 years, three were aged
20-40 years, and three were aged over 40 years;
four were male, and six were female. Of the 27 af-
fected people from other villages, three were aged
less than 10 years, six were aged 10-20 years, 10
were aged 21-40 years, and eight were aged over 40
years; 15 were male.
Laboratory procedure
Rectal swabs collected from the diarrhoealpatients
were inoculated into alkaline peptone water [1%
bactopeptone (Difco), 1% NaCl, pH 8.5] and in-
cubated overnight. One loopful of the enriched
sample was plated onto thiosulphate citrate bile
salts sucrose (TCBS) agar (Eiken Chemical Co. Ltd.,
Tokyo, Japan), followed by incubation at 37 °C
overnight. Yellow colonies on theTCBS plates were
tested for oxidase reaction. Oxidase-positive strains
thatdid not agglutinate with Vibrio cholerae-specific
antisera (O1 and O139) were further characterized
biochemically in the API 20E identification system
(bioMérieux). Salt tolerance was determined by
growth of strains at 37 °C in1% peptone broth sup-
plemented with 7% NaCl but not in the absence
of NaCl. The string test was performed using 0.5%
sodium deoxycholate solution with fresh cultures
grown on nutrient agar. Thepresence of other com-
mon enteric pathogens was also examinedby stan-
dard procedures (3).
RESULTS
In Pakhirala village, the situation was the worst.
Within a span of six weeks (5 June–20 July 2009),
3,529 (91.2%) of the 3,871 residents were affected
by watery diarrhoea. Of all the cases (n=3,529),
918 (26%) were affected by moderate to severe
diarrhoea. In other villages, 28,550 (70%) of the
40,786 people were affected. Of those affected,
3,997 (14%) had moderate to severe watery diar-
rhoea. The attack rate and the severity of the cases
were significantly higher (p<0.05) in Pakhirala vil-
lage compared to other affected villages (Table 1).
The laboratory results revealed that V. fluvialis was
a predominant pathogen in Pakhirala village (5 of
6 laboratory-confirmed organisms was V. fluvialis, 1
was Escherichia coli) whereas V. cholerae O1 Ogawa
was the predominant pathogen in other villages of
Gosaba block (7 of 9 laboratory-confirmed organ-
isms were found to be V. cholerae O1 Ogawa, and
two were E. coli).
Figure 2 shows the day-wise distribution of moder-
ate to severe cases at Pakhirala village (n=918). The
epidemic curve appears to be that of a common
source epidemic with its peak around 18th
and 19th
days, followed by gradual decline of cases over the
next 2-3-week period.
Table 1. Attack rate and moderate to severe case rate of diarrhoeal diseases among residents of Pakhirala
village and surrounding areas of Gosaba block, Sunderban area, 5 June–20 July 2009
Village Total population All cases Attack rate (%)
Pakhirala village 3,871 3,529 91
Other villages 40,786 28,550 70
Village All cases Moderate-severe cases
Moderate to
severe case rate (%)
Pakhirala village 3,529 918 26
Other villages 28,550 3,997 14
4. Bhattacharjee S et al.Post-cyclone Vibrio fluvialis epidemic in India
JHPN314
Figure 3 shows age and sex distribution of the cases
in Pakhirala village. The disease was distributed
mostly in extremes of ages. Males and females ap-
peared to be equally susceptible in all age-groups,
except in the age-groups of 20-25 years and 35-40
years, where all the affected were female.
Clinically, watery stool was the commonest pre-
sentation with or without presence of blood. Sixty-
two percent of ill subjects had blood in their stools.
Another important feature was abdominal pain,
which was experienced by 57% of the participants
(Table 2).
DISCUSSION
Several villages of Gosaba block of the Sundarbans
were hit by the post-Aila flood that led to an epi-
Fig. 2. Epidemic curve showing moderate to severe diarrhoea cases reported to local health facilites
of Pakhirala village, Gosaba block, Sundarbans area, 5 June–20 July 2009
No.ofdiarrhoeacases
200
180
160
140
120
100
80
60
40
20
0
Days
1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45
%ofdiarrhoeacases
20
15
10
5
0
Male
0-5
6-10
11-15
16-20
21-25
26-30
31-35
36-40
41-45
46-50
51-55
56-60
61-65
>65
Female
Age-group (years)
Fig. 3. Age and sex distribution of reported moderate to severe cases (n=100) at Pakhirala village,
Gosaba block, Sundarbans area, 5 June–20 July 2009
Table 2. Symptoms experienced by moderate
to severe cases (n=100) at Pakhirala vil-
lage, Gosaba block, Sundarbans area, 5
June–20 July 2009
Symptoms of disease due to
Vibrio fluvialis
%
Watery stool 86
Blood in stool 62
Chills 23
Abdominal pain 57
Nausea 29
Vomiting 41
Muscle pain 12
Headache 7
Fever 21
5. Bhattacharjee S et al.Post-cyclone Vibrio fluvialis epidemic in India
Volume 28 | Number 4 | August 2010 315
demic of watery diarrhoea. The epidemic experi-
enced by the people of Pakhirala village appeared
to be different from that of the remaining affected
villages. Epidemiologically, the attack rate in Pakhi-
rala village was significantly higher compared to the
remaining affected villages (91% vs 70%; p<0.05).
The proportion of moderate to severe cases was also
significantly higher in Pakhirala village compared
to other villages (26% vs 14%; p<0.05). This indi-
cates that the organism causing epidemic at Pak-
hirala village appeared to be more virulent. Clini-
cally, most study participants suffered from watery
diarrhoea. Other major symptoms were presence of
blood in stool, abdominal pain, and vomiting, and
only a few experienced mild fever. These symptoms
were similar to other Fluvialis-related diarrhoea
cases as observed in Jakarta, Indonesia, and Bangla-
desh (4,5). A striking feature reported in the present
study is that 62% of the ill subjects had blood in
their stools. Gastroenteritis caused by V. fluvialis of-
ten leads to presence of erythrocytes/blood in stool
(6). Notably, the combination of watery diarrhoea
with or without blood in stool and abdominal pain
was not observed in patients of other affected vil-
lages. This also supports the fact that the epidemic
in Pakhirala village was different from the other
villages. V. fluvialis is generally common in infants,
children, and young adults (4,6,7). In the present
study, children aged ≤10 years and elderly people
aged 55 years or above were more affected than
others. As reported in a study (4), the cases were
equally distributed between both the sexes.
The laboratory-confirmed report supports the view
that the predominant pathogen causing epidemic
at Pakhirala village was V. fluvialis whereas epidem-
ic in the remaining villages was dominated by V.
cholerae O1 Ogawa. Circumstantial evidence also
provides support in favour of a focal outbreak of
watery diarrhoea which preceeded this post-Aila
epidemic in February 2009. During this outbreak,
confirmed V. fluvialis cases were reported by the
laboratory of National Institute of Cholera & Enter-
ic Diseases, Kolkata (unpublished data). The organ-
ism was detected from the drinking-water sources
(piped water system) and from stool samples of the
infected patients at that time. Prior presence of V.
fluvialis in Pakhirala village environment has prob-
ably facilitated a different kind of epidemic not ex-
perienced by other affected villages. A similar kind
of outbreak was never reported from any other vil-
lage of Gosaba block.
Fluvialis cases were treated with injection ceftri-
axone. Antibiotic sensitivity revealed that the or-
ganism was sensitive to doxycycline, norfloxacin,
second/third-generation cephlosporin and azithro-
mycin. It was, however, resistant to ciprofloxacin,
nalidixic acid, and ampicillin. A safe and effective
vaccine will probably prevent the indiscriminate
use of antibiotics and, thus, prevent the develop-
ment of resistant and more virulent strains (8). This
is specially significant in resource-poor settings,
such as the Sundarbans where medical facilities are
hardly available leading to the indiscriminate use
of antibiotics.
Furniss et al. documented the first diarrhoea case
caused by V. fluvialis in 1977 (9). It was later des-
cribed and named by Lee et al. in 1981 (10). Sub-
sequently, sporadic cases of gastroenterities and
outbreaks of diarrhoea were reported from differ-
ent parts of the world (11-17). The largest-known
outbreak due to Fluvialis during October 1976–June
1977 was reported by Huq et al. in Bangladesh (5).
One small epidemic due to foodborne Fluvialis was
reported from Maharashtra, India, in 1981 (18).
However, no waterborne epidemic caused by V.
fluvialis has so far been reported from this region.
This is perhaps the first report of an epidemic of wa-
tery diarrhoea caused by V. fluvialis in a southeast
Asian country, following a natural disaster like Aila.
Its epidemic potential and higher pathogenicity
compared to V. cholerae is of great concern. It is also
interesting to observe an epidemic caused predom-
inantly by V. fluvialis in one village and V. cholerae
in other villages of the same district block (Gosaba).
The existence of V. fluvialis in Pakhirala village is
probably facilitated by costal region (saline water)
since the pathogen is known to be halophilic and
is generally found in marine andestuarine environ-
ments (19-22).
Surprisingly, although the villages other than Pak-
hirala village are also surrounded by brakish sea-
water, the outbreak due to V. fluvialis has not af-
fected these villages. Further investigation is, thus,
perhaps required to determine the epidemiology of
V. fluvialis in this epidemic. If V. fluvialis has an epi-
demic potential similar to V. cholerae O139, it might
cause a disaster in future. Experience suggests that
V. cholerae O139 Bengal, which first emerged dur-
ing 1992-1993 along the coastal lines, later caused
large epidemics of cholera in Bangladesh, India,
and neighbouring countries (23,24). The situation
in Pakhirala is further complicated by the presence
of tourism which allows a large number of national
and insternational tourists to gather each year. An
urgent community-based intervention with safe
environmental sanitation is, therefore, necessary to
6. Bhattacharjee S et al.Post-cyclone Vibrio fluvialis epidemic in India
JHPN316
prevent similar epidemics in fututre in the affected
areas. Much interest has recently been shown by
the scientific community on development of a safe
and immunogenic cholera vaccine to be used in
cholera-endemic areas.
In India, so far, the most common pathogen caus-
ing epidemics of cholera has been V. cholerae O1
(25-27). Most vaccines developed so far target V.
cholerae O1 and O139 (28). If in future, V. fluvialis
gains importance as an epidemic-causing Vibrio, es-
pecially in the costal areas, question arises whether
blanket coverage by present vaccines will be effec-
tive in reducing epidemics of diarrhoea. Question
also remains whether the present vaccines will pro-
vide any cross-immunity against V. fluvialis-asso-
ciated infection. Another matter of concern is that
blanket coverage by cholera vaccines can lead to a
false sense of security in areas more prone to infec-
tion due to V. fluvialis. If V. fluvialis-related epidem-
ics become widespread in future, perhaps more spe-
cific vaccines need to be developed. Strategies can
be thought of to immunize people in the coastal ar-
eas before the beginning of the rainy season to pro-
tect them from flood-related diarrhoeal diseases.
Limitations
We acknowledge that, due to heavy flood, a diffi-
cult working situation, and scarcity of resources, it
was not possible for us to collect an adequate num-
ber of stool samples/rectal swabs for laboratory con-
firmation. Even of those samples collected, only a
few reached the laboratory on time for proper bac-
teriological diagnosis. Although confirmatory tests
were carried out to diagnose the causative agent,
due to lack of resources, it was not possible to carry
out other molecular tests, such as pulsed-field gel
electrophoresis. We, therefore, report the findings
of this study based on circumstantial evidence and
clinical findings which showed clear demarcation
between cases from Pakhirala village and those
from other villages. Cases from the former region
presented with watery diarrhoea with or without
the presence of blood whereas those from other vil-
lages presented with only watery diarrhoea and no
trace of blood.
Conclusions
The Sundarbans, the world’s largest delta islands
that harbours the lushness of the Mangrove for-
ests, has been labelled a World Heritage site by
the United Nations Educational, Scientific and
Cultural Organization and has been short-listed as
one of the new Seven Wonders of the world. Pak-
hirala, the gateway to domestic and foreign tour-
ists visiting the Sundarbans, has only one tourist
accommodation. Every year, a considerable num-
ber of tourists visit this village and are exposed to
its contaminated drinking-water. The situation,
thereby, poses a threat and can lead to the spread
of an epidemic caused by V. fluvialis. With no al-
ternative water supply and existence of an ideal
environmental condition suitable for the survival
of V. fluvialis, an epidemic of a magnanimous scale
due to diarrhoea can result in future. Moreover,
the islands of the Sundarbans are often affected by
flood, and as such, V. fluvialis can very soon find
its way to other islands, thereby affecting the wider
geographic area. The situation can become worse if
V. fluvialis does indeed have an epidemic potential
higher than that of V. cholerae O1 as was found in
this study. Further studies are required to better un-
derstand the epidemiology of V. fluvialis, especially
as epidemic-causing bacteria. The need of the hour,
thus, lies in the realization of the present situation
and calls for necessary steps of precaution without
which an epidemic of a huge scale perhaps remains
impending in the near future. The cluster of islands
already on the verge of depletion, thus, calls for
help to escape a looming disaster in the future.
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