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Cholera Epidemics of the Past Offer New Insights Into an Old Enemy
- Source :
- The Journal of Infectious Diseases, Phelps, M, Perner, M L, Pitzer, V E, Andreasen, V, Jensen, P K M & Simonsen, L 2018, ' Cholera epidemics of the past offer new insights into an old enemy ', The Journal of Infectious Diseases, vol. 217, no. 4, pp. 641–649 . https://doi.org/10.1093/infdis/jix602
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Abstract
- We investigate cholera transmission using data from historical cholera epidemics. The results suggest short-cycle (household/institution level) transmission was important in early secondary transmission. This study of historical outbreaks can inform investigations in current cholera epidemic settings.<br />Background Although cholera is considered the quintessential long-cycle waterborne disease, studies have emphasized the existence of short-cycle (food, household) transmission. We investigated singular Danish cholera epidemics (in 1853) to elucidate epidemiological parameters and modes of spread. Methods Using time series data from cities with different water systems, we estimated the intrinsic transmissibility (R0). Accessing cause-specific mortality data, we studied clinical severity and age-specific impact. From physicians’ narratives we established transmission chains and estimated serial intervals. Results Epidemics were seeded by travelers from cholera-affected cities; initial transmission chains involving household members and caretakers ensued. Cholera killed 3.4%–8.9% of the populations, with highest mortality among seniors (16%) and lowest in children (2.7%). Transmissibility (R0) was 1.7–2.6 and the serial interval was estimated at 3.7 days (95% confidence interval, 2.9–4.7 days). The case fatality ratio (CFR) was high (54%–68%); using R0 we computed an adjusted CFR of 4%–5%. Conclusions Short-cycle transmission was likely critical to early secondary transmission in historic Danish towns. The outbreaks resembled the contemporary Haiti outbreak with respect to transmissibility, age patterns, and CFR, suggesting a role for broader hygiene/sanitation interventions to control contemporary outbreaks.
- Subjects :
- Male
Denmark
Basic Reproduction Number
0302 clinical medicine
Hygiene
Epidemiology
Case fatality rate
Immunology and Allergy
030212 general & internal medicine
Child
media_common
Aged, 80 and over
transmission patterns
Transmission (medicine)
Waterborne diseases
History, 19th Century
Middle Aged
historical
Cholera
3. Good health
Infectious Diseases
Child, Preschool
Female
epidemiology
Serial interval
Adult
medicine.medical_specialty
Adolescent
media_common.quotation_subject
030231 tropical medicine
cholera
Biology
epidemics
Young Adult
Major Articles and Brief Reports
03 medical and health sciences
Disease Transmission, Infectious
medicine
Humans
Cities
Mortality
Aged
R0
Bacteria
Infant, Newborn
Infant
Outbreak
medicine.disease
Virology
Demography
Subjects
Details
- Language :
- English
- ISSN :
- 15376613 and 00221899
- Volume :
- 217
- Issue :
- 4
- Database :
- OpenAIRE
- Journal :
- The Journal of Infectious Diseases
- Accession number :
- edsair.doi.dedup.....d4b88a684800426974f169d169d0fbca
- Full Text :
- https://doi.org/10.1093/infdis/jix602