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CORRESPONDENCE
Year : 2012  |  Volume : 135  |  Issue : 5  |  Page : 678-679

An outbreak of cholera among a rural population in south India: Is it time to vaccinate the children in endemic areas?


Department of Microbiology, Faculty of Medicine, Government Theni Medical College, The Tamilnadu Dr MGR Medical University, Theni 625 512, India

Date of Web Publication29-Jun-2012

Correspondence Address:
Ramalingam Sekar
Department of Microbiology, Faculty of Medicine, Government Theni Medical College, The Tamilnadu Dr MGR Medical University, Theni 625 512
India
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Source of Support: None, Conflict of Interest: None


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How to cite this article:
Sekar R, Amudhan M, Sivashankar M, Mythily N, Mythreyee M. An outbreak of cholera among a rural population in south India: Is it time to vaccinate the children in endemic areas?. Indian J Med Res 2012;135:678-9

How to cite this URL:
Sekar R, Amudhan M, Sivashankar M, Mythily N, Mythreyee M. An outbreak of cholera among a rural population in south India: Is it time to vaccinate the children in endemic areas?. Indian J Med Res [serial online] 2012 [cited 2021 Sep 24];135:678-9. Available from: https://www.ijmr.org.in/text.asp?2012/135/5/678/97744

Sir,

Cholera, the most dreadful of all diarrhoeal diseases, is an acute intestinal infection, caused by Vibrio cholerae, which afflicts 3 to 5 million of people and causes 0.1 million deaths every year [1],[2] . Cholera outbreaks have been infrequently reported from developed countries [3] and often reported from various parts of developing, and underdeveloped countries mainly owing to poor sanitation of potable water [2],[4],[5],[6] . In India sporadic cases of acute watery diarrhoea occur throughout the year, especially in rural areas. These sporadic cases have potential to cause epidemic outbreaks when the drinking water gets contaminated with the faeces of affected people [6],[7] . A similar outbreak was emerged in the rural part of Theni district, located in the south Indian State of Tamil Nadu. The region was recognised to be endemic to cholera, and the present outbreak was documented during middle of the summer 2010, among the population of Uthamapalayam village.

The aetiologic agent of the seventh cholera pandemic is V. cholerae O1 biotype El Tor, which has completely replaced its counterpart classical biotype over a period of time [2],[4],[8] . The members of the serogroup O1 are further classified into two major serotypes, Ogawa and Inaba. According to the earlier reports from India, El Tor V. cholerae O1, serotype Ogawa has been the predominant causative organism of cholera outbreaks [6],[7],[9] .

Stool and rectal swab specimens were collected from the randomly selected patients attending the Government Theni Medical College (GTMC) Hospital, and various primary health care centres of Theni district during May 12-20, 2010. All specimens were bacteriologically investigated for aetiology by following standard procedure [10] at the Department of Microbiology, GTMC. Isolates of V. cholerae were biotyped by polymyxin B (50 units) susceptibility test [10] . Serotyping was performed using the antiserum obtained from King Institute of Preventive Medicine, Chennai. Antimicrobial susceptibility test was carried out by Kirby-Bauer disc diffusion method adhering to Clinical Laboratory Standards Institute (CLSI) guidelines [11] using the commercially available ampicillin (10 μg), chloramphenicol (30 μg), trimethoprim-sulphamethoxazole (TMP-SMX) (1.25/23.75 μg) and tetracycline (30 μg) antibiotic discs (Hi-media, Mumbai) with ATCC 25922  Escherichia More Details coli as control.

Of the 66 faecal samples collected during the study period, V. cholerae O1 was isolated in 37 samples (56%). All the isolates of V. cholerae were identified as El Tor biotype, and Ogawa serotype. The water samples from Uthamapalayam village were also analysed, which revealed the contamination of drinking water with El Tor Vibrio cholerae O1, Ogawa serotype. During this outbreak one death (10 yr old, female) was documented due to severe dehydration, on the second day of the epidemic. More than 1000 cases were reported with similar clinical symptoms during the epidemic period. Since, the resources were limited, only a few of the randomly selected cases were investigated.

A uniform antibiotic susceptibility pattern was observed among all clinical isolates of V. cholerae. All isolates were found to be resistant to ampicillin and TMP-SMX, and sensitive to chloramphenicol. Four clinical isolates were found to be resistant to tetracycline during the late stage of epidemic, suggesting a development of resistance due to inappropriate use of antibiotics. The emergence of resistance to tetracycline among V. cholerae is now well-documented [9] and it was observed in 11 per cent of isolates in current epidemic.

In conclusion, the present study documented the cholera outbreak in rural set up of Theni district, south India. The source of the outbreak was found to be the contaminated water provided by the municipal water supply. The present outbreak indicates the lacunae in the arrangements of potable water, sanitation and hygienic practices in the rural area, which are not uncommon in developing and underdeveloped countries, and it also suggests the immediate implementation of vaccination among the children who are residing in the high risk areas [1],[2],[12] to evade the cholera associated mortality.

 
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1.Cholera vaccines: WHO position paper. Wkly Epidemiol Rec 2010; 85 : 117-28.  Back to cited text no. 1
    
2.Kanungo S, Sah BK, Lopez AL, Sung JS, Paisley AM, Sur D, et al. Cholera in india: An analysis of reports, 1997-2006. Bull World Health Organ 2010; 88 : 185-91.  Back to cited text no. 2
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3.Tobin-D'Angelo M, Smith AR, Bulens SN, Thomas S, Hodel M, Izumiya H, et al. Severe diarrhoea caused by cholera toxin-producing Vibrio cholerae serogroup O75 infections acquired in the southeastern United States. Clin Infect Dis 2008; 47 : 1035-40.  Back to cited text no. 3
    
4.Kaper JB, Morris JG Jr, Levine MM. Cholera. Clin Microbiol Rev 1995; 8 : 48-86.  Back to cited text no. 4
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5.Mintz ED, Guerrant RL. A lion in our village - the unconscionable tragedy of cholera in Africa. N Engl J Med 2009; 360 : 1060-3.  Back to cited text no. 5
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6.Sur D, Dutta P, Nair GB, Bhattacharya SK. Severe cholera outbreak following floods in a northern district of West Bengal. Indian J Med Res 2000; 112 : 178-82.  Back to cited text no. 6
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7.Sundaram SP, Revathi J, Sarkar BL, Bhattacharya SK. Bacteriological profile of cholera in Tamil Nadu (1980-2001). Indian J Med Res 2002; 116 : 258-63.  Back to cited text no. 7
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8.Sack DA, Sack RB, Nair GB, Siddique AK. Cholera. Lancet 2004; 363 : 223-33.  Back to cited text no. 8
    
9.Chander J, Kaistha N, Gupta V, Mehta M, Singla N, Deep A, et al. Epidemiology & antibiograms of Vibrio cholerae isolates from a tertiary care hospital in chandigarh, north india. Indian J Med Res 2009; 129 : 613-7.  Back to cited text no. 9
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10.CDC. Centers for Disease Control and Prevention. Laboratory methods for the diagnosis of epidemic dysentery and cholera. Atlanta, Georgia; CDC: 1999.  Back to cited text no. 10
    
11.CLSI. Clinical and laboratory standards institute: Performance standards for antimicrobial susceptibility testing. 16 th informational supplement m100-s16. Wayne, PA, USA: CLSI; 2006.  Back to cited text no. 11
    
12.Sur D, Lopez AL, Kanungo S, Paisley A, Manna B, Ali M, et al. Efficacy and safety of a modified killed-whole-cell oral cholera vaccine in india: An interim analysis of a cluster-randomised, double-blind, placebo-controlled trial. Lancet 2009; 374 : 1694-702.  Back to cited text no. 12
    




 

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