Cholera outbreak in southeast of Iran: Routes of transmission in the situation of good primary health care services and poor individual hygienic practices

Abstract

Within the years 2001 to 2004, Sistan-va-Baluchestan was the only province with transmission of cholera in Iran. The objective of this study was to determine the epidemiological characteristics of the cholera outbreak that occurred in 2004 in the Sarbaz district in the southern parts of this province. The surveillance data were analyzed, and a matched case-control study was performed. From 22 October to 15 November 2004, from 2,242 diarrhea cases that were sampled for stool culture, 90 cases were positive for Vibrio cholerae O1 El-Tor biotype, serotype Ogawa. Multivariate analysis showed that risk factors for cholera were drinking beverages from street vendors (OR = 10.16, 95% CI: 2.55-40.50), illiteracy (OR = 5.76, 95% CI: 2.63-30.09), no hand washing with soap after toilet use (OR = 22.06, 95% CI: 2.91-167.11), no hand washing with soap before meals (OR = 3.64, 95% CI: 1.03-12.82), sex (OR = 3.73, 95% CI: 1.17-11.89) and eating food left over from previous meals without reheating (OR = 4.03, 95% CI: 1.23-13.18). The source of drinking water showed weak association with cholera only in univariate analysis (OR = 2.83, 95% CI: 1.12-7.19). The development of primary health care, even though it can improve the conditions that control the spread of an epidemic, is not enough of a control measure as long as the social hygienic standards are low and people do not follow the basic personal hygiene regulations.