1 Duke Global Health Institute, Durham, North Carolina USA.
Prehosp Disaster Med. 2013 Dec;28(6):567-72. doi: 10.1017/S1049023X13008984. Epub 2013 Oct 29.
Large earthquakes can cause population displacement, critical sanitation infrastructure damage, and increased threats to water resources, potentially predisposing populations to waterborne disease epidemics such as cholera. Problem The risk of cholera outbreaks after earthquake disasters remains uncertain. A cross-country analysis of World Health Organization (WHO) cholera data that would contribute to this discussion has yet to be published.
A cross-country longitudinal analysis was conducted among 63 low- and middle-income countries from 1995-2009. The association between earthquake disasters of various effect sizes and a relative spike in cholera rates for a given country was assessed utilizing fixed-effects logistic regression and adjusting for gross domestic product per capita, water and sanitation level, flooding events, percent urbanization, and under-five child mortality. Also, the association between large earthquakes and cholera rate increases of various degrees was assessed.
Forty-eight of the 63 countries had at least one year with reported cholera infections during the 15-year study period. Thirty-six of these 48 countries had at least one earthquake disaster. In adjusted analyses, country-years with ≥10,000 persons affected by an earthquake had 2.26 times increased odds (95 CI, 0.89-5.72, P = .08) of having a greater than average cholera rate that year compared to country-years having <10,000 individuals affected by an earthquake. The association between large earthquake disasters and cholera infections appeared to weaken as higher levels of cholera rate increases were tested.
A trend of increased risk of greater than average cholera rates when more people were affected by an earthquake in a country-year was noted. However these findings did not reach statistical significance at traditional levels and may be due to chance. Frequent large-scale cholera outbreaks after earthquake disasters appeared to be relatively uncommon.
大地震可能导致人口流离失所、关键卫生基础设施受损，并增加对水资源的威胁，从而使人们更容易感染霍乱等水源性疾病疫情。问题：地震灾害后霍乱爆发的风险仍不确定。尚未发表过利用世界卫生组织（WHO）霍乱数据进行的跨国分析来对此进行讨论。
在 1995 年至 2009 年期间，对 63 个中低收入国家进行了跨国纵向分析。利用固定效应逻辑回归评估了不同影响规模的地震灾害与特定国家霍乱发病率相对飙升之间的关联，并根据人均国内生产总值、水和卫生设施水平、洪水事件、城市化率和五岁以下儿童死亡率进行了调整。此外，还评估了大地震与各种程度的霍乱发病率增加之间的关联。
在 15 年的研究期间，63 个国家中有 48 个国家至少有一年报告了霍乱感染病例。在这 48 个国家中，有 36 个国家至少发生过一次地震灾害。在调整分析中，受灾人数达到 10,000 人以上的国家与受灾人数低于 10,000 人的国家相比，当年发生霍乱的可能性增加了 2.26 倍（95%CI，0.89-5.72，P=0.08）。当测试更高水平的霍乱发病率增加时，大地震灾害与霍乱感染之间的关联似乎减弱。
注意到当一个国家/年份中受灾人数增加时，霍乱发病率高于平均水平的风险呈上升趋势。然而，这些发现并未达到传统水平的统计学意义，可能是由于偶然因素所致。地震灾害后频繁发生大规模霍乱疫情似乎相对较少。
