National Centre for Disease Control, 22 Sham Nath Marg, New Delhi, 110054, India.
State health department, Hyderabad, Telangana, 500095, India.
BMC Public Health. 2020 Feb 14;20(1):231. doi: 10.1186/s12889-020-8263-2.
In 2016, India reported 709 acute diarrheal disease (ADD) outbreaks (> 25% of all outbreaks). Tribal populations are at higher risk with 27% not having accessibility to safe drinking water and 75% households not having toilets. On June 26, 2017 Pedda-Gujjul-Thanda, a tribal village reported an acute diarrheal disease (ADD) outbreak. We investigated to describe the epidemiology, identify risk factors, and provide evidence-based recommendations.
We defined a case as ≥3 loose stools within 24 h in Pedda-Gujjul-Thanda residents from June 24-30, 2017. We identified cases by reviewing hospital records and house-to-house survey. We conducted a retrospective cohort study and collected stool samples for culture. We assessed drinking water supply and sanitation practices and tested water samples for faecal-contamination.
We identified 191 cases (65% females) with median age 36 years (range 4-80 years) and no deaths. The attack-rate (AR) was 37% (191/512). Downhill colonies (located on slope of hilly terrains of the village) reported higher ARs (56%[136/243], p < 0.001) than others (20%[55/269]). Symptoms included diarrhea (100%), fever (17%), vomiting (16%) and abdominal pain (13%). Drinking water from five shallow bore-wells located in downhill colonies was significantly associated with illness (RR = 4.6, 95%CI = 3.4-6.1 and population attributable fraction 61%). In multi-variate analysis, drinking water from the shallow bore-wells located in downhill colonies (aOR = 7.9, [95% CI =4.7-13.2]), illiteracy (aOR =6, [95% CI = 3.6-10.1]), good hand-washing practice (aOR = 0.4, [95%CI = 0.2-0.7]) and household water treatment (aOR = 0.3, [95%CI = 0.2-0.5]) were significantly associated with illness. Two stool cultures were negative for Vibrio cholerae. Heavy rainfall was reported from June 22-24. Five of six water samples collected from shallow bore-wells located in downhill colonies were positive for faecal contamination.
An ADD outbreak with high attack rate in a remote tribal village was associated with drinking water from shallow downhill bore-wells, likely contaminated via runoff from open defecation areas after heavy rains. Based on our recommendations, immediate public health actions including repair of leakages at contaminated water sources and alternative supply of purified canned drinking water to families, and as long-term public health measures construction of house-hold latrines and piped-water supply initiated.
2016 年，印度报告了 709 起急性腹泻病（ADD）暴发（占所有暴发的 25%以上）。部落人口面临更高的风险，有 27%的人无法获得安全饮用水，75%的家庭没有厕所。2017 年 6 月 26 日，一个部落村庄 Pedda-Gujjul-Thanda 报告了一起急性腹泻病（ADD）暴发。我们进行了调查，以描述其流行病学特征，确定风险因素，并提供循证建议。
我们将 2017 年 6 月 24 日至 30 日期间 Pedda-Gujjul-Thanda 居民中 24 小时内出现≥3 次稀便的病例定义为病例。我们通过查阅医院记录和逐户调查来确定病例。我们进行了回顾性队列研究，并采集粪便样本进行培养。我们评估了饮用水供应和卫生设施情况，并检测了水样的粪便污染情况。
我们共发现了 191 例病例（65%为女性），中位年龄为 36 岁（范围为 4-80 岁），无死亡病例。发病率（AR）为 37%（191/512）。位于村庄丘陵地形下坡处的下山殖民地（downhill colonies）的发病率更高（56%[136/243]，p<0.001），而其他地区（20%[55/269]）则较低。症状包括腹泻（100%）、发热（17%）、呕吐（16%）和腹痛（13%）。饮用位于下山殖民地的五个浅层浅井中的水与疾病显著相关（RR=4.6，95%CI=3.4-6.1，人群归因分数为 61%）。多变量分析显示，饮用位于下山殖民地的浅层浅井中的水（aOR=7.9，[95%CI=4.7-13.2]）、文盲（aOR=6，[95%CI=3.6-10.1]）、良好的洗手习惯（aOR=0.4，[95%CI=0.2-0.7]）和家庭水处理（aOR=0.3，[95%CI=0.2-0.5]）与疾病显著相关。两份粪便培养物均未检出霍乱弧菌。6 月 22 日至 24 日报告了强降雨。从位于下山殖民地的五个浅层浅井中采集的五份水样均呈粪便污染阳性。
在一个偏远的部落村庄发生了一起发病率高的 ADD 暴发，与饮用浅层下山浅井中的水有关，这些水可能是在强降雨后，通过露天排便区的径流污染的。根据我们的建议，立即采取公共卫生行动，包括修复受污染水源的泄漏，并为家庭提供净化罐装饮用水作为替代，以及作为长期公共卫生措施，建造家庭厕所和管道供水。
