India EIS Officer, Division of Epidemiology, National Centre for Disease Control, New Delhi, India.
Joint Director, Division of Epidemiology, National Centre for Disease Control, New Delhi, India.
Indian J Public Health. 2021 Jan;65(Supplement):S34-S40. doi: 10.4103/ijph.IJPH_1111_20.
Acute diarrheal disease (ADD) outbreaks frequently occur in the Gangetic plains of Uttar Pradesh, India. In August 2017, Muzaffarpur village, Uttar Pradesh, reported an ADD outbreak.
Outbreak investigation was conducted to find out the epidemiology and to identify the risk factors.
A 1:1 area-matched case-control study was conducted. Suspected ADD case was defined as ≥3 loose stools or vomiting within 24 h in a Muzaffarpur resident between August 7 and September 9, 2017. A control was defined as an absence of loose stools and vomiting in a resident between August 7 and September 9, 2017. A matched odds ratio (mOR) with 95% confidence intervals (CIs) was calculated. Drinking water was assessed to test for the presence of any contamination. Stool specimens were tested for Vibrio cholerae, and water samples were also tested for any fecal contamination and residual chlorine.
Among 70 cases (female = 60%; median age = 12 years, range = 3 months-70 years), two cases died and 35 cases were hospitalized. Area-A in Muzaffarpur had the highest attack rate (8%). The index case washed soiled clothes at well - A1 1 week before other cases occurred. Among 67 case-control pairs, water consumption from well-A1 (mOR: 43.00; 95% CI: 2.60-709.88) and not washing hands with soap (mOR: 2.87; 95% CI: 1.28-6.42) were associated with illness. All seven stool specimens tested negative for V. cholerae. All six water samples, including one from well-A1, tested positive for fecal contamination with <0.2 ppm of residual chlorine.
This outbreak was associated with consumption of contaminated well water and hand hygiene. We recommended safe water provision, covering wells, handwashing with soap, access to toilets, and improved laboratory capacity for testing diarrheal pathogens.
印度北方邦恒河平原经常发生急性腹泻病（ADD）暴发。2017 年 8 月，北方邦穆扎法尔布尔村报告了一起 ADD 暴发事件。
开展暴发调查，以了解流行病学情况并确定危险因素。
采用 1:1 面积匹配的病例对照研究。疑似 ADD 病例定义为 2017 年 8 月 7 日至 9 月 9 日期间，恒河平原居民在 24 小时内出现≥3 次稀便或呕吐；对照定义为 2017 年 8 月 7 日至 9 月 9 日期间，恒河平原居民无稀便和呕吐。计算比值比（OR）及其 95%置信区间（CI）。评估饮用水是否存在任何污染。采集粪便标本检测霍乱弧菌，采集水样检测是否存在粪便污染和余氯。
在 70 例病例（女性占 60%；中位数年龄为 12 岁，范围为 3 个月至 70 岁）中，有 2 例死亡，35 例住院。穆扎法尔布尔的 A 区发病率最高（8%）。首例病例在其他病例发生前一周在 A1 水井洗脏衣服。在 67 对病例对照中，从 A1 水井饮水（OR：43.00；95%CI：2.60-709.88）和未用肥皂洗手（OR：2.87；95%CI：1.28-6.42）与发病相关。所有 7 份粪便标本均未检出霍乱弧菌。包括 A1 水井水样在内的 6 份水样均检测出粪便污染，余氯含量低于 0.2ppm。
此次暴发与饮用污染井水和手部卫生不佳有关。我们建议提供安全用水、覆盖水井、用肥皂洗手、提供厕所和提高检测腹泻病原体的实验室能力。
