Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama 700-8530, Japan.
Collaborative Research Center of Okayama University for Infectious Diseases in India, Kolkata 700010, India.
Int J Environ Res Public Health. 2022 May 8;19(9):5738. doi: 10.3390/ijerph19095738.
Fecal contamination of water sources and open defecation have been linked to cholera outbreaks in India. However, a systematic review on the drivers responsible for these outbreaks has yet to be published. Here, we systematically review the published literature on cholera outbreaks in India between 2011 and 2020. We searched studies in English in three databases (MEDLINE, EMBASE, and Web of Science) and the Integrated Disease Surveillance Program that tracks cholera outbreaks throughout India. Two authors independently extracted data and assessed the quality of the included studies. Quantitative data on the modes of transmission reviewed in this study were assessed for any change over time between 2011-2015 and 2016-2020. Our search retrieved 10823 records initially, out of which 81 full-text studies were assessed for eligibility. Among these 81 studies, 20 were eligible for inclusion in this review. There were 565 reported outbreaks between 2011 and 2020 that led to 45,759 cases and 263 deaths. Outbreaks occurred throughout the year; however, they exploded with monsoons (June through September). In Tamil Nadu, a typical peak of cholera outbreaks was observed from December to January. Seventy-two percent (33,089/45,759) of outbreak-related cases were reported in five states, namely Maharashtra, West Bengal, Punjab, Karnataka, and Madhya Pradesh. Analysis of these outbreaks highlighted the main drivers of cholera including contaminated drinking water and food, inadequate sanitation and hygiene (including open defecation), and direct contact between households. The comparison between 2011-2015 and 2016-2020 showed a decreasing trend in the outbreaks that arose due to damaged water pipelines. Many Indians still struggle with open defecation, sanitation, and clean water access. These issues should be addressed critically. In addition, it is essential to interrupt cholera short-cycle transmission (mediated by households, stored drinking water and foodstuffs) during an outbreak. As cholera is associated with deprivation, socio-economic development is the only long-term solution.
水源粪便污染和露天排便与印度的霍乱爆发有关。然而，目前尚未发表关于导致这些爆发的驱动因素的系统评价。在这里，我们系统地回顾了 2011 年至 2020 年期间印度霍乱爆发的已发表文献。我们在三个数据库（MEDLINE、EMBASE 和 Web of Science）和跟踪印度各地霍乱爆发的综合疾病监测计划中用英文搜索了研究。两名作者独立提取数据并评估了纳入研究的质量。对本研究中审查的传播模式的定量数据进行了评估，以了解 2011-2015 年与 2016-2020 年之间的任何变化。我们的搜索最初检索到 10823 条记录，其中 81 篇全文研究被评估为符合条件。在这 81 项研究中，有 20 项符合本综述的纳入标准。2011 年至 2020 年期间报告了 565 次暴发，导致 45759 例病例和 263 例死亡。暴发全年发生；然而，它们随着季风（6 月至 9 月）而爆发。在泰米尔纳德邦，观察到从 12 月到 1 月霍乱暴发的典型高峰。在五个邦（马哈拉施特拉邦、西孟加拉邦、旁遮普邦、卡纳塔克邦和中央邦）报告了与暴发相关的 72%（33089/45759）病例。对这些暴发的分析强调了霍乱的主要驱动因素，包括饮用水和食物污染、卫生设施和卫生条件差（包括露天排便）以及家庭之间的直接接触。2011-2015 年与 2016-2020 年之间的比较显示，由于供水管线损坏而引发的暴发呈下降趋势。许多印度人仍然难以获得露天排便、卫生设施和清洁水。这些问题应得到认真处理。此外，在暴发期间，必须中断霍乱短周期传播（由家庭、储存的饮用水和食物介导）。由于霍乱与贫困有关，社会经济发展是唯一的长期解决方案。
