Nutrition and Clinical Services Division, International Centre for Diarrheal Disease Research, Bangladesh (icddr, b), 68 Shaheed Tajuddin Ahmed Sharani, Dhaka, 1212, Bangladesh.
Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, 30322, USA.
Sci Rep. 2023 Apr 19;13(1):6411. doi: 10.1038/s41598-023-33576-3.
With more than 100,000 cases estimated each year, Bangladesh is one of the countries with the highest number of people at risk for cholera. Moreover, Bangladesh is formulating a countrywide cholera-control plan to satisfy the GTFCC (The Global Task Force on Cholera Control) Roadmap's goals. With a particular focus on cholera trends, variance in baseline and clinical characteristics of cholera cases, and trends in antibiotic susceptibility among clinical isolates of Vibrio cholerae, we used data from facility-based surveillance systems from icddr,b's Dhaka, and Matlab Hospitals from years 2000 to 2021. Female patients comprised 3,553 (43%) in urban and 1,099 (51.6%) in rural sites. Of the cases and most patients 5,236 (63.7%) in urban and 1,208 (56.7%) in the rural site were aged 15 years and more. More than 50% of the families belonged to the poor and lower-middle-class; in 2009 (24.4%) were in urban and in 1,791 (84.2%) were in rural sites. In the urban site, 2,446 (30%) of households used untreated drinking water, and 702 (9%) of families disposed of waste in their courtyard. In the multiple logistic regression analysis, the risk of cholera has significantly increased due to waste disposal in the courtyard and the boiling of water has a protective effect against cholera. Rotavirus (9.7%) was the most prevalent co-pathogen among the under-5 children in both sites. In urban sites, the percentage of V. cholerae along with co-existing ETEC and Campylobacter is changing in the last 20 years; Campylobacter (8.36%) and Enterotoxigenic Escherichia coli (ETEC) (7.15%) were the second and third most prevalent co-pathogens. Shigella (1.64%) was the second most common co-pathogen in the rural site. Azithromycin susceptibility increased slowly from 265 (8%) in 2006-2010 to 1485 (47.8%) in 2016-2021, and erythromycin susceptibility dropped substantially over 20 years period from 2,155 (98.4%) to 21 (0.9%). Tetracycline susceptibility decreased in the urban site from 2051 (45.9%) to 186 (4.2%) and ciprofloxacin susceptibility decreased from 2,581 (31.6%) to 1,360 (16.6%) until 2015, then increased 1,009 (22.6%) and 1,490 (18.2%) in 2016-2021, respectively. Since 2016, doxycycline showed 902 (100%) susceptibility. Clinicians need access to up-to-date information on antimicrobial susceptibility for treating hospitalized patients. To achieve the WHO-backed objective of eliminating cholera by 2030, the health systems need to be put under a proper surveillance system that may help to improve water and sanitation practices and deploy oral cholera vaccines strategically.
孟加拉国每年估计有超过 10 万例病例，是感染霍乱风险最高的国家之一。此外，孟加拉国正在制定一项全国性的霍乱控制计划，以满足全球霍乱控制工作队（GTFCC）路线图的目标。本研究重点关注霍乱趋势、霍乱病例基线和临床特征的差异，以及霍乱弧菌临床分离株对抗生素敏感性的趋势，使用了来自 icddr,b 的达卡和 Matlab 医院的基于机构的监测系统的数据，时间跨度为 2000 年至 2021 年。城市地区的女性患者占 3553 例（43%），农村地区的女性患者占 1099 例（51.6%）。在城市和农村地区，大多数患者 5236 例（63.7%）和 1208 例（56.7%）年龄在 15 岁及以上。超过 50%的家庭属于贫困和中下阶层；2009 年，城市地区有 24.4%的家庭属于贫困和中下阶层，农村地区有 1791 例（84.2%）。在城市地区，2446 个家庭（30%）使用未经处理的饮用水，702 个家庭（9%）在自家院子里处理垃圾。在多因素逻辑回归分析中，由于在自家院子里处理垃圾，霍乱的风险显著增加，而煮沸水对霍乱有保护作用。轮状病毒（9.7%）是两个地点 5 岁以下儿童中最常见的合并病原体。在城市地区，20 年来，霍乱弧菌与共存肠产毒性大肠杆菌（ETEC）和弯曲杆菌的比例发生了变化；弯曲杆菌（8.36%）和肠产毒性大肠埃希菌（ETEC）（7.15%）是第二和第三常见的合并病原体。志贺菌（1.64%）是农村地区的第二大常见合并病原体。阿奇霉素的敏感性从 2006-2010 年的 265 例（8%）缓慢增加到 2016-2021 年的 1485 例（47.8%），而红霉素的敏感性在 20 年期间大幅下降，从 2155 例（98.4%）下降到 21 例（0.9%）。在城市地区，四环素的敏感性从 2051 例（45.9%）下降到 186 例（4.2%），环丙沙星的敏感性从 2581 例（31.6%）下降到 1360 例（16.6%），直到 2015 年，然后在 2016-2021 年分别增加了 1009 例（22.6%）和 1490 例（18.2%）。自 2016 年以来，多西环素显示出 100%的敏感性。临床医生需要获得有关治疗住院患者的抗生素敏感性的最新信息。为了实现世界卫生组织支持的到 2030 年消除霍乱的目标，卫生系统需要建立一个适当的监测系统，这可能有助于改善水和卫生设施，并战略性地部署口服霍乱疫苗。
