Nguyen Thuy Tien, Kim Chaelin, Goucher Gerard, Kim Jong-Hoon
Institute for Medical Information Processing, Biometry, and Epidemiology - IBE, LMU Munich, Munich, Germany.
Pettenkofer School of Public Health, Munich, Germany.
BMC Infect Dis. 2025 Sep 26;25(1):1165. doi: 10.1186/s12879-025-11533-x.
Cholera is a significant health risk for low- and middle-income countries (LMIC), and the threat of outbreaks is likely to increase due to climate change. To keep up to date with the link between water quality and cholera, we conducted a systematic review and meta-analysis to update a previous review while only focusing on water-related exposures. We searched Embase, Web of Science and PubMed for literature published between 2016 and 2022. Search terms were consistent with the previous review. Study quality was assessed using the Risk Of Bias In Non-randomized Studies - of Exposures (ROBINS-E). Water-related exposures were categorized according to the WHO/UNICEF Joint Monitoring Program for Water Supply, Sanitation and Hygiene (JMP) and further divided by the service ladder. Odds ratios were extracted and pooled by performing random-effects meta-analysis. We identified 22 new eligible studies and analysed them in addition to the 45 studies included in the previous review. Analyses revealed higher odds of cholera when consuming sachet water (OR = 1.69, 95% CI: 1.13 to 2.52), unimproved water (OR = 2.91, 95% CI: 1.21 to 7.02), surface water (OR = 3.40, 95% CI: 2.52 to 4.58), and untreated water (OR = 2.51, 95% CI: 2.03 to 3.10). Meanwhile, treating water (OR = 0.42, 95% CI: 0.27 to 0.65) by boiling (OR = 0.38, 95% CI: 0.17 to 0.84) or chlorination (OR = 0.37, 95% CI: 0.17 to 0.83), and drinking basic water (OR = 0.44, 95% CI: 0.27 to 0.69) showed protection. Water-related exposures were prioritized to synthesize the evidence on cholera transmission through drinking water, with sanitation and hygiene as additional risk factors. While the JMP service ladder provided a useful classification framework, context-specific differences in infrastructure and interpretation should be considered when evaluating these findings. Pooled estimates changed with updated evidence while qualitative insights on the protective or risk factors remain valid. Relatively low-cost methods like boiling or chlorinating water provide good protection comparable to providing basic water to the public.
霍乱对低收入和中等收入国家（LMIC）构成重大健康风险，而且由于气候变化，霍乱暴发的威胁可能会增加。为了及时了解水质与霍乱之间的联系，我们进行了一项系统综述和荟萃分析，以更新之前的综述，同时仅关注与水相关的暴露因素。我们在Embase、Web of Science和PubMed上搜索了2016年至2022年发表的文献。检索词与之前的综述一致。使用暴露因素非随机研究中的偏倚风险（ROBINS-E）评估研究质量。与水相关的暴露因素根据世界卫生组织/联合国儿童基金会供水、环境卫生和个人卫生联合监测计划（JMP）进行分类，并进一步按服务阶梯划分。通过进行随机效应荟萃分析提取并汇总比值比。我们确定了22项新的合格研究，并将其与之前综述中纳入的45项研究一起进行分析。分析显示，饮用袋装水（OR = 1.69，95%CI：1.13至2.52）、未改善的水（OR = 2.91，95%CI：1.21至7.02）、地表水（OR = 3.40，95%CI：2.52至4.58）和未经处理的水（OR = 2.51，95%CI：2.03至3.10）时，霍乱发生几率更高。同时，通过煮沸（OR = 0.38，95%CI：0.17至0.84）或氯化（OR = 0.37，95%CI：0.17至0.83）处理水（OR = 0.42，95%CI：0.27至0.65）以及饮用基本水（OR = 0.44，95%CI：0.27至0.69）显示出有保护作用。优先考虑与水相关的暴露因素，以综合关于通过饮用水传播霍乱的证据，将环境卫生和个人卫生作为额外的风险因素。虽然JMP服务阶梯提供了一个有用的分类框架，但在评估这些发现时应考虑基础设施和解释方面的具体情况差异。汇总估计值随新证据而变化，而关于保护因素或风险因素的定性见解仍然有效。像煮沸或氯化水这样成本相对较低的方法提供的良好保护效果与向公众提供基本水相当。
