Madico G, Checkley W, Gilman R H, Bravo N, Cabrera L, Calderon M, Ceballos A
Universidad Peruana Cayetano Heredia, A.B. PRISMA, Lima, Peru.
J Clin Microbiol. 1996 Dec;34(12):2968-72. doi: 10.1128/jcm.34.12.2968-2972.1996.
The 1991 Peruvian cholera epidemic has thus far been responsible for 600,000 cholera cases in Peru. In an attempt to design a cholera surveillance program in the capital city of Lima, weekly sewage samples were collected between August 1993 and May 1996 and examined for the presence of Vibrio cholerae O1 bacteria and V. cholerae O1 bacteriophages (i.e., vibriophages). During the 144 weeks of surveillance, 6,323 cases of clinically defined cholera were recorded in Lima. We arbitrarily defined an outbreak as five or more reported cases of cholera in a week. The odds of having an outbreak were 7.6 times greater when V. cholerae O1 was present in sewage water during the four previous weeks compared with when it was not (P < 0.001). Furthermore, the odds of having an outbreak increased as the number of V. cholerae O1 isolations during the previous 4 weeks increased (P < 0.001). The odds of having an outbreak were 2.4 times greater when vibriophages were present in sewage water during the four previous weeks compared with when they were not, but this increase was not statistically significant (P = 0.15). The odds of having an outbreak increased as the number of vibriophage isolations during the previous 4 weeks increased (P < 0.05). The signaling of a potential cholera outbreak 1 month in advance may be a valuable tool for implementation of preventive measures. In Peru, active surveillance for V. cholerae O1 and possibly vibriophages in sewage water appears to be a feasible and effective means of predicting and outbreak of cholera.
1991年秘鲁霍乱疫情至今已在秘鲁造成60万例霍乱病例。为了在首都利马设计一个霍乱监测项目，于1993年8月至1996年5月期间每周采集污水样本，检测其中霍乱弧菌O1型细菌和霍乱弧菌O1噬菌体（即弧菌噬菌体）的存在情况。在144周的监测期间，利马记录了6323例临床确诊的霍乱病例。我们将一周内报告五例或更多霍乱病例的情况任意定义为一次疫情暴发。与前四周污水中不存在霍乱弧菌O1型细菌时相比，前四周污水中存在该细菌时发生疫情暴发的几率高7.6倍（P<0.001）。此外，随着前四周霍乱弧菌O1型细菌分离株数量的增加，发生疫情暴发的几率也增加（P<0.001）。与前四周污水中不存在弧菌噬菌体时相比，前四周污水中存在该噬菌体时发生疫情暴发的几率高2.4倍，但这种增加无统计学意义（P=0.15）。随着前四周弧菌噬菌体分离株数量的增加，发生疫情暴发的几率也增加（P<0.05）。提前1个月发出潜在霍乱疫情暴发的信号可能是实施预防措施的一项宝贵工具。在秘鲁，对污水中的霍乱弧菌O1型细菌以及可能的弧菌噬菌体进行主动监测似乎是预测霍乱疫情暴发的一种可行且有效的手段。
