In Sankarpura village of Tilathi-Koiladi Rural Municipality of Saptari district, Nepal had reported a cluster of acute watery diarrhea cases in October 2017. The outbreak investigation of cholera was done with the main objective to investigate and identify the distribution and determinants of acute watery diarrhea/cholera cases. It helped in diagnosing the cases and determining factors to control the disease as well.
This was a cross-sectional investigation for which line list of diarrhea cases was collected at the temporary health camp of Sankarpura village. Case investigations and household investigations were conducted for assessing the practice of sanitation, source of drinking water and probable cause of diarrheal disease using standard checklists and forms. There were four stool samples from diarrhea patients admitted in the temporary health camp and two water samples collected from the tube well of the index case and the community pond. Stool and water samples were tested for vibrio cholerae by conducting rapid diagnostic tests in the field, and then, culturing the samples at the National Public Health Laboratory and PCR at Johns Hopkins University, Baltimore, USA. Later, the data were entered in Excel and analyzed for the descriptive statistics using SPSS.
As a result, a total of 195 persons who suffered from watery diarrhea from October 3 to October 10, 2017, were identified. Mainly females within the age group 25 to 34 years were affected, and there were no deaths across all age groups. The vibrio cholerae O1 was confirmed in three out of four stool samples through PCR, but the result was negative for water samples.
From this investigation, the conclusion was that the cases were epidemiologically linked with cholera disease because 75 percent of the samples were positive. There were repeated outbreaks of cholera in the Tilathi-Koiladi Rural Municipality in the past as well. The existing poor personal hygiene behaviors and lack of environmental sanitation, along with the lack of water treatment at the household level, seem to be the main factors causing this site to be a hotspot for cholera outbreaks.