Typhoid fever outbreak in the Democratic Republic of Congo: Case control and ecological study

Hdl Handle:
http://hdl.handle.net/10144/619268
Title:
Typhoid fever outbreak in the Democratic Republic of Congo: Case control and ecological study
Authors:
Brainard, J; D’hondt, R; Ali, E; Van den Bergh, R; De Weggheleire, A; Baudot, Y; Patigny, F; Lambert, V; Zachariah, R; Maes, P; Kuma-Kuma Kenge, D; Hunter, PR
Journal:
PLOS Neglected Tropical Diseases
Abstract:
During 2011 a large outbreak of typhoid fever affected an estimated 1430 people in Kikwit, Democratic Republic of Congo. The outbreak started in military camps in the city but then spread to the general population. This paper reports the results of an ecological analysis and a case-control study undertaken to examine water and other possible transmission pathways. Attack rates were determined for health areas and risk ratios were estimated with respect to spatial exposures. Approximately 15 months after the outbreak, demographic, environmental and exposure data were collected for 320 cases and 640 controls residing in the worst affected areas, using a structured interview questionnaire. Unadjusted and adjusted odds ratios were estimated. Complete data were available for 956 respondents. Residents of areas with water supplied via gravity on the mains network were at much greater risk of disease acquisition (risk ratio = 6.20, 95%CI 3.39–11.35) than residents of areas not supplied by this mains network. In the case control study, typhoid was found to be associated with ever using tap water from the municipal supply (OR = 4.29, 95% CI 2.20–8.38). Visible urine or faeces in the latrine was also associated with increased risk of typhoid and having chosen a water source because it is protected was negatively associated. Knowledge that washing hands can prevent typhoid fever, and stated habit of handwashing habits before cooking or after toileting was associated with increased risk of disease. However, observed associations between handwashing or plate-sharing with disease risk could very likely be due to recall bias. This outbreak of typhoid fever was strongly associated with drinking water from the municipal drinking water supply, based on the descriptive and analytic epidemiology and the finding of high levels of faecal contamination of drinking water. Future outbreaks of potentially waterborne disease need an integrated response that includes epidemiology and environmental microbiology during early stages of the outbreak.
Publisher:
Public Library of Science
Issue Date:
3-Oct-2018
URI:
http://hdl.handle.net/10144/619268
DOI:
10.1371/journal.pntd.0006795
Additional Links:
http://dx.plos.org/10.1371/journal.pntd.0006795
Submitted date:
2018-10-15
Language:
en
ISSN:
1935-2735
Appears in Collections:
Other Diseases

Full metadata record

DC FieldValue Language
dc.contributor.authorBrainard, Jen
dc.contributor.authorD’hondt, Ren
dc.contributor.authorAli, Een
dc.contributor.authorVan den Bergh, Ren
dc.contributor.authorDe Weggheleire, Aen
dc.contributor.authorBaudot, Yen
dc.contributor.authorPatigny, Fen
dc.contributor.authorLambert, Ven
dc.contributor.authorZachariah, Ren
dc.contributor.authorMaes, Pen
dc.contributor.authorKuma-Kuma Kenge, Den
dc.contributor.authorHunter, PRen
dc.date.accessioned2018-10-16T16:30:21Z-
dc.date.available2018-10-16T16:30:21Z-
dc.date.issued2018-10-03-
dc.date.submitted2018-10-15-
dc.identifier.citationTyphoid fever outbreak in the Democratic Republic of Congo: Case control and ecological study 2018, 12 (10):e0006795 PLOS Neglected Tropical Diseasesen
dc.identifier.issn1935-2735-
dc.identifier.doi10.1371/journal.pntd.0006795-
dc.identifier.urihttp://hdl.handle.net/10144/619268-
dc.description.abstractDuring 2011 a large outbreak of typhoid fever affected an estimated 1430 people in Kikwit, Democratic Republic of Congo. The outbreak started in military camps in the city but then spread to the general population. This paper reports the results of an ecological analysis and a case-control study undertaken to examine water and other possible transmission pathways. Attack rates were determined for health areas and risk ratios were estimated with respect to spatial exposures. Approximately 15 months after the outbreak, demographic, environmental and exposure data were collected for 320 cases and 640 controls residing in the worst affected areas, using a structured interview questionnaire. Unadjusted and adjusted odds ratios were estimated. Complete data were available for 956 respondents. Residents of areas with water supplied via gravity on the mains network were at much greater risk of disease acquisition (risk ratio = 6.20, 95%CI 3.39–11.35) than residents of areas not supplied by this mains network. In the case control study, typhoid was found to be associated with ever using tap water from the municipal supply (OR = 4.29, 95% CI 2.20–8.38). Visible urine or faeces in the latrine was also associated with increased risk of typhoid and having chosen a water source because it is protected was negatively associated. Knowledge that washing hands can prevent typhoid fever, and stated habit of handwashing habits before cooking or after toileting was associated with increased risk of disease. However, observed associations between handwashing or plate-sharing with disease risk could very likely be due to recall bias. This outbreak of typhoid fever was strongly associated with drinking water from the municipal drinking water supply, based on the descriptive and analytic epidemiology and the finding of high levels of faecal contamination of drinking water. Future outbreaks of potentially waterborne disease need an integrated response that includes epidemiology and environmental microbiology during early stages of the outbreak.en
dc.language.isoenen
dc.publisherPublic Library of Scienceen
dc.relation.urlhttp://dx.plos.org/10.1371/journal.pntd.0006795en
dc.rightsArchived with thanks to PLOS Neglected Tropical Diseasesen
dc.titleTyphoid fever outbreak in the Democratic Republic of Congo: Case control and ecological studyen
dc.identifier.journalPLOS Neglected Tropical Diseasesen
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