Okullo A Bwire G and Ario AR The 6 TH EAHSC Cholera Outbreak Caused by Drinking Contaminated Lakeshore Water Kaiso Village Uganda Oct 2015 Events leading to investigation ID: 1009029
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1. Oguttu D.W (BBLT, MZOO/Par, FET), Okullo A, Bwire G and Ario A.R.The 6TH EAHSC Cholera Outbreak Caused by Drinking Contaminated Lakeshore Water:Kaiso Village, Uganda, Oct 2015
2. Events leading to investigation1 – 10 Oct12 Oct 1 NovInvestigationOutbreak reported,District response2 suspected cholera deaths in Kaiso
3. Located on shoreline of Lake Albert
4. ObjectivesIdentify source of infection Identify mode of transmission Recommend evidence-based public health actions to prevent future outbreaks
5. Case definitionSuspected case: Onset of watery diarrhoea in a resident of Kaiso village from 1st October onwardConfirmed case: A suspected case with vibrio cholerae identified in fecal sample by Lab culture
6. Systematic case finding and investigation123 cases line listed from cholera treatment center and communityRainfall data from Kabwoya Wildlife Reserve weather station
7. A point source outbreak after heavy rainfallTx ctr openedH2O chlorinationInvestigationRainfall (mm)# casesOctNovRainfall
8. Symptoms were consistent with Cholera
9. Cases by age and genderSexMale70Female53Age Range8mon – 65y Median 20y
10. Case distribution by settlement zoneSZ1SZ2SZ3
11. High Attack rates in SZ2 and SZ3 ZoneCasesPopn(Estim.)Attack rate (/1000)Kaiso Village123900014SZ2 35200017SZ3 83650013SZ 1 25004
12. Water likely source of transmissionLake primary source of water for all cases100% cases no water treatmentHeavy rainfall prior to outbreakNo large community festival prior to outbreak>90% cases ate hot food from their homes
13. Case - control study61 cases126 randomly selected village controls from village registerObtained Info on sources of drinking water and boiling water
14. Exposure% cases exposed (n=61)% controls exposed(n=126)ORM-H (95% CI) Site C water69336.7 (2.5 – 17) Site B water21371.8 (0.64 – 5.3) Site A water1030refWater collection points associated with cholera
15. Exposure% cases exposed (n=61)% controls exposed(n=126)ORM-H (95% CI)Drinking Un-boiled water10093∞ (1.0-∞)*Drinking boiled H2O 07Ref.Drinking unboiled water associated with disease *Fisher’s exact CI
16. Environmental investigation:3 water collection sites: A, B & CSZ1SZ2SZ3ABCLake Albert
17. Site C was contaminatedRaw feces
18. Gully channel washed sewage into lake shore at site CC
19. Open defecation along the channel
20. Piped water system vandalized
21. ConclusionDrinking lakeshore water contaminated by feces washed down a gully channel from hillside open defecation area caused this outbreak
22. RecommendationsImmediate interventions:Boiling & treatment of drinking water Construction of public latrinesUltimate solution: Fix the broken piped water system or provide alternative safe water to the community
23. AcknowledgementsHoima DHO and DHT MembersMoHWHOPHFP fellow Allen OkulloPHFP mentors Dr. Bao Ping Zhu and Dr. Ario AlexKabwoya Wild Life Reserve adminChairman LC1 Kaiso and VHTs
24. Kaiso village
25. Site was contaminated Site A: RescueSite B: BakobyaSite C: LenduRaw feces
26. Kaiso on hill side
27. Distribution of cases in village zones
28. Environmental investigation:3 water collection sites: A, B & CSonga-LenduSonga-BakobyaFicama SZ3Attack rate 13/1000ZS2Attack rate 17/1000SZ1Attack rate 4/1000ABC