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Submitted: 16 May 2007
HERDIN Record #: PCHRDHE901724

A case-control study on cholera in Manila, Philippines.

 White FM,
 Diosomito-Dantes L,
 Benabaye RMS,
 Lucas-Aquino R,
 Dayrit MM,
 White ME,
 Romualdo T

Cholera is endemic in the Philippines, but its transmission and maintenance are still poorly understood. Most bacteriologically-confirmed cases occur between June and December, but the cause of this seasonality is nuclear
We did a case-control study on culture-proven cholera cases from San Lazaro Hospital, Metro Manila between August and October, 1988. Cases were matched for age and sex with controls admitted for diseases other than diarrhea at nearby Jose Reyes Memorial Hospital. However, during the design of the study, the potability of the city water was questioned. Therefore, we collected water samples in Las Pinas, Manila an area where some cases resided. Because drinking water was sometimes distributed from a single faucet to several houses through rubber hoses, water was collected directly from faucets and rubber hoses and sent to the Bureau of Research and Laboratories for potability studies and the Research Institute for Tropical Medicine for V. cholerae isolation. We also collected water from the shallow well and a river in Las Pi$as
A total of 108 pairs of cases and controls were gathered. Ages of cases ranged from 4 months to 77 years, mean 19 years. There were 58 (54%) females and 50 (46%) males. Cholera patients were twice as likely to get their water from wells rather than from the Metropolitan Waterworks and Sewerage System (MWSS) (OR = 2.4, 95% CI 1.12 - 5.36, p-value 0.01*).Cholera patients were 5 times more likely to store water, (OR
We sampled 11 rubber hoses and found 1 repeatedly positive for enteric bacteria and toxigenic V. cholerae 01 serotype Ogawa. All 11 MWSS faucets were negative for E. coli and vibrios. The contaminated hose was intermittently submerged in a river. This river and nearby open dug well were positive for V. cholerae 01 serotype Ogawa
This study suggests that cholera transmission in Metro Manila is sometimes through contaminated water. The seasonal occurence of cholera in Metro Manila coincides with the rainy season months when flood waters may contaminate leaky rubber hoses or open dug wells. These support efforts to improve water distribution and iliminate open dug wells to prevent diarrhea. While it appears that cases were 6 times more likely to consume food sidewalk vendors, we were unable to identify a specific food or food-handling practice associated with the disease

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