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Submitted: 16 May 2007
HERDIN Record #: PCHRDHE901725

Cholera outbreak in Echague District, Isabela.

 Conanan EC

Records showed that 75 diarrheal cases were reported from August 15 to August 28, 1988. Of the 75 reported cases, 36 (48%) were positive for V. cholera from the rectal swabs examined at the Cagayan Valley Regional Hospital. The isolates were validated at the Bureau of Research and Laboratories in Manila. There were two deaths reported. The municipalities of Alicia, Angadanan and Echague were affected. The municipality of Angadanan had the highest attack rate (5.5/1000 population). The attack rate for females (2.9/1000 population) was higher than for males (1.3/1000 population). The thirty to thirty-nine age range had the highest attack rate (3.4/1000 population)
The investigators interviewed 23 (64%) of the confirmed cases and 29 (74%) of the suspected cases. All of the 23 confirmed cases interviewed were included in the case control study
Although records showed that eight cases were reported on the same day, these came from different areas of the district. No common food items was recalled by the cases. There were clusters of cases in four different barangays of Echague District. Each barangay was investigated
Barangay Pangal Norte, Echague had the most confirmed cases. The first reported case was a 7 year old female who represented with diarrhea and vomiting on August 15, 1988. Succeeding cases were then noted on August 17, 21, and 22. Interviews conducted in eight of the confirmed cases revealed that seven of them had a common water source. This was identified as a shallow pump shared by the neighborhood. Four of the patients recalled that they first noticed the symptoms a few hours after consuming iced-water in which home-packed ice were bought from a nearby store
The first two cases in the municipality of Alicia were reported on August 15. These patients had attended to a relative who was confined in a hospital for diarrhea. Two other patients claimed that they had eaten raw "bagoong na isda" 8 to 24 hours before they had diarrhea and vomiting
In the municipality of Angadanan, eleven of the thirteen cases were reported from this barangays which were not geographically connected to each other. These are barangays San Ambrocio and Dalenat. In San Ambrocio, a total of 7 cases were reported. The first three cases had the same history of drinking rates from a condemned shallow water pump. One claimed that he ate bagoong before developing the symptoms. The other three patients could not recall the cause of the diarrhea. Four of the cases in Barangay Dalenat came from the same household. They had a history of eating "tulya" taken from a nearby creek one to three days before developing the symptoms. Other cases from the area did not have a history of eating "tulya" prior to developing the symptoms. One hundred fourteen of the one hundred twenty-two (93%) water samples collected in the affected area tested through the PHC media showed that they were fecally contaminated. No V. cholera was isolated from the 56 various food samples collected and examined at the Research Institute for Tropical Medicine
The case control study included 23 cases and 26 controls. It showed that cases were more likely to have no proper waste disposal (9/23) as compared to the controls (1/26) (p 0.05 by Fishers Exact Test). Four of the 23 cases had eaten "bagoong na isda" a day prior to onset of illness. Nobody from the controls claimed the same (p 0.05 by Fishers Exact Test)

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