Cholera Outbreak in Sinapangan Village, Libungan, North Cotabato, Philippines, July 17-20, 2018

  • Water or foodborne
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Background:
On July 2018, we received a report on increasing diarrhea cases in Sinapangan Village, Libungan, North Cotabato. An FETP team was sent to determine existence of an outbreak, source and mode of transmission, risk factors and recommend control and preventive measures.

Methods:
We did an unmatched 1:3 case-control study. A suspect cholera case was a previously well individual in Sinapangan Village, Libungan with diarrhea from June 1–July 19, 2018. A confirmed cholera case was a suspect case positive for Vibrio cholera. A control is any well individual negative for any pathogen within the same area and time period. We conducted key informant interviews and environmental survey of water sources. We sent rectal swabs and water samples for bacteriologic testing.

Results:
Ninety cases were identified. One died (Case Fatality Rate: 1%). Forty-nine (54%) were males. Age ranged from three months to 74 years (Median=27). There was heavy rainfall which resulted to flooding at end of May. Cases appeared two weeks later; peaked on 1st week of July. Spring water sources are unprotected. Water sources were not regularly tested and chlorinated. Water pipelines are leaking and in close proximity to pit privies and disposed animal and human wastes. Three (13%) of 23 rectal swabs were positive for Vibrio cholera Ogawa biotype El Tor. Risk factor was sharing of toilet (OR=2.46, 95% CI=1.31-4.61). Protective factors were boiling drinking water (OR=0.31, CI=0.17-0.56) and using spoon and fork when eating (OR=0.34, CI=0.17-0.67).

Conclusion:
There was a cholera outbreak in Sinapangan Village. Water sources became contaminated with fecal matter due to flooding. Neither were there measures to immediately disinfect the system at the source or at the household level. Household chlorination of drinking water was immediately done. We also recommended the rehabilitation of water system and improvement of sanitation by provision of sanitary toilets and proper garbage collection.

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