Cholera epidemics of the past offer new insights into an old enemy

TY - JOUR

T1 - Cholera epidemics of the past offer new insights into an old enemy

AU - Phelps, Matthew

AU - Perner, Mads Linnet

AU - Pitzer, Virginia E

AU - Andreasen, Viggo

AU - Jensen, Peter K M

AU - Simonsen, Lone

PY - 2018/2/15

Y1 - 2018/2/15

N2 - Background. Although cholera is considered the quintessential long-cycle waterborne disease, studies have emphasized the existence of short-cycle (food, household) transmission. We investigated singular Danish cholera epidemics (in 1853) to elucidate epidemiological parameters and modes of spread. Methods. Using time series data from cities with different water systems, we estimated the intrinsic transmissibility (R 0 ). Accessing cause-specific mortality data, we studied clinical severity and age-specific impact. From physicians' narratives we established transmission chains and estimated serial intervals. Results. Epidemics were seeded by travelers from cholera-affected cities; initial transmission chains involving household members and caretakers ensued. Cholera killed 3.4%-8.9% of the populations, with highest mortality among seniors (16%) and lowest in children (2.7%). Transmissibility (R 0 ) was 1.7-2.6 and the serial interval was estimated at 3.7 days (95% confidence interval, 2.9-4.7 days). The case fatality ratio (CFR) was high (54%-68%); using R 0 we computed an adjusted CFR of 4%-5%. Conclusions. Short-cycle transmission was likely critical to early secondary transmission in historic Danish towns. The outbreaks resembled the contemporary Haiti outbreak with respect to transmissibility, age patterns, and CFR, suggesting a role for broader hygiene/sanitation interventions to control contemporary outbreaks.

AB - Background. Although cholera is considered the quintessential long-cycle waterborne disease, studies have emphasized the existence of short-cycle (food, household) transmission. We investigated singular Danish cholera epidemics (in 1853) to elucidate epidemiological parameters and modes of spread. Methods. Using time series data from cities with different water systems, we estimated the intrinsic transmissibility (R 0 ). Accessing cause-specific mortality data, we studied clinical severity and age-specific impact. From physicians' narratives we established transmission chains and estimated serial intervals. Results. Epidemics were seeded by travelers from cholera-affected cities; initial transmission chains involving household members and caretakers ensued. Cholera killed 3.4%-8.9% of the populations, with highest mortality among seniors (16%) and lowest in children (2.7%). Transmissibility (R 0 ) was 1.7-2.6 and the serial interval was estimated at 3.7 days (95% confidence interval, 2.9-4.7 days). The case fatality ratio (CFR) was high (54%-68%); using R 0 we computed an adjusted CFR of 4%-5%. Conclusions. Short-cycle transmission was likely critical to early secondary transmission in historic Danish towns. The outbreaks resembled the contemporary Haiti outbreak with respect to transmissibility, age patterns, and CFR, suggesting a role for broader hygiene/sanitation interventions to control contemporary outbreaks.

U2 - 10.1093/infdis/jix602

DO - 10.1093/infdis/jix602

M3 - Journal article

C2 - 29165706

SN - 0022-1899

VL - 217

SP - 641

EP - 649

JO - Journal of Infectious Diseases

JF - Journal of Infectious Diseases

IS - 4

ER -