A case-control study about routs of transmission of cholera during summer outbreak in Zahedan

Background: Within the past few years out breaks of cholera has occurred in different
points of Sistan and Baluchestan province of Iran, especially in the Zahedan district. The
objective of this study was definition of the most important routs of transmission of cholera in
the rural areas of Zahedan district involved in the cholera outbreak of summer 2003. The
outbreak lasted for about 1.5 months.
Methods and Materials: A case-control study was performed on 20 patients and 89 subjects
as controls. A questionnaire was completed for every subject about individual hygiene,
hygiene regulations of the family, the source of the drinkable water, use of chlorination of
water, use of soap for hand washing, eating and drinking outside in feasts (such as weddings),
getting ice from street vendors, and travel history. Stool culture for detection of cholera was
performed for all cases and also for consent controls.
Results: In multivariate analysis age (OR = 0.8, P = 0.004), eating food in parties
(OR = 34.5, P = 0.020), absence of soap in hand-washing place (OR = 4.7, P = 0.000) and
household size (OR = 1.3, P = 0.002) were significantly associated with cholera. In univariate
analysis, getting ice from street vendors (P = 0.032) also had relationship with catching
cholera.
Conclusions: Different routs of transmission of cholera are mentioned in reference books;
however every outbreak has its own special circumstances. The most important points with
regard to this outbreak were the importance of individual hygiene (especially using soap in
hand washing), control of production and distribution of ice by street vendors, and the
importance of eating and drinking in ceremonies even feats and weddings. Warning of people
about these points may play key role in controlling a cholera outbreak.