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

Matthew David Phelps, Mads Linnet Perner, Virginia E Pitzer, Viggo Andreasen, Peter Kjær Mackie Jensen, Lone Simonsen

Publikation: Bidrag til tidsskriftTidsskriftartikelpeer review

Abstract

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 (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 (R0). Accessing cause-specific mortality data we studied clinical severity, 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 (R0) was 1.7-2.6 and the serial interval was estimated at 3.7 days (95% CI: 2.9 - 4.7). The case fatality ratio (CFR) was high (54%-68%); using R0 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.
OriginalsprogEngelsk
TidsskriftJournal of Infectious Diseases
Vol/bind217
Udgave nummer4
Sider (fra-til)641–649
ISSN0022-1899
DOI
StatusUdgivet - 2018

Bibliografisk note

This article has been located as Bronze Open Access on Febrary 9th 2018. Please notify rucforsk@ruc.dk, if the access changes to 'No access'

Citer dette