[Source: Journal of Infectious Diseases, full page: (LINK). Abstract, edited.]
Cholera epidemics of the past offer new insights into an old enemy
Matthew Phelps, Mads Linnet Perner, Virginia E Pitzer, Viggo Andreasen, Peter K M Jensen, Lone Simonsen
The Journal of Infectious Diseases, jix602, https://doi.org/10.1093/infdis/jix602
Published: 20 November 2017 – Received: 04 September 2017
Citation: Matthew Phelps, Mads Linnet Perner, Virginia E Pitzer, Viggo Andreasen, Peter K M Jensen, Lone Simonsen; Cholera epidemics of the past offer new insights into an old enemy, The Journal of Infectious Diseases, , jix602, https://doi.org/10.1093/infdis/jix602
© 2017 Oxford University Press
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.
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.
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%.
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.
Issue Section: Major Article
© The Author 2017. Published by Oxford University Press for the Infectious Diseases Society of America.
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