Cholera Outbreaks in India, 2011-2020: A Systematic Review

Basilua Andre Muzembo; Kei Kitahara; Anusuya Debnath; Ayumu Ohno; Keinosuke Okamoto; Shin-Ichi Miyoshi

doi:10.3390/ijerph19095738

Cholera Outbreaks in India, 2011-2020: A Systematic Review

Int J Environ Res Public Health. 2022 May 8;19(9):5738. doi: 10.3390/ijerph19095738.

Authors

Basilua Andre Muzembo¹, Kei Kitahara^{1

2}, Anusuya Debnath^{1

3}, Ayumu Ohno^{1

2}, Keinosuke Okamoto¹, Shin-Ichi Miyoshi¹

Affiliations

¹ Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama 700-8530, Japan.
² Collaborative Research Center of Okayama University for Infectious Diseases in India, Kolkata 700010, India.
³ Department of Biotechnology, Brainware University, Kolkata 700125, India.

Abstract

Fecal contamination of water sources and open defecation have been linked to cholera outbreaks in India. However, a systematic review on the drivers responsible for these outbreaks has yet to be published. Here, we systematically review the published literature on cholera outbreaks in India between 2011 and 2020. We searched studies in English in three databases (MEDLINE, EMBASE, and Web of Science) and the Integrated Disease Surveillance Program that tracks cholera outbreaks throughout India. Two authors independently extracted data and assessed the quality of the included studies. Quantitative data on the modes of transmission reviewed in this study were assessed for any change over time between 2011-2015 and 2016-2020. Our search retrieved 10823 records initially, out of which 81 full-text studies were assessed for eligibility. Among these 81 studies, 20 were eligible for inclusion in this review. There were 565 reported outbreaks between 2011 and 2020 that led to 45,759 cases and 263 deaths. Outbreaks occurred throughout the year; however, they exploded with monsoons (June through September). In Tamil Nadu, a typical peak of cholera outbreaks was observed from December to January. Seventy-two percent (33,089/45,759) of outbreak-related cases were reported in five states, namely Maharashtra, West Bengal, Punjab, Karnataka, and Madhya Pradesh. Analysis of these outbreaks highlighted the main drivers of cholera including contaminated drinking water and food, inadequate sanitation and hygiene (including open defecation), and direct contact between households. The comparison between 2011-2015 and 2016-2020 showed a decreasing trend in the outbreaks that arose due to damaged water pipelines. Many Indians still struggle with open defecation, sanitation, and clean water access. These issues should be addressed critically. In addition, it is essential to interrupt cholera short-cycle transmission (mediated by households, stored drinking water and foodstuffs) during an outbreak. As cholera is associated with deprivation, socio-economic development is the only long-term solution.

Keywords: India; behavioral changes; cholera; close contact; food; household; open defecation; outbreak; sewage; water supply.

Publication types

Review
Systematic Review
Research Support, Non-U.S. Gov't

MeSH terms

Cholera* / epidemiology
Disease Outbreaks
Drinking Water*
Humans
India / epidemiology
Sanitation

Substances

Drinking Water

Grants and funding

We declare that we have no conflicts of interest. This study was supported by the Japan Initiative for Global Research Network on Infectious Diseases (J-GRID) from the Ministry of Education, Culture, Sports, Science & Technology in Japan (MEXT), and the Japan Agency for Medical Research and Development (AMED; Grant Number 21wm0125004h0002). The funders had no role in its study design, data collection and analysis, decision to publish, or preparation of the manuscript. All authors had full access to all the data in the review process, and the corresponding author had the final responsibility in deciding to submit this article for publication.