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Am J Trop Med Hyg. 2013 Oct;89(4):654-64. doi: 10.4269/ajtmh.13-0208.

Seroepidemiologic survey of epidemic cholera in Haiti to assess spectrum of illness and risk factors for severe disease.

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  • 1Epidemic Intelligence Service, Division of Foodborne, Waterborne, and Environmental Diseases, Health Systems Reconstruction Office, and Division of Blood Disorders, Centers for Disease Control and Prevention, Atlanta, Georgia; Laboratoire National de Santé Publique, Direction d'Epidémiologie, des Laboratoires, et de la Recherche, Ministère de la Santé Publique et de la Population, Port-au-Prince, Haiti; Centers for Disease Control and Prevention (Haiti Office), Port-au-Prince, Haiti.


To assess the spectrum of illness from toxigenic Vibrio cholerae O1 and risk factors for severe cholera in Haiti, we conducted a cross-sectional survey in a rural commune with more than 21,000 residents. During March 22-April 6, 2011, we interviewed 2,622 residents ≥ 2 years of age and tested serum specimens from 2,527 (96%) participants for vibriocidal and antibodies against cholera toxin; 18% of participants reported a cholera diagnosis, 39% had vibriocidal titers ≥ 320, and 64% had vibriocidal titers ≥ 80, suggesting widespread infection. Among seropositive participants (vibriocidal titers ≥ 320), 74.5% reported no diarrhea and 9.0% had severe cholera (reported receiving intravenous fluids and overnight hospitalization). This high burden of severe cholera is likely explained by the lack of pre-existing immunity in this population, although the virulence of the atypical El Tor strain causing the epidemic and other factors might also play a role.

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