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Diarrhoeal Epidemics in Dhaka, Bangladesh, During Three Consecutive Floods: 1988, 1998 and 2004

Author(s): Schwartz BS, Harris JB, Khanai, Larocquerc, Sack DA et. al.

Abstract

Background: Dhaka, Bangladesh suffered severe flooding during the monsoon seasons of 1988, 1998, and twice in 2004. This flooding resulted in destruction of basic infrastructure, contamination of water, and epidemics of diarrheal illness. Methods: We examined demographic, microbiologic, and clinical data on patients presenting during the flood-related epidemics utilizing a patient-surveillance system at a diarrheal-treatment hospital in Dhaka, Bangladesh. Results: Collectively, 2,275 patients were enrolled in the surveillance system during the flood-related epidemics. Compared to patients presenting during non-flood periods, patients presenting during the flood-related epidemics were older (p<0.001), had more severe dehydration (p<0.001), and were more likely to be infected with V. cholerae (p<0.001). While V. cholerae was the infecting pathogen in over 40% of cases in the 1998 and the second 2004 epidemics, a significantly smaller proportion of cases in the other two epidemics were attributable to V. cholerae infection. The most commonly identified pathogen in the first 2004 epidemic was rotavirus. Additionally, we found an increase in the mean cases per day of Shigella species during flood-related epidemics of 1988 and 1998 (p<0.001). Despite the increased burden of diarrheal disease during these flood periods, we observed no increase in patient mortality (p=0.76). Conclusions: These results may be used by public health officials in preparing for future flood-related epidemics in Bangladesh. In particular, preparations should involve stocking adequate supplies of oral rehydration salts, intravenous fluids, and antibiotics suitable for use in V. cholerae and shigella infections.

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