Protracted cholera outbreak in the Central Region, Ghana, 2016

Area of Science:

• Public Health
• Epidemiology
• Infectious Disease Surveillance

Background:

• A suspected cholera outbreak was reported in the Cape Coast Metropolis (CCM) on October 24, 2016.
• The Central Regional Health Directorate initiated an investigation to confirm the outbreak and identify its causes and risk factors.

Purpose of the Study:

• To confirm the diagnosis of the suspected cholera outbreak.
• To identify the causative agent and associated risk factors for the spread of cholera.
• To implement effective control measures to manage the outbreak.

Main Methods:

• A descriptive study was conducted, followed by a 1:2 unmatched case-control study.
• Data collection involved reviewing medical records, active case searching, contact tracing, and environmental assessments.
• Stool samples were tested using point-of-care kits and laboratory confirmation at Cape Coast Teaching Hospital.

Main Results:

• The outbreak was caused by *Vibrio cholerae* serotype Ogawa, with no reported mortality.
• A total of 704 case-patients were identified, with the University of Cape Coast subdistrict as the epicenter (48.44% of cases).
• Risk factors included visiting cholera treatment centers (aOR=12.1), drinking pipe-borne water (aOR=11.7), and drinking street-vended sachet water (aOR=11.0). Open defecation and broken sewage pipes were noted in the epicenter.

Conclusions:

• The CCM cholera outbreak, caused by *Vibrio cholerae* serotype Ogawa, predominantly affected the youth.
• Visiting cholera treatment centers emerged as a significant risk factor.
• Control measures included prompt case management, contact tracing, health education, restricted access to treatment centers, and water, sanitation, and hygiene (WASH) interventions.