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. 2022 May 8;19(9):5738.
doi: 10.3390/ijerph19095738.

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

Basilua Andre Muzembo  1 , Kei Kitahara  1   2 , Anusuya Debnath  1   3 , Ayumu Ohno  1   2 , Keinosuke Okamoto  1 , Shin-Ichi Miyoshi  1
Affiliations

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

Basilua Andre Muzembo et al. Int J Environ Res Public Health. .

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.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Cholera outbreaks (n = 565) by state and union territories, India, 2011–2020.
Figure 2
Figure 2
Cholera outbreaks (n = 565) by year and state, India, 2011–2020.
Figure 3
Figure 3
Cholera outbreaks (n = 565) by year, India, 2011–2020.
Figure 4
Figure 4
Cholera outbreaks (n = 565) by year and season, India, 2011–2020. Winter = December to January; Pre-monsoon = March to May; Monsoon = June to September; and Post-monsoon = October to November.
Figure 5
Figure 5
Reported cholera cases during outbreaks by state, India, 2011–2020.
Figure 6
Figure 6
Rate of reported cholera outbreaks per 100,000 persons, India, 2011–2020.
Figure 7
Figure 7
Cholera outbreaks (n = 565) by type of setting (rural vs. urban), India, 2011–2020. DNHDD = Dadra and Nagar Haveli and Daman and Diu.
Figure 8
Figure 8
Number of cholera outbreaks (n = 565) by month and transmission routes, India, 2011–2020.
Figure 9
Figure 9
Cholera outbreaks (n = 565) in different seasons, India, 2011 to 2020. Winter = December to January; Pre-monsoon = March to May; Monsoon = June to September; and Post-monsoon = October to November.
Figure 10
Figure 10
Number of cholera outbreaks (n = 565) by state and transmission routes, India, 2011–2020. Multiple modes of transmission were involved in some outbreaks.
Figure 11
Figure 11
Number of cholera outbreaks (n = 565) by transmission routes and year, India, 2011–2020.
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