TY - JOUR

T1 - Individual and household exposures associated with cholera transmission in case-control studies

T2 - a systematic review

AU - Phelps, Matthew D

AU - Simonsen, Lone

AU - Jensen, Peter K M

N1 - This article is protected by copyright. All rights reserved.

PY - 2019

Y1 - 2019

N2 - OBJECTIVE: Uncertainty persists regarding cholera transmission routes. We conducted a structured review of case-control studies on cholera transmission and provide a qualitative summary of reported exposures in order to inform public health efforts and future cholera research.METHODS: We searched two electronic databases for published case-control studies that investigated risk factors for cholera, and included any publications that did not match our exclusion criteria. From the included studies, we grouped exposures using two parameters, whether transmission domain was public or domestic, and also on the vehicle of transmission. We extracted data on study location, method of case and control inclusion, type of statistical analysis performed, and which exposures were included. Additionally, two parallel subgroup analyses were performed. The first included the subgroup of all studies that used culture-confirmed cholera cases, and the second included the subgroup of all studies employing a multivariate analysis. In the second analysis we calculated the population attributable risk (PAR).RESULTS: Our search yielded 2347 peer reviewed publications, of which 65 did not match our exclusion criteria, comprising 69 individual studies. Water-based exposures were investigated in 97% of these studies, of which 70% found a significant association with cholera infection. Food-based exposures were investigated in 75% of studies, of which 63% found a significant association with risk of cholera infection. Close personal contact with cholera cases was investigated in 30% of studies, of which 52% found a significant association with risk of cholera infection. Hygiene-related exposures were investigated in 51% of studies, of which 63% found a significant association with cholera transmission. Among studies that examined at least one exposure related to the domestic domain, 76% found a significant association with cholera infection, vs. 71% of studies investigating at least one public domain exposure. The subgroup analyses produced similar results.CONCLUSIONS: Despite strong evidence for cholera transmission via foodborne-, hygiene-, waterborne-, and close personal contact-related pathways in both domestic and public domains, we found that non-waterborne-related factors are understudied. Future cholera case-control studies would benefit from investigating all transmission vehicles and transmission domains. This article is protected by copyright. All rights reserved.

AB - OBJECTIVE: Uncertainty persists regarding cholera transmission routes. We conducted a structured review of case-control studies on cholera transmission and provide a qualitative summary of reported exposures in order to inform public health efforts and future cholera research.METHODS: We searched two electronic databases for published case-control studies that investigated risk factors for cholera, and included any publications that did not match our exclusion criteria. From the included studies, we grouped exposures using two parameters, whether transmission domain was public or domestic, and also on the vehicle of transmission. We extracted data on study location, method of case and control inclusion, type of statistical analysis performed, and which exposures were included. Additionally, two parallel subgroup analyses were performed. The first included the subgroup of all studies that used culture-confirmed cholera cases, and the second included the subgroup of all studies employing a multivariate analysis. In the second analysis we calculated the population attributable risk (PAR).RESULTS: Our search yielded 2347 peer reviewed publications, of which 65 did not match our exclusion criteria, comprising 69 individual studies. Water-based exposures were investigated in 97% of these studies, of which 70% found a significant association with cholera infection. Food-based exposures were investigated in 75% of studies, of which 63% found a significant association with risk of cholera infection. Close personal contact with cholera cases was investigated in 30% of studies, of which 52% found a significant association with risk of cholera infection. Hygiene-related exposures were investigated in 51% of studies, of which 63% found a significant association with cholera transmission. Among studies that examined at least one exposure related to the domestic domain, 76% found a significant association with cholera infection, vs. 71% of studies investigating at least one public domain exposure. The subgroup analyses produced similar results.CONCLUSIONS: Despite strong evidence for cholera transmission via foodborne-, hygiene-, waterborne-, and close personal contact-related pathways in both domestic and public domains, we found that non-waterborne-related factors are understudied. Future cholera case-control studies would benefit from investigating all transmission vehicles and transmission domains. This article is protected by copyright. All rights reserved.

U2 - 10.1111/tmi.13293

DO - 10.1111/tmi.13293

M3 - Review

C2 - 31343805

VL - 24

SP - 1151

EP - 1168

JO - Tropical Medicine & International Health

JF - Tropical Medicine & International Health

SN - 1360-2276

IS - 10

ER -