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  • Title: Report of an outbreak of diarrhoeal disease caused by cholera followed by rotavirus in Manipur.
    Author: Gupta DN, Sen D, Saha MR, Sengupta PG, Sikder SN, Ghosh S, Sarkar K, Singh NC, Sharma R.
    Journal: Indian J Public Health; 1990; 34(1):62-5. PubMed ID: 2101390.
    Abstract:
    An outbreak of acute diarrhoeal disease between August and October 1985 in 3 districts of Manipur state was investigated amongst 9,29,077 population at risk. The overall attack rate and case fatality rate were 0.2% and 0.9% respectively. Hospital records revealed that 58.8% of cases occurred amongst older children above 5 years of age. V.cholera was isolated from 25.3% of cases sampled. Interestingly, increased frequency in weekly admission of cases amongst children during first two years of life increased in the beginning of October when the original peak of diarrhoeal outbreak was about to decline. The October peak was caused by rotavirus which could be detected from 50.0% of diarrhoeal children in this age group. This possibly reflected beginning of the usual rotavirus diarrhoea season in the locality. Between August 24-October 20, 1985, an outbreak of acute diarrheal disease occurred among 1833 children in Imphal, Bishenpur, and Thoubal districts in Manipur State in India for an overall attach rate of 2/1000. 17 children died, a case fatality rate of 9/1000. Hospital and health center personnel treated 1711 cases with rehydration therapy (oral or intravenous fluids). Local, mainly unqualified, practitioners treated the remaining 122 cases with antidarrheal drugs. Children treated at home were more likely to die than those treated at health facilities (case fatality rates 0.6% vs. 4.9%; p.001). Nevertheless these case fatality rates were lower than those in a 1973-1974 outbreak of gastroenteritis in Manipur, perhaps because the health authority distributed oral rehydration solution packets during this 1985 epidemic. The leading symptoms were watery diarrhea (82.5%), vomiting (67.5%), and abdominal pain (37.5%). Children 5 years old tended to experience severe dehydration more so than younger children (31.3% vs. 12.5%). 58.8% of hospitalized cases were older children who suffered the highest death rate. (1.9%). Peak admissions occurred the last week of September ending on October 2. Yet during the decline phase, the admission rate of children 2 years old rose. 25.3% of cases sampled recovered V. cholerae with the highest isolation rate (30.8%) found in older children and adults. 50% of fecal samples of children 6-23 months old tested positive for rotavirus. The researchers did not find any obvious epidemiological link between the 3 areas. They concluded that the rotavirus epidemic which peaked the week after that of cholera represented the beginning of the usual rotavirus diarrhea season.
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