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  • Title: Cholera in a developing megacity; Karachi, Pakistan.
    Author: Sheikh A, Khan A, Malik T, Fisher-Hoch SP.
    Journal: Epidemiol Infect; 1997 Dec; 119(3):287-92. PubMed ID: 9440430.
    Abstract:
    Despite rapid urbanization and increasing affluence in Karachi, cases of cholera are frequent. We analysed computerized isolation data from the AKUH Clinical Microbiology Laboratory, Karachi, from 1990-6 to examine microbiological, temporal and demographic trends in Vibrio cholerae infections. During this period 888 strains of V. cholerae (566 V. cholerae serogroup O1, and 204 V. cholerae serogroup O139) were isolated from specimens from 886 patients; 214/464 were adult inpatients, and 250/464 paediatric inpatients, the remaining 422 outpatients. Isolations peaked between June and August. Overlapping epidemics occurred in 1993 and 1994 of serogroup O1 (May to August), and serogroup O139 (August to October). All ages and social and economic strata were affected. Forty-four percent of all isolates were from children under the age of 5 years. The mean age of all patients with serogroup O1 infections was 19.6 years (+/-0.9) compared with 367 (+/-1.7) for serogroup O139 infections (P < 0.0001, t test). More than a quarter (27%) of all serogroup O1 isolates were from babies under 2 years of age. One patient had a serogroup O1 infection followed by a serogroup O139 infection 1 year later. Another patient was infected with serogroup O1 strains 5 years apart. Emergence of resistant strains was observed, but by 1996 serogroup O139 had disappeared. An aquatic organism, cholera nevertheless continues to take its toll in this city of 11 million situated in a desert. An analysis of computerized isolation data from the Aga Khan University Hospital Clinical Microbiology Laboratory (Karachi, Pakistan) for the 1990-96 period was performed to identify microbiologic, temporal, and demographic trends in Vibrio cholerae infections. During the study period, 888 strains of V. cholerae (566 V. cholerae serogroup O1 and 204 serogroup O139) were isolated in specimens from 886 patients (214 adult inpatients, 250 child inpatients, and 442 adult and child outpatients). Overlapping epidemics occurred in 1993 and 1994 of serogroup O1 (May-August) and serogroup O139 (August-October). 44% of all isolates involved children under 5 years of age and 27% of serogroup O1 isolates were from those under 2 years of age. There were no differences in cholera infection by socioeconomic status. The mean age of patients with serogroup O1 infections was 19.6 years compared with 36.7 years for those with serogroup O139 infections (p 0.0001). 1 patient had a serogroup O1 infection followed by a serogroup O139 infection 12 months later. Another patient was infected with serogroup O1 strains 5 years apart. Although emergence of resistant strains was observed, serogroup O139 had disappeared by 1996. These findings confirm the continuing presence of cholera in Karachi--a desert community with infrequent rainfall--and document its seasonal and temporal periodicity.
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