American Journal of Epidemiology Vol. 146, No. 12: 1067-1075
Copyright © 1997 by The Johns Hopkins University School of Hygiene and Public Health
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Cholera in Lima, Peru, Correlates with Prior Isolation of Vibrio cholerae from the Environment
1Institute de Medicina Tropical "Alexander von Humboldt," Universidad Peruana Cayetano Heredia Lima, Peru
2Department of Medicine, University of Maryland School of Medicine, and Veterans Affairs Medical Center Baltimore, MD
3Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine Baltimore, MD
4Department of Pathology, University of Maryland School of Medicine Baltimore, MD
Reprint requests to Dr. Glenn Morris, Room 934 MSTF, University of Maryland School of Medicine, 10 S, Pine Street, Baltimore, MD 21201
The authors utilized a recently developed DNA probe technique to obtain quantitative data on occurrence of Vibrio cholerae in samples collected monthly from 12 environmental sites in Lima, Peru, from November 1993 through March 1995. Peak V. cholerae counts ranged from 1027/ml to 105/ml, with the highest counts in sewage-contaminated areas and irrigation water. With our methodology, no V. cholerae cases were detected at any site during the winter months of July through October. Counts were detectable in the environment before onset of cholera in the community, with counts at "cleaner" sites upriver correlating significantly with occurrence of community disease 2 and 3 months later. In sites with heavy sewage contamination, V. cholerae could still be detected before the onset of cases in the community; however, in contrast to upriver sites, counts at these latter sites correlated most closely with the number of concurrently occurring cholera cases. These data support a model of cholera seasonality in which initial increases in number of V. cholerae in the environment (possibly triggered by temperature) are followed by onset of illness in the community, with these human cases further amplifying the organism as the epidemic cycle proceeds. Am J Epidemiol 1997;146: 1067–75.
cholera; environment; Vibrio cholerae
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