In response to the Latin American cholera epidemic, El Salvador began a prevention programme in April 1991. The first case was confirmed in August, and 700 cases were reported within 3 months. A matched case-control study was conducted in rural La Libertad Department in November 1991. Illness was associated with eating cold cooked or raw seafood (odds ratio [OR] = 7·0; 95% confidence limits [CL] = 1·4, 35·0) and with drinking water outside the home (OR = 8·8; 95% CL = 1·7, 44·6). Assertion of knowledge about how to prevent cholera (OR = 0·2; 95% CL = 0·1, 0·8) and eating rice (OR = 0·2; 95% CL = 0·1, 0·8) were protective. More controls than patients regularly used soap (OR = 0·3; 95% CL = 0·1, 1·0). This study demonstrated three important points for cholera prevention: (1) seafood should be eaten cooked and hot; (2) populations at risk should be taught to treat household drinking water and to avoid drinking water outside the home unless it is known to be treated; and (3) education about hygiene can be an important tool in preventing cholera.
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