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    GRANDESSO, F. ALLAN, M. JEAN-SIMON, P. S. J. BONCY, J. BLAKE, A. PIERRE, R. ALBERTI, K. P. MUNGER, A. ELDER, G. OLSON, D. PORTEN, K. and LUQUERO, F. J. 2014. Risk factors for cholera transmission in Haiti during inter-peak periods: insights to improve current control strategies from two case-control studies. Epidemiology and Infection, Vol. 142, Issue. 08, p. 1625.

    Kamm, K. B. Feikin, D. R. Bigogo, G. M. Aol, G. Audi, A. Cohen, A. L. Shah, M. M. Yu, J. Breiman, R. F. and Ram, P. K. 2014. Associations between presence of handwashing stations and soap in the home and diarrhoea and respiratory illness, in children less than five years old in rural western Kenya. Tropical Medicine & International Health, Vol. 19, Issue. 4, p. 398.

    Date, K. Person, B. Nygren, B. Were, V. Kola, S. Ayers, T. and Quick, R. 2013. Evaluation of a Rapid Cholera Response Activity--Nyanza Province, Kenya, 2008. Journal of Infectious Diseases, Vol. 208, Issue. suppl 1, p. S62.

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    Lund, Barbara M. 2008. The Microbiological Safety of Food in Healthcare Settings.


Epidemic cholera in urban Zambia: hand soap and dried fish as protective factors

  • A. E. DUBOIS (a1) (a2), M. SINKALA (a3), P. KALLURI (a1), M. MAKASA-CHIKOYA (a3) and R. E. QUICK (a1)
  • DOI:
  • Published online: 01 April 2006

Between 28 November 2003 and 23 February 2004, 4343 cases and 154 deaths from cholera (case-fatality rate 3·5%) were reported in Lusaka, Zambia. A case-control study was conducted in February 2004 to assess potential transmission routes and prevention strategies. Consumption of raw vegetables was significantly associated with cholera [adjusted odds ratio (aOR) 4·7, 95% confidence interval (CI) 1·7–13, P=0·003). Consumption of a local sardine-like fish was protective (aOR 0·3, 95% CI 0·1–0·7, P=0·008). Hand soap was present in 90% of control homes and 58% of case homes. Observed hand soap was a strongly protective factor (aOR 0·1, 95% CI 0·04–0·4, P=0·001). No water source or treatment practice was significantly associated with cholera. This study documents the importance of foodborne transmission of cholera, illustrates the protective role of hand washing in an epidemic setting, and identifies a novel possible protective factor, a local fish, which warrants further research.

Corresponding author
Global AIDS Program Guyana, Centers for Disease Control and Prevention, 3170 Georgetown Place, Washington, DC 20521, USA. (Email:
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Epidemiology & Infection
  • ISSN: 0950-2688
  • EISSN: 1469-4409
  • URL: /core/journals/epidemiology-and-infection
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