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Epidemiology of an outbreak of cholera in Senegal (West Africa) in 1985: modes of transmission and mortality.
[Unpublished] . 24,  p.A cholera outbreak in villages under demographic surveillance by a team of ORSTOM researchers in the center part of Senegal during the first three months of 1985 is described. Health authorities started a vaccination campaign and disinfection of the wells. The ORSTOM team helped to treat cholera cases and a house-to-house survey of the area was started immediately. All cases of cholera-like diarrhea and vomiting that occurred during January-March 1985 in the villages were recorded on special forms. Most cases (63%) and most deaths occurred in January. The epidemic reached a peak during the fourth week of January, then plunged. Interventions started at the end of the third week with a mass vaccination campaign, chlorinization of wells, treatment of cases with oral rehydration therapy (ORT) and tetracycline (4 x 500 mg per day for 2 days), and chemoprophylaxis of cholera patient contacts with sulfadoxine. The pattern of the disease transmission was clearly identified from retrospective interviews in 4% of all cases. Among the 102 identified cases, 56% showed evidence of primary contamination at a funeral ceremony and 44% were secondary cases within the household caused by person-to-person cholera transmission. 70% of adults were contaminated at a burial ceremony and 82% of children inside the compound. 31% of all cholera patients were below 15 years of age (more than 44% of the total population), while 28% of all cholera cases were among the population aged over 50 (14% of the population). During these 3 months, 235 cases of cholera with 44 deaths were recorded. The overall attack rate was 1.9/100 population, and the global lethality rate was 18.7%. However, below age 50 the case-fatality rate was 10%, and after age 50 it rose to 40%. 24.7% of males vs. 14.5% of females were at risk of dying. The drop from a peak of 43% lethality to less than 10% a week later was most probably attributable to ORT and tetracycline treatment.