CHOLERA IN SANA'A, YEMEN: CLINICAL FEATURES, RISK FACTORS AND ANTIBIOTIC SENSITIVITY OF VIBRIO CHOLERAE
Authors: Al-Mohanadi Eman Mohmmed Ahmed , Moharem Ahmed Saif Seed , Al-Moyed Khaled Abdul-Karim A , Al-Shamahy Hassan Abdulwahab , Al-Haidari Sami Ahmed , Al-Hadad Ahmed Mohamed 
Published: July 2022

Background: Cholera, caused by Vibrio cholerae O1 or O139 serotypes, is one of the most important healthcare associated infections (HAI) among patients in Yemen.
Aim: This study aimed to determine the risk factors associated with cholera outbreaks, clinical presentations, and antibiotic susceptibility of the V. cholerae strains isolated among inpatient in Diarrheal Treatment Centers (DTCs) in Sana’a City.
Methods: This is a matched case-control study carried out on 134 DTC inpatients (cases) aged from 2 to 85 years who had a mean age of  26.8 years; and 134 community healthy individuals (control), ranged in age from 2 to 85 years with a mean age of 27.1 years in Sana'a. The identified isolates were tested for antibiotics susceptibility using disc diffusion technique.  Data were analyzed using Epi Info 7.2. Express the quantitative data as mean values, standard deviation (SD), when the data are normally distributed.
Results: Among the cases, females are more susceptible to cholera than males (62.7% vs. 37.3%), and there is an increase in the incidence of cholera with age as 32.8% of cases were in the ≥35-year age group. There were significant risk factors for cholera with unwashed fruits (OR=33, p<0.001), unwashed vegetables (OR=5.3, p=0.001), outside foods (OR=129, p<0.001), and leftovers un-cooled food (OR=2, p=0.04). Also, collapsed drinking water and sanitation system (OR=4.5, p<0.001), sewage running in street (OR=8.7, p<0.001), and contact with diarrhea persons in the home (OR=33.3, p<0.001) were factors associated with cholera, while being vaccinated with cholera vaccines (OR=0.11, p<0.001) and use of pipes for sewage disposal (OR=0.5, p=0.02) were factors protectively associated with cholera.
Conclusion: Cholera affects all age groups in Sana’a, with females and persons of the age group greater than 35 years mostly affected. The most common clinical presentations were watery diarrhea and abdominal pain. Consumption of unwashed fruits, vegetables, outside food, unrefrigerated food, use of breakdown sewage system, dilapidated sewage near the home, running of street sewage, and contact with diarrhea in the home were risk factors, while cholera vaccination was protective against it. Therefore there is need to ensure that proper hygiene and sanitation to prevent infection.
                       
Peer Review History:
Received: 1 May 2022; Revised: 12 June; Accepted: 28 June, Available online: 15 July 2022
Academic Editor: Dr. Asia Selman Abdullah, Pharmacy institute, University of Basrah, Iraq, asia_abdullah65@yahoo.com
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Received file:                                Reviewer's Comments:
Average Peer review marks at initial stage: 6.0/10
Average Peer review marks at publication stage: 7.0/10
Reviewers:
Dr. Bountain Welcome Tebeda,Chemical Pathology Department, Federal Medical Centre, Yenagoa, Nigeria. bountaintebeda@yahoo.com
Dr. Esther Marguerite Chase DJANGA, Faculty of Medicine and Biomedical Sciences. Department of Public Health. University of Yaoundé I, Cameroon. e.djanga@yahoo.com
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