207733 Cholera Outbreak Training: Evaluation from Rural Zimbabwe and Next Steps

Wednesday, November 11, 2009: 9:10 AM

Eric Nelson, PhD MS , Molecular Biology and Microbiology, Tufts University School of Medicine, Boston, MA
Danielle Kauk, MD MPH , Lawrence Family Medicine Residency Program, Lawrence, MA
David Sack, MD , International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
Andrew Camilli, PhD , Molecular biology and microbiology, Tufts University School of Medicine/ HHMI, Boston, MA
The Cholera Outbreak Training and Shigellosis program (COTS program) is a to-the-point guideline for the management of cholera outbreaks in resource-poor settings. The COTS program is an interactive eBook (www.cotsprogram.org) designed for rapid training during outbreaks, as well as a tool for public health educators. COTS is based on established protocols developed at the WHO and the International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B). During the 2008-9 Zimbabwe cholera outbreak, COTS was successfully rolled-out by USAID and the WHO. Despite the strengths of the program, there were unique challenges in Zimbabwe that included a strain that equitably attacked all age groups, a population that proved to be immunologically na´ve, and patients spread across an expansive, difficult geography. These factors, paired with the complete collapse of the healthcare system, likely contributed to the case fatality rate (CFR) of 5% -- a rate five times above the accepted CFR. Based on our clinical experience at a rural Zimbabwean clinic, we make recommendations herein to update COTS, improve NGO Aid Kits, and cater to the clinical needs of populations co-infected with HIV. In addition, we explore options for transferring this experience back to the laboratory to optimize the field application of current vaccine development.

Learning Objectives:
Identify areas for improving the management of cholera outbreaks based on experience in rural Zimbabwe. Design better protocols for cholera management for rural African populations with a high HIV burden.

Keywords: Water, Infectious Diseases

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: Author of Cholera Outbreak Training and Shigellosis program. PhD and MS in environmental microbiology and transmission of cholera.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.