Online Program

New evidence of drug resistance observed in an outbreak of Cholera in Kumasi, Ghana 2012

Tuesday, November 5, 2013 : 2:35 p.m. - 2:55 p.m.

Dennis O. Laryea, MD MPH MGCP, Public Health Unit, Komfo Anokye Teaching Hospital, Kumasi, Ghana
Iman K. Martin, MPH MS PhD, Division of Epidemiology and Biostatistics, University of Illinois at Chicago School of Public Health, Chicago, IL
Robert Nii Awuley Lartey, BSc, Department of Clinical Microbiology, Komfo Anokye Teaching Hospital, Kumasi, Ghana
Joyce Asamoah, BSc, Public Health Unit, Komfo Anokye Teaching Hospital, Kumasi, Ghana
Yaw Amoako, BSc MD FWACP, Directorate of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana
Kathryn Spangenberg, MD, FGCP, Family Medicine Directorate, Komfo Anokye Teaching Hospital, Kumasi, Ghana
Cholera remains of great public health concern in developing countries. There is limited, yet convincing evidence of multi-drug resistant Cholera in Ghana.In an effort to continue documentation of resistance trends in Ghana, we present this recent clinically observed evidence of resistance to commonly used antibiotics. Currently, three antibiotics are recommended for treatment of Cholera per national guidelines; Tetracycline, Doxycycline and Erythromycin.The Ashanti Region is the most populated region in Ghana accounting for nearly 20% of the 25 million Ghanians. Kumasi houses the Komfo Anokye Teaching Hospital (KATH), the only national referral center in the region. Various environmental and sanitation conditions in the region are conducive for cholera transmission.Between the 24th November and 26th December 2012, the hospital recorded 26 suspected cases of Cholera. All patients presented with a history of profuse non-bloody, non-mucoid, watery diarrhea. A polyvalent serum was used to determine the serotypes of V. cholerae. Sixteen unique samples were sent for microbiologic investigation. Nine samples (56.3%) had V. cholera isolated with corresponding serotypes being Ogawa (n=8) and Inaba (n=1). Sensitivity patterns observed for routine antibiotics were 50% resistance for Erythromycin (n=2); 50% for Tetracycline(n=8); Ciprofloxacin 0% (n=9); Ceftriaxone 0% (n=8) and Cefuroxime 56% (n=8). The observed resistance challenges current national guidelines on antibiotic therapy for cholera.These data highlight potential for Ciprofloxacin use in future Cholera outbreaks in the region.Preventive measures notwithstanding, this small outbreak calls for capacity-building in large-scale molecular techniques for outbreak response. KATH is the only public institution regionally, and one of few nationally, capable of conducting antibiotic sensitivity testing.

Learning Areas:

Protection of the public in relation to communicable diseases including prevention or control

Learning Objectives:
Describe a recent Cholera outbreak in Ghana's Ashanti Region;Identify resistance to commonly used drugs; Explain the current capacity for microbiology in the regions hospitals; Discuss the need for further development of the local-national outbreak response and capacity building in molecular epidemiology

Keyword(s): Outbreaks, International Public Health

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am the Head of the Public Health Unit for the sole National referral center in the Ashanti Region of Ghana, which protects and serves more than 1.5 million patrons. I have various academic and public health credentials which enable me to present the data in this abstract. I have been apart of the national outbreak response (including Cholera) efforts for more than 5 years.
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.