Correlation Between Some Risk Factors and the Incidence of Diarrhea Outbreak in Kosar Industrial Estate, A Case-Control Study in 2013

Document Type : Original Article


1 Gonabad University of Medical Sciences, Gonabad, IR Iran

2 Medicine School, Gonabad University of Medical Sciences, Gonabad, IR Iran

3 Department of Basic Sciences, School of Paramedical Sciences, Gonabad University of Medical Sciences, Gonabad, IR Iran


Background: The most important diarrheal disease of the year warm seasons is cholera with Vibrio cholera bacteria that some cases are observed in the country every year. Objectives: The purpose of this study was to identify the outbreak factors of diarrheal disease and prevention ways of its mortality rate among Gonabad city workers. Patients and Methods: This study is a case-control study conducted in 29 June 2013 to 6 August 2013, followed by diarrhea outbreak occurred in Brick kilns of Kosar industrial unit in Gonabad city. The data were collected by a questionnaire from patients and healthy people. Cholera sample and Stool exam were taken from all the patients. To determine the source of disease, water microbial sampling, chlorine metering and chlorine chlorination was conducted. Results: A total of 120 workers were studied (60 cases and 60 controls) who were the same from age and sex point of view. Clinical signs observed in 60% of cases were abdominal cramping and 11.6% had nausea. Human test results showed 1 sample of Eltor ogawa serotype and 4 Nag strains. No significant differentiation was observed in hand washing between the patients and the healthy ones (P = 0.15). The risk factor of using from water storage was 3 times more in case than the control group. Conclusions: Health disobedience and neglect of local residents were the causes of water pollution that was controlled with preventional measures, with performing daily chlorination of Brick kilns drinking water and diarrheal disease treatment of the patients.


  1. 1.Seas C, Gotuzzo E. Vibrio cholera. In: Mandell GL, Bennett JE, Dolin R editors. Principles and Practice of Infectious Diseases.. New York: Churchill Livingston; 2000. Ramezani Aval Riabi H et al. 6 Razavi Int J Med. 2015;3(1):e23582

    1. Khazaei HA, Rezaei N, Bagheri GR, Moin AA. A six-year study on Vibrio cholerae in southeastern Iran. Jpn J Infect Dis. 2005; 58(1):8–10.
    2. Bentivoglio M, Pacini P. Filippo Pacini: a determined observer. Brain Res Bull. 1995;38(2):161–5.
    3. WHO.. Fact sheet on cholera.. Available from: mediacentre/factsheets/fs107/en/.
    4. Moieni Gazeni A. What you need to know about:Eltor For physicians.; 2008.
    5. Kaper JB, Morris JG Jr, Levine MM. Cholera. Clin Microbiol Rev. 1995;8(1):48–86.
    6. Yamai S, Okitsu T, Shimada T, Katsube Y. [Distribution of serogroups of Vibrio cholerae non-O1 non-O139 with specific reference to their ability to produce cholera toxin, and addition of novel serogroups]. Kansenshogaku Zasshi. 1997;71(10):1037–45.
    7. Dalsgaard A, Albert MJ, Taylor DN, Shimada T, Meza R, Serichantalergs O, et al. Characterization of Vibrio cgolerae non-O1 serogroups obtained from an outbreak of diarrhea in Lima, Peru. J Clin Microbiol. 1995;33(10):2715–22.
    8. Dalsgaard A, Forslund A, Bodhidatta L, Serichantalergs O, Pitarangsi C, Pang L, et al. A high proportion of Vibrio cholerae strains isolated from children with diarrhoea in Bangkok, Thailand are multiple antibiotic resistant and belong to heterogenous nonO1, non-O139 O-serotypes. Epidemiol Infect. 1999;122(2):217–26.
    9. Kamble TK, More SR, Chavan SS, Kulkarni ND, Lodha NS, Kamble AS. Clinical profile of non-O1 strain-O139 of Vibrio cholerae in the region of Ambajogai, Maharashtra. J Assoc Physicians India. 2000;48(5):505–6.
    10. Morris JG Jr, Takeda T, Tall BD, Losonsky GA, Bhattacharya SK, Forrest BD, et al. Experimental non-O group 1 Vibrio cholerae gastroenteritis in humans. J Clin Invest. 1990;85(3):697–705.
    11. Mukhopadhyay AK, Saha PK, Garg S, Bhattacharya SK, Shimada T, Takeda T, et al. Distribution and virulence of Vibrio cholerae belonging to serogroups other than O1 and O139: a nationwide survey. Epidemiol Infect. 1995;114(1):65–70.
    12. Ramamurthy T, Bag PK, Pal A, Bhattacharya SK, Bhattacharya MK, Shimada T, et al. Virulence patterns of Vibrio cholerae non-O1 strains isolated from hospitalised patients with acute diarrhoea in Calcutta, India. J Med Microbiol. 1993;39(4):310–7.
    13. Rudra S, Mahajan R, Mathur M, Kathuria K, Talwar V. Cluster of cases of clinical cholera due to Vibrio cholerae 010 in east Delhi. Indian J Med Res. 1996;103:71–3.
    14. Aldova E, Laznickova K, Stepankova E, Lietava J. Isolation of nonagglutinable vibrios from an enteritis outbreak in Czechoslovakia. J Infect Dis. 1968;118(1):25–31.
    15. Dalsgaard A, Serichantalergs O, Forslund A, Lin W, Mekalanos J, Mintz E, et al. Clinical and environmental isolates of Vibrio cholerae serogroup O141 carry the CTX phage and the genes encoding the toxin-coregulated pili. J Clin Microbiol. 2001;39(11):4086–92.
    16. Sharma C, Thungapathra M, Ghosh A, Mukhopadhyay AK, Basu A, Mitra R, et al. Molecular analysis of non-O1, non-O139 Vibrio cholerae associated with an unusual upsurge in the incidence of cholera-like disease in Calcutta, India. J Clin Microbiol. 1998;36(3):756–63.
    17. Stine OC, Alam M, Tang L, Nair GB, Siddique AK, Faruque SM, et al. Seasonal cholera from multiple small outbreaks, rural Bangladesh. Emerg Infect Dis. 2008;14(5):831–3.
    18. Yoshia P, Nasehi M, Zamani S. Technical guidance and control of epidemic of cholera. .
    19. Hejazi A, Falkiner FR. Serratia marcescens. J Med Microbiol. 1997;46(11):903–12.
    20. Shah HD, Shah VP, Desai AN. An epidemic outbreak of Vibrio Cholerae El Tor 01 serotype ogawa biotype in a Lalpur town, Jamnagar, India. J Postgrad Med. 2012;58(1):14–8.
    21. Izadi S, Shakeri H, Roham P, Sheikhzadeh K. Cholera outbreak in southeast of iran: routes of transmission in the situation of good primary health care services and poor individual hygienic practices. Jpn J Infect Dis. 2006;59(3):174–8.
    22. Taneja N, Biswal M, Tarai B, Sharma M. Emergence of Vibrio cholerae O1 Biotype El Tor serotype Inaba in north India. Jpn J Infect Dis. 2005;58(4):238–40.
    23. Guo Z, Huang J, Shi G, Su CH, Niu JJ. A food-borne outbreak of gastroenteritis caused by norovirus GII in a university located in Xiamen City, China. Int J Infect Dis. 2014;28:101–6.