Clinical Characteristics of 6578 Adult Patients With Cholera Admitted to Community and Referral Cholera Treatment Centers in Lusaka, Zambia, October 2023 to April 2024 - Report - MDSpire
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Clinical Characteristics of 6578 Adult Patients With Cholera Admitted to Community and Referral Cholera Treatment Centers in Lusaka, Zambia, October 2023 to April 2024
Clinical Features of 6,578 Adult Cholera Patients Hospitalized in Lusaka, Zambia
Overview
During the 2023–2024 cholera outbreak in Lusaka, Zambia, 6,578 adult patients were hospitalized with an overall case fatality rate of 1.0%. Age, HIV infection, diabetes mellitus, and severe dehydration at admission were independently associated with fatal outcomes.
Background
Cholera is an acute diarrheal disease caused by Vibrio cholerae, with severe symptoms developing in 5%–10% of patients. Zambia, a cholera-endemic country, experienced its largest outbreak in history from October 2023 to April 2024, primarily affecting Lusaka. Multiple cholera treatment centers (CTCs) were established to manage patients, with referral systems in place for severe cases and those with underlying conditions. Understanding clinical characteristics and risk factors for severe outcomes in adults is critical for improving case management during outbreaks.
Data Highlights
Parameter
Value
Total adult cholera cases
6,578
Overall case fatality rate (CFR)
1.0% (51 of 5,020)
CFR at referral CTC for underlying conditions
4.1% (32 of 772)
Odds ratio for fatal outcome - Age
1.05 (95% CI, 1.02–1.09)
Odds ratio for fatal outcome - HIV infection
5.68 (95% CI, 2.12–15.30)
Odds ratio for fatal outcome - Diabetes mellitus
8.21 (95% CI, 1.38–34.00)
Odds ratio for fatal outcome - Severe dehydration
5.97 (95% CI, 1.29–56.94)
Key Findings
A total of 6,578 adult cholera cases were hospitalized in Lusaka during the outbreak.
The overall case fatality rate was 1.0%, but it was significantly higher (4.1%) in referral centers managing patients with underlying conditions.
Older age was independently associated with increased risk of fatal outcome (OR 1.05 per year).
Human immunodeficiency virus (HIV) infection markedly increased the risk of death (OR 5.68).
Diabetes mellitus was strongly correlated with fatal outcomes (OR 8.21).
Severe dehydration at admission was a significant predictor of mortality (OR 5.97).
Clinical Implications
Clinicians should prioritize early identification and aggressive management of adult cholera patients who are older, have HIV infection, diabetes, or present with severe dehydration. Referral systems and enhanced case management strategies targeting these high-risk groups may reduce mortality during cholera outbreaks. Resource allocation should consider these risk factors to optimize patient outcomes.
Conclusion
This large outbreak study highlights key clinical factors associated with fatal outcomes in adult cholera patients in Lusaka. Targeted interventions for high-risk groups are essential to reduce case fatality rates in future outbreaks.
References
Zambia Ministry of Health and Zambia National Public Health Institute, 2024 -- Clinical Features of Adult Cholera Patients in Lusaka
