Tag: Disease Outbreaks

Shaheed Syed Nazrul Islam Medical College Journal
Volume 11, Issue 1
January, 2026

Acute Watery Diarrhoea Outbreak from Contaminated Municipal Water Supply in Jashore, Bangladesh, 2015

*Billah MM,¹ Rahaman MR,² Samad MS,³ Habib ZH,⁴ Billah SB,⁵ Rahman M⁶

Abstract

Background: Diarrhoeal outbreaks commonly occur during pre- and post-monsoon seasons in Bangladesh. On October 12, 2015, the Superintendent of the 250-bedded General Hospital, Jashore, informed the Institute of Epidemiology, Disease Control and Research, Bangladesh, of an increase in admission of patients with acute watery diarrhoea from Jashore Municipality. We investigated the event to ascertain the cause of the outbreak and its associated risk factors.
Methods: We conducted a descriptive study followed by a case–control study in Jashore Municipality from October 13 – 20, 2015. We defined a case as any person living in Jashore Municipality having three or more episodes of loose motion per day with symptoms lasting ≤7 days. A control was defined as any person living in Jashore Municipality without a history of loose motion in the preceding 7 days. Stool samples of untreated patients were tested for a rapid dipstick test for Vibrio cholerae O1 and culture sensitivity. Water samples from the municipal water pump and households were tested for microbial contamination. Cases were enrolled from hospitals and asymptomatic controls were identified by convenience sampling from the same hospitals’ outpatient clinics, matched by municipal residence and household access to municipal water. Descriptive analysis and logistic regressions were performed. We calculated adjusted odds ratios (AOR) and 95% confidence intervals (CI).
Results: Between 9–14 October, 214 patients were admitted to the hospital; 115 (53.7%) lived in Jashore municipality. Cases were from all age groups, with 57% males. We enrolled 27 cases and 49 controls. Drinking municipal supplied water in the preceding 24 hours was significantly associated with illness (AOR 4.5; 95% CI: 1.3–15.3; p=0.015). In stool samples, Vibrio cholerae O1 was identified by rapid test in 3/8 (37.5%) samples and two were confirmed by culture. Household-level municipal water had total coliforms up to 8,000 CFU/ml. Environmental inspection found multiple breaches in water supply pipes running through open drains.
Conclusion: The investigation confirmed a cholera outbreak in Jashore district, most likely spread through the contaminated municipal water supply. We recommended repairing leakages, chlorination, and public education to prevent future outbreaks in similar urban settings.

[Shaheed Syed Nazrul Islam Med Col J 2026, Jan; 11 (1):14-23]
DOI: https://www.doi.org/10.69699/ssnimcj.2026.11.1.3
Keywords: Acute Watery Diarrhoea, Cholera, Water Supply, Disease Outbreaks, Case-Control Studies, Environmental Monitoring, Bangladesh

 

1. *Dr. Mallick Masum Billah, MSc in Applied Epidemiology, MPH (Epidemiology), MBBS, Resident Advisor, Field Epidemiology Training Program, Nepal, South Asia Field Epidemiology and Technology Network Inc. (SAFETYNET) https://orcid.org/0000-0002-8545-2879 . drmasumbillah@yahoo.com
2. Md Rezanur Rahaman, PhD, MSc in Applied Epidemiology, MPH, Assistant Professor National Centre for Epidemiology and Population Health, The Australian National University, Canberra, ACT 2601, Australia https://orcid.org/0000-0003-4782-4149
3. Mohammad Sohel Samad, PhD, MPH; MS, Associate Professor & Head (Community Medicine & Public Health, Mugda Medical College, Dhaka, https://orcid.org/0000-0003-4502-8747
4. Zakir Hossain Habib, Professor of. Microbiology & Chief Scientific Officer, Department of. Microbiology, Institute of Epidemiology, Disease Control and Research (IEDCR), Dhaka https://orcid.org/0000-0003-2163-3600
5. Syed Md Baqui Billah, PhD, MPH (Epidemiology), MBBS, Deputy Director, Directorate General of Medical Education, Mohakhali, Dhaka, Bangladesh https://orcid.org/0000-0001-9337-9627
6. Professor Mahmudur Rahman, PhD, MPH, Former Director, Institute of Epidemiology, Disease Control and Research (IEDCR), Dhaka https://orcid.org/0000-0002-3698-4852

*For correspondence

Full Article in PDF