Cholera has caused seven global pandemics, including the current one which has been ongoing since 1961. A systematic review of risk factors for symptomatic cholera infection has not been previously published.
In accordance with PRISMA guidelines, we performed a systematic review and meta-analysis of individual and household risk factors for symptomatic cholera infection.
We identified 110 studies eligible for inclusion in qualitative synthesis. Factors associated with symptomatic cholera that were eligible for meta-analysis included education less than secondary level (summary OR 2.64, 95% CI 1.41-4.92, I2 = 8%), unimproved water source (summary OR 4.78, 95% CI 3.02-7.57, I2 = 49%), open container water storage (summary OR 2.51, 95% CI 1.57-4.01, I2 = 33%), consumption of food outside the home (summary OR 5.02, 95% CI 2.34-10.76, I2 = 61%), household contact with cholera (summary OR 3.99, 95% CI 2.03-7.87, I2 = 89%), water treatment (summary OR 0.22, 95% CI 0.13-0.36, I2 = 37%), and handwashing (summary OR 0.17, 95% CI 0.10-0.30, I2 = 37%). Other notable associations with symptomatic infection included income/wealth, blood group, gastric acidity, infant breastfeeding status, and HIV infection.
We identified potential risk factors for symptomatic cholera infection including environmental characteristics, socioeconomic factors, and intrinsic patient factors. Ultimately, a combination of interventional approaches targeting various groups with risk-adapted intensities may prove to be the optimal strategy for cholera control.
L. Eberly, None
L. C. Ivers, None