Cholera Outbreak Linked to Food Exposure-Rukwa Region, Tanzania, February to May 2025
1
Epidemiology and biostatistics, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es salaam, Tanzania, United Republic of
Popul. Med. 2026;8(Supplement Supplement 1):
ABSTRACT
BACKGROUND:
The Rukwa Region, Tanzania, experienced a significant cholera outbreak, reporting 1323 patients and 15 associated deaths by May 21 in 2025. To guide effective outbreak control efforts, we aimed at identifying the key environmental, behavioral, and socio-demographic factors associated with cholera infection in the area.
METHODS:
We conducted an unmatched case-control study from February 7 to May 21 in 2025. Cases were individuals from the line list meeting the national cholera surveillance case definition (suspected clinically or confirmed by laboratory testing), and controls were asymptomatic relatives or friends randomly selected from the same ward. Data was gathered using a structured questionnaire. We calculated crude odds ratios using logistic regression and included variables with p<0.2 in a multivariable model. Statistical significance was set at p<0.05 with 95% confidence intervals.
RESULTS:
We enrolled 232 participants: 85 patients with cholera and 147 controls. The median age was 19 years, and 51 (60%) of 85 patients were younger than 20 years. Females accounted for 52 (61.2%) of 85 patients and 82 (55.8%) of 147 controls. Eating food prepared outside the home was reported by 25 (29.4%) of 85 patients, compared to 14 (9.5%) of 147 controls, and was strongly associated with infection (adjusted odds ratio: 6.42; 95% confidence interval: 2.75-15.00). Participants older than 20 years had reduced odds of infection (adjusted odds ratio: 0.42; p=0.007). Using River/stream water suggested increased risk (adjusted odds ratio: 1.89; p=0.074), but this was not statistically significant.
CONCLUSIONS:
Cholera infection was strongly associated with eating food prepared outside the home and with younger age. Public health measures include temporary closure of food outlets, strengthening food hygiene in community food outlets through intensified inspections, strict adherence to safe food-handling practices, and focused hygiene education for younger residents. Following these actions, the outbreak was declared over two months later.
The Rukwa Region, Tanzania, experienced a significant cholera outbreak, reporting 1323 patients and 15 associated deaths by May 21 in 2025. To guide effective outbreak control efforts, we aimed at identifying the key environmental, behavioral, and socio-demographic factors associated with cholera infection in the area.
METHODS:
We conducted an unmatched case-control study from February 7 to May 21 in 2025. Cases were individuals from the line list meeting the national cholera surveillance case definition (suspected clinically or confirmed by laboratory testing), and controls were asymptomatic relatives or friends randomly selected from the same ward. Data was gathered using a structured questionnaire. We calculated crude odds ratios using logistic regression and included variables with p<0.2 in a multivariable model. Statistical significance was set at p<0.05 with 95% confidence intervals.
RESULTS:
We enrolled 232 participants: 85 patients with cholera and 147 controls. The median age was 19 years, and 51 (60%) of 85 patients were younger than 20 years. Females accounted for 52 (61.2%) of 85 patients and 82 (55.8%) of 147 controls. Eating food prepared outside the home was reported by 25 (29.4%) of 85 patients, compared to 14 (9.5%) of 147 controls, and was strongly associated with infection (adjusted odds ratio: 6.42; 95% confidence interval: 2.75-15.00). Participants older than 20 years had reduced odds of infection (adjusted odds ratio: 0.42; p=0.007). Using River/stream water suggested increased risk (adjusted odds ratio: 1.89; p=0.074), but this was not statistically significant.
CONCLUSIONS:
Cholera infection was strongly associated with eating food prepared outside the home and with younger age. Public health measures include temporary closure of food outlets, strengthening food hygiene in community food outlets through intensified inspections, strict adherence to safe food-handling practices, and focused hygiene education for younger residents. Following these actions, the outbreak was declared over two months later.
| eISSN: | 2654-1459 |
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