Clinical Characteristics of 6578 Adult Patients With Cholera Admitted to Community and Referral Cholera Treatment Centers in Lusaka, Zambia, October 2023 to April 2024

Abstract

Background: Zambia experienced the largest cholera outbreak in the country history in 2023-2024 in the capital, Lusaka. This study aimed to identify the clinical characteristics of the adult patients hospitalized at the community and referral cholera treatment centers (CTCs) to determine factors associated with their severe clinical outcomes during the outbreak. Methods: Clinical information on the adult patients with cholera in the community and referral CTCs was retrospectively analyzed. Clinical factors associated with the fatal outcome were explored by multivariate analysis, using Firth's penalized logistic regression. Results: A total of 6578 adult cases were identified. The overall case fatality rate was 1.0% (51 of 5020), and it was highest in a referral CTC specializing in patients with underlying conditions (4.1% [32 of 772]). In the multivariate analysis, age (odds ratio, 1.05 [95% confidence interval, 1.02-1.09]), human immunodeficiency virus infections (5.68 [2.12-15.30]), diabetes mellitus (8.21 [1.38-34.00]), and severe dehydration at admission (5.97 [1.29-56.94]) were independently correlated with fatal outcomes. Conclusions: Clinical factors, including age, underlying conditions, and disease severity at admission, were shown to be associated with severe clinical outcomes in adult patients with cholera. Enhanced case management strategies targeted for such high-risk groups might be beneficial in reducing the case fatality rate during cholera outbreaks.