Prevention and control of cholera with household and community water, sanitation and hygiene (WASH) interventions: A scoping review of current international guidelines

Autoři: Lauren D’Mello-Guyett aff001;  Karin Gallandat aff001;  Rafael Van den Bergh aff003;  Dawn Taylor aff004;  Gregory Bulit aff005;  Dominique Legros aff006;  Peter Maes aff002;  Francesco Checchi aff007;  Oliver Cumming aff001
Působiště autorů: Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom aff001;  Environmental Health Unit, Médecins Sans Frontières, Brussels, Belgium aff002;  LuxOR, Luxembourg Operational Research Unit, Médecins Sans Frontières, Luxembourg aff003;  Public Health Unit, Médecins Sans Frontières, Amsterdam, Netherlands aff004;  Water, Sanitation and Hygiene, UNICEF, New York, New York, United States of America aff005;  Global Task Force on Cholera Control, World Health Organization, Geneva, Switzerland aff006;  Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom aff007
Vyšlo v časopise: PLoS ONE 15(1)
Kategorie: Research Article



Cholera remains a frequent cause of outbreaks globally, particularly in areas with inadequate water, sanitation and hygiene (WASH) services. Cholera is spread through faecal-oral routes, and studies demonstrate that ingestion of Vibrio cholerae occurs from consuming contaminated food and water, contact with cholera cases and transmission from contaminated environmental point sources. WASH guidelines recommending interventions for the prevention and control of cholera are numerous and vary considerably in their recommendations. To date, there has been no review of practice guidelines used in cholera prevention and control programmes.


We systematically searched international agency websites to identify WASH intervention guidelines used in cholera programmes in endemic and epidemic settings. Recommendations listed in the guidelines were extracted, categorised and analysed. Analysis was based on consistency, concordance and recommendations were classified on the basis of whether the interventions targeted within-household or community-level transmission.


Eight international guidelines were included in this review: three by non-governmental organisations (NGOs), one from a non-profit organisation (NPO), three from multilateral organisations and one from a research institution. There were 95 distinct recommendations identified, and concordance among guidelines was poor to fair. All categories of WASH interventions were featured in the guidelines. The majority of recommendations targeted community-level transmission (45%), 35% targeted within-household transmission and 20% both.


Recent evidence suggests that interventions for effective cholera control and response to epidemics should focus on case-centred approaches and within-household transmission. Guidelines did consistently propose interventions targeting transmission within households. However, the majority of recommendations listed in guidelines targeted community-level transmission and tended to be more focused on preventing contamination of the environment by cases or recurrent outbreaks, and the level of service required to interrupt community-level transmission was often not specified. The guidelines in current use were varied and interpretation may be difficult when conflicting recommendations are provided. Future editions of guidelines should reflect on the inclusion of evidence-based approaches, cholera transmission models and resource-efficient strategies.

Klíčová slova:

Disinfection – Hygiene – Cholera – Sanitation – Surface water – Water management – Water quality – Water resources


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