Household Water Treatment Uptake during a Public Health Response to a Large Typhoid Fever Outbreak in Harare, Zimbabwe

Maho Imanishi Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Epidemic Intelligence Service, Scientific Education and Professional Development Program Office, Centers for Disease Control and Prevention, Atlanta, Georgia; Field Epidemiology & Laboratory Training Program, National Institute for Communicable Diseases, Johannesburg, South Africa; School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa; Safe Water Systems, Population Services International-Zimbabwe, Harare, Zimbabwe; Water Sanitation and Hygiene, Welthungerhilfe-Zimbabwe, Harare, Zimbabwe; Collaborating Centre for Operational Research and Evaluation, United Nations Children's Fund-Zimbabwe, Harare, Zimbabwe; City of Harare Health Services Department, Harare, Zimbabwe; Laboratory Services, National Microbiology Reference Laboratory, Harare Zimbabwe; Ministry of Health and Child Welfare, Harare, Zimbabwe; Centers for Disease Control and Prevention-Zimbabwe, Harare, Zimbabwe; Division of Global HIV/AIDS, Centers for Disease Control and Prevention, Atlanta, Georgia; Tufts University, Medford, Massachusetts

Search for other papers by Maho Imanishi in
Current site
Google Scholar
PubMed Close
,
Patience F. Kweza Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Epidemic Intelligence Service, Scientific Education and Professional Development Program Office, Centers for Disease Control and Prevention, Atlanta, Georgia; Field Epidemiology & Laboratory Training Program, National Institute for Communicable Diseases, Johannesburg, South Africa; School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa; Safe Water Systems, Population Services International-Zimbabwe, Harare, Zimbabwe; Water Sanitation and Hygiene, Welthungerhilfe-Zimbabwe, Harare, Zimbabwe; Collaborating Centre for Operational Research and Evaluation, United Nations Children's Fund-Zimbabwe, Harare, Zimbabwe; City of Harare Health Services Department, Harare, Zimbabwe; Laboratory Services, National Microbiology Reference Laboratory, Harare Zimbabwe; Ministry of Health and Child Welfare, Harare, Zimbabwe; Centers for Disease Control and Prevention-Zimbabwe, Harare, Zimbabwe; Division of Global HIV/AIDS, Centers for Disease Control and Prevention, Atlanta, Georgia; Tufts University, Medford, Massachusetts

Search for other papers by Patience F. Kweza in
Current site
Google Scholar
PubMed Close
,
Rachel B. Slayton Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Epidemic Intelligence Service, Scientific Education and Professional Development Program Office, Centers for Disease Control and Prevention, Atlanta, Georgia; Field Epidemiology & Laboratory Training Program, National Institute for Communicable Diseases, Johannesburg, South Africa; School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa; Safe Water Systems, Population Services International-Zimbabwe, Harare, Zimbabwe; Water Sanitation and Hygiene, Welthungerhilfe-Zimbabwe, Harare, Zimbabwe; Collaborating Centre for Operational Research and Evaluation, United Nations Children's Fund-Zimbabwe, Harare, Zimbabwe; City of Harare Health Services Department, Harare, Zimbabwe; Laboratory Services, National Microbiology Reference Laboratory, Harare Zimbabwe; Ministry of Health and Child Welfare, Harare, Zimbabwe; Centers for Disease Control and Prevention-Zimbabwe, Harare, Zimbabwe; Division of Global HIV/AIDS, Centers for Disease Control and Prevention, Atlanta, Georgia; Tufts University, Medford, Massachusetts

Search for other papers by Rachel B. Slayton in
Current site
Google Scholar
PubMed Close
,
Tanaka Urayai Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Epidemic Intelligence Service, Scientific Education and Professional Development Program Office, Centers for Disease Control and Prevention, Atlanta, Georgia; Field Epidemiology & Laboratory Training Program, National Institute for Communicable Diseases, Johannesburg, South Africa; School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa; Safe Water Systems, Population Services International-Zimbabwe, Harare, Zimbabwe; Water Sanitation and Hygiene, Welthungerhilfe-Zimbabwe, Harare, Zimbabwe; Collaborating Centre for Operational Research and Evaluation, United Nations Children's Fund-Zimbabwe, Harare, Zimbabwe; City of Harare Health Services Department, Harare, Zimbabwe; Laboratory Services, National Microbiology Reference Laboratory, Harare Zimbabwe; Ministry of Health and Child Welfare, Harare, Zimbabwe; Centers for Disease Control and Prevention-Zimbabwe, Harare, Zimbabwe; Division of Global HIV/AIDS, Centers for Disease Control and Prevention, Atlanta, Georgia; Tufts University, Medford, Massachusetts

Search for other papers by Tanaka Urayai in
Current site
Google Scholar
PubMed Close
,
Odrie Ziro Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Epidemic Intelligence Service, Scientific Education and Professional Development Program Office, Centers for Disease Control and Prevention, Atlanta, Georgia; Field Epidemiology & Laboratory Training Program, National Institute for Communicable Diseases, Johannesburg, South Africa; School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa; Safe Water Systems, Population Services International-Zimbabwe, Harare, Zimbabwe; Water Sanitation and Hygiene, Welthungerhilfe-Zimbabwe, Harare, Zimbabwe; Collaborating Centre for Operational Research and Evaluation, United Nations Children's Fund-Zimbabwe, Harare, Zimbabwe; City of Harare Health Services Department, Harare, Zimbabwe; Laboratory Services, National Microbiology Reference Laboratory, Harare Zimbabwe; Ministry of Health and Child Welfare, Harare, Zimbabwe; Centers for Disease Control and Prevention-Zimbabwe, Harare, Zimbabwe; Division of Global HIV/AIDS, Centers for Disease Control and Prevention, Atlanta, Georgia; Tufts University, Medford, Massachusetts

Search for other papers by Odrie Ziro in
Current site
Google Scholar
PubMed Close
,
Wellington Mushayi Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Epidemic Intelligence Service, Scientific Education and Professional Development Program Office, Centers for Disease Control and Prevention, Atlanta, Georgia; Field Epidemiology & Laboratory Training Program, National Institute for Communicable Diseases, Johannesburg, South Africa; School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa; Safe Water Systems, Population Services International-Zimbabwe, Harare, Zimbabwe; Water Sanitation and Hygiene, Welthungerhilfe-Zimbabwe, Harare, Zimbabwe; Collaborating Centre for Operational Research and Evaluation, United Nations Children's Fund-Zimbabwe, Harare, Zimbabwe; City of Harare Health Services Department, Harare, Zimbabwe; Laboratory Services, National Microbiology Reference Laboratory, Harare Zimbabwe; Ministry of Health and Child Welfare, Harare, Zimbabwe; Centers for Disease Control and Prevention-Zimbabwe, Harare, Zimbabwe; Division of Global HIV/AIDS, Centers for Disease Control and Prevention, Atlanta, Georgia; Tufts University, Medford, Massachusetts

Search for other papers by Wellington Mushayi in
Current site
Google Scholar
PubMed Close
,
Monica Francis-Chizororo Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Epidemic Intelligence Service, Scientific Education and Professional Development Program Office, Centers for Disease Control and Prevention, Atlanta, Georgia; Field Epidemiology & Laboratory Training Program, National Institute for Communicable Diseases, Johannesburg, South Africa; School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa; Safe Water Systems, Population Services International-Zimbabwe, Harare, Zimbabwe; Water Sanitation and Hygiene, Welthungerhilfe-Zimbabwe, Harare, Zimbabwe; Collaborating Centre for Operational Research and Evaluation, United Nations Children's Fund-Zimbabwe, Harare, Zimbabwe; City of Harare Health Services Department, Harare, Zimbabwe; Laboratory Services, National Microbiology Reference Laboratory, Harare Zimbabwe; Ministry of Health and Child Welfare, Harare, Zimbabwe; Centers for Disease Control and Prevention-Zimbabwe, Harare, Zimbabwe; Division of Global HIV/AIDS, Centers for Disease Control and Prevention, Atlanta, Georgia; Tufts University, Medford, Massachusetts

Search for other papers by Monica Francis-Chizororo in
Current site
Google Scholar
PubMed Close
,
Lazarus R. Kuonza Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Epidemic Intelligence Service, Scientific Education and Professional Development Program Office, Centers for Disease Control and Prevention, Atlanta, Georgia; Field Epidemiology & Laboratory Training Program, National Institute for Communicable Diseases, Johannesburg, South Africa; School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa; Safe Water Systems, Population Services International-Zimbabwe, Harare, Zimbabwe; Water Sanitation and Hygiene, Welthungerhilfe-Zimbabwe, Harare, Zimbabwe; Collaborating Centre for Operational Research and Evaluation, United Nations Children's Fund-Zimbabwe, Harare, Zimbabwe; City of Harare Health Services Department, Harare, Zimbabwe; Laboratory Services, National Microbiology Reference Laboratory, Harare Zimbabwe; Ministry of Health and Child Welfare, Harare, Zimbabwe; Centers for Disease Control and Prevention-Zimbabwe, Harare, Zimbabwe; Division of Global HIV/AIDS, Centers for Disease Control and Prevention, Atlanta, Georgia; Tufts University, Medford, Massachusetts

Search for other papers by Lazarus R. Kuonza in
Current site
Google Scholar
PubMed Close
,
Tracy Ayers Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Epidemic Intelligence Service, Scientific Education and Professional Development Program Office, Centers for Disease Control and Prevention, Atlanta, Georgia; Field Epidemiology & Laboratory Training Program, National Institute for Communicable Diseases, Johannesburg, South Africa; School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa; Safe Water Systems, Population Services International-Zimbabwe, Harare, Zimbabwe; Water Sanitation and Hygiene, Welthungerhilfe-Zimbabwe, Harare, Zimbabwe; Collaborating Centre for Operational Research and Evaluation, United Nations Children's Fund-Zimbabwe, Harare, Zimbabwe; City of Harare Health Services Department, Harare, Zimbabwe; Laboratory Services, National Microbiology Reference Laboratory, Harare Zimbabwe; Ministry of Health and Child Welfare, Harare, Zimbabwe; Centers for Disease Control and Prevention-Zimbabwe, Harare, Zimbabwe; Division of Global HIV/AIDS, Centers for Disease Control and Prevention, Atlanta, Georgia; Tufts University, Medford, Massachusetts

Search for other papers by Tracy Ayers in
Current site
Google Scholar
PubMed Close
,
Molly M. Freeman Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Epidemic Intelligence Service, Scientific Education and Professional Development Program Office, Centers for Disease Control and Prevention, Atlanta, Georgia; Field Epidemiology & Laboratory Training Program, National Institute for Communicable Diseases, Johannesburg, South Africa; School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa; Safe Water Systems, Population Services International-Zimbabwe, Harare, Zimbabwe; Water Sanitation and Hygiene, Welthungerhilfe-Zimbabwe, Harare, Zimbabwe; Collaborating Centre for Operational Research and Evaluation, United Nations Children's Fund-Zimbabwe, Harare, Zimbabwe; City of Harare Health Services Department, Harare, Zimbabwe; Laboratory Services, National Microbiology Reference Laboratory, Harare Zimbabwe; Ministry of Health and Child Welfare, Harare, Zimbabwe; Centers for Disease Control and Prevention-Zimbabwe, Harare, Zimbabwe; Division of Global HIV/AIDS, Centers for Disease Control and Prevention, Atlanta, Georgia; Tufts University, Medford, Massachusetts

Search for other papers by Molly M. Freeman in
Current site
Google Scholar
PubMed Close
,
Emmaculate Govore Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Epidemic Intelligence Service, Scientific Education and Professional Development Program Office, Centers for Disease Control and Prevention, Atlanta, Georgia; Field Epidemiology & Laboratory Training Program, National Institute for Communicable Diseases, Johannesburg, South Africa; School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa; Safe Water Systems, Population Services International-Zimbabwe, Harare, Zimbabwe; Water Sanitation and Hygiene, Welthungerhilfe-Zimbabwe, Harare, Zimbabwe; Collaborating Centre for Operational Research and Evaluation, United Nations Children's Fund-Zimbabwe, Harare, Zimbabwe; City of Harare Health Services Department, Harare, Zimbabwe; Laboratory Services, National Microbiology Reference Laboratory, Harare Zimbabwe; Ministry of Health and Child Welfare, Harare, Zimbabwe; Centers for Disease Control and Prevention-Zimbabwe, Harare, Zimbabwe; Division of Global HIV/AIDS, Centers for Disease Control and Prevention, Atlanta, Georgia; Tufts University, Medford, Massachusetts

Search for other papers by Emmaculate Govore in
Current site
Google Scholar
PubMed Close
,
Clemence Duri Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Epidemic Intelligence Service, Scientific Education and Professional Development Program Office, Centers for Disease Control and Prevention, Atlanta, Georgia; Field Epidemiology & Laboratory Training Program, National Institute for Communicable Diseases, Johannesburg, South Africa; School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa; Safe Water Systems, Population Services International-Zimbabwe, Harare, Zimbabwe; Water Sanitation and Hygiene, Welthungerhilfe-Zimbabwe, Harare, Zimbabwe; Collaborating Centre for Operational Research and Evaluation, United Nations Children's Fund-Zimbabwe, Harare, Zimbabwe; City of Harare Health Services Department, Harare, Zimbabwe; Laboratory Services, National Microbiology Reference Laboratory, Harare Zimbabwe; Ministry of Health and Child Welfare, Harare, Zimbabwe; Centers for Disease Control and Prevention-Zimbabwe, Harare, Zimbabwe; Division of Global HIV/AIDS, Centers for Disease Control and Prevention, Atlanta, Georgia; Tufts University, Medford, Massachusetts

Search for other papers by Clemence Duri in
Current site
Google Scholar
PubMed Close
,
Prosper Chonzi Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Epidemic Intelligence Service, Scientific Education and Professional Development Program Office, Centers for Disease Control and Prevention, Atlanta, Georgia; Field Epidemiology & Laboratory Training Program, National Institute for Communicable Diseases, Johannesburg, South Africa; School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa; Safe Water Systems, Population Services International-Zimbabwe, Harare, Zimbabwe; Water Sanitation and Hygiene, Welthungerhilfe-Zimbabwe, Harare, Zimbabwe; Collaborating Centre for Operational Research and Evaluation, United Nations Children's Fund-Zimbabwe, Harare, Zimbabwe; City of Harare Health Services Department, Harare, Zimbabwe; Laboratory Services, National Microbiology Reference Laboratory, Harare Zimbabwe; Ministry of Health and Child Welfare, Harare, Zimbabwe; Centers for Disease Control and Prevention-Zimbabwe, Harare, Zimbabwe; Division of Global HIV/AIDS, Centers for Disease Control and Prevention, Atlanta, Georgia; Tufts University, Medford, Massachusetts

Search for other papers by Prosper Chonzi in
Current site
Google Scholar
PubMed Close
,
Sekesai Mtapuri-Zinyowera Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Epidemic Intelligence Service, Scientific Education and Professional Development Program Office, Centers for Disease Control and Prevention, Atlanta, Georgia; Field Epidemiology & Laboratory Training Program, National Institute for Communicable Diseases, Johannesburg, South Africa; School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa; Safe Water Systems, Population Services International-Zimbabwe, Harare, Zimbabwe; Water Sanitation and Hygiene, Welthungerhilfe-Zimbabwe, Harare, Zimbabwe; Collaborating Centre for Operational Research and Evaluation, United Nations Children's Fund-Zimbabwe, Harare, Zimbabwe; City of Harare Health Services Department, Harare, Zimbabwe; Laboratory Services, National Microbiology Reference Laboratory, Harare Zimbabwe; Ministry of Health and Child Welfare, Harare, Zimbabwe; Centers for Disease Control and Prevention-Zimbabwe, Harare, Zimbabwe; Division of Global HIV/AIDS, Centers for Disease Control and Prevention, Atlanta, Georgia; Tufts University, Medford, Massachusetts

Search for other papers by Sekesai Mtapuri-Zinyowera in
Current site
Google Scholar
PubMed Close
,
Portia Manangazira Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Epidemic Intelligence Service, Scientific Education and Professional Development Program Office, Centers for Disease Control and Prevention, Atlanta, Georgia; Field Epidemiology & Laboratory Training Program, National Institute for Communicable Diseases, Johannesburg, South Africa; School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa; Safe Water Systems, Population Services International-Zimbabwe, Harare, Zimbabwe; Water Sanitation and Hygiene, Welthungerhilfe-Zimbabwe, Harare, Zimbabwe; Collaborating Centre for Operational Research and Evaluation, United Nations Children's Fund-Zimbabwe, Harare, Zimbabwe; City of Harare Health Services Department, Harare, Zimbabwe; Laboratory Services, National Microbiology Reference Laboratory, Harare Zimbabwe; Ministry of Health and Child Welfare, Harare, Zimbabwe; Centers for Disease Control and Prevention-Zimbabwe, Harare, Zimbabwe; Division of Global HIV/AIDS, Centers for Disease Control and Prevention, Atlanta, Georgia; Tufts University, Medford, Massachusetts

Search for other papers by Portia Manangazira in
Current site
Google Scholar
PubMed Close
,
Peter H. Kilmarx Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Epidemic Intelligence Service, Scientific Education and Professional Development Program Office, Centers for Disease Control and Prevention, Atlanta, Georgia; Field Epidemiology & Laboratory Training Program, National Institute for Communicable Diseases, Johannesburg, South Africa; School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa; Safe Water Systems, Population Services International-Zimbabwe, Harare, Zimbabwe; Water Sanitation and Hygiene, Welthungerhilfe-Zimbabwe, Harare, Zimbabwe; Collaborating Centre for Operational Research and Evaluation, United Nations Children's Fund-Zimbabwe, Harare, Zimbabwe; City of Harare Health Services Department, Harare, Zimbabwe; Laboratory Services, National Microbiology Reference Laboratory, Harare Zimbabwe; Ministry of Health and Child Welfare, Harare, Zimbabwe; Centers for Disease Control and Prevention-Zimbabwe, Harare, Zimbabwe; Division of Global HIV/AIDS, Centers for Disease Control and Prevention, Atlanta, Georgia; Tufts University, Medford, Massachusetts

Search for other papers by Peter H. Kilmarx in
Current site
Google Scholar
PubMed Close
,
Eric Mintz Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Epidemic Intelligence Service, Scientific Education and Professional Development Program Office, Centers for Disease Control and Prevention, Atlanta, Georgia; Field Epidemiology & Laboratory Training Program, National Institute for Communicable Diseases, Johannesburg, South Africa; School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa; Safe Water Systems, Population Services International-Zimbabwe, Harare, Zimbabwe; Water Sanitation and Hygiene, Welthungerhilfe-Zimbabwe, Harare, Zimbabwe; Collaborating Centre for Operational Research and Evaluation, United Nations Children's Fund-Zimbabwe, Harare, Zimbabwe; City of Harare Health Services Department, Harare, Zimbabwe; Laboratory Services, National Microbiology Reference Laboratory, Harare Zimbabwe; Ministry of Health and Child Welfare, Harare, Zimbabwe; Centers for Disease Control and Prevention-Zimbabwe, Harare, Zimbabwe; Division of Global HIV/AIDS, Centers for Disease Control and Prevention, Atlanta, Georgia; Tufts University, Medford, Massachusetts

Search for other papers by Eric Mintz in
Current site
Google Scholar
PubMed Close
,
Daniele Lantagne Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Epidemic Intelligence Service, Scientific Education and Professional Development Program Office, Centers for Disease Control and Prevention, Atlanta, Georgia; Field Epidemiology & Laboratory Training Program, National Institute for Communicable Diseases, Johannesburg, South Africa; School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa; Safe Water Systems, Population Services International-Zimbabwe, Harare, Zimbabwe; Water Sanitation and Hygiene, Welthungerhilfe-Zimbabwe, Harare, Zimbabwe; Collaborating Centre for Operational Research and Evaluation, United Nations Children's Fund-Zimbabwe, Harare, Zimbabwe; City of Harare Health Services Department, Harare, Zimbabwe; Laboratory Services, National Microbiology Reference Laboratory, Harare Zimbabwe; Ministry of Health and Child Welfare, Harare, Zimbabwe; Centers for Disease Control and Prevention-Zimbabwe, Harare, Zimbabwe; Division of Global HIV/AIDS, Centers for Disease Control and Prevention, Atlanta, Georgia; Tufts University, Medford, Massachusetts

Search for other papers by Daniele Lantagne in
Current site
Google Scholar
PubMed Close
, and
the Zimbabwe Typhoid Fever Outbreak Working Group 2011–2012 Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Epidemic Intelligence Service, Scientific Education and Professional Development Program Office, Centers for Disease Control and Prevention, Atlanta, Georgia; Field Epidemiology & Laboratory Training Program, National Institute for Communicable Diseases, Johannesburg, South Africa; School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa; Safe Water Systems, Population Services International-Zimbabwe, Harare, Zimbabwe; Water Sanitation and Hygiene, Welthungerhilfe-Zimbabwe, Harare, Zimbabwe; Collaborating Centre for Operational Research and Evaluation, United Nations Children's Fund-Zimbabwe, Harare, Zimbabwe; City of Harare Health Services Department, Harare, Zimbabwe; Laboratory Services, National Microbiology Reference Laboratory, Harare Zimbabwe; Ministry of Health and Child Welfare, Harare, Zimbabwe; Centers for Disease Control and Prevention-Zimbabwe, Harare, Zimbabwe; Division of Global HIV/AIDS, Centers for Disease Control and Prevention, Atlanta, Georgia; Tufts University, Medford, Massachusetts

Search for other papers by the Zimbabwe Typhoid Fever Outbreak Working Group 2011–2012 in
Current site
Google Scholar
PubMed Close
DOI:
https://doi.org/10.4269/ajtmh.13-0497
Volume/Issue:
Volume 90: Issue 5
Page(s):
945–954
Restricted access
Get Permissions

Locally manufactured sodium hypochlorite (chlorine) solution has been sold in Zimbabwe since 2010. During October 1, 2011–April 30, 2012, 4,181 suspected and 52 confirmed cases of typhoid fever were identified in Harare. In response to this outbreak, chlorine tablets were distributed. To evaluate household water treatment uptake, we conducted a survey and water quality testing in 458 randomly selected households in two suburbs most affected by the outbreak. Although 75% of households were aware of chlorine solution and 85% received chlorine tablets, only 18% had reportedly treated stored water and had the recommended protective level of free chlorine residuals. Water treatment was more common among households that reported water treatment before the outbreak, and those that received free tablets during the outbreak (P < 0.01), but was not associated with chlorine solution awareness or use before the outbreak (P > 0.05). Outbreak response did not build on pre-existing prevention programs.

Author Notes

* Address correspondence to Maho Imanishi, Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road NE MSC-09, Atlanta, GA 30329. E-mail: m.imanishi@gmail.com
† These authors are co-first authors.
‡ Zimbabwe Typhoid Fever Outbreak Working Group 2011–2012: Ajay Paul (Welthungerhilfe-Zimbabwe); Chiwurawa Zinyama and Phineas Jasi (Population Services International-Zimbabwe); Boiketho Murima, Blessing Zindi, Belete Woldeamanuel, and Susan M. L. Laver (United Nations Children's Funds-Zimbabwe); Innocent Mukeredzi (City of Harare Health Services Department); Peter Gumbo (National Microbiology Reference Laboratory-Zimbabwe); Panganai Dhliwayo (Centers for Disease Control and Prevention-Zimbabwe); Geofrey Jagero and Jane Juma (Centers for Disease Control and Prevention-Kenya/Kenya Medical Research Institute); Seymour Williams (Centers for Disease Control and Prevention-South Africa); Peter Wasswa (African Field Epidemiology Network); Gladys Gonzalez-Aviles, Kevin J. Joyce, Katherine A. O'Connor, and Michele B. Parsons (Centers for Disease Control and Prevention-Atlanta).

Financial support: This investigation was supported by the U.S. Centers for Disease Control and Prevention Division of Global Disease Detection and Emergency Response, the U.S. Agency for International Development's Office of U.S. Foreign Disaster Assistance, the United Nations Children's Fund-Zimbabwe, Welthungerhilfe-Zimbabwe, and Population Services International-Zimbabwe.

Authors' addresses: Maho Imanishi and Rachel B. Slayton, Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, GA, and Epidemic Intelligence Service, Scientific Education and Professional Development Program Office, Centers for Disease Control and Prevention, Atlanta, GA, E-mails: m.imanishi@gmail.com and via3@cdc.gov. Tracy Ayers, Molly M. Freeman, and Eric Mintz, Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, GA, E-mails: eyk6@cdc.gov, evy7@cdc.gov, and emintz@cdc.gov. Patience F. Kweza and Lazarus R. Kuonza, Field Epidemiology and Laboratory Training Program, National Institute for Communicable Diseases, Johannesburg, South Africa, E-mails: Patiencek@nicd.ac.za and LazarusK@nicd.ac.za. Tanaka Urayai, Population Services International-Zimbabwe, Harare, Zimbabwe, E-mail: turayai@psi-zim.co.zw. Odrie Ziro, Welthungerhilfe-Zimbabwe, Harare, Zimbabwe, E-mail: Odrie.Ziro@welthungerhilfe.de. Wellington Mushayi and Monica Francis-Chizororo, Collaborating Centre for Operational Research and Evaluation, United Nations Children's Funds-Zimbabwe, Harare, Zimbabwe, E-mails: wmushayi@unicef.org and mchizororo@unicef.org. Emmaculate Govore, Clemence Duri, and Prosper Chonzi, City of Harare Health Services Department, Harare, Zimbabwe, E-mails: echotogovore@yahoo.com, kireduri@gmail.com, and chonziprosper@yahoo.com. Sekesai Mtapuri-Zinyowera, National Microbiology Reference Laboratory, Ministry of Health and Child Welfare, Harare, Zimbabwe, E-mail: zinyoweras@nmrl.org.zw. Portia Manangazira, Ministry of Health and Child Welfare, Harare, Zimbabwe, E-mail: directoredc@gmail.com. Peter H. Kilmarx, Centers for Disease Control and Prevention-Zimbabwe, Harare, Zimbabwe, and Division of Global HIV/AIDS, Centers for Disease Control and Prevention, Atlanta, GA, E-mail: pbk4@cdc.gov. Daniele Lantagne, Tufts University, Medford, MA, E-mail: daniele.lantagne@tufts.edu.

Copyright:
© The American Society of Tropical Medicine and Hygiene 2014
Received:
27 Aug 2013
|
Accepted:
10 Jan 2014
|
Published Online:
07 May 2014
Cover The American Journal of Tropical Medicine and Hygiene
The American Journal of Tropical Medicine and Hygiene
Print ISSN:
0002-9637
Online ISSN:
1476-1645
  • 1.

    Levine MM, 2009. Typhoid Fever. Brachman PS, Abrutyn E, eds. Bacterial Infections of Humans: Epidemiology and Control. Fourth edition. New York, NY: Springer, 913–937.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2.

    Buckle GC, Walker CL, Black RE, 2012. Typhoid fever and paratyphoid fever: systematic review to estimate global morbidity and mortality for 2010. J Glob Health 2: 10401.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3.

    Nhapi I, 2009. The water situation in Harare, Zimbabwe: a policy and management problem. Water Policy 11: 221–235.

  • 4.

    Tanyanyiwa VI, Mutungamiri I, 2011. Residents perception on water and sanitation problems in Dzivaresekwa 1 high density suburb, Harare. Journal of Sustainable Development in Africa 13: 309–342.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5.

    Zimbabwe National Statistics Agency, 2013. Census 2012 Preliminary Report. Available at: http://www.zimstat.co.zw/dmdocuments/CensusPreliminary2012.pdf. Accessed May 28, 2013.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6.

    World Health Organization, 2009. Cholera in Zimbabwe: Epidemiological Bulletin Number 27 Week 24. Available at: http://www.who.int/hac/crises/zwe/sitreps/zimbabwe_epi_w24_7_13june2009.pdf. Accessed January 31, 2014.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7.

    Quick RE, Venczel LV, Mintz ED, Soleto L, Aparicio J, Gironaz M, Hutwagner L, Greene K, Bopp C, Maloney K, Chavez D, Sobsey M, Tauxe RV, 1999. Diarrhoea prevention in Bolivia through point-of-use water treatment and safe storage: a promising new strategy. Epidemiol Infect 122: 83–90.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8.

    Quick RE, Kimura A, Thevos A, Tembo M, Shamputa I, Hutwagner L, Mintz E, 2002. Diarrhea prevention through household-level water disinfection and safe storage in Zambia. Am J Trop Med Hyg 66: 584–589.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9.

    Arnold BF, Colford JM Jr, 2007. Treating water with chlorine at point-of-use to improve water quality and reduce child diarrhea in developing countries: a systematic review and meta-analysis. Am J Trop Med Hyg 76: 354–364.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10.

    Lantagne DS, Clasen TF, 2012. Use of household water treatment and safe storage methods in acute emergency response: case study results from Nepal, Indonesia, Kenya, and Haiti. Environ Sci Technol 46: 11352–11360.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11.

    Date KPB, Nygren B, Were V, Koka V, Ayers T, Quick R, 2013. Evaluation of a rapid cholera response activity—Nyanza Province, Kenya, 2008. J Infect Dis 208 (Suppl 1): S62–S68.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12.

    Centers for Disease Control and Prevention, 2012. Notes from the field: Salmonella Typhi infections associated with contaminated water—Zimbabwe, October 2011–May 2012. MMWR 61: 435.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13.

    Ribot EM, Fair MA, Gautom R, Cameron DN, Hunter SB, Swaminathan B, Barrett TJ, 2006. Standardization of pulsed-field gel electrophoresis protocols for the subtyping of Escherichia coli O157:H7, Salmonella, and Shigella for PulseNet. Foodborne Pathog Dis 3: 59–67.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14.

    Clinical and Laboratory Standards Institute, 2013. Performance Standards for Antimicrobial Susceptibility Testing; Twentieth Informational Supplement. Wayne, PA: CLSI.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15.

    Patel DS, Chapman S, 2005. The Dashboard: A Tool for Social Marketing Decision Making. PSI Research Division: Concept paper. Available at: http://www.psi.org/sites/default/files/publication_files/dashboard-2005.pdf. Accessed May 10, 2013.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16.

    Chapman S, Patel D, 2004. Concept Paper PSI Behavior Change Framework “Bubbles”: Proposed Revision. Available at: http://www.psi.org/sites/default/files/publication_files/behaviorchange.pdf. Accessed April 18, 2013.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17.

    United States Agency for International Development, 2010. Access and Behavioral Outcome Indicators for Water, Sanitation, and Hygiene. Available at: http://www.hip.watsan.net/page/4148. Accessed April 14, 2013.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18.

    Centers for Disease Control and Prevention, 2012. The Safe Water System, Jerry Cans. Available at: http://www.cdc.gov/safewater/jerrycan.html. Accessed October 23, 2013.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19.

    Slayton RB, Date KA, Mintz ED, 2013. Vaccination for typhoid fever in sub-Saharan Africa. Hum Vaccin Immunother 9: 903–906.

  • 20.

    Breiman RF, Cosmas L, Njuguna H, Audi A, Olack B, Ochieng JB, Wamola N, Bigogo GM, Awiti G, Tabu CW, Burke H, Williamson J, Oundo JO, Mintz ED, Feikin DR, 2012. Population-based incidence of typhoid fever in an urban informal settlement and a rural area in Kenya: implications for typhoid vaccine use in Africa. PLoS ONE 7: e29119.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 21.

    Lutterloh E, Likaka A, Sejvar J, Manda R, Naiene J, Monroe SS, Khaila T, Chilima B, Mallewa M, Kampondeni SD, Lowther SA, Capewell L, Date K, Townes D, Redwood Y, Schier JG, Nygren B, Tippett Barr B, Demby A, Phiri A, Lungu R, Kaphiyo J, Humphrys M, Talkington D, Joyce K, Stockman LJ, Armstrong GL, Mintz E, 2012. Multidrug-resistant typhoid fever with neurologic findings on the Malawi-Mozambique border. Clin Infect Dis 54: 1100–1106.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 22.

    Muyembe-Tamfum JJ, Veyi J, Kaswa M, Lunguya O, Verhaegen J, Boelaert M, 2009. An outbreak of peritonitis caused by multidrug-resistant Salmonella typhi in Kinshasa, Democratic Republic of Congo. Travel Med Infect Dis 7: 40–43.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 23.

    Wood S, Foster J, Kols A, 2012. Understanding why women adopt and sustain home water treatment: insights from the Malawi antenatal care program. Soc Sci Med 75: 634–642.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 24.

    Quick R, 2003. Changing community behavior: experience from three African countries. Int J Environ Health Res 13 (Suppl 1): S115–S121.

  • 25.

    Luby SP, Mendoza C, Keswick BH, Chiller TM, Hoekstra RM, 2008. Difficulties in bringing point-of-use water treatment to scale in rural Guatemala. Am J Trop Med Hyg 78: 382–387.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 26.

    Figueroa ME, Kincaid DL, 2010. Social, Cultural and Behavioral Correlates of Household Water Treatment and Storage. Available at: http://www.jhuccp.org/sites/all/files/Household%20Water%20Treatment%20and%20Storage%202010.pdf. Accessed December 13, 2013.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 27.

    Waterkeyn J, Cairncross S, 2005. Creating demand for sanitation and hygiene through community health clubs: a cost-effective intervention in two districts in Zimbabwe. Soc Sci Med 61: 1958–1970.

    • PubMed
    • Search Google Scholar
    • Export Citation
Past two years Past Year Past 30 Days
Abstract Views 569 501 35
Full Text Views 527 21 1
PDF Downloads 252 13 1
 
 
 
 
Affiliate Membership Banner
 
 
Research for Health Information Banner
 
 
CLOCKSS
 
 
 
Society Publishers Coalition Banner
Save