{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T07:54:04Z","timestamp":1790927644942,"version":"4.1.0"},"reference-count":33,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2026,7,25]],"date-time":"2026-07-25T00:00:00Z","timestamp":1784937600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,7,25]],"date-time":"2026-07-25T00:00:00Z","timestamp":1784937600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100009647","name":"Ministry of Health","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100009647","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Health Science Reports"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background and Aims<\/jats:title>\n                    <jats:p>Acute watery diarrhea (AWD) remains a major global public health problem, and cholera continues to cause substantial morbidity and mortality in settings with inadequate water, sanitation, and hygiene (WASH). Chattogram, a coastal district of Bangladesh, is particularly vulnerable due to seasonal hydroclimatic changes, salinity intrusion, and high population density. On May 6, 2023, an increase in AWD cases was reported, prompting an outbreak investigation. We aimed to describe the epidemiology, identify the causative pathogens and source, assess environmental contributors, examine seasonal trends, and recommend preventive measures.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We conducted a descriptive investigation from May 7 to May 15 2023, in two tertiary hospitals, two Upazila Health Complexes, and affected communities. Five\u2010year historical data were reviewed to assess seasonal patterns, and facility\u2010based surveillance data from April 2023 were analyzed. Active community case finding, standardized interviews, environmental assessments, stool culture and sensitivity testing, and water\u2010quality testing for coliforms,\n                      <jats:italic>Vibrio cholerae<\/jats:italic>\n                      , and salinity were performed.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Between April 1 and May 15 2023, 7956 AWD hospital admissions were reported, with sustained transmission during the pre\u2010monsoon period. Among 166 interviewed patients, adults aged 18\u201340 years were most affected (65\/166, 39%); all had AWD, and 85% (141\/166) reported vomiting. Six (6) of 23 stool cultures yielded\n                      <jats:italic>V. cholerae<\/jats:italic>\n                      . Coliform was detected in two (2) of three (3) tube wells and all pond samples, while non\u2010O1\/non\u2010O139\n                      <jats:italic>V. cholerae<\/jats:italic>\n                      was identified in multiple water sources. Salinity ranged from 210 to 2320\u2009mg\/L, with several sources exceeding recommended limits. Urban cases mainly relied on intermittent piped water, whereas rural households depended on tube wells and contaminated surface water with low treatment practices.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The outbreak was associated with unsafe and saline water, intermittent supply, and inadequate household water treatment. Strengthening climate\u2010resilient water systems, routine water\u2010quality monitoring, sanitation, and pre\u2010monsoon preparedness is essential to prevent recurrent cholera\u2010associated AWD outbreaks in coastal Bangladesh.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/hsr2.72844","type":"journal-article","created":{"date-parts":[[2026,7,26]],"date-time":"2026-07-26T06:32:26Z","timestamp":1785047546000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Seasonal Trends, Environmental Drivers, and Lessons Learned From the 2023 Cholera Outbreak in Chattogram, Bangladesh: A Descriptive Study"],"prefix":"10.1002","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-3492-8680","authenticated-orcid":false,"given":"Immamul","family":"Muntasir","sequence":"first","affiliation":[{"name":"Institute of Epidemiology, Disease Control and Research (IEDCR) Mohakhali Dhaka 1212 Bangladesh"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Md. Jahidur","family":"Rahman","sequence":"additional","affiliation":[{"name":"Institute of Epidemiology, Disease Control and Research (IEDCR) Mohakhali Dhaka 1212 Bangladesh"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sayik Bin","family":"Alam","sequence":"additional","affiliation":[{"name":"Directorate General Health Services (DGHS), Ministry of Health and Family Welfare  Bangladesh"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abir Shaqran","family":"Mahmood","sequence":"additional","affiliation":[{"name":"Institute of Epidemiology, Disease Control and Research (IEDCR) Mohakhali Dhaka 1212 Bangladesh"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tanvir","family":"Ahmed","sequence":"additional","affiliation":[{"name":"Directorate General Health Services (DGHS), Ministry of Health and Family Welfare  Bangladesh"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mithun","family":"Bahadur","sequence":"additional","affiliation":[{"name":"Directorate General Health Services (DGHS), Ministry of Health and Family Welfare  Bangladesh"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Farzana Islam","family":"Khan","sequence":"additional","affiliation":[{"name":"Institute of Epidemiology, Disease Control and Research (IEDCR) Mohakhali Dhaka 1212 Bangladesh"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kyaw Thowai Prue","family":"Prince","sequence":"additional","affiliation":[{"name":"Institute of Epidemiology, Disease Control and Research (IEDCR) Mohakhali Dhaka 1212 Bangladesh"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammad Rashedul","family":"Hassan","sequence":"additional","affiliation":[{"name":"Institute of Epidemiology, Disease Control and Research (IEDCR) Mohakhali Dhaka 1212 Bangladesh"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zakir Hossain","family":"Habib","sequence":"additional","affiliation":[{"name":"Institute of Epidemiology, Disease Control and Research (IEDCR) Mohakhali Dhaka 1212 Bangladesh"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5061-3783","authenticated-orcid":false,"given":"Tahmina","family":"Shirin","sequence":"additional","affiliation":[{"name":"Institute of Epidemiology, Disease Control and Research (IEDCR) Mohakhali Dhaka 1212 Bangladesh"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,7,25]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(18)30362-1"},{"key":"e_1_2_11_3_1","unstructured":"World Health Organization \u201cDiarrhoeal Disease \u201d updated 2017 https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/diarrhoeal-disease."},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.3389\/ijph.2024.1606399"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.4269\/ajtmh.21-1219"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12887-021-03022-2"},{"key":"e_1_2_11_7_1","first-page":"182","article-title":"Knowledge, Attitude, and Practice of Mothers of Under\u2010Five Children Regarding Diarrheal Illness: A Cross Sectional Study; Hyderabad","volume":"4","author":"Bapanpally N.","year":"2021","journal-title":"International Journal of Health and Clinical Research"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciac561"},{"key":"e_1_2_11_9_1","unstructured":"\u201cGlobal Burden of Disease Study 2017 (GBD 2017) Data Resources|GHDx \u201d accessed February 14 2026 https:\/\/ghdx.healthdata.org\/gbd-2017."},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pntd.0009953"},{"key":"e_1_2_11_11_1","unstructured":"M.Sultana R. 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