{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T23:28:57Z","timestamp":1779233337137,"version":"3.51.4"},"reference-count":25,"publisher":"Cambridge University Press (CUP)","issue":"6","license":[{"start":{"date-parts":[[2013,10,29]],"date-time":"2013-10-29T00:00:00Z","timestamp":1383004800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/www.cambridge.org\/core\/terms"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Prehosp. Disaster med."],"published-print":{"date-parts":[[2013,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec id=\"S1049023X13008984_abs1\" sec-type=\"intro\"><jats:title>Introduction<\/jats:title><jats:p>Large earthquakes can cause population displacement, critical sanitation infrastructure damage, and increased threats to water resources, potentially predisposing populations to waterborne disease epidemics such as cholera.<\/jats:p><\/jats:sec><jats:sec id=\"S1049023X13008984_abs2\" sec-type=\"general\"><jats:title>Problem<\/jats:title><jats:p>The risk of cholera outbreaks after earthquake disasters remains uncertain. A cross-country analysis of World Health Organization (WHO) cholera data that would contribute to this discussion has yet to be published.<\/jats:p><\/jats:sec><jats:sec id=\"S1049023X13008984_abs3\" sec-type=\"methods\"><jats:title>Methods<\/jats:title><jats:p>A cross-country longitudinal analysis was conducted among 63 low- and middle-income countries from 1995-2009. The association between earthquake disasters of various effect sizes and a relative spike in cholera rates for a given country was assessed utilizing fixed-effects logistic regression and adjusting for gross domestic product per capita, water and sanitation level, flooding events, percent urbanization, and under-five child mortality. Also, the association between large earthquakes and cholera rate increases of various degrees was assessed.<\/jats:p><\/jats:sec><jats:sec id=\"S1049023X13008984_abs4\" sec-type=\"results\"><jats:title>Results<\/jats:title><jats:p>Forty-eight of the 63 countries had at least one year with reported cholera infections during the 15-year study period. Thirty-six of these 48 countries had at least one earthquake disaster. In adjusted analyses, country-years with \u226510,000 persons affected by an earthquake had 2.26 times increased odds (95 CI, 0.89-5.72,<jats:italic>P<\/jats:italic>= .08) of having a greater than average cholera rate that year compared to country-years having &lt;10,000 individuals affected by an earthquake. The association between large earthquake disasters and cholera infections appeared to weaken as higher levels of cholera rate increases were tested.<\/jats:p><\/jats:sec><jats:sec id=\"S1049023X13008984_abs5\" sec-type=\"conclusion\"><jats:title>Conclusion<\/jats:title><jats:p>A trend of increased risk of greater than average cholera rates when more people were affected by an earthquake in a country-year was noted. However these findings did not reach statistical significance at traditional levels and may be due to chance. Frequent large-scale cholera outbreaks after earthquake disasters appeared to be relatively uncommon.<\/jats:p><jats:p><jats:mixed-citation id=\"S1049023X13008984_ref\" publication-type=\"journal\"><jats:name name-style=\"western\"><jats:surname>Sumner<\/jats:surname><jats:given-names>S<\/jats:given-names><\/jats:name>,<jats:name name-style=\"western\"><jats:surname>Turner<\/jats:surname><jats:given-names>E<\/jats:given-names><\/jats:name>,<jats:name name-style=\"western\"><jats:surname>Thielman<\/jats:surname><jats:given-names>N<\/jats:given-names><\/jats:name>.<jats:article-title>Association between earthquake events and cholera outbreaks: a cross-country 15-year longitudinal analysis<\/jats:article-title>.<jats:source>Prehosp Disaster Med<\/jats:source>.<jats:year>2013<\/jats:year>;<jats:volume>28<\/jats:volume>(<jats:issue>6<\/jats:issue>):<jats:fpage>1<\/jats:fpage>-<jats:lpage>6<\/jats:lpage><\/jats:mixed-citation>.<\/jats:p><\/jats:sec>","DOI":"10.1017\/s1049023x13008984","type":"journal-article","created":{"date-parts":[[2013,10,29]],"date-time":"2013-10-29T14:21:00Z","timestamp":1383056460000},"page":"567-572","source":"Crossref","is-referenced-by-count":6,"title":["Association Between Earthquake Events and Cholera Outbreaks: A Cross-country 15-year Longitudinal Analysis"],"prefix":"10.1017","volume":"28","author":[{"given":"Steven A.","family":"Sumner","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elizabeth L.","family":"Turner","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nathan M.","family":"Thielman","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"56","published-online":{"date-parts":[[2013,10,29]]},"reference":[{"key":"S1049023X13008984_ref8","doi-asserted-by":"publisher","DOI":"10.1186\/1752-1505-1-2"},{"key":"S1049023X13008984_ref14","unstructured":"Cholera surveillance and number of cases: International Health Regulations (IHR). World Health Organization; 2012. http:\/\/www.who.int\/topics\/cholera\/surveillance\/en\/index.html. Accessed January 9, 2012."},{"key":"S1049023X13008984_ref","doi-asserted-by":"publisher","DOI":"10.1017\/S1049023X13008984"},{"key":"S1049023X13008984_ref23","unstructured":"Cameron AC, Trivedi PK. Microeconometrics Using Stata. Stata Press; 2010. College Station, Texas."},{"key":"S1049023X13008984_ref3","doi-asserted-by":"crossref","first-page":"317","DOI":"10.1136\/bmj.322.7282.317\/a","article-title":"Pneumonia, cholera, and dysentery feared after earthquake","volume":"322","author":"Sharma","year":"2001","journal-title":"BMJ"},{"key":"S1049023X13008984_ref1","doi-asserted-by":"crossref","first-page":"1067","DOI":"10.4269\/ajtmh.2006.74.1067","article-title":"Diarrheal epidemics in Dhaka, Bangladesh, during three consecutive floods: 1988, 1998, and 2004","volume":"74","author":"Schwartz","year":"2006","journal-title":"Am J Trop Med Hyg"},{"key":"S1049023X13008984_ref6","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(00)02642-8"},{"key":"S1049023X13008984_ref19","doi-asserted-by":"publisher","DOI":"10.1093\/ije\/29.4.764"},{"key":"S1049023X13008984_ref5","doi-asserted-by":"publisher","DOI":"10.3201\/eid1301.060779"},{"key":"S1049023X13008984_ref16","unstructured":"Weekly epidemiological record: cholera articles. 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