Outbreaks of acute diarrheal disease in tribal areas of Madhya Pradesh, India: epidemiological and microbiological analysis

: Background Outbreak of acute diarrheal diseases (ADD) are major public health problem in developing world. We conducted outbreak investigations to identify the etiology and suggest interventions. Methods Cases of ADD were reported form three blocks of two tribal districts viz. Balaghat and Mandla of Madhya Pradesh, India, during July-August 2024. Rapid response teams (RRTs) conducted outbreak investigations. Door-to-door surveys and hospital visits were done. Stool samples, rectal swabs and water samples were collected and tested for presence of viral and bacterial pathogens. Results A total of 322 cases were identified in Kosmi block of Balaghat district and 233 and 45 cases were detected in the Bichhiya and Ghughri blocks of Mandla district, respectively. Adults (72.60%) and males (55%) were more affected. A total of 8 deaths, 1 in Kosmi block, 3 in Bichhiya and 4 in Ghughri block were attributed to diarrhea. Eighty-one percent (35/43) water samples showed faecal contamination. Two out of 31 rectal swabs from Kosmi block, Balaghat, were positive for enterovirus. Vibrio cholerae O1 Ogawa was isolated from two stool samples, Shigella flexneri from one, and adenovirus from one out of 10 stool samples in Mandla district. Conclusions Outbreaks of diarrhea with involvement of multiple pathogens occurred in tribal areas of Madhya Pradesh, India. Identification of V. cholerae O1 Ogawa, S. flexneri and viral pathogens is alarming. Despite of few limitation of data on risk factors the study indicates regular surveillance is essential to avoid outbreaks and fatalities among tribal communities.