Cholera outbreak and water resources: Linkages between consumption, infection spread at Mehar village, Sagar district in India.

A cholera outbreak in Mehar village, Sagar District, Madhya Pradesh (July 2024) affected 901 individuals (attack rate 18.02%) with 4 deaths among elderly comorbid patients. Epidemic investigation confirmed Vibrio cholerae and faecal coliforms in rectal swabs, stool samples and water from the community bore well serving as the primary drinking source near the temple. Despite multiple alternative water sources available, this single bore well supplied most households, schoolchildren (37%) and open defecation- practising communities (80%). Contaminated bore well water represented the point source of outbreak, exacerbated by open defecation despite absence of visible contamination markers nearby. Thus, we show outbreak investigation methodology by demonstrating integrated water source tracing and rapid microbiological confirmation as essential strategies for cholera containment in rural settings.