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Cholera deaths in Soho, London, 1854: Risk Terrain Modeling for epidemiological investigations
Joel M. Caplan | Leslie W. Kennedy | Christine H. Neudecker
Date of Publication:
Risk Terrain Modeling (RTM) is a spatial analysis technique used to diagnose environmental conditions that lead to hazardous outcomes. Originally developed for applications to violent crime analysis, RTM is utilized here to analyze Dr. John Snow’s data from the 1854 cholera outbreak in London to demonstrate its potential value to contemporary epidemiological investigations. Dr. Snow saved countless lives when he traced the source of the cholera outbreak to a specific water pump through inductive reasoning, which he communicated through maps and spatial evidence. His methods have since inspired several fields of scientific inquiry. Informed by the extant research on RTM, we speculated that it could have helped test Dr. Snow’s hypothesis about cholera and empirically identified the sole source of contaminated well water. We learned that it could and, although it was not available to Dr. Snow in the 1800s, we discuss RTM’s implications for present-day research and practice as it relates to the analysis, prevention and treatment of cholera and other public health threats around the world.
Contemporary Nigerian public health problem: prevention and surveillance are key to combating cholera
Israel Oluwasegun Ayenigbara | George Omoniyi Ayenigbara | Rowland Olasunkanmi Adeleke
Date of Publication:
GMS Hygiene and Infection Control
This review characterizes a cholera outbreak in Nigeria in 2017/2018. On the basis of own experiences and the analysis of historical outbreaks, the Vibrio cholera strains, mode of transmission, signs and symptoms, and most important the prevention and control measures are identified. Untreated, the lethality of cholera is up to 70%. Therefore, a multifaceted approach including public policy, surveillance, water purification and hygiene, community sensitization, and the use of oral cholera vaccination is vital to prevent, control, and reduce the cholera mortality rate. It is recommended that the government pass legislation to implement preventive and surveillance measures, e.g., invest in drinking water systems, sanitation systems and sewage treatment, and promote public education on basic hygiene. The latter includes boiling and treating water before drinking, washing hands frequently with soap and clean water, thoroughly cooking food before consumption, avoiding open defecation, disposing of wastes properly, and immediately taking anyone with signs and symptoms of cholera such as watery diarrhea to the hospital for treatment.
Delayed second dose of oral cholera vaccine administered before high-risk period for cholera transmission: Cholera control strategy in Lusaka, 2016
Eva Ferreras | Belem Matapo | Elizabeth Chizema-Kawesha | Orbrie Chewe | Hannah Mzyece | Alexandre Blake | Loveness Moonde | Gideon Zulu | Marc Poncin | Nyambe Sinyange | Nancy Kasese-Chanda | Caroline Phiri | Kennedy Malama | Victor Mukonka | Sandra Cohuet | Florent Uzzeni | Iza Ciglenecki | M. Carolina Danovaro-Holliday | Francisco J. Luquero | Lorenzo Pezzoli
Date of Publication:
In April 2016, an emergency vaccination campaign using one dose of Oral Cholera Vaccine (OCV) was organized in response to a cholera outbreak that started in Lusaka in February 2016. In December 2016, a second round of vaccination was conducted, with the objective of increasing the duration of protection, before the high-risk period for cholera transmission. We assessed vaccination coverage for the first and second rounds of the OCV campaign. Vaccination coverage was estimated after each round from a sample selected from targeted-areas for vaccination using a cross-sectional survey in to establish the vaccination status of the individuals recruited. The vaccination coverage with two doses was 58.1% (25/43; 95%CI: 42.1–72.9) in children 1–5 years old, 59.5% (69/116; 95%CI: 49.9–68.5) in children 5–15 years old and 19.9% (56/281; 95%CI: 15.4–25.1) in adults above 15 years old. The overall dropout rate was 10.9% (95%CI: 8.1–14.1). Overall, 69.9% (n = 309/442; 95%CI: 65.4–74.1) reported to have received at least one OCV dose. In conclusion, the areas at highest risk of cholera outbreak were targeted for vaccination obtaining relatively high vaccine coverage after each round. However, the long delay between doses in areas subject to considerable population movement resulted in many individuals receiving only one OCV dose. Additional vaccination campaigns may be required to sustain protection over time in case of persistence of risk. Further evidence is needed to establish a maximum optimal interval time of a delayed second dose and variations in different settings.