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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.
Predicting quality and quantity of water used by urban households based on tap water service
Aurelie Jeandron | Oliver Cumming | Lumami Kapepula | Simon Cousens
Date of Publication:
December 16, 2019
npj Clean Water
Despite significant progress in improving access to safe water globally, inadequate access remains a major public health concern in low- and middle-income countries. We collected data on the bacterial quality of stored drinking water and the quantity of water used domestically from 416 households in Uvira, Democratic Republic of the Congo. An indicator of tap water availability was constructed using invoices from 3,685 georeferenced piped water connections. We examined how well this indicator predicts the probability that a household’s stored drinking water is contaminated with Escherichia coli, and the total amount of water used at home daily, accounting for distance from alternative surface water sources. Probability of drinking water contamination is predicted with good discrimination overall, and very good discrimination for poorer households. More than 80% of the households are predicted to store contaminated drinking water in areas closest to the rivers and with the worst tap water service, where river water is also the most likely reported source of drinking water. A model including household composition predicts nearly two-thirds of the variability in the reported quantity of water used daily at home. Households located near surface water and with a poor tap water service indicator are more likely to use water directly at the source. Our results provide valuable information that supports an ongoing large-scale investment in water supply infrastructure in Uvira designed to reduce the high burden of cholera and other diarrhoeal diseases. This approach may be useful in other urban settings with limited water supply access.
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.
Cholera prevention and control in refugee settings: Successes and continued challenges
Kerry Shannon | Marisa Hast | Andrew S. Azman | Dominique Legros | Heather McKay | Justin Lessler
Date of Publication:
PLoS Neglected Tropical Diseases
Cholera has long been viewed as a serious threat for refugee populations. In the 1980s and 90s, refugee camps proliferated in Africa and Asia as a result of large civil wars and environmental disasters. These camps experienced large-scale cholera outbreaks with regularity because of overcrowding, scarce clean water, and poor sanitation and hygiene practices. Death rates were often high because of preexisting malnutrition, comorbidities, and limited access to medical care. Mobilization around these issues was greatly accelerated in 1994, when a particularly massive outbreak occurred among Rwandan refugees in the Lake Kivu region of Zaire (present-day Democratic Republic of the Congo), and approximately 42,000 people died. In response to this unprecedented tragedy, the humanitarian community developed and adopted the Sphere standards for the minimum acceptable living conditions and availability of health services in refugee camps and other humanitarian responses. Although refugee camps continue to experience many vulnerabilities, the increased focus on improved camp coordination, preparedness, timely multisectoral response, and adherence to minimum standards has resulted in a notable decrease in the number and size of camp-based cholera outbreaks and associated mortality.