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Cholera Incidence and Mortality in Sub-Saharan African Sites during Multi-country Surveillance
Delphine Sauvageot | Berthe-Marie Njanpop-Lafourcade | Laurent Akilimali | Jean-Claude Anne | Pawou Bidjada | Didier Bompangue | Godfrey Bwire | Daouda Coulibaly | Liliana Dengo-Baloi | Mireille Dosso | Christopher Garimoi Orach | Dorteia Inguane | Atek Kagirita | Adele Kacou-N’Douba | Sakoba Keita | Abiba Kere Banla | Yao Jean-Pierre Kouame | Dadja Essoya Landoh | José Paulo Langa | Issa Makumbi | Berthe Miwanda | Muggaga Malimbo | Guy Mutombo | Annie Mutombo | Emilienne Niamke NGuetta | Mamadou Saliou | Veronique Sarr | Raphael Kakongo Senga | Fode Sory | Cynthia Sema | Ouyi Valentin Tante | Bradford D. Gessner | Martin A. Mengel | Edward T. Ryan
Date of Publication:
PLOS Neglected Tropical Diseases
Cholera burden in Africa remains unknown, often because of weak national surveillance systems. We analyzed data from the African Cholera Surveillance Network (www.africhol.org).
During June 2011-December 2013, we conducted enhanced surveillance in seven zones and four outbreak sites in Togo, the Democratic Republic of Congo (DRC), Guinea, Uganda, Mozambique and Cote d'Ivoire. All health facilities treating cholera cases were included. Cholera incidences were calculated using culture-confirmed cholera cases and culture-confirmed cholera cases corrected for lack of culture testing usually due to overwhelmed health systems and imperfect test sensitivity. Of 13,377 reported suspected cases, 34% occurred in Conakry, Guinea, 47% in Goma, DRC, and 19% in the remaining sites. From 0-40% of suspected cases were aged under five years and from 0.3-86% had rice water stools. Within surveillance zones, 0-37% of suspected cases had confirmed cholera compared to 27-38% during outbreaks. Annual confirmed incidence per 10,000 population was <0.5 in surveillance zones, except Goma where it was 4.6. Goma and Conakry had corrected incidences of 20.2 and 5.8 respectively, while the other zones a median of 0.3. During outbreaks, corrected incidence varied from 2.6 to 13.0. Case fatality ratios ranged from 0-10% (median, 1%) by country.
Across different African epidemiological contexts, substantial variation occurred in cholera incidence, age distribution, clinical presentation, culture confirmation, and testing frequency. These results can help guide preventive activities, including vaccine use.