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Identification of cholera hotspots in Zambia: A spatiotemporal analysis of cholera data from 2008 to 2017
John Mwaba | Amanda K. Debes | Patrick Shea | Victor Mukonka | Orbrie Chewe | Caroline Chisenga | Michelo Simuyandi | Geoffrey Kwenda | David Sack | Roma Chilengi | Mohammad Ali
Date of Publication:
PLoS Neglected Tropical Diseases
Zambia has experienced cholera outbreaks since 1977. It is a landlocked country bordered by the DRC and Tanzania to the north, Malawi and Mozambique to the east and Zimbabwe to the south; all of which experience regular cholera outbreaks. The Zambian Ministry of Health included cholera vaccination, in addition to standard cholera control measures, e.g., clean water, improving sanitation and promoting hygiene to counter a cholera outbreak in 2016. The implementation of these control measures is in line with Zambia’s National Cholera Eliminating Plan (NCEP) by 2025 and is also consistent with guidance by the Global Task Force on Cholera Control’s (GTFCC) global roadmap to end cholera by 2030. In both plans, the identification of high risk areas known as cholera “hotspots” is necessary to prioritize OCV deployment while also key in identifying areas where improvements are needed including surveillance systems and effective WASH improvements. In this study, we retrospectively analyzed district-level cholera data from 2008 to 2017. Sixteen of 72 districts were identified to have an increased risk of cholera using a geostatistical model. Outside of Lusaka district, which is a primary hotspot, the additional hotspot districts share borders with Zambia’s neighboring countries. To achieve cholera elimination in Zambia by 2025, a regional strategy involving each of the countries bordering will be needed.
Cholera hotspots and surveillance constraints contributing to recurrent epidemics in Tanzania
Yaovi M. G. Hounmanou | Kåre Mølbak | Jonas Kähler | Robinson H. Mdegela | John E. Olsen | Anders Dalsgaard
Date of Publication:
BMC Research Notes
We described the dynamics of cholera in Tanzania between 2007 and 2017 and assessed the weaknesses of the current surveillance system in providing necessary data in achieving the global roadmap to 2030 for cholera control. The Poisson-based spatial scan identified cholera hotspots in mainland Tanzania. A zero-inflated Poisson regression investigated the relationship between the incidence of cholera and available demographic, socio-economic and climatic exposure variables. Four cholera hotspots were detected covering 17 regions, home to 28 million people, including the central regions and those surrounding the Lakes Victoria, Tanganyika and Nyaza. The risk of experiencing cholera in these regions was up to 2.9 times higher than elsewhere in the country. Regression analyses revealed that every 100 km of water perimeter in a region increased the cholera incidence by 1.5%. Due to the compilation of surveillance data at regional level rather than at district, we were unable to reliably identify any other significant risk factors and specific hotspots. Cholera high-risk populations in Tanzania include those living near lakes and central regions. Successful surveillance require disaggregated data available weekly and at district levels in order to serve as data for action to support the roadmap for cholera control.
Recurrent Cholera Outbreaks, Democratic Republic of the Congo, 2008–2017
Brecht Ingelbeen | David Hendrickx | Berthe Miwanda | Marianne A.B. van der Sande | Mathias Mossoko | Hilde Vochten | Bram Riems | Jean-Paul Nyakio | Veerle Vanlerberghe | Octavie Lunguya | Jan Jacobs | Marleen Boelaert | Benoît Ilunga Kebela | Didier Bompangue | Jean-Jacques Muyembe
Date of Publication:
Emerging Infectious Diseases
In 2017, the exacerbation of an ongoing countrywide cholera outbreak in the Democratic Republic of the Congo resulted in >53,000 reported cases and 1,145 deaths. To guide control measures, we analyzed the characteristics of cholera epidemiology in DRC on the basis of surveillance and cholera treatment center data for 2008–2017. The 2017 nationwide outbreak resulted from 3 distinct mechanisms: considerable increases in the number of cases in cholera-endemic areas, so-called hotspots, around the Great Lakes in eastern DRC; recurrent outbreaks progressing downstream along the Congo River; and spread along Congo River branches to areas that had been cholera-free for more than a decade. Case-fatality rates were higher in nonendemic areas and in the early phases of the outbreaks, possibly reflecting low levels of immunity and less appropriate prevention and treatment. Targeted use of oral cholera vaccine, soon after initial cases are diagnosed, could contribute to lower case-fatality rates.