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Dynamics of cholera epidemics from Benin to Mauritania
Sandra Moore | Anthony Zunuo Dongdem | David Opare | Paul Cottavoz | Maria Fookes | Adodo Yao Sadji | Emmanuel Dzotsi | Michael Dogbe | Fakhri Jeddi | Bawimodom Bidjada | Martine Piarroux | Ouyi Tante Valentin | Clément Kakaï Glèlè | Stanislas Rebaudet | Amy Gassama Sow | Guillaume Constantin de Magny | Lamine Koivogui | Jessica Dunoyer | Francois Bellet | Eric Garnotel | Nicholas Thomson | Renaud Piarroux
Date of Publication:
PLoS neglected tropical diseases
The countries of West Africa are largely portrayed as cholera endemic, although the dynamics of outbreaks in this region of Africa remain largely unclear. To understand the dynamics of cholera in a major portion of West Africa, we analyzed cholera epidemics from 2009 to 2015 from Benin to Mauritania. We conducted a series of field visits as well as multilocus variable tandem repeat analysis and whole-genome sequencing analysis of V. cholerae isolates throughout the study region. During this period, Ghana accounted for 52% of the reported cases in the entire study region (coastal countries from Benin to Mauritania). From 2009 to 2015, we found that one major wave of cholera outbreaks spread from Accra in 2011 northwestward to Sierra Leone and Guinea in 2012. Molecular epidemiology analysis confirmed that the 2011 Ghanaian isolates were related to those that seeded the 2012 epidemics in Guinea and Sierra Leone. Interestingly, we found that many countries deemed “cholera endemic” actually suffered very few outbreaks, with multi-year lulls. This study provides the first cohesive vision of the dynamics of cholera epidemics in a major portion of West Africa. This epidemiological overview shows that from 2009 to 2015, at least 54% of reported cases concerned populations living in the three urban areas of Accra, Freetown, and Conakry. These findings may serve as a guide to better target cholera prevention and control efforts in the identified cholera hotspots in West Africa.
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.