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case-area targeted interventions
Micro-Hotspots of Risk in Urban Cholera Epidemics
Andrew S Azman | Francisco J Luquero | Henrik Salje | Nathan Naibei Mbaïbardoum | Ngandwe Adalbert | Mohammad Ali | Enrico Bertuzzo | Flavio Finger | Brahima Touré | Louis Albert Massing | Romain Ramazani | Bansaga Saga | Maya Allan | David Olson | Jerome Leglise | Klaudia Porten | Justin Lessler
Date of Publication:
The Journal of Infectious Diseases
Targeted interventions have been delivered to neighbors of cholera cases in major epidemic responses globally despite limited evidence for the impact of such targeting. Using data from urban epidemics in Chad and Democratic Republic of the Congo, we estimated the extent of spatiotemporal zones of increased cholera risk around cases. In both cities, we found zones of increased risk of at least 200 meters during the five days immediately after case presentation to a clinic. Risk was highest for those living closest to cases and diminished in time and space similarly across settings. These results provide a rational basis for rapidly delivering targeting interventions.
The potential impact of case-area targeted interventions in response to cholera outbreaks: A modeling study
Flavio Finger | Enrico Bertuzzo | Francisco J. Luquero | Nathan Naibei | Brahima Touré | Maya Allan | Klaudia Porten | Justin Lessler | Andrea Rinaldo | Andrew S. Azman
Date of Publication:
Cholera prevention and control interventions targeted to neighbors of cholera cases (case-area targeted interventions [CATIs]), including improved water, sanitation, and hygiene, oral cholera vaccine (OCV), and prophylactic antibiotics, may be able to efficiently avert cholera cases and deaths while saving scarce resources during epidemics. Efforts to quickly target interventions to neighbors of cases have been made in recent outbreaks, but little empirical evidence related to the effectiveness, efficiency, or ideal design of this approach exists. Here, we aim to provide practical guidance on how CATIs might be used by exploring key determinants of intervention impact, including the mix of interventions, “ring” size, and timing, in simulated cholera epidemics fit to data from an urban cholera epidemic in Africa. We developed a micro-simulation model and calibrated it to both the epidemic curve and the small-scale spatiotemporal clustering pattern of case households from a large 2011 cholera outbreak in N’Djamena, Chad (4,352 reported cases over 232 days), and explored the potential impact of CATIs in simulated epidemics. In conclusion, we found that CATIs using OCV, antibiotics, and water treatment interventions at an appropriate radius around cases could be an effective and efficient way to fight cholera epidemics. They can provide a complementary and efficient approach to mass intervention campaigns and may prove particularly useful during the initial phase of an outbreak, when there are few cases and few available resources, or to shorten the often protracted tails of cholera epidemics.
Water, Sanitation and Hygiene and Cholera Epidemiology: An Integrated Evaluation in the countries of the Lake Chad Basin
Pierre-Yves Oger | Bertrand Sudre
Date of Publication:
The preparation for and response to cholera epidemics demand a multi-sectoral approach based on knowledge about the epidemiology of the disease over different dimensions of space and time and involving actors in charge of access to water, sanitation and hygiene. Following the explosion of sub-regional epidemics in 2010, the present study aims to propose integrated Health-WASH responses through, on the one hand, by describing the epidemiology of cholera in the Lake Chad Basin and, on the other hand, by proposing interventions based on coordinated actions of prevention, preparation and response to cholera epidemics with the support of all health sector actors as well as those from the domains of water access, sanitation and hygiene.