1
|
Irenge LM, Ambroise J, Bearzatto B, Durant JF, Bonjean M, Wimba LK, Gala JL. Genomic evolution and rearrangement of CTX-Φ prophage elements in Vibrio cholerae during the 2018-2024 cholera outbreaks in eastern Democratic Republic of the Congo. Emerg Microbes Infect 2024; 13:2399950. [PMID: 39259213 PMCID: PMC11395875 DOI: 10.1080/22221751.2024.2399950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 11/22/2023] [Accepted: 12/11/2023] [Indexed: 09/12/2024]
Abstract
ABSTRACTBetween 2018 and 2024, we conducted systematic whole-genome sequencing and phylogenomic analysis on 263 V. cholerae O1 isolates from cholera patients across four provinces in the Democratic Republic of Congo (North-Kivu, South-Kivu, Tanganyika, and Kasai Oriental). These isolates were classified into the AFR10d and AFR10e sublineages of AFR10 lineage, originating from the third wave of the seventh El Tor cholera pandemic (7PET). Compared to the strains analysed between 2014 and 2017, both sublineages had few genetic changes in the core genome but recent isolates (2022-2024) had significant CTX prophage rearrangement. AFR10e spread across all four provinces, while AFR10d appeared to be extinct by the end of 2020. Since 2022, most V. cholerae O1 isolates exhibited significant CTX prophage rearrangements, including a tandem repeat of an environmental satellite phage RS1 downstream the ctxB toxin gene of the CTX-Φ-3 prophage on the large chromosome, as well as two or more arrayed copies of an environmental pre-CTX-Φ prophage precursor on the small chromosome. We used Illumina data for mapping and coverage estimation to identify isolates with unique CTX-Φ genomic features. Gene localization was then determined on MinION-derived assemblies, revealing an organization similar to that of non-O1 V. cholerae isolates found in Asia (O139 VC1374, and environmental O4 VCE232), but never described in V. cholerae O1 El Tor from the third wave. In conclusion, while the core genome of AFR10d and AFR10e showed minimal changes, significant alterations in the CTX-Φ and pre-CTX-Φ prophage content and organization were identified in AFR10e from 2022 onwards.
Collapse
Affiliation(s)
- Leonid M Irenge
- Centre for Applied Molecular Technologies, Institute of Clinical and Experimental Research, Université catholique de Louvain (UCLouvain), Woluwe-Saint-Lambert, Belgium
| | - Jérôme Ambroise
- Centre for Applied Molecular Technologies, Institute of Clinical and Experimental Research, Université catholique de Louvain (UCLouvain), Woluwe-Saint-Lambert, Belgium
| | - Bertrand Bearzatto
- Centre for Applied Molecular Technologies, Institute of Clinical and Experimental Research, Université catholique de Louvain (UCLouvain), Woluwe-Saint-Lambert, Belgium
| | - Jean-François Durant
- Centre for Applied Molecular Technologies, Institute of Clinical and Experimental Research, Université catholique de Louvain (UCLouvain), Woluwe-Saint-Lambert, Belgium
| | - Maxime Bonjean
- Centre for Applied Molecular Technologies, Institute of Clinical and Experimental Research, Université catholique de Louvain (UCLouvain), Woluwe-Saint-Lambert, Belgium
| | - Louisette K Wimba
- Institut Supérieur des Techniques Médicales/Bukavu, Bukavu, The Democratic Republic of the Congo
| | - Jean-Luc Gala
- Centre for Applied Molecular Technologies, Institute of Clinical and Experimental Research, Université catholique de Louvain (UCLouvain), Woluwe-Saint-Lambert, Belgium
| |
Collapse
|
2
|
Briskin E, Bateyi Mustafa SH, Mahamba R, Kabunga D, Kubuya J, Porten K, Akilimali L, Okitayemba Welo P, Broban A. Oral cholera vaccine coverage in Goma, Democratic Republic of the Congo, 2022, following 2019-2020 targeted preventative mass campaigns. Vaccine X 2024; 20:100555. [PMID: 39315336 PMCID: PMC11417590 DOI: 10.1016/j.jvacx.2024.100555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2024] [Revised: 09/06/2024] [Accepted: 09/09/2024] [Indexed: 09/25/2024] Open
Abstract
Background In 2019-2020, preventative Oral Cholera Vaccine campaigns were conducted in 24/32 non-contiguous health areas of Goma, DR Congo. In August 2022, we measured coverage and factors potentially influencing success of the delivery strategy. Methods We used random geo-sampled stratified cluster survey to estimate OCV coverage and assess population movement, diarrhea history, and reasons for non-vaccination. Results 603 households were visited. Coverage with at least one dose was 46.4 % (95 %CI: 41.8-51.0), and 50.1 % (95 %CI: 45.4-54.8) in areas targeted by vaccination compared to 26.3 % (95 %CI: 19.2-34.9) in non-targeted areas. Additionally, 7.0 % of participants reported moving from outside Goma since 2019, and 5.4 % reported history of severe diarrhea. Absence and unawareness were the main reasons for non-vaccination. Conclusion Results suggest that targeting non-contiguous urban areas had a coverage-diluting effect. Targeting entire geographically contiguous areas, adapted distribution, and regular catch-up campaigns are operational recommendations to reach higher coverages arising from the study.
Collapse
Affiliation(s)
| | - Stéphane Hans Bateyi Mustafa
- Programme Elargi de Vaccination, North Kivu, Democratic Republic of the Congo
- Provincial Health Division, North Kivu, Democratic Republic of the Congo
| | | | - Deka Kabunga
- Provincial Health Division, North Kivu, Democratic Republic of the Congo
| | - Janvier Kubuya
- Provincial Health Division, North Kivu, Democratic Republic of the Congo
| | | | - Epicentre-MSF DRC cholera working group
- Epicentre, Paris, France
- Programme Elargi de Vaccination, North Kivu, Democratic Republic of the Congo
- Provincial Health Division, North Kivu, Democratic Republic of the Congo
- Epicentre, Goma, Democratic Republic of the Congo
- National Program for the Elimination of Cholera and the Control of Other Diarrheal Diseases (PNECHOL-MD), Democratic Republic of the Congo
| | - Laurent Akilimali
- National Program for the Elimination of Cholera and the Control of Other Diarrheal Diseases (PNECHOL-MD), Democratic Republic of the Congo
| | - Placide Okitayemba Welo
- National Program for the Elimination of Cholera and the Control of Other Diarrheal Diseases (PNECHOL-MD), Democratic Republic of the Congo
| | | |
Collapse
|
3
|
Ngere P, Langat D, Ngere I, Dawa J, Okunga E, Nasimiyu C, Kiama C, Lokamar P, Ngunu C, Makayotto L, Njenga MK, Osoro E. A protracted cholera outbreak in Nairobi City County accentuated by mass gathering events, Kenya, 2017. PLoS One 2024; 19:e0297324. [PMID: 39208189 PMCID: PMC11361576 DOI: 10.1371/journal.pone.0297324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 07/23/2024] [Indexed: 09/04/2024] Open
Abstract
Cholera continues to cause many outbreaks in low and middle-income countries due to inadequate water, sanitation, and hygiene services. We describe a protracted cholera outbreak in Nairobi City County, Kenya in 2017. We reviewed the cholera outbreak line lists from Nairobi City County in 2017 to determine its extent and factors associated with death. A suspected case of cholera was any person aged >2 years old who had acute watery diarrhea, nausea, or vomiting, whereas a confirmed case was where Vibrio cholerae was isolated from the stool specimen. We summarized cases using means for continuous variables and proportions for categorical variables. Associations between admission status, sex, age, residence, time to care seeking, and outbreak settings; and cholera associated deaths were assessed using odds ratio (OR) with 95% confidence interval (CI). Of the 2,737 cholera cases reported, we analyzed 2,347 (85.7%) cases including 1,364 (58.1%) outpatients, 1,724 (73.5%) not associated with mass gathering events, 1,356 (57.8%) male and 2,202 (93.8%) aged ≥5 years, and 35 deaths (case fatality rate: 1.5%). Cases were reported from all the Sub Counties of Nairobi City County with an overall county attack rate of 50 per 100,000 people. Vibrio cholerae Ogawa serotype was isolated from 78 (34.8%) of the 224 specimens tested and all isolates were sensitive to tetracycline and levofloxacin but resistant to amikacin. The odds of cholera-related deaths was lower among outpatient cases (aOR: 0.35; [95% CI: 0.17-0.72]), age ≥5 years old (aOR: 0.21 [95% CI: 0.09-0.55]), and mass gathering events (aOR: 0.26 [95% CI: 0.07-0.91]) while threefold higher odds among male (aOR: 3.04 [95% CI: 1.30-7.13]). Nairobi City County experienced a protracted and widespread cholera outbreak with a high case fatality rate in 2017.
Collapse
Affiliation(s)
- Philip Ngere
- Washington State University Global Health Program, Nairobi City, Kenya
- Division of Disease Surveillance and Response, Ministry of Health, Nairobi City, Kenya
| | - Daniel Langat
- Division of Disease Surveillance and Response, Ministry of Health, Nairobi City, Kenya
| | - Isaac Ngere
- Washington State University Global Health Program, Nairobi City, Kenya
| | - Jeanette Dawa
- Washington State University Global Health Program, Nairobi City, Kenya
| | - Emmanuel Okunga
- Division of Disease Surveillance and Response, Ministry of Health, Nairobi City, Kenya
| | - Carolyne Nasimiyu
- Washington State University Global Health Program, Nairobi City, Kenya
| | - Catherine Kiama
- Washington State University Global Health Program, Nairobi City, Kenya
| | - Peter Lokamar
- National Public Health Laboratory Services, Ministry of Health, Nairobi City, Kenya
| | - Carol Ngunu
- Department of Health Services, Nairobi City County Government, Nairobi City, Kenya
| | - Lyndah Makayotto
- Division of Disease Surveillance and Response, Ministry of Health, Nairobi City, Kenya
| | - M. Kariuki Njenga
- Washington State University Global Health Program, Nairobi City, Kenya
- Paul G Allen School for Global Health, Washington State University, Pullman, WA, United States of America
| | - Eric Osoro
- Washington State University Global Health Program, Nairobi City, Kenya
- Paul G Allen School for Global Health, Washington State University, Pullman, WA, United States of America
| |
Collapse
|
4
|
Kering K, Wang Y, Mbae C, Mugo M, Ongadi B, Odityo G, Muturi P, Yakubu H, Liu P, Durry S, Deshpande A, Gebreyes W, Moe C, Kariuki S. Pathways of exposure to Vibrio Cholerae in an urban informal settlement in Nairobi, Kenya. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002880. [PMID: 39163285 PMCID: PMC11335117 DOI: 10.1371/journal.pgph.0002880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 07/31/2024] [Indexed: 08/22/2024]
Abstract
Cholera is a diarrhoeal disease caused by Vibrio cholerae (V. cholerae) bacterium, with strains belonging to serogroups 01 and 0139 causing a huge proportion of the disease. V. cholerae can contaminate drinking water sources and food through poor sanitation and hygiene. This study aimed to identify environmental routes of exposure to V. cholerae within Mukuru informal settlement in Nairobi. We collected nine types of environmental samples (drinking water, flood water, open drains, surface water, shaved ice, raw produce, street food, soil, and public latrine swabs) over 12 months. All samples were analysed for V. cholerae by culture and qPCR, then qPCR-positive samples were quantified using a V. cholerae DNA standard. Data about the frequency of contact with the environment was collected using behavioural surveys. Of the 803 samples collected, 28.5% were positive for V. cholerae by qPCR. However, none were positive for V. cholerae by culture. V. cholerae genes were detected in majority of the environmental water samples (79.3%), including open drains, flood water, and surface water, but were only detected in small proportions of other sample types. Vibrio-positive environmental water samples had higher mean V. cholerae concentrations [2490-3469 genome copies (gc) per millilitre (mL)] compared to drinking water samples (25.6 gc/mL). Combined with the behavioural data, exposure assessment showed that contact with surface water had the highest contribution to the total V. cholerae exposure among children while ingestion of municipal drinking water and street food and contact with surface water made substantial contributions to the total V. cholerae exposure for adults. Detection of V. cholerae in street food and drinking water indicates possible risk of exposure to toxigenic V. cholerae in this community. Exposure to V. cholerae through multiple pathways highlights the need to improve water and sanitation infrastructure, strengthen food hygiene practices, and roll out cholera vaccination.
Collapse
Affiliation(s)
- Kelvin Kering
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Yuke Wang
- Center for Global Safe Water, Sanitation, and Hygiene, Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Cecilia Mbae
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Michael Mugo
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Beatrice Ongadi
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Georgina Odityo
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Peter Muturi
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Habib Yakubu
- Center for Global Safe Water, Sanitation, and Hygiene, Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Pengbo Liu
- Center for Global Safe Water, Sanitation, and Hygiene, Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Sarah Durry
- Center for Global Safe Water, Sanitation, and Hygiene, Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Aniruddha Deshpande
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Wondwossen Gebreyes
- Global One Health initiative (GOHi), The Ohio State University, Columbus, Ohio, United States of America
- Veterinary Preventive Medicine, The Ohio State University, Columbus, Ohio, United States of America
| | - Christine Moe
- Center for Global Safe Water, Sanitation, and Hygiene, Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Samuel Kariuki
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| |
Collapse
|
5
|
Hulland EN, Charpignon ML, El Hayek GY, Zhao L, Desai AN, Majumder MS. Estimating time-varying cholera transmission and oral cholera vaccine effectiveness in Haiti and Cameroon, 2021-2023. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.06.12.24308792. [PMID: 39185512 PMCID: PMC11343247 DOI: 10.1101/2024.06.12.24308792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 08/27/2024]
Abstract
In 2023, cholera affected approximately 1 million people and caused more than 5000 deaths globally, predominantly in low-income and conflict settings. In recent years, the number of new cholera outbreaks has grown rapidly. Further, ongoing cholera outbreaks have been exacerbated by conflict, climate change, and poor infrastructure, resulting in prolonged crises. As a result, the demand for treatment and intervention is quickly outpacing existing resource availability. Prior to improved water and sanitation systems, cholera, a disease primarily transmitted via contaminated water sources, also routinely ravaged high-income countries. Crumbling infrastructure and climate change are now putting new locations at risk - even in high-income countries. Thus, understanding the transmission and prevention of cholera is critical. Combating cholera requires multiple interventions, the two most common being behavioral education and water treatment. Two-dose oral cholera vaccination (OCV) is often used as a complement to these interventions. Due to limited supply, countries have recently switched to single-dose vaccines (OCV1). One challenge lies in understanding where to allocate OCV1 in a timely manner, especially in settings lacking well-resourced public health surveillance systems. As cholera occurs and propagates in such locations, timely, accurate, and openly accessible outbreak data are typically inaccessible for disease modeling and subsequent decision-making. In this study, we demonstrated the value of open-access data to rapidly estimate cholera transmission and vaccine effectiveness. Specifically, we obtained non-machine readable (NMR) epidemic curves for recent cholera outbreaks in two countries, Haiti and Cameroon, from figures published in situation and disease outbreak news reports. We used computational digitization techniques to derive weekly counts of cholera cases, resulting in nominal differences when compared against the reported cumulative case counts (i.e., a relative error rate of 5.67% in Haiti and 0.54% in Cameroon). Given these digitized time series, we leveraged EpiEstim-an open-source modeling platform-to derive rapid estimates of time-varying disease transmission via the effective reproduction number (R t ). To compare OCV1 effectiveness in the two considered countries, we additionally used VaxEstim, a recent extension of EpiEstim that facilitates the estimation of vaccine effectiveness via the relation among three inputs: the basic reproduction number (R 0 ),R t , and vaccine coverage. Here, with Haiti and Cameroon as case studies, we demonstrated the first implementation of VaxEstim in low-resource settings. Importantly, we are the first to use VaxEstim with digitized data rather than traditional epidemic surveillance data. In the initial phase of the outbreak, weekly rolling average estimates ofR t were elevated in both countries: 2.60 in Haiti [95% credible interval: 2.42-2.79] and 1.90 in Cameroon [1.14-2.95]. These values are largely consistent with previous estimates ofR 0 in Haiti, where average values have ranged from 1.06 to 3.72, and in Cameroon, where average values have ranged from 1.10 to 3.50. In both Haiti and Cameroon, this initial period of high transmission preceded a longer period during whichR t oscillated around the critical threshold of 1. Our results derived from VaxEstim suggest that Haiti had higher OCV1 effectiveness than Cameroon (75.32% effective [54.00-86.39%] vs. 54.88% [18.94-84.90%]). These estimates of OCV1 effectiveness are generally aligned with those derived from field studies conducted in other countries. Thus, our case study reinforces the validity of VaxEstim as an alternative to costly, time-consuming field studies of OCV1 effectiveness. Indeed, prior work in South Sudan, Bangladesh, and the Democratic Republic of the Congo reported OCV1 effectiveness ranging from approximately 40% to 80%. This work underscores the value of combining NMR sources of outbreak case data with computational techniques and the utility of VaxEstim for rapid, inexpensive estimation of vaccine effectiveness in data-poor outbreak settings.
Collapse
Affiliation(s)
- Erin N Hulland
- Computational Health Informatics Program, Boston Children's Hospital & Harvard Medical School, Boston, MA, United States
- Comp Epi Dispersed Volunteer Research Network, Boston, MA, United States
| | - Marie-Laure Charpignon
- Comp Epi Dispersed Volunteer Research Network, Boston, MA, United States
- Institute for Data, Systems, and Society, Massachusetts Institute of Technology, Cambridge, MA, United States
| | - Ghinwa Y El Hayek
- Comp Epi Dispersed Volunteer Research Network, Boston, MA, United States
| | - Lihong Zhao
- Comp Epi Dispersed Volunteer Research Network, Boston, MA, United States
- Department of Mathematics, Virginia Tech, Blacksburg, VA, United States
| | - Angel N Desai
- Comp Epi Dispersed Volunteer Research Network, Boston, MA, United States
- Department of Internal Medicine, Division of Infectious Diseases, University of California, Davis Health Medical Center, Sacramento, CA, United States
| | - Maimuna S Majumder
- Computational Health Informatics Program, Boston Children's Hospital & Harvard Medical School, Boston, MA, United States
- Comp Epi Dispersed Volunteer Research Network, Boston, MA, United States
| |
Collapse
|
6
|
Worku Demlie Y, Gedefaw A, Jeon Y, Hailu D, Getahun T, Mogeni OD, Mukasa D, Jang GH, Pak GD, Kim DR, Getachew EM, Yeshitela B, Ayele Abebe S, Edosa M, Wossen M, Teferi M, Park SE. Retrospective Analysis of Cholera/Acute Watery Diarrhea Outbreaks in Ethiopia From 2001 To 2023: Incidence, Case Fatality Rate, and Seasonal and Multiyear Epidemic Patterns. Clin Infect Dis 2024; 79:S8-S19. [PMID: 38996039 PMCID: PMC11244192 DOI: 10.1093/cid/ciae236] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Indexed: 07/14/2024] Open
Abstract
BACKGROUND The Ethiopian government has developed the multisectoral cholera elimination plan (NCP) with an aim of reducing cholera incidence and case fatality rate (CFR). To better understand and monitor the progress of this plan, a comprehensive review of national cholera epidemiology is needed. METHODS Reported data on cholera/acute watery diarrhea (AWD) cases in the past 20 years were extracted from the Ethiopian Public Health Institute and World Health Organization databases. Descriptive statistics, Pearson χ2, and logistic regression analyses were conducted. RESULTS From January 2001 to November 2023, a total of 215 205 cholera/AWD cases, 2355 deaths with a cumulative CFR of 1.10% (95% confidence interval [CI], 1.092-1.095), and a mean annual incidence rate of 8.9/100 000 (95% CI, 6.5-11.3) were reported. Two major upsurges of cholera epidemics were found in the last two decades with mean attack rate (AR) of 20.57/100 000 in 2006-2010 and 14.83/100 000 in 2016-2020. Another resurgence of outbreaks occured in 2021-2023 (mean AR, 8.63/100 000). In 2015-2023, 54.0% (53 990/99 945) of cases were aged 15-44 years. National cholera CFR (3.13% [95% CI: 2.1-4.5]) was the highest in 2022. The 2015-2023 cumulative cholera CFR was different across regions: Benishangul Gumuz (6.07%), Gambela (1.89%), Sidama (1.42%), Southern Nation, Nationalities, and Peoples' (1.34%), Oromia (1.10%), and Amhara (1.09%). Cholera/AWD patients in older adults (≥45 years), severe dehydration, peak rainy season (June-August), and outpatients were associated with higher risk of death. CONCLUSIONS Cholera has been a public health problem in Ethiopia with case fatalities still above the global target. Case management needs to be improved particularly in outpatients and older populations. Outbreak preparedness should be rolled out well in advance of the typical rainy seasons. Significant investments are essential to advance the cholera surveillance system at healthcare setting and community level. Underlying factors of cholera deaths per areas should be further investigated to guide appropriate interventions to meet the NCP target by 2028.
Collapse
Affiliation(s)
- Yeshambel Worku Demlie
- Diseases Surveillance and Response Directorate, Ethiopia Public Health Institute, Addis Ababa, Ethiopia
| | - Abel Gedefaw
- Clinical, Assessment, Regulatory, Evaluation (CARE) Unit, International Vaccine Institute, Seoul, Republic of Korea
- College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Yeonji Jeon
- Clinical, Assessment, Regulatory, Evaluation (CARE) Unit, International Vaccine Institute, Seoul, Republic of Korea
| | - Dejene Hailu
- Clinical, Assessment, Regulatory, Evaluation (CARE) Unit, International Vaccine Institute, Seoul, Republic of Korea
- School of Public Health, Hawassa University, Hawassa, Ethiopia
| | - Tomas Getahun
- Clinical Trials Directorate, Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Ondari D Mogeni
- Clinical, Assessment, Regulatory, Evaluation (CARE) Unit, International Vaccine Institute, Seoul, Republic of Korea
| | - David Mukasa
- Biostatistics and Data Management Department (BDM), International Vaccine Institute, Seoul, Republic of Korea
| | - Geun Hyeog Jang
- Biostatistics and Data Management Department (BDM), International Vaccine Institute, Seoul, Republic of Korea
| | - Gi Deok Pak
- Biostatistics and Data Management Department (BDM), International Vaccine Institute, Seoul, Republic of Korea
| | - Deok Ryun Kim
- Biostatistics and Data Management Department (BDM), International Vaccine Institute, Seoul, Republic of Korea
| | | | - Biruk Yeshitela
- Bacterial and Viral Disease Research Directorate, Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Samuyel Ayele Abebe
- Data Science Division, Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Moti Edosa
- Diseases Surveillance and Response Directorate, Ethiopia Public Health Institute, Addis Ababa, Ethiopia
| | - Mesfin Wossen
- Diseases Surveillance and Response Directorate, Ethiopia Public Health Institute, Addis Ababa, Ethiopia
| | - Mekonnen Teferi
- Clinical Trials Directorate, Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Se Eun Park
- Clinical, Assessment, Regulatory, Evaluation (CARE) Unit, International Vaccine Institute, Seoul, Republic of Korea
- Department of Global Health and Disease Control, Yonsei University Graduate School of Public Health, Seoul, Republic of Korea
| |
Collapse
|
7
|
Black RE, Perin J, Yeung D, Rajeev T, Miller J, Elwood SE, Platts-Mills JA. Estimated global and regional causes of deaths from diarrhoea in children younger than 5 years during 2000-21: a systematic review and Bayesian multinomial analysis. Lancet Glob Health 2024; 12:e919-e928. [PMID: 38648812 PMCID: PMC11099298 DOI: 10.1016/s2214-109x(24)00078-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 02/07/2024] [Accepted: 02/07/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND Information on the causes of deaths from diarrhoea in children younger than 5 years is needed to design improved preventive and therapeutic approaches. We aimed to conduct a systematic analysis of studies to report estimates of the causes of deaths from diarrhoea in children younger than 5 years at global and regional levels during 2000-21. METHODS For this systematic review and Bayesian multinomial analysis, we included 12 pathogens with the highest attributable incidence in the Global Enteric Multicenter Study. We searched PubMed, Scopus, Embase, Web of Science, Global Health Index Medicus, Global Health OVID, IndMed, Health Information Platform for the Americas (PLISA), Africa-Wide Information, and Cochrane Collaboration for articles published between Jan 1, 2000, and Dec 31, 2020, using the search terms "child", "hospital", "diarrhea", "diarrhoea", "dysentery", "rotavirus", "Escherichia coli", "salmonella", "shigella", "campylobacter", "Vibrio cholerae", "cryptosporidium", "norovirus", "astrovirus", "sapovirus", and "adenovirus". To be included, studies had to have a patient population of children younger than 5 years who were hospitalised for diarrhoea (at least 90% of study participants), at least a 12-month duration, reported prevalence in diarrhoeal stools of at least two of the 12 pathogens, all patients with diarrhoea being included at the study site or a systematic sample, at least 100 patients with diarrhoea, laboratory tests done on rectal swabs or stool samples, and standard laboratory methods (ie, quantitative PCR [qPCR] or non-qPCR). Studies published in any language were included. Studies were excluded if they were limited to nosocomial, chronic, antibiotic-associated, or outbreak diarrhoea or to a specific population (eg, only children with HIV or AIDS). Each article was independently reviewed by two researchers; a third arbitrated in case of disagreement. If both reviewers identified an exclusion criterion, the study was excluded. Data sought were summary estimates. Data on causes from published studies were adjusted when necessary to account for the poor sensitivity of non-qPCR methods and for attributable fraction based on quantification of pathogens in children who are ill or non-ill. The causes of deaths from diarrhoea were modelled on the causes of hospitalisations for diarrhoea. We separately modelled studies reporting causes of diarrhoea in children who were hospitalised in low-income and middle-income countries (LMICs) and in high-income countries (HICs). FINDINGS Of 74 282 papers identified in the initial database search, we included 138 studies (91 included data from LMICs and 47 included data from HICs) from 73 countries. We modelled estimates for 194 WHO member states (hereafter referred to as countries), including 42 HICs and 152 LMICs. We could attribute a cause to 1 003 448 (83·8%) of the estimated 1 197 044 global deaths from diarrhoea in children younger than 5 years in 2000 and 360 730 (81·3%) of the estimated 443 833 global deaths from diarrhoea in children younger than 5 years in 2021. The cause with the largest estimated global attribution was rotavirus; in LMICs, the proportion of deaths from diarrhoea due to rotavirus in children younger than 5 years appeared lower in 2021 (108 322 [24·4%] of 443 342, 95% uncertainty interval 21·6-29·5) than in 2000 (316 382 [26·5%] of 1 196 134, 25·7-28·5), but the 95% CIs overlapped. In 2000, the second largest estimated attribution was norovirus GII (95 817 [8·0%] of 1 196 134 in LMICs and 225 [24·7%] of 910 in HICs); in 2021, Shigella sp had the second largest estimated attribution in LMICs (36 082 [8·1%] of 443 342), but norovirus remained with the second largest estimated attribution in HICs (84 [17·1%] of 490). INTERPRETATION Our results indicate progress in the reduction of deaths from diarrhoea caused by 12 pathogens in children younger than 5 years in the past two decades. There is a need to increase efforts for prevention, including with rotavirus vaccine, and treatment to eliminate further deaths. FUNDING Bill & Melinda Gates Foundation via Johns Hopkins University and the University of Virginia.
Collapse
Affiliation(s)
- Robert E Black
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
| | - Jamie Perin
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Diana Yeung
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Tushara Rajeev
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Jacob Miller
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Sarah E Elwood
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA, USA
| | - James A Platts-Mills
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA, USA
| |
Collapse
|
8
|
Amisu BO, Okesanya OJ, Adigun OA, Manirambona E, Ukoaka BM, Lawal OA, Idris NB, Olaleke NO, Okon II, Ogaya JB, Prisno DEL. Cholera resurgence in Africa: assessing progress, challenges, and public health response towards the 2030 global elimination target. LE INFEZIONI IN MEDICINA 2024; 32:148-156. [PMID: 38827826 PMCID: PMC11142410 DOI: 10.53854/liim-3202-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 04/14/2024] [Indexed: 06/05/2024]
Abstract
Global efforts to combat epidemic cholera outbreaks have witnessed tremendous feats over the decades. However, sporadic outbreaks in regions, particularly across African states, mask these advancements. This regressive trend is frequently fuelled by factors retarding efforts towards optimal environmental sanitation and personal hygiene, which include ingesting infected food, drinking contaminated waters, and engaging in unhealthy environmental practices such as indiscriminate waste and sewage disposal and poor toilet practices. The ongoing efforts to achieve the Global Taskforce on Cholera Control (GTFCC) targets of a 90% reduction in cases and deaths by 2030, even in the wake of continuous outbreaks across various African regions, as reported by the World Health Organization (WHO) face a significant threat. One such effort, among others, is the AFRICHOL project, an enhanced cholera surveillance consortium launched in Africa over a decade ago as part of the GTFCC at WHO to monitor and fast-track the GTFCC's 2030 targets. It is tasked with supporting the implementation of research-based strategies for combating cholera in Africa. The prequalified oral cholera vaccines - Dukoral, Shanchol, and Euvichol - and those with recombinant DNA technology have also emerged as remarkable strides. In the face of this progress, challenges persist. Climate change, including extreme weather events and the lack of safe water, sanitation, and hygiene facilities, acts as a multiplier, amplifying existing challenges and hindering progress. Porous borders with inefficient disease surveillance networks among member states also facilitate the inter-territorial spread of the disease. Despite ongoing challenges, global targets are achievable provided strong institutional infrastructure and additional evidence-based public health initiatives are promulgated and enacted. The Global Roadmap to Ending Cholera Outbreaks by 2030 is a resourceful tool for advancing this fight and eradicating cholera.
Collapse
Affiliation(s)
- Blessing Olawunmi Amisu
- Department of Medical Laboratory Science, Uniosun Teaching Hospital, Osogbo, Osun state, Nigeria
| | - Olalekan John Okesanya
- Department of Public Health and Maritime Transport, University of Thessaly, Volos, Greece
| | | | - Emery Manirambona
- College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | | | - Okikiola Azeez Lawal
- Department of Medical Laboratory Sciences, Kwara State University, Kwara State, Nigeria
| | - Nimat Bola Idris
- Department of Public Health, Al-Hikmah University, Ilorin, Kwara State, Nigeria
| | - Noah Olabode Olaleke
- Department of Medical Laboratory Science, Obafemi Awolowo University Teaching Hospitals Complex, Ile Ife, Osun State, Nigeria
| | - Inibehe Ime Okon
- Department of Neurosurgery, Hospital of the Babcock University, Ogun State, Nigeria
| | | | - Don Eliseo Lucero Prisno
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
| |
Collapse
|
9
|
Semá Baltazar C, Langa JP, Baloi LD, Elias Chitio JJ, Manuel JA, Mboane RBJ, Assane S, Omar A, Manso M, Capitine I, Luiz N, Mukasa D, Jang GH, Park JY, Marks F, Mraidi R, Pak GD, Kim DR, Park SE. Cholera and diarrheal diseases in Cuamba District, Niassa Province, Mozambique: Systematic healthcare facility-based surveillance strengthening, characteristics of suspected cholera and diarrheal patients, and incidence of diarrheal diseases. PLoS Negl Trop Dis 2024; 18:e0011843. [PMID: 38687808 PMCID: PMC11086855 DOI: 10.1371/journal.pntd.0011843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 05/10/2024] [Accepted: 04/18/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND Mozambique is one of the countries in Africa that is continuously at risk of cholera outbreaks due to poor sanitation, hygiene, and limited access to potable water in some districts. The Mozambique Cholera Prevention and Surveillance (MOCA) project was implemented in Cuamba District, Niassa Province to prevent and control cholera outbreaks through a preemptive cholera vaccination, strengthened surveillance system for cholera and diarrheal diseases, and better understanding of cholera-related healthcare seeking behavior of local populations, which may further guide the national cholera control and prevention strategies. This article presents the surveillance component of the MOCA project. METHODOLOGY/PRINCIPAL FINDINGS A prospective healthcare facility (HCF)-based surveillance of cholera and diarrheal disease was conducted in six HCFs in the District of Cuamba from March 2019 to December 2020. A systematic surveillance procedure has been put in place with capacity building in selected sentinel HCFs and a basic microbiology laboratory established on-site. Patients presenting with suspected cholera or other diarrheal symptoms were eligible for enrollment. Clinical data and rectal swab samples were collected for laboratory confirmation of Vibrio Cholerae and other pathogens. A total of 419 eligible patients from six HCFs were enrolled. The median age was 19.8 years with a similar age distribution between sentinel sites. The majority were patients who exhibited diarrhea symptoms not suspected of cholera (88.8%; n = 410). Among those, 59.2% (210/397) were female and 59.9% (235/392) were 15 years and above. There were 2 cholera cases, coming outside of the catchment area. The incidence of diarrheal diseases ranged from 40-103 per 100,000 population. No Vibrio cholerae was isolated among surveillance catchment population and Escherichia coli spp. (82/277; 29.6%) was the most common pathogen isolated. CONCLUSION/SIGNIFICANCE Efforts were made to strengthen the systematic surveillance of suspected cholera with standardised patient screening, enrolment, and diagnostics. The first basic microbiology laboratory in Niassa Province established in Cuamba District under the MOCA project needs to be integrated into the national network of laboratories for sustainability. No reports of laboratory confirmed cholera cases from the surveillance catchment area may be highly related to the pre-emptive oral cholera vaccine (OCV) mass vaccination campaign conducted in 2018 and the use of drugs by local populations prior to visiting the sentinel HCFs. Continued systematic cholera surveillance is needed to closely monitor the cholera endemicity and epidemics, and further evaluate the long-term impact of this vaccination. High incidence of diarrheal illnesses needs to be addressed with improved water, sanitation, and hygiene (WaSH) conditions in Cuamba District. Efforts integrated with the prioritization of prevention measures are fundamental for the control of cholera in the country.
Collapse
Affiliation(s)
| | | | | | | | | | - Ramos B. J. Mboane
- Provincial Health Directorate, Lichinga City, Niassa Province, Mozambique
| | - Sadate Assane
- Provincial Health Directorate, Lichinga City, Niassa Province, Mozambique
| | - Alide Omar
- District Health Directorate, Cuamba City, Cuamba District, Niassa Province, Mozambique
| | - Mariana Manso
- District Health Directorate, Cuamba City, Cuamba District, Niassa Province, Mozambique
| | | | - Naira Luiz
- Clinical, Assessment, Regulatory, Evaluation (CARE) Unit, International Vaccine Institute, Seoul, Republic of Korea
| | - David Mukasa
- Biostatistics and Data Management (BDM) Department, International Vaccine Institute, Seoul, Republic of Korea
| | - Geun Hyeog Jang
- Biostatistics and Data Management (BDM) Department, International Vaccine Institute, Seoul, Republic of Korea
| | - Ju Yeon Park
- Biostatistics and Data Management (BDM) Department, International Vaccine Institute, Seoul, Republic of Korea
| | - Florian Marks
- Epidemiology, Public Health, Impact (EPIC) Unit, International Vaccine Institute, Seoul, Republic of Korea
- Department of Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Ramzi Mraidi
- Biostatistics and Data Management (BDM) Department, International Vaccine Institute, Seoul, Republic of Korea
| | - Gi Deok Pak
- Biostatistics and Data Management (BDM) Department, International Vaccine Institute, Seoul, Republic of Korea
| | - Deok Ryun Kim
- Biostatistics and Data Management (BDM) Department, International Vaccine Institute, Seoul, Republic of Korea
| | - Se Eun Park
- Clinical, Assessment, Regulatory, Evaluation (CARE) Unit, International Vaccine Institute, Seoul, Republic of Korea
- Yonsei University Graduate School of Public Health, Seoul, Republic of Korea
| |
Collapse
|
10
|
Xu H, Zou K, Dent J, Wiens KE, Malembaka EB, Bwire G, Okitayemba PW, Hampton LM, Azman AS, Lee EC. Enhanced cholera surveillance to improve vaccination campaign efficiency. Nat Med 2024; 30:1104-1110. [PMID: 38443690 PMCID: PMC11031394 DOI: 10.1038/s41591-024-02852-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 01/30/2024] [Indexed: 03/07/2024]
Abstract
Systematic testing for Vibrio cholerae O1 is rare, which means that the world's limited supply of oral cholera vaccines (OCVs) may not be delivered to areas with the highest true cholera burden. Here we used a phenomenological model with subnational geographic targeting and fine-scale vaccine effects to model how expanding V. cholerae testing affected impact and cost-effectiveness for preventive vaccination campaigns across different bacteriological confirmation and vaccine targeting assumptions in 35 African countries. Systematic testing followed by OCV targeting based on confirmed cholera yielded higher efficiency and cost-effectiveness and slightly fewer averted cases than status quo scenarios targeting suspected cholera. Targeting vaccine to populations with an annual incidence rate greater than 10 per 10,000, the testing scenario averted 10.8 (95% prediction interval (PI) 9.4-12.6) cases per 1,000 fully vaccinated persons while the status quo scenario averted 6.9 (95% PI 6.0-7.8) cases per 1,000 fully vaccinated persons. In the testing scenario, testing costs increased by US$31 (95% PI 25-39) while vaccination costs reduced by US$248 (95% PI 176-326) per averted case compared to the status quo. Introduction of systematic testing into cholera surveillance could improve efficiency and reach of global OCV supply for preventive vaccination.
Collapse
Affiliation(s)
- Hanmeng Xu
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Kaiyue Zou
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Juan Dent
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Kirsten E Wiens
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Epidemiology and Biostatistics, College of Public Health, Temple University, Philadelphia, PA, USA
| | - Espoir Bwenge Malembaka
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Center for Tropical Diseases and Global Health, Université Catholique de Bukavu, Bukavu, Democratic Republic of the Congo
| | - Godfrey Bwire
- Division of Public Health Emergency Preparedness and Response, Ministry of Health, Kampala, Uganda
- Makerere University School of Public Health, Kampala, Uganda
| | - Placide Welo Okitayemba
- Programme National d'Elimination de Choléra et lutte contre les autres Maladies Diarrhéiques, Kinshasa, Democratic Republic of the Congo
| | | | - Andrew S Azman
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Geneva Centre for Emerging Viral Diseases, Geneva University Hospitals, Geneva, Switzerland
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Elizabeth C Lee
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| |
Collapse
|
11
|
Finger F, Lemaitre J, Juin S, Jackson B, Funk S, Lessler J, Mintz E, Dely P, Boncy J, Azman AS. Inferring the proportion of undetected cholera infections from serological and clinical surveillance in an immunologically naive population. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.11.01.23297461. [PMID: 37961651 PMCID: PMC10635253 DOI: 10.1101/2023.11.01.23297461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
Most infections with pandemic Vibrio cholerae are thought to result in subclinical disease and are not captured by surveillance. Previous estimates of the ratio of infections to clinical cases have varied widely (2 to 100). Understanding cholera epidemiology and immunity relies on the ability to translate between numbers of clinical cases and the underlying number of infections in the population. We estimated the infection incidence during the first months of an outbreak in a cholera-naive population using a Bayesian vibriocidal antibody titer decay model combining measurements from a representative serosurvey and clinical surveillance data. 3,880 suspected cases were reported in Grande Saline, Haiti, between 20 October 2010 and 6 April 2011 (clinical attack rate 18.4%). We found that more than 52.6% (95% Credible Interval (CrI) 49.4-55.7) of the population ≥2 years showed serologic evidence of infection, with a lower infection rate among children aged 2-4 years (35.5%; 95%CrI 24.2-51.6) compared with people ≥5 years (53.1%; 95%CrI 49.4-56.4). This estimated infection rate, nearly three times the clinical attack rate, with underdetection mainly seen in those ≥5 years, has likely impacted subsequent outbreak dynamics. Our findings show how seroincidence estimates improve understanding of links between cholera burden, transmission dynamics and immunity.
Collapse
Affiliation(s)
- Flavio Finger
- Centre for the Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, London, UK
- Epicentre, Paris, France
| | - Joseph Lemaitre
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Stanley Juin
- Center for Global Health, Massachusetts General Hospital, Boston, MA, USA
| | - Brendan Jackson
- United States Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sebastian Funk
- Centre for the Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Justin Lessler
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Eric Mintz
- United States Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Patrick Dely
- Ministère de la Santé Publique et de la Population, Port au Prince, Haiti
| | - Jacques Boncy
- Ministère de la Santé Publique et de la Population, Port au Prince, Haiti
| | - Andrew S Azman
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals, Geneva, Switzerland
- Center for Emerging Viral Diseases, Geneva University Hospitals, Geneva, Switzerland
| |
Collapse
|
12
|
Kayembe HC, Bompangue D, Linard C, Mandja BA, Batumbo D, Matunga M, Muwonga J, Moutschen M, Situakibanza H, Ozer P. Drivers of the dynamics of the spread of cholera in the Democratic Republic of the Congo, 2000-2018: An eco-epidemiological study. PLoS Negl Trop Dis 2023; 17:e0011597. [PMID: 37639440 PMCID: PMC10491302 DOI: 10.1371/journal.pntd.0011597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 09/08/2023] [Accepted: 08/14/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND The dynamics of the spread of cholera epidemics in the Democratic Republic of the Congo (DRC), from east to west and within western DRC, have been extensively studied. However, the drivers of these spread processes remain unclear. We therefore sought to better understand the factors associated with these spread dynamics and their potential underlying mechanisms. METHODS In this eco-epidemiological study, we focused on the spread processes of cholera epidemics originating from the shores of Lake Kivu, involving the areas bordering Lake Kivu, the areas surrounding the lake areas, and the areas out of endemic eastern DRC (eastern and western non-endemic provinces). Over the period 2000-2018, we collected data on suspected cholera cases, and a set of several variables including types of conflicts, the number of internally displaced persons (IDPs), population density, transportation network density, and accessibility indicators. Using multivariate ordinal logistic regression models, we identified factors associated with the spread of cholera outside the endemic eastern DRC. We performed multivariate Vector Auto Regressive models to analyze potential underlying mechanisms involving the factors associated with these spread dynamics. Finally, we classified the affected health zones using hierarchical ascendant classification based on principal component analysis (PCA). FINDINGS The increase in the number of suspected cholera cases, the exacerbation of conflict events, and the number of IDPs in eastern endemic areas were associated with an increased risk of cholera spreading outside the endemic eastern provinces. We found that the increase in suspected cholera cases was influenced by the increase in battles at lag of 4 weeks, which were influenced by the violence against civilians with a 1-week lag. The violent conflict events influenced the increase in the number of IDPs 4 to 6 weeks later. Other influences and uni- or bidirectional causal links were observed between violent and non-violent conflicts, and between conflicts and IDPs. Hierarchical clustering on PCA identified three categories of affected health zones: densely populated urban areas with few but large and longer epidemics; moderately and accessible areas with more but small epidemics; less populated and less accessible areas with more and larger epidemics. CONCLUSION Our findings argue for monitoring conflict dynamics to predict the risk of geographic expansion of cholera in the DRC. They also suggest areas where interventions should be appropriately focused to build their resilience to the disease.
Collapse
Affiliation(s)
- Harry César Kayembe
- Department of Basic Sciences, Faculty of Medicine, Université de Kinshasa, Kinshasa, Democratic Republic of the Congo
- Department of Environmental Sciences and Management, UR SPHERES, Faculty of Sciences, Université de Liège, Arlon, Belgium
| | - Didier Bompangue
- Department of Basic Sciences, Faculty of Medicine, Université de Kinshasa, Kinshasa, Democratic Republic of the Congo
- Chrono-Environnement, UMR CNRS 6249, Université de Franche-Comté, Besançon, France
| | | | - Bien-Aimé Mandja
- Department of Basic Sciences, Faculty of Medicine, Université de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Doudou Batumbo
- Department of Basic Sciences, Faculty of Medicine, Université de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Muriel Matunga
- Graduate School Public Health Department, Adventist International Institute of Advanced Studies, Silang, Cavite, Philippines
| | - Jérémie Muwonga
- Department of Medical Biology, Faculty of Medicine, Université de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Michel Moutschen
- Department of Clinical Sciences, Immunopathology—Infectious Diseases and General Internal Medicine, Université de Liège, Liege, Belgium
| | - Hippolyte Situakibanza
- Department of Internal Medicine, Faculty of Medicine, Université de Kinshasa, Kinshasa, Democratic Republic of the Congo
- Department of Parasitology and Tropical Medicine, Faculty of Medicine, Université de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Pierre Ozer
- Department of Environmental Sciences and Management, UR SPHERES, Faculty of Sciences, Université de Liège, Arlon, Belgium
| |
Collapse
|
13
|
Montero DA, Vidal RM, Velasco J, George S, Lucero Y, Gómez LA, Carreño LJ, García-Betancourt R, O’Ryan M. Vibrio cholerae, classification, pathogenesis, immune response, and trends in vaccine development. Front Med (Lausanne) 2023; 10:1155751. [PMID: 37215733 PMCID: PMC10196187 DOI: 10.3389/fmed.2023.1155751] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 04/14/2023] [Indexed: 05/24/2023] Open
Abstract
Vibrio cholerae is the causative agent of cholera, a highly contagious diarrheal disease affecting millions worldwide each year. Cholera is a major public health problem, primarily in countries with poor sanitary conditions and regions affected by natural disasters, where access to safe drinking water is limited. In this narrative review, we aim to summarize the current understanding of the evolution of virulence and pathogenesis of V. cholerae as well as provide an overview of the immune response against this pathogen. We highlight that V. cholerae has a remarkable ability to adapt and evolve, which is a global concern because it increases the risk of cholera outbreaks and the spread of the disease to new regions, making its control even more challenging. Furthermore, we show that this pathogen expresses several virulence factors enabling it to efficiently colonize the human intestine and cause cholera. A cumulative body of work also shows that V. cholerae infection triggers an inflammatory response that influences the development of immune memory against cholera. Lastly, we reviewed the status of licensed cholera vaccines, those undergoing clinical evaluation, and recent progress in developing next-generation vaccines. This review offers a comprehensive view of V. cholerae and identifies knowledge gaps that must be addressed to develop more effective cholera vaccines.
Collapse
Affiliation(s)
- David A. Montero
- Departamento de Microbiología, Facultad de Ciencias Biológicas, Universidad de Concepción, Concepción, Chile
| | - Roberto M. Vidal
- Programa de Microbiología y Micología, Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile, Santiago, Chile
- Instituto Milenio de Inmunología e Inmunoterapia, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Juliana Velasco
- Unidad de Paciente Crítico, Clínica Hospital del Profesor, Santiago, Chile
- Programa de Formación de Especialista en Medicina de Urgencia, Universidad Andrés Bello, Santiago, Chile
| | - Sergio George
- Programa de Microbiología y Micología, Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Yalda Lucero
- Programa de Microbiología y Micología, Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile, Santiago, Chile
- Departamento de Pediatría y Cirugía Infantil, Hospital Dr. Roberto del Rio, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Leonardo A. Gómez
- Departamento de Microbiología, Facultad de Ciencias Biológicas, Universidad de Concepción, Concepción, Chile
| | - Leandro J. Carreño
- Instituto Milenio de Inmunología e Inmunoterapia, Facultad de Medicina, Universidad de Chile, Santiago, Chile
- Programa de Inmunología, Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Richard García-Betancourt
- Programa de Inmunología, Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Miguel O’Ryan
- Programa de Microbiología y Micología, Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| |
Collapse
|
14
|
Bwire G, Sack DA, Lunkuse SM, Ongole F, Ngwa MC, Namanya DB, Nsungwa J, Aceng Ocero JR, Mwebesa HG, Muruta A, Nakinsige A, Kisakye A, Kalyebi P, Kemirembe J, Makumbi I, Kagirita A, Ampeire I, Mutegeki D, Matseketse D, Debes AK, Orach CG. Development of a Scorecard to Monitor Progress toward National Cholera Elimination: Its Application in Uganda. Am J Trop Med Hyg 2023; 108:954-962. [PMID: 37037429 PMCID: PMC10160876 DOI: 10.4269/ajtmh.23-0007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 02/01/2023] [Indexed: 04/12/2023] Open
Abstract
In 2017, the Global Task Force for Cholera Control (GTFCC) set a goal to eliminate cholera from ≥ 20 countries and to reduce cholera deaths by 90% by 2030. Many countries have included oral cholera vaccine (OCV) in their cholera control plans. We felt that a simple, user-friendly monitoring tool would be useful to guide national progress toward cholera elimination. We reviewed cholera surveillance data of Uganda from 2015 to 2021 by date and district. We defined a district as having eliminated cholera if cholera was not reported in that district for at least 4 years. We prepared maps to show districts with cholera, districts that had eliminated it, and districts that had eliminated it but then "relapsed." These maps were compared with districts where OCV was used and the hotspot map recommended by the GTFCC. Between 2018 and 2021, OCV was administered in 16 districts previously identified as hotspots. In 2018, cholera was reported during at least one of the four previous years from 36 of the 146 districts of Uganda. This number decreased to 18 districts by 2021. Cholera was deemed "eliminated" from four of these 18 districts but then "relapsed." The cholera elimination scorecard effectively demonstrated national progress toward cholera elimination and identified districts where additional resources are needed to achieve elimination by 2030. Identification of the districts that have eliminated cholera and those that have relapsed will assist the national programs to focus on addressing the factors that result in elimination or relapse of cholera.
Collapse
Affiliation(s)
- Godfrey Bwire
- Department of Community Health, Ministry of Health Uganda, Kampala, Uganda
| | - David A. Sack
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Stella M. Lunkuse
- Division of Surveillance, Knowledge and Information Management, Ministry of Health, Kampala, Uganda
| | - Francis Ongole
- Department of National Health Laboratory and Diagnostic Services, Ministry of Health, Kampala, Uganda
| | - Moise Chi Ngwa
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | - Jesca Nsungwa
- Department of Maternal and Child Health, Ministry of Health, Kampala, Uganda
| | | | - Henry G. Mwebesa
- Office of the Director General Health Service, Ministry of Health, Kampala, Uganda
| | - Allan Muruta
- Department of Integrated Epidemiology and Public Health Emergencies, Ministry of Health, Kampala, Uganda
| | - Anne Nakinsige
- Division of Public Health Emergency Preparedness and Response, Ministry of Health, Kampala, Uganda
| | | | - Peter Kalyebi
- Department of Environmental Health, Ministry of Health, Kampala, Uganda
| | | | - Issa Makumbi
- Public Health Emergency Operation Centre, Ministry of Health, Kampala, Uganda
| | - Atek Kagirita
- Division of Surveillance, Knowledge and Information Management, Ministry of Health, Kampala, Uganda
| | - Immaculate Ampeire
- Uganda National Immunization Programme, Ministry of Health, Kampala, Uganda
| | - David Mutegeki
- Public Health Emergency Operation Centre, Ministry of Health, Kampala, Uganda
| | | | - Amanda Kay Debes
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | |
Collapse
|
15
|
Gelormini M, Gripenberg M, Marke D, Murray M, Yambasu S, Koblo Kamara M, Michael Thomas C, Donald Sonne K, Sang S, Kayita J, Pezzoli L, Caleo G. Coverage survey and lessons learned from a pre-emptive cholera vaccination campaign in urban and rural communities affected by landslides and floods in Freetown Sierra Leone. Vaccine 2023; 41:2397-2403. [PMID: 36872143 PMCID: PMC10102719 DOI: 10.1016/j.vaccine.2023.01.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 12/02/2022] [Accepted: 01/11/2023] [Indexed: 03/06/2023]
Abstract
BACKGROUND On 14 August 2017, massive landslides and floods hit Freetown (Sierra Leone). More than 1,000 people lost their lives while approximately 6,000 people were displaced. The areas most affected included parts of the town with challenged access to basic water and sanitation facilities, with communal water sources likely contaminated by the disaster. To avert a possible cholera outbreak following this emergency, the Ministry of Health and Sanitation (MoHS), supported by the World Health Organization (WHO) and international partners, including Médecins Sans Frontières (MSF) and UNICEF, launched a two-dose pre-emptive vaccination campaign using Euvichol™, an oral cholera vaccine (OCV). METHODS We conducted a stratified cluster survey to estimate vaccination coverage during the OCV campaign and also monitor adverse events. The study population - subsequently stratified by age group and residence area type (urban/rural) - included all individuals aged 1 year or older, living in one of the 25 communities targeted for vaccination. RESULTS In total 3,115 households were visited, 7,189 individuals interviewed; 2,822 (39%) people in rural and 4,367 (61%) in urban areas. The two-dose vaccination coverage was 56% (95% confidence interval (CI): 51.0-61.5), 44% (95%CI: 35.2-53.0) in rural and 57% (95%CI: 51.6-62.8) in urban areas. Vaccination coverage with at least one dose was 82% (95%CI: 77.3-85.5), 61% (95%CI: 52.0-70.2) in rural and 83% (95%CI: 78.5-87.1) in urban areas. CONCLUSIONS The Freetown OCV campaign exemplified a timely public health intervention to prevent a cholera outbreak, even if coverage was lower than expected. We hypothesised that vaccination coverage in Freetown was sufficient in providing at least short-term immunity to the population. However, long-term interventions to ensure access to safe water and sanitation are needed.
Collapse
Affiliation(s)
| | | | - Dennis Marke
- Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Mariama Murray
- Ministry of Health and Sanitation, Freetown, Sierra Leone
| | | | | | | | | | - Sibylle Sang
- Médecins Sans Frontières, OCA, Amsterdam, the Netherlands
| | - Janet Kayita
- World Health Organization, Freetown, Sierra Leone
| | | | - Grazia Caleo
- Médecins Sans Frontières, OCA, Amsterdam, the Netherlands
| |
Collapse
|
16
|
Rumunu J, Wamala JF, Konga SB, Igale AL, Adut AA, Lonyik SK, Lasu RM, Kaya RD, Guracha G, Nsubuga P, Ndenzako F, Olu OO. Integrated disease surveillance and response in humanitarian context: South Sudan experience. Pan Afr Med J 2022; 42:13. [PMID: 36158932 PMCID: PMC9474851 DOI: 10.11604/pamj.supp.2022.42.1.33779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 06/11/2022] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION decades of instability continue to impact the implementation of the Integrated Disease Surveillance and Response (IDSR) strategy. The study reviewed the progress and outcomes of rolling out IDSR in South Sudan. METHODS this descriptive cross-sectional study used epidemiological data for 2019, 2020, and other program data to assess indicators for the five surveillance components including surveillance priorities, core and support functions, and surveillance system structure and quality. RESULTS South Sudan expanded the priority disease scope from 26 to 59 to align with national and regional epidemiological trends and the International Health Regulations (IHR) 2005. Completing the countrywide rollout of electronic Early Warning Alert and Response (EWARS) reporting has improved both the timeliness and completeness of weekly reporting to 78% and 90%, respectively, by week 39 of 2020 in comparison to a baseline of 54% on both timeliness and completeness of reporting in 2019. The National Public Health Laboratory confirmatory testing capacities have been expanded to include cholera, measles, HIV, tuberculosis (TB), influenza, Ebola, yellow fever, and Severe Acute Respiratory Syndrome 2 (SARS-COV-2). Rapid response teams have been established to respond to epidemics and pandemics. CONCLUSION since 2006, South Sudan has registered progress towards using indicator and event-based surveillance and continues to strengthen IHR (2005) capacities. Following the adoption of third edition IDSR guidelines, the current emphasis entails maintaining earlier gains and strengthening community and event-based surveillance, formalizing cross-sectoral one-health engagement, optimal EWARS and District Health Information Systems (DHIS2) use, and strengthening cross-border surveillance. It is also critical that optimal government, and donors' resources are dedicated to supporting health system strengthening and disease surveillance.
Collapse
Affiliation(s)
- John Rumunu
- Directorate of Preventive Health Services, South Sudan Ministry of Health, Joint Doctoral Program in Global Health, Humanitarian Aid and Disaster Medicine, Universita Del Pemonte Orientale and Vrije University Brussel, Juba, South Sudan,,Corresponding author John Rumunu, Directorate of Preventive Health Services, South Sudan Ministry of Health, Joint Doctoral Program in Global Health, Humanitarian Aid and Disaster Medicine, Universita Del Pemonte Orientale and Vrije University Brussel, Juba, South Sudan.
| | | | | | | | | | | | | | | | - Guyo Guracha
- World Health Organization Country office, Juba, South Sudan
| | | | | | | |
Collapse
|