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Taty N, Bompangue D, Moore S, Muyembe JJ, de Richemond NM. Spatiotemporal dynamics of cholera hotspots in the Democratic Republic of the Congo from 1973 to 2022. BMC Infect Dis 2024; 24:360. [PMID: 38549076 PMCID: PMC10976723 DOI: 10.1186/s12879-024-09164-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 02/22/2024] [Indexed: 04/01/2024] Open
Abstract
BACKGROUND Since the early 1970s, cholera outbreaks have been a major public health burden in the Democratic Republic of Congo (DRC). Cholera cases have been reported in a quasi-continuous manner in certain lakeside areas in the Great Lakes Region. As these cholera-endemic health zones constitute a starting point for outbreaks and diffusion towards other at-risk areas, they play a major role in cholera dynamics in the country. Monitoring the spatiotemporal dynamics of cholera hotspots and adjusting interventions accordingly thus reduces the disease burden in an efficient and cost-effective manner. METHODS A literature review was conducted to describe the spatiotemporal dynamics of cholera in the DRC at the province level from 1973 to 1999. We then identified and classified cholera hotspots at the provincial and health zone levels from 2003 to 2022 and described the spatiotemporal evolution of hotspots. We also applied and compared three different classification methods to ensure that cholera hotspots are identified and classified according to the DRC context. RESULTS According to all three methods, high-priority hotspots were concentrated in the eastern Great Lakes Region. Overall, hotspots largely remained unchanged over the course of the study period, although slight improvements were observed in some eastern hotspots, while other non-endemic areas in the west experienced an increase in cholera outbreaks. The Global Task Force on Cholera Control (GTFCC) and the Department of Ecology and Infectious Disease Control (DEIDC) methods largely yielded similar results for the high-risk hotspots. However, the medium-priority hotspots identified by the GTFCC method were further sub-classified by the DEIDC method, thereby providing a more detailed ranking for priority targeting. CONCLUSIONS Overall, the findings of this comprehensive study shed light on the dynamics of cholera hotspots in the DRC from 1973 to 2022. These results may serve as an evidence-based foundation for public health officials and policymakers to improve the implementation of the Multisectoral Cholera Elimination Plan, guiding targeted interventions and resource allocation to mitigate the impact of cholera in vulnerable communities.
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Affiliation(s)
- Nadège Taty
- Department of Infectious Disease Ecology and Control, Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of the Congo.
- Montpellier Geography and Spatial Planning Laboratory, Paul Valéry Montpellier 3 University, Montpellier, France.
- National Program for the Elimination of Cholera and the Fight against Other Diarrheal Diseases, Ministry of Health, Hygiene and Prevention, Kinshasa, Democratic Republic of the Congo.
| | - Didier Bompangue
- Department of Infectious Disease Ecology and Control, Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
- National Program for the Elimination of Cholera and the Fight against Other Diarrheal Diseases, Ministry of Health, Hygiene and Prevention, Kinshasa, Democratic Republic of the Congo
- Chrono-Environment Laboratory, UMR 6249, University of Bourgogne Franche-Comté, Besançon, France
| | | | - J J Muyembe
- National Institute of Biomedical Research, Kinshasa, Democratic Republic of the Congo
| | - Nancy Meschinet de Richemond
- Montpellier Geography and Spatial Planning Laboratory, Paul Valéry Montpellier 3 University, Montpellier, France
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Lemopoulos A, Miwanda B, Drebes Dörr NC, Stutzmann S, Bompangue D, Muyembe-Tamfum JJ, Blokesch M. Genome sequences of Vibrio cholerae strains isolated in the DRC between 2009 and 2012. Microbiol Resour Announc 2024; 13:e0082723. [PMID: 38345380 DOI: 10.1128/mra.00827-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 01/21/2024] [Indexed: 03/13/2024] Open
Abstract
Vibrio cholerae has caused seven cholera pandemics in the past two centuries. The seventh and ongoing pandemic has been particularly severe on the African continent. Here, we report long read-based genome sequences of six V. cholerae strains isolated in the Democratic Republic of the Congo between 2009 and 2012.
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Affiliation(s)
- Alexandre Lemopoulos
- Laboratory of Molecular Microbiology, Global Health Institute, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Berthe Miwanda
- Institut National de Recherche Biomédicale (INRB), Kinshasa, Democratic Republic of Congo
| | - Natália C Drebes Dörr
- Laboratory of Molecular Microbiology, Global Health Institute, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Sandrine Stutzmann
- Laboratory of Molecular Microbiology, Global Health Institute, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Didier Bompangue
- Département de Microbiologie, Faculté de Médecine, Université de Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Jean-Jacques Muyembe-Tamfum
- Institut National de Recherche Biomédicale (INRB), Kinshasa, Democratic Republic of Congo
- Département de Microbiologie, Faculté de Médecine, Université de Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Melanie Blokesch
- Laboratory of Molecular Microbiology, Global Health Institute, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
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Makuntima NT, Bompangue D, Moore S, de Richemond NM, Vandevelde T, Mwamba D, Colwell R, Muyembe JJ. Cholera resurgence potentially induced by the consequences of climate in the El Niño phenomenon: an urgent call for strengthened cholera elimination in Africa. Pan Afr Med J 2023; 46:96. [PMID: 38405090 PMCID: PMC10891368 DOI: 10.11604/pamj.2023.46.96.42258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 11/30/2023] [Indexed: 02/27/2024] Open
Abstract
A resurgence in cholera cases has been observed throughout Africa during the first half of 2023. Among the many factors that drive cholera transmission, the ongoing climate phenomenon El Niño is likely to continue until March to May 2024. To prevent further cholera spread, it is critical to strengthen cholera control efforts in Africa.
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Affiliation(s)
- Nadège Taty Makuntima
- Service d'Ecologie et Contrôle des Maladies Infectieuses, Faculté de Médecine, Université de Kinshasa, République démocratique du Congo
- Laboratoire de Géographie et d´Aménagement de l´Espace de Montpellier, Université Paul Valéry Montpellier 3, France
- Programme National d´Elimination du Choléra et de Lutte Contre les Autres Maladies Diarrhéiques, Ministère de la Santé, Hygiène et Prévention, République démocratique du Congo
| | - Didier Bompangue
- Service d'Ecologie et Contrôle des Maladies Infectieuses, Faculté de Médecine, Université de Kinshasa, République démocratique du Congo
- Programme National d´Elimination du Choléra et de Lutte Contre les Autres Maladies Diarrhéiques, Ministère de la Santé, Hygiène et Prévention, République démocratique du Congo
- Laboratory Chrono-Environnement, UMR 6249, University of Bourgogne Franche-Comté, France
| | | | - Nancy Meschinet de Richemond
- Laboratoire de Géographie et d´Aménagement de l´Espace de Montpellier, Université Paul Valéry Montpellier 3, France
| | | | - Dieudonné Mwamba
- Institut National de Santé Publique, Kinshasa, République démocratique du Congo
| | - Rita Colwell
- Maryland Pathogen Research Institute, University of Maryland, MD, College Park, United States of America
- University of Maryland Institute for Advanced Computer Studies, University of Maryland, College Park, MD, United States of America
- CosmosID Inc, Rockville, MD, United States of America
| | - Jean Jacques Muyembe
- Institut National des Recherches Biomédicales, Kinshasa, République démocratique du Congo
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Bompangue D, Oyugi B, Bokulu M, Tshijuke SM, Das T, Conteh IN, Ejiofor NE, Abok P, Okeibunor J, Salio F, Balde T, Braka F. COVID-19 as an Accelerator of the Implementation of Emergency Medical Teams Initiative in the AFRO Region. Disaster Med Public Health Prep 2023; 17:e489. [PMID: 37702057 DOI: 10.1017/dmp.2023.31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/14/2023]
Abstract
OBJECTIVE This study describes the progress that the World Health Organization (WHO) African (AFRO) region has made in establishing National Emergency Medical Teams (N-EMTs), the coordination mechanisms of the EMTs, and the regional training centers. METHODS It used a retrospective descriptive analysis of the formulation and implementation of the EMTs Initiative from an insider perspective. The analysis is based on the review of available documents such as EMTs mission reports, assessments, surveys, EMT monthly bulletins, and meeting minutes in addition to key informant interviews (n = 5) with the EMT teams' members to validate the findings and share field experiences. RESULTS The emergence of coronavirus disease 2019 (COVID-19) acted as an accelerator for the implementation of the EMT initiative in the AFRO region. A total of 18 EMT deployments were carried out in 16 countries in the AFRO region through the WHO EMT-network during COVID-19, providing support to countries in managing severe and critical COVID-19 cases. CONCLUSIONS A Regional Training Center for N-EMTs is being set up in Addis Ababa to train the N-EMTs and strengthen local capacity of health personnel in the region. Challenges include unavailability of mentors to support countries in implementing N-EMTs and the Regional Simulation Training Center, poor funding, and coordination in the rolling out of the N-EMTs.
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Affiliation(s)
- Didier Bompangue
- World Health Organization, Regional Office for Africa, Emergency Preparedness and Response Programme, Brazzaville, Congo
| | - Boniface Oyugi
- World Health Organization, Regional Office for Africa, Emergency Preparedness and Response Programme, Brazzaville, Congo
- Centre for Health Services Studies (CHSS), University of Kent, George Allen Wing, Canterbury, United Kingdom
| | - Melanie Bokulu
- World Health Organization, Regional Office for Africa, Emergency Preparedness and Response Programme, Brazzaville, Congo
| | - Serge Mudipanu Tshijuke
- World Health Organization, Regional Office for Africa, Emergency Preparedness and Response Programme, Brazzaville, Congo
| | - Timothy Das
- World Health Organization, Headquarters, WPE/CRS/HCR, Geneva, Switzerland
| | - Ishata Nannie Conteh
- World Health Organization, Regional Office for Africa, Emergency Preparedness and Response Programme, Brazzaville, Congo
| | - Nonso Ephraim Ejiofor
- World Health Organization, Regional Office for Africa, Emergency Preparedness and Response Programme, Brazzaville, Congo
| | - Patrick Abok
- World Health Organization, Regional Office for Africa, Emergency Preparedness and Response Programme, Brazzaville, Congo
| | - Joseph Okeibunor
- World Health Organization, Regional Office for Africa, Emergency Preparedness and Response Programme, Brazzaville, Congo
| | - Flavio Salio
- World Health Organization, Headquarters, WPE/CRS/HCR, Geneva, Switzerland
| | - Thierno Balde
- World Health Organization, Regional Office for Africa, Emergency Preparedness and Response Programme, Brazzaville, Congo
| | - Fiona Braka
- World Health Organization, Regional Office for Africa, Emergency Preparedness and Response Programme, Brazzaville, Congo
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Taty N, Bompangue D, de Richemond NM, Muyembe JJ. Spatiotemporal dynamics of cholera in the Democratic Republic of the Congo before and during the implementation of the Multisectoral Cholera Elimination Plan: a cross-sectional study from 2000 to 2021. BMC Public Health 2023; 23:1592. [PMID: 37608355 PMCID: PMC10463990 DOI: 10.1186/s12889-023-16449-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 08/03/2023] [Indexed: 08/24/2023] Open
Abstract
BACKGROUND The Democratic Republic of the Congo (DRC) implemented the first strategic Multisectoral Cholera Elimination Plan (MCEP) in 2008-2012. Two subsequent MCEPs have since been implemented covering the periods 2013-2017 and 2018-2021. The current study aimed to assess the spatiotemporal dynamics of cholera over the recent 22-year period to determine the impact of the MCEPs on cholera epidemics, establish lessons learned and provide an evidence-based foundation to improve the implementation of the next MCEP (2023-2027). METHODS In this cross-sectional study, secondary weekly epidemiological cholera data covering the 2000-2021 period was extracted from the DRC Ministry of Health surveillance databases. The data series was divided into four periods: pre-MCEP 2003-2007 (pre-MCEP), first MCEP (MCEP-1), second MCEP (MCEP-2) and third MCEP (MCEP-3). For each period, we assessed the overall cholera profiles and seasonal patterns. We analyzed the spatial dynamics and identified cholera risk clusters at the province level. We also assessed the evolution of cholera sanctuary zones identified during each period. RESULTS During the 2000-2021 period, the DRC recorded 520,024 suspected cases and 12,561 deaths. The endemic provinces remain the most affected with more than 75% of cases, five of the six endemic provinces were identified as risk clusters during each MCEP period (North Kivu, South Kivu, Tanganyika, Haut-Lomami and Haut-Katanga). Several health zones were identified as cholera sanctuary zones during the study period: 14 health zones during MCEP-1, 14 health zones during MCEP-2 and 29 health zones during MCEP-3. Over the course of the study period, seasonal cholera patterns remained constant, with one peak during the dry season and one peak during the rainy season. CONCLUSION Despite the implementation of three MCEPs, the cholera context in the DRC remains largely unchanged since the pre-MCEP period. To better orient cholera elimination activities, the method used to classify priority health zones should be optimized by analyzing epidemiological; water, sanitation and hygiene; socio-economic; environmental and health indicators at the local level. Improvements should also be made regarding the implementation of the MCEP, reporting of funded activities and surveillance of cholera cases. Additional studies should aim to identify specific bottlenecks and gaps in the coordination and strategic efforts of cholera elimination interventions at the local, national and international levels.
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Affiliation(s)
- Nadège Taty
- Laboratoire de géographie et d'aménagement de Montpellier, Université Paul Valéry Montpellier 3, Montpellier, France.
- Service d'Ecologie et Contrôle des Maladies Infectieuses, Faculté de Médecine, Université de Kinshasa, République démocratique, Congo.
- Programme National d'Elimination du choléra et de lutte contre les autres maladies diarrhéiques, Ministère de la Santé, Hygiène et Prévention, République démocratique, Congo.
| | - Didier Bompangue
- Service d'Ecologie et Contrôle des Maladies Infectieuses, Faculté de Médecine, Université de Kinshasa, République démocratique, Congo
- Programme National d'Elimination du choléra et de lutte contre les autres maladies diarrhéiques, Ministère de la Santé, Hygiène et Prévention, République démocratique, Congo
- Laboratory Chrono-Environnement, UMR 6249, University of Bourgogne Franche-Comté, Besançon, France
| | - Nancy Meschinet de Richemond
- Laboratoire de géographie et d'aménagement de Montpellier, Université Paul Valéry Montpellier 3, Montpellier, France
| | - J J Muyembe
- Institut National des Recherches Biomédicales, Kinshasa, Democratic Republic of the Congo
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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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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
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Mandja BA, Handschumacher P, Bompangue D, Gonzalez JP, Muyembe JJ, Sauleau EA, Mauny F. Environmental Drivers of Monkeypox Transmission in the Democratic Republic of the Congo. Ecohealth 2022; 19:354-364. [PMID: 36029356 DOI: 10.1007/s10393-022-01610-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 08/03/2022] [Indexed: 06/15/2023]
Abstract
Monkeypox (MPX) is an emergent severe zoonotic disease resembling that of smallpox. To date, most cases of human MPX have been reported in the Democratic Republic of the Congo (DRC). While the number of cases has increased steadily in the DRC over the last 30 years, the environmental risk factors that drive the spatiotemporal dynamics of MPX transmission remain poorly understood. This study aimed to investigate the spatiotemporal associations between environmental risk factors and annual MPX incidence in the DRC. All MPX cases reported weekly at the health zone level over a 16-year period (2000-2015) were analyzed. A Bayesian hierarchical generalized linear mixed model was conducted to identify the spatiotemporal associations between annual MPX incidence and three types of environmental risk factors illustrating environment as a system resulting from physical, social and cultural interactions Primary forest (IRR 1.034 [1.029-1.040]), economic well-being (IRR 1.038 [1.031-1.047]), and temperature (IRR 1.143 [1.028-1.261]) were positively associated with annual MPX incidence. Our study shows that physical environmental risk factors alone cannot explain the emergence of MPX outbreaks in the DRC. Economic level and cultural practices participate from environment as a whole and thus, must be considered to understand exposure to MPX risk Future studies should examine the impact of these factors in greater detail.
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Affiliation(s)
- Bien-Aimé Mandja
- Département des Sciences de Base, Service d'Écologie et Contrôle des Maladies Infectieuses, Faculté de Médecine, Université de Kinshasa, Quartier Lemba, BP 834 KIN XI, Kinshasa, Democratic Republic of the Congo.
- Laboratoire Chrono-Environnement, UMR 6249 CNRS, Université de Bourgogne Franche-Comté, Besançon, France.
| | | | - Didier Bompangue
- Département des Sciences de Base, Service d'Écologie et Contrôle des Maladies Infectieuses, Faculté de Médecine, Université de Kinshasa, Quartier Lemba, BP 834 KIN XI, Kinshasa, Democratic Republic of the Congo
- Laboratoire Chrono-Environnement, UMR 6249 CNRS, Université de Bourgogne Franche-Comté, Besançon, France
| | - Jean-Paul Gonzalez
- Department of Microbiology and Immunology, Division of Biomedical Graduate Research Organization, Georgetown University School of Medicine, 4000 Reservoir Road, Washington, DC, 20057, USA
| | - Jean-Jacques Muyembe
- Département des Sciences de Base, Service d'Écologie et Contrôle des Maladies Infectieuses, Faculté de Médecine, Université de Kinshasa, Quartier Lemba, BP 834 KIN XI, Kinshasa, Democratic Republic of the Congo
- Institut National de Recherche Biomédicale, Gombe, Kinshasa, Democratic Republic of the Congo
| | - Erik-André Sauleau
- Laboratoire de Biostatistique et Informatique Médicale, Faculté de Médecine, Laboratoire ICube UMR CNRS 7357, Université de Strasbourg, Strasbourg, France
| | - Frédéric Mauny
- Laboratoire Chrono-Environnement, UMR 6249 CNRS, Université de Bourgogne Franche-Comté, Besançon, France
- Centre Hospitalier Universitaire de Besançon, uMETh Inserm CIC 1431, Besançon, France
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Nsenga N, Bompangue D, Oyugi B, Atsyor C, Lukhele N, Salio F, Das T, Lajolo C, Anderson D, Mee A, Kent A, Okello VN, Conteh IN, Okeibunor JC, Yoti Z, Gueye AS. The role of emergency medical teams in Eswatini during the COVID-19 pandemic. Pan Afr Med J 2022; 41:9. [PMID: 36159025 PMCID: PMC9474951 DOI: 10.11604/pamj.supp.2022.41.2.32546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 01/05/2022] [Indexed: 11/18/2022] Open
Abstract
The paper documents experiences and lesson learned in responding to COVID-19 pandemic in Eswatini with the support of the Emergency Medical Teams. WHO databases, operation reports and hospitalization records were reviewed. The WHO Emergency Medical Teams built the capacity of the local response teams in Eswatini. The conclusion is that following the intervention of the WHO Emergency Medical Teams, Eswatini is better prepared to respond to the ongoing COVID-19 pandemic and future outbreaks.
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Affiliation(s)
- Ngoy Nsenga
- World Health Organisation, Regional Office for Africa, Emergency Preparedness and Response Programme, Brazzaville, Congo,,Corresponding author: Ngoy Nsenga, World Health Organisation, Regional Office for Africa, Emergency Preparedness and Response Programme, Brazzaville, Congo.
| | - Didier Bompangue
- World Health Organisation, Regional Office for Africa, Emergency Preparedness and Response Programme, Brazzaville, Congo
| | - Boniface Oyugi
- World Health Organisation, Regional Office for Africa, Emergency Preparedness and Response Programme, Brazzaville, Congo
| | | | | | - Flavio Salio
- World Health Organisation, Headquarters, WPE/CRS/HCR, Geneva, Switzerland
| | - Timothy Das
- World Health Organisation, Headquarters, WPE/CRS/HCR, Geneva, Switzerland
| | - Camila Lajolo
- World Health Organisation, Headquarters, WPE/CRS/HCR, Geneva, Switzerland
| | | | | | | | | | - Ishata Nannie Conteh
- World Health Organisation, Regional Office for Africa, Emergency Preparedness and Response Programme, Brazzaville, Congo
| | - Joseph Chukwudi Okeibunor
- World Health Organisation, Regional Office for Africa, Emergency Preparedness and Response Programme, Brazzaville, Congo
| | - Zabulon Yoti
- World Health Organisation, Regional Office for Africa, Emergency Preparedness and Response Programme, Brazzaville, Congo
| | - Abdou Salam Gueye
- World Health Organisation, Regional Office for Africa, Emergency Preparedness and Response Programme, Brazzaville, Congo
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Kayembe-Ntumba HC, Vangola F, Ansobi P, Kapour G, Bokabo E, Mandja BA, Bompangue D. Vaccination dropout rates among children aged 12-23 months in Democratic Republic of the Congo: a cross-sectional study. Arch Public Health 2022; 80:18. [PMID: 34986887 PMCID: PMC8728983 DOI: 10.1186/s13690-021-00782-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 12/24/2021] [Indexed: 11/27/2022] Open
Abstract
Background Overall, 1.8 million children fail to receive the 3-dose series for diphtheria, tetanus and pertussis each year in the Democratic Republic of the Congo (DRC). Currently, an emergency plan targeting 9 provinces including Kinshasa, the capital of the DRC, is launched to reinforce routine immunization. Mont Ngafula II was the only health district that experienced high vaccination dropout rates for nearly five consecutive years. This study aimed to identify factors predicting high immunization dropout rates among children aged 12-23 months in the Mont Ngafula II health district. Methods A cross-sectional household survey was conducted among 418 children in June-July 2019 using a two-stage sampling design. Socio-demographic and perception data were collected through a structured interviewer-administered questionnaire. The distribution of 2017-2018 immunization coverage and dropout rate was extracted from the local health district authority and mapped. Logistic random effects regression models were used to identify predictors of high vaccination dropout rates. Results Of the 14 health areas in the Mont Ngafula II health district, four reported high vaccine coverage, only one recorded low vaccine coverage, and three reported both low vaccine coverage and high dropout rate. In the final multivariate logistic random effects regression model, the predictors of immunization dropout among children aged 12-23 months were: living in rural areas, unavailability of seats, non-compliance with the order of arrival during vaccination in health facilities, and lack of a reminder system on days before the scheduled vaccination. Conclusions Our results advocate for prioritizing targeted interventions and programs to strengthen interpersonal communication between immunization service providers and users during vaccination in health facilities and to implement an SMS reminder system on days before the scheduled vaccination.
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Affiliation(s)
- Harry-César Kayembe-Ntumba
- Ecology and Control of Infectious Diseases Unit, Department of Basic Sciences, Faculty of Medicine, University of Kinshasa, Kin XI, BP: 834, Kinshasa, Democratic Republic of the Congo.
| | - Felly Vangola
- Master of Ecology of Infectious Diseases, Natural Hazards and Risk Management, Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Papy Ansobi
- Ecology and Control of Infectious Diseases Unit, Department of Basic Sciences, Faculty of Medicine, University of Kinshasa, Kin XI, BP: 834, Kinshasa, Democratic Republic of the Congo
| | - Germain Kapour
- Ecology and Control of Infectious Diseases Unit, Department of Basic Sciences, Faculty of Medicine, University of Kinshasa, Kin XI, BP: 834, Kinshasa, Democratic Republic of the Congo
| | - Eric Bokabo
- Ecology and Control of Infectious Diseases Unit, Department of Basic Sciences, Faculty of Medicine, University of Kinshasa, Kin XI, BP: 834, Kinshasa, Democratic Republic of the Congo
| | - Bien-Aimé Mandja
- Ecology and Control of Infectious Diseases Unit, Department of Basic Sciences, Faculty of Medicine, University of Kinshasa, Kin XI, BP: 834, Kinshasa, Democratic Republic of the Congo
| | - Didier Bompangue
- Ecology and Control of Infectious Diseases Unit, Department of Basic Sciences, Faculty of Medicine, University of Kinshasa, Kin XI, BP: 834, Kinshasa, Democratic Republic of the Congo.,Chrono-Environnement Laboratory, CNRS, UMR 6249, University of Bourgogne Franche- Comté, Besançon, France
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10
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Kayembe HCN, Linard C, Bompangue D, Muwonga J, Moutschen M, Situakibanza H, Ozer P. The spread of cholera in western Democratic Republic of the Congo is not unidirectional from East-West: a spatiotemporal analysis, 1973-2018. BMC Infect Dis 2021; 21:1261. [PMID: 34923959 PMCID: PMC8684622 DOI: 10.1186/s12879-021-06986-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Accepted: 12/16/2021] [Indexed: 11/20/2022] Open
Abstract
Background Cholera outbreaks in western Democratic Republic of the Congo (DRC) are thought to be primarily the result of westward spread of cases from the Great Lakes Region. However, other patterns of spatial spread in this part of the country should not be excluded. The aim of this study was to explore alternative routes of spatial spread in western DRC. Methods A literature review was conducted to reconstruct major outbreak expansions of cholera in western DRC since its introduction in 1973. We also collected data on cholera cases reported at the health zone (HZ) scale by the national surveillance system during 2000–2018. Based on data from routine disease surveillance, we identified two subperiods (week 45, 2012–week 42, 2013 and week 40, 2017–week 52, 2018) for which the retrospective space–time permutation scan statistic was implemented to detect spatiotemporal clusters of cholera cases and then to infer the spread patterns in western DRC other than that described in the literature. Results Beyond westward and cross-border spread in the West Congo Basin from the Great Lakes Region, other dynamics of cholera epidemic propagation were observed from neighboring countries, such as Angola, to non-endemic provinces of southwestern DRC. Space–time clustering analyses sequentially detected clusters of cholera cases from southwestern DRC to the northern provinces, demonstrating a downstream-to-upstream spread along the Congo River. Conclusions The spread of cholera in western DRC is not one-sided. There are other patterns of spatial spread, including a propagation from downstream to upstream areas along the Congo River, to be considered as preferential trajectories of cholera in western DRC. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-021-06986-9.
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Affiliation(s)
- Harry César Ntumba Kayembe
- Service d'Ecologie et Contrôle des Maladies Infectieuses, Département des Sciences de Base, Faculté de Médecine, Université de Kinshasa, Kinshasa, Democratic Republic of the Congo. .,Département de Sciences Et Gestion de L'environnement, Faculté Des Sciences, Université de Liège, Arlon, Belgium. .,Service d'Ecologie et Contrôle des Maladies Infectieuses, Département des Sciences de Base, Faculté de Médecine, Université de Kinshasa, Kin XI, B.P. : 834, Kinshasa, Democratic Republic of the Congo.
| | | | - Didier Bompangue
- Service d'Ecologie et Contrôle des Maladies Infectieuses, Département des Sciences de Base, Faculté de Médecine, Université de Kinshasa, Kinshasa, Democratic Republic of the Congo.,Chrono-Environnement, UMR CNRS 6249, Université de Franche-Comté, Besançon, France
| | - Jérémie Muwonga
- Département de Biologie Clinique, Faculté de Médecine, Université de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Michel Moutschen
- Département des Sciences Cliniques, Immunopathologie-Maladies infectieuses et Médecine interne générale, Université de Liège, Liege, Belgium
| | - Hippolyte Situakibanza
- Département de Médecine Interne, Faculté de Médecine, Université de Kinshasa, Kinshasa, Democratic Republic of the Congo.,Département de Parasitologie Et Médecine Tropicale, Faculté de Médecine, Université de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Pierre Ozer
- Département de Sciences Et Gestion de L'environnement, Faculté Des Sciences, Université de Liège, Arlon, Belgium
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11
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Mazamay S, Guégan JF, Diallo N, Bompangue D, Bokabo E, Muyembe JJ, Taty N, Vita TP, Broutin H. An overview of bacterial meningitis epidemics in Africa from 1928 to 2018 with a focus on epidemics "outside-the-belt". BMC Infect Dis 2021; 21:1027. [PMID: 34592937 PMCID: PMC8485505 DOI: 10.1186/s12879-021-06724-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 08/10/2021] [Indexed: 11/10/2022] Open
Abstract
Background Bacterial meningitis occurs worldwide but Africa remains the most affected continent, especially in the "Meningitis belt" that extends from Senegal to Ethiopia. Three main bacteria are responsible for causing bacterial meningitis, i.e., N. meningitidis (Nm), S. pneumoniae and H. influenzae type b. Among Nm, serogroup A used to be responsible for up to 80 to 85% of meningococcal meningitis cases in Africa. Since 2000, other Nm serogroups including W, X and C have also been responsible for causing epidemics. This overview aims to describe the main patterns of meningitis disease cases and pathogens from 1928 to 2018 in Africa with a special focus on disease conditions “out-of-the-belt” area that is still usually unexplored. Based on basic spatio-temporal methods, and a 90-years database of reported suspected meningitis cases and death from the World Health Organization, we used both geographic information system and spatio-temporal statistics to identify the major localizations of meningitis epidemics over this period in Africa. Results Bacterial meningitis extends today outside its historical limits of the meningitis belt. Since the introduction of MenAfrivac vaccine in 2010, there has been a dramatic decrease in NmA cases while other pathogen species and Nm variants including NmW, NmC and Streptococcus pneumoniae have become more prevalent reflecting a greater diversity of bacterial strains causing meningitis epidemics in Africa today. Conclusion Bacterial meningitis remains a major public health problem in Africa today. Formerly concentrated in the region of the meningitis belt with Sub-Saharan and Sudanian environmental conditions, the disease extends now outside these historical limits to reach more forested regions in the central parts of the continent. With global environmental changes and massive vaccination targeting a unique serogroup, an epidemiological transition of bacterial meningitis is ongoing, requiring both a better consideration of the etiological nature of the responsible agents and of their proximal and distal determinants. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-021-06724-1.
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Affiliation(s)
- Serge Mazamay
- Département de Microbiologie, Faculté de Médecine, Université de Kinshasa, Kinshasa, Democratic Republic of Congo. .,MIVEGEC, Université de Montpellier, IRD, CNRS, 911 avenue Agropolis, BP 64501, 34394, Montpellier Cedex 5, France.
| | - Jean-François Guégan
- MIVEGEC, Université de Montpellier, IRD, CNRS, 911 avenue Agropolis, BP 64501, 34394, Montpellier Cedex 5, France.,ASTRE, INRAE, Cirad, Université de Montpellier, Campus international de Baillarguet, 34398, Montpellier Cedex 5, France
| | - Neby Diallo
- Département de Microbiologie, Faculté de Médecine, Université de Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Didier Bompangue
- Département de Microbiologie, Faculté de Médecine, Université de Kinshasa, Kinshasa, Democratic Republic of Congo.,Chrono-Environnement, UMR CNRS 6249 Université de Franche-Comté, Besançon, France
| | - Eric Bokabo
- Département de Microbiologie, Faculté de Médecine, Université de Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Jean-Jacques Muyembe
- Département de Microbiologie, Faculté de Médecine, Université de Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Nadège Taty
- Département de Microbiologie, Faculté de Médecine, Université de Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Tonton Paul Vita
- Département de Microbiologie, Faculté de Médecine, Université de Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Hélène Broutin
- MIVEGEC, Université de Montpellier, IRD, CNRS, 911 avenue Agropolis, BP 64501, 34394, Montpellier Cedex 5, France.,Département de Parasitologie-Mycologie, Faculté de Médecine, Université Cheikh Anta Diop (UCAD), Dakar, Sénégal.,Centre de Recherche en Ecologie et Evolution de la Santé (CREES), Montpellier, France
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12
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Bompangue D, Moore S, Taty N, Ipouma B, Sudre B, Manda R, Balde T, Mboussou F, Vandevelde T. Description of the targeted WASH response strategy implemented during the cholera outbreak of 2017-2018 in Kinshasa, DRC. Int J Infect Dis 2020. [DOI: 10.1016/j.ijid.2020.09.378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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13
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Taty N, de Vos D, Pirnay JP, Bompangue D. The cholera endemic in the Democratique republic of Congo: The last decades. Int J Infect Dis 2020. [DOI: 10.1016/j.ijid.2020.09.336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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14
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Mazamay S, Broutin H, Bompangue D, Muyembe JJ, Guégan JF. The environmental drivers of bacterial meningitis epidemics in the Democratic Republic of Congo, central Africa. PLoS Negl Trop Dis 2020; 14:e0008634. [PMID: 33027266 PMCID: PMC7540884 DOI: 10.1371/journal.pntd.0008634] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 07/23/2020] [Indexed: 01/17/2023] Open
Abstract
INTRODUCTION Bacterial meningitis still constitutes an important threat in Africa. In the meningitis belt, a clear seasonal pattern in the incidence of meningococcal disease during the dry season has been previously correlated with several environmental parameters like dust and sand particles as well as the Harmattan winds. In parallel, the evidence of seasonality in meningitis dynamics and its environmental variables remain poorly studied outside the meningitis belt. This study explores several environmental factors associated with meningitis cases in the Democratic Republic of Congo (DRC), central Africa, outside the meningitis belt area. METHODS Non-parametric Kruskal-Wallis' tests were used to establish the difference between the different health zones, climate and vegetation types in relation to both the number of cases and attack rates for the period 2000-2018. The relationships between the number of meningitis cases for the different health zones and environmental and socio-economical parameters collected were modeled using different generalized linear (GLMs) and generalized linear mixed models (GLMMs), and different error structure in the different models, i.e., Poisson, binomial negative, zero-inflated binomial negative and more elaborated multi-hierarchical zero-inflated binomial negative models, with randomization of certain parameters or factors (health zones, vegetation and climate types). Comparing the different statistical models, the model with the smallest Akaike's information criterion (AIC) were selected as the best ones. 515 different health zones from 26 distinct provinces were considered for the construction of the different GLM and GLMM models. RESULTS Non-parametric bivariate statistics showed that there were more meningitis cases in urban health zones than in rural conditions (χ2 = 6.910, p-value = 0.009), in areas dominated by savannah landscape than in areas with dense forest or forest in mountainous areas (χ2 = 15.185, p-value = 0.001), and with no significant difference between climate types (χ2 = 1.211, p-value = 0,449). Additionally, no significant difference was observed for attack rate between the two types of heath zones (χ2 = 0.982, p-value = 0.322). Conversely, strong differences in attack rate values were obtained for vegetation types (χ2 = 13.627, p-value = 0,001) and climate types (χ2 = 13.627, p-value = 0,001). This work demonstrates that, all other parameters kept constant, an urban health zone located at high latitude and longitude eastwards, located at low-altitude like in valley ecosystems predominantly covered by savannah biome, with a humid tropical climate are at higher risk for the development of meningitis. In addition, the regions with mean range temperature and a population with a low index of economic well-being (IEW) constitute the perfect conditions for the development of meningitis in DRC. CONCLUSION In a context of global environmental change, particularly climate change, our findings tend to show that an interplay of different environmental and socio-economic drivers are important to consider in the epidemiology of bacterial meningitis epidemics in DRC. This information is important to help improving meningitis control strategies in a large country located outside of the so-called meningitis belt.
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Affiliation(s)
- Serge Mazamay
- Département de Microbiologie, Faculté de Médecine, Université de Kinshasa, Kinshasa, Democratic Republic of Congo
- MIVEGEC, IRD, CNRS, Université de Montpellier, Montpellier, France
- * E-mail:
| | - Hélène Broutin
- MIVEGEC, IRD, CNRS, Université de Montpellier, Montpellier, France
- Département de Parasitologie-Mycologie, Faculté de Médecine, Université Cheikh Anta Diop (UCAD), Dakar, Sénégal
- Centre de Recherche en Evolution et Ecologie de la Santé (CREES), Montpellier, France
| | - Didier Bompangue
- Département de Microbiologie, Faculté de Médecine, Université de Kinshasa, Kinshasa, Democratic Republic of Congo
- Chrono-Environnement, UMR CNRS 6249 Université de Franche-Comté, Besançon, France
| | - Jean-Jacques Muyembe
- Département de Microbiologie, Faculté de Médecine, Université de Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Jean-François Guégan
- MIVEGEC, IRD, CNRS, Université de Montpellier, Montpellier, France
- ASTRE, INRAE, Cirad, Université de Montpellier, Campus International de Baillarguet, Montpellier, France
- oneHEALTH Global Research Programme, FutureEarth programme, Paris, France
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Batumbo Boloweti D, Giraudoux P, Deniel C, Garnier E, Mauny F, Kasereka CM, Kizungu R, Muyembe JJ, Bompangue D, Bornette G. Volcanic activity controls cholera outbreaks in the East African Rift. PLoS Negl Trop Dis 2020; 14:e0008406. [PMID: 32776919 PMCID: PMC7441828 DOI: 10.1371/journal.pntd.0008406] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 08/20/2020] [Accepted: 05/21/2020] [Indexed: 11/18/2022] Open
Abstract
We hypothesized that Cholera (Vibrio cholerae) that appeared along Lake Kivu in the African Rift in the seventies, might be controlled by volcano-tectonic activity, which, by increasing surface water and groundwater salinity and temperature, may partly rule the water characteristics of Lake Kivu and promote V. cholerae proliferation. Volcanic activity (assessed weekly by the SO2 flux of Nyiragongo volcano plume over the 2007-2012 period) is highly positively correlated with the water conductivity, salinity and temperature of the Kivu lake. Over the 2007-2012 period, these three parameters were highly positively correlated with the temporal dynamics of cholera cases in the Katana health zone that border the lake. Meteorological variables (air temperature and rainfall), and the other water characteristics (namely pH and dissolved oxygen concentration in lake water) were unrelated to cholera dynamics over the same period. Over the 2016-2018 period, we sampled weekly lake water salinity and conductivity, and twice a month vibrio occurrence in lake water and fish. The abundance of V. cholerae in the lake was positively correlated with lake salinity, temperature, and the number of cholera cases in the population of the Katana health zone. V. cholerae abundance in fishes was positively correlated with V. cholerae abundance in lake water, suggesting that their consumption directly contaminate humans. The activity of the volcano, by controlling the physico-chemical characteristics of Lake Kivu, is therefore a major determinant of the presence of the bacillus in the lake. SO2 fluxes in the volcano plume can be used as a tool to predict epidemic risks.
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Affiliation(s)
| | - Patrick Giraudoux
- UMR CNRS 6249 Chrono-Environnement, University of Bourgogne Franche
Comté, Besançon, France
| | - Catherine Deniel
- UMR CNRS 6524 Laboratoire Magmas et Volcans, University of Blaise
Pascal-CNRS-IRD, Clermont Ferrand, France
| | - Emmanuel Garnier
- UMR CNRS 6249 Chrono-Environnement, University of Bourgogne Franche
Comté, Besançon, France
| | - Frederic Mauny
- UMR CNRS 6249 Chrono-Environnement, University of Bourgogne Franche
Comté, Besançon, France
| | | | - Roger Kizungu
- Faculty of Agronomy, University of Kinshasa, Kinshasa, Democratic
Republic of Congo
| | - Jean Jacques Muyembe
- Department of Microbiology, Faculty of Medicine, University of Kinshasa,
Kinshasa, Democratic Republic of Congo
| | - Didier Bompangue
- UMR CNRS 6249 Chrono-Environnement, University of Bourgogne Franche
Comté, Besançon, France
| | - Gudrun Bornette
- UMR CNRS 6249 Chrono-Environnement, University of Bourgogne Franche
Comté, Besançon, France
- * E-mail:
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Ndumbi P, Mboussou F, Otiobanda F, Mbayo G, Bompangue D, Mukinda V, Nsambu MN, Kanyonga JM, Ngom R, Hamblion E, Impouma B. Assessing the preparedness of primary healthcare facilities during a cholera outbreak in Kinshasa, Democratic Republic of the Congo, 2018. Public Health 2020; 183:102-109. [PMID: 32470696 DOI: 10.1016/j.puhe.2020.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 03/20/2020] [Accepted: 03/24/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE During the 2017-2018 cholera outbreak in Kinshasa, many patients initially reported to primary healthcare centers (HCs) before being transferred to the nearest cholera treatment centers. This study aims to assess the level of preparedness of HCs in responding to cholera outbreaks. STUDY DESIGN Descriptive cross-sectional survey. METHODS We conducted a descriptive cross-sectional survey in 180 of 374 primary HCs in Kinshasa. We collected data on 14 cholera preparedness criteria and described their prevalence among HCs. We used logistic regression to assess the association between each preparedness criteria and previous reporting of cholera cases by HCs. RESULTS The median number of preparedness criteria met by HCs was 5 [range: 0-11]. Five percent (n = 9) of HCs [95% confidence interval (CI): 2.3%-9.3%] met at least 10 criteria. HCs that previously reported ≥3 cholera cases were less likely to meet the criteria for 'presence of an isolation unit' (adjusted odds ratio [aOR]: 0.12; 95% CI [0.03-0.61]) and 'availability of sufficient quantity of chlorine' (aOR: 0.13; 95% CI [0.02-0.64]). CONCLUSIONS Despite past experience of cholera cases, health facilities in Kinshasa exhibit a low level of cholera preparedness. There is a need to prioritize the reinforcement of the preparedness of primary HCs to prevent future cholera outbreaks.
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Affiliation(s)
- P Ndumbi
- World Health Organization Regional Office for Africa, Emergency Preparedness and Response, Brazzaville, Congo.
| | - F Mboussou
- World Health Organization Regional Office for Africa, Emergency Preparedness and Response, Brazzaville, Congo.
| | - F Otiobanda
- University Hospital Centre, Brazzaville, Congo
| | - G Mbayo
- World Health Organization Regional Office for Africa, Health Emergency, Brazzaville, Congo
| | - D Bompangue
- National Programme for Cholera Elimination, Kinshasa, Congo
| | - V Mukinda
- World Health Organization Country Office, Kinshasa, Congo
| | - M N Nsambu
- World Health Organization Country Office, Kinshasa, Congo
| | | | - R Ngom
- World Health Organization Regional Office for Africa, Emergency Preparedness and Response, Brazzaville, Congo
| | - E Hamblion
- World Health Organization Regional Office for Africa, Emergency Preparedness and Response, Brazzaville, Congo
| | - B Impouma
- World Health Organization Regional Office for Africa, Emergency Preparedness and Response, Brazzaville, Congo
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Mazamay S, Bompangue D, Guégan JF, Muyembe JJ, Raoul F, Broutin H. Understanding the spatio-temporal dynamics of meningitis epidemics outside the belt: the case of the Democratic Republic of Congo (DRC). BMC Infect Dis 2020; 20:291. [PMID: 32312246 PMCID: PMC7168871 DOI: 10.1186/s12879-020-04996-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Accepted: 03/27/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Bacterial meningitis remains a major threat for the population of the meningitis belt. Between 2004 and 2009, in the countries of this belt, more than 200,000 people were infected with a 10% mortality rate. However, for almost 20 years, important meningitis epidemics are also reported outside this belt. Research is still very poorly developed in this part of the word like in the Democratic Republic of Congo (DRC), which experiences recurrent epidemics. This article describes for the first time the spatio-temporal patterns of meningitis cases and epidemics in DRC, in order to provide new insights for surveillance and control measures. METHODS Based on weekly suspected cases of meningitis (2000-2012), we used time-series analyses to explore the spatio-temporal dynamics of the disease. We also used both geographic information systems and geostatistics to identify spatial clusters of cases. Both using conventional statistics and the Cleveland's algorithm for decomposition into general trend, seasonal and residuals, we searched for the existence of seasonality. RESULTS We observed a low rate of biological confirmation of cases (11%) using soluble antigens search, culture and PCR. The main strains found are Streptococcus pneumoniae, Haemophilus influenzae and Neisseria meningitidis (A and C) serogroups. We identified 8 distinct spatial clusters, located in the northeastern and southeastern part of DRC, and in the capital city province, Kinshasa. A low seasonal trend was observed with higher incidence and attack rate of meningitis during the dry season, with a high heterogeneity in seasonal patterns occurring across the different districts and regions of DRC. CONCLUSION Despite challenges related to completeness of data reporting, meningitis dynamics shows weak seasonality in DRC. This tends to suggest that climatic, environmental factors might be less preponderant in shaping seasonal patterns in central Africa. The characterization of 8 distinct clusters of meningitis could be used for a better sentinel meningitis surveillance and optimization of vaccine strategy in DRC. Improving biological monitoring of suspected cases should be a priority for future eco-epidemiological studies to better understand the emergence and spread of meningitis pathogens, and the potential ecological, environmental drivers of this disease.
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Affiliation(s)
- Serge Mazamay
- Département de Microbiologie, Faculté de Médecine, Université de Kinshasa, Kinshasa, Democratic Republic of Congo
- MIVEGEC, UMR IRD CNRS UM, 911 avenue Agropolis, BP 64501, 34394 Montpellier Cedex 5, France
| | - Didier Bompangue
- Département de Microbiologie, Faculté de Médecine, Université de Kinshasa, Kinshasa, Democratic Republic of Congo
- UMR CNRS 6249 Chrono-Environnement, Besançon, France
| | - Jean-François Guégan
- MIVEGEC, UMR IRD CNRS UM, 911 avenue Agropolis, BP 64501, 34394 Montpellier Cedex 5, France
- ASTRE UMR INRAE Cirad UM, Campus International de Baillarguet, 34398 Montpellier 722 Cedex 5, France
| | - Jean-Jacques Muyembe
- Département de Microbiologie, Faculté de Médecine, Université de Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Francis Raoul
- UMR CNRS 6249 Chrono-Environnement, Besançon, France
| | - Hélène Broutin
- MIVEGEC, UMR IRD CNRS UM, 911 avenue Agropolis, BP 64501, 34394 Montpellier Cedex 5, France
- Département de Parasitologie-Mycologie, Faculté de Médecine, Université Cheikh Anta Diop (UCAD), Dakar, Senegal
- CREES (Centre de Recherche en Ecologie et Evolution de la Santé), Montpellier, France
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Bompangue D, Moore S, Taty N, Impouma B, Sudre B, Manda R, Balde T, Mboussou F, Vandevelde T. Description of the targeted water supply and hygiene response strategy implemented during the cholera outbreak of 2017-2018 in Kinshasa, DRC. BMC Infect Dis 2020; 20:226. [PMID: 32183745 PMCID: PMC7079479 DOI: 10.1186/s12879-020-4916-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 02/21/2020] [Indexed: 12/16/2022] Open
Abstract
Background Rapid control of cholera outbreaks is a significant challenge in overpopulated urban areas. During late-2017, Kinshasa, the capital of the Democratic Republic of the Congo, experienced a cholera outbreak that showed potential to spread throughout the city. A novel targeted water and hygiene response strategy was implemented to quickly stem the outbreak. Methods We describe the first implementation of the cluster grid response strategy carried out in the community during the cholera outbreak in Kinshasa, in which response activities targeted cholera case clusters using a grid approach. Interventions focused on emergency water supply, household water treatment and safe storage, home disinfection and hygiene promotion. We also performed a preliminary community trial study to assess the temporal pattern of the outbreak before and after response interventions were implemented. Cholera surveillance databases from the Ministry of Health were analyzed to assess the spatiotemporal dynamics of the outbreak using epidemic curves and maps. Results From January 2017 to November 2018, a total of 1712 suspected cholera cases were reported in Kinshasa. During this period, the most affected health zones included Binza Météo, Limeté, Kokolo, Kintambo and Kingabwa. Following implementation of the response strategy, the weekly cholera case numbers in Binza Météo, Kintambo and Limeté decreased by an average of 57% after 2 weeks and 86% after 4 weeks. The total weekly case numbers throughout Kinshasa Province dropped by 71% 4 weeks after the peak of the outbreak. Conclusion During the 2017–2018 period, Kinshasa experienced a sharp increase in cholera case numbers. To contain the outbreak, water supply and hygiene response interventions targeted case households, nearby neighbors and public areas in case clusters using a grid approach. Following implementation of the response, the outbreak in Kinshasa was quickly brought under control. A similar approach may be adapted to quickly interrupt cholera transmission in other urban settings.
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Affiliation(s)
- Didier Bompangue
- Ministry of Health, Kinshasa, Democratic Republic of the Congo.,Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of the Congo.,Laboratory Chrono-Environnement, UMR 6249, University of Bourgogne Franche-Comté, Bourgogne Franche-Comté, France
| | | | - Nadège Taty
- Ministry of Health, Kinshasa, Democratic Republic of the Congo.,Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Benido Impouma
- World Health Organization, African Regional Office, Brazzaville, Republic of, Congo
| | - Bertrand Sudre
- Laboratory Chrono-Environnement, UMR 6249, University of Bourgogne Franche-Comté, Bourgogne Franche-Comté, France
| | - Richard Manda
- Ministry of Health, Kinshasa, Democratic Republic of the Congo
| | - Thierno Balde
- World Health Organization, African Regional Office, Brazzaville, Republic of, Congo
| | - Franck Mboussou
- World Health Organization, African Regional Office, Brazzaville, Republic of, Congo
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Ingelbeen B, Hendrickx D, Miwanda B, van der Sande MA, Mossoko M, Vochten H, Riems B, Nyakio JP, Vanlerberghe V, Lunguya O, Jacobs J, Boelaert M, Kebela BI, Bompangue D, Muyembe JJ. Recurrent Cholera Outbreaks, Democratic Republic of the Congo, 2008-2017. Emerg Infect Dis 2019; 25:856-864. [PMID: 31002075 PMCID: PMC6478228 DOI: 10.3201/eid2505.181141] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
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 hot spots, 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.
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Affiliation(s)
- Harry César Kayembe Ntumba
- Research and Training Unit on the Ecology and Control of Infectious Diseases, Department of Microbiology, Medicine School, University of Kinshasa, Kinshasa BP 834, DR Congo.
| | - Didier Bompangue
- Research and Training Unit on the Ecology and Control of Infectious Diseases, Department of Microbiology, Medicine School, University of Kinshasa, Kinshasa BP 834, DR Congo
| | - Hippolyte Situakibanza
- Department of Parasitology and Tropical Medicine, Medicine School, University of Kinshasa, Kinshasa BP 834, DR Congo
| | | | - Pierre Ozer
- Department of Environmental Sciences and Management, University of Liege, Arlon, Belgium
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Mandja BAM, Brembilla A, Handschumacher P, Bompangue D, Gonzalez JP, Muyembe JJ, Mauny F. Temporal and Spatial Dynamics of Monkeypox in Democratic Republic of Congo, 2000-2015. Ecohealth 2019; 16:476-487. [PMID: 31410720 DOI: 10.1007/s10393-019-01435-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 06/04/2019] [Accepted: 07/08/2019] [Indexed: 05/25/2023]
Abstract
Monkeypox is a viral disease with a clinical presentation resembling that of smallpox. Although monkeypox is considered to be an important zoonotic viral disease, its epidemiology remains poorly understood, especially the spatial and temporal distribution of the disease. The present study examined weekly reports of monkeypox cases collected from 2000 to 2015 at the health zone scale in the Democratic Republic of Congo. SaTScan® was performed to identify spatial and temporal clusters of monkeypox cases. Significant primary spatial clusters were detected in the districts of Sankuru and Tshuapa. A centrifugal pattern was found, with significant primary spatial clusters extending over time from Sankuru and Tshuapa to several neighboring districts. Peaks of cases occurred from July to September for the 2000-2002 and 2003-2009 sub-periods and from January to March for the 2010-2015 sub-period. Despite the lack of additional data for confirmation, the increasing of monkeypox reported incidence was observed in the Democratic Republic of Congo during 2000-2015 period and this increase cannot be explain only by the improvements of surveillance systems. The detected spatial clusters were located in the dense rainforest of the Congo basin. The reasons for the excess incidence of monkeypox cases in the central region of the country are unknown, and the relative influence of ecological, environmental, and human factors on the mechanism of emergence of monkeypox has yet to be identified.
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Affiliation(s)
- Bien-Aimé Makasa Mandja
- Service de Microbiologie, Faculté de Médecine, Université de Kinshasa, KIN XI, Quartier Lemba, BP 834, Kinshasa, Democratic Republic of the Congo.
- Laboratoire Chrono-Environnement, UMR 6249, CNRS, Université de Bourgogne Franche-Comté, Besançon, France.
| | - Alice Brembilla
- Laboratoire Chrono-Environnement, UMR 6249, CNRS, Université de Bourgogne Franche-Comté, Besançon, France
- Centre Hospitalier Universitaire de Besançon, Besançon, France
| | | | - Didier Bompangue
- Service de Microbiologie, Faculté de Médecine, Université de Kinshasa, KIN XI, Quartier Lemba, BP 834, Kinshasa, Democratic Republic of the Congo
- Laboratoire Chrono-Environnement, UMR 6249, CNRS, Université de Bourgogne Franche-Comté, Besançon, France
| | - Jean-Paul Gonzalez
- Department of Microbiology and Immunology, Division of Biomedical Graduate Research Organization, Georgetown University School of Medicine, 4000 Reservoir Road, Washington, DC, 20057, USA
| | - Jean-Jacques Muyembe
- Service de Microbiologie, Faculté de Médecine, Université de Kinshasa, KIN XI, Quartier Lemba, BP 834, Kinshasa, Democratic Republic of the Congo
- Institut National de Recherche Biomédicale, Gombe, Kinshasa, Democratic Republic of the Congo
| | - Frédéric Mauny
- Laboratoire Chrono-Environnement, UMR 6249, CNRS, Université de Bourgogne Franche-Comté, Besançon, France
- Centre Hospitalier Universitaire de Besançon, Besançon, France
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22
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Mandja BAM, Bompangue D, Handschumacher P, Gonzalez JP, Salem G, Muyembe JJ, Mauny F. The score of integrated disease surveillance and response adequacy (SIA): a pragmatic score for comparing weekly reported diseases based on a systematic review. BMC Public Health 2019; 19:624. [PMID: 31118016 PMCID: PMC6532185 DOI: 10.1186/s12889-019-6954-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 05/08/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Integrated Disease Surveillance and Response (IDSR) strategy implemented by the World Health Organization (WHO) in Africa has produced a large amount of data on participating countries, and in particular on the Democratic Republic of Congo (DRC). These data are increasingly considered as unevaluable and, therefore, as requiring a rigorous process of validation before they can be used for research or public health purposes. The aim of this study was to propose a method to assess the level of adequacy of IDSR morbidity data in reflecting actual morbidity. METHODS A systematic search of English- and French-language articles was performed in Scopus, Medline, Science Direct, Springer Link, Cochrane, Cairn, Persée, and Erudit databases. Other types of documents were identified through manual searches. Selected articles focused on the determinants of the discrepancies (differences) between reported morbidity and actual morbidity. An adequacy score was constructed using some of the identified determinants. This score was applied to the 15 weekly reported diseases monitored by IDSR surveillance in the DRC. A classification was established using the Jenks method and a sensitivity analysis was performed. Twenty-three classes of determinants were identified in 35 IDSR technical guides and reports of outbreak investigations and in 71 out of 2254 researched articles. For each of the 15 weekly reported diseases, the SIA was composed of 12 items grouped in 6 dimensions. RESULTS The SIA classified the 15 weekly reported diseases into 3 categories or types: high score or good adequacy (value > = 14), moderate score or fair adequacy (value > = 8 and < 14), and low score or low or non-adequacy (value < 8). Regardless of the criteria used in the sensitivity analysis, there was no notable variation in SIA values or categories for any of the 15 weekly reported diseases. CONCLUSION In a context of sparse health information in low- and middle-income countries, this study developed a score to help classify IDSR morbidity data as usable, usable after adjustment, or unusable. This score can serve to prioritize, optimize, and interpret data analyses for epidemiological research or public health purposes.
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Affiliation(s)
- Bien-Aimé Makasa Mandja
- Service de Microbiologie, Faculté de Médecine, Université de Kinshasa, Kinshasa, Democratic Republic of Congo.
- Laboratoire Chrono-Environnement, UMR 6249 CNRS, Université de Bourgogne Franche-Comté, Besançon, France.
| | - Didier Bompangue
- Service de Microbiologie, Faculté de Médecine, Université de Kinshasa, Kinshasa, Democratic Republic of Congo
- Laboratoire Chrono-Environnement, UMR 6249 CNRS, Université de Bourgogne Franche-Comté, Besançon, France
| | | | - Jean-Paul Gonzalez
- Department of Microbiology and Immunology, Division of Biomedical Graduate Research Organization, Georgetown University School of Medicine, 4000 Reservoir Road, Washington, D.C., NW, 20057, USA
| | | | - Jean-Jacques Muyembe
- Service de Microbiologie, Faculté de Médecine, Université de Kinshasa, Kinshasa, Democratic Republic of Congo
- Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of Congo
| | - Frédéric Mauny
- Laboratoire Chrono-Environnement, UMR 6249 CNRS, Université de Bourgogne Franche-Comté, Besançon, France
- Centre Hospitalier Universitaire de Besançon, uMETh, Besançon, France
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Lessler J, Moore SM, Luquero FJ, McKay HS, Grais R, Henkens M, Mengel M, Dunoyer J, M'bangombe M, Lee EC, Djingarey MH, Sudre B, Bompangue D, Fraser RSM, Abubakar A, Perea W, Legros D, Azman AS. Mapping the burden of cholera in sub-Saharan Africa and implications for control: an analysis of data across geographical scales. Lancet 2018; 391:1908-1915. [PMID: 29502905 PMCID: PMC5946088 DOI: 10.1016/s0140-6736(17)33050-7] [Citation(s) in RCA: 96] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 11/09/2017] [Accepted: 11/15/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND Cholera remains a persistent health problem in sub-Saharan Africa and worldwide. Cholera can be controlled through appropriate water and sanitation, or by oral cholera vaccination, which provides transient (∼3 years) protection, although vaccine supplies remain scarce. We aimed to map cholera burden in sub-Saharan Africa and assess how geographical targeting could lead to more efficient interventions. METHODS We combined information on cholera incidence in sub-Saharan Africa (excluding Djibouti and Eritrea) from 2010 to 2016 from datasets from WHO, Médecins Sans Frontières, ProMED, ReliefWeb, ministries of health, and the scientific literature. We divided the study region into 20 km × 20 km grid cells and modelled annual cholera incidence in each grid cell assuming a Poisson process adjusted for covariates and spatially correlated random effects. We combined these findings with data on population distribution to estimate the number of people living in areas of high cholera incidence (>1 case per 1000 people per year). We further estimated the reduction in cholera incidence that could be achieved by targeting cholera prevention and control interventions at areas of high cholera incidence. FINDINGS We included 279 datasets covering 2283 locations in our analyses. In sub-Saharan Africa (excluding Djibouti and Eritrea), a mean of 141 918 cholera cases (95% credible interval [CrI] 141 538-146 505) were reported per year. 4·0% (95% CrI 1·7-16·8) of districts, home to 87·2 million people (95% CrI 60·3 million to 118·9 million), have high cholera incidence. By focusing on the highest incidence districts first, effective targeted interventions could eliminate 50% of the region's cholera by covering 35·3 million people (95% CrI 26·3 million to 62·0 million), which is less than 4% of the total population. INTERPRETATION Although cholera occurs throughout sub-Saharan Africa, its highest incidence is concentrated in a small proportion of the continent. Prioritising high-risk areas could substantially increase the efficiency of cholera control programmes. FUNDING The Bill & Melinda Gates Foundation.
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Affiliation(s)
- Justin Lessler
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Sean M Moore
- Department of Biological Sciences, University of Notre Dame, Notre Dame, IN, USA; Eck Institute for Global Health, University of Notre Dame, Notre Dame, IN, USA
| | - Francisco J Luquero
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Epicentre, Paris, France
| | - Heather S McKay
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Myriam Henkens
- Médecins Sans Frontières International Office, Brussels, Belgium
| | | | - Jessica Dunoyer
- UNICEF West and Central Africa Regional Office, Dakar, Senegal
| | | | - Elizabeth C Lee
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Global Infectious Diseases, Georgetown University, Washington, DC, USA
| | | | - Bertrand Sudre
- European Centre for Disease Prevention and Control, Stockholm, Sweden
| | - Didier Bompangue
- Ministry of Health, Kinshasa, Democratic Republic of the Congo; University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Robert S M Fraser
- International Federation for the Red Cross and Red Crescent Societies, Geneva, Switzerland
| | | | | | | | - Andrew S Azman
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Médecins sans Frontières, Geneva, Switzerland
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Massing LA, Aboubakar S, Blake A, Page AL, Cohuet S, Ngandwe A, Mukomena Sompwe E, Ramazani R, Allheimen M, Levaillant P, Lechevalier P, Kashimi M, de la Motte A, Calmejane A, Bouhenia M, Dabire E, Bompangue D, Kebela B, Porten K, Luquero F. Highly targeted cholera vaccination campaigns in urban setting are feasible: The experience in Kalemie, Democratic Republic of Congo. PLoS Negl Trop Dis 2018; 12:e0006369. [PMID: 29734337 PMCID: PMC5957443 DOI: 10.1371/journal.pntd.0006369] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 05/17/2018] [Accepted: 03/06/2018] [Indexed: 01/21/2023] Open
Abstract
Introduction Oral cholera vaccines are primarily recommended by the World Health Organization for cholera control in endemic countries. However, the number of cholera vaccines currently produced is very limited and examples of OCV use in endemic countries, and especially in urban settings, are scarce. A vaccination campaign was organized by Médecins Sans Frontières and the Ministry of Health in a highly endemic area in the Democratic Republic of Congo. This study aims to describe the vaccine coverage achieved with this highly targeted vaccination campaign and the acceptability among the vaccinated communities. Methods and findings We performed a cross-sectional survey using random spatial sampling. The study population included individuals one year old and above, eligible for vaccination, and residing in the areas targeted for vaccination in the city of Kalemie. Data sources were household interviews with verification by vaccination card. In total 2,488 people were included in the survey. Overall, 81.9% (95%CI: 77.9–85.3) of the target population received at least one dose of vaccine. The vaccine coverage with two doses was 67.2% (95%CI: 61.9–72.0) among the target population. The vaccine coverage was higher during the first round (74.0, 95%CI: 69.3–78.3) than during the second round of vaccination (69.1%, 95%CI: 63.9–74.0). Vaccination coverage was lower in male adults. The main reason for non-vaccination was to be absent during the campaign. No severe adverse events were notified during the interviews. Conclusions Cholera vaccination campaigns using highly targeted strategies are feasible in urban settings. High vaccination coverage can be obtained using door to door vaccination. However, alternative strategies should be considered to reach non-vaccinated populations like male adults and also in order to improve the efficiency of the interventions. The oral cholera vaccine, Shanchol, has already been shown as an effective tool in controlling a cholera outbreak. The limited amount of doses, concurrently with the logistic constraints associated with a targeted vaccination campaign are serious difficulties to tackle in order to organize a vaccination campaign in an urban setting. Although the World Health Organization recommends its use for cholera control in endemic countries, the fact remains that the use of the oral cholera vaccine in endemic setting has scarcely been described, especially in an urban setting, until now. Médecins Sans Frontières and the Ministry of Health from Democratic Republic of Congo organized a vaccination campaign of a limited part of the urbanized and highly endemic city of Kalemie, in the Tanganyika Province using a door to door strategy. The vaccine coverage in the targeted zones was high and demonstrated the feasibility of cholera vaccination campaign in this setting but also the need for creative strategies in order to reach population remaining hard to vaccine.
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Affiliation(s)
| | | | | | | | | | - Adalbert Ngandwe
- Ministère de la Santé Publique, Katanga, Democratic Republic of Congo
| | | | - Romain Ramazani
- Médecins Sans Frontières, Katanga, Democratic Republic of Congo
| | | | | | | | - Marie Kashimi
- Médecins Sans Frontières, Katanga, Democratic Republic of Congo
| | | | | | | | - Ernest Dabire
- World Health Organization, Kinshasa, Democratic Republic of Congo
| | - Didier Bompangue
- Ministère de la Santé Publique, Kinshasa, Democratic Republic of Congo
| | - Benoit Kebela
- Ministère de la Santé Publique, Kinshasa, Democratic Republic of Congo
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Sauvageot D, Njanpop-Lafourcade BM, Akilimali L, Anne JC, Bidjada P, Bompangue D, Bwire G, Coulibaly D, Dengo-Baloi L, Dosso M, Orach CG, Inguane D, Kagirita A, Kacou-N’Douba A, Keita S, Kere Banla A, Kouame YJP, Landoh DE, Langa JP, Makumbi I, Miwanda B, Malimbo M, Mutombo G, Mutombo A, NGuetta EN, Saliou M, Sarr V, Senga RK, Sory F, Sema C, Tante OV, Gessner BD, Mengel MA. Cholera Incidence and Mortality in Sub-Saharan African Sites during Multi-country Surveillance. PLoS Negl Trop Dis 2016; 10:e0004679. [PMID: 27186885 PMCID: PMC4871502 DOI: 10.1371/journal.pntd.0004679] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Accepted: 04/09/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND 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). METHODS/ PRINCIPAL FINDINGS 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. CONCLUSIONS/SIGNIFICANCE 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.
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Affiliation(s)
| | | | | | | | | | - Didier Bompangue
- Universite de Kinshasa, Kinshasa, Republique Democratique du Congo
| | | | | | | | | | | | | | - Atek Kagirita
- Central Public Health Laboratory, Ministry of Health, Kampala, Uganda
| | | | - Sakoba Keita
- Ministere de la sante publique et de l’hygiene publique, Conakry, Guinea
| | | | | | | | | | | | - Berthe Miwanda
- Institut National de Recherche Biomedicale, Kinshasa, Republique Democratique du Congo
| | | | - Guy Mutombo
- Ministere de la santé, Division Provinciale de la santé, Goma, Republique Democratique du Congo
| | - Annie Mutombo
- Ministère de la santé, Kinshasa, Republique Democratique du Congo
| | | | | | - Veronique Sarr
- Ministere de la sante publique et de l’hygiene publique, Conakry, Guinea
| | | | - Fode Sory
- Ministere de la sante publique et de l’hygiene publique, Conakry, Guinea
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Kamwiziku G, Quilici M, Bompangue D, Muyembe J. Phenotypic and genotypic characterization of V.cholerae O1 strains isolated in Democratic Republic of Congo in sanctuaries areas. Int J Infect Dis 2016. [DOI: 10.1016/j.ijid.2016.02.338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Moore S, Miwanda B, Sadji AY, Thefenne H, Jeddi F, Rebaudet S, de Boeck H, Bidjada B, Depina JJ, Bompangue D, Abedi AA, Koivogui L, Keita S, Garnotel E, Plisnier PD, Ruimy R, Thomson N, Muyembe JJ, Piarroux R. Relationship between Distinct African Cholera Epidemics Revealed via MLVA Haplotyping of 337 Vibrio cholerae Isolates. PLoS Negl Trop Dis 2015; 9:e0003817. [PMID: 26110870 PMCID: PMC4482140 DOI: 10.1371/journal.pntd.0003817] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Accepted: 05/06/2015] [Indexed: 11/29/2022] Open
Abstract
Background Since cholera appeared in Africa during the 1970s, cases have been reported on the continent every year. In Sub-Saharan Africa, cholera outbreaks primarily cluster at certain hotspots including the African Great Lakes Region and West Africa. Methodology/Principal Findings In this study, we applied MLVA (Multi-Locus Variable Number Tandem Repeat Analysis) typing of 337 Vibrio cholerae isolates from recent cholera epidemics in the Democratic Republic of the Congo (DRC), Zambia, Guinea and Togo. We aimed to assess the relationship between outbreaks. Applying this method, we identified 89 unique MLVA haplotypes across our isolate collection. MLVA typing revealed the short-term divergence and microevolution of these Vibrio cholerae populations to provide insight into the dynamics of cholera outbreaks in each country. Our analyses also revealed strong geographical clustering. Isolates from the African Great Lakes Region (DRC and Zambia) formed a closely related group, while West African isolates (Togo and Guinea) constituted a separate cluster. At a country-level scale our analyses revealed several distinct MLVA groups, most notably DRC 2011/2012, DRC 2009, Zambia 2012 and Guinea 2012. We also found that certain MLVA types collected in the DRC persisted in the country for several years, occasionally giving rise to expansive epidemics. Finally, we found that the six environmental isolates in our panel were unrelated to the epidemic isolates. Conclusions/Significance To effectively combat the disease, it is critical to understand the mechanisms of cholera emergence and diffusion in a region-specific manner. Overall, these findings demonstrate the relationship between distinct epidemics in West Africa and the African Great Lakes Region. This study also highlights the importance of monitoring and analyzing Vibrio cholerae isolates. Cholera is caused by the toxigenic bacterium Vibrio cholerae. Since cholera was imported into the West African country of Guinea in 1970, cases have been reported on the continent every year. In Sub-Saharan Africa, cholera occurs in a heterogeneous manner; outbreaks primarily cluster at certain hotspots including the African Great Lakes Region and West Africa. To gain further insight into the mechanisms by which cholera outbreaks emerge and diffuse, we performed genetic analyses of 337 Vibrio cholera isolates from the Democratic Republic of the Congo (DRC), Zambia, Guinea and Togo. Isolates from both patients and environmental samples were examined. Our findings demonstrate the relationship between distinct epidemics in West Africa and the African Great Lakes Region. For example, certain strains in the DRC have circulated in the region over a period of several years, occasionally giving rise to expansive epidemics. We also found that the six environmental isolates in our panel were unrelated to the epidemic isolates. Such insight into the country- and region-specific dynamics of the disease is critical to implement optimized public health strategies to control and prevent cholera epidemics. This study also highlights the importance of analyzing Vibrio cholerae isolates to complement epidemiological studies.
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Affiliation(s)
- Sandra Moore
- Department of Parasitology and Mycology, Assistance Publique—Hôpitaux de Marseille/Aix-Marseille University, UMR MD3, Marseille, France
| | - Berthe Miwanda
- Institut National de Recherche Biomédicale, Ministry of Public Health, Kinshasa, Democratic Republic of the Congo
| | - Adodo Yao Sadji
- Department of Bacteriology, National Institute of Hygiene, Lomé, Togo
| | | | - Fakhri Jeddi
- Department of Parasitology and Mycology, Assistance Publique—Hôpitaux de Marseille/Aix-Marseille University, UMR MD3, Marseille, France
| | - Stanislas Rebaudet
- Department of Parasitology and Mycology, Assistance Publique—Hôpitaux de Marseille/Aix-Marseille University, UMR MD3, Marseille, France
| | - Hilde de Boeck
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Bawimodom Bidjada
- Department of Bacteriology, National Institute of Hygiene, Lomé, Togo
| | | | - Didier Bompangue
- Institut National de Recherche Biomédicale, Ministry of Public Health, Kinshasa, Democratic Republic of the Congo
- Department of Microbiology, Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
- Laboratoire Chrono-Environnement, UMR 6249, CNRS, University of Franche-Comte, Besançon, France
| | | | - Lamine Koivogui
- Institut National de Santé Publique, Conakry, Republic of Guinea
| | - Sakoba Keita
- Division Prévention et Lutte contre la Maladie, Ministère de la Santé Publique et de l’Hygiène Publique, Conakry, Republic of Guinea
| | - Eric Garnotel
- Hôpital d'Instruction des Armées Laveran, Marseille, France
| | | | - Raymond Ruimy
- Clinical Research Department, Nice University Hospital, Nice, France
| | - Nicholas Thomson
- Pathogen Genomics, Wellcome Trust Sanger Institute, Hinxton, Cambridge, United Kingdom
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Jean-Jacques Muyembe
- Institut National de Recherche Biomédicale, Ministry of Public Health, Kinshasa, Democratic Republic of the Congo
- Department of Microbiology, Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Renaud Piarroux
- Department of Parasitology and Mycology, Assistance Publique—Hôpitaux de Marseille/Aix-Marseille University, UMR MD3, Marseille, France
- * E-mail:
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Muyembe JJ, Bompangue D, Mutombo G, Akilimali L, Mutombo A, Miwanda B, Mpuruta JDD, Deka KK, Bitakyerwa F, Saidi JM, Mutadi AL, Kakongo RS, Birembano F, Mengel M, Gessner BD, Ilunga BK. Elimination of Cholera in the Democratic Republic of the Congo: The New National Policy. J Infect Dis 2013; 208 Suppl 1:S86-91. [DOI: 10.1093/infdis/jit204] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Bompangue D, Le Duc G, Vesenbeckh S, Blackwell N. Elimination of cholera transmission. Lancet 2012; 379:e46-7. [PMID: 22464391 DOI: 10.1016/s0140-6736(12)60515-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Bompangue D, Vesenbeckh SM, Giraudoux P, Castro M, Muyembe JJ, Kebela Ilunga B, Murray M. Cholera ante portas - The re-emergence of cholera in Kinshasa after a ten-year hiatus. PLoS Curr 2012; 4:RRN1310. [PMID: 22453903 PMCID: PMC3299488 DOI: 10.1371/currents.rrn1310] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 03/05/2012] [Indexed: 11/19/2022]
Abstract
Background: Cholera is an endemic disease in certain well-defined areas
in the east of the Democratic Republic of Congo (DRC). The west of the country,
including the mega-city Kinshasa, has been free of cases since mid 2001 when the
last outbreak ended. Methods and Findings: We used routinely collected passive
surveillance data to construct epidemic curves of the cholera cases and map the
spatio-temporal progress of the disease during the first 47 weeks of 2011. We
compared the spatial distribution of disease spread to that which occurred in
the last cholera epidemic in Kinshasa between 1996 and 2001. To better
understand previous determinants of cholera spread in this region, we conducted
a correlation analysis to assess the impact of rainfall on weekly health zone
cholera case counts between December 1998 and March 2001 and a Generalized
Linear Model (GLM) regression analysis to identify factors that have been
associated with the most vulnerable health zones within Kinshasa between October
1998 and June 1999. In February 2011, cholera reemerged in a region surrounding
Kisangani and gradually spread westwards following the course of the Congo River
to Kinshasa, home to 10 million people. Ten sampled isolates were confirmed to
be Vibrio cholerae O1, biotype El Tor, serotype Inaba, resistant to
trimethoprim-sulfa, furazolidone, nalidixic acid, sulfisoxaole, and
streptomycin, and intermediate resistant to Chloramphenicol. An analysis of a
previous outbreak in Kinshasa shows that rainfall was correlated with case
counts and that health zone population densities as well as fishing and trade
activities were predictors of case counts. Conclusion: Cholera is particularly
difficult to tackle in the DRC. Given the duration of the rainy season and
increased riverine traffic from the eastern provinces in late 2011, we expect
further increases in cholera in the coming months and especially within the
mega-city Kinshasa. We urge all partners involved in the response to remain
alert. Didier Bompangue and Silvan Vesenbeckh contributed equally to this work.
*corresponding author: Silvan Vesenbeckh, Harvard School of Public Health
(vesenbeckh@gmail.com) Didier Bompangue is Associate Professor in the Department of Microbiology
(University of Kinshasa) and Epidemiologist in the DRC Ministry of Health. He was involved in the
investigations of the described outbreak since February 2011.
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Affiliation(s)
- Didier Bompangue
- Laboratoire Chrono-environnement, UMR6249, CNRS, University of Franche-Comté, Place Leclerc 25030 Besançon, France. Laboratory of Microbiology, Faculty of Medicine, University of Kinshasa, BP: 834, Kinshasa, Democratic Republic of Congo. Direction de Lutte contre la Maladie, Ministry of Public Health, Av. de la Justice 39, Gombe I, Kinshasa, Democratic Republic of Congo.; Harvard School of Public Health, Center for Communicable Disease Dynamics, 677 Huntington Avenue, Boston MA 02115, USA. Brigham and Women's Hospital, Division of Global Health Equity, 75 Francis Street, Boston MA 02115, USA; Laboratoire Chrono-environnement, UMR6249, CNRS, University of Franche-Comté, Place Leclerc 25030 Besançon, France; Harvard School of Public Health, Department of Global Health and Population, 677 Huntington Avenue, Boston MA 02115, USA; Laboratory of Microbiology, Faculty of Medicine, University of Kinshasa, BP: 834, Kinshasa, Democratic Republic of Congo; Direction de Lutte contre la Maladie, Ministry of Public Health, Av. de la Justice 39, Gombe I, Kinshasa, Democratic Republic of Congo and Brigham and Women's Hospital, Division of Global Health Equity, 75 Francis Street, Boston MA 02115, USA. Harvard School of Public Health, Department of Epidemiology, 677 Huntington Avenue, Boston MA 02115, USA
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Bompangue D, Giraudoux P, Piarroux M, Mutombo G, Shamavu R, Sudre B, Mutombo A, Mondonge V, Piarroux R. Cholera epidemics, war and disasters around Goma and Lake Kivu: an eight-year survey. PLoS Negl Trop Dis 2009; 3:e436. [PMID: 19436726 PMCID: PMC2677153 DOI: 10.1371/journal.pntd.0000436] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2008] [Accepted: 04/21/2009] [Indexed: 11/19/2022] Open
Abstract
Background During the last eight years, North and South Kivu, located in a lake area in Eastern Democratic Republic of Congo, have been the site of a major volcano eruption and of numerous complex emergencies with population displacements. These conditions have been suspected to favour emergence and spread of cholera epidemics. Methodology/Principal Findings In order to assess the influence of these conditions on outbreaks, reports of cholera cases were collected weekly from each health district of North Kivu (4,667,699 inhabitants) and South Kivu (4,670,121 inhabitants) from 2000 through 2007. A geographic information system was established, and in each health district, the relationships between environmental variables and the number of cholera cases were assessed using regression techniques and time series analysis. We further checked for a link between complex emergencies and cholera outbreaks. Finally, we analysed data collected during an epidemiological survey that was implemented in Goma after Nyiragongo eruption. A total of 73,605 cases and 1,612 deaths of cholera were reported. Time series decomposition showed a greater number of cases during the rainy season in South Kivu but not in North Kivu. Spatial distribution of cholera cases exhibited a higher number of cases in health districts bordering lakes (Odds Ratio 7.0, Confidence Interval range 3.8–12.9). Four epidemic reactivations were observed in the 12-week periods following war events, but simulations indicate that the number of reactivations was not larger than that expected during any random selection of period with no war. Nyiragongo volcanic eruption was followed by a marked decrease of cholera incidence. Conclusion/Significance Our study points out the crucial role of some towns located in lakeside areas in the persistence of cholera in Kivu. Even if complex emergencies were not systematically followed by cholera epidemics, some of them enabled cholera spreading. With the number of cholera cases up to 73,000 during the last eight years and successive wars that have persisted for fifteen years, the North and South Kivu provinces of the Democratic Republic of Congo are currently heavily hit by both cholera outbreaks and war-related population displacements. Prior to this study, no research had been done to identify the sources of epidemics and the pathways used by cholera to spread throughout the Kivu provinces. Here we show that a few cities located on the lakeshore of Lake Kivu and Lake Tanganyika act as the main sources of cholera epidemics and that the number of cholera cases tends to increase during the rainy season. We also found that only a minority of population displacements were followed by cholera outbreaks. Finally, we think that the low number of cholera cases recorded after the Nyiragongo eruption is one more argument to implement programs aiming at restoring, and if possible improving, drinking water access following natural disasters
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Affiliation(s)
- Didier Bompangue
- Direction de la Lutte contre les Maladies, Ministère de la Santé Publique, Kinshasa-Gombe, République Démocratique du Congo
- Laboratoire Chrono-Environnement, CNRS, UMR 6249, Université de Franche-Comté, UFR Sciences et Techniques, Besançon, France
- Service de Microbiologie, Université de Kinshasa, Kinshasa, République Démocratique du Congo
| | - Patrick Giraudoux
- Laboratoire Chrono-Environnement, CNRS, UMR 6249, Université de Franche-Comté, UFR Sciences et Techniques, Besançon, France
| | - Martine Piarroux
- Laboratoire Théoriser et Modéliser pour Aménager (ThéMA), UMR 6049 du CNRS, Université de Franche-Comté, Besançon, France
| | - Guy Mutombo
- Division Provinciale de la Santé-Nord Kivu, Ministère de la Santé Publique, Goma, République Démocratique du Congo
| | - Rick Shamavu
- Division Provinciale de la Santé-Sud Kivu, Ministère de la Santé Publique, Uvira, République Démocratique du Congo
| | - Bertrand Sudre
- Laboratoire Chrono-Environnement, CNRS, UMR 6249, Université de Franche-Comté, UFR Sciences et Techniques, Besançon, France
| | - Annie Mutombo
- Direction de la Lutte contre les Maladies, Ministère de la Santé Publique, Kinshasa-Gombe, République Démocratique du Congo
| | - Vital Mondonge
- Direction de la Lutte contre les Maladies, Ministère de la Santé Publique, Kinshasa-Gombe, République Démocratique du Congo
| | - Renaud Piarroux
- Laboratoire Chrono-Environnement, CNRS, UMR 6249, Université de Franche-Comté, UFR Sciences et Techniques, Besançon, France
- * E-mail:
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Piarroux R, Bompangue D, Oger PY, Haaser F, Boinet A, Vandevelde T. From research to field action: example of the fight against cholera in the Democratic Republic of Congo. Field Actions Sci Rep 2009. [DOI: 10.5194/facts-2-69-2009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Bompangue D, Giraudoux P, Handschumacher P, Piarroux M, Sudre B, Ekwanzala M, Kebela I, Piarroux R. Lakes as source of cholera outbreaks, Democratic Republic of Congo. Emerg Infect Dis 2008; 14:798-800. [PMID: 18439365 PMCID: PMC2600234 DOI: 10.3201/eid1405.071260] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
We studied the epidemiology of cholera in Katanga and Eastern Kasai, in the Democratic Republic of Congo, by compiling a database including all cases recorded from 2000 through 2005. Results show that lakes were the sources of outbreaks and demonstrate the inadequacy of the strategy used to combat cholera.
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