Cholera outbreaks in sub-Saharan Africa during 2010-2019: a descriptive analysis

Background: Cholera remains a public health threat but is inequitably distributed across sub-Saharan Africa. Lack of standardized reporting and inconsistent outbreak definitions limit our understanding of cholera outbreak epidemiology. Methods: From a database of cholera incidence and mortality, we...

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Main Authors: Qulu Zheng, Francisco J Luquero, Iza Ciglenecki, Joseph F Wamala, Abdinasir Abubakar, Placide Welo, Mukemil Hussen, Mesfin Wossen, Sebastian Yennan, Alama Keita, Justin Lessler, Andrew S Azman, Elizabeth C Lee
Format: Article
Language:English
Published: Elsevier 2022-09-01
Series:International Journal of Infectious Diseases
Subjects:
Online Access:http://www.sciencedirect.com/science/article/pii/S1201971222003034
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author Qulu Zheng
Francisco J Luquero
Iza Ciglenecki
Joseph F Wamala
Abdinasir Abubakar
Placide Welo
Mukemil Hussen
Mesfin Wossen
Sebastian Yennan
Alama Keita
Justin Lessler
Andrew S Azman
Elizabeth C Lee
author_facet Qulu Zheng
Francisco J Luquero
Iza Ciglenecki
Joseph F Wamala
Abdinasir Abubakar
Placide Welo
Mukemil Hussen
Mesfin Wossen
Sebastian Yennan
Alama Keita
Justin Lessler
Andrew S Azman
Elizabeth C Lee
author_sort Qulu Zheng
collection DOAJ
description Background: Cholera remains a public health threat but is inequitably distributed across sub-Saharan Africa. Lack of standardized reporting and inconsistent outbreak definitions limit our understanding of cholera outbreak epidemiology. Methods: From a database of cholera incidence and mortality, we extracted data from sub-Saharan Africa and reconstructed outbreaks of suspected cholera starting in January 2010 to December 2019 based on location-specific average weekly incidence rate thresholds. We then described the distribution of key outbreak metrics. Results: We identified 999 suspected cholera outbreaks in 744 regions across 25 sub-Saharan African countries. The outbreak periods accounted for 1.8 billion person-months (2% of the total during this period) from January 2010 to January 2020. Among 692 outbreaks reported from second-level administrative units (e.g., districts), the median attack rate was 0.8 per 1000 people (interquartile range (IQR), 0.3-2.4 per 1000), the median epidemic duration was 13 weeks (IQR, 8-19), and the median early outbreak reproductive number was 1.8 (range, 1.1-3.5). Larger attack rates were associated with longer times to outbreak peak, longer epidemic durations, and lower case fatality risks. Conclusions: This study provides a baseline from which the progress toward cholera control and essential statistics to inform outbreak management in sub-Saharan Africa can be monitored.
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spelling doaj.art-5db63916c5b04636b54c54ad28466b552022-12-22T04:24:04ZengElsevierInternational Journal of Infectious Diseases1201-97122022-09-01122215221Cholera outbreaks in sub-Saharan Africa during 2010-2019: a descriptive analysisQulu Zheng0Francisco J Luquero1Iza Ciglenecki2Joseph F Wamala3Abdinasir Abubakar4Placide Welo5Mukemil Hussen6Mesfin Wossen7Sebastian Yennan8Alama Keita9Justin Lessler10Andrew S Azman11Elizabeth C Lee12Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USADepartment of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Global Alliance for Vaccines and Immunization (GAVI), Geneva, SwitzerlandMédecins Sans Frontières, Geneva, SwitzerlandWorld Health Organization, Juba, South SudanWHO, Regional Office for Eastern Mediterranean, Cairo, EgyptPNECHOL-MD, Community IMCI, Ministry of Health, Democratic Republic of the CongoDisease and Health Events Surveillance and Response Directorate, Ethiopia Public Health Institute, Addis Ababa, EthiopiaDisease and Health Events Surveillance and Response Directorate, Ethiopia Public Health Institute, Addis Ababa, EthiopiaSurveillance and Epidemiology, Nigeria Centre for Disease Control, Abuja, NigeriaRegional Office for West & Central Africa, UNICEF, Dakar, SenegalDepartment of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Corresponding author.Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Corresponding author.Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Corresponding author.Background: Cholera remains a public health threat but is inequitably distributed across sub-Saharan Africa. Lack of standardized reporting and inconsistent outbreak definitions limit our understanding of cholera outbreak epidemiology. Methods: From a database of cholera incidence and mortality, we extracted data from sub-Saharan Africa and reconstructed outbreaks of suspected cholera starting in January 2010 to December 2019 based on location-specific average weekly incidence rate thresholds. We then described the distribution of key outbreak metrics. Results: We identified 999 suspected cholera outbreaks in 744 regions across 25 sub-Saharan African countries. The outbreak periods accounted for 1.8 billion person-months (2% of the total during this period) from January 2010 to January 2020. Among 692 outbreaks reported from second-level administrative units (e.g., districts), the median attack rate was 0.8 per 1000 people (interquartile range (IQR), 0.3-2.4 per 1000), the median epidemic duration was 13 weeks (IQR, 8-19), and the median early outbreak reproductive number was 1.8 (range, 1.1-3.5). Larger attack rates were associated with longer times to outbreak peak, longer epidemic durations, and lower case fatality risks. Conclusions: This study provides a baseline from which the progress toward cholera control and essential statistics to inform outbreak management in sub-Saharan Africa can be monitored.http://www.sciencedirect.com/science/article/pii/S1201971222003034CholeraOutbreaksSub-Saharan Africa
spellingShingle Qulu Zheng
Francisco J Luquero
Iza Ciglenecki
Joseph F Wamala
Abdinasir Abubakar
Placide Welo
Mukemil Hussen
Mesfin Wossen
Sebastian Yennan
Alama Keita
Justin Lessler
Andrew S Azman
Elizabeth C Lee
Cholera outbreaks in sub-Saharan Africa during 2010-2019: a descriptive analysis
International Journal of Infectious Diseases
Cholera
Outbreaks
Sub-Saharan Africa
title Cholera outbreaks in sub-Saharan Africa during 2010-2019: a descriptive analysis
title_full Cholera outbreaks in sub-Saharan Africa during 2010-2019: a descriptive analysis
title_fullStr Cholera outbreaks in sub-Saharan Africa during 2010-2019: a descriptive analysis
title_full_unstemmed Cholera outbreaks in sub-Saharan Africa during 2010-2019: a descriptive analysis
title_short Cholera outbreaks in sub-Saharan Africa during 2010-2019: a descriptive analysis
title_sort cholera outbreaks in sub saharan africa during 2010 2019 a descriptive analysis
topic Cholera
Outbreaks
Sub-Saharan Africa
url http://www.sciencedirect.com/science/article/pii/S1201971222003034
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