Household-Level Spatiotemporal Patterns of Incidence of Cholera, Haiti, 2011

Blackburn, Jason K.; Diamond, Ulrica; Kracalik, Ian; Widmer, Jocelyn; Brown, Will J H; Morrissey, B. David; Alexander, Kathleen A.; Curtis, Andrew; Ali, Afsar; Morris, J. Glenn

doi:10.3201/eid2009.131882

Cited by 18 publications

(9 citation statements)

References 11 publications

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“…Additionally, despite the high spatial-resolution of our data, long-cycle transmission within a single neighborhood is possible and would instead be captured by the within-neighborhood transmission coefficient ( β i ). It is probable that the epidemic resulted from multiple disparate transmission routes, a hypothesis consistent with recent models of the Haitian outbreak [ 34 , 39 ]. Our analysis could not investigate any specific alternative pathway, although contemporary reports of human waste used as fertilizer for food crops highlights one possible alternative route, which has been observed in other outbreaks as well [ 40 ].…”

Section: Discussionsupporting

confidence: 64%

The importance of thinking beyond the water-supply in cholera epidemics: A historical urban case-study

et al. 2017

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BackgroundPlanning interventions to respond to cholera epidemics requires an understanding of the major transmission routes. Interrupting short-cycle (household, foodborne) transmission may require different approaches as compared long-cycle (environmentally-mediated/waterborne) transmission. However, differentiating the relative contribution of short- and long-cycle routes has remained difficult, and most cholera outbreak control efforts focus on interrupting long-cycle transmission. Here we use high-resolution epidemiological and municipal infrastructure data from a cholera outbreak in 1853 Copenhagen to explore the relative contribution of short- and long-cycle transmission routes during a major urban epidemic.Methodology/Principal findingsWe fit a spatially explicit time-series meta-population model to 6,552 physician-reported cholera cases from Copenhagen in 1853. We estimated the contribution of long-cycle waterborne transmission between neighborhoods using historical municipal water infrastructure data, fitting the force of infection from hydraulic flow, then comparing model performance. We found the epidemic was characterized by considerable transmission heterogeneity. Some neighborhoods acted as localized transmission hotspots, while other neighborhoods were less affected or important in driving the epidemic. We found little evidence to support long-cycle transmission between hydrologically-connected neighborhoods. Collectively, these findings suggest short-cycle transmission was significant.Conclusions/SignificanceSpatially targeted cholera interventions, such as reactive vaccination or sanitation/hygiene campaigns in hotspot neighborhoods, would likely have been more effective in this epidemic than control measures aimed at interrupting long-cycle transmission, such as improving municipal water quality. We recommend public health planners consider programs aimed at interrupting short-cycle transmission as essential tools in the cholera control arsenal.

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Section: Discussionsupporting

confidence: 64%

The importance of thinking beyond the water-supply in cholera epidemics: A historical urban case-study

et al. 2017

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“…Changes in temperature [45] and precipitation [13, 15, 45] levels have been previously associated with the probability of subsequent cholera outbreaks. Local geographic features, such as highways [2], inland waterbodies (lakes/rivers) [2, 46], and coastline/shoreline [5, 47] have also been associated with elevated disease frequency.…”

Section: Methodsmentioning

confidence: 99%

Cholera in Cameroon, 2000-2012: Spatial and Temporal Analysis at the Operational (Health District) and Sub Climate Levels

et al. 2016

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IntroductionRecurrent cholera outbreaks have been reported in Cameroon since 1971. However, case fatality ratios remain high, and we do not have an optimal understanding of the epidemiology of the disease, due in part to the diversity of Cameroon’s climate subzones and a lack of comprehensive data at the health district level.Methods/FindingsA unique health district level dataset of reported cholera case numbers and related deaths from 2000–2012, obtained from the Ministry of Public Health of Cameroon and World Health Organization (WHO) country office, served as the basis for the analysis. During this time period, 43,474 cholera cases were reported: 1748 were fatal (mean annual case fatality ratio of 7.9%), with an attack rate of 17.9 reported cases per 100,000 inhabitants per year. Outbreaks occurred in three waves during the 13-year time period, with the highest case fatality ratios at the beginning of each wave. Seasonal patterns of illness differed strikingly between climate subzones (Sudano-Sahelian, Tropical Humid, Guinea Equatorial, and Equatorial Monsoon). In the northern Sudano-Sahelian subzone, highest number of cases tended to occur during the rainy season (July-September). The southern Equatorial Monsoon subzone reported cases year-round, with the lowest numbers during peak rainfall (July-September). A spatial clustering analysis identified multiple clusters of high incidence health districts during 2010 and 2011, which were the 2 years with the highest annual attack rates. A spatiotemporal autoregressive Poisson regression model fit to the 2010–2011 data identified significant associations between the risk of transmission and several factors, including the presence of major waterbody or highway, as well as the average daily maximum temperature and the precipitation levels over the preceding two weeks. The direction and/or magnitude of these associations differed between climate subzones, which, in turn, differed from national estimates that ignored subzones differences in climate variables.Conclusions/SignificanceThe epidemiology of cholera in Cameroon differs substantially between climate subzones. Development of an optimal comprehensive country-wide control strategy for cholera requires an understanding of the impact of the natural and built environment on transmission patterns at the local level, particularly in the setting of ongoing climate change.

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“…Transmission models that only include ingestion of V. cholerae through environmental point sources, or environment-to-human transmission, cannot explain the steep rise in case numbers usually seen in outbreaks [27,45,47]. Spatiotemporal analyses of cholera in endemic and epidemic settings have instead demonstrated clusters of cases within 200m distances of case-households during the first five days after index cases present with symptoms [48][49][50], and a 100-fold higher risk of household contacts of cases to contract the disease compared to those outside the household [43,[51][52][53][54]. Research on the genomics of cholera transmission has also demonstrated strong phylogenetic similarities among same-household cases [43,[55][56][57][58], and a recent paper found 80% of transmission occurs between people who share a household [55].…”

Section: Introductionmentioning

confidence: 99%

Prevention and control of cholera with household and community water, sanitation and hygiene (WASH) interventions: A scoping review of current international guidelines

et al. 2020

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Introduction Cholera remains a frequent cause of outbreaks globally, particularly in areas with inadequate water, sanitation and hygiene (WASH) services. Cholera is spread through faecaloral routes, and studies demonstrate that ingestion of Vibrio cholerae occurs from consuming contaminated food and water, contact with cholera cases and transmission from contaminated environmental point sources. WASH guidelines recommending interventions for the prevention and control of cholera are numerous and vary considerably in their recommendations. To date, there has been no review of practice guidelines used in cholera prevention and control programmes. Methods We systematically searched international agency websites to identify WASH intervention guidelines used in cholera programmes in endemic and epidemic settings. Recommendations listed in the guidelines were extracted, categorised and analysed. Analysis was based on consistency, concordance and recommendations were classified on the basis of whether the interventions targeted within-household or community-level transmission. Results Eight international guidelines were included in this review: three by non-governmental organisations (NGOs), one from a non-profit organisation (NPO), three from multilateral organisations and one from a research institution. There were 95 distinct recommendations identified, and concordance among guidelines was poor to fair. All categories of WASH interventions were

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Household-Level Spatiotemporal Patterns of Incidence of Cholera, Haiti, 2011

Cited by 18 publications

References 11 publications

The importance of thinking beyond the water-supply in cholera epidemics: A historical urban case-study

The importance of thinking beyond the water-supply in cholera epidemics: A historical urban case-study

Cholera in Cameroon, 2000-2012: Spatial and Temporal Analysis at the Operational (Health District) and Sub Climate Levels

Prevention and control of cholera with household and community water, sanitation and hygiene (WASH) interventions: A scoping review of current international guidelines

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