A Multisectoral Emergency Response Approach to a Cholera Outbreak in Zambia: October 2017–February 2018

Kapata, Nathan; Sinyange, Nyambe; Mazaba, Mazyanga L.; Musonda, Kunda; Hamoonga, Raymond; Kapina, Muzala; Zyambo, Khozya; Malambo, Warren; Yard, Ellen E.; Riggs, Margaret A.; Narra, Rupa; Murphy, J.W.; Brunkard, Joan; Azman, Andrew S.; Monze, Namani; Malama, Kennedy; Mulwanda, Jabbin; Mukonka, Victor

doi:10.1093/infdis/jiy490

Cited by 13 publications

(24 citation statements)

References 7 publications

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“…The epidemic preparedness and response in Zambia remains on high alert for the COVID-19 pandemic and capacity for contact tracing in the community has been built steadily over time due to experience with previous outbreaks such as Lujo haemorrhagic fever and cholera (Paweska et al, 2009;Kapata et al, 2018) as well as ongoing surveillance for influenza and haemorrhagic fever viruses in humans and animals including wildlife (Simulundu et al, 2011;Ogawa et al, 2015;Theo et al, 2012;Changula et al, 2018;Kajihara et al, 2019;Simusika et al, 2020). These activities have contributed to capacity building for the various multidisciplinary teams working in the health facilities including laboratories for infectious diseases and public health emergencies.. Health system strengthening for future outbreaks using the 'One Health' multisectoral approach has also proved to be a key ingredient to mounting an effective response towards prevention of spread of COVID-19.…”

Section: Discussionmentioning

confidence: 99%

First COVID-19 case in Zambia — Comparative phylogenomic analyses of SARS-CoV-2 detected in African countries

Simulundu

Mupeta

Chanda‐Kapata

et al. 2021

International Journal of Infectious Diseases

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Highlights Whilst African countries were relatively spared initially when COVID-19 was first reported from China, the frequent travel links between China, Europe and Africa, meant importation of SARS-CoV-2 into Africa was inescapable. In preparation, Zambia had applied a multisectoral national epidemic disease surveillance and response system resulting in the identification of the first case within 48 hours of the individual entering the country by air travel from a trip to France. Phylogenomic analysis showed that the detected SARS-CoV-2 belonged to lineage B.1.1., sharing the last common ancestor with SARS-CoV-2 strains recovered from South Africa. At the African continental level, our analysis showed that lineage B.1 and B.1.1 lineages appear to be predominant in Africa. Whole genome sequence analysis should be part of all surveillance activities to monitor the origin and evolution of SARS-CoV-2 lineages across Africa.

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Section: Discussionmentioning

confidence: 99%

First COVID-19 case in Zambia — Comparative phylogenomic analyses of SARS-CoV-2 detected in African countries

Simulundu

Mupeta

Chanda‐Kapata

et al. 2021

International Journal of Infectious Diseases

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“…Reducing delays in the timelines of patients presenting to health facilities, increasing capacity of health workers to recognize suspect cases of cholera, and reinforcing local investigation and response therefore remain as important as vaccination and other emerging tools. Some of the largest outbreaks in recent years in South Sudan (2014–6), Ethiopia (2015 onwards), and Zambia (2017–8) have suffered from late detection and/or response, which has led to surges of cases that have overwhelmed health systems [ 131 , 140 , 174 – 176 ].…”

Section: Discussionmentioning

confidence: 99%

Early detection of cholera epidemics to support control in fragile states: estimation of delays and potential epidemic sizes

Ratnayake

Finger²,

Edmunds

et al. 2020

BMC Med

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Background Cholera epidemics continue to challenge disease control, particularly in fragile and conflict-affected states. Rapid detection and response to small cholera clusters is key for efficient control before an epidemic propagates. To understand the capacity for early response in fragile states, we investigated delays in outbreak detection, investigation, response, and laboratory confirmation, and we estimated epidemic sizes. We assessed predictors of delays, and annual changes in response time. Methods We compiled a list of cholera outbreaks in fragile and conflict-affected states from 2008 to 2019. We searched for peer-reviewed articles and epidemiological reports. We evaluated delays from the dates of symptom onset of the primary case, and the earliest dates of outbreak detection, investigation, response, and confirmation. Information on how the outbreak was alerted was summarized. A branching process model was used to estimate epidemic size at each delay. Regression models were used to investigate the association between predictors and delays to response. Results Seventy-six outbreaks from 34 countries were included. Median delays spanned 1–2 weeks: from symptom onset of the primary case to presentation at the health facility (5 days, IQR 5–5), detection (5 days, IQR 5–6), investigation (7 days, IQR 5.8–13.3), response (10 days, IQR 7–18), and confirmation (11 days, IQR 7–16). In the model simulation, the median delay to response (10 days) with 3 seed cases led to a median epidemic size of 12 cases (upper range, 47) and 8% of outbreaks ≥ 20 cases (increasing to 32% with a 30-day delay to response). Increased outbreak size at detection (10 seed cases) and a 10-day median delay to response resulted in an epidemic size of 34 cases (upper range 67 cases) and < 1% of outbreaks < 20 cases. We estimated an annual global decrease in delay to response of 5.2% (95% CI 0.5–9.6, p = 0.03). Outbreaks signaled by immediate alerts were associated with a reduction in delay to response of 39.3% (95% CI 5.7–61.0, p = 0.03). Conclusions From 2008 to 2019, median delays from symptom onset of the primary case to case presentation and to response were 5 days and 10 days, respectively. Our model simulations suggest that depending on the outbreak size (3 versus 10 seed cases), in 8 to 99% of scenarios, a 10-day delay to response would result in large clusters that would be difficult to contain. Improving the delay to response involves rethinking the integration at local levels of event-based detection, rapid diagnostic testing for cluster validation, and integrated alert, investigation, and response.

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“…The following is a detailed description of the research process. outbreak in Lusaka (i.e., Stage 2 in Fig 1) [8]. Within the settlement, 3 out of 13 health zones were selected for data collection (i.e., Stage 3 in Fig 1).…”

Section: Methodsmentioning

confidence: 99%

“…Poor WASH has also been linked to the nations annual cholera outbreaks which usually emanate from rural fishing villages and peri-urban settlements [7]. During the 2017/2018 rain season, an outbreak of cholera emanating from the peri-urban resulted in 5,905 registered suspected cases, the majority of them (91.7%) from Zambia's capital city, Lusaka [8]. Approximately 70% of the city's population are peri-urban residents; the city is home to 37 peri-urban settlements [5].…”

Section: Introductionmentioning

confidence: 99%

The improved and the unimproved: Factors influencing sanitation and diarrhoea in a peri-urban settlement of Lusaka, Zambia

2020

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Accounting for peri-urban sanitation poses a unique challenge due to its high density, unplanned stature, with limited space and funding for conventional sanitation instalment. To better understand users, needs and inform peri-urban sanitation policy, our study used multivariate stepwise logistic regression to assess the factors associated with use of improved (toilet) and unimproved (chamber) sanitation facilities among peri-urban residents. We analysed data from 205 household heads in 1 peri-urban settlement of Lusaka, Zambia on socio-demographics (economic status, education level, marital status, etc.), household sanitation characteristics (toilet facility, ownership and management) and household diarrhoea prevalence. Household water, sanitation and hygiene (WASH) facilities were assessed based on WHO-UNICEF criteria. Of particular interest was the simultaneous use of toilet facilities and chambers, an alternative form of unimproved sanitation with focus towards allin-one suitable alternatives. Findings revealed that having a regular income, private toilet facility, improved drinking water and handwashing facility were all positively correlated to having an improved toilet facility. Interestingly, both improved toilets and chambers indicated increased odds for diarrhoea prevalence. Odds of chamber usage were also higher for females and users of unimproved toilet facilities. Moreover, when toilets were owned by residents, and hygiene was managed externally, use of chambers was more likely. Findings finally revealed higher diarrhoea prevalence for toilets with more users. Results highlight the need for a holistic, simultaneous approach to WASH for overall success in sanitation. To better access and increase peri-urban sanitation, this study recommends a separate sanitation ladder for high density areas which considers improved private and shared facilities, toilet management and all-inclusive usage (cancelling unimproved alternatives). It further calls for financial plans supporting urban poor access to basic sanitation and increased education on toilet facility models, hygiene, management and risk to help with choice and proper facility use to maximize toilet use benefit.

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A Multisectoral Emergency Response Approach to a Cholera Outbreak in Zambia: October 2017–February 2018

Cited by 13 publications

References 7 publications

First COVID-19 case in Zambia — Comparative phylogenomic analyses of SARS-CoV-2 detected in African countries

First COVID-19 case in Zambia — Comparative phylogenomic analyses of SARS-CoV-2 detected in African countries

Early detection of cholera epidemics to support control in fragile states: estimation of delays and potential epidemic sizes

The improved and the unimproved: Factors influencing sanitation and diarrhoea in a peri-urban settlement of Lusaka, Zambia

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