Cholera Epidemiology in Mozambique Using National Surveillance Data

Gujral, Lorna; Semá, Cynthia; Rebaudet, Stanislas; Taibo, Catia Luciana Abulfattahe; Manjate, Alice; Piarroux, Renaud; Gessner, Bradford D.; Jani, Ilesh

doi:10.1093/infdis/jit212

Cited by 37 publications

(45 citation statements)

References 13 publications

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“…Increasing resistance to tetracycline was consistent with data from Zambia [ 11 ], urban and rural Bangladesh [ 12 ]; DRC [ 13 ]; Nigeria [ 14 ] and South Mozambique [ 4 , 6 ]. However, decreasing resistance to tetracycline have been reported in other places, such as Calcutta [ 15 ], East Delhi [ 16 ] and Ghana [ 17 ] and susceptibility to tetracycline, in Puduchuary in India [ 18 ], Haiti [ 19 ] and north India [ 20 ].…”

Section: Discussionsupporting

confidence: 85%

“…Resistance to Nalidixic acid for tested isolates in the study was 100%, being consistent with data obtained from Iran [ 21 ], Haiti [ 19 ], Mozambique South rural area [ 4 ], and an increasing resistance in Calcutta [ 15 , 17 ]. Conversely, in East Deli [ 16 ] and urban South Mozambique [ 6 ] was found susceptibility to Nalidixic acid in tested isolates.…”

Section: Discussionmentioning

confidence: 99%

“…The last decades have seen a growing trend in antimicrobial resistance in Mozambique, previous researches have reported V . cholera e Ogawa O1 El Tor drug resistance in the last decade for Maputo [ 4 – 6 ], Zambezia and Tete [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

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Antibiotics resistance in El Tor Vibrio cholerae 01 isolated during cholera outbreaks in Mozambique from 2012 to 2015

et al. 2017

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RationaleMozambique has recorded cyclically epidemic outbreaks of cholera. Antibiotic therapy is recommended in specific situations for management and control of cholera outbreaks. However, an increase in resistance rates to antibiotics by Vibrio cholerae has been reported in several epidemic outbreaks worldwide. On the other hand, there are few recent records of continuous surveillance of antibiotics susceptibility pattern of V. cholerae in Mozambique.GoalsThe purpose of this study was to evaluate antibiotics resistance pattern of Vibrio cholerae O1 Ogawa isolated during Cholera outbreaks in Mozambique to commonly used antibiotics.MethodologyWe analyzed data from samples received in the context of surveillance and response to Cholera outbreaks in the National Reference Laboratory of Microbiology from the National Institute of Health of Mozambique, 159 samples suspected of cholera from cholera treatment centers of, Metangula (09), Memba (01), Tete City (08), Moatize (01), Morrumbala (01) districts, City of Quelimane (01), Lichinga (06) and Nampula (86) districts, from 2012 to 2015. Laboratory culture and standard biochemical tests were employed to isolate and identify Vibrio cholerae; serotypes were determined by antisera agglutination reaction in blade. Biotype and presence of important virulence factors analysis was done by PCR. Antibiotics susceptibility pattern was detected by disk diffusion method Kirby Bauer. Antibiotic susceptibility and results were interpreted by following as per recommendations of CLSI (Clinical and Laboratory Standards Institute) 2014. All samples were collected and tested in the context of Africhol Project, approved by the National Bioethics Committee for Health.ResultsAmong isolates from of Vibrio cholerae O1 El Tor Ogawa resistance to Sulphamethoxazole-trimethropim was 100% (53/53) to Trimethoprim-, being 100% (54/54) for Ampicillin, 99% (72/74) for Nalidixic Acid, 97% (64/66) to Chloramphenicol, 95% (42/44) for Nitrofurantoin and (19/20) Cotrimoxazole, 83% (80/97) Tetracycline, 56% (5/13) Doxycycline, 56% (39/70) Azithromycin and 0% (0/101) for Ciprofloxacin. PCR analysis suggested strains of V. cholerae O1 being descendants of the current seventh pandemic V. cholerae O1 CIRS 101 hybrid variant. The V. cholerae O1 currently causing cholera epidemics in north and central Mozambique confirmed a CTXΦ genotype and a molecular arrangement similar to the V. cholerae O1 CIRS 101.ConclusionAlthough V. cholerae infections in Mozambique are generally not treated with antibiotics circulating strains of the bacteria showed high frequency of in vitro resistance to available antibiotics. Continuous monitoring of antibiotic resistance pattern of epidemic strains is therefore crucial since the appearance of antibiotic resistance can influence cholera control strategies.

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Section: Discussionsupporting

confidence: 85%

Section: Discussionmentioning

confidence: 99%

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Antibiotics resistance in El Tor Vibrio cholerae 01 isolated during cholera outbreaks in Mozambique from 2012 to 2015

et al. 2017

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“…Consequently, the district health officials also need to explore the issues of poor health-seeking behavior and access to care as possible factors contributing to the deaths in the community. It is key to highlight the importance of providing regular community education on cholera signs and symptoms and prevention and treatment measures even in periods outside epidemics [12, 20, 21]. Capacity of community health volunteers should be built to educate community members on making water safe for drinking, regular hand washing with soap and other proper hygiene and sanitation practices, promote early reporting to health facilities and to report insanitary conditions that may predispose the community to future outbreaks to relevant authorities for action [18].…”

Section: Discussionmentioning

confidence: 99%

Assessment of the response to cholera outbreaks in two districts in Ghana

Ohene

Klenyuie

Sarpeh³

2016

Infect Dis Poverty

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BackgroundDespite recurring outbreaks of cholera in Ghana, very little has been reported on assessments of outbreak response activities undertaken in affected areas. This study assessed the response activities undertaken in two districts, Akatsi District in Volta Region and Komenda-Edina-Eguafo-Abirem (KEEA) Municipal in Central Region during the 2012 cholera epidemic in Ghana.MethodsWe conducted a retrospective assessment of the events, strengths and weaknesses of the cholera outbreak response activities in the two districts making use of the WHO cholera evaluation tool. Information sources included surveillance and facility records, reports and interviews with relevant health personnel involved in the outbreak response from both district health directorates and health facilities. We collected data on age, sex, area of residence, date of reporting to health facility of cholera cases, district population data and information on the outbreak response activities and performed descriptive analyses of the outbreak data by person, time and place.ResultsThe cholera outbreak in Akatsi was explosive with a high attack rate (AR) of 374/100,000 and case fatality rate (CFR) of 1.2 % while that in KEEA was on a relatively smaller scale AR of 23/100,000 but with a high case fatality rate of 18.8 %. For both districts, we identified multiple strengths in the response to the outbreak including timely notification of the district health officials which triggered prompt investigation of the suspected outbreak facilitating confirmation of cholera and initiation of public health response activities. Others were coordination of the activities by multi-sectoral committees, instituting water, sanitation and hygiene measures and appropriate case management at health facilities. We also found areas that needed improvement in both districts including incomplete surveillance data, sub-optimal community based surveillance considering the late reporting and the deaths in the community and the inadequate community knowledge about cholera preventive measures.ConclusionThe assessment of the cholera outbreak response in the two districts highlighted strengths in the epidemic control activities. There was however need to strengthen preparedness especially in the area of improving community surveillance and awareness about cholera prevention and the importance of seeking prompt treatment in health facilities in the event of an outbreak.Electronic supplementary materialThe online version of this article (doi:10.1186/s40249-016-0192-z) contains supplementary material, which is available to authorized users.

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“…Cases of cholera reported in Mozambique accounted for one-third to one-fifth of all cases reported in Africa in the years 1992, 1993, 1998, 1999, and 2004 [15]. In recent years, from 2009 to 2013, the reported cases dropped significantly, with a fatality rate of around 1% [15].…”

Section: Introductionmentioning

confidence: 99%

Epidemic waves of cholera in the last two decades in Mozambique

Langa

Semá

Deus

et al. 2015

J Infect Dev Ctries

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Introduction: Africa is increasingly affected by cholera. In Mozambique, cholera appeared in the early 1970s when the seventh pandemic entered Africa from the Indian subcontinent. In the following decades, several epidemics were registered in the country, the 1997-1999 epidemic being the most extended. Since then, Mozambique has been considered an endemic area for cholera, characterized by yearly outbreaks occurring with a seasonal pattern.. At least three pandemic variants are thought to have originated in the Indian subcontinent and spread worldwide at different times. To understand the epidemiology of cholera in Mozambique, whether the disease re-emerges periodically or is imported by different routes of transmission, we investigated clinical V. cholerae O1 isolated during 1997-1999 and 2012-2014 epidemics. Methodology: By detecting and characterizing seven genetic elements, the mobilome profile of each isolate was obtained. By comparing it to known seventh pandemic reference strains, it was possible to discern among different V. cholerae O1 variants active in the country. Results: During 1997-1999, epidemic strains showed two different genetic profiles, both related to a pandemic clone that originated from India and was reported in other African countries in the 1990s. Isolates from 2012-2014 outbreaks showed a genetic background related to the pandemic strains currently active as the prevalent causative agent of cholera worldwide. Conclusions: Despite cholera being endemic in Mozambique, the epidemiology of the disease in the past 20 years has been strongly influenced by the cholera seventh pandemic waves that originated in the Indian subcontinent.

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Cholera Epidemiology in Mozambique Using National Surveillance Data

Abstract: Mozambique continues to experience widespread cholera outbreaks of short duration involving distinct spatial clusters. These findings will influence choice of public health strategies.

Cited by 37 publications

References 13 publications

Antibiotics resistance in El Tor Vibrio cholerae 01 isolated during cholera outbreaks in Mozambique from 2012 to 2015

Antibiotics resistance in El Tor Vibrio cholerae 01 isolated during cholera outbreaks in Mozambique from 2012 to 2015

Assessment of the response to cholera outbreaks in two districts in Ghana

Epidemic waves of cholera in the last two decades in Mozambique

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