Development of a Scorecard to Monitor Progress toward National Cholera Elimination: Its Application in Uganda

Abstract

In 2017, the Global Task Force for Cholera Control (GTFCC) set a goal to eliminate cholera from ≥ 20 countries and to reduce cholera deaths by 90% by 2030. Many countries have included oral cholera vaccine (OCV) in their cholera control plans. We felt that a simple, user-friendly monitoring tool would be useful to guide national progress toward cholera elimination. We reviewed cholera surveillance data of Uganda from 2015 to 2021 by date and district. We defined a district as having eliminated cholera if cholera was not reported in that district for at least 4 years. We prepared maps to show districts with cholera, districts that had eliminated it, and districts that had eliminated it but then “relapsed.” These maps were compared with districts where OCV was used and the hotspot map recommended by the GTFCC. Between 2018 and 2021, OCV was administered in 16 districts previously identified as hotspots. In 2018, cholera was reported during at least one of the four previous years from 36 of the 146 districts of Uganda. This number decreased to 18 districts by 2021. Cholera was deemed “eliminated” from four of these 18 districts but then “relapsed.” The cholera elimination scorecard effectively demonstrated national progress toward cholera elimination and identified districts where additional resources are needed to achieve elimination by 2030. Identification of the districts that have eliminated cholera and those that have relapsed will assist the national programs to focus on addressing the factors that result in elimination or relapse of cholera.

Navigating the Cholera Elimination Roadmap in Zambia - a Scoping Review (2013-2023)

“…Because of the risk of reintroduction of cholera following elimination at ward and district levels [29,30], interventions are best planned using a decentralized community-centric approach to surveillance and case management through case-area targeted interventions. This has been seen to be effective in countries such as Uganda, DRC and Burundi, which are also all working towards elimination [7,61,62]. The predictable geographic location and seasonality of the outbreaks could be used to envisage the location and size of repeat vaccination campaigns with the possibility of pre-emptive campaigns timed before the rainy season to be included in the expanded program for immunizations [63][64][65].…”

“…Lastly, Uganda noted the use of a scorecard to track cholera elimination efforts at district and ward levels. They highlighted the risks of periods of elimination and then resurgence in some areas if ongoing elimination efforts such as improved WASH and OCV campaigns were not sustained [7]. Global efforts to improve vaccine availability and rapid diagnostic kits must be matched by domestic adaptation of GTFCC guidelines to ensure better response efforts during outbreaks and a speedier transition from control to elimination of cholera in endemic countries.…”

Cholera and COVID-19 pandemic prevention in multiple hotspot districts of Uganda: vaccine coverage, adverse events following immunization and WASH conditions survey

“…Ntoroko district recorded the least second dose coverage of 55% which was still higher than the 50% that is required for the community to acquire herd immunity against cholera [ 38 ]. The high vaccination coverage registered in these districts following OCV campaigns and the subsequently acquired herd immunity could be responsible for the reported zero cholera outbreaks in these districts of Uganda during the period that followed the vaccination campaigns up to the end of 2021 as established in another study on cholera in Uganda [ 60 ].…”