Lakes as Source of Cholera Outbreaks, Democratic Republic of Congo

Bompangue, Didier; Giraudoux, Patrick; Handschumacher, Pascal; Piarroux, Martine; Súdre, Bertrand; Ekwanzala, Mosiana; Kebela, Ilunga; Piarroux, Renaud

doi:10.3201/eid1405.071260

Cited by 79 publications

(85 citation statements)

References 6 publications

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“…The causative bacterium may be free-living in the environment, with environmental reservoirs well described in endemic regions in Asia [1]; the microorganism can live in both fresh- (inland lakes) [2, 3] and salt-water (coastal, estuarine areas) environments [1]. Illness tends to occur in seasonal patterns [4–6], with seasonality often associated with environmental parameters such as rainfall [7] and temperature [8, 9].…”

Section: Introductionmentioning

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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Section: Introductionmentioning

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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“…The study sites are located in Katanga Province approximately 200 km east of Lubumbashi in a riverine and lakeland area with a high prevalence of childhood diarrhea and endemic cholera. 37,38 Two sites eligible for both rotavirus and cholera vaccine introduction were selected, one (Kasenga) being more urban than the other (Nkolé). Kasenga is a rural town situated on the riverside of the Luapula River, which forms the border with Zambia, and has eight quartiers with a total population of 27,000 persons, mainly ciBemba-speaking inhabitants living in an area of 10 km 2 .…”

Section: Methodsmentioning

confidence: 99%

Sociocultural Determinants of Anticipated Vaccine Acceptance for Acute Watery Diarrhea in Early Childhood in Katanga Province, Democratic Republic of Congo

Merten

Scheffold²,

Manianga³

et al. 2013

The American Society of Tropical Medicine and Hygiene

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Abstract. Rotavirus and oral cholera vaccines have the potential to reduce diarrhea-related child mortality in low-income settings and are recommended by the World Health Organization. Uptake of vaccination depends on community support, and is based on local priorities. This study investigates local perceptions of acute watery diarrhea in childhood and anticipated vaccine acceptance in two sites in the Democratic Republic of Congo. In 2010, 360 randomly selected non-affected adults were interviewed by using a semi-structured questionnaire. Witchcraft and breastfeeding were perceived as potential cause of acute watery diarrhea by 51% and 48% of respondents. Despite misperceptions, anticipated vaccine acceptance at no cost was 99%. The strongest predictor of anticipated vaccine acceptance if costs were assumed was the educational level of the respondents. Results suggest that the introduction of vaccines is a local priority and local (mis)perceptions of illness do not compromise vaccine acceptability if the vaccine is affordable.

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“…18 Bathing and drinking lake water have been shown to be risk factors for disease in Lake Victoria and Lake Tanganyika, both East African lakes in which hyacinth is prevalent. [7][8][9][10][11] A study in western Democratic Republic of Congo found that cholera outbreaks were more likely to occur and persist near lakes and that individual cholera cases were more likely among people living closer to the lakes. 8 The experimental data along with the epidemiologic linkage of cholera to lakes suggest that hyacinth might act as a nidus for amplification and/or maintenance of a reservoir for V. cholerae that can lead to repeated infections among people drinking or swallowing lake water.…”

Section: Discussionmentioning

confidence: 99%

“…Exposure to lakes has been shown to be epidemiologically linked with cholera disease in several East African countries. [7][8][9] Many of the Great Lakes in East Africa have become colonized with an exotic plant, the water hyacinth ( Eichhornia crassipes ); it was first documented in Lake Victoria in 1988. 10,11 We explore the temporal association between water-hyacinth coverage on Lake Victoria and cholera incidence in the Kenyan province bordering the lake.…”

Section: Introductionmentioning

confidence: 99%

Does Water Hyacinth on East African Lakes Promote Cholera Outbreaks?

Feikin

Tabu²,

Gichuki

2010

The American Society of Tropical Medicine and Hygiene

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Cholera outbreaks continue to occur regularly in Africa. Cholera has been associated with proximity to lakes in East Africa, and Vibrio cholerae has been found experimentally to concentrate on the floating aquatic plant, water hyacinth, which is periodically widespread in East African lakes since the late 1980s. From 1994 to 2008, Nyanza Province, which is the Kenyan province bordering Lake Victoria, accounted for a larger proportion of cholera cases than expected by its population size (38.7% of cholera cases versus 15.3% of national population). Yearly water-hyacinth coverage on the Kenyan section of Lake Victoria was positively associated with the number of cholera cases reported in Nyanza Province (r = 0.83; P = 0.0010). Water hyacinth on freshwater lakes might play a role in initiating cholera outbreaks and causing sporadic disease in East Africa.

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Lakes as Source of Cholera Outbreaks, Democratic Republic of Congo

Cited by 79 publications

References 6 publications

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

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

Sociocultural Determinants of Anticipated Vaccine Acceptance for Acute Watery Diarrhea in Early Childhood in Katanga Province, Democratic Republic of Congo

Does Water Hyacinth on East African Lakes Promote Cholera Outbreaks?

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