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Background Cholera is an acute, severe, illness caused by infection with Vibrio cholerae . Cholera outbreaks are closely linked to armed conflicts and humanitarian emergencies. This study describes the cholera outbreak amidst conflict in Gadaref state, discusses the possible factors mediated its spread and proposes future improvements in preparedness and response measures. Methods A retrospective analytical study was conducted using national surveillance records of cholera cases, supported by interviews with key informants involved in preparedness and response, along with a review of state reports, to identify possible factors contributing to the spread and to evaluate the response. Result The outbreak was confirmed after the isolation of Vibrio cholerae of O1 serotype, with both Inaba and Ogawa serogroups. A total of 2,047 cholera cases records reviewed. The mean age was 16.8 (SD, 15.8) with an equal gender distribution. The case fatality ratio was 2.4% and the overall attack (AR) rate was 7.38 cases per 10,000 population, with the highest in Medeinat Gadaref locality (21.07/10,000). Interviews and reports review suggest that the outbreak was likely imported to villages near Ethiopian border before spreading to other parts of Gadaref. Atbara seasonal river, was the identified source of infection at the beginning. A disrupted health system due to conflict, delays in response teams’ deployment, and late implementation of control measures were identified as factors contributing to response delay and expansion of the outbreak. Oral cholera vaccine campaign was implemented in five localities, followed by an observable decline in cases. Conclusion Cholera remains a recurrent risk that has been further exacerbated by the armed conflict. The reporting of index cases from a border village highlights the need to strengthen surveillance at points of entry. Investment in case management and risk communication is necessary to improve clinical outcomes. The use of Oral Cholera Vaccine was associated with a decline in cases; however, further field studies are recommended to analyze its actual contribution in limiting the outbreak. The government’s primary role in leading and financing preparedness and response interventions has been limited by the conflict, urging investment in community-led interventions, while moving to more strategic outbreak preparedness and response financing mechanisms remains a priority, with partner support being essential in conflict settings.

In the aftermath of 2 extreme weather events in 2022, Malawi experienced a severe cholera outbreak; 59,325 cases and 1,774 deaths were reported by March 31, 2024. We generated 49 Vibrio cholerae full genomes from isolates collected during December 2022-March 2023. Phylogenetic and phylogeographic methods confirmed that the Malawi outbreak strains originated from Pakistan's 2022 cholera outbreak. That finding aligns with substantial travel between the 2 countries. The estimated most recent ancestor of this lineage was from June-August 2022, coinciding with Pakistan's floods and cholera surge. Our analysis indicates that major floods in Malawi contributed to the outbreak; reproduction numbers peaked in late December 2022. We conclude that extreme weather events and humanitarian crises in Malawi created conditions conducive to the spread of cholera, and population displacement likely contributed to transmission to susceptible populations in areas relatively unaffected by cholera for more than a decade.

A Vibrio cholerae O1 outbreak emerged in Haiti in October 2022 after years of cholera absence. In samples from a 2021 serosurvey, we found lower circulating antibodies against V. cholerae lipopolysaccharide in children <5 years of age and no vibriocidal antibodies, suggesting high susceptibility to cholera, especially among young children.

Cameroon chose Oral Cholera Vaccine (OCV) mass vaccination campaign in addition to other interventions to respond to outbreaks since 2015. There is still a persistent controversy on the effectiveness of reactive OCV mass vaccination campaign. This article aimed to share evidence-based observations on the effect of a reactive single-dose OCV mass vaccination campaign on cholera cases in Cameroon. Health area centered risk analysis was used to identify nine high risk health areas among four health districts in the |North Region as hotspots. About 537,274 people at risk of cholera transmission one year of age and above including pregnant women were eligible to receive OCV. A total of 537,279 doses of OCV was deployed for vaccination from August 1–5, 2019 through door-to-door strategy for urban health districts, and fixed/ temporary fixed posts strategies for rural health districts. The overall vaccination coverage was 99.9%. Vaccine wastage rate was less than 0.5% (0.0011%). Independent monitoring showed vaccination coverage at 97.2%. The 2019 epidemic curve went down after OCV intervention on the contrary to that in the year 2018 at the same period. After OCV intervention, cholera cases dropped from about 10.5 to 9.3 cases per week at the regional level while at the district level, they dropped from 5.3 to 2.1, 2.2 to 1.7, 0.6 to 0 and 1.7 to 1.5 cases per week respectively for Garoua, Garoua II, Tchollire and Pitoa. Though not statistically significant (p = 1.4, α = 0.05), cases per 1000 population seemed to remain unchanged among OCV zones (0.32/1000) and non-OCV zones (0.31/1000) in 2018 while they increased from 0.37 (OCV zones) to 0.53 (non-0CV zones) cases per 1000 population in 2019. There might have been a general trend in the reduction of the number of new cases after a reactive single-dose OCV campaign.

Background Cholera persists as a global public health threat, endangering the lives of vulnerable societies including the MENA region where many countries are facing recent cholera outbreaks. The present study aimed to characterize the knowledge, attitude, and practices status related to cholera in six MENA countries in the MENA region. Methods A cross-sectional study was conducted using a structured, validated questionnaire and distributed across different social media platforms in Egypt, Sudan, Jordan, Syria, Lebanon, and Yemen between December 2022 and January 2023. Univariate and multivariate analyses were used to determine factors associated with knowledge, attitudes, and practices related to cholera. Results A total of 2971 participants were included in the study, of which 62.5% were females; with a mean age of 34.8 ± 12.3 years; 85.4% heard about cholera; and 1.9% experienced cholera infection during cholera outbreaks in their countries. Among those who heard about cholera, 50.7% had adequate knowledge, 67.3% had desirable attitudes, and 50.3% reported good practices. Multivariate analysis revealed that being older, highly educated, employed, working in the medical field, and living in an outbreak country were the significant predictors affecting good knowledge. Additionally, good attitudes were significantly increased by older ages, females, those working in the medical sector, and those living in an outbreak country. Whereas working in the medical sector and having a larger number of people living in the same house significantly decreased the practice scores. Conclusions Raising community awareness about fecal-oral diseases transmitted via contaminated food or water, such as cholera, is crucial. This can be achieved by organizing targeted awareness campaigns for the whole community. Furthermore, mandatory educational workshops and programs for medical professionals are essential, as they serve as role models for the community.

During the 2022–2023 cholera outbreak in Lebanon, cases were reported through the District Health Information System 2 (DHIS2). We developed automated procedures in R computing language to improve completeness of routinely notified variables, apply case definition criteria, improve geographic accuracy and documentation of laboratory results. We developed R scripts for data cleaning, standardization, and reclassification, plotted epidemic curves and produced maps to display cholera incidence rates and rapid diagnostic test (RDT) coverage by district. We shared the R scripts on GitHub platform for open adaptation and use. Prior to cleaning, missingness reached 99.7% for inpatient status and 17–35% for other key variables. After cleaning, all fields were complete. Initially, 92.8% of cases were notified through DHIS2 as suspected and 7.2% as confirmed. Following reclassification, 40% were classified as suspected, 5.8% as confirmed, and 48.6% with unspecified classification. Laboratory data revealed that 5.8% of cases were culture positive, 2.2% RDT positive, and 65.1% had no documented testing. Among facility-entered cases (n = 5953), 11.4% were reported from a different governorate than the patient’s residence. At the time of the outbreak, the daily maps were generated based on place of residence. Integrating R-based analytics with DHIS2 enhanced data completeness, improved case classification, and enabled more better spatial and laboratory analysis. This combined approach provided a clearer epidemiological picture of the cholera outbreak, supporting data-driven public health decision-making and highlighting the value of integrating analytical tools with routine surveillance systems.

Background Cholera remains a disease of public health importance in Nigeria associated with high morbidity and mortality. In November 2014, the Nigeria Field Epidemiology and Laboratory Training Programme (NFELTP) was notified of an increase in suspected cholera cases in Gomani, Kwali Local Government Area. NFELTP residents were deployed to investigate the outbreak with the objectives of verifying the diagnosis, identifying risk factors and instituting appropriate control measures to control the outbreak. Methods We conducted an unmatched case-control study. We defined a cholera case as any person aged ≥5 years with acute watery diarrhea in Gomani community. We identified community controls. A total of 43 cases and 68 controls were recruited. Structured questionnaires were administered to both cases and controls. Four stool samples from case-patients and two water samples from the community water source were collected for laboratory investigation. We performed univariate and bivariate analysis using Epi-Info version 7.1.3.10. Results The mean age of cases and controls was 20.3 years and 25.4 respectively ( p value 0.09). Females constituted 58.1% (cases) and 51.5%(controls). The attack rate was 4.3% with a case fatality rate of 13%. Four stool (100%) specimen tested positive for Vibrio cholerae . The water source and environment were polluted by indiscriminate defecation. Compared to controls, cases were more likely to have drank from Zamani river (OR 14.2, 95% CI: 5.5–36.8) and living in households(HH) with more than 5 persons/HH (OR 5.9, 95% CI: 1.3–27.2). Good hand hygiene was found to be protective (OR 0.3, 95% CI: 0.1–0.7). Conclusion Vibrio cholerae was the cause of the outbreak in Gomani. Drinking water from Zamani river, living in overcrowded HH and poor hand hygiene were significantly associated with the outbreak. We initiated hand hygiene and water treatment to control the outbreak.

Background Cholera is an acute infectious disease caused by ingestion of contaminated food or water with Vibrio cholerae . Cholera remains a global threat to public health and an indicator of inequity and lack of social development. The aim of this study was to assess the prevalence and antimicrobial susceptibility pattern of V. cholerae from cholera outbreak sites in Ethiopia. Methods Across-sectional study was conducted from May 2022 to October 2023 across different regions in Ethiopia: Oromia National Regional State, Amhara National Regional State and Addis Ababa City Administration. A total of 415 fecal samples were collected from the three regions. Two milliliter fecal samples were collected from each study participants. The collected samples were cultured on Blood Agar, MacConkey Agar and Thiosulfate Citrate Bile Salt Sucrose Agar. A series of biochemical tests Oxidase test, String test, Motility, Indole, Citrate, Gas production, H 2 S production, Urease test were used to identify V. cholerae species. Both polyvalent and monovalent antisera were used for agglutination tests to identify and differentiate V. cholerae serogroup and serotypes. In addition, Kirby-Bauer Disk diffusion antibiotic susceptibility test method was done. Data were registered in epi-enfo version 7 and analyzed by Statistical Package for Social Science version 25. Descriptive statistics were used to determine the prevalence of Vibrio cholerae . Logistic regression model was fitted and p -value < 0.05 was considered as statically significant. Results The prevalence of V. cholerae in the fecal samples was 30.1%. Majority of the isolates were from Oromia National Regional State 43.2% ( n  = 54) followed by Amhara National Regional State 31.2% ( n  = 39) and Addis Ababa City Administration 25.6% ( n  = 32). Most of the V. cholerae isolates were O1 serogroups 90.4% ( n  = 113) and Ogawa serotypes 86.4% ( n  = 108). Majority of the isolates were susceptible to ciprofloxacin 100% ( n  = 125), tetracycline 72% ( n  = 90) and gentamycin 68% ( n  = 85). More than half of the isolates were resistant to trimethoprim-sulfamethoxazole 62.4% ( n  = 78) and ampicillin 56.8% ( n  = 71). In this study, participants unable to read and write were about four times more at risk for V. cholerae infection (AOR: 3.8, 95% CI: 1.07–13.33). In addition, consumption of river water were about three times more at risk for V. cholerae infection (AOR: 2.8, 95% CI: 1.08–7.08). Conclusion our study revealed a high prevalence of V. cholerae from fecal samples. The predominant serogroups and serotypes were O1 and Ogawa, respectively. Fortunately, the isolates showed susceptible to most tested antibiotics. Drinking water from river were the identified associated risk factor for V. cholerae infection. Protecting the community from drinking of river water and provision of safe and treated water could reduce cholera outbreaks in the study areas.

The developing world has been facing a significant health issue due to cholera as an endemic communicable disease. Lusaka was Zambia’s worst affected province, with 5414 reported cases of cholera during the outbreak from late October 2017 to May 12, 2018. To explore the epidemiological characteristics associated with the outbreak, we fitted weekly reported cholera cases with a compartmental disease model that incorporates two transmission routes, namely environment-to-human and human-to-human . Estimates of the basic reproduction number show that both transmission modes contributed almost equally during the first wave. In contrast, the environment-to-human transmission appears to be mostly dominating factor for the second wave. Our study finds that a massive abundance of environmental vibrio’s with a huge reduction in water sanitation efficacy triggered the secondary wave. To estimate the expected time to extinction (ETE) of cholera, we formulate the stochastic version of our model and find that cholera can last up to 6.5–7 years in Lusaka if any further outbreak occurs at a later time. Results indicate that a considerable amount of attention is to be paid to sanitation and vaccination programs in order to reduce the severity of the disease and to eradicate cholera from the community in Lusaka.

Background In October 2021, a large outbreak of cholera was declared in Cameroon, disproportionately affecting the Southwest region, one of 10 administrative regions in the country. In this region, the cases were concentrated in three major cities where a humanitarian crisis had concomitantly led to an influx of internally displaced persons. Meanwhile, across the border, Nigeria was facing an unprecedented cholera outbreak. In this paper, we describe the spread of cholera in the region and analyse associated factors. Methods We analysed surveillance data collected in the form of a line list between October 2021 and July 2022. In a case-control study, we assessed factors associated with cholera, with specific interest in the association between overcrowding (defined by the number of household members) and cholera. Results Between October 15, 2021 and July 21, 2022, 6,023 cases (median age 27 years, IQR 18–40, 54% male) and 93 deaths (case fatality 1.54%) were recorded in the region. In total 5,344 (89%) cases were reported from 6 mainland health districts (attack rate 0.47%), 679 (11%) from 4 maritime health districts (attack rate 0.32%). More than 80% of cases were recorded in 3 of 10 health districts: Limbe, Buea, and Tiko. The first cases originated from maritime health districts along the Nigeria-Cameroon border, and spread progressively in-country over time, with an exponential rise in number of cases in mainland health districts following pipe-borne water interruptions. Case fatality was higher in maritime health districts (3.39%) compared to mainland districts (1.5%, p  < 0.01). We did not find an association between overcrowding and cholera, but the results suggest a potential dose-response relationship with an increasing number of household members (>5 people: (crude OR 1.73, 95% CI 0.97–3.12) and 3–5 people: (crude OR 1.47, 95% CI 0.85–2.60)), even after adjusting for internally displaced status and number of household compartments in the multivariable model (aOR 1.54, 95% CI 0.80–3.02). Conclusions We report the largest cholera outbreak in the Southwest region. Our findings suggest the cross-border spread of cases from the Nigerian outbreak, likely driven by overcrowding in major cities. Our study highlights the need for cross-border surveillance, especially during humanitarian crises.