Impact of a multi-pronged cholera intervention in an endemic setting.

Cholera is a bacterial water-borne diarrheal disease transmitted via the fecal-oral route that causes high morbidity in sub-Saharan Africa and Asia. It is preventable with vaccination, and Water, Sanitation, and Hygiene (WASH) improvements. However, the impact of vaccination in endemic settings rema...

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Main Authors: Alexandre Blake, Adam Walder, Ephraim M Hanks, Placide Okitayemba Welo, Francisco Luquero, Didier Bompangue, Nita Bharti
Format: Article
Language:English
Published: Public Library of Science (PLoS) 2025-02-01
Series:PLoS Neglected Tropical Diseases
Online Access:https://doi.org/10.1371/journal.pntd.0012867
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author Alexandre Blake
Adam Walder
Ephraim M Hanks
Placide Okitayemba Welo
Francisco Luquero
Didier Bompangue
Nita Bharti
author_facet Alexandre Blake
Adam Walder
Ephraim M Hanks
Placide Okitayemba Welo
Francisco Luquero
Didier Bompangue
Nita Bharti
author_sort Alexandre Blake
collection DOAJ
description Cholera is a bacterial water-borne diarrheal disease transmitted via the fecal-oral route that causes high morbidity in sub-Saharan Africa and Asia. It is preventable with vaccination, and Water, Sanitation, and Hygiene (WASH) improvements. However, the impact of vaccination in endemic settings remains unclear. Cholera is endemic in the city of Kalemie, on the shore of Lake Tanganyika, in the Democratic Republic of Congo, where both seasonal mobility and the lake, a potential environmental reservoir, may promote transmission. Kalemie received a vaccination campaign and WASH improvements in 2013-2016. We assessed the impact of this intervention to inform future control strategies in endemic settings. We fit compartmental models considering seasonal mobility and environmentally-based transmission. We estimated the number of cases the intervention avoided, and the relative contributions of the elements promoting local cholera transmission. We estimated the intervention avoided 5,259 cases (95% credible interval: 1,576.6-11,337.8) over 118 weeks. Transmission did not rely on seasonal mobility and was primarily environmentally-driven. Removing environmental exposure or contamination could control local transmission. Repeated environmental exposure could maintain high population immunity and decrease the impact of vaccination in similar endemic areas. Addressing environmental exposure and contamination should be the primary target of interventions in such settings.
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spelling doaj-art-2a7873a522fe4f08b4c30c751e91d2e72025-08-20T01:49:05ZengPublic Library of Science (PLoS)PLoS Neglected Tropical Diseases1935-27271935-27352025-02-01192e001286710.1371/journal.pntd.0012867Impact of a multi-pronged cholera intervention in an endemic setting.Alexandre BlakeAdam WalderEphraim M HanksPlacide Okitayemba WeloFrancisco LuqueroDidier BompangueNita BhartiCholera is a bacterial water-borne diarrheal disease transmitted via the fecal-oral route that causes high morbidity in sub-Saharan Africa and Asia. It is preventable with vaccination, and Water, Sanitation, and Hygiene (WASH) improvements. However, the impact of vaccination in endemic settings remains unclear. Cholera is endemic in the city of Kalemie, on the shore of Lake Tanganyika, in the Democratic Republic of Congo, where both seasonal mobility and the lake, a potential environmental reservoir, may promote transmission. Kalemie received a vaccination campaign and WASH improvements in 2013-2016. We assessed the impact of this intervention to inform future control strategies in endemic settings. We fit compartmental models considering seasonal mobility and environmentally-based transmission. We estimated the number of cases the intervention avoided, and the relative contributions of the elements promoting local cholera transmission. We estimated the intervention avoided 5,259 cases (95% credible interval: 1,576.6-11,337.8) over 118 weeks. Transmission did not rely on seasonal mobility and was primarily environmentally-driven. Removing environmental exposure or contamination could control local transmission. Repeated environmental exposure could maintain high population immunity and decrease the impact of vaccination in similar endemic areas. Addressing environmental exposure and contamination should be the primary target of interventions in such settings.https://doi.org/10.1371/journal.pntd.0012867
spellingShingle Alexandre Blake
Adam Walder
Ephraim M Hanks
Placide Okitayemba Welo
Francisco Luquero
Didier Bompangue
Nita Bharti
Impact of a multi-pronged cholera intervention in an endemic setting.
PLoS Neglected Tropical Diseases
title Impact of a multi-pronged cholera intervention in an endemic setting.
title_full Impact of a multi-pronged cholera intervention in an endemic setting.
title_fullStr Impact of a multi-pronged cholera intervention in an endemic setting.
title_full_unstemmed Impact of a multi-pronged cholera intervention in an endemic setting.
title_short Impact of a multi-pronged cholera intervention in an endemic setting.
title_sort impact of a multi pronged cholera intervention in an endemic setting
url https://doi.org/10.1371/journal.pntd.0012867
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