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Title: The epidemiology of cholera in Zanzibar: Implications for the zanzibar comprehensive cholera elimination plan
Authors: Qifang Bi
Fadhil M. Abdalla
Salma Masauni
Rita Reyburn
Marko Msambazi
Carole Deglise
Lorenz Von Seidlein
Jacqueline Deen
Mohamed Saleh Jiddawi
David Olson
Iriya Nemes
Jamala Adam Taib
Justin Lessler
Ghirmay Redae Andemichael
Andrew S. Azman
University of the Philippines Manila
Organisation Mondiale de la Santé
Mahidol University
Murdoch Children's Research Institute
Medecins Sans Frontieres
Johns Hopkins Bloomberg School of Public Health
Zanzibar Ministry of Health
Keywords: Medicine
Issue Date: 15-Oct-2018
Citation: Journal of Infectious Diseases. Vol.218, (2018), S173-S180
Abstract: © The Author(s) 2018. Published by Oxford University Press for the Infectious Diseases Society of America. Background Cholera poses a public health and economic threat to Zanzibar. Detailed epidemiologic analyses are needed to inform a multisectoral cholera elimination plan currently under development. Methods We collated passive surveillance data from 1997 to 2017 and calculated the outbreak-specific and cumulative incidence of suspected cholera per shehia (neighborhood). We explored the variability in shehia-specific relative cholera risk and explored the predictive power of targeting intervention at shehias based on historical incidence. Using flexible regression models, we estimated cholera's seasonality and the relationship between rainfall and cholera transmission. Results From 1997 and 2017, 11921 suspected cholera cases were reported across 87% of Zanzibar's shehias, representing an average incidence rate of 4.4 per 10000/year. The geographic distribution of cases across outbreaks was variable, although a number of high-burden areas were identified. Outbreaks were highly seasonal with 2 high-risk periods corresponding to the annual rainy seasons. Conclusions Shehia-targeted interventions should be complemented with island-wide cholera prevention activities given the spatial variability in cholera risk from outbreak to outbreak. In-depth risk factor analyses should be conducted in the high-burden shehias. The seasonal nature of cholera provides annual windows of opportunity for cholera preparedness activities.
ISSN: 15376613
Appears in Collections:Scopus 2018

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