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      Exploring Droughts and Floods and Their Association with Cholera Outbreaks in Sub-Saharan Africa: A Register-Based Ecological Study from 1990 to 2010

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          Abstract.

          Cholera outbreaks in Africa have been attributed to both droughts and floods, but whether the risk of a cholera outbreak is elevated during droughts is unknown. We estimated the risk of cholera outbreaks during droughts and floods compared with drought- and flood-free periods in 40 sub-Saharan African countries during 1990–2010 based on data from Emergency Events Database: the Office of Foreign Disaster Assistance /Centre for Research on the Epidemiology of Disasters International Disaster Database ( www.emdat.be). A cholera outbreak was registered in one of every three droughts and one of every 15 floods. We observed an increased incidence rate of cholera outbreaks during drought periods (incidence rate ratio [IRR] = 4.3, 95% confidence interval [CI] = 2.9–7.2) and during flood periods (IRR = 144, 95% CI = 101–208) when compared with drought/flood-free periods. Floods are more strongly associated with cholera outbreaks, yet the prevalence of cholera outbreaks is higher during droughts because of droughts’ long durations. The results suggest that droughts in addition to floods call for increased cholera preparedness.

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          The global burden of cholera.

          Mohammad Alauddin Mohammad Ali, Anna Lena Lopez, Young You … (2012)
          To estimate the global burden of cholera using population-based incidence data and reports. Countries with a recent history of cholera were classified as endemic or non-endemic, depending on whether they had reported cholera cases in at least three of the five most recent years. The percentages of the population in each country that lacked access to improved sanitation were used to compute the populations at risk for cholera, and incidence rates from published studies were applied to groups of countries to estimate the annual number of cholera cases in endemic countries. The estimates of cholera cases in non-endemic countries were based on the average numbers of cases reported from 2000 to 2008. Literature-based estimates of cholera case-fatality rates (CFRs) were used to compute the variance-weighted average cholera CFRs for estimating the number of cholera deaths. About 1.4 billion people are at risk for cholera in endemic countries. An estimated 2.8 million cholera cases occur annually in such countries (uncertainty range: 1.4-4.3) and an estimated 87,000 cholera cases occur in non-endemic countries. The incidence is estimated to be greatest in children less than 5 years of age. Every year about 91,000 people (uncertainty range: 28,000 to 142,000) die of cholera in endemic countries and 2500 people die of the disease in non-endemic countries. The global burden of cholera, as determined through a systematic review with clearly stated assumptions, is high. The findings of this study provide a contemporary basis for planning public health interventions to control cholera.
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            Epidemics after Natural Disasters

            John T. Watson, Michelle Gayer, Maire Connolly (2007)
            The relationship between natural disasters and communicable diseases is frequently misconstrued. The risk for outbreaks is often presumed to be very high in the chaos that follows natural disasters, a fear likely derived from a perceived association between dead bodies and epidemics. However, the risk factors for outbreaks after disasters are associated primarily with population displacement. The availability of safe water and sanitation facilities, the degree of crowding, the underlying health status of the population, and the availability of healthcare services all interact within the context of the local disease ecology to influence the risk for communicable diseases and death in the affected population. We outline the risk factors for outbreaks after a disaster, review the communicable diseases likely to be important, and establish priorities to address communicable diseases in disaster settings.
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              Refractory periods and climate forcing in cholera dynamics.

              Katia Koelle, Md Mostafa, Mercedes Pascual … (2005)
              Outbreaks of many infectious diseases, including cholera, malaria and dengue, vary over characteristic periods longer than 1 year. Evidence that climate variability drives these interannual cycles has been highly controversial, chiefly because it is difficult to isolate the contribution of environmental forcing while taking into account nonlinear epidemiological dynamics generated by mechanisms such as host immunity. Here we show that a critical interplay of environmental forcing, specifically climate variability, and temporary immunity explains the interannual disease cycles present in a four-decade cholera time series from Matlab, Bangladesh. We reconstruct the transmission rate, the key epidemiological parameter affected by extrinsic forcing, over time for the predominant strain (El Tor) with a nonlinear population model that permits a contributing effect of intrinsic immunity. Transmission shows clear interannual variability with a strong correspondence to climate patterns at long periods (over 7 years, for monsoon rains and Brahmaputra river discharge) and at shorter periods (under 7 years, for flood extent in Bangladesh, sea surface temperatures in the Bay of Bengal and the El Niño-Southern Oscillation). The importance of the interplay between extrinsic and intrinsic factors in determining disease dynamics is illustrated during refractory periods, when population susceptibility levels are low as the result of immunity and the size of cholera outbreaks only weakly reflects climate forcing.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Am J Trop Med Hyg
                Journal ID (iso-abbrev): Am. J. Trop. Med. Hyg
                Journal ID (publisher-id): tpmd
                Journal ID (hwp): tropmed
                Title: The American Journal of Tropical Medicine and Hygiene
                Publisher: The American Society of Tropical Medicine and Hygiene
                ISSN (Print): 0002-9637
                ISSN (Electronic): 1476-1645
                Publication date (Print): May 2018
                Publication date (Electronic): 05 March 2018
                Publication date PMC-release: 05 March 2018
                Volume: 98
                Issue: 5
                Pages: 1269-1274
                Affiliations
                [1 ]University of Southern Denmark, Odense, Denmark;
                [2 ]University of Copenhagen, Copenhagen, Denmark;
                [3 ]Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
                Author notes
                [* ]Address correspondence to Peter Kjær Mackie Jensen, University of Copenhagen, Østerfarimagsgade 5, Copenhagen 1371, Denmark. E-mail: mackie@ 123456sund.ku.dk
                [†]

                These authors contributed equally to this work.

                Authors’ addresses: Andreas Rieckmann, OPEN, Institute of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark, and Bandim Health Project, Statens Serum Institut, Copenhagen, Denmark, E-mail: andrieck2@ 123456gmail.com . Charlotte C. Tamason and Peter Kjær Mackie Jensen, Department of Public Health, Copenhagen Center for Disaster Research, Department of Public Health, University of Copenhagen, Copenhagen, Denmark, E-mails: cctamason@ 123456gmail.com and mackie@ 123456sund.ku.dk . Emily S. Gurley, Johns Hopkins University Bloomberg School of Public Health, Department of Epidemiology, Baltimore, MD, E-mail: egurley1@ 123456jhu.edu . Naja Hulvej Rod, Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark, E-mail: nahuro@ 123456sund.ku.dk .

                Article
                Publisher ID: tpmd170778
                DOI: 10.4269/ajtmh.17-0778
                PMC ID: 5953376
                PubMed ID: 29512484
                SO-VID: bebffdf8-b76c-4535-b125-a0a434e96eb1
                Copyright © © The American Society of Tropical Medicine and Hygiene
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                Date received : 06 October 2017
                Date accepted : 20 January 2018
                Page count
                Pages: 6
                Categories
                Subject: Articles

                ScienceOpen disciplines: Infectious disease & Microbiology
                Data availability:
                ScienceOpen disciplines: Infectious disease & Microbiology

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