title: Dynamics of cholera outbreaks in Great Lakes region of Africa, 1978-2008.
abstract: Cholera outbreaks have occurred in Burundi, Rwanda, Democratic Republic of Congo, Tanzania, Uganda, and Kenya almost every year since 1977-1978, when the disease emerged in these countries. We used a multiscale, geographic information system-based approach to assess the link between cholera outbreaks, climate, and environmental variables. We performed time-series analyses and field investigations in the main affected areas. Results showed that cholera greatly increased during El Nino warm events (abnormally warm El Ninos) but decreased or remained stable between these events. Most epidemics occurred in a few hotspots in lakeside areas, where the weekly incidence of cholera varied by season, rainfall, fluctuations of plankton, and fishing activities. During lull periods, persistence of cholera was explained by outbreak dynamics, which suggested a metapopulation pattern, and by endemic foci around the lakes. These links between cholera outbreaks, climate, and lake environments need additional, multidisciplinary study.
authors.affiliation: Université de Franche-Comté, Besançon, France.
authors.forename: Didier
authors.initials: D
authors.lastname: Bompangue Nkoko
authors.forename: Patrick
authors.initials: P
authors.lastname: Giraudoux
authors.forename: Pierre-Denis
authors.initials: PD
authors.lastname: Plisnier
authors.forename: Annie Mutombo
authors.initials: AM
authors.lastname: Tinda
authors.forename: Martine
authors.initials: M
authors.lastname: Piarroux
authors.forename: Bertrand
authors.initials: B
authors.lastname: Sudre
authors.forename: Stephanie
authors.initials: S
authors.lastname: Horion
authors.forename: Jean-Jacques Muyembe
authors.initials: JJ
authors.lastname: Tamfum
authors.forename: Benoît Kebela
authors.initials: BK
authors.lastname: Ilunga
authors.forename: Renaud
authors.initials: R
authors.lastname: Piarroux
mesh_terms: D000351:Africa, Eastern / Q000453:epidemiology; D002771:Cholera / Q000453:epidemiology*; D004196:Disease Outbreaks; D005398:Fisheries; D006801:Humans; D015994:Incidence; D010839:Phytoplankton; D015995:Prevalence; D012621:Seasons; D014329:Tropical Climate; D014734:Vibrio cholerae
references.citation: Trans R Soc Trop Med Hyg. 2009 Feb;103(2):137-43
references.pmid: 18783808
references.citation: Nature. 2003 Aug 14;424(6950):766-8
references.pmid: 12917682
references.citation: Lancet. 1997 Apr 5;349(9057):981-5
references.pmid: 9100624
references.citation: Emerg Infect Dis. 2008 May;14(5):798-800
references.pmid: 18439365
references.citation: Epidemiology. 2010 Sep;21(5):706-10
references.pmid: 20562706
references.citation: Emerg Infect Dis. 2011 Jul;17(7):1161-8
references.pmid: 21762567
references.citation: Proc Natl Acad Sci U S A. 2007 Nov 6;104(45):17801-6
references.pmid: 17968017
references.citation: Trans Am Clin Climatol Assoc. 2009;120:119-28
references.pmid: 19768169
references.citation: Lancet Infect Dis. 2007 Aug;7(8):521-30
references.pmid: 17584531
references.citation: Emerg Infect Dis. 2004 May;10(5):858-64
references.pmid: 15200820
references.citation: Science. 1996 Dec 20;274(5295):2025-31
references.pmid: 8953025
references.citation: Epidemiol Infect. 2010 Jan;138(1):99-107
references.pmid: 19538819
references.citation: Am J Trop Med Hyg. 2006 Nov;75(5):973-7
references.pmid: 17123999
references.citation: Emerg Infect Dis. 2006 Nov;12(11):1689-95
references.pmid: 17283618
references.citation: Am J Trop Med Hyg. 1999 Feb;60(2):271-6
references.pmid: 10072150
references.citation: PLoS Negl Trop Dis. 2009;3(5):e436
references.pmid: 19436726