title: Evaluation and use of surveillance system data toward the identification of high-risk areas for potential cholera vaccination: a case study from Niger.
abstract: BACKGROUND
  In 2008, Africa accounted for 94% of the cholera cases reported worldwide. Although the World Health Organization currently recommends the oral cholera vaccine in endemic areas for high-risk populations, its use in Sub-Saharan Africa has been limited. Here, we provide the principal results of an evaluation of the cholera surveillance system in the region of Maradi in Niger and an analysis of its data towards identifying high-risk areas for cholera.
  
  
  RESULTS
  We evaluated the cholera surveillance data using a standard CDC protocol, through interviews with heads of the system, and a review of cholera data collected between 2006-2009. The surveillance system was found to be sufficiently reliable to be able to utilize the data for the detection of high risk areas for cholera vaccination. Temporal, geographic and socio-demographic analyses of cholera cases indicated that between 2006 and 2009, 433 cholera cases were reported in the Maradi region of Niger. Two deprived neighborhoods of the region's capital city, Bagalam and Yandaka, represented 1% of the regional population and 21% of the cholera cases, reaching a yearly incidence rate of 3 per 1000 in 2006 and 2008, respectively.
  
  
  CONCLUSIONS
  The results of this evaluation suggest that the reporting sensitivity of the surveillance system is sufficient, to appropriately classify the region as cholera endemic. Additionally, two overcrowded neighborhoods in the regional capital met WHO criteria for consideration for cholera vaccination.
authors.affiliation: Epicentre-8, Rue St-Sabin, 75011 Paris, France. j.guerra.sp@gmail.com
authors.forename: Jose
authors.initials: J
authors.lastname: Guerra
authors.forename: Bachir
authors.initials: B
authors.lastname: Mayana
authors.forename: Ali
authors.initials: A
authors.lastname: Djibo
authors.forename: Mahamane L
authors.initials: ML
authors.lastname: Manzo
authors.forename: Augusto E
authors.initials: AE
authors.lastname: Llosa
authors.forename: Rebecca F
authors.initials: RF
authors.lastname: Grais
mesh_terms: D017677:Age Distribution; D002771:Cholera / Q000453:epidemiology* / Q000276:immunology / Q000517:prevention & control*; D022121:Cholera Vaccines / Q000276:immunology*; D002947:Cities; D003625:Data Collection; D005843:Geography; D006801:Humans; D007407:Interviews as Topic; D009548:Niger / Q000453:epidemiology; D011159:Population Surveillance; D012307:Risk Factors; D013997:Time Factors; D014611:Vaccination / Q000706:statistics & numerical data*
chemical_list: D022121:Cholera Vaccines