title: The burden of cholera in Uganda.
abstract: BACKGROUND
  In 2010, the World Health Organization released a new cholera vaccine position paper, which recommended the use of cholera vaccines in high-risk endemic areas. However, there is a paucity of data on the burden of cholera in endemic countries. This article reviewed available cholera surveillance data from Uganda and assessed the sufficiency of these data to inform country-specific strategies for cholera vaccination.
  
  
  METHODS
  The Uganda Ministry of Health conducts cholera surveillance to guide cholera outbreak control activities. This includes reporting the number of cases based on a standardized clinical definition plus systematic laboratory testing of stool samples from suspected cases at the outset and conclusion of outbreaks. This retrospective study analyzes available data by district and by age to estimate incidence rates. Since surveillance activities focus on more severe hospitalized cases and deaths, a sensitivity analysis was conducted to estimate the number of non-severe cases and unrecognized deaths that may not have been captured.
  
  
  RESULTS
  Cholera affected all ages, but the geographic distribution of the disease was very heterogeneous in Uganda. We estimated that an average of about 11,000 cholera cases occurred in Uganda each year, which led to approximately 61-182 deaths. The majority of these cases (81%) occurred in a relatively small number of districts comprising just 24% of Uganda's total population. These districts included rural areas bordering the Democratic Republic of Congo, South Sudan, and Kenya as well as the slums of Kampala city. When outbreaks occurred, the average duration was about 15 weeks with a range of 4-44 weeks.
  
  
  CONCLUSIONS
  There is a clear subdivision between high-risk and low-risk districts in Uganda. Vaccination efforts should be focused on the high-risk population. However, enhanced or sentinel surveillance activities should be undertaken to better quantify the endemic disease burden and high-risk populations prior to introducing the vaccine.
authors: Control of Diarrheal Diseases Section, Ministry of Health, Kampala, Uganda.
authors: Godfrey
authors: G
authors: Bwire
authors: Mugagga
authors: M
authors: Malimbo
authors: Brian
authors: B
authors: Maskery
authors: Young Eun
authors: YE
authors: Kim
authors: Vittal
authors: V
authors: Mogasale
authors: Ann
authors: A
authors: Levin
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D002648:Child; D002675:Child, Preschool; D002771:Cholera / Q000453:epidemiology*; D022121:Cholera Vaccines / Q000008:administration & dosage; D015023:Democratic Republic of the Congo; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D007630:Kenya; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018570:Risk Assessment; D018571:Sentinel Surveillance; D013397:Sudan; D014454:Uganda / Q000453:epidemiology; D055815:Young Adult
chemical_list: D022121:Cholera Vaccines