title: Epidemiology of cholera in the Philippines.
abstract: BACKGROUND
  Despite being a cholera-endemic country, data on cholera in the Philippines remain sparse. Knowing the areas where cholera is known to occur and the factors that lead to its occurrence will assist in planning preventive measures and disaster mitigation.
  
  
  METHODS
  Using sentinel surveillance data, PubMed and ProMED searches covering information from 2008-2013 and event-based surveillance reports from 2010-2013, we assessed the epidemiology of cholera in the Philippines. Using spatial log regression, we assessed the role of water, sanitation and population density on the incidence of cholera.
  
  
  CONCLUSIONS
  We identified 12 articles from ProMED and none from PubMed that reported on cholera in the Philippines from 2008 to 2013. Data from ProMed and surveillance revealed 42,071 suspected and confirmed cholera cases reported from 2008 to 2013, among which only 5,006 were confirmed. 38 (47%) of 81 provinces and metropolitan regions reported at least one confirmed case of cholera and 32 (40%) reported at least one suspected case. The overall case fatality ratio in sentinel sites was 0.62%, but was 2% in outbreaks. All age groups were affected. Using both confirmed and suspected cholera cases, the average annual incidence in 2010-2013 was 9.1 per 100,000 population. Poor access to improved sanitation was consistently associated with higher cholera incidence. Paradoxically, access to improved water sources was associated with higher cholera incidence using both suspected and confirmed cholera data sources. This finding may have been due to the breakdown in the infrastructure and non-chlorination of water supplies, emphasizing the need to maintain public water systems.
  
  
  CONCLUSIONS
  Our findings confirm that cholera affects a large proportion of the provinces in the country. Identifying areas most at risk for cholera will support the development and implementation of policies to minimize the morbidity and mortality due to this disease.
authors.affiliation: University of the Philippines Manila-National Institutes of Health, Philippines.
authors.forename: Anna Lena
authors.initials: AL
authors.lastname: Lopez
authors.affiliation: Department of Health, Manila, Philippines.
authors.forename: Lino Y
authors.initials: LY
authors.lastname: Macasaet
authors.affiliation: University of the Philippines Manila-National Institutes of Health, Philippines.
authors.forename: Michelle
authors.initials: M
authors.lastname: Ylade
authors.affiliation: Department of Health, Manila, Philippines.
authors.forename: Enrique A
authors.initials: EA
authors.lastname: Tayag
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Ali
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D002771:Cholera / Q000453:epidemiology*; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D010679:Philippines / Q000453:epidemiology; D012621:Seasons; D013997:Time Factors