title: Cholera Incidence and Mortality in Sub-Saharan African Sites during Multi-country Surveillance.
abstract: Cholera burden in Africa remains unknown, often because of weak national surveillance systems. We analyzed data from the African Cholera Surveillance Network (www.africhol.org).
  
  
  
  During June 2011-December 2013, we conducted enhanced surveillance in seven zones and four outbreak sites in Togo, the Democratic Republic of Congo (DRC), Guinea, Uganda, Mozambique and Cote d'Ivoire. All health facilities treating cholera cases were included. Cholera incidences were calculated using culture-confirmed cholera cases and culture-confirmed cholera cases corrected for lack of culture testing usually due to overwhelmed health systems and imperfect test sensitivity. Of 13,377 reported suspected cases, 34% occurred in Conakry, Guinea, 47% in Goma, DRC, and 19% in the remaining sites. From 0-40% of suspected cases were aged under five years and from 0.3-86% had rice water stools. Within surveillance zones, 0-37% of suspected cases had confirmed cholera compared to 27-38% during outbreaks. Annual confirmed incidence per 10,000 population was <0.5 in surveillance zones, except Goma where it was 4.6. Goma and Conakry had corrected incidences of 20.2 and 5.8 respectively, while the other zones a median of 0.3. During outbreaks, corrected incidence varied from 2.6 to 13.0. Case fatality ratios ranged from 0-10% (median, 1%) by country.
  
  
  
  Across different African epidemiological contexts, substantial variation occurred in cholera incidence, age distribution, clinical presentation, culture confirmation, and testing frequency. These results can help guide preventive activities, including vaccine use.
authors.affiliation: Agence de Medecine Preventive, Paris, France.
authors.forename: Delphine
authors.initials: D
authors.lastname: Sauvageot
authors.affiliation: Agence de Medecine Preventive, Paris, France.
authors.forename: Berthe-Marie
authors.initials: BM
authors.lastname: Njanpop-Lafourcade
authors.affiliation: Ministère de la santé, Kinshasa, Republique Democratique du Congo.
authors.forename: Laurent
authors.initials: L
authors.lastname: Akilimali
authors.affiliation: Institut Pasteur, Abidjan, Cote d'Ivoire.
authors.forename: Jean-Claude
authors.initials: JC
authors.lastname: Anne
authors.affiliation: Institut National d'Hygiene, Lome, Togo.
authors.forename: Pawou
authors.initials: P
authors.lastname: Bidjada
authors.affiliation: Universite de Kinshasa, Kinshasa, Republique Democratique du Congo.
authors.forename: Didier
authors.initials: D
authors.lastname: Bompangue
authors.affiliation: Ministry of Health, Kampala, Uganda.
authors.forename: Godfrey
authors.initials: G
authors.lastname: Bwire
authors.affiliation: Institut National d'hygiene Publique, Abidjan, Ivory Coast.
authors.forename: Daouda
authors.initials: D
authors.lastname: Coulibaly
authors.affiliation: Instituto Nacional de Saude, Maputo, Mozambique.
authors.forename: Liliana
authors.initials: L
authors.lastname: Dengo-Baloi
authors.affiliation: Institut Pasteur, Abidjan, Cote d'Ivoire.
authors.forename: Mireille
authors.initials: M
authors.lastname: Dosso
authors.affiliation: Makerere School of Public Health, Kampala, Uganda.
authors.forename: Christopher Garimoi
authors.initials: CG
authors.lastname: Orach
authors.affiliation: Instituto Nacional de Saude, Maputo, Mozambique.
authors.forename: Dorteia
authors.initials: D
authors.lastname: Inguane
authors.affiliation: Central Public Health Laboratory, Ministry of Health, Kampala, Uganda.
authors.forename: Atek
authors.initials: A
authors.lastname: Kagirita
authors.affiliation: Institut Pasteur, Abidjan, Cote d'Ivoire.
authors.forename: Adele
authors.initials: A
authors.lastname: Kacou-N'Douba
authors.affiliation: Ministere de la sante publique et de l'hygiene publique, Conakry, Guinea.
authors.forename: Sakoba
authors.initials: S
authors.lastname: Keita
authors.affiliation: Institut National d'Hygiene, Lome, Togo.
authors.forename: Abiba
authors.initials: A
authors.lastname: Kere Banla
authors.affiliation: Institut National d'hygiene Publique, Abidjan, Ivory Coast.
authors.forename: Yao Jean-Pierre
authors.initials: YJ
authors.lastname: Kouame
authors.affiliation: Ministere de la sante, Lome, Togo.
authors.forename: Dadja Essoya
authors.initials: DE
authors.lastname: Landoh
authors.affiliation: Instituto Nacional de Saude, Maputo, Mozambique.
authors.forename: Jose Paulo
authors.initials: JP
authors.lastname: Langa
authors.affiliation: Ministry of Health, Kampala, Uganda.
authors.forename: Issa
authors.initials: I
authors.lastname: Makumbi
authors.affiliation: Institut National de Recherche Biomedicale, Kinshasa, Republique Democratique du Congo.
authors.forename: Berthe
authors.initials: B
authors.lastname: Miwanda
authors.affiliation: Ministry of Health, Kampala, Uganda.
authors.forename: Muggaga
authors.initials: M
authors.lastname: Malimbo
authors.affiliation: Ministere de la santé, Division Provinciale de la santé, Goma, Republique Democratique du Congo.
authors.forename: Guy
authors.initials: G
authors.lastname: Mutombo
authors.affiliation: Ministère de la santé, Kinshasa, Republique Democratique du Congo.
authors.forename: Annie
authors.initials: A
authors.lastname: Mutombo
authors.affiliation: Institut National d'hygiene Publique, Abidjan, Ivory Coast.
authors.forename: Emilienne Niamke
authors.initials: EN
authors.lastname: NGuetta
authors.affiliation: Institut National de Sante Publique, Conakry, Guinea.
authors.forename: Mamadou
authors.initials: M
authors.lastname: Saliou
authors.affiliation: Ministere de la sante publique et de l'hygiene publique, Conakry, Guinea.
authors.forename: Veronique
authors.initials: V
authors.lastname: Sarr
authors.affiliation: Ami-labo, Goma, Republique Democratique du Congo.
authors.forename: Raphael Kakongo
authors.initials: RK
authors.lastname: Senga
authors.affiliation: Ministere de la sante publique et de l'hygiene publique, Conakry, Guinea.
authors.forename: Fode
authors.initials: F
authors.lastname: Sory
authors.affiliation: Instituto Nacional de Saude, Maputo, Mozambique.
authors.forename: Cynthia
authors.initials: C
authors.lastname: Sema
authors.affiliation: Ministere de la sante, Lome, Togo.
authors.forename: Ouyi Valentin
authors.initials: OV
authors.lastname: Tante
authors.affiliation: Agence de Medecine Preventive, Paris, France.
authors.forename: Bradford D
authors.initials: BD
authors.lastname: Gessner
authors.affiliation: Agence de Medecine Preventive, Paris, France.
authors.forename: Martin A
authors.initials: MA
authors.lastname: Mengel
mesh_terms: D000293:Adolescent; D000328:Adult; D017954:Africa South of the Sahara / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D002771:Cholera / Q000453:epidemiology* / Q000401:mortality / Q000517:prevention & control; D006801:Humans; D015994:Incidence; D007223:Infant; D008875:Middle Aged