Cholera epidemics, war and disasters around Goma and Lake Kivu: an eight-year survey.
Cholera epidemics, war and disasters around Goma and Lake Kivu: an eight-year survey.
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DOI：
10.1371/journal.pntd.0000436
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发表时间：
2009
影响因子：
3.8
通讯作者：
Piarroux R
中科院分区：
文献类型：
--
作者：
Bompangue D;Giraudoux P;Piarroux M;Mutombo G;Shamavu R;Sudre B;Mutombo A;Mondonge V;Piarroux R
在过去八年中，位于刚果东部湖泊地区的南北基伍发生了一次大规模火山爆发和许多复杂的紧急情况，造成人口流离失所。这些条件被怀疑有利于霍乱流行病的出现和传播。为了评估这些条件对疫情的影响，从2000年至2007年，每周从北基伍（4 667 699名居民）和南基伍（4 670 121名居民）的每个卫生区收集霍乱病例报告。建立了一个地理信息系统，在每个卫生区，利用回归技术和时间序列分析评估了环境变量与霍乱病例数之间的关系。我们进一步检查了复杂紧急情况与霍乱爆发之间的联系。最后，我们分析了在尼拉贡戈火山爆发后在戈马进行的流行病学调查期间收集的数据。据报告，共有73 605例霍乱病例和1 612人死亡。时间序列分解显示，雨季期间南基伍的案件数量较多，而北基伍则不然。霍乱病例的空间分布显示，在毗邻湖泊的卫生区病例数较多（比值比7.0，置信区间范围3.8-12.9）。在战争事件发生后的12周内，观察到四次流行病的重新激活，但模拟表明，重新激活的数量并不大于任何随机选择的无战争时期的预期数量。尼拉贡戈火山爆发后，霍乱发病率明显下降。我们的研究指出，位于湖边地区的一些城镇在基伍霍乱持续蔓延方面发挥了关键作用。即使复杂的紧急情况没有系统地导致霍乱流行，其中一些紧急情况也使霍乱得以传播。由于过去八年中霍乱病例多达73 000例，加上连续十五年的战争，刚果民主共和国南北基伍省目前受到霍乱爆发和与战争有关的人口流离失所的严重打击。在进行这项研究之前，没有进行任何研究来查明流行病的来源和霍乱在基伍各省蔓延的途径。在这里，我们表明，位于基伍湖和坦噶尼喀湖的湖岸的几个城市作为霍乱流行病的主要来源，霍乱病例的数量往往在雨季增加。我们还发现，只有少数人口流离失所后爆发霍乱。最后，我们认为，尼拉贡戈火山爆发后记录的霍乱病例数量较低，这是实施旨在恢复并在可能的情况下改善自然灾害后饮用水供应的方案的又一个理由。
During the last eight years, North and South Kivu, located in a lake area in Eastern Democratic Republic of Congo, have been the site of a major volcano eruption and of numerous complex emergencies with population displacements. These conditions have been suspected to favour emergence and spread of cholera epidemics. In order to assess the influence of these conditions on outbreaks, reports of cholera cases were collected weekly from each health district of North Kivu (4,667,699 inhabitants) and South Kivu (4,670,121 inhabitants) from 2000 through 2007. A geographic information system was established, and in each health district, the relationships between environmental variables and the number of cholera cases were assessed using regression techniques and time series analysis. We further checked for a link between complex emergencies and cholera outbreaks. Finally, we analysed data collected during an epidemiological survey that was implemented in Goma after Nyiragongo eruption. A total of 73,605 cases and 1,612 deaths of cholera were reported. Time series decomposition showed a greater number of cases during the rainy season in South Kivu but not in North Kivu. Spatial distribution of cholera cases exhibited a higher number of cases in health districts bordering lakes (Odds Ratio 7.0, Confidence Interval range 3.8–12.9). Four epidemic reactivations were observed in the 12-week periods following war events, but simulations indicate that the number of reactivations was not larger than that expected during any random selection of period with no war. Nyiragongo volcanic eruption was followed by a marked decrease of cholera incidence. Our study points out the crucial role of some towns located in lakeside areas in the persistence of cholera in Kivu. Even if complex emergencies were not systematically followed by cholera epidemics, some of them enabled cholera spreading. With the number of cholera cases up to 73,000 during the last eight years and successive wars that have persisted for fifteen years, the North and South Kivu provinces of the Democratic Republic of Congo are currently heavily hit by both cholera outbreaks and war-related population displacements. Prior to this study, no research had been done to identify the sources of epidemics and the pathways used by cholera to spread throughout the Kivu provinces. Here we show that a few cities located on the lakeshore of Lake Kivu and Lake Tanganyika act as the main sources of cholera epidemics and that the number of cholera cases tends to increase during the rainy season. We also found that only a minority of population displacements were followed by cholera outbreaks. Finally, we think that the low number of cholera cases recorded after the Nyiragongo eruption is one more argument to implement programs aiming at restoring, and if possible improving, drinking water access following natural disasters
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影响因子：
168.9
作者：
SIDDIQUE, AK;SALAM, A;LASTON, S
通讯作者：
LASTON, S
影响因子：
64.8
作者：
Koelle, K;Rod贸, X;Mostafa, G
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Mostafa, G
影响因子：
11.8
作者：
Floret N;Viel JF;Mauny F;Hoen B;Piarroux R
通讯作者：
Piarroux R
DOI：
10.4269/ajtmh.2008.79.708
发表时间：
2008-11-01
影响因子：
3.3
作者：
Harris, Aaron M.;Chowdhury, Fahima;Qadri, Firdausi
通讯作者：
Qadri, Firdausi
DOI：
10.4269/ajtmh.1999.60.271
发表时间：
1999-02-01
影响因子：
3.3
作者：
Shapiro, RL;Otieno, MR;Slutsker, L
通讯作者：
Slutsker, L