Cholera in Goma, DRC

项目总结/摘要 霍乱是一种古老的疾病，在现代社会中表现出了非凡的持续和传播能力。 世界根据世卫组织2016年的数据，38个国家报告了132，121例霍乱病例和2420例死亡。 然而，考虑到可能的漏报，全球疾病负担估计为 每年有130万至400万霍乱病例，21 000至143 000人死亡。霍乱通常是一种 在人道主义紧急情况和公共卫生基础设施崩溃的地区， 最近，也门的大规模流行突出了这一点，据报有100多万病例， 约会鉴于这些问题的顽固性，以及气候变化、城市化和 随着人口的增长，霍乱可能仍然是对公共卫生的一个经常性的全球威胁。 而印度次大陆是霍乱的祖籍地，并可能发生疫情危机 在过去20年中，撒哈拉以南非洲已成为 全球霍乱疾病负担的主要场所。在非洲，两个主要的区域内陆“热点”， 霍乱活动已经确定：一个在乍得湖地区，另一个在五大湖地区， 以刚果民主共和国的戈马为中心。世卫组织全球霍乱控制工作队最近制定了一项 以三个战略轴心为基础的消灭霍乱的“全球路线图”： “通过在霍乱热点采取多部门干预措施预防疾病复发”。内 在这一路线图中，他们还重点关注了对国家级数据的需求， 在了解当地情况和传播模式的指导下采取干预措施。 戈马人口超过100万（包括大量难民人口），位于北方， 基伍湖的海岸，与卢旺达接壤;这个城市至少在2000年有经常性的，每年的霍乱流行病。 在过去的十年中，与动态分析表明，持久性的“五大湖”的进化枝V。 霍乱O 1在该地区。我们建议对霍乱传播进行有针对性的多部门分析， 戈马，利用强有力的流行病学和流行病学动态技术，有两个主要目标：1）进一步扩大 我们对这种古老的病原体如何进化和适应新的地理区域和新的环境的理解， 2）为制定切实可行的、科学的霍乱防治计划提供数据 根据世卫组织全球工作队的建议，在这一区域霍乱热点地区开展霍乱控制工作。 实现这些目标的具体目标： ·具体目标1：研究霍乱疑似病例家庭内的霍乱传播和感染情况 在戈马; ·具体目标2：查明和评估霍乱的水生环境源/宿主; ·具体目标3。临床和环境霍乱弧菌O 1菌株的系统动力学分析。

Project Summary/Abstract Cholera is an ancient disease that has shown a remarkable ability to persist and spread in the modern world. In WHO data for 2016, 132,121 cholera cases and 2420 deaths were reported from 38 countries. However, taking into account likely underreporting, the global disease burden has been estimated to be in the range of 1.3 to 4.0 million cholera cases and 21,000-143,000 deaths per year. Cholera is frequently a disease of poverty, striking in areas with humanitarian emergencies and crumbling public health infrastructure: most recently, this has been highlighted by the massive epidemic in Yemen, with over a million cases reported to date. Given the intransigence of such problems, and ongoing issues with climate change, urbanization, and population growth, cholera is likely to remain a recurring global threat to public health. While the Indian subcontinent is the ancestral home of cholera, and epidemics may occur in crisis situations such as currently seen in Yemen, over the past two decades sub-Saharan Africa has emerged as the primary locus of the global cholera disease burden. Within Africa, two major regional inland “hotspots” of cholera activity have been identified: one in the Lake Chad region, and the other in the Great Lakes region, centered on Goma in the DRC. The WHO Global Task Force for Cholera Control has recently developed a “global roadmap” leading toward cholera eradication, based on three strategic axes: the second of these axes is “Prevention of disease reoccurrence by targeting multi-sectorial interventions in cholera hotspots.” Within this roadmap, they have also placed a strong focus on the need for country-level data, with targeting of interventions directed by an understanding of local circumstances and transmission patterns. Goma, with a population of over 1 million (including substantial refugee populations), is on the northern shore of Lake Kivu, bordering Rwanda; the city has had recurrent, annual cholera epidemics for at least the past decade, with phylodynamic analysis demonstrating the persistence of a “Great Lakes” clade of V. cholerae O1 in the region. We are proposing a targeted, multi-sectorial analysis of cholera transmission in Goma, utilizing robust epidemiologic and phylodynamic techniques, with two major goals: 1) to further expand our understanding of how this ancient pathogen evolves and adapts to new geographic areas and new populations; and 2) to provide data for development of a practical, scientifically-informed plan for cholera control in this regional cholera hotspot, building on recommendations of the WHO Global Task Force. Specific Aims to accomplish these objectives: • Specific Aim 1: Studies of cholera transmission and infection within households of suspected cholera cases in Goma; • Specific Aim 2: Identification and assessment of aquatic environmental sources/reservoirs for cholera; and • Specific Aim 3. Phylodynamic analysis of clinical and environmental V. cholerae O1 strains.