Cholera in Goma, DRC

项目摘要/摘要 霍乱是一种古老的疾病，在现代社会中表现出非凡的持续和传播能力。 世界。在世卫组织2016年的数据中，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，全球疾病负担估计在 每年有130至400万霍乱病例和21,000至143,000人死亡。霍乱常常是一种疾病 贫困，在人道主义紧急情况和公共卫生基础设施摇摇欲坠的地区肆虐：大多数 最近，也门的大规模流行病突显了这一点，据报告有100多万病例。 约会。鉴于这些问题的顽固不化，以及与气候变化、城市化和 随着人口的增长，霍乱很可能仍然是一个反复出现的对公共卫生的全球威胁。 而印度次大陆是霍乱的发源地，疫情可能在危机中发生 在过去的二十年里，像也门目前这样的情况，撒哈拉以南非洲地区出现了 全球霍乱疾病负担的主要源头。在非洲，两个主要的地区性内陆“热点” 已确定霍乱活动：一起在乍得湖地区，另一起在大湖区， 以刚果民主共和国境内的戈马为中心。世卫组织霍乱控制全球工作组最近开发了一种 “全球路线图”，以三个战略轴心为基础走向消灭霍乱：这些轴心中的第二个 《通过针对霍乱热点地区的多部门干预措施预防疾病复发》。在 在这份路线图中，他们还将重点放在对国家一级数据的需求上，目标是 通过了解当地情况和传播模式来指导干预措施。 戈马有100多万人口(包括大量难民)，位于北部 基伍湖畔，与卢旺达接壤；该市至少在 在过去的十年里，系统动力学分析表明，V。 该地区有O1群霍乱弧菌。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系统动力学技术，有两个主要目标：1)进一步扩大 我们对这种古老病原体如何进化和适应新的地理区域和新的 2)为制定切实可行的、有科学依据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进行控制。 实现这些目标的具体目标： ·具体目标1：霍乱疑似病例家庭内霍乱传播和感染研究 在戈马； ·具体目标2：确定和评估霍乱的水环境来源/水库； ·具体目标3.临床和环境O1霍乱弧菌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.