Suchergebnisse

Mathematical models of cholera dynamics can not only help in identifying environmental drivers and processes that influence disease transmission, but may also represent valuable tools for the prediction of the epidemiological patterns in time and space as well as for the allocation of health care resources. Cholera outbreaks have been reported in the Democratic Republic of the Congo since the 1970s. They have been ravaging the shore of Lake Kivu in the east of the country repeatedly during the last decades. Here we employ a spatially explicit, inhomogeneous Markov chain model to describe cholera incidence in eight health zones on the shore of the lake. Remotely sensed data sets of chlorophyll a concentration in the lake, precipitation and indices of global climate anomalies are used as environmental drivers in addition to baseline seasonality. The effect of human mobility is also modelled mechanistically. We test several models on a multiyear data set of reported cholera cases. The best fourteen models, accounting for different environmental drivers, and selected using the Akaike information criterion, are formally compared via proper cross validation. Among these, the one accounting for seasonality, El Niño Southern Oscillation, precipitation and human mobility outperforms the others in cross validation. Some drivers (such as human mobility and rainfall) are retained only by a few models, possibly indicating that the mechanisms through which they influence cholera dynamics in the area will have to be investigated further. Key Points Markov chain model of cholera dynamics in the Lake Kivu area (DRC) Global climate anomalies are the main drivers, together with rainfall The influence of mobility and remotely sensed chlorophyll a were also tested

Targeted interventions have been delivered to neighbors of cholera cases in major epidemic responses globally despite limited evidence for the impact of such targeting. Using data from urban epidemics in Chad and Democratic Republic of the Congo, we estimate the extent of spatiotemporal zones of increased cholera risk around cases. In both cities, we found zones of increased risk of at least 200 meters during the 5 days immediately after case presentation to a clinic. Risk was highest for those living closest to cases and diminished in time and space similarly across settings. These results provide a rational basis for rapidly delivering targeting interventions.