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- Title
Spatio-Temporal Dynamics of Cholera during the First Year of the Epidemic in Haiti.
- Authors
Gaudart, Jean; Rebaudet, Stanislas; Barrais, Robert; Boncy, Jacques; Faucher, Benoit; Piarroux, Martine; Magloire, Roc; Thimothe, Gabriel; Piarroux, Renaud
- Abstract
Background: In October 2010, cholera importation in Haiti triggered an epidemic that rapidly proved to be the world's largest epidemic of the seventh cholera pandemic. To establish effective control and elimination policies, strategies rely on the analysis of cholera dynamics. In this report, we describe the spatio-temporal dynamics of cholera and the associated environmental factors. Methodology/Principal findings: Cholera-associated morbidity and mortality data were prospectively collected at the commune level according to the World Health Organization standard definition. Attack and mortality rates were estimated and mapped to assess epidemic clusters and trends. The relationships between environmental factors were assessed at the commune level using multivariate analysis. The global attack and mortality rates were 488.9 cases/10,000 inhabitants and 6.24 deaths/10,000 inhabitants, respectively. Attack rates displayed a significantly high level of spatial heterogeneity (varying from 64.7 to 3070.9 per 10,000 inhabitants), thereby suggesting disparate outbreak processes. The epidemic course exhibited two principal outbreaks. The first outbreak (October 16, 2010–January 30, 2011) displayed a centrifugal spread of a damping wave that suddenly emerged from Mirebalais. The second outbreak began at the end of May 2011, concomitant with the onset of the rainy season, and displayed a highly fragmented epidemic pattern. Environmental factors (river and rice fields: p<0.003) played a role in disease dynamics exclusively during the early phases of the epidemic. Conclusion: Our findings demonstrate that the epidemic is still evolving, with a changing transmission pattern as time passes. Such an evolution could have hardly been anticipated, especially in a country struck by cholera for the first time. These results argue for the need for control measures involving intense efforts in rapid and exhaustive case tracking. Author Summary: Cholera is the prototypical "waterborne" disease that can provoke deadly acute watery diarrhea epidemics in settings deprived of clean water and proper sanitation. In spite chronic deprivation, Haiti had been spared cholera for a century until the vibrio was imported in October 2010, which triggered the largest national epidemic ever recorded. To better understand the progression of the epidemic and adapt control measures, we describe and analyze the spatio-temporal dynamics and underlying factors associated with the first year of this cholera epidemic in Haiti. Attack rates reached highly heterogeneous levels between communes (from 64.7 to 3070.9 cases per 10,000 inhabitants), thereby suggesting disparate outbreak processes. While the first principal outbreak spread centrifugally like a damping wave that suddenly emerged from Mirebalais and Lower Artibonite, a second principal outbreak erupted at the end of May 2011, concomitant with the rainy season, and displayed a highly fragmented epidemic pattern. Environmental factors, such as rivers and rice fields, appeared to play a role in disease dynamics exclusively during the beginning of the epidemic. The dynamics of the cholera epidemic varied from place to place as time passed, following no clearly predictable scheme. Therefore, cholera control measures in Haiti should include rapid and exhaustive case tracking.
- Subjects
HAITI; CHOLERA; WORLD Health Organization; EPIDEMICS; PADDY fields; RICE diseases &; pests; DEATH rate; MULTIVARIATE analysis; SANITATION
- Publication
PLoS Neglected Tropical Diseases, 2013, Vol 7, Issue 4, p1
- ISSN
1935-2727
- Publication type
Article
- DOI
10.1371/journal.pntd.0002145