Search

Summary Background Cholera remains a persistent health problem in sub-Saharan Africa and worldwide. Cholera can be controlled through appropriate water and sanitation, or by oral cholera vaccination, which provides transient (∼3 years) protection, although vaccine supplies remain scarce. We aimed to map cholera burden in sub-Saharan Africa and assess how geographical targeting could lead to more efficient interventions. Methods We combined information on cholera incidence in sub-Saharan Africa (excluding Djibouti and Eritrea) from 2010 to 2016 from datasets from WHO, Médecins Sans Frontières, ProMED, ReliefWeb, ministries of health, and the scientific literature. We divided the study region into 20 km × 20 km grid cells and modelled annual cholera incidence in each grid cell assuming a Poisson process adjusted for covariates and spatially correlated random effects. We combined these findings with data on population distribution to estimate the number of people living in areas of high cholera incidence (>1 case per 1000 people per year). We further estimated the reduction in cholera incidence that could be achieved by targeting cholera prevention and control interventions at areas of high cholera incidence. Findings We included 279 datasets covering 2283 locations in our analyses. In sub-Saharan Africa (excluding Djibouti and Eritrea), a mean of 141 918 cholera cases (95% credible interval [CrI] 141 538–146 505) were reported per year. 4·0% (95% CrI 1·7–16·8) of districts, home to 87·2 million people (95% CrI 60·3 million to 118·9 million), have high cholera incidence. By focusing on the highest incidence districts first, effective targeted interventions could eliminate 50% of the region's cholera by covering 35·3 million people (95% CrI 26·3 million to 62·0 million), which is less than 4% of the total population. Interpretation Although cholera occurs throughout sub-Saharan Africa, its highest incidence is concentrated in a small proportion of the continent. Prioritising high-risk areas could substantially increase the efficiency of cholera control programmes. Funding The Bill & Melinda Gates Foundation.

International audience

BACKGROUND: Killed whole-cell oral cholera vaccines (kOCVs) are becoming a standard cholera control and prevention tool. However, vaccine efficacy and direct effectiveness estimates have varied, with differences in study design, location, follow-up duration, and vaccine composition posing challenges for public health decision making. We did a systematic review and meta-analysis to generate average estimates of kOCV efficacy and direct effectiveness from the available literature. METHODS: For this systematic review and meta-analysis, we searched PubMed, Embase, Scopus, and the Cochrane Review Library on July 9, 2016, and ISI Web of Science on July 11, 2016, for randomised controlled trials and observational studies that reported estimates of direct protection against medically attended confirmed cholera conferred by kOCVs. We included studies published on any date in English, Spanish, French, or Chinese. We extracted from the published reports the primary efficacy and effectiveness estimates from each study and also estimates according to number of vaccine doses, duration, and age group. The main study outcome was average efficacy and direct effectiveness of two kOCV doses, which we estimated with random-effect models. This study is registered with PROSPERO, number CRD42016048232. FINDINGS: Seven trials (with 695 patients with cholera) and six observational studies (217 patients with cholera) met the inclusion criteria, with an average two-dose efficacy of 58% (95% CI 42-69, I2=58%) and effectiveness of 76% (62-85, I2=0). Average two-dose efficacy in children younger than 5 years (30% [95% CI 15-42], I2=0%) was lower than in those 5 years or older (64% [58-70], I2=0%; p

Introduction: Despite some improvement in provision of safe drinking water, proper sanitation and hygiene promotion, cholera still remains a major public health problem in Malawi with outbreaks occurring almost every year since 1998. In response to 2014/2015 cholera outbreak, ministry of health and partners made a decision to assess the feasibility and acceptability of conducting a mass oral cholera vaccine (OCV) as an additional public health measure. This paper highlights the burden of the 2014/15 cholera outbreak, successes and challenges of OCV campaign conducted in March and April 2015. Methods: This was a documentation of the first OCV campaign conducted in Malawi. The campaign targeted over 160,000 people aged one year or more living in 19 camps of people internally displaced by floods and their surrounding communities in Nsanje district. It was a reactive campaign as additional measure to improved water, sanitation and hygiene in response to the laboratory confirmed cholera outbreak. Results: During the first round of the OCV campaign conducted from 30 March to 4 April 2015, a total of 156,592 (97.6%) people out of 160,482 target population received OCV. During the second round (20 to 25 April 2015), a total of 137,629 (85.8%) people received OCV. Of these, 108,247 (67.6%) people received their second dose while 29,382 (18.3%) were their first dose. Of the 134,836 people with known gender and sex who received 1 or 2 doses, 54.4% were females and over half (55.4%) were children under the age of 15 years. Among 108,237 people who received 2 doses (fully immunized), 54.4% were females and 51.9% were children under 15 years of age. No severe adverse event following immunization was reported. The main reason for non-vaccination or failure to take the 2 doses was absence during the period of the campaign. Conclusion: This documentation has demonstrated that it was feasible, acceptable by the community to conduct a largescale mass OCV campaign in Malawi within five weeks. Of 320,000 OCV doses received, Malawi managed to administer at least 294,221 (91.9%) of the doses. OCV could therefore be considered to be introduced as additional measure in cholera hot spot areas in Malawi. Pan African Medical Journal 2016; 23

From the definition of a new paradigm expressing that any system can be defined as a combination Spaces - Processes the proposed work defines a new system modelling aiming to preserve a purely systemic approach since the identification of concepts down to the model. This paradigm basically expressing that a system can be seen through the behaviour of various properties of its entities; a system being a space containing all the conditions and the necessary means in completion of processes. The dissertation proposes an unified representation of properties allowing their abstract and semantic manipulation. A particular structure of dynamics of systems will be then proposed. This structure based on regular expressions as an ordered set of symbols representatives of properties of systems. The dissertation will show how to use these particular forms to simply and usefully describe systems behavior. The dissertation will show how to manipulate these items and which properties get out of it. The first aim of this work being an application in risks management, operation of the model to find out and to identify dangerous situations but also the capability in evaluating occurrence criteria will be assumed.; A partir de la définition d'un paradigme espaces - processus énonçant que tout système peut se définir comme une combinaison espaces - processus, les espaces contenant toutes les conditions et moyens nécessaires à l'achèvement du processus, le travail proposé définit une approche modélisatrice permettant de conserver une démarche purement systémique depuis l'identification des concepts du système jusqu'au modèle de représentation. Ce paradigme exprimant simplement qu'un système peut être vu à travers le comportement des différentes propriétés des entités intervenantes, le mémoire va proposer une représentation unifiée de la propriété permettant la manipulation conceptuelle et sémantique. Une forme de représentation des comportements des propriétés sera ensuite proposée. Cette représentation sera définie à partir de l'expression d'un comportement sous forme d'expressions rationnelles; ces expressions étant elles-mêmes des suites de symboles représentatives des propriétés du système observé. Le mémoire montrera comment la forme de représentation proposée permet de retranscrire et d'exploiter simplement les comportements observés ou observables. Le mémoire montrera comment manipuler ces éléments et quelles propriétés s'en dégagent. En particulier, le premier objectif de ce travail est une application à la maîtrise des risques systèmes, on exploitera donc le modèle dans la recherche et l'identification de situations dangereuses mais aussi pour la capacité d'évaluation des critères d'occurrence par un transfert de l'espace de propriétés vers un espace de probabilités.

From the definition of a new paradigm expressing that any system can be defined as a combination Spaces - Processes the proposed work defines a new system modelling aiming to preserve a purely systemic approach since the identification of concepts down to the model. This paradigm basically expressing that a system can be seen through the behaviour of various properties of its entities; a system being a space containing all the conditions and the necessary means in completion of processes. The dissertation proposes an unified representation of properties allowing their abstract and semantic manipulation. A particular structure of dynamics of systems will be then proposed. This structure based on regular expressions as an ordered set of symbols representatives of properties of systems. The dissertation will show how to use these particular forms to simply and usefully describe systems behavior. The dissertation will show how to manipulate these items and which properties get out of it. The first aim of this work being an application in risks management, operation of the model to find out and to identify dangerous situations but also the capability in evaluating occurrence criteria will be assumed.; A partir de la définition d'un paradigme espaces - processus énonçant que tout système peut se définir comme une combinaison espaces - processus, les espaces contenant toutes les conditions et moyens nécessaires à l'achèvement du processus, le travail proposé définit une approche modélisatrice permettant de conserver une démarche purement systémique depuis l'identification des concepts du système jusqu'au modèle de représentation. Ce paradigme exprimant simplement qu'un système peut être vu à travers le comportement des différentes propriétés des entités intervenantes, le mémoire va proposer une représentation unifiée de la propriété permettant la manipulation conceptuelle et sémantique. Une forme de représentation des comportements des propriétés sera ensuite proposée. Cette représentation sera définie à partir de l'expression d'un comportement sous forme d'expressions rationnelles; ces expressions étant elles-mêmes des suites de symboles représentatives des propriétés du système observé. Le mémoire montrera comment la forme de représentation proposée permet de retranscrire et d'exploiter simplement les comportements observés ou observables. Le mémoire montrera comment manipuler ces éléments et quelles propriétés s'en dégagent. En particulier, le premier objectif de ce travail est une application à la maîtrise des risques systèmes, on exploitera donc le modèle dans la recherche et l'identification de situations dangereuses mais aussi pour la capacité d'évaluation des critères d'occurrence par un transfert de l'espace de propriétés vers un espace de probabilités.

International audience