Direction de la Lutte contre les Maladies, Ministère de la Santé Publique, Kinshasa-Gombe, République Démocratique du Congo.
PLoS Negl Trop Dis. 2009;3(5):e436. doi: 10.1371/journal.pntd.0000436. Epub 2009 May 19.
During the last eight years, North and South Kivu, located in a lake area in Eastern Democratic Republic of Congo, have been the site of a major volcano eruption and of numerous complex emergencies with population displacements. These conditions have been suspected to favour emergence and spread of cholera epidemics.
METHODOLOGY/PRINCIPAL FINDINGS: In order to assess the influence of these conditions on outbreaks, reports of cholera cases were collected weekly from each health district of North Kivu (4,667,699 inhabitants) and South Kivu (4,670,121 inhabitants) from 2000 through 2007. A geographic information system was established, and in each health district, the relationships between environmental variables and the number of cholera cases were assessed using regression techniques and time series analysis. We further checked for a link between complex emergencies and cholera outbreaks. Finally, we analysed data collected during an epidemiological survey that was implemented in Goma after Nyiragongo eruption. A total of 73,605 cases and 1,612 deaths of cholera were reported. Time series decomposition showed a greater number of cases during the rainy season in South Kivu but not in North Kivu. Spatial distribution of cholera cases exhibited a higher number of cases in health districts bordering lakes (Odds Ratio 7.0, Confidence Interval range 3.8-12.9). Four epidemic reactivations were observed in the 12-week periods following war events, but simulations indicate that the number of reactivations was not larger than that expected during any random selection of period with no war. Nyiragongo volcanic eruption was followed by a marked decrease of cholera incidence.
CONCLUSION/SIGNIFICANCE: Our study points out the crucial role of some towns located in lakeside areas in the persistence of cholera in Kivu. Even if complex emergencies were not systematically followed by cholera epidemics, some of them enabled cholera spreading.
在过去的八年中，位于刚果民主共和国东部湖区的南北基伍省一直是一场大规模火山爆发和多次人口流离失所的复杂紧急情况的所在地。这些情况可能有利于霍乱疫情的出现和传播。
方法/主要发现：为了评估这些情况对疫情爆发的影响，我们从 2000 年至 2007 年每周从北基伍省（4667699 人）和南基伍省（4670121 人）的每个卫生区收集霍乱病例报告。建立了一个地理信息系统，在每个卫生区，使用回归技术和时间序列分析评估环境变量与霍乱病例数量之间的关系。我们进一步检查了复杂紧急情况与霍乱疫情爆发之间的联系。最后，我们分析了在尼拉贡戈火山爆发后在戈马进行的流行病学调查中收集的数据。共报告了 73605 例霍乱病例和 1612 例死亡。时间序列分解表明，南基伍省雨季的病例数更多，但北基伍省则不然。霍乱病例的空间分布显示，与湖泊接壤的卫生区的病例数更多（优势比为 7.0，置信区间范围为 3.8-12.9）。在战争事件后的 12 周内观察到了四次疫情复发，但模拟表明，在没有战争的任何随机选择的时间段内，疫情复发的次数并不比预期的多。尼拉贡戈火山爆发后，霍乱发病率显著下降。
结论/意义：我们的研究指出了位于湖滨地区的一些城镇在基伍持续存在霍乱方面的关键作用。即使复杂的紧急情况没有系统地伴随着霍乱流行，其中一些情况还是促进了霍乱的传播。
