Service d'Ecologie et Contrôle des Maladies Infectieuses, Département des Sciences de Base, Faculté de Médecine, Université de Kinshasa, Kinshasa, Democratic Republic of the Congo.
Département de Sciences Et Gestion de L'environnement, Faculté Des Sciences, Université de Liège, Arlon, Belgium.
BMC Infect Dis. 2021 Dec 19;21(1):1261. doi: 10.1186/s12879-021-06986-9.
Cholera outbreaks in western Democratic Republic of the Congo (DRC) are thought to be primarily the result of westward spread of cases from the Great Lakes Region. However, other patterns of spatial spread in this part of the country should not be excluded. The aim of this study was to explore alternative routes of spatial spread in western DRC.
A literature review was conducted to reconstruct major outbreak expansions of cholera in western DRC since its introduction in 1973. We also collected data on cholera cases reported at the health zone (HZ) scale by the national surveillance system during 2000-2018. Based on data from routine disease surveillance, we identified two subperiods (week 45, 2012-week 42, 2013 and week 40, 2017-week 52, 2018) for which the retrospective space-time permutation scan statistic was implemented to detect spatiotemporal clusters of cholera cases and then to infer the spread patterns in western DRC other than that described in the literature.
Beyond westward and cross-border spread in the West Congo Basin from the Great Lakes Region, other dynamics of cholera epidemic propagation were observed from neighboring countries, such as Angola, to non-endemic provinces of southwestern DRC. Space-time clustering analyses sequentially detected clusters of cholera cases from southwestern DRC to the northern provinces, demonstrating a downstream-to-upstream spread along the Congo River.
The spread of cholera in western DRC is not one-sided. There are other patterns of spatial spread, including a propagation from downstream to upstream areas along the Congo River, to be considered as preferential trajectories of cholera in western DRC.
据认为，刚果民主共和国（DRC）西部的霍乱疫情主要是由于病例从大湖地区向西蔓延造成的。然而，该国其他地区的空间传播模式也不应被排除。本研究旨在探索刚果民主共和国西部其他可能的空间传播途径。
对 1973 年以来刚果民主共和国西部霍乱的主要暴发扩展进行文献回顾。我们还收集了 2000-2018 年期间国家监测系统在卫生区（HZ）层面报告的霍乱病例数据。根据常规疾病监测数据，我们确定了两个子时段（2012 年第 45 周-2013 年第 42 周和 2017 年第 40 周-2018 年第 52 周），在此期间实施了回顾性时空置换扫描统计，以检测霍乱病例的时空聚集，并推断刚果民主共和国西部除文献中所述之外的传播模式。
除了从大湖地区向西和跨境传播到西刚果盆地外，从邻国安哥拉等国也观察到了霍乱疫情传播的其他动态，传播到刚果民主共和国西南部的非流行省份。时空聚类分析依次检测到来自刚果民主共和国西南部到北部省份的霍乱病例集群，表明沿着刚果河呈下游到上游的传播。
刚果民主共和国西部的霍乱传播不是单方面的。还有其他空间传播模式，包括沿着刚果河从下游到上游地区的传播，这被认为是刚果民主共和国西部霍乱的优先传播轨迹。
