Maluda Marilyn Charlene Montini, Johnson Emilia, Robinson Fredie, Jikal Muhammad, Fong Siat Yee, Saffree Mohammad Jeffree, Fornace Kimberly M, Ahmed Kamruddin
Department of Public Health Medicine, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia.
Sabah State Health Department, Ministry of Health Malaysia, Kota Kinabalu, Sabah, Malaysia.
PLOS Glob Public Health. 2024 Jan 30;4(1):e0002861. doi: 10.1371/journal.pgph.0002861. eCollection 2024.
Vibrio cholerae remains a notable public health challenge across Malaysia. Although the Malaysian state of Sabah is considered a cholera-affected area, gaps remain in understanding the epidemiological trends and spatial distribution of outbreaks. Therefore, to determine longitudinal and spatial trends in cholera cases data were obtained from the Sabah State Health Department for all notified cases of cholera between 2005-2020. A cholera outbreak is defined as one or more confirmed cases in a single locality with the evidence of local transmission. All records were geolocated to village level. Satellite-derived data and generalised linearized models were used to assess potential risk factors, including population density, elevation, and distance to the sea. Spatiotemporal clustering of reported cholera cases and zones of increased cholera risk were evaluated using the tau statistic (τ) at 550m, 5km and 10km distances. Over a 15-year period between 2005-2020, 2865 cholera cases were recorded in Sabah, with a mean incidence rate of 5.6 cases per 100,000 (95% CI: 3.4-7.9). From 2015-2020, 705 symptomatic cases and 727 asymptomatic cases were reported. Symptomatic cases primarily occurred in local Malaysian populations (62.6%, 441/705) and in children and adolescents under 15-years old (49.4%, 348/705). On average, cases were reported in areas with low population density (19.45 persons/km2), low elevations (19.45m) and near coastal areas. Spatiotemporal clustering of cholera cases was identified up to 3.5km, with increased village-level cholera risk within 500m and 5 days of initial case presentation to a health facility (Risk Ratio = 9.7, 95% CI: 7.5-12.4). Cholera incidence has high spatial and temporal heterogeneity within Sabah, with some districts experiencing repeated outbreaks. Cholera cases clustered across space and time, with village-level risk of cholera highest within 5 days and within close proximity to primary case villages, suggesting local transmission.
霍乱弧菌仍是马来西亚面临的一项重大公共卫生挑战。尽管马来西亚沙巴州被视为霍乱疫区，但在了解疫情的流行病学趋势和空间分布方面仍存在差距。因此，为了确定霍乱病例的纵向和空间趋势，我们从沙巴州卫生部获取了2005年至2020年期间所有通报的霍乱病例数据。霍乱疫情被定义为在一个地点出现一例或多例确诊病例并有本地传播的证据。所有记录均定位到村庄级别。利用卫星衍生数据和广义线性模型评估潜在风险因素，包括人口密度、海拔高度和距海距离。使用tau统计量（τ）在550米、5公里和10公里的距离上评估报告的霍乱病例的时空聚集情况以及霍乱风险增加的区域。在2005年至2020年的15年期间，沙巴州共记录了2865例霍乱病例，平均发病率为每10万人5.6例（95%置信区间：3.4 - 7.9）。2015年至2020年期间，报告了705例有症状病例和727例无症状病例。有症状病例主要发生在马来西亚当地人群中（62.6%，441/705）以及15岁以下的儿童和青少年中（49.4%，348/705）。平均而言，病例报告发生在人口密度低（每平方公里19.45人）、海拔低（19.45米）且靠近沿海地区的区域。霍乱病例的时空聚集在3.5公里范围内被识别出来，在最初病例向医疗机构报告后的500米范围内和5天内村庄层面的霍乱风险增加（风险比 = 9.7，95%置信区间：7.5 - 12.4）。沙巴州内霍乱发病率具有高度的空间和时间异质性，一些地区经历了反复疫情。霍乱病例在时空上聚集，在5天内以及靠近首例病例村庄的范围内村庄层面的霍乱风险最高，表明存在本地传播。
