Diseases Surveillance and Response Directorate, Ethiopia Public Health Institute, Addis Ababa, Ethiopia.
Clinical, Assessment, Regulatory, Evaluation (CARE) Unit, International Vaccine Institute, Seoul, Republic of Korea.
Clin Infect Dis. 2024 Jul 12;79(Supplement_1):S8-S19. doi: 10.1093/cid/ciae236.
The Ethiopian government has developed the multisectoral cholera elimination plan (NCP) with an aim of reducing cholera incidence and case fatality rate (CFR). To better understand and monitor the progress of this plan, a comprehensive review of national cholera epidemiology is needed.
Reported data on cholera/acute watery diarrhea (AWD) cases in the past 20 years were extracted from the Ethiopian Public Health Institute and World Health Organization databases. Descriptive statistics, Pearson χ2, and logistic regression analyses were conducted.
From January 2001 to November 2023, a total of 215 205 cholera/AWD cases, 2355 deaths with a cumulative CFR of 1.10% (95% confidence interval [CI], 1.092-1.095), and a mean annual incidence rate of 8.9/100 000 (95% CI, 6.5-11.3) were reported. Two major upsurges of cholera epidemics were found in the last two decades with mean attack rate (AR) of 20.57/100 000 in 2006-2010 and 14.83/100 000 in 2016-2020. Another resurgence of outbreaks occured in 2021-2023 (mean AR, 8.63/100 000). In 2015-2023, 54.0% (53 990/99 945) of cases were aged 15-44 years. National cholera CFR (3.13% [95% CI: 2.1-4.5]) was the highest in 2022. The 2015-2023 cumulative cholera CFR was different across regions: Benishangul Gumuz (6.07%), Gambela (1.89%), Sidama (1.42%), Southern Nation, Nationalities, and Peoples' (1.34%), Oromia (1.10%), and Amhara (1.09%). Cholera/AWD patients in older adults (≥45 years), severe dehydration, peak rainy season (June-August), and outpatients were associated with higher risk of death.
Cholera has been a public health problem in Ethiopia with case fatalities still above the global target. Case management needs to be improved particularly in outpatients and older populations. Outbreak preparedness should be rolled out well in advance of the typical rainy seasons. Significant investments are essential to advance the cholera surveillance system at healthcare setting and community level. Underlying factors of cholera deaths per areas should be further investigated to guide appropriate interventions to meet the NCP target by 2028.
埃塞俄比亚政府制定了多部门霍乱消除计划（NCP），旨在降低霍乱发病率和病死率（CFR）。为了更好地了解和监测该计划的进展情况，需要对国家霍乱流行病学进行全面审查。
从埃塞俄比亚公共卫生研究所和世界卫生组织数据库中提取了过去 20 年霍乱/急性水样腹泻（AWD）病例的报告数据。采用描述性统计、Pearson χ2 和逻辑回归分析。
从 2001 年 1 月至 2023 年 11 月，共报告了 215205 例霍乱/AWD 病例、2355 例死亡，累积 CFR 为 1.10%（95%置信区间[CI]，1.092-1.095），平均年发病率为 8.9/100000（95%CI，6.5-11.3）。在过去的二十年中，发现了两次主要的霍乱疫情高峰，2006-2010 年的平均攻击率（AR）为 20.57/100000，2016-2020 年的平均攻击率为 14.83/100000。2021-2023 年又出现了一次疫情爆发（平均 AR，8.63/100000）。2015-2023 年，54.0%（53990/99945）的病例年龄在 15-44 岁之间。国家霍乱 CFR（3.13%[95%CI：2.1-4.5]）在 2022 年最高。2015-2023 年期间，各地区的霍乱累积 CFR 不同：本尚古勒-古马兹（Benishangul Gumuz）（6.07%）、甘贝拉（Gambela）（1.89%）、锡达马（Sidama）（1.42%）、南方各族州（Southern Nation, Nationalities, and Peoples'）（1.34%）、奥罗米亚（Oromia）（1.10%）和阿姆哈拉（Amhara）（1.09%）。年龄较大的成年人（≥45 岁）、严重脱水、雨季高峰（6 月至 8 月）和门诊患者的霍乱/AWD 患者死亡风险更高。
霍乱一直是埃塞俄比亚的一个公共卫生问题，病死率仍高于全球目标。需要改进病例管理，特别是在门诊和老年人群中。应在典型雨季前提前做好疫情准备。为了推进医疗保健机构和社区层面的霍乱监测系统，需要进行重大投资。应进一步调查霍乱死亡的地区相关因素，以指导采取适当干预措施，实现 2028 年 NCP 目标。
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