Mbewe Nyuma, Tembo John, Kasonde Mpanga, Mwangilwa Kelvin, Zulu Paul Msanzya, Sereki Joseph Adive, Ngosa William, Lishipmi Kennedy, Mulenga Lloyd, Chilengi Roma, Kapata Nathan, Grobusch Martin Peter
National Cholera Elimination Taskforce, Zambia National Public Health Institute, Lusaka, Zambia.
HERPEZ Zambia - Institute for Infectious Disease Research, Lusaka, Zambia.
PLoS Negl Trop Dis. 2025 Jun 23;19(6):e0012422. doi: 10.1371/journal.pntd.0012422. eCollection 2025 Jun.
Cholera outbreaks are increasing in frequency and severity, particularly in Sub-Saharan Africa. Zambia, committed to ending cholera by 2025, instead experienced its most significant outbreak in 2024. This review examines the perceived regression in elimination efforts by addressing two questions: (i) What is known about cholera in Zambia? and (ii) What are the main suggested mechanisms and strategies to further elimination efforts in the region?.
METHODOLOGY/PRINCIPAL FINDINGS: A scoping literature search was conducted in PUBMED to identify relevant qualitative and quantitative research studies published between 1st January 2013 and 30th June 2024 using the search terms 'cholera' and 'Zambia'. We identified 53 relevant publications. With the increasing influence of climate change, population growth, and rural-urban migration, further increases in outbreak frequency and magnitude are expected. Risk factors for recurrent outbreaks, including poor access to water, sanitation, and hygiene (WASH) services in unplanned urban settlements and rural fishing villages, continue to derail elimination efforts. Interventions are best planned at a decentralised, community-centric approach to prevent elimination and reintroduction at the district level. Pre-emptive vaccination campaigns before the rainy season and climate-resilient WASH infrastructure in cholera hotspots are also recommended.
CONCLUSIONS/SIGNIFICANCE: The goal to eliminate cholera by 2025 was unrealistic, as evidence points to the disease becoming endemic. Our findings confirm the need to align health and WASH investments with the Global Roadmap to Cholera Elimination by 2030 through a climate-focused lens. Recommendations for cholera elimination, including improved access to safe drinking water and sanitation, remain elusive in many low-income settings like Zambia. Patient-level information on survival and transmissibility is lacking. New research tailored to country-level solutions and enhancing community participation is urgently required. Insights from this review will be integrated into the next iteration of the National Cholera Control Plan and could apply to other countries with similar settings.
霍乱疫情的发生频率和严重程度正在上升，特别是在撒哈拉以南非洲地区。赞比亚致力于在2025年前消灭霍乱，但在2024年却经历了最严重的疫情爆发。本综述通过解决两个问题来审视在消除霍乱努力方面所察觉到的倒退：（i）关于赞比亚的霍乱情况已知哪些信息？（ii）进一步推动该地区消除霍乱努力的主要建议机制和策略有哪些？
方法/主要发现：在PUBMED中进行了范围界定文献检索，以使用搜索词“霍乱”和“赞比亚”来识别2013年1月1日至2024年6月30日期间发表的相关定性和定量研究。我们识别出了五十三篇相关出版物。随着气候变化、人口增长和城乡迁移的影响不断增加，预计疫情爆发的频率和规模将进一步上升。反复爆发的风险因素，包括在无规划的城市住区和农村渔村难以获得水、环境卫生和个人卫生（WASH）服务，继续阻碍消除努力。干预措施最好以分散的、以社区为中心的方式进行规划，以防止在地区层面出现消除失败和疾病重新引入的情况。还建议在雨季前开展预防性疫苗接种运动，并在霍乱热点地区建设具有气候适应能力的WASH基础设施。
结论/意义：到2025年消除霍乱的目标不切实际，因为有证据表明该疾病正成为地方病。我们的研究结果证实，需要通过以气候为重点的视角，使卫生和WASH投资与《2030年全球霍乱消除路线图》保持一致。在赞比亚等许多低收入环境中，关于改善安全饮用水和环境卫生的霍乱消除建议仍然难以实现。缺乏关于患者层面生存和传播性的信息。迫切需要针对国家层面解决方案并加强社区参与的新研究。本综述的见解将被纳入国家霍乱控制计划的下一版本，并可能适用于其他具有类似情况的国家。
