Perez-Saez Javier, Zheng Qulu, Kaminsky Joshua, Zou Kaiyue, Demby Maya N, Alam Christina, Landau Daniel, DePencier Rachel, Langa Jose Paulo M, Chilengi Roma, Welo Okitayemba Placide, Bwire Godfrey, Esso Linda, Ngomba Armelle Viviane, Fouda Mbarga Nicole, Okunga Emmanuel Wandera, Yennan Sebastian, Kapaya Fred, Ohize Stephen Ogirima, Seriki Adive Joseph, Hegde Sonia T, Sikder Mustafa, Lessler Justin, Datta Abhirup, Azman Andrew S, Lee Elizabeth C
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Center for Emerging Viral Diseases, Geneva University Hospitals and University of Geneva, Geneva, Switzerland.
Nat Med. 2025 Aug 7. doi: 10.1038/s41591-025-03847-9.
Cholera outbreaks cause substantial morbidity and mortality in Africa, yet changes in the geographic distribution of cholera burden over time remain uncharacterized. We used surveillance data and spatial statistical models to estimate the mean annual incidence of reported suspected cholera for 2011-2015 and 2016-2020 on a 20-km grid across Africa. Across 43 countries, mean annual incidence rates remained at 11 cases per 100,000 population, with 125,701 cases estimated annually (95% credible interval (CrI): 124,737-126,717) from 2016 to 2020. Cholera incidence shifted from western to eastern Africa. There were 296 million people (95% CrI: 282-312 million) in high-incidence second-level administrative (ADM2) units (≥10 cases per 100,000 per year) in 2020, 135 million of whom experienced low incidence (<1 per 100,000) in 2011-2015. ADM2 units with high incidence in central and eastern Africa from 2011 to 2020 were more likely to report cholera in 2022-2023. In hypothetical scenarios of preventive disease control planning, targeting the 100 million highest-burden populations had potential to reach up to 63% of 2016-2020 mean annual cases but only 37% when targeting by past incidence. This retrospective analysis highlights spatiotemporal instability in cholera burden and can be used as a benchmark for tracking future progress in disease control.
霍乱疫情在非洲造成了大量发病和死亡，但霍乱负担的地理分布随时间的变化仍未得到描述。我们使用监测数据和空间统计模型，以20公里的网格估算了2011 - 2015年和2016 - 2020年非洲各地报告的疑似霍乱的年平均发病率。在43个国家中，年平均发病率保持在每10万人11例，2016年至2020年每年估计有125,701例（95%可信区间（CrI）：124,737 - 126,717）。霍乱发病率从非洲西部转移到了东部。2020年，在高发病率的二级行政区（ADM2）单位（每年每10万人≥10例）中有2.96亿人（95% CrI：2.82 - 3.12亿），其中1.35亿人在2011 - 2015年经历过低发病率（每10万人<1例）。2011年至2020年在中非和东非高发病率的ADM2单位在2022 - 2023年更有可能报告霍乱。在预防性疾病控制规划的假设情景中，针对负担最重的1亿人口有可能达到2016 - 2020年年平均病例数的63%，但按过去的发病率进行目标设定时仅能达到37%。这项回顾性分析突出了霍乱负担的时空不稳定性，可作为跟踪未来疾病控制进展的基准。
