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Cholera is a contagious diarrhoeal disease affecting only human, caused by Vibrio cholerae, a gram-negative bacillus. The disease results in profuse watery diarrhoea sometimes accompanied by vomiting, occurring after a few hours or a few days after the ingestion of food or water soiled by V. cholerae. In the environment, Vibrio cholerae is found in brackish water of estuarine zones where it colonizes the surface of algae and copepods, persisting in the absence of men for prolonged periods of time. So is the situation in the estuarine zones of South-East Asia such as the Bay of Bengal where the disease is known since the highest antiquity. After having been relatively spared by the first six pandemics, continental Africa was stroke in 1970 by the spread of the 7th pandemic of cholera. Since this date, according to the World Health Organization (WHO), more than 90 % of the cases of cholera were reported by Sub-Saharan African countries. Among them, the Democratic Republic of Congo (DRC) is one of the most affected countries. In DRC, from 2000 to 2008, 208,875 cases and 7,335 deaths (case fatality rate: 3.51 %) of cholera were reported to WHO, that is to say about 15 % of the cases and 20 % of the deaths observed worldwide during the same period. These cholera cases were mostly notified in the provinces of the East of the DRC, next to the African Great Lakes area. After more than 30 years of fight against cholera in DRC, an epidemiological study of the dynamics of cholera was set up in this country in order to better understand the epidemic factors of recurrence and to perform adjustments for the operational approaches. The main results of this research work have highlighted that less than 10 % of the health zones, all bordering lakes located in the East of the DRC, play the role of sanctuary zones for cholera. These results have also highlighted the seasonal variations of cholera, with fewer cases during the dry season, and the specific role of the fishermen populations, tradesmen and traditional minors in the restarts and diffusion of cholera epidemics. It was also shown that the cholera is not endemic all over of the East of the DRC. Overall, functioning of cholera in this area of Africa is mostly unstable, with epidemic flare-ups followed by relatively prolonged phases of extinction; this behaviour of cholera and its epidemic flare-ups is therefore characterized by a metastable state. However, it was also shown that some areas, namely Kalemie and Goma areas, functioning until there on a metastable mode have now changed for some years for an endemic mode. On the basis of these results, the implementation of a project of fight against cholera was recommended which aims to eliminate this disease from the whole DRC. This plan will concentrate the fight on the seven identified sanctuaries zones, giving priority to drinking water supply among the ranges of existing means of fight. The first actions implemented on the pilot site of Kalemie have yet modified the dynamics of cholera in this area. Indeed during the phase of intensification of the water supply activities in Kalemie the number of suspected cholera cases dramatically decreased while microbiological tests showed that the few remaining diarrhoeas cases were due to bacteria other than Vibrio cholerae. The epidemiology of cholera, as we observed it in the African Great Lakes area is different from the one described in South-East Asia estuarine zone. Even if several questions remain unsolved, such as the role of the lakes as a reservoir of V. cholera strains, -18- the results of this work open a new hope on the revival of the fight against this neglected disease. ; Le choléra est une maladie diarrhéique contagieuse strictement humaine, causée par Vibrio cholerae, un bacille gram négatif. La maladie se traduit par une diarrhée acqueuse profuse parfois accompagnée de vomissements survenant quelques heures à quelques jours après l'ingestion d'eau ou d'aliments souillés par V. cholerae. Dans l'environnement, V. cholerae est retrouvé dans les eaux saumâtres des zones d'estuaire où il colonise la surface de certaines algues et de copépodes, pouvant ainsi persister en l'absence de l'homme pendant des périodes de temps prolongées. C'est le cas dans les zones estuariennes d'Asie du Sud-Est telle que la région du golfe du Bengale, où la maladie est connue depuis la plus haute antiquité. Après avoir été relativement épargnée par les six premières pandémies, l'Afrique continentale a été frappée par la 7ème pandémie en 1970. Depuis cette date, selon l'Organisation Mondiale de la Santé (OMS), plus de 90 % des cas de choléra sont rapportés par l'Afrique sub-saharienne. La République Démocratique du Congo (RDC) fait partie des pays les plus touchés. En RDC, de 2000 à 2008, 208 875 cas et 7 335 décès (létalité de 3,51%) dus au choléra ont été notifiés à l'OMS, soit 15 % des cas et 20 % des décès rapportés dans le monde pour la même période. Ces cas de choléra touchent essentiellement les provinces de l'est de la RDC, situées dans la région des grands lacs. Après plus de trente ans de lutte contre le choléra en RDC, une étude épidémiologique de la dynamique du choléra a été initiée dans ce pays dans le but de comprendre les facteurs de récurrence épidémique et de proposer des ajustements sur les approches opérationnelles. Les principaux résultats de ce travail de recherche ont permis de mettre en évidence qu'à peine 10 % des zones de santé, toutes situées à proximité des lacs de l'est de la RDC, jouent le rôle de zones sanctuaires pour le choléra. Ces résultats ont également permis de mettre en évidence la saisonnalité du choléra, avec moins de cas en saison sèche, et le rôle spécifique des populations de pêcheurs, de commerçants et de mineurs artisanaux dans l'émergence et la diffusion des épidémies de choléra. Il a également été démontré que le choléra n'est pas endémique dans toutes les régions de l'est de la RDC. Le fonctionnement du choléra dans cette région d'Afrique est globalement instable avec des flambées épidémiques suivies de phases d'extinction relativement prolongées, les flambées épidémiques se produisant selon un mode métastable lorsqu'on considère l'Est de la RDC dans son ensemble. Cependant, il a aussi été montré que certains foyers fonctionnant jusque-là sur un mode métastable sont, depuis quelques années, passés à un fonctionnement endémique. C'est le cas des foyers de Kalemie et de Goma. Sur la base de ces résultats, il a été recommandé la mise en place d'un projet de lutte contre le choléra avec pour objectif d'éliminer cette maladie de l'ensemble de la RDC. Ce plan vise à concentrer les efforts de lutte sur les sept foyers sanctuaires identifiés en privilégiant les apports en eau potable parmi l'éventail des moyens de lutte existant. Lorsque les premières actions ont été mises en oeuvre sur le site pilote de Kalemie, nous avons constaté une diminution importante de l'incidence du choléra, tandis que les examens microbiologiques ont confirmé que les quelques cas de diarrhée encore rapportés à Kalemie n'étaient plus dus à V. cholerae mais à d'autres bactéries. L'épidémiologie du choléra telle que nous l'observons dans la région des Grands Lacs africains est différente de celle décrite en zone estuarienne d'Asie du Sud-Est. Même si plusieurs questionnements subsistent concernant les modes de persistance du choléra dans les zones lacustres ou la pérennité du V. cholerae dans les eaux des lacs, les résultats de ce travail sont porteurs d'un nouvel espoir pour la relance de la lutte contre cette maladie négligée.

Cholera is a contagious diarrhoeal disease affecting only human, caused by Vibrio cholerae, a gram-negative bacillus. The disease results in profuse watery diarrhoea sometimes accompanied by vomiting, occurring after a few hours or a few days after the ingestion of food or water soiled by V. cholerae. In the environment, Vibrio cholerae is found in brackish water of estuarine zones where it colonizes the surface of algae and copepods, persisting in the absence of men for prolonged periods of time. So is the situation in the estuarine zones of South-East Asia such as the Bay of Bengal where the disease is known since the highest antiquity. After having been relatively spared by the first six pandemics, continental Africa was stroke in 1970 by the spread of the 7th pandemic of cholera. Since this date, according to the World Health Organization (WHO), more than 90 % of the cases of cholera were reported by Sub-Saharan African countries. Among them, the Democratic Republic of Congo (DRC) is one of the most affected countries. In DRC, from 2000 to 2008, 208,875 cases and 7,335 deaths (case fatality rate: 3.51 %) of cholera were reported to WHO, that is to say about 15 % of the cases and 20 % of the deaths observed worldwide during the same period. These cholera cases were mostly notified in the provinces of the East of the DRC, next to the African Great Lakes area. After more than 30 years of fight against cholera in DRC, an epidemiological study of the dynamics of cholera was set up in this country in order to better understand the epidemic factors of recurrence and to perform adjustments for the operational approaches. The main results of this research work have highlighted that less than 10 % of the health zones, all bordering lakes located in the East of the DRC, play the role of sanctuary zones for cholera. These results have also highlighted the seasonal variations of cholera, with fewer cases during the dry season, and the specific role of the fishermen populations, tradesmen and traditional minors in the ...

International audience ; Bacterial meningitis remains an international public health threat. The most affected area worldwide is the Sahelian region between Senegal and Ethiopia called the meningitis belt. In parallel recurrent epidemics have also occurred out of the belt in Africa for the last twenty years. While environmental, socioeconomic and demographic factors are well described to explain the epidemiology of meningitis in the belt, very few studies have focused on the role of these factors to understand meningitis epidemics outside of the belt. Based on epidemiological, socio-economic, demographic and environmental data collected for the period 2000-2018 in the Democratic Republic of Congo (DRC), we used different statistical methods to explore the links between meningitis cases and the different explored factors. Our results showed that urbanized areas where populations have a low economic index of well-being, high latitude and longitude eastwards, medium to low altitude level, savannah-type vegetation, medium temperature value, are risk factors of meningitis outbreaks from North to South in the DRC. This information is important to help improving meningitis control strategies in a large country located outside the so-called meningitis belt.

International audience ; Bacterial meningitis remains an international public health threat. The most affected area worldwide is the Sahelian region between Senegal and Ethiopia called the meningitis belt. In parallel recurrent epidemics have also occurred out of the belt in Africa for the last twenty years. While environmental, socioeconomic and demographic factors are well described to explain the epidemiology of meningitis in the belt, very few studies have focused on the role of these factors to understand meningitis epidemics outside of the belt. Based on epidemiological, socio-economic, demographic and environmental data collected for the period 2000-2018 in the Democratic Republic of Congo (DRC), we used different statistical methods to explore the links between meningitis cases and the different explored factors. Our results showed that urbanized areas where populations have a low economic index of well-being, high latitude and longitude eastwards, medium to low altitude level, savannah-type vegetation, medium temperature value, are risk factors of meningitis outbreaks from North to South in the DRC. This information is important to help improving meningitis control strategies in a large country located outside the so-called meningitis belt.

International audience ; Bacterial meningitis remains an international public health threat. The most affected area worldwide is the Sahelian region between Senegal and Ethiopia called the meningitis belt. In parallel recurrent epidemics have also occurred out of the belt in Africa for the last twenty years. While environmental, socioeconomic and demographic factors are well described to explain the epidemiology of meningitis in the belt, very few studies have focused on the role of these factors to understand meningitis epidemics outside of the belt. Based on epidemiological, socio-economic, demographic and environmental data collected for the period 2000-2018 in the Democratic Republic of Congo (DRC), we used different statistical methods to explore the links between meningitis cases and the different explored factors. Our results showed that urbanized areas where populations have a low economic index of well-being, high latitude and longitude eastwards, medium to low altitude level, savannah-type vegetation, medium temperature value, are risk factors of meningitis outbreaks from North to South in the DRC. This information is important to help improving meningitis control strategies in a large country located outside the so-called meningitis belt.

International audience ; Bacterial meningitis remains an international public health threat. The most affected area worldwide is the Sahelian region between Senegal and Ethiopia called the meningitis belt. In parallel recurrent epidemics have also occurred out of the belt in Africa for the last twenty years. While environmental, socioeconomic and demographic factors are well described to explain the epidemiology of meningitis in the belt, very few studies have focused on the role of these factors to understand meningitis epidemics outside of the belt. Based on epidemiological, socio-economic, demographic and environmental data collected for the period 2000-2018 in the Democratic Republic of Congo (DRC), we used different statistical methods to explore the links between meningitis cases and the different explored factors. Our results showed that urbanized areas where populations have a low economic index of well-being, high latitude and longitude eastwards, medium to low altitude level, savannah-type vegetation, medium temperature value, are risk factors of meningitis outbreaks from North to South in the DRC. This information is important to help improving meningitis control strategies in a large country located outside the so-called meningitis belt.

International audience ; Bacterial meningitis remains an international public health threat. The most affected area worldwide is the Sahelian region between Senegal and Ethiopia called the meningitis belt. In parallel recurrent epidemics have also occurred out of the belt in Africa for the last twenty years. While environmental, socioeconomic and demographic factors are well described to explain the epidemiology of meningitis in the belt, very few studies have focused on the role of these factors to understand meningitis epidemics outside of the belt. Based on epidemiological, socio-economic, demographic and environmental data collected for the period 2000-2018 in the Democratic Republic of Congo (DRC), we used different statistical methods to explore the links between meningitis cases and the different explored factors. Our results showed that urbanized areas where populations have a low economic index of well-being, high latitude and longitude eastwards, medium to low altitude level, savannah-type vegetation, medium temperature value, are risk factors of meningitis outbreaks from North to South in the DRC. This information is important to help improving meningitis control strategies in a large country located outside the so-called meningitis belt.

Background: Bacterial meningitis remains a major threat for the population of the meningitis belt. Between 2004 and 2009, in the countries of this belt, more than 200,000 people were infected with a 10% mortality rate. However, for almost 20 years, important meningitis epidemics are also reported outside this belt. Research is still very poorly developed in this part of the word like in the Democratic Republic of Congo (DRC), which experiences recurrent epidemics. This article describes for the first time the spatio-temporal patterns of meningitis cases and epidemics in DRC, in order to provide new insights for surveillance and control measures. Methods: Based on weekly suspected cases of meningitis (2000-2012), we used time-series analyses to explore the spatio-temporal dynamics of the disease. We also used both geographic information systems and geostatistics to identify spatial clusters of cases. Both using conventional statistics and the Cleveland's algorithm for decomposition into general trend, seasonal and residuals, we searched for the existence of seasonality. Results: We observed a low rate of biological confirmation of cases (11%) using soluble antigens search, culture and PCR. The main strains found are Streptococcus pneumoniae, Haemophilus influenzae and Neisseria meningitidis (A and C) serogroups. We identified 8 distinct spatial clusters, located in the northeastern and southeastern part of DRC, and in the capital city province, Kinshasa. A low seasonal trend was observed with higher incidence and attack rate of meningitis during the dry season, with a high heterogeneity in seasonal patterns occurring across the different districts and regions of DRC.

Background: Bacterial meningitis remains a major threat for the population of the meningitis belt. Between 2004 and 2009, in the countries of this belt, more than 200,000 people were infected with a 10% mortality rate. However, for almost 20 years, important meningitis epidemics are also reported outside this belt. Research is still very poorly developed in this part of the word like in the Democratic Republic of Congo (DRC), which experiences recurrent epidemics. This article describes for the first time the spatio-temporal patterns of meningitis cases and epidemics in DRC, in order to provide new insights for surveillance and control measures. Methods: Based on weekly suspected cases of meningitis (2000-2012), we used time-series analyses to explore the spatio-temporal dynamics of the disease. We also used both geographic information systems and geostatistics to identify spatial clusters of cases. Both using conventional statistics and the Cleveland's algorithm for decomposition into general trend, seasonal and residuals, we searched for the existence of seasonality. Results: We observed a low rate of biological confirmation of cases (11%) using soluble antigens search, culture and PCR. The main strains found are Streptococcus pneumoniae, Haemophilus influenzae and Neisseria meningitidis (A and C) serogroups. We identified 8 distinct spatial clusters, located in the northeastern and southeastern part of DRC, and in the capital city province, Kinshasa. A low seasonal trend was observed with higher incidence and attack rate of meningitis during the dry season, with a high heterogeneity in seasonal patterns occurring across the different districts and regions of DRC.

Background: Bacterial meningitis remains a major threat for the population of the meningitis belt. Between 2004 and 2009, in the countries of this belt, more than 200,000 people were infected with a 10% mortality rate. However, for almost 20 years, important meningitis epidemics are also reported outside this belt. Research is still very poorly developed in this part of the word like in the Democratic Republic of Congo (DRC), which experiences recurrent epidemics. This article describes for the first time the spatio-temporal patterns of meningitis cases and epidemics in DRC, in order to provide new insights for surveillance and control measures. Methods: Based on weekly suspected cases of meningitis (2000-2012), we used time-series analyses to explore the spatio-temporal dynamics of the disease. We also used both geographic information systems and geostatistics to identify spatial clusters of cases. Both using conventional statistics and the Cleveland's algorithm for decomposition into general trend, seasonal and residuals, we searched for the existence of seasonality. Results: We observed a low rate of biological confirmation of cases (11%) using soluble antigens search, culture and PCR. The main strains found are Streptococcus pneumoniae, Haemophilus influenzae and Neisseria meningitidis (A and C) serogroups. We identified 8 distinct spatial clusters, located in the northeastern and southeastern part of DRC, and in the capital city province, Kinshasa. A low seasonal trend was observed with higher incidence and attack rate of meningitis during the dry season, with a high heterogeneity in seasonal patterns occurring across the different districts and regions of DRC.

Background: Bacterial meningitis remains a major threat for the population of the meningitis belt. Between 2004 and 2009, in the countries of this belt, more than 200,000 people were infected with a 10% mortality rate. However, for almost 20 years, important meningitis epidemics are also reported outside this belt. Research is still very poorly developed in this part of the word like in the Democratic Republic of Congo (DRC), which experiences recurrent epidemics. This article describes for the first time the spatio-temporal patterns of meningitis cases and epidemics in DRC, in order to provide new insights for surveillance and control measures. Methods: Based on weekly suspected cases of meningitis (2000-2012), we used time-series analyses to explore the spatio-temporal dynamics of the disease. We also used both geographic information systems and geostatistics to identify spatial clusters of cases. Both using conventional statistics and the Cleveland's algorithm for decomposition into general trend, seasonal and residuals, we searched for the existence of seasonality. Results: We observed a low rate of biological confirmation of cases (11%) using soluble antigens search, culture and PCR. The main strains found are Streptococcus pneumoniae, Haemophilus influenzae and Neisseria meningitidis (A and C) serogroups. We identified 8 distinct spatial clusters, located in the northeastern and southeastern part of DRC, and in the capital city province, Kinshasa. A low seasonal trend was observed with higher incidence and attack rate of meningitis during the dry season, with a high heterogeneity in seasonal patterns occurring across the different districts and regions of DRC.

Background: Bacterial meningitis remains a major threat for the population of the meningitis belt. Between 2004 and 2009, in the countries of this belt, more than 200,000 people were infected with a 10% mortality rate. However, for almost 20 years, important meningitis epidemics are also reported outside this belt. Research is still very poorly developed in this part of the word like in the Democratic Republic of Congo (DRC), which experiences recurrent epidemics. This article describes for the first time the spatio-temporal patterns of meningitis cases and epidemics in DRC, in order to provide new insights for surveillance and control measures. Methods: Based on weekly suspected cases of meningitis (2000-2012), we used time-series analyses to explore the spatio-temporal dynamics of the disease. We also used both geographic information systems and geostatistics to identify spatial clusters of cases. Both using conventional statistics and the Cleveland's algorithm for decomposition into general trend, seasonal and residuals, we searched for the existence of seasonality. Results: We observed a low rate of biological confirmation of cases (11%) using soluble antigens search, culture and PCR. The main strains found are Streptococcus pneumoniae, Haemophilus influenzae and Neisseria meningitidis (A and C) serogroups. We identified 8 distinct spatial clusters, located in the northeastern and southeastern part of DRC, and in the capital city province, Kinshasa. A low seasonal trend was observed with higher incidence and attack rate of meningitis during the dry season, with a high heterogeneity in seasonal patterns occurring across the different districts and regions of DRC.

BACKGROUND: Bacterial meningitis remains a major threat for the population of the meningitis belt. Between 2004 and 2009, in the countries of this belt, more than 200,000 people were infected with a 10% mortality rate. However, for almost 20 years, important meningitis epidemics are also reported outside this belt. Research is still very poorly developed in this part of the word like in the Democratic Republic of Congo (DRC), which experiences recurrent epidemics. This article describes for the first time the spatio-temporal patterns of meningitis cases and epidemics in DRC, in order to provide new insights for surveillance and control measures. METHODS: Based on weekly suspected cases of meningitis (2000–2012), we used time-series analyses to explore the spatio-temporal dynamics of the disease. We also used both geographic information systems and geostatistics to identify spatial clusters of cases. Both using conventional statistics and the Cleveland's algorithm for decomposition into general trend, seasonal and residuals, we searched for the existence of seasonality. RESULTS: We observed a low rate of biological confirmation of cases (11%) using soluble antigens search, culture and PCR. The main strains found are Streptococcus pneumoniae, Haemophilus influenzae and Neisseria meningitidis (A and C) serogroups. We identified 8 distinct spatial clusters, located in the northeastern and southeastern part of DRC, and in the capital city province, Kinshasa. A low seasonal trend was observed with higher incidence and attack rate of meningitis during the dry season, with a high heterogeneity in seasonal patterns occurring across the different districts and regions of DRC. CONCLUSION: Despite challenges related to completeness of data reporting, meningitis dynamics shows weak seasonality in DRC. This tends to suggest that climatic, environmental factors might be less preponderant in shaping seasonal patterns in central Africa. The characterization of 8 distinct clusters of meningitis could be used for a better sentinel ...

BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12879-021-06986-9.

We studied the epidemiology of cholera in Katanga and Eastern Kasai, in the Democratic Republic of Congo, by compiling a database including all cases recorded from 2000 through 2005. Results show that lakes were the sources of outbreaks and demonstrate the inadequacy of the strategy used to combat cholera.