Abstract
BackgroundRapid control of cholera outbreaks is a significant challenge in overpopulated urban areas. During late-2017, Kinshasa, the capital of the Democratic Republic of the Congo, experienced a cholera outbreak that showed potential to spread throughout the city. A novel targeted water and hygiene response strategy was implemented to quickly stem the outbreak.MethodsWe describe the first implementation of the cluster grid response strategy carried out in the community during the cholera outbreak in Kinshasa, in which response activities targeted cholera case clusters using a grid approach. Interventions focused on emergency water supply, household water treatment and safe storage, home disinfection and hygiene promotion. We also performed a preliminary community trial study to assess the temporal pattern of the outbreak before and after response interventions were implemented. Cholera surveillance databases from the Ministry of Health were analyzed to assess the spatiotemporal dynamics of the outbreak using epidemic curves and maps.ResultsFrom January 2017 to November 2018, a total of 1712 suspected cholera cases were reported in Kinshasa. During this period, the most affected health zones included Binza Météo, Limeté, Kokolo, Kintambo and Kingabwa. Following implementation of the response strategy, the weekly cholera case numbers in Binza Météo, Kintambo and Limeté decreased by an average of 57% after 2 weeks and 86% after 4 weeks. The total weekly case numbers throughout Kinshasa Province dropped by 71% 4 weeks after the peak of the outbreak.ConclusionDuring the 2017–2018 period, Kinshasa experienced a sharp increase in cholera case numbers. To contain the outbreak, water supply and hygiene response interventions targeted case households, nearby neighbors and public areas in case clusters using a grid approach. Following implementation of the response, the outbreak in Kinshasa was quickly brought under control. A similar approach may be adapted to quickly interrupt cholera transmission in other urban settings.
Highlights
Rapid control of cholera outbreaks is a significant challenge in overpopulated urban areas
Study design and site In this report, we describe the first implementation of the cluster grid response strategy carried out in the community during the cholera outbreak in Kinshasa, in which water and hygiene interventions were carried out in cholera case clusters
The second and main outbreak began on November 25, 2017 [30]. This outbreak spread quickly throughout Kinshasa, with cases first reported in densely inhabited Camp Luka in Binza Météo Health zone, followed by Limeté during the last week of 2017, and Kintambo during earlyJanuary 2018 (Fig. 3)
Summary
Rapid control of cholera outbreaks is a significant challenge in overpopulated urban areas. The disease continues to represent a global public health concern, especially in Sub-Saharan Africa [3] To stem this public health threat, the Global Task Force for Cholera Control (GTFCC) has endorsed a call to action in 2017 with the plan “Ending Cholera – A Global Roadmap to 2030” [4]. Rapid control of cholera outbreaks can be a major challenge in urban settings, where cholera case numbers can quickly increase [2, 5]. Once cholera outbreaks expand in urban areas, cholera has often eventually spread to linked regions within the country or across international borders when infected individuals travel [6,7,8]. Effective strategies to control cholera outbreaks in urban settings may play a major role in the control and prevention of the disease on a local, national and regional level
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