Situation épidémiologique du choléra en République Démocratique du Congo en 2011
Author: Cellule de suivi du choléra en RDC - Juin 2012
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Cholera Epidemiological Situation in the Democratic Republic of Congo in 2011
Cholera remains a major public health problem in the Democratic Republic of Congo (DRC). In 2011, there were 21,753 cases and 424 deaths, or a case fatality ratio of 1.9%, the highest level in the past three years. The overall attack rate of 43 cases per 100,000 inhabitants is still very far from the elimination threshold set at 1 case out of 100,000 inhabitants.
The year 2011 saw a resurgence of cholera in the city of Kisangani (Orientale Province) and its dissemination in the health zones of the western provinces along the Congo River and its major tributaries (after nearly 7 to 10 years without any reported cholera cases).
The first cases observed in Kisangani in February 2011 were likely due to a cholera outbreak originating in Lubutu (in Maniema) in January 2011, and which spread to the area of Lubunga in Kisangani, where the terminus of the bus from Lubutu is located. However, only molecular biological analyzes could confirm or refute this hypothesis. Confirmation would show that cholera spread from endemic areas and sanctuaries of the Great Lakes region to western epidemic areas, as was the case for epidemics from 1997 to 2001.
In 2011, 33% of reported cases of Vibrio cholerae were confirmed through biological analysis. This relatively low rate calls not only for the improvement of the collection and transportation of stool samples, but also for the identification of other strains responsible for diarrhea cases clinically suspected to be cholera but which test negative for V. cholerae in biological analysis. The increasingly frequent identification of positive cases of V. cholerae in the age group of less than two years, i.e. 37% in 2011 (21 confirmed cases out of 57 samples taken from suspected cases in this age group), also raises the issue of the likely need to modify the clinical case definition currently in use.
Although, overall, the elimination of cholera has not been funded as a strategy, significant funds were raised for the fight against the disease in 2011. Despite this funding, coordination difficulties and the lack of a technical structure that can provide epidemiological insight into the challenges of cholera elimination are among the obstacles to achieving the expected results.
The presence of cholera in western DRC thus reveals the insufficient diagnosis of factors contributing to its persistence, and the inadequacy of control measures implemented to date.
In eastern DRC, renewed insecurity and population movements in poor hygiene and sanitation conditions could explain, in part, the resurgence of outbreaks and the spread to new areas observed in 2011.
If the factors contributing to the persistence, resurgence, and diffusion of cholera are controlled, the elimination of cholera as a public health problem in the DRC remains possible.
Advocacy for the funding and implementation of the strategic plan of elimination of cholera, with global support for epidemiological diagnosis, should improve the cholera situation in the country.