Cholera Surveillance

A Multi-Partner Consortium for Sustainable Cholera Surveillance

Agence de Médecine Préventive (AMP) launched the African Cholera Surveillance Network (Africhol) in 2009 with funding from the Bill & Melinda Gates Foundation. The project’s overall objective was to collect data for evidence-based decisions on cholera prevention in Africa and the world. Africhol’s primary aim, therefore, was to better define cholera burden, geographic distribution, seasonal patterns, and risk groups to inform prevention strategies, including immunization. 

To achieve this goal, the project, which ended in 2016, successfully built a consortium of national and international organizations to implement and sustain a multi-site cholera surveillance network in 11 African countries: Cameroon, Côte d'Ivoire, Democratic Republic of the Congo (DRC), Guinea, Kenya, Mozambique, Nigeria, Tanzania, Togo, Uganda, and Zimbabwe. The surveillance network was then able to collate evidence for cholera prevention and control measures (including vaccine adoption).

Africhol also strengthened countries’ national capacity in outbreak investigations by reinforcing existing surveillance systems, and in national laboratories by providing material and training. To accomplish this, the project worked within existing national surveillance systems to implement a protocol for data collection and analysis. The common protocol for all participating countries ensured that the data collected was standardized and comparable between all countries.

Through the network, scientific information on cholera disease burden and incidence was gathered and shared with partners, countries, and the scientific community, and contributed towards improving the understanding of the dynamics of epidemics and enabling decision makers to determine the most appropriate interventions.

Strengthening Cholera Response

By 2015 the network had grown to 24 surveillance and outbreak sites, with Africhol assisting participating countries by:

 

Africhol Achievements

 

Africhol Findings

  1. Those with confirmed cases throughout the year such as Goma (DRC). By contrast, sustained occurrence of confirmed cases may result from ongoing environmental source contamination from which a continuously renewed susceptible, non-immune population is infected; this may have occurred in Goma, which has experienced several waves of immigration due to regional conflicts. 
  2. Those with sporadic cases plus additional outbreaks at irregular intervals such as in Lome (Togo), Mbale (Uganda), and Conakry (Guinea). The presence of sporadic cases without ensuing outbreaks may occur from occasional introduction of infected persons into a low risk community, e.g., a community with recent cholera and a high degree of population immunity or a community with good water and sanitation infrastructure. 
  3. Those with a history of recurrent cholera epidemics but no cases during the surveillance period, such as Beira (Mozambique) or Abidjan (Cote d’Ivoire).