Field Actions Science Reports www.field-actions-sci-rep.net 1867-139X 1867-8521 2 1 2009 10.5194/facts-2-69-2009 http://www.field-actions-sci-rep.net/2/69/2009/ http://www.field-actions-sci-rep.net/2/69/2009/facts-2-69-2009.html http://www.field-actions-sci-rep.net/2/69/2009/facts-2-69-2009.pdf 69 77 2009-02-12 From research to field action: example of the fight against cholera in the Democratic Republic of Congo R. Piarroux renaud.piarroux@ap-hm.fr D. Bompangue P.-Y. Oger F. Haaser A. Boinet T. Vandevelde Hôpital de la Timone, Assistance Publique-Hôpitaux de Marseille, France Laboratoire Chrono-Environnement, CNRS, UMR 6249, Université de Franche-Comté, UFR Sciences et Techniques, Besançon, France Direction de la Lutte contre la Maladie, Ministère de la Santé Publique, Kinshasa, Democratic Republic of Congo Fondation Veolia Environnement, Nanterre, France Solidarités, Clichy, France The Democratic Republic of Congo (DRC) is the country in the world which reported the highest number of cholera cases to WHO from 2002 to 2007 (128 936 cases out of a worldwide 902 071 cases). We, therefore, implemented research work which intends to understand the epidemiology of cholera in the DRC and to ensure improvements in the strategy to fight against cholera. This broad study enabled us to accurately determine the cholera epidemic's mechanisms on different scales; to identify the source zones of the disease, and the groups of populations acting as vectors of the spread. It was then possible to demonstrate the role of "sanctuary'', played by some suburbs of lakeside cities. A collaborative network, including several scientific institutions in Europe and in the DRC, local and national government administrations in the field of public health and sanitation, international agencies, NGOs and private foundations, was progressively set up. Following the conclusions of our epidemiological studies, a drastic change of strategy was proposed: the limited curative approach on the one hand, the few existing water/sanitation programs on the other hand, have been merged in a global approach involving a larger scale water and sanitation infrastructure improvement, environmental protection, hygiene awareness and medical surveys targeting a few focus areas playing a central role in the epidemics. In conclusion, by better targeting intervention zones, one can gather human and technical resources previously scattered on the vast territory of the DRC. The strategy presented here revives the hope to eliminate cholera in the DRC. Acosta, C. J., Galindo, C. M., Kimario, J., Senkoro, K., Urassa, H., Casals, C., Corachán, M., Eseko, N., Tanner, M., Mshinda, H., Lwilla, F., Vila, J., and Alonso, P. L.: Cholera outbreak in southern Tanzania: risk factors and patterns of transmission, Emerg. Infect. Dis., 7(3 Suppl.), 583–587, 2001. Birmingham, M. E., Lee, L. A., Ndayimirije, N., Nkurikiye, S., Hersh, B. S., Wells, J. G., and Deming, M. S.: Epidemic cholera in Burundi: patterns of transmission in the Great Rift Valley Lake region, Lancet, 349(9057), 981–985, 1997. Bompangue, D., Giraudoux, P., Handschumacher, P., Piarroux, M., Sudre, B., Ekwanzala, M., Kebela, I., and Piarroux, R.: Lakes as source of cholera outbreaks, Democratic Republic of Congo, Emerg. Infect. Dis., 14(5), 798–800, 2008. Brown, V., Guerin, P. J., Legros, D., Paquet, C., Pécoul, B., and Moren, A.: Research in complex humanitarian emergencies: the Médecins Sans Frontières/Epicentre experience, PLoS Med., 5(4), e89, 2008. Constantin de Magny, G., Guégan, J. F., and Petit, M.: Cazelles Regional-scale climate-variability synchrony of cholera epidemies in West Africa, BMC Infect. Dis., 19, 7–20, 2007. Emch, M., Feldacker, C., Islam, M. S., and Ali, M.: Seasonality of cholera from 1974 to 2005: a review of global patterns, Int. J. Health Geogr., 20, 7–31, 2008. Griffith, D. C., Kelly-Hope, L. A., and Miller, M. A.: Review of reported cholera outbreaks worldwide, 1995–2005, Am. J. Trop. Med. Hyg., 75(5), 973–977, 2006. Goma Epidemiology Group: Public health impact of Rwandan refugee crisis: what happened in Goma, Zaire, in July, 1994?, Lancet, 345(8946), 339–344, 1995. Heyman, S. N., Ginosar, Y., Shapiro, M., Kluger, Y., Marx, N., and Maayan, S.: Diarrheal epidemies among Rwandan refugees in 1994. Management and outcome in a field hospital, J. Clin. Gastroenterol., 25(4), 595–601, 1997. Huq, A., Sack, R. B., Nizam, A., Longini, I. M., Nair, G. B., Ali, A., Morris Jr., J. G., Khan, M. N., Siddique, A. K., Yunus, M., Albert, M. J., Sack, D. A., and Colwell, R. R.: Critical factors influencing the occurrence of Vibrio cholerae in the environment of Bangladesh, Appl. Environ. Microbiol., 71(8), 4645–4654, 2005. Koelle, K., Rodó, X., Pascual, M., Yunus, M., and Mostafa, G.: Refractory periods and climate forcing in cholera dynamics, Nature, 436(7051), 696–700, 2005. Mendelsohn, J. and Dawson, T.: Climate and cholera in KwaZulu-Natal, South Africa: the role of environmental factors and implications for epidemic preparedness, Int. J. Hyg. Environ. Health, 211(1–2), 156–162, 2008. Olago, D., Marshall, M., Wandiga, S. O., Opondo, M., Yanda, P. Z., Kanalawe, R., Githeko, A. K., Downs, T., Opere, A., Kavumvuli, R., Kirumira, E., Ogallo, L., Mugambi, P., Apindi, E., Githui, F., Kathuri, J., Olaka, L., Sigalla, R., Nanyunja, R., Baguma, T., and Achola, P.: Climatic, socio-economic, and health factors affecting human vulnerability to cholera in the Lake Victoria basin, East Africa, Ambio, 36(4), 350–358, 2007. Roberts, L. and Toole, M. J.: Cholera deaths in Goma, Lancet, 346(8987), 1431, 1995. Sack, R. B., Siddique, A. K., Longini Jr., I. M., Nizam, A., Yunus, M., Islam, M. S., Morris Jr., J. G., Ali, A., Huq, A., Nair, G. B., Qadri, F., Faruque, S. M., Sack, D. A., and Colwell, R. R.: A 4-year study of the epidemiology of Vibrio cholerae in four rural areas of Bangladesh, J. Infect. Dis., 187(1), 96–101, 2003. Shapiro, R. L., Otieno, M. R., Adcock, P. M., Phillips-Howard, P. A., Hawley, W. A., Kumar, L., Waiyaki, P., Nahlen, B. L., and Slutsker, L.: Transmission of epidemic Vibrio cholerae O1 in rural western Kenya associated with drinking water from Lake Victoria: an environmental reservoir for cholera?, Am. J. Trop. Med. Hyg., 60(2), 271–276, 1999. Siddique, A. K., Salam, A., Islam, M. S., Akram, K., Majumdar, R. N., Zaman, K., Fronczak, N., and Laston, S.: Why treatment centres failed to prevent cholera deaths among Rwandan refugees in Goma, Zaire, Lancet, 345(8946), 359–361, 1995. WHO: Cholera, 2007, Wkly. Epidemiol. Rec., 83(31), 269–283, 2008. WHO: Cholera, 2006, Wkly. Epidemiol. Rec., 82(31), 273–284, 2007. WHO: Cholera, 2005, Wkly. Epidemiol. Rec., 81(31), 297–307, 2006. WHO: Cholera, 2004, Wkly. Epidemiol. Rec., 80(31), 261–268, 2005. WHO: Cholera, 2003, Wkly. Epidemiol. Rec., 79(31), 281–288, 2004. WHO: Cholera, 2002, Wkly. Epidemiol. Rec., 78(31), 269–276, 2003. Zuckerman, J. N., Rombo, L., and Fisch, A.: The true burden and risk of cholera: implications for prevention and control, Lancet Infect. Dis., 7(8), 521–530, 2007.