Estimating effectiveness of case-area targeted response interventions against cholera in Haiti

  1. Edwige Michel
  2. Jean Gaudart
  3. Samuel Beaulieu
  4. Gregory Bulit
  5. Martine Piarroux
  6. Jacques Boncy
  7. Patrick Dely
  8. Renaud Piarroux  Is a corresponding author
  9. Stanislas Rebaudet  Is a corresponding author
  1. Ministry of Public Health and Population, Haiti
  2. Aix Marseille University, APHM, INSERM, IRD, SESSTIM, Hop Timone, BioSTIC, Biostatistics and ICT, France
  3. United Nations Children's Fund, Haiti
  4. Service de Santé des Armées, France
  5. Sorbonne Université, INSERM, Institut Pierre-Louis d'Epidémiologie et de Santé Publique, AP-HP, Hôpital Pitié-Salpêtrière, France
  6. APHM, Aix Marseille University, INSERM, IRD, Hôpital Européen, SESSTIM, France

Abstract

Case-area targeted interventions (CATIs) against cholera are conducted by rapid response teams, and may include various activities like water, sanitation, hygiene measures. However, their real-world effectiveness has never been established. We conducted a retrospective observational study in 2015-2017 in the Centre department of Haiti. Using cholera cases, stool cultures and CATI records, we identified 238 outbreaks that were responded to. After adjusting for potential confounders, we found that a prompt response could reduce the number of accumulated cases by 76% (95% confidence interval, 59 to 86) and the outbreak duration by 61% (41 to 75) when compared to a delayed response. An intense response could reduce the number of accumulated cases by 59% (11 to 81) and the outbreak duration by 73% (49 to 86) when compared to a weaker response. These results suggest that prompt and repeated CATIs were significantly effective at mitigating and shortening cholera outbreaks in Haiti.

Data availability

Data generated or analysed during this study are included in the manuscript and supporting files.Source data files have been provided for Figures 1 and 4.

Article and author information

Author details

  1. Edwige Michel

    Directorate of Epidemiology Laboratory and Research, Ministry of Public Health and Population, Delmas, Haiti
    Competing interests
    The authors declare that no competing interests exist.
  2. Jean Gaudart

    Aix Marseille University, APHM, INSERM, IRD, SESSTIM, Hop Timone, BioSTIC, Biostatistics and ICT, Marseille, France
    Competing interests
    The authors declare that no competing interests exist.
    ORCID icon "This ORCID iD identifies the author of this article:" 0000-0001-9006-5729
  3. Samuel Beaulieu

    United Nations Children's Fund, Port-au-Prince, Haiti
    Competing interests
    The authors declare that no competing interests exist.
  4. Gregory Bulit

    United Nations Children's Fund, Port-au-Prince, Haiti
    Competing interests
    The authors declare that no competing interests exist.
  5. Martine Piarroux

    Centre d'Épidémiologie et de Santé Publique des Armées, Service de Santé des Armées, Marseille, France
    Competing interests
    The authors declare that no competing interests exist.
  6. Jacques Boncy

    National Laboratory of Public Health, Ministry of Public Health and Population, Port-au-Prince, Haiti
    Competing interests
    The authors declare that no competing interests exist.
  7. Patrick Dely

    Directorate of Epidemiology Laboratory and Research, Ministry of Public Health and Population, Delmas, Haiti
    Competing interests
    The authors declare that no competing interests exist.
  8. Renaud Piarroux

    Service de Parasitologie Mycologie, Sorbonne Université, INSERM, Institut Pierre-Louis d'Epidémiologie et de Santé Publique, AP-HP, Hôpital Pitié-Salpêtrière, Paris, France
    For correspondence
    renaud.piarroux@aphp.fr
    Competing interests
    The authors declare that no competing interests exist.
  9. Stanislas Rebaudet

    APHM, Aix Marseille University, INSERM, IRD, Hôpital Européen, SESSTIM, Marseille, France
    For correspondence
    stanreb@gmail.com
    Competing interests
    The authors declare that no competing interests exist.
    ORCID icon "This ORCID iD identifies the author of this article:" 0000-0001-5099-1947

Funding

UNICEF

  • Samuel Beaulieu
  • Gregory Bulit
  • Stanislas Rebaudet

Assistance Publique - Hopitaux de Marseille

  • Stanislas Rebaudet

Assistance Publique - Hopitaux de Paris

  • Renaud Piarroux

The funders of this study (UNICEF, APHM, APHP) had staff (co-authors of this manuscript) who had a role in data collection, analyses and writing of the report. However, the funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Reviewing Editor

  1. Mark Jit, London School of Hygiene & Tropical Medicine, and Public Health England, United Kingdom

Ethics

Human subjects: All analyses retrospectively included routinely collected cholera surveillance and control data. The study protocol received authorization #1718-24 from the National Bioethics Committee of Haiti MSPP. The study only analysed anonymised data. Informed consent from patients and from people who benefited from a response intervention was therefore not required for this study.

Version history

  1. Received: July 16, 2019
  2. Accepted: December 20, 2019
  3. Accepted Manuscript published: December 30, 2019 (version 1)
  4. Version of Record published: February 25, 2020 (version 2)

Copyright

© 2019, Michel et al.

This article is distributed under the terms of the Creative Commons Attribution License permitting unrestricted use and redistribution provided that the original author and source are credited.

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  1. Edwige Michel
  2. Jean Gaudart
  3. Samuel Beaulieu
  4. Gregory Bulit
  5. Martine Piarroux
  6. Jacques Boncy
  7. Patrick Dely
  8. Renaud Piarroux
  9. Stanislas Rebaudet
(2019)
Estimating effectiveness of case-area targeted response interventions against cholera in Haiti
eLife 8:e50243.
https://doi.org/10.7554/eLife.50243

Share this article

https://doi.org/10.7554/eLife.50243

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