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.

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.

Reviewing Editor

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

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

Further reading

    1. Epidemiology and Global Health
    Victoria P Mak, Kami White ... Loic Le Marchand
    Research Article Updated

    Background:

    The Coronavirus Disease of 2019 (COVID-19) has impacted the health and day-to-day life of individuals, especially the elderly and people with certain pre-existing medical conditions, including cancer. The purpose of this study was to investigate how COVID-19 impacted access to cancer screenings and treatment, by studying the participants in the Multiethnic Cohort (MEC) study.

    Methods:

    The MEC has been following over 215,000 residents of Hawai‘i and Los Angeles for the development of cancer and other chronic diseases since 1993–1996. It includes men and women of five racial and ethnic groups: African American, Japanese American, Latino, Native Hawaiian, and White. In 2020, surviving participants were sent an invitation to complete an online survey on the impact of COVID-19 on their daily life activities, including adherence to cancer screening and treatment. Approximately 7,000 MEC participants responded. A cross-sectional analysis was performed to investigate the relationships between the postponement of regular health care visits and cancer screening procedures or treatment with race and ethnicity, age, education, and comorbidity.

    Results:

    Women with more education, women with lung disease, COPD, or asthma, and women and men diagnosed with cancer in the past 5 years were more likely to postpone any cancer screening test/procedure due to the COVID-19 pandemic. Groups less likely to postpone cancer screening included older women compared to younger women and Japanese American men and women compared to White men and women.

    Conclusions:

    This study revealed specific associations of race/ethnicity, age, education level, and comorbidities with the cancer-related screening and healthcare of MEC participants during the COVID-19 pandemic. Increased monitoring of patients in high-risk groups for cancer and other diseases is of the utmost importance as the chance of undiagnosed cases or poor prognosis is increased as a result of delayed screening and treatment.

    Funding:

    This research was partially supported by the Omidyar 'Ohana Foundation and grant U01 CA164973 from the National Cancer Institute.

    1. Epidemiology and Global Health
    Gayathri Nagaraj, Shaveta Vinayak ... Dimpy P Shah
    Research Article Updated

    Background:

    Limited information is available for patients with breast cancer (BC) and coronavirus disease 2019 (COVID-19), especially among underrepresented racial/ethnic populations.

    Methods:

    This is a COVID-19 and Cancer Consortium (CCC19) registry-based retrospective cohort study of females with active or history of BC and laboratory-confirmed severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection diagnosed between March 2020 and June 2021 in the US. Primary outcome was COVID-19 severity measured on a five-level ordinal scale, including none of the following complications, hospitalization, intensive care unit admission, mechanical ventilation, and all-cause mortality. Multivariable ordinal logistic regression model identified characteristics associated with COVID-19 severity.

    Results:

    1383 female patient records with BC and COVID-19 were included in the analysis, the median age was 61 years, and median follow-up was 90 days. Multivariable analysis revealed higher odds of COVID-19 severity for older age (aOR per decade, 1.48 [95% CI, 1.32–1.67]); Black patients (aOR 1.74; 95 CI 1.24–2.45), Asian Americans and Pacific Islander patients (aOR 3.40; 95 CI 1.70–6.79) and Other (aOR 2.97; 95 CI 1.71–5.17) racial/ethnic groups; worse ECOG performance status (ECOG PS ≥2: aOR, 7.78 [95% CI, 4.83–12.5]); pre-existing cardiovascular (aOR, 2.26 [95% CI, 1.63–3.15])/pulmonary comorbidities (aOR, 1.65 [95% CI, 1.20–2.29]); diabetes mellitus (aOR, 2.25 [95% CI, 1.66–3.04]); and active and progressing cancer (aOR, 12.5 [95% CI, 6.89–22.6]). Hispanic ethnicity, timing, and type of anti-cancer therapy modalities were not significantly associated with worse COVID-19 outcomes. The total all-cause mortality and hospitalization rate for the entire cohort was 9% and 37%, respectively however, it varied according to the BC disease status.

    Conclusions:

    Using one of the largest registries on cancer and COVID-19, we identified patient and BC-related factors associated with worse COVID-19 outcomes. After adjusting for baseline characteristics, underrepresented racial/ethnic patients experienced worse outcomes compared to non-Hispanic White patients.

    Funding:

    This study was partly supported by National Cancer Institute grant number P30 CA068485 to Tianyi Sun, Sanjay Mishra, Benjamin French, Jeremy L Warner; P30-CA046592 to Christopher R Friese; P30 CA023100 for Rana R McKay; P30-CA054174 for Pankil K Shah and Dimpy P Shah; KL2 TR002646 for Pankil Shah and the American Cancer Society and Hope Foundation for Cancer Research (MRSG-16-152-01-CCE) and P30-CA054174 for Dimpy P Shah. REDCap is developed and supported by Vanderbilt Institute for Clinical and Translational Research grant support (UL1 TR000445 from NCATS/NIH). The funding sources had no role in the writing of the manuscript or the decision to submit it for publication.

    Clinical trial number:

    CCC19 registry is registered on ClinicalTrials.gov, NCT04354701.