PDF(Pubmed)
Abstract：
BACKGROUND: Cholera outbreaks are on the rise globally, with conflict-affected settings particularly at risk. Case-area targeted interventions (CATIs), a strategy whereby teams provide a package of interventions to case and neighboring households within a predefined \"ring,\" are increasingly employed in cholera responses. However, evidence on their ability to attenuate incidence is limited.
RESULTS: We conducted a prospective observational cohort study in 3 conflict-affected states in Nigeria in 2021. Enumerators within rapid response teams observed CATI implementation during a cholera outbreak and collected data on household demographics; existing water, sanitation, and hygiene (WASH) infrastructure; and CATI interventions. Descriptive statistics showed that CATIs were delivered to 46,864 case and neighbor households, with 80.0% of cases and 33.5% of neighbors receiving all intended supplies and activities, in a context with operational challenges of population density, supply stock outs, and security constraints. We then applied prospective Poisson space-time scan statistics (STSS) across 3 models for each state: (1) an unadjusted model with case and population data; (2) an environmentally adjusted model adjusting for distance to cholera treatment centers and existing WASH infrastructure (improved water source, improved latrine, and handwashing station); and (3) a fully adjusted model adjusting for environmental and CATI variables (supply of Aquatabs and soap, hygiene promotion, bedding and latrine disinfection activities, ring coverage, and response timeliness). We ran the STSS each day of our study period to evaluate the space-time dynamics of the cholera outbreaks. Compared to the unadjusted model, significant cholera clustering was attenuated in the environmentally adjusted model (from 572 to 18 clusters) but there was still risk of cholera transmission. Two states still yielded significant clusters (range 8-10 total clusters, relative risk of 2.2-5.5, 16.6-19.9 day duration, including 11.1-56.8 cholera cases). Cholera clustering was completely attenuated in the fully adjusted model, with no significant anomalous clusters across time and space. Associated measures including quantity, relative risk, significance, likelihood of recurrence, size, and duration of clusters reinforced the results. Key limitations include selection bias, remote data monitoring, and the lack of a control group.
CONCLUSIONS: CATIs were associated with significant reductions in cholera clustering in Northeast Nigeria despite operational challenges. Our results provide a strong justification for rapid implementation and scale-up CATIs in cholera-response, particularly in conflict settings where WASH access is often limited.
RESULTS: We conducted a prospective observational cohort study in 3 conflict-affected states in Nigeria in 2021. Enumerators within rapid response teams observed CATI implementation during a cholera outbreak and collected data on household demographics; existing water, sanitation, and hygiene (WASH) infrastructure; and CATI interventions. Descriptive statistics showed that CATIs were delivered to 46,864 case and neighbor households, with 80.0% of cases and 33.5% of neighbors receiving all intended supplies and activities, in a context with operational challenges of population density, supply stock outs, and security constraints. We then applied prospective Poisson space-time scan statistics (STSS) across 3 models for each state: (1) an unadjusted model with case and population data; (2) an environmentally adjusted model adjusting for distance to cholera treatment centers and existing WASH infrastructure (improved water source, improved latrine, and handwashing station); and (3) a fully adjusted model adjusting for environmental and CATI variables (supply of Aquatabs and soap, hygiene promotion, bedding and latrine disinfection activities, ring coverage, and response timeliness). We ran the STSS each day of our study period to evaluate the space-time dynamics of the cholera outbreaks. Compared to the unadjusted model, significant cholera clustering was attenuated in the environmentally adjusted model (from 572 to 18 clusters) but there was still risk of cholera transmission. Two states still yielded significant clusters (range 8-10 total clusters, relative risk of 2.2-5.5, 16.6-19.9 day duration, including 11.1-56.8 cholera cases). Cholera clustering was completely attenuated in the fully adjusted model, with no significant anomalous clusters across time and space. Associated measures including quantity, relative risk, significance, likelihood of recurrence, size, and duration of clusters reinforced the results. Key limitations include selection bias, remote data monitoring, and the lack of a control group.
CONCLUSIONS: CATIs were associated with significant reductions in cholera clustering in Northeast Nigeria despite operational challenges. Our results provide a strong justification for rapid implementation and scale-up CATIs in cholera-response, particularly in conflict settings where WASH access is often limited.
摘要：
背景：霍乱疫情在全球范围内呈上升趋势，受冲突影响的环境特别危险。病例区针对性干预(CATI)，一种策略，即团队在预定义的“环内为案件和邻近家庭提供一揽子干预措施，“越来越多地用于霍乱应对。然而,关于他们减少发病率的能力的证据是有限的.
结果：我们于2021年在尼日利亚3个受冲突影响的州进行了一项前瞻性观察性队列研究。快速反应小组的成员观察了霍乱爆发期间的CATI实施情况，并收集了有关家庭人口统计的数据；现有水，卫生，和卫生(WASH)基础设施；以及CATI干预措施。描述性统计数据显示，CATI被送到46864个病例和邻居家庭，80.0%的案件和33.5%的邻居收到了所有预期的用品和活动，在人口密度的运营挑战的背景下，供应缺货，和安全限制。然后，我们对每个州的3个模型应用了前瞻性泊松时空扫描统计（STSS）：（1）具有病例和人口数据的未调整模型；（2）环境调整模型，调整到霍乱治疗中心和现有WASH基础设施的距离（改善的水源，改进型厕所,andhandwashingstation);and(3)afullyadjustedmodeladjustedforenvironmentalandCATIvariables(supplyofAquatabsandsoap,卫生宣传,床上用品和厕所消毒活动，环覆盖,和响应及时性)。我们在研究期间的每天运行STSS，以评估霍乱暴发的时空动态。与未调整的模型相比，在环境调整模型中,显著的霍乱聚集减弱(从572个至18个聚集),但仍存在霍乱传播风险.两个州仍然产生了显著的集群(范围为8-10个总集群，相对危险度为2.2-5.5，16.6-19.9天，包括11.1-56.8例霍乱病例)。在完全调整的模型中，霍乱聚类完全减弱，在时间和空间上没有明显的异常簇。相关措施，包括数量，相对风险，意义,复发的可能性,尺寸,集群的持续时间加强了结果。主要限制包括选择偏差，远程数据监控,缺乏对照组。
结论：尽管存在操作挑战，但尼日利亚东北部的CATI与霍乱聚集的显著减少相关。我们的结果为霍乱反应中快速实施和扩大CATI提供了强有力的理由，特别是在WASH访问通常受到限制的冲突设置中。
结果：我们于2021年在尼日利亚3个受冲突影响的州进行了一项前瞻性观察性队列研究。快速反应小组的成员观察了霍乱爆发期间的CATI实施情况，并收集了有关家庭人口统计的数据；现有水，卫生，和卫生(WASH)基础设施；以及CATI干预措施。描述性统计数据显示，CATI被送到46864个病例和邻居家庭，80.0%的案件和33.5%的邻居收到了所有预期的用品和活动，在人口密度的运营挑战的背景下，供应缺货，和安全限制。然后，我们对每个州的3个模型应用了前瞻性泊松时空扫描统计（STSS）：（1）具有病例和人口数据的未调整模型；（2）环境调整模型，调整到霍乱治疗中心和现有WASH基础设施的距离（改善的水源，改进型厕所,andhandwashingstation);and(3)afullyadjustedmodeladjustedforenvironmentalandCATIvariables(supplyofAquatabsandsoap,卫生宣传,床上用品和厕所消毒活动，环覆盖,和响应及时性)。我们在研究期间的每天运行STSS，以评估霍乱暴发的时空动态。与未调整的模型相比，在环境调整模型中,显著的霍乱聚集减弱(从572个至18个聚集),但仍存在霍乱传播风险.两个州仍然产生了显著的集群(范围为8-10个总集群，相对危险度为2.2-5.5，16.6-19.9天，包括11.1-56.8例霍乱病例)。在完全调整的模型中，霍乱聚类完全减弱，在时间和空间上没有明显的异常簇。相关措施，包括数量，相对风险，意义,复发的可能性,尺寸,集群的持续时间加强了结果。主要限制包括选择偏差，远程数据监控,缺乏对照组。
结论：尽管存在操作挑战，但尼日利亚东北部的CATI与霍乱聚集的显著减少相关。我们的结果为霍乱反应中快速实施和扩大CATI提供了强有力的理由，特别是在WASH访问通常受到限制的冲突设置中。
