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Abstract：
BACKGROUND: The Ethiopian government has developed the multisectoral cholera elimination plan (NCP) with an aim of reducing cholera incidence and case fatality rate (CFR). To better understand and monitor the progress of this plan, a comprehensive review of national cholera epidemiology is needed.
METHODS: Reported data on cholera/acute watery diarrhea (AWD) cases in the past 20 years were extracted from the Ethiopian Public Health Institute and World Health Organization databases. Descriptive statistics, Pearson χ2, and logistic regression analyses were conducted.
RESULTS: From January 2001 to November 2023, a total of 215 205 cholera/AWD cases, 2355 deaths with a cumulative CFR of 1.10% (95% confidence interval [CI], 1.092-1.095), and a mean annual incidence rate of 8.9/100 000 (95% CI, 6.5-11.3) were reported. Two major upsurges of cholera epidemics were found in the last two decades with mean attack rate (AR) of 20.57/100 000 in 2006-2010 and 14.83/100 000 in 2016-2020. Another resurgence of outbreaks occured in 2021-2023 (mean AR, 8.63/100 000). In 2015-2023, 54.0% (53 990/99 945) of cases were aged 15-44 years. National cholera CFR (3.13% [95% CI: 2.1-4.5]) was the highest in 2022. The 2015-2023 cumulative cholera CFR was different across regions: Benishangul Gumuz (6.07%), Gambela (1.89%), Sidama (1.42%), Southern Nation, Nationalities, and Peoples\' (1.34%), Oromia (1.10%), and Amhara (1.09%). Cholera/AWD patients in older adults (≥45 years), severe dehydration, peak rainy season (June-August), and outpatients were associated with higher risk of death.
CONCLUSIONS: Cholera has been a public health problem in Ethiopia with case fatalities still above the global target. Case management needs to be improved particularly in outpatients and older populations. Outbreak preparedness should be rolled out well in advance of the typical rainy seasons. Significant investments are essential to advance the cholera surveillance system at healthcare setting and community level. Underlying factors of cholera deaths per areas should be further investigated to guide appropriate interventions to meet the NCP target by 2028.
METHODS: Reported data on cholera/acute watery diarrhea (AWD) cases in the past 20 years were extracted from the Ethiopian Public Health Institute and World Health Organization databases. Descriptive statistics, Pearson χ2, and logistic regression analyses were conducted.
RESULTS: From January 2001 to November 2023, a total of 215 205 cholera/AWD cases, 2355 deaths with a cumulative CFR of 1.10% (95% confidence interval [CI], 1.092-1.095), and a mean annual incidence rate of 8.9/100 000 (95% CI, 6.5-11.3) were reported. Two major upsurges of cholera epidemics were found in the last two decades with mean attack rate (AR) of 20.57/100 000 in 2006-2010 and 14.83/100 000 in 2016-2020. Another resurgence of outbreaks occured in 2021-2023 (mean AR, 8.63/100 000). In 2015-2023, 54.0% (53 990/99 945) of cases were aged 15-44 years. National cholera CFR (3.13% [95% CI: 2.1-4.5]) was the highest in 2022. The 2015-2023 cumulative cholera CFR was different across regions: Benishangul Gumuz (6.07%), Gambela (1.89%), Sidama (1.42%), Southern Nation, Nationalities, and Peoples\' (1.34%), Oromia (1.10%), and Amhara (1.09%). Cholera/AWD patients in older adults (≥45 years), severe dehydration, peak rainy season (June-August), and outpatients were associated with higher risk of death.
CONCLUSIONS: Cholera has been a public health problem in Ethiopia with case fatalities still above the global target. Case management needs to be improved particularly in outpatients and older populations. Outbreak preparedness should be rolled out well in advance of the typical rainy seasons. Significant investments are essential to advance the cholera surveillance system at healthcare setting and community level. Underlying factors of cholera deaths per areas should be further investigated to guide appropriate interventions to meet the NCP target by 2028.
摘要：
背景：埃塞俄比亚政府制定了多部门霍乱消除计划（NCP），旨在降低霍乱发病率和病死率（CFR）。为了更好地了解和监控这个计划的进展，需要对国家霍乱流行病学进行全面审查.
方法：从埃塞俄比亚公共卫生研究所和世界卫生组织数据库中提取了过去20年霍乱/急性水样腹泻（AWD）病例的报告数据。描述性统计，进行了Pearsonχ2和逻辑回归分析。
结果：从2001年1月到2023年11月，共215205例霍乱/AWD病例，2355例死亡，累积CFR为1.10%(95%置信区间[CI]，1.092-1.095),平均年发病率为8.9/100000(95%CI,6.5-11.3).在过去的二十年中，发现了两次霍乱流行的主要爆发，2006-2010年的平均发作率（AR）为20.57/100000，2016-2020年为14.83/100000。疫情的再次爆发发生在2021-2023年(平均AR，8.63/100000）。2015-2023年，54.0%(53990/99945)的病例年龄为15-44岁。国家霍乱CFR（3.13%[95%CI：2.1-4.5]）是2022年最高的。2015-2023年累积霍乱CFR在各地区不同：BenishangulGumuz（6.07%），Gambela(1.89%),Sidama（1.42%），南方民族,国籍,和人民（1.34%），奥罗米亚（1.10%），和阿姆哈拉（1.09%）。老年人（≥45岁）的霍乱/AWD患者，严重脱水,雨季高峰（6月至8月），门诊患者的死亡风险较高。
结论：霍乱一直是埃塞俄比亚的一个公共卫生问题，病例死亡人数仍高于全球目标。需要改善病例管理，特别是在门诊患者和老年人群中。疫情准备工作应在典型的雨季之前进行。重大投资对于在医疗保健环境和社区层面推进霍乱监测系统至关重要。应进一步调查每个地区霍乱死亡的潜在因素，以指导适当的干预措施，以在2028年前实现NCP目标。
方法：从埃塞俄比亚公共卫生研究所和世界卫生组织数据库中提取了过去20年霍乱/急性水样腹泻（AWD）病例的报告数据。描述性统计，进行了Pearsonχ2和逻辑回归分析。
结果：从2001年1月到2023年11月，共215205例霍乱/AWD病例，2355例死亡，累积CFR为1.10%(95%置信区间[CI]，1.092-1.095),平均年发病率为8.9/100000(95%CI,6.5-11.3).在过去的二十年中，发现了两次霍乱流行的主要爆发，2006-2010年的平均发作率（AR）为20.57/100000，2016-2020年为14.83/100000。疫情的再次爆发发生在2021-2023年(平均AR，8.63/100000）。2015-2023年，54.0%(53990/99945)的病例年龄为15-44岁。国家霍乱CFR（3.13%[95%CI：2.1-4.5]）是2022年最高的。2015-2023年累积霍乱CFR在各地区不同：BenishangulGumuz（6.07%），Gambela(1.89%),Sidama（1.42%），南方民族,国籍,和人民（1.34%），奥罗米亚（1.10%），和阿姆哈拉（1.09%）。老年人（≥45岁）的霍乱/AWD患者，严重脱水,雨季高峰（6月至8月），门诊患者的死亡风险较高。
结论：霍乱一直是埃塞俄比亚的一个公共卫生问题，病例死亡人数仍高于全球目标。需要改善病例管理，特别是在门诊患者和老年人群中。疫情准备工作应在典型的雨季之前进行。重大投资对于在医疗保健环境和社区层面推进霍乱监测系统至关重要。应进一步调查每个地区霍乱死亡的潜在因素，以指导适当的干预措施，以在2028年前实现NCP目标。
