Climate Variability and the Outbreaks of Cholera in Zanzibar, East Africa: A Time Series Analysis

Rita Reyburn International Vaccine Institute, Seoul, Korea; University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Ministry of Health and Social Welfare, Zanzibar, Tanzania

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Deok Ryun Kim International Vaccine Institute, Seoul, Korea; University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Ministry of Health and Social Welfare, Zanzibar, Tanzania

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Michael Emch International Vaccine Institute, Seoul, Korea; University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Ministry of Health and Social Welfare, Zanzibar, Tanzania

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Ahmed Khatib International Vaccine Institute, Seoul, Korea; University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Ministry of Health and Social Welfare, Zanzibar, Tanzania

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Lorenz von Seidlein International Vaccine Institute, Seoul, Korea; University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Ministry of Health and Social Welfare, Zanzibar, Tanzania

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Mohammad Ali International Vaccine Institute, Seoul, Korea; University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Ministry of Health and Social Welfare, Zanzibar, Tanzania

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Global cholera incidence is increasing, particularly in sub-Saharan Africa. We examined the impact of climate and ocean environmental variability on cholera outbreaks, and developed a forecasting model for outbreaks in Zanzibar. Routine cholera surveillance reports between 1997 and 2006 were correlated with remotely and locally sensed environmental data. A seasonal autoregressive integrated moving average (SARIMA) model determined the impact of climate and environmental variability on cholera. The SARIMA model shows temporal clustering of cholera. A 1°C increase in temperature at 4 months lag resulted in a 2-fold increase of cholera cases, and an increase of 200 mm of rainfall at 2 months lag resulted in a 1.6-fold increase of cholera cases. Temperature and rainfall interaction yielded a significantly positive association (P < 0.04) with cholera at a 1-month lag. These results may be applied to forecast cholera outbreaks, and guide public health resources in controlling cholera in Zanzibar.

Author Notes

*Address correspondence to Rita Reyburn, IVI, CHOZAN Project, PO Box 3524, Zanzibar, Tanzania. E-mail: rita_reyburn@hotmail.com

Financial support: Support for this study was provided by the Bill & Melinda Gates Foundation through the Cholera Vaccine Initiative (CHOVI) Program, administered by the International Vaccine Institute (IVI), and the Swedish International Development Cooperation Agency (SIDA).

Authors' addresses: Rita Reyburn, International Vaccine Institute (IVI), CHOZAN project, Zanzibar, Tanzania, E-mail: rita_reyburn@hotmail.com. Deok Ryun Kim, Lorenz von Seidlein, and Mohammad Ali, International Vaccine Institute, SNU Research Park, Seoul, Korea, E-mails: drkim@ivi.int, lseidlein@ivi.int, and mali@ivi.int. Michael Emch, Department of Geography, University of North Carolina, Saunders Hall, Chapel Hill, NC, E-mail: emch@email.unc.edu. Ahmed Khatib, Ministry of Health and Social Welfare, Zanzibar, Tanzania, E-mail: ahmedbenga@yahoo.com.

  • 1.

    WHO, 2009. Weekly Epidemiological Record.

  • 2.

    Gaffga NH, Tauxe RV, Mintz ED, 2007. Cholera: a new homeland in Africa? Am J Trop Med Hyg 77: 705713.

  • 3.

    United Nations Office for the Coordination of Humanitarian Affairs, 2009. Daily cholera update. Afghanistan: OCHA.

    • PubMed
    • Export Citation
  • 4.

    Colwell RR, 1996. Global climate and infectious disease: the cholera paradigm. Science 274: 20252031.

  • 5.

    Sack DA, Sack RB, Nair GB, Siddique AK, 2004. Cholera. Lancet 363: 223233.

  • 6.

    Colwell RR, Huq A, Islam MS, Aziz KM, Yunus M, Khan NH, Mahmud A, Sack RB, Nair GB, Chakraborty J, Sack DA, Russek-Cohen E, 2003. Reduction of cholera in Bangladeshi villages by simple filtration. Proc Natl Acad Sci USA 100: 10511055.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7.

    Huq A, Whitehouse CA, Grim CJ, Alam M, Colwell RR, 2008. Biofilms in water, its role and impact in human disease transmission. Curr Opin Biotechnol 19: 244247.

  • 8.

    Colwell RR, 2000. Viable but nonculturable bacteria: a survival strategy. J Infect Chemother 6: 121125.

  • 9.

    Sack DA, 1997. Cholera. Lancet 349: 18251830.

  • 10.

    Lobitz B, Beck L, Huq A, Wood B, Fuchs G, Faruque AS, Colwell R, 2000. Climate and infectious disease: use of remote sensing for detection of Vibrio cholerae by indirect measurement. Proc Natl Acad Sci USA 97: 14381443.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11.

    Ali M, Emch M, Donnay JP, Yunus M, Sack RB, 2002. The spatial epidemiology of cholera in an endemic area of Bangladesh. Soc Sci Med 55: 10151024.

  • 12.

    Constantin de Magny G, Murtugudde R, Sapiano MR, Nizam A, Brown CW, Busalacchi AJ, Yunus M, Nair GB, Gil CL, Lanata CF, Calkins J, Manna B, Rajendran K, Bhattacharya MK, Huq A, Sack RB, Colwell RR, 2008. Environmental signatures associated with cholera epidemics. Proc Natl Acad Sci USA 105: 1767617681.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13.

    Emch M, Feldacker C, Yunus M, Streatfield PK, Dinh Thiem V, Canh do G, Ali M, 2008. Local environmental predictors of cholera in Bangladesh and Vietnam. Am J Trop Med Hyg 78: 823832.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14.

    Colwell RR, 2002. A voyage of discovery: cholera, climate and complexity. Environ Microbiol 4: 6769.

  • 15.

    Luque Fernandez MA, Bauernfeind A, Jimenez JD, Gil CL, El Omeiri N, Guibert DH, 2009. Influence of temperature and rainfall on the evolution of cholera epidemics in Lusaka, Zambia, 2003–2006: analysis of a time series. Trans R Soc Trop Med Hyg 103: 137143.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16.

    MoHSW Z, 2008. Country Health Profile. Zanzibar: Ministry of Health and Social Welfare.

  • 17.

    Meterorological Department Z, 2009. Monthly weather data. Zanzibar town: data on weather variables.

  • 18.

    Health Management Information System M, 2008. National Guidelines for Integrated Disease Surveillance and Response Guidelines (IDRS). Zanzibar: Ministry of Health and Social Welfare.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19.

    WHO, Global Task Force on Cholera Outbreak 2004. Cholera outbreak: assessing the outbreak response and improving preparedness. Geneva, Switzerland: WHO.

  • 20.

    Chatfield C, 1975. The Analysis of Time Series: Theory and Practice. London, UK: Chapman and Hall.

  • 21.

    Chatfield WR, Rogers TG, Brownlee BE, Rippon PE, 1975. Placental scanning with computer-linked gamma camera to detect impaired placental blood flow and intrauterine growth retardation. BMJ 2: 120122.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 22.

    Zhang Y, Bi P, Hiller J, 2008. Climate variations and salmonellosis transmission in Adelaide, South Australia: a comparison between regression models. Int J Biometeorol 52: 179187.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 23.

    Johnson RA, Wichern DW, 1998. Applied Multivariate Statistical Analysis. Englewood Cliffs, NJ: Prentice Hall.

  • 24.

    Naish S, Hu W, Nicholls N, Mackenzie JS, McMichael AS, Dale P, Tong S, 2006. Weather variability, tides, and Barmah Forest virus disease in the Gladstone region, Australia. Environ Health Perspect 114: 678683.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 25.

    Hashizume M, Armstrong B, Hajat S, Wagatsuma Y, Faruque AS, Hayashi T, Sack DA, 2008. The effect of rainfall on the incidence of cholera in Bangladesh. Epidemiology 19: 103110.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 26.

    Houshold Budget Survey, 2006. Zanzibar: Ministry of Health and Social Welfare.

    • PubMed
    • Export Citation
  • 27.

    Alam M, Sultana M, Nair GB, Siddique AK, Hasan NA, Sack RB, Sack DA, Ahmed KU, Sadique A, Watanabe H, Grim CJ, Huq A, Colwell RR, 2007. Viable but nonculturable Vibrio cholerae O1 in biofilms in the aquatic environment and their role in cholera transmission. Proc Natl Acad Sci USA 104: 1780117806.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 28.

    Colwell RR, 2004. Infectious disease and environment: cholera as a paradigm for waterborne disease. Int Microbiol 7: 285289.

  • 29.

    Louis VR, Russek-Cohen E, Choopun N, Choopun N, Rivera IN, Gangle B, Jiang SC, Rubin A, Patz JA, Huq A, Colwell RR, 2003. Predictability of Vibrio cholerae in Chesapeake Bay. Appl Environ Microbiol 69: 27732785.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 30.

    Lipp EK, Huq A, Colwell RR, 2002. Effects of global climate on infectious disease: the cholera model. Clin Microbiol Rev 15: 757770.

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