Volume 98, Issue 5
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



Cholera outbreaks in Africa have been attributed to both droughts and floods, but whether the risk of a cholera outbreak is elevated during droughts is unknown. We estimated the risk of cholera outbreaks during droughts and floods compared with drought- and flood-free periods in 40 sub-Saharan African countries during 1990–2010 based on data from Emergency Events Database: the Office of Foreign Disaster Assistance /Centre for Research on the Epidemiology of Disasters International Disaster Database (www.emdat.be). A cholera outbreak was registered in one of every three droughts and one of every 15 floods. We observed an increased incidence rate of cholera outbreaks during drought periods (incidence rate ratio [IRR] = 4.3, 95% confidence interval [CI] = 2.9–7.2) and during flood periods (IRR = 144, 95% CI = 101–208) when compared with drought/flood-free periods. Floods are more strongly associated with cholera outbreaks, yet the prevalence of cholera outbreaks is higher during droughts because of droughts’ long durations. The results suggest that droughts in addition to floods call for increased cholera preparedness.

[open-access] This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


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  1. World Health Organization, 2014. Weekly Epidemiological Record, No. 31, 2014, 89. Geneva, Switzerland: WHO, 345–356.
  2. Rebaudet S, Sudre B, Faucher B, Piarroux R, , 2013. Environmental determinants of cholera outbreaks in inland Africa: a systematic review of main transmission foci and propagation routes. J Infect Dis 208 (Suppl 1): S46S54.
  3. Tauxe RV, Holmberg SD, Dodin A, Wells JV, Blake PA, , 1988. Epidemic cholera in Mali: high mortality and multiple routes of transmission in a famine area. Epidemiol Infect 100: 279289.
  4. Aragón M, Barreto A, Tabbard P, Chambule J, Santos C, Noya A, , 1994. Cholera epidemiology in Mozambique: 1973–1992. Rev Saude Publica 28: 332336.
  5. World Health Organization. Flooding and Communicable Diseases Fact Sheet. Geneva, Switzerland: WHO.
  6. World Health Organization (WHO), Global Task Force on Cholera Control, 2004. Cholera Outbreak: Assessing the Outbreak Response and Improving Preparedness. Geneva, Switzerland: WHO.
  7. Collins AE, , 2003. Vulnerability to coastal cholera ecology. Soc Sci Med 57: 13971407.
  8. UNICEF and WHO, 2015. Progress on Sanitation and Drinking Water2015 Update and MDG Assessment. Geneva, Switzerland: WHO.
  9. Intergovernmental Panel on Climate Change, 2014. Climate change 2014: impacts, adaptation, and vulnerability. Field CB, et al, eds. Part A: Global and Sectoral Aspects. Contribution of Working Group II to the Fifth Assessment Report of the Intergovernmental Panel on Climate Change. Cambridge, United Kingdom and New York, NY: Cambridge University Press.
  10. Jensen PK, Jayasinghe G, van der Hoek W, Cairncross S, Dalsgaard A, , 2004. Is there an association between bacteriological drinking water quality and childhood diarrhoea in developing countries? Trop Med Int Health 9: 12101215.
  11. Guha-Sapir D, Below R, Hoyois P, , 2009. EM-DAT, International Disaster Database. Brussels, Belgium: Université Catholique de Louvain. Available at: http://www.emdat.be. Accessed June 1, 2015.
  12. Heymann DLN, , 2004. Control of Communicable Diseases Manual. Washington, DC: American Public Health Association USA, ISBN: 0-87553-034-6.
  13. World Health Organization, 2000. WHO Report on Global Surveillance of Epidemic-Prone Infectious Diseases. Available at: http://apps.who.int/iris/bitstream/10665/66485/1/WHO_CDS_CSR_ISR_2000.1.pdf. Accessed August 7, 2016.
  14. Zhou XH, Eckert GJ, Tierney WM, , 2001. Multiple imputation in public health research. Stat Med 20: 15411549.
  15. Below R, Grover-Kopec E, Dilley M, , 2007. Documenting drought-related disasters: a global reassessment. J Environ Dev 16: 328344.
  16. Petersen I, Douglas I, Whitaker H, , 2016. Self controlled case series methods: an alternative to standard epidemiological study designs. BMJ 354: i4515.
  17. McMahon MM, , 2007. Disasters and poverty. Disaster Manag Response 5: 9597.
  18. United Nations Development Programme, 2014. Human Development Reports. Available at: http://hdr.undp.org/en/. Accessed March 24, 2015.
  19. Ali M, Lopez AL, You YA, Kim YE, Sah B, Maskery B, Clemens J, , 2012. The global burden of cholera. Bull World Health Organ 90: 209218A.
  20. World Health Organization, 2010. Weekly Epidemiological Record, No. 13, 2010, 85, 117–128. Geneva, Switzerland: WHO. Available at: http://www.who.int/wer/2010/wer8513.pdf?ua=1. Accessed February 21, 2016.
  21. King AA, Ionides EL, Pascual M, Bouma MJ, , 2008. Inapparent infections and cholera dynamics. Nature 454: 877880.
  22. Guha-Sapir D, Below R, , 2002. Quality and Accuracy of Disaster Data: A Comparative Analyse of 3 Global Data Sets. CRED Working Paper. Brussels, Belgium, University of Louvain School of Medicine.
  23. Saidi SM, Yamasaki S, Lijima Y, Kariuki S, , 2011. Cholera-like diarrhoea due to Salmonella infection. J Infect Dev Ctries 5: 6870.
  24. Smith AM, Keddy KH, Ismail H, Tau N, Sooka A, Archer BN, Thomas J, Crispd N, , 2012. Possible laboratory contamination leads to incorrect reporting of Vibrio cholerae O1 and initiates an outbreak response. J Clin Microbiol 50: 480482.
  25. Huggel C, Raissig A, Rohrer M, Romero G, Diaz A, Salzmann N, , 2015. How useful and reliable are disaster databases in the context of climate and global change? a comparative case study analysis in Peru. Nat Hazards Earth Syst Sci 15: 475485.
  26. Griffith DC, Kelly-Hope LA, Miller MA, , 2006. Review of reported cholera outbreaks worldwide, 1995–2005. Am J Trop Med Hyg 75: 973977.
  27. Koelle K, Rodó X, Pascual M, Yunus M, Mostafa G, , 2005. Refractory periods and climate forcing in cholera dynamics. Nature 436: 696700.
  28. Rogers L, , 1957. Thirty years’ research on the control of cholera epidemics. Br Med J 2: 11931197.
  29. Bradley M, Shakespeare R, Ruwende A, Woolhouse ME, Mason E, Munatsi A, , 1996. Epidemiological features of epidemic cholera (El Tor) in Zimbabwe. Trans R Soc Trop Med Hyg 90: 378382.
  30. Orata FD, Keim PS, Boucher Y, , 2014. The 2010 cholera outbreak in Haiti: how science solved a controversy. PLoS Pathog 10: e1003967.
  31. 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.
  32. Felsenfeld O, , 1965. Notes on food, beverages and fomites contaminated with Vibrio cholerae. Bull World Health Organ 33: 725.
  33. Jensen PK, Ensink JHJ, Jayasinghe G, van der Hoek W, Cairncross S, Dalsgaard A, , 2002. Domestic transmission routes of pathogens: the problem of in-house contamination of drinking water during storage in developing countries. Trop Med Int Health 7: 604609.
  34. Esrey SA, Potash JB, Roberts L, Shiff C, , 1991. Effects of improved water supply and sanitation on ascariasis, diarrhoea, dracunculiasis, hookworm infection, schistosomiasis, and trachoma. Bull World Health Organ 69: 609621.
  35. Watson JT, Gayer M, Connolly MA, , 2007. Epidemics after natural disasters. Emerg Infect Dis 13: 15.
  36. Gianella RA, Broitman SA, Zamcheck N, , 1973. Influence of gastric acidity on bacterial and parasitic enteric infections. A perspective. Ann Intern Med 78: 271276.

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  • Received : 06 Oct 2017
  • Accepted : 20 Jan 2018

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