Epidemiological and molecular forensics of cholera recurrence in Haiti

Stanislas Rebaudet (1, 2, 3) , Sandra Moore (4) , Emmanuel Rossignol (5) , Herve Bogreau (6, 7) , Jean Gaudart (8, 9) , Anne-Cécile Normand (10) , Marie-José Laraque (5) , Paul Adrien (11) , Jacques Boncy (5) , Renaud Piarroux (10, 12)

1 APHM - Assistance Publique - Hôpitaux de Marseille
2 Hôpital Européen [Fondation Ambroise Paré - Marseille]
3 Biostatistiques - Département de la Recherche Clinique et de l’Innovation - DRCI [IP-C, Marseille]
4 AMU - Aix Marseille Université
5 National Public Health Laboratory [Delmas, Haiti]
6 VITROME - Vecteurs - Infections tropicales et méditerranéennes
7 Unité de Parasitologie et d’Entomologie [IRBA, Marseille]
8 SESSTIM - U1252 INSERM - Aix Marseille Univ - UMR 259 IRD - Sciences Economiques et Sociales de la Santé & Traitement de l'Information Médicale
9 BiosTIC - Biostatistique et technologies de l'information et de la communication (BioSTIC) - [Hôpital de la Timone - APHM]
10 iPLESP - Institut Pierre Louis d'Epidémiologie et de Santé Publique
11 Directorate of Epidemiology Laboratory and Research [Delmas, Haiti]
12 CHU Pitié-Salpêtrière [AP-HP]

Cholera has affected Haiti with damping waves of outbreaks since October 2010. However, mechanisms behind disease persistence during lull periods remain poorly understood. By mid 2014, cholera transmission seemed to only persist in the northern part of Haiti. Meanwhile, cholera appeared nearly extinct in the capital, Port-au-Prince, where it eventually exploded in September 2014. This study aimed to determine whether this outbreak was caused by local undetected cases or by re-importation of the disease from the north. Applying an integrated approach between November 2013 and November 2014, we assessed the temporal and spatial dynamics of cholera using routine surveillance data and performed population genetics analyses of 178 Vibrio cholerae O1 clinical isolates. The results suggest that the northern part of the country exhibited a persisting metapopulation pattern with roaming oligoclonal outbreaks that could not be effectively controlled. Conversely, undetected and unaddressed autochthonous low-grade transmission persisted in the Port-au-Prince area, which may have been the source of the acute outbreak in late-2014. Cholera genotyping is a simple but powerful tool to adapt control strategies based on epidemic specificities. In Haiti, these data have already yielded significant progress in cholera surveillance, which is a key component of the strategy to eventually eliminate cholera.

Domaines: Santé publique et épidémiologie; Maladies infectieuses; Maladies émergentes

Stanislas Rebaudet, Sandra Moore, Emmanuel Rossignol, Herve Bogreau, Jean Gaudart, et al.. Epidemiological and molecular forensics of cholera recurrence in Haiti. Scientific Reports, inPress, 9 (1), pp.1164. ⟨10.1038/s41598-018-37706-0⟩. ⟨hal-02148469⟩