Uganda’s cholera elimination journey in a cholera endemic region of Africa

Résumé

Uganda has been endemic for cholera since 1971. To reduce the threat of cholera, Uganda reviewed its approach to cholera, emphasizing surveillance, continued using single dose doxycycline for cholera patients and their households, and conducted 16 oral cholera vaccine campaigns in high-risk districts between 2018 and 2021.To understand recent changes in cholera patternsand the impact of the OCV campaigns, we classified districts as endemic, eliminated, or relapsed using the method as defined by the "cholera elimination scorecard" for the years 2018-2024 using cholera surveillance data from the Ministry of Health. We also reviewed Uganda's policy regarding cholera surveillance and antibiotic use for cholera patients and their immediate households. To understand risks from cross-border cholera transmission, we reviewed cholera reports from the other countries in the East African Community. During the 16 campaigns with OCV (each campaign with two rounds), 2,263,790 people living in high risk subcounties of the hotspot districts were targeted for vaccination. Overall administrative vaccine coverage was 94% for the first round and 84% for the second round. Based on national surveillance data, the number of endemic districts fell from 36 prior to the campaigns to six after the campaigns. To identify new outbreaks and reduce the threat from cholera, Uganda implemented enhanced cholera surveillance, especially in the border areas, and administered single dose doxycycline to all cholera patients and their households with the intention to treat them and prevent spread of the outbreak. Since 2021, all cholera outbreaks in Uganda have been epidemiologically linked with cross-border spread from neighboring countries.Uganda has eliminated endogenous cholera (that is, cholera originating from within the country), but it remains vulnerable to cholera from neighboring countries in the region. Uganda's experience to control cholera may be useful for other countries in Africa which are attempting to eliminate this disease.

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