Cholera Mortality rates by age
ASSIGNMENT INSTRUCTIONS: EPIDEMIOLOGY CLASS
***Assignment
- Discuss about CHOLERA
- Cholera (what it is, transmission, clinical features, prevention & management) Briefly
- Countries mostly affected (Kim article)
- Incidence and Mortality rates by age, susceptibility to the disease (Kim article)
- May discuss briefly about the “The 2010 cholera epidemic in Haiti was one of the largest cholera epidemics ever recorded” and mortality rates. https://wwwnc.cdc.gov/eid/article/22/3/14-1970_article
- The impact of Immunization and sanitation campaigns
- PLEASE USE MY REFERENCES, I’m attaching all the articles. If you want to use an extra reference, it must be scholarly, peer reviewed article. Please include DOI numbers on the reference page (It’s required in APA). References MUST be scholarly journal articles (Nothing from conferences, other text books online, goggle, .com).
- This assignment is for the DNP class and the grading is rigorous including grammar and APA style.
Thank you and let me know if you have any questions
***Some important information from articles
-Today, the global burden of cholera is high, and Africa seems to be the major locus for this disease burden. An analysis suggests that approximately 2·9 million cases and 95 000 deaths occur annually in countries with endemic cholera, with 60% of cases and 68% of deaths recorded in Africa (Clements….2017)
Cholera is a serious public health problem in developing countries. One recent study estimates there are 1.3-4.0 million cholera cases and 21000-143000 deaths per year [1] . As of 2012, there are 69 cholera-endemic countries with annual cholera incidences ranging from 10 to 2600 cases per 10000 persons. In addition to being endemic to many countries, cholera can cause epidemics in populations with little or no natural immunity, often following natural disasters during which the quality of water and sanitation can be compromised. The cholera epidemic in Haiti following the catastrophic earthquake in 2010 provides a pertinent example, where 745588 cases and 8972 deaths were reported to Ministry of Health as of 10 August 2015 (Kim..2016)
The expected size of the population at risk of cholera increases from 1348194910 in 2015 to 1549854090 in 2030 and the cholera incidence increases from 3046238 in 2015 and 3787385 in 2030 globally (Fig. 2 and see Table S1 in the Supplementary Material for details for each region and country). African and South Asian regions (AFR-D,-E, and SEAR-D) comprise 84.2% and 86.6% of global population at risk of cholera in 2015 and 2030, respectively. Cholera incidence in these three regions is responsible for 27.6% and 21.1% of global incidence in 2015 and 2030, (Kim 2017)
annual incidence and age distribution of cholera cases for three countries (Fig. 3 (a) and (b)), with four parameters (βW and χi for i=2, 3, 4) adjusted (Fig. 3 (c) and (d)). Difference in age distribution of cases between Indonesia and the other two countries (e.g., incidence rate is lowest in 5-14 year olds for Indonesia) appears to lead to the differences in estimated relative susceptibility and transmission rates. Children aged 1-4 years have the highest susceptibility in Nigeria and also in Uganda with some variability across different parameter sets, whereas infants, whose susceptibility was set to be one, have the highest susceptibility in Indonesia (Kim…2017)
the different cholera incidence rates by age are mainly due to history of exposure and subsequent immunity to the disease [3] . Because the likelihood of historic exposure to the pathogen will increase with age, cholera incidence rates will decrease with age accordingly. However, this immunity to the disease does not fully capture the observed variance in age distribution. There may be behavioral (e.g., age-specific mixing or risky behavior) or biological differences (e.g., strength of the immune system) that put young children at higher risk of (symptomatic) infection. (Kim..2017)
impacts of OCV vaccination strategies in three example countries in Africa and Asia with high cholera burden. (Kim…2016)
vaccination program reduces cholera incidence, where vaccines are given to people aged 1 year and older every three years starting in 2016 (Fig. 4 (a)). Cholera incidence following a vaccination program is maintained at low levels in all three countries with incidence being lowest in Indonesia where per capita incidence without vaccination is also lowest. Fig. 4 (b) shows that percent reduction in the number of cholera cases, or overall vaccine effectiveness in other literature [25,57] , increases with increasing vaccine coverage rate in all three countries over the period of 2015-2030. However, cholerapersists even at very high vaccine coverage rate (e.g., 90 or 100%) in some parameter sets in all three countries. Difference in percent reduction by country seems to arise because different age groups have different susceptibility and will likely play different roles in determining the population level of cholera. For example, infants are the most susceptible age group in Indonesia ( Fig. 3 (c)) and thus vaccinating 1+ year olds will likely have smaller impact in Indonesia than vaccinating the same population in Uganda where infants have the lowest susceptibility. In Nigeria, susceptibility of infants is higher than 5+ year olds, but lower than 1-4 year olds and thus the vaccination impact is between that in Uganda and Indonesia. Vaccinating about a half of the population every three years over the period of 2015-2030 reduces cholera incidence about 90%, 95%, and 60% in Nigeria, Uganda, and Indonesia, respectively. Fig. 4 (c) shows the number of cholera cases averted can vary from <1 to >50 case per 1000 vaccine doses depending on the vaccine coverage rate and country.
Along with previous modeling studies and clinical trials, our study predicts that OCVs may serve as an important tool to reduce the global burden of cholera. Periodic vaccination every three or five years can be an effective vaccination strategy and even a single round of mass vaccination can bring a significant impact in the long run. The impact of vaccination may vary by, among many other factors, how much transmission occurs via water-to-person or person-to-person route. A more sophisticated approach that can address this will be needed to better examine the impact of OCVs. (Kim …2017)
Please see assignment instructions, will upload
- 2 articles uploaded, can use the CDC website as the 3rd reference.
**Please ensure that all the paragraphs have citations (for all the papers submitted already as well), everything has to be supported with scholarly research. Thank you s much!
