{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T03:20:43Z","timestamp":1791861643602,"version":"4.3.4"},"reference-count":72,"publisher":"Springer Science and Business Media LLC","issue":"10","license":[{"start":{"date-parts":[[2025,8,7]],"date-time":"2025-08-07T00:00:00Z","timestamp":1754524800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,8,7]],"date-time":"2025-08-07T00:00:00Z","timestamp":1754524800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100000865","name":"Bill and Melinda Gates Foundation","doi-asserted-by":"publisher","award":["INV-044865"],"award-info":[{"award-number":["INV-044865"]}],"id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000865","name":"Bill and Melinda Gates Foundation","doi-asserted-by":"publisher","award":["INV-044865"],"award-info":[{"award-number":["INV-044865"]}],"id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000865","name":"Bill and Melinda Gates Foundation","doi-asserted-by":"publisher","award":["INV-044865"],"award-info":[{"award-number":["INV-044865"]}],"id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000865","name":"Bill and Melinda Gates Foundation","doi-asserted-by":"publisher","award":["INV-044865"],"award-info":[{"award-number":["INV-044865"]}],"id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000865","name":"Bill and Melinda Gates Foundation","doi-asserted-by":"publisher","award":["INV-044865"],"award-info":[{"award-number":["INV-044865"]}],"id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000865","name":"Bill and Melinda Gates Foundation","doi-asserted-by":"publisher","award":["INV-044865"],"award-info":[{"award-number":["INV-044865"]}],"id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000865","name":"Bill and Melinda Gates Foundation","doi-asserted-by":"publisher","award":["INV-044865"],"award-info":[{"award-number":["INV-044865"]}],"id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000865","name":"Bill and Melinda Gates Foundation","doi-asserted-by":"publisher","award":["INV-044865"],"award-info":[{"award-number":["INV-044865"]}],"id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000865","name":"Bill and Melinda Gates Foundation","doi-asserted-by":"publisher","award":["INV-044865"],"award-info":[{"award-number":["INV-044865"]}],"id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000865","name":"Bill and Melinda Gates Foundation","doi-asserted-by":"publisher","award":["INV-044865"],"award-info":[{"award-number":["INV-044865"]}],"id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000865","name":"Bill and Melinda Gates Foundation","doi-asserted-by":"publisher","award":["INV-044865"],"award-info":[{"award-number":["INV-044865"]}],"id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000865","name":"Bill and Melinda Gates Foundation","doi-asserted-by":"publisher","award":["INV-044865"],"award-info":[{"award-number":["INV-044865"]}],"id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000865","name":"Bill and Melinda Gates Foundation","doi-asserted-by":"publisher","award":["INV-044865"],"award-info":[{"award-number":["INV-044865"]}],"id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Nat Med"],"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:p>Cholera outbreaks cause substantial morbidity and mortality in Africa, yet changes in the geographic distribution of cholera burden over time remain uncharacterized. We used surveillance data and spatial statistical models to estimate the mean annual incidence of reported suspected cholera for 2011\u20132015 and 2016\u20132020 on a 20-km grid across Africa. Across 43 countries, mean annual incidence rates remained at 11 cases per 100,000 population, with 125,701 cases estimated annually (95% credible interval (CrI): 124,737\u2013126,717) from 2016 to 2020. Cholera incidence shifted from western to eastern Africa. There were 296 million people (95% CrI: 282\u2013312 million) in high-incidence second-level administrative (ADM2) units (\u226510 cases per 100,000 per year) in 2020, 135 million of whom experienced low incidence (&lt;1 per 100,000) in 2011\u20132015. ADM2 units with high incidence in central and eastern Africa from 2011 to 2020 were more likely to report cholera in 2022\u20132023. In hypothetical scenarios of preventive disease control planning, targeting the 100 million highest-burden populations had potential to reach up to 63% of 2016\u20132020 mean annual cases but only 37% when targeting by past incidence. This retrospective analysis highlights spatiotemporal instability in cholera burden and can be used as a benchmark for tracking future progress in disease control.<\/jats:p>","DOI":"10.1038\/s41591-025-03847-9","type":"journal-article","created":{"date-parts":[[2025,8,7]],"date-time":"2025-08-07T09:02:50Z","timestamp":1754557370000},"page":"3380-3387","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Geographical shifting of cholera burden in Africa and its implications for disease control"],"prefix":"10.1038","volume":"31","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3909-2048","authenticated-orcid":false,"given":"Javier","family":"Perez-Saez","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qulu","family":"Zheng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joshua","family":"Kaminsky","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2568-8193","authenticated-orcid":false,"given":"Kaiyue","family":"Zou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5315-325X","authenticated-orcid":false,"given":"Maya N.","family":"Demby","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christina","family":"Alam","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Landau","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel","family":"DePencier","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jose Paulo M.","family":"Langa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0221-9527","authenticated-orcid":false,"given":"Roma","family":"Chilengi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Placide","family":"Welo Okitayemba","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8376-2857","authenticated-orcid":false,"given":"Godfrey","family":"Bwire","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linda","family":"Esso","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Armelle Viviane","family":"Ngomba","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0508-8027","authenticated-orcid":false,"given":"Nicole","family":"Fouda Mbarga","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emmanuel Wandera","family":"Okunga","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sebastian","family":"Yennan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fred","family":"Kapaya","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9206-1596","authenticated-orcid":false,"given":"Stephen Ogirima","family":"Ohize","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adive Joseph","family":"Seriki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6426-0096","authenticated-orcid":false,"given":"Sonia T.","family":"Hegde","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6977-7913","authenticated-orcid":false,"given":"Mustafa","family":"Sikder","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Justin","family":"Lessler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abhirup","family":"Datta","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8662-9077","authenticated-orcid":false,"given":"Andrew S.","family":"Azman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4156-9637","authenticated-orcid":false,"given":"Elizabeth C.","family":"Lee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,8,7]]},"reference":[{"key":"3847_CR1","unstructured":"Multi-Country Outbreak of Cholera, External Situation Report #1 - 28 March 2023 (World Health Organization, 2023); https:\/\/www.who.int\/publications\/m\/item\/multi-country-outbreak-of-cholera--external-situation-report--1---28-march-2023"},{"key":"3847_CR2","unstructured":"Multi-Country Outbreak of Cholera, External Situation Report #13 - 17 April 2024 (World Health Organization, 2024); https:\/\/www.who.int\/publications\/m\/item\/multi-country-outbreak-of-cholera--external-situation-report--13---17-april-2024"},{"key":"3847_CR3","unstructured":"Shortage of cholera vaccines leads to temporary suspension of two-dose strategy, as cases rise worldwide. World Health Organization https:\/\/www.who.int\/news\/item\/19-10-2022-shortage-of-cholera-vaccines-leads-to-temporary-suspension-of-two-dose-strategy--as-cases-rise-worldwide (2022)."},{"key":"3847_CR4","doi-asserted-by":"publisher","first-page":"1908","DOI":"10.1016\/S0140-6736(17)33050-7","volume":"391","author":"J Lessler","year":"2018","unstructured":"Lessler, J. et al. Mapping the burden of cholera in sub-Saharan Africa and implications for control: an analysis of data across geographical scales. Lancet 391, 1908\u20131915 (2018).","journal-title":"Lancet"},{"key":"3847_CR5","first-page":"431","volume":"98","author":"World Health Organization.","year":"2023","unstructured":"World Health Organization. Cholera, 2022. Wkly Epidemiol. Rec. 98, 431\u2013443 (2023).","journal-title":"Wkly Epidemiol. Rec."},{"key":"3847_CR6","unstructured":"Ending Cholera: A Global Roadmap to 2030 (Global Task Force for Cholera Control, 2017); https:\/\/www.gtfcc.org\/wp-content\/uploads\/2020\/09\/ending-cholera-a-global-roadmap-to-2030.pdf"},{"key":"3847_CR7","doi-asserted-by":"publisher","first-page":"A132","DOI":"10.1016\/j.vaccine.2019.08.086","volume":"38","author":"L Pezzoli","year":"2020","unstructured":"Pezzoli, L. et al. Global oral cholera vaccine use, 2013\u20132018. Vaccine 38, A132\u2013A140 (2020).","journal-title":"Vaccine"},{"key":"3847_CR8","unstructured":"Guidance and Tool for Countries to Identify Priority Areas for Intervention (Global Task Force on Cholera Control, 2019)."},{"key":"3847_CR9","unstructured":"Public Health Surveillance for Cholera (Global Task Force on Cholera Control, 2024); https:\/\/www.gtfcc.org\/resources\/public-health-surveillance-for-cholera\/"},{"key":"3847_CR10","unstructured":"Zambia Multisectorial Cholera Elimination Plan 2019\u20132025 (Republic of Zambia Ministry of Health, 2019); https:\/\/www.gtfcc.org\/wp-content\/uploads\/2025\/02\/national-cholera-plan-zambia.pdf"},{"key":"3847_CR11","unstructured":"Zanzibar Comprehensive Cholera Elimination Plan 2018\u20132027 (Revolutionary Government of Zanzibar, 2018); https:\/\/www.gtfcc.org\/wp-content\/uploads\/2025\/02\/national-cholera-plan-zanzibar.pdf"},{"key":"3847_CR12","unstructured":"Multi-Sectorial Cholera Elimination Plan Ethiopia 2021\u20132028 (Ethiopian Public Health Institute, 2023); https:\/\/ephi.gov.et\/wp-content\/uploads\/2022\/11\/Multi_Sectorial_Cholera_Elimination_Plan_Ethiopia_2022_2028_V2.pdf"},{"key":"3847_CR13","unstructured":"National Multi-Sectoral Cholera Elimination Plan 2022\u20132030 (Republic of Kenya Ministry of Health and Republic of Kenya Ministry of Water, Sanitation and Irrigation, accessed 14 July 2025); https:\/\/www.nphi.go.ke\/sites\/default\/files\/2024-02\/Final%20NMCEP%202022%20-2030%20Finalized%20in%20August%202023%2008.09.2023_compressed.pdf"},{"key":"3847_CR14","unstructured":"National Cholera Control Plan for Bangladesh 2019\u20132030 (Government of Bangladesh Ministry of Health and Family Welfare, accessed 14 July 2025); https:\/\/www.gtfcc.org\/wp-content\/uploads\/2025\/06\/national-cholera-plan-bangladesh.pdf"},{"key":"3847_CR15","doi-asserted-by":"publisher","first-page":"e1003003","DOI":"10.1371\/journal.pmed.1003003","volume":"16","author":"EC Lee","year":"2019","unstructured":"Lee, E. C. et al. The projected impact of geographic targeting of oral cholera vaccination in sub-Saharan Africa: a modeling study. PLoS Med. 16, e1003003 (2019).","journal-title":"PLoS Med."},{"key":"3847_CR16","unstructured":"Oral Rehydration Points (ORP) (Management of a Cholera Epidemic, accessed 14 July 2025) https:\/\/medicalguidelines.msf.org\/en\/node\/872"},{"key":"3847_CR17","doi-asserted-by":"publisher","first-page":"e0010042","DOI":"10.1371\/journal.pntd.0010042","volume":"15","author":"M Sikder","year":"2021","unstructured":"Sikder, M. et al. Case-area targeted preventive interventions to interrupt cholera transmission: current implementation practices and lessons learned. PLoS Negl. Trop. Dis. 15, e0010042 (2021).","journal-title":"PLoS Negl. Trop. Dis."},{"key":"3847_CR18","doi-asserted-by":"publisher","first-page":"e37","DOI":"10.1016\/S1473-3099(20)30479-5","volume":"21","author":"R Ratnayake","year":"2021","unstructured":"Ratnayake, R. et al. Highly targeted spatiotemporal interventions against cholera epidemics, 2000\u201319: a scoping review. Lancet Infect. Dis. 21, e37\u2013e48 (2021).","journal-title":"Lancet Infect. Dis."},{"key":"3847_CR19","doi-asserted-by":"publisher","first-page":"1104","DOI":"10.1038\/s41591-024-02852-8","volume":"30","author":"H Xu","year":"2024","unstructured":"Xu, H. et al. Enhanced cholera surveillance to improve vaccination campaign efficiency. Nat. Med. 30, 1104\u20131110 (2024).","journal-title":"Nat. Med."},{"key":"3847_CR20","unstructured":"Identification of Priority Areas for Multisectoral Interventions (PAMIs) for Cholera Control (Global Task Force on Cholera Control, 2023); https:\/\/www.gtfcc.org\/resources\/identification-of-priority-areas-for-multisectoral-interventions-pamis-for-cholera-control\/"},{"key":"3847_CR21","doi-asserted-by":"publisher","first-page":"1204","DOI":"10.1016\/S0140-6736(20)30925-9","volume":"396","author":"T Vos","year":"2020","unstructured":"Vos, T. et al. Global burden of 369 diseases and injuries in 204 countries and territories, 1990\u20132019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet 396, 1204\u20131222 (2020).","journal-title":"Lancet"},{"key":"3847_CR22","doi-asserted-by":"publisher","first-page":"1779","DOI":"10.1016\/S0140-6736(20)30114-8","volume":"395","author":"RC Reiner","year":"2020","unstructured":"Reiner, R. C. et al. Mapping geographical inequalities in childhood diarrhoeal morbidity and mortality in low-income and middle-income countries, 2000\u201317: analysis for the Global Burden of Disease Study 2017. Lancet 395, 1779\u20131801 (2020).","journal-title":"Lancet"},{"key":"3847_CR23","doi-asserted-by":"publisher","first-page":"1187\u20131201","DOI":"10.2147\/RMHP.S419616","volume":"16","author":"D Shi","year":"2023","unstructured":"Shi, D. et al. Trends of the global, regional and national incidence, mortality, and disability-adjusted life years of malaria, 1990\u20132019: an analysis of the Global Burden of Disease Study 2019. Risk Manag. Healthc. Policy 16, 1187\u20131201 (2023).","journal-title":"Risk Manag. Healthc. Policy"},{"key":"3847_CR24","unstructured":"Millions at risk from cholera due to lack of clean water, soap and toilets, and shortage of cholera vaccine. World Health Organization https:\/\/www.who.int\/news\/item\/20-03-2024-millions-at-risk-from-cholera-due-to-lack-of-clean-water-soap-and-toilets-and-shortage-of-cholera-vaccine (2024)."},{"key":"3847_CR25","doi-asserted-by":"publisher","first-page":"e0006379","DOI":"10.1371\/journal.pntd.0006379","volume":"12","author":"S Moore","year":"2018","unstructured":"Moore, S. et al. Dynamics of cholera epidemics from Benin to Mauritania. PLoS Negl. Trop. Dis. 12, e0006379 (2018).","journal-title":"PLoS Negl. Trop. Dis."},{"key":"3847_CR26","doi-asserted-by":"publisher","first-page":"S1","DOI":"10.1093\/cid\/ciae200","volume":"79","author":"M Hussen","year":"2024","unstructured":"Hussen, M. et al. Ethiopia National Cholera Elimination Plan 2022\u20132028: experiences, challenges, and the way forward. Clin. Infect. Dis. 79, S1\u2013S7 (2024).","journal-title":"Clin. Infect. Dis."},{"key":"3847_CR27","first-page":"148\u2013156","volume":"32","author":"BO Amisu","year":"2024","unstructured":"Amisu, B. O. et al. Cholera resurgence in Africa: assessing progress, challenges, and public health response towards the 2030 global elimination target. Infez. Med. 32, 148\u2013156 (2024).","journal-title":"Infez. Med."},{"key":"3847_CR28","doi-asserted-by":"publisher","first-page":"e016491","DOI":"10.1136\/bmjgh-2024-016491","volume":"10","author":"EL Koua","year":"2025","unstructured":"Koua, E. L. et al. Exploring the burden of cholera in the WHO African region: patterns and trends from 2000 to 2023 cholera outbreak data. BMJ Glob. Health 10, e016491 (2025).","journal-title":"BMJ Glob. Health"},{"key":"3847_CR29","doi-asserted-by":"publisher","first-page":"e577","DOI":"10.1016\/S2542-5196(20)30255-2","volume":"4","author":"FK Jones","year":"2020","unstructured":"Jones, F. K. et al. Successive epidemic waves of cholera in South Sudan between 2014 and 2017: a descriptive epidemiological study. Lancet Planet. Health 4, e577\u2013e587 (2020).","journal-title":"Lancet Planet. Health"},{"key":"3847_CR30","doi-asserted-by":"publisher","first-page":"7170","DOI":"10.1038\/s41598-024-51324-z","volume":"14","author":"S Moore","year":"2024","unstructured":"Moore, S. et al. Spatiotemporal dynamics of cholera epidemics in Ethiopia: 2015\u20132021. Sci. Rep. 14, 7170 (2024).","journal-title":"Sci. Rep."},{"key":"3847_CR31","doi-asserted-by":"publisher","first-page":"360","DOI":"10.1016\/j.coph.2021.08.002","volume":"60","author":"EI Ohimain","year":"2021","unstructured":"Ohimain, E. I. & Silas-Olu, D. The 2013\u20132016 Ebola virus disease outbreak in West Africa. Curr. Opin. Pharmacol. 60, 360\u2013365 (2021).","journal-title":"Curr. Opin. Pharmacol."},{"key":"3847_CR32","doi-asserted-by":"publisher","first-page":"330\u2013340B","DOI":"10.2471\/BLT.19.245803","volume":"98","author":"MF Jalloh","year":"2020","unstructured":"Jalloh, M. F. et al. Evidence of behaviour change during an Ebola virus disease outbreak, Sierra Leone. Bull. World Health Organ. 98, 330\u2013340B (2020).","journal-title":"Bull. World Health Organ."},{"key":"3847_CR33","unstructured":"Ghana Cholera Outbreak 2024\u2014DREF Operation (International Federation of Red Cross and Red Crescent Societies, 2025); https:\/\/reliefweb.int\/report\/ghana\/ghana-cholera-outbreak-2024-dref-operation-mdrgh020"},{"key":"3847_CR34","doi-asserted-by":"publisher","first-page":"e65159","DOI":"10.7554\/eLife.65159","volume":"10","author":"E Ekeng","year":"2021","unstructured":"Ekeng, E. et al. Regional sequencing collaboration reveals persistence of the T12 Vibrio cholerae O1 lineage in West Africa. eLife 10, e65159 (2021).","journal-title":"eLife"},{"key":"3847_CR35","doi-asserted-by":"publisher","first-page":"785","DOI":"10.1126\/science.aad5901","volume":"358","author":"FX Weill","year":"2017","unstructured":"Weill, F. X. et al. Genomic history of the seventh pandemic of cholera in Africa. Science 358, 785\u2013789 (2017).","journal-title":"Science"},{"key":"3847_CR36","doi-asserted-by":"publisher","unstructured":"Xiao, S. et al. Whole genome sequencing and transmission analysis of Vibrio cholerae isolates from Eastern and Southern Africa: a genomic epidemiology study. Preprint at medRxiv https:\/\/doi.org\/10.1101\/2024.03.28.24302717 (2025).","DOI":"10.1101\/2024.03.28.24302717"},{"key":"3847_CR37","doi-asserted-by":"publisher","first-page":"e1004286","DOI":"10.1371\/journal.pmed.1004286","volume":"20","author":"KE Wiens","year":"2023","unstructured":"Wiens, K. E. et al. Estimating the proportion of clinically suspected cholera cases that are true Vibrio cholerae infections: a systematic review and meta-analysis. PLoS Med. 20, e1004286 (2023).","journal-title":"PLoS Med."},{"key":"3847_CR38","doi-asserted-by":"publisher","first-page":"10185","DOI":"10.1021\/acs.est.3c01317","volume":"57","author":"M Sikder","year":"2023","unstructured":"Sikder, M. et al. Water, sanitation, and cholera in sub-Saharan Africa. Environ. Sci. Technol. 57, 10185\u201310192 (2023).","journal-title":"Environ. Sci. Technol."},{"key":"3847_CR39","doi-asserted-by":"publisher","first-page":"e15591","DOI":"10.5812\/iji.15591","volume":"4","author":"LM Manzo","year":"2017","unstructured":"Manzo, L. M. et al. Cholera in Niger Republic: an analysis of national surveillance data, 1991\u20132015. Int. J. Infect. 4, e15591 (2017).","journal-title":"Int. J. Infect."},{"key":"3847_CR40","doi-asserted-by":"publisher","first-page":"e0011597","DOI":"10.1371\/journal.pntd.0011597","volume":"17","author":"HC Kayembe","year":"2023","unstructured":"Kayembe, H. C. et al. Drivers of the dynamics of the spread of cholera in the Democratic Republic of the Congo, 2000\u20132018: an eco-epidemiological study. PLoS Negl. Trop. Dis. 17, e0011597 (2023).","journal-title":"PLoS Negl. Trop. Dis."},{"key":"3847_CR41","doi-asserted-by":"publisher","first-page":"e0008227","DOI":"10.1371\/journal.pntd.0008227","volume":"14","author":"J Mwaba","year":"2020","unstructured":"Mwaba, J. et al. Identification of cholera hotspots in Zambia: a spatiotemporal analysis of cholera data from 2008 to 2017. PLoS Negl. Trop. Dis. 14, e0008227 (2020).","journal-title":"PLoS Negl. Trop. Dis."},{"key":"3847_CR42","doi-asserted-by":"publisher","first-page":"e0010928","DOI":"10.1371\/journal.pntd.0010928","volume":"17","author":"W Boru","year":"2023","unstructured":"Boru, W. et al. Prioritizing interventions for cholera control in Kenya, 2015\u20132020. PLoS Negl. Trop. Dis. 17, e0010928 (2023).","journal-title":"PLoS Negl. Trop. Dis."},{"key":"3847_CR43","doi-asserted-by":"publisher","first-page":"e0006118","DOI":"10.1371\/journal.pntd.0006118","volume":"11","author":"G Bwire","year":"2017","unstructured":"Bwire, G. et al. Identifying cholera \u2018hotspots\u2019 in Uganda: an analysis of cholera surveillance data from 2011 to 2016. PLoS Negl. Trop. Dis. 11, e0006118 (2017).","journal-title":"PLoS Negl. Trop. Dis."},{"key":"3847_CR44","doi-asserted-by":"publisher","first-page":"e0011166","DOI":"10.1371\/journal.pntd.0011166","volume":"17","author":"C Kiama","year":"2023","unstructured":"Kiama, C. et al. Mapping of cholera hotspots in Kenya using epidemiologic and water, sanitation, and hygiene (WASH) indicators as part of Kenya\u2019s new 2022\u20132030 cholera elimination plan. PLoS Negl. Trop. Dis. 17, e0011166 (2023).","journal-title":"PLoS Negl. Trop. Dis."},{"key":"3847_CR45","doi-asserted-by":"publisher","first-page":"664","DOI":"10.1186\/s13104-019-4731-0","volume":"12","author":"YMG Hounmanou","year":"2019","unstructured":"Hounmanou, Y. M. G. et al. Cholera hotspots and surveillance constraints contributing to recurrent epidemics in Tanzania. BMC Res. Notes 12, 664 (2019).","journal-title":"BMC Res. Notes"},{"key":"3847_CR46","doi-asserted-by":"publisher","first-page":"e0005105","DOI":"10.1371\/journal.pntd.0005105","volume":"10","author":"MC Ngwa","year":"2016","unstructured":"Ngwa, M. C. et al. Cholera in Cameroon, 2000\u20132012: spatial and temporal analysis at the operational (health district) and sub climate levels. PLoS Negl. Trop. Dis. 10, e0005105 (2016).","journal-title":"PLoS Negl. Trop. Dis."},{"key":"3847_CR47","doi-asserted-by":"publisher","first-page":"S173\u2013S180","DOI":"10.1093\/infdis\/jiy500","volume":"218","author":"Q Bi","year":"2018","unstructured":"Bi, Q. et al. The epidemiology of cholera in Zanzibar: implications for the Zanzibar Comprehensive Cholera Elimination Plan. J. Infect. Dis. 218, S173\u2013S180 (2018).","journal-title":"J. Infect. Dis."},{"key":"3847_CR48","doi-asserted-by":"publisher","first-page":"e0005941","DOI":"10.1371\/journal.pntd.0005941","volume":"11","author":"CS Baltazar","year":"2017","unstructured":"Baltazar, C. S. et al. Multi-site cholera surveillance within the African Cholera Surveillance Network shows endemicity in Mozambique, 2011\u20132015. PLoS Negl. Trop. Dis. 11, e0005941 (2017).","journal-title":"PLoS Negl. Trop. Dis."},{"key":"3847_CR49","doi-asserted-by":"publisher","first-page":"e0231866","DOI":"10.1371\/journal.pone.0231866","volume":"15","author":"D Runfola","year":"2020","unstructured":"Runfola, D. et al. geoBoundaries: a global database of political administrative boundaries. PLoS ONE 15, e0231866 (2020).","journal-title":"PLoS ONE"},{"key":"3847_CR50","unstructured":"Cholera Taxonomy (Johns Hopkins Cholera Dynamics Team, accessed 14 July 2025); https:\/\/cholera-taxonomy.middle-distance.com\/"},{"key":"3847_CR51","unstructured":"World Population Prospects 2022: Summary of Results (United Nations, Department of Economic and Social Affairs, Population Division, 2022); https:\/\/www.un.org\/development\/desa\/pd\/sites\/www.un.org.development.desa.pd\/files\/wpp2022_summary_of_results.pdf"},{"key":"3847_CR52","unstructured":"Rivers of Africa. AQUASTAT (FAO) https:\/\/data.apps.fao.org\/catalog\/iso\/b891ca64-4cd4-4efd-a7ca-b386e98d52e8 (accessed 1 April 2024)."},{"key":"3847_CR53","unstructured":"Data Catalog. Africa - Water Bodies (World Bank Group, 2018); https:\/\/datacatalog.worldbank.org\/search\/dataset\/0040797 (accessed 1 April 2024)."},{"key":"3847_CR54","doi-asserted-by":"publisher","first-page":"1221","DOI":"10.1214\/19-BA1177","volume":"14","author":"A Datta","year":"2019","unstructured":"Datta, A., Banerjee, S., Hodges, J. S. & Gao, L. Spatial disease mapping using directed acyclic graph auto-regressive (DAGAR) models. Bayesian Anal. 14, 1221\u20131244 (2019).","journal-title":"Bayesian Anal."},{"key":"3847_CR55","doi-asserted-by":"crossref","unstructured":"Carpenter, B. et al. Stan: a probabilistic programming language. J. Stat. Softw. 76, 1 (2017).","DOI":"10.18637\/jss.v076.i01"},{"key":"3847_CR56","doi-asserted-by":"publisher","first-page":"457","DOI":"10.1214\/ss\/1177011136","volume":"7","author":"A Gelman","year":"1992","unstructured":"Gelman, A. & Rubin, D. B. Inference from iterative simulation using multiple sequences. Stat. Sci. 7, 457\u2013472 (1992).","journal-title":"Stat. Sci."},{"key":"3847_CR57","unstructured":"Betancourt, M. Towards a principled Bayesian workflow. https:\/\/betanalpha.github.io\/assets\/case_studies\/principled_bayesian_workflow.html (2020)."},{"key":"3847_CR58","unstructured":"Goodman, A. Test: Soft vs Hard sum-to-zero constrain + choosing the right prior for soft constrain. The Stan Forums https:\/\/discourse.mc-stan.org\/t\/test-soft-vs-hard-sum-to-zero-constrain-choosing-the-right-prior-for-soft-constrain\/3884\/31 (2018)."},{"key":"3847_CR59","unstructured":"Multi-Country Outbreak of Cholera, External Situation Report #9 - 7 December 2023. (World Health Organization, 2023); https:\/\/www.who.int\/publications\/m\/item\/multi-country-outbreak-of-cholera--external-situation-report--9---7-december-2023"},{"key":"3847_CR60","unstructured":"Multi-Country Outbreak of Cholera, External Situation Report#7 - 5 October 2023 (World Health Organization, 2023); https:\/\/www.who.int\/publications\/m\/item\/multi-country-outbreak-of-cholera--external-situation-report--7---5-october-2023"},{"key":"3847_CR61","unstructured":"Multi-Country Outbreak of Cholera, External Situation Report #8 - 2 November 2023 (World Health Organization, 2023); https:\/\/www.who.int\/publications\/m\/item\/multi-country-outbreak-of-cholera--external-situation-report--8---2-november-2023"},{"key":"3847_CR62","unstructured":"Multi-Country Outbreak of Cholera, External Situation Report #6 - 6 September 2023 (World Health Organization, 2023); https:\/\/www.who.int\/publications\/m\/item\/multi-country-outbreak-of-cholera--external-situation-report--6---6-september-2023"},{"key":"3847_CR63","unstructured":"Multi-Country Outbreak of Cholera, External Situation Report #5 - 4 August 2023 (World Health Organization, 2023); https:\/\/www.who.int\/publications\/m\/item\/multi-country-outbreak-of-cholera--external-situation-report--5---4-august-2023"},{"key":"3847_CR64","unstructured":"Multi-Country Outbreak of Cholera, External Situation Report #4 - 6 July 2023 (World Health Organization, 2023); https:\/\/www.who.int\/publications\/m\/item\/multi-country-outbreak-of-cholera--external-situation-report--4---6-july-2023"},{"key":"3847_CR65","unstructured":"Multi-Country Outbreak of Cholera, External Situation Report #3 - 1 June 2023 (World Health Organization, 2023); https:\/\/www.who.int\/publications\/m\/item\/multi-country-outbreak-of-cholera--external-situation-report--3---1-june-2023"},{"key":"3847_CR66","unstructured":"Multi-Country Outbreak of Cholera, External Situation Report #2 - 15 May 2023 (World Health Organization, 2023); https:\/\/www.who.int\/publications\/m\/item\/multi-country-outbreak-of-cholera--external-situation-report--2---15-may-2023"},{"key":"3847_CR67","unstructured":"Multi-Country Outbreak of Cholera, External Situation Report #10 - 11 January 2024 (World Health Organization, 2024); https:\/\/www.who.int\/publications\/m\/item\/multi-country-outbreak-of-cholera--external-situation-report--10---11-january-2024"},{"key":"3847_CR68","unstructured":"An Update of Cholera Outbreak in Nigeria (Nigeria Centre for Disease Control and Prevention, accessed 14 July 2025); https:\/\/ncdc.gov.ng\/diseases\/sitreps\/?cat=7&name=An%20update%20of%20Cholera%20outbreak%20in%20Nigeria"},{"key":"3847_CR69","unstructured":"South Sudan: Cholera Outbreak Situation Report_2023 (World Health Organization African Region, 2023); https:\/\/www.afro.who.int\/countries\/south-sudan\/publication\/south-sudan-cholera-outbreak-situation-report-2023"},{"key":"3847_CR70","unstructured":"Cholera in the WHO African Region, Weekly Regional Cholera Bulletin 29 January 2024 (World Health Organization African Region, 2024); https:\/\/www.afro.who.int\/countries\/togo\/publication\/weekly-regional-cholera-bulletin-29-january-2024"},{"key":"3847_CR71","unstructured":"Weekly Bulletin on Outbreaks and Other Emergencies: Week 40: 02 October - 08 October 2023 (World Health Organization African Region, 2023); https:\/\/reliefweb.int\/report\/ethiopia\/weekly-bulletin-outbreaks-and-other-emergencies-week-40-02-october-08-october-2023-data-reported-1700-08-october-2023"},{"key":"3847_CR72","unstructured":"Sudan Outbreaks Dashboard (World Health Organization, accessed 14 July 2025); https:\/\/worldhealthorg.shinyapps.io\/OutbreaksDashboard\/"}],"container-title":["Nature Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/s41591-025-03847-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41591-025-03847-9","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41591-025-03847-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,16]],"date-time":"2025-10-16T14:05:16Z","timestamp":1760623516000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/s41591-025-03847-9"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,7]]},"references-count":72,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2025,10]]}},"alternative-id":["3847"],"URL":"https:\/\/doi.org\/10.1038\/s41591-025-03847-9","relation":{},"ISSN":["1078-8956","1546-170X"],"issn-type":[{"value":"1078-8956","type":"print"},{"value":"1546-170X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,7]]},"assertion":[{"value":"6 September 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"18 June 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"7 August 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"Several authors participate regularly in meetings or are members of the Global Task Force on Cholera Control Surveillance and Oral Cholera Vaccine Working Groups, which provide technical expertise on cholera surveillance and oral cholera vaccine use. A.S.A. is a member of the Gavi Independent Review Committee.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}]}}