{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,5]],"date-time":"2026-11-05T07:32:55Z","timestamp":1793863975972,"version":"4.6.1"},"reference-count":50,"publisher":"National Academy of Sciences","issue":"17","license":[{"start":{"date-parts":[[2017,4,10]],"date-time":"2017-04-10T00:00:00Z","timestamp":1491782400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/www.pnas.org\/site\/misc\/userlicense.xhtml"}],"funder":[{"DOI":"10.13039\/100000865","name":"Bill and Melinda Gates Foundation","doi-asserted-by":"publisher","award":["OPP1127318"],"award-info":[{"award-number":["OPP1127318"]}],"id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000001","name":"National Science Foundation","doi-asserted-by":"publisher","award":["1639214"],"award-info":[{"award-number":["1639214"]}],"id":[{"id":"10.13039\/100000001","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.pnas.org"],"crossmark-restriction":true},"short-container-title":["Proc. Natl. Acad. Sci. U.S.A."],"published-print":{"date-parts":[[2017,4,25]]},"abstract":"<jats:title>Significance<\/jats:title>\n                  <jats:p>In the wake of the 2015\u20132016 El Ni\u00f1o, multiple cholera epidemics occurred in East Africa, including the largest outbreak since the 1997\u20131998 El Ni\u00f1o in Tanzania, suggesting a link between El Ni\u00f1o and cholera in Africa. However, little evidence exists for this link. Using high-resolution mapping techniques, we found the cholera burden shifts to East Africa during and following El Ni\u00f1o events. Throughout Africa, cholera incidence increased three-fold in El Ni\u00f1o-sensitive regions, and 177 million people experienced an increase in cholera incidence. Without treatment, the case fatality rate can reach 50%, but accessible, appropriate care nearly eliminates mortality. Climatic forecasts predicting El Ni\u00f1o events 6\u201312 mo in advance could trigger public health preparations and save lives.<\/jats:p>","DOI":"10.1073\/pnas.1617218114","type":"journal-article","created":{"date-parts":[[2017,4,10]],"date-time":"2017-04-10T20:55:27Z","timestamp":1491857727000},"page":"4436-4441","update-policy":"https:\/\/doi.org\/10.1073\/pnas.cm10313","source":"Crossref","is-referenced-by-count":113,"title":["El Ni\u00f1o and the shifting geography of cholera in Africa"],"prefix":"10.1073","volume":"114","author":[{"given":"Sean M.","family":"Moore","sequence":"first","affiliation":[{"name":"Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205;"},{"name":"Department of Biological Sciences, University of Notre Dame, Notre Dame, IN 46556;"},{"name":"Eck Institute for Global Health, University of Notre Dame, Notre Dame, IN 46556;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew S.","family":"Azman","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin F.","family":"Zaitchik","sequence":"additional","affiliation":[{"name":"Department of Earth and Planetary Sciences, Johns Hopkins University, Baltimore, MD 21218;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric D.","family":"Mintz","sequence":"additional","affiliation":[{"name":"Division of Foodborne, Waterborne and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30329;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joan","family":"Brunkard","sequence":"additional","affiliation":[{"name":"Division of Foodborne, Waterborne and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30329;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dominique","family":"Legros","sequence":"additional","affiliation":[{"name":"Department of Pandemic and Epidemic Diseases, World Health Organization, 1211, Geneva, Switzerland;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandra","family":"Hill","sequence":"additional","affiliation":[{"name":"Department of Pandemic and Epidemic Diseases, World Health Organization, 1211, Geneva, Switzerland;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heather","family":"McKay","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francisco J.","family":"Luquero","sequence":"additional","affiliation":[{"name":"Epicentre, 75012 Paris, France;"},{"name":"Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Olson","sequence":"additional","affiliation":[{"name":"Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Justin","family":"Lessler","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"341","published-online":{"date-parts":[[2017,4,10]]},"reference":[{"key":"e_1_3_3_1_2","first-page":"517","article-title":"Cholera, 2014","volume":"90","author":"World Health Organization","year":"2015","unstructured":"; World Health Organization, Cholera, 2014. Wkly Epidemiol Rec 90, 517\u2013528 (2015).","journal-title":"Wkly Epidemiol Rec"},{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1038\/nature10392"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(95)90344-5"},{"key":"e_1_3_3_4_2","first-page":"117","article-title":"Cholera outbreaks in Africa","volume":"379","author":"Mengel MA","year":"2014","unstructured":"MA Mengel, I Delrieu, L Heyerdahl, BD Gessner, Cholera outbreaks in Africa. Curr Top Microbiol Immunol 379, 117\u2013144 (2014).","journal-title":"Curr Top Microbiol Immunol"},{"key":"e_1_3_3_5_2","unstructured":"; WHO Cholera case fatality rate: Situations and trends. Available at www.who.int\/gho\/epidemic_diseases\/cholera\/case_fatality_rate_text\/en. Accessed May 5 2016. (2015)."},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2334-7-20"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.4269\/ajtmh.2011.10-0277"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1126\/science.289.5485.1766"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1038\/nature04188"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1126\/science.222.4629.1195"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1175\/1520-0493(1987)115<1606:GARSPP>2.0.CO;2"},{"key":"e_1_3_3_12_2","unstructured":"; National Oceanic and Atmospheric Administration Climate Prediction Center: ENSO diagnostic discussion. Available at www.cpc.ncep.noaa.gov\/products\/analysis_monitoring\/enso_advisory\/ensodisc.html. Accessed April 6 2016. (2016)."},{"key":"e_1_3_3_13_2","volume-title":"The History of Cholera in India from 1862-1881: Being a Descriptive and Statistical Account of the Disease as Derived from the Published Official Reports of the Several Provincial Governments During that Period and Mainly in Illustration of the Relation Between Cholera Activity and Climatic Conditions Together with Original Observations on the Causes and Nature of Cholera","author":"Bellew HW","year":"1885","unstructured":"HW Bellew The History of Cholera in India from 1862-1881: Being a Descriptive and Statistical Account of the Disease as Derived from the Published Official Reports of the Several Provincial Governments During that Period and Mainly in Illustration of the Relation Between Cholera Activity and Climatic Conditions Together with Original Observations on the Causes and Nature of Cholera (Trubner & Co., London, 1885)."},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.1126\/science.274.5295.2025"},{"key":"e_1_3_3_15_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2672.1998.tb05292.x"},{"key":"e_1_3_3_16_2","doi-asserted-by":"publisher","DOI":"10.1038\/nature03820"},{"key":"e_1_3_3_17_2","doi-asserted-by":"publisher","DOI":"10.1093\/infdis\/jit195"},{"key":"e_1_3_3_18_2","first-page":"2026","article-title":"Dynamics of cholera outbreaks in Great Lakes region of Africa, 1978-2008","volume":"17","author":"Bompangue Nkoko D","year":"2011","unstructured":"D Bompangue Nkoko, , Dynamics of cholera outbreaks in Great Lakes region of Africa, 1978-2008. Emerg Infect Dis 17, 2026\u20132034 (2011).","journal-title":"Emerg Infect Dis"},{"key":"e_1_3_3_19_2","doi-asserted-by":"publisher","DOI":"10.1579\/0044-7447(2007)36[350:CSAHFA]2.0.CO;2"},{"key":"e_1_3_3_20_2","doi-asserted-by":"publisher","DOI":"10.1017\/S0022172400060083"},{"key":"e_1_3_3_21_2","doi-asserted-by":"publisher","DOI":"10.1017\/S0950268800067418"},{"key":"e_1_3_3_22_2","doi-asserted-by":"publisher","DOI":"10.4269\/ajtmh.2006.75.973"},{"key":"e_1_3_3_23_2","unstructured":"; World Health Organization Weekly epidemiological record: Cholera articles. Available at www.who.int\/cholera\/statistics\/en. Accessed March 30 2016. (2014)."},{"key":"e_1_3_3_24_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pntd.0003832"},{"key":"e_1_3_3_25_2","doi-asserted-by":"publisher","DOI":"10.1038\/nclimate2100"},{"key":"e_1_3_3_26_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10584-015-1439-6"},{"key":"e_1_3_3_27_2","doi-asserted-by":"publisher","DOI":"10.1038\/nature12683"},{"key":"e_1_3_3_28_2","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1007\/978-94-017-7499-4_4","volume-title":"El Ni\u00f1o and Southern Oscillation (ENSO): A Review. Coral Reefs of the Eastern Tropical Pacific","author":"Wang C","year":"2017","unstructured":"C Wang, C Deser, J-Y Yu, P DiNezio, A Clement, Coral reefs of the eastern tropical Pacific. El Ni\u00f1o and Southern Oscillation (ENSO): A Review. Coral Reefs of the Eastern Tropical Pacific, eds PW Glynn, DP Manzello, IC Enochs (Springer, Dordrecht, The Netherlands), pp. 85\u2013106 (2017)."},{"key":"e_1_3_3_29_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00382-011-1222-y"},{"key":"e_1_3_3_30_2","doi-asserted-by":"publisher","DOI":"10.1126\/sciadv.1500682"},{"key":"e_1_3_3_31_2","doi-asserted-by":"publisher","DOI":"10.1073\/pnas.1323058111"},{"key":"e_1_3_3_32_2","doi-asserted-by":"publisher","DOI":"10.1175\/BAMS-D-11-00111.1"},{"key":"e_1_3_3_33_2","unstructured":"United Nations International Children\u2019s Emergency Fund (2016) Cholera outbreaks in Central and West Africa: 2016 regional update - Week 06. Available at https:\/\/www.unicef.org\/cholera\/files\/WCA_Cholera_Update_W6.pdf. Accessed April 6 2016."},{"key":"e_1_3_3_34_2","unstructured":"R Bivand C Rundel rgeos: Interface to Geometry Engine - Open Source (GEOS) . Available at cran.r-project.org\/web\/packages\/rgeos\/index.html Accessed November 16 2016. (2014)."},{"key":"e_1_3_3_35_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhydrol.2004.03.028"},{"key":"e_1_3_3_36_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1001626"},{"key":"e_1_3_3_37_2","unstructured":"RJ Hijmans raster: Geographic Data Analysis and Modeling . Available at https:\/\/cran.r-project.org\/web\/packages\/raster\/index.html. Accessed November 16 2016. (2015)."},{"key":"e_1_3_3_38_2","doi-asserted-by":"publisher","DOI":"10.1038\/sdata.2015.66"},{"key":"e_1_3_3_39_2","doi-asserted-by":"publisher","DOI":"10.1175\/BAMS-85-3-381"},{"key":"e_1_3_3_40_2","unstructured":"K Didan MOD13C2 MODIS\/Terra Vegetation Indices Monthly L3 Global 0.05Deg CMG V006 https:\/\/dx.doi.org\/10.5067\/MODIS\/MOD13C2.006. (2015)."},{"key":"e_1_3_3_41_2","doi-asserted-by":"publisher","DOI":"10.1175\/2007JCLI2100.1"},{"key":"e_1_3_3_42_2","doi-asserted-by":"publisher","DOI":"10.1007\/BF00116466"},{"key":"e_1_3_3_43_2","doi-asserted-by":"publisher","DOI":"10.1201\/b17115"},{"key":"e_1_3_3_44_2","doi-asserted-by":"publisher","DOI":"10.1002\/1097-0258(20000915\/30)19:17\/18<2377::AID-SIM576>3.0.CO;2-1"},{"key":"e_1_3_3_45_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.csda.2008.08.010"},{"key":"e_1_3_3_46_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.sste.2011.03.001"},{"key":"e_1_3_3_47_2","doi-asserted-by":"publisher","DOI":"10.1137\/1109020"},{"key":"e_1_3_3_48_2","first-page":"359","article-title":"Smooth regression analysis","volume":"26","author":"Watson GS","year":"1964","unstructured":"GS Watson, Smooth regression analysis. Sankhya Ser A 26, 359\u2013372 (1964).","journal-title":"Sankhya Ser A"},{"key":"e_1_3_3_49_2","unstructured":"D Nychka R Furrer S Sain fields: Tools for Spatial Data . Available at https:\/\/cran.r-project.org\/web\/packages\/fields\/index.html. Accessed November 16 2016. (2015)."},{"key":"e_1_3_3_50_2","doi-asserted-by":"publisher","DOI":"10.1002\/hyp.9740"}],"container-title":["Proceedings of the National Academy of Sciences"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.pnas.org\/syndication\/doi\/10.1073\/pnas.1617218114","content-type":"unspecified","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/pnas.org\/doi\/pdf\/10.1073\/pnas.1617218114","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,4,13]],"date-time":"2022-04-13T02:24:36Z","timestamp":1649816676000},"score":1,"resource":{"primary":{"URL":"https:\/\/pnas.org\/doi\/full\/10.1073\/pnas.1617218114"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,4,10]]},"references-count":50,"journal-issue":{"issue":"17","published-print":{"date-parts":[[2017,4,25]]}},"alternative-id":["10.1073\/pnas.1617218114"],"URL":"https:\/\/doi.org\/10.1073\/pnas.1617218114","relation":{},"ISSN":["0027-8424","1091-6490"],"issn-type":[{"value":"0027-8424","type":"print"},{"value":"1091-6490","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,4,10]]},"assertion":[{"value":"2017-04-10","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}