{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T14:59:02Z","timestamp":1793372342595,"version":"4.5.0"},"reference-count":48,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,12,1]],"date-time":"2021-12-01T00:00:00Z","timestamp":1638316800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,12,19]],"date-time":"2021-12-19T00:00:00Z","timestamp":1639872000000},"content-version":"vor","delay-in-days":18,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Infect Dis"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>Cholera outbreaks in western Democratic Republic of the Congo (DRC) are thought to be primarily the result of westward spread of cases from the Great Lakes Region. However, other patterns of spatial spread in this part of the country should not be excluded. The aim of this study was to explore alternative routes of spatial spread in western DRC.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>A literature review was conducted to reconstruct major outbreak expansions of cholera in western DRC since its introduction in 1973. We also collected data on cholera cases reported at the health zone (HZ) scale by the national surveillance system during 2000\u20132018. Based on data from routine disease surveillance, we identified two subperiods (week 45, 2012\u2013week 42, 2013 and week 40, 2017\u2013week 52, 2018) for which the retrospective space\u2013time permutation scan statistic was implemented to detect spatiotemporal clusters of cholera cases and then to infer the spread patterns in western DRC other than that described in the literature.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Beyond westward and cross-border spread in the West Congo Basin from the Great Lakes Region, other dynamics of cholera epidemic propagation were observed from neighboring countries, such as Angola, to non-endemic provinces of southwestern DRC. Space\u2013time clustering analyses sequentially detected clusters of cholera cases from southwestern DRC to the northern provinces, demonstrating a downstream-to-upstream spread along the Congo River.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>The spread of cholera in western DRC is not one-sided. There are other patterns of spatial spread, including a propagation from downstream to upstream areas along the Congo River, to be considered as preferential trajectories of cholera in western DRC.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12879-021-06986-9","type":"journal-article","created":{"date-parts":[[2021,12,19]],"date-time":"2021-12-19T06:03:45Z","timestamp":1639893825000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["The spread of cholera in western Democratic Republic of the Congo is not unidirectional from East\u2013West: a spatiotemporal analysis, 1973\u20132018"],"prefix":"10.1186","volume":"21","author":[{"given":"Harry C\u00e9sar Ntumba","family":"Kayembe","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catherine","family":"Linard","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Didier","family":"Bompangue","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J\u00e9r\u00e9mie","family":"Muwonga","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michel","family":"Moutschen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hippolyte","family":"Situakibanza","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pierre","family":"Ozer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,12,19]]},"reference":[{"key":"6986_CR1","doi-asserted-by":"crossref","unstructured":"Weill F-X, Domman D, Njamkepo E, Tarr C, Rauzier J, Fawal N, et al. Genomic history of the seventh pandemic of cholera in Africa. Science. 2017;358(6364):785\u20139. https:\/\/science.sciencemag.org\/content\/358\/6364\/785","DOI":"10.1126\/science.aad5901"},{"key":"6986_CR2","doi-asserted-by":"crossref","unstructured":"Bompangue Nkoko D, Giraudoux P, Plisnier P-D, Tinda AM, Piarroux M, Sudre B, et al. Dynamics of cholera outbreaks in great lakes region of Africa, 1978\u20132008. Emerg Infect Dis. 2011;17(11):2026\u201334. https:\/\/hal.archives-ouvertes.fr\/hal-00650525","DOI":"10.3201\/eid1711.110170"},{"key":"6986_CR3","unstructured":"Centers for Disease Control and Prevention. History of Ebola Virus Disease (EVD) Outbreaks. Cases and Outbreaks of EVD by Country. https:\/\/www.cdc.gov\/vhf\/ebola\/history\/chronology.html"},{"issue":"1","key":"6986_CR4","doi-asserted-by":"publisher","first-page":"9","DOI":"10.1186\/1752-1505-8-9","volume":"8","author":"S Mancini","year":"2014","unstructured":"Mancini S, Coldiron ME, Ronsse A, Ilunga BK, Porten K, Grais RF. Description of a large measles epidemic in Democratic Republic of Congo, 2010\u20132013. Confl Health. 2014;8(1):9. https:\/\/doi.org\/10.1186\/1752-1505-8-9.","journal-title":"Confl Health."},{"issue":"5","key":"6986_CR5","doi-asserted-by":"publisher","first-page":"542","DOI":"10.1016\/S1473-3099(20)30265-6","volume":"20","author":"T Ducomble","year":"2020","unstructured":"Ducomble T, Gignoux E. Learning from a massive epidemic: measles in DRC. Lancet Infect Dis. 2020;20(5):542.","journal-title":"Lancet Infect Dis."},{"issue":"12","key":"6986_CR6","doi-asserted-by":"publisher","first-page":"e0007029","DOI":"10.1371\/journal.pntd.0007029","volume":"12","author":"B Ingelbeen","year":"2018","unstructured":"Ingelbeen B, Weregemere NA, Noel H, Tshapenda GP, Mossoko M, Nsio J, et al. Urban yellow fever outbreak\u2014Democratic Republic of the Congo, 2016: Towards more rapid case detection. PLoS Negl Trop Dis. 2018;12(12):e0007029. https:\/\/doi.org\/10.1371\/journal.pntd.0007029.","journal-title":"PLoS Negl Trop Dis."},{"key":"6986_CR7","first-page":"1","volume":"984","author":"World Health Organization","year":"2013","unstructured":"World Health Organization. Control and surveillance of human African trypanosomiasis. World Health Organ Tech Rep Ser. 2013;984:1\u2013237.","journal-title":"World Health Organ Tech Rep Ser"},{"key":"6986_CR8","doi-asserted-by":"publisher","first-page":"20","DOI":"10.1186\/s12942-015-0013-9","volume":"14","author":"C Lumbala","year":"2015","unstructured":"Lumbala C, Simarro PP, Cecchi G, Paone M, Franco JR, Mesu V, et al. Human African trypanosomiasis in the Democratic Republic of the Congo: disease distribution and risk. Int J Health Geogr. 2015;14:20.","journal-title":"Int J Health Geogr."},{"issue":"4","key":"6986_CR9","first-page":"391","volume":"59","author":"C Schyns","year":"1979","unstructured":"Schyns C, Fossa A, et al. Cholera in Eastern Zaire, 1978. Ann Soc Belg Med Trop. 1979;59(4):391\u2013400.","journal-title":"Ann Soc Belg Med Trop."},{"issue":"4","key":"6986_CR10","first-page":"401","volume":"59","author":"M Malengreau","year":"1979","unstructured":"Malengreau M, Gillieaux M, De Feyter M, Wittman L. The cholera epidemic in Eastern Zaire in 1978. Ann Soc Belg Med Trop. 1979;59(4):401\u201312.","journal-title":"Ann Soc Belg Med Trop"},{"issue":"8946","key":"6986_CR11","doi-asserted-by":"publisher","first-page":"339","DOI":"10.1016\/S0140-6736(95)90338-0","volume":"345","author":"Goma Epidemiology Group","year":"1995","unstructured":"Goma Epidemiology Group. Public health impact of Rwandan refugee crisis: what happened in Goma, Zaire, in July, 1994? Lancet. 1995;345(8946):339\u201344.","journal-title":"Lancet"},{"key":"6986_CR12","unstructured":"World Health Organization. Cholera case and death numbers by country. Wkly Epidemiol Rec. http:\/\/www.who.int\/cholera\/en\/"},{"key":"6986_CR13","unstructured":"INS. Enqu\u00eates par grappes \u00e0 indicateurs multiples, 2017\u20132018, rapport des r\u00e9sultats de l\u2019enqu\u00eate. Kinshasa, R\u00e9publique D\u00e9mocratique du Congo. 2019. https:\/\/www.unicef.org\/drcongo\/rapports\/resume-mics-palu-2017-2018"},{"key":"6986_CR14","unstructured":"Minist\u00e8re du Plan et Suivi de la Mise en \u0153uvre de la R\u00e9volution de la Modernit\u00e9, Minist\u00e8re de la Sant\u00e9 Publique et ICF International. Enqu\u00eate D\u00e9mographique et de Sant\u00e9 en R\u00e9publique D\u00e9mocratique du Congo. 2014. https:\/\/www.unicef.org\/drcongo\/media\/1046\/file\/EDS-RDC%20II%202013-2014.pdf"},{"issue":"5","key":"6986_CR15","doi-asserted-by":"publisher","first-page":"798","DOI":"10.3201\/eid1405.071260","volume":"14","author":"D Bompangue","year":"2008","unstructured":"Bompangue D, Giraudoux P, Handschumacher P, Piarroux M, Sudre B, Ekwanzala M, et al. Lakes as Source of Cholera Outbreaks, Democratic Republic of Congo. Emerg Infect Dis. 2008;14(5):798\u2013800.","journal-title":"Emerg Infect Dis."},{"key":"6986_CR16","doi-asserted-by":"publisher","first-page":"5","DOI":"10.1371\/journal.pntd.0000436","volume":"3","author":"D Bompangue","year":"2009","unstructured":"Bompangue D, Giraudoux P, Piarroux M, Mutombo G, Shamavu R, Sudre B, et al. Cholera Epidemics, War and Disasters around Goma and Lake Kivu: An Eight-Year Survey. PLoS Negl Trop Dis. 2009;3:5.","journal-title":"PLoS Negl Trop Dis."},{"key":"6986_CR17","doi-asserted-by":"crossref","unstructured":"Bompangue D, Vesenbeckh SM, Giraudoux P, Castro M, Muyembe J-J, Ilunga BK, et al. Cholera ante portas\u2013The re-emergence of cholera in Kinshasa after a ten-year hiatus. PLOS Curr Disasters. 2012;4:RRN1310. http:\/\/currents.plos.org\/disasters\/article\/cholera-ante-portas-the-re-emergence-of-cholera-in-kinshasa-after-a-ten-year-hiatus\/","DOI":"10.1371\/currents.RRN1310"},{"issue":"Suppl 1","key":"6986_CR18","doi-asserted-by":"publisher","first-page":"S46","DOI":"10.1093\/infdis\/jit195","volume":"208","author":"S Rebaudet","year":"2013","unstructured":"Rebaudet S, Sudre B, Faucher B, Piarroux R. Environmental determinants of cholera outbreaks in inland Africa: a systematic review of main transmission foci and propagation routes. J Infect Dis. 2013;208(Suppl 1):S46-54.","journal-title":"J Infect Dis"},{"issue":"5","key":"6986_CR19","doi-asserted-by":"publisher","first-page":"856","DOI":"10.3201\/eid2505.181141","volume":"25","author":"B Ingelbeen","year":"2019","unstructured":"Ingelbeen B, Hendrickx D, Miwanda B, van der Sande MAB, Mossoko M, Vochten H, et al. Recurrent Cholera Outbreaks, Democratic Republic of the Congo, 2008\u20132017. Emerg Infect Dis. 2019;25(5):856\u201364.","journal-title":"Emerg Infect Dis"},{"key":"6986_CR20","unstructured":"World Health Organization. 1997 - Health situation in Rwandan refugee camp in Zaire. 1997. https:\/\/www.who.int\/csr\/don\/1997_01_20\/en\/"},{"key":"6986_CR21","unstructured":"Centers for Disease Control and Prevention (CDC). Cholera outbreak among Rwandan refugees--Democratic Republic of Congo, April 1997. MMWR Morb Mortal Wkly Rep. 1998;47(19):389\u201391."},{"issue":"16","key":"6986_CR22","first-page":"109","volume":"72","author":"World Health Organization","year":"1997","unstructured":"World Health Organization. Weekly epidemiological record - 18 April 1997. Wkly Epidemiol Rec. 1997;72(16):109\u201316.","journal-title":"Wkly Epidemiol Rec"},{"key":"6986_CR23","doi-asserted-by":"crossref","unstructured":"Bruneau J-C. Les nouvelles provinces de la R\u00e9publique D\u00e9mocratique du Congo\u202f: construction territoriale et ethnicit\u00e9s [Internet]. L\u2019Espace Politique. Revue en ligne de g\u00e9ographie politique et de g\u00e9opolitique. D\u00e9partement de g\u00e9ographie de l\u2019universit\u00e9 de Reims Champagne-Ardenne. 2009. https:\/\/journals.openedition.org\/espacepolitique\/1296","DOI":"10.4000\/espacepolitique.1296"},{"key":"6986_CR24","unstructured":"Neyt F. Fleuve Congo. Arts d\u2019Afrique centrale, correspondances et mutations des formes. 2010. https:\/\/www.decitre.fr\/livres\/fleuve-congo-9789061539148.html"},{"key":"6986_CR25","unstructured":"GTFCC Surveillance Working Group. Interim guidance document on cholera surveillance. 2017. https:\/\/www.who.int\/cholera\/task_force\/GTFCC-Guidance-cholera-surveillance.pdf?ua=1"},{"key":"6986_CR26","unstructured":"World Health Organization. Guidelines for Cholera Control. 1996. http:\/\/helid.digicollection.org\/en\/d\/Jwho90e\/"},{"key":"6986_CR27","unstructured":"Kulldorff M. SaTScanTM v9.6: Software for the Spatial and Space-Time Scan Statistics. Information Management Services. 2018. www.satscan.org."},{"issue":"1","key":"6986_CR28","doi-asserted-by":"publisher","first-page":"449","DOI":"10.1186\/1471-2334-14-449","volume":"14","author":"PF Horwood","year":"2014","unstructured":"Horwood PF, Karl S, Mueller I, Jonduo MH, Pavlin BI, Dagina R, et al. Spatio-temporal epidemiology of the cholera outbreak in Papua New Guinea, 2009\u20132011. BMC Infect Dis. 2014;14(1):449. https:\/\/doi.org\/10.1186\/1471-2334-14-449.","journal-title":"BMC Infect Dis."},{"key":"6986_CR29","doi-asserted-by":"crossref","unstructured":"R\u00e9my G, Dejours H. L\u2019Africanisation du chol\u00e9ra. Cahiers d'outre-mer. 1988;41(162):105\u201338. https:\/\/www.persee.fr\/doc\/caoum_0373-5834_1988_num_41_162_3258","DOI":"10.3406\/caoum.1988.3258"},{"issue":"34","key":"6986_CR30","first-page":"17","volume":"2","author":"B Carme","year":"1983","unstructured":"Carme B, Mavumu Ngwak M, Trape J-F, Yala F, Felix M. L\u2019implantation et l\u2019extension du chol\u00e9ra en Afrique Noire\u202f: 1970\u20131980. Rev M\u00e9d Congo. 1983;2(34):17\u201329.","journal-title":"Rev M\u00e9d Congo"},{"issue":"1","key":"6986_CR31","doi-asserted-by":"publisher","first-page":"262","DOI":"10.3201\/eid2701.200375","volume":"27","author":"S Breurec","year":"2021","unstructured":"Breurec S, Franck T, Njamkepo E, Mbecko J-R, Rauzier J, Sanke-Wa\u00efgana H, et al. Seventh Pandemic Vibrio cholerae O1 Sublineages Central African Republic. Emerg Infect Dis. 2021;27(1):262\u20136.","journal-title":"Emerg Infect Dis"},{"key":"6986_CR32","unstructured":"Moore S, Dunoyer J, Sudre B, Valingot C, Rebaudet S, Piarroux R. Epidemiological study of cholera hotspots and epidemiological basins in East and Southern Africa. In-depth report on cholera epidemiology in Angola. UNICEF. 2018. http:\/\/www.platefor.mywhc.ca\/attachments\/article\/794\/Cholera%20epidemiology%20in%20Angola_UNICEF_2018_FINAL.pdf"},{"key":"6986_CR33","unstructured":"Minist\u00e8re de la Sant\u00e9 Publique. Situation \u00e9pid\u00e9miologique du chol\u00e9ra en R\u00e9publique D\u00e9mocratique du Congo en 2011. 2012. https:\/\/reliefweb.int\/sites\/reliefweb.int\/files\/resources\/RAPPORT%20SUR%20LA%20SITUATION%20DU%20CHOLERA%20EN%20RDC%20EN%202011%20DB-30_06_12.pdf"},{"key":"6986_CR34","unstructured":"UNICEF. UNICEF fights \u201cone of the worst ever\u201d cholera outbreaks in West and Central Africa - Cameroon. ReliefWeb. 2011. https:\/\/reliefweb.int\/report\/cameroon\/unicef-fights-%E2%80%9Cone-worst-ever%E2%80%9D-cholera-outbreaks-west-and-central-africa"},{"key":"6986_CR35","unstructured":"World Health Organization. Cholera outbreaks in the Democratic Republic of Congo (DRC) and the Republic of Congo [Internet]. WHO. World Health Organization; 2011 [cited 2021 May 12]. https:\/\/www.who.int\/csr\/don\/2011_07_22\/en\/"},{"key":"6986_CR36","unstructured":"UNICEF. Cholera outbreaks in Central and West Africa: 2016 Regional Update - Week 52 [EN\/FR] - Democratic Republic of the Congo. ReliefWeb. 2016. https:\/\/reliefweb.int\/report\/democratic-republic-congo\/cholera-outbreaks-central-and-west-africa-2016-regional-update-7"},{"key":"6986_CR37","doi-asserted-by":"publisher","first-page":"4","DOI":"10.1371\/journal.pntd.0007642","volume":"14","author":"LM Irenge","year":"2020","unstructured":"Irenge LM, Ambroise J, Mitangala PN, Bearzatto B, Kabangwa RKS, Durant J-F, et al. Genomic analysis of pathogenic isolates of Vibrio cholerae from eastern Democratic Republic of the Congo (2014\u20132017). PLoS Negl Trop Dis. 2020;14:4.","journal-title":"PLoS Negl Trop Dis."},{"key":"6986_CR38","unstructured":"World Health Organization. Global Task Force on Cholera Control - Cholera country profile: Angola. 2013. https:\/\/www.who.int\/cholera\/countries\/AngolaCountryProfile2013.pdf?ua=1"},{"issue":"11","key":"6986_CR39","doi-asserted-by":"publisher","first-page":"e0005105","DOI":"10.1371\/journal.pntd.0005105","volume":"10","author":"MC Ngwa","year":"2016","unstructured":"Ngwa MC, Liang S, Kracalik IT, Morris L, Blackburn JK, Mbam LM, et al. Cholera in Cameroon, 2000\u20132012: Spatial and Temporal Analysis at the Operational (Health District) and Sub Climate Levels. PLoS Negl Trop Dis. 2016;10(11):e0005105. https:\/\/doi.org\/10.1371\/journal.pntd.0005105.","journal-title":"PLoS Negl Trop Dis."},{"issue":"1","key":"6986_CR40","doi-asserted-by":"publisher","first-page":"e0009046","DOI":"10.1371\/journal.pntd.0009046","volume":"15","author":"MC Ngwa","year":"2021","unstructured":"Ngwa MC, Ihekweazu C, Okwor T, Yennan S, Williams N, Elimian K, et al. The cholera risk assessment in Kano State, Nigeria: A historical review, mapping of hotspots and evaluation of contextual factors. PLoS Negl Trop Dis. 2021;15(1):e0009046. https:\/\/doi.org\/10.1371\/journal.pntd.0009046.","journal-title":"PLoS Negl Trop Dis."},{"issue":"3","key":"6986_CR41","doi-asserted-by":"publisher","first-page":"330","DOI":"10.1016\/S1473-3099(16)30513-8","volume":"17","author":"MUG Kraemer","year":"2017","unstructured":"Kraemer MUG, Faria NR, Reiner RC, Golding N, Nikolay B, Stasse S, et al. Spread of yellow fever virus outbreak in Angola and the Democratic Republic of the Congo 2015\u201316: a modelling study. Lancet Infect Dis. 2017;17(3):330\u20138.","journal-title":"Lancet Infect Dis."},{"key":"6986_CR42","unstructured":"Pena ES, Bwire G, Dzotsi E, Bonnet MC, Hessel L. New momentum in prevention, control and elimination of cholera in Africa: priority actions identified by affected countries. Wkly Epidemiol Rec. 2016;91(24):305\u201316. https:\/\/www.who.int\/wer\/2016\/wer9124.pdf?ua=1"},{"key":"6986_CR43","doi-asserted-by":"crossref","unstructured":"Ntumba HCK, Bompangue D, Situakibanza H, Tamfum J-JM, Ozer P. Ebola response and community engagement: how to build a bridge? The Lancet. 2019;394(10216):2242. https:\/\/www.thelancet.com\/journals\/lancet\/article\/PIIS0140-6736(19)32532-2\/abstract","DOI":"10.1016\/S0140-6736(19)32532-2"},{"key":"6986_CR44","doi-asserted-by":"publisher","unstructured":"Mandja B-AM, Bompangue D, Handschumacher P, Gonzalez J-P, Salem G, Muyembe J-J, et al. The score of integrated disease surveillance and response adequacy (SIA): a pragmatic score for comparing weekly reported diseases based on a systematic review. BMC Public Health. 2019;19(1):624. https:\/\/doi.org\/10.1186\/s12889-019-6954-3","DOI":"10.1186\/s12889-019-6954-3"},{"key":"6986_CR45","doi-asserted-by":"crossref","unstructured":"Fall IS, Rajatonirina S, Yahaya AA, Zabulon Y, Nsubuga P, Nanyunja M, et al. Integrated Disease Surveillance and Response (IDSR) strategy: current status, challenges and perspectives for the future in Africa. BMJ Glob Health. 2019;4(4):e001427. https:\/\/gh.bmj.com\/content\/4\/4\/e001427","DOI":"10.1136\/bmjgh-2019-001427"},{"key":"6986_CR46","unstructured":"The World Bank. Congo, Dem. Rep. | Data. https:\/\/data.worldbank.org\/country\/CD"},{"issue":"10","key":"6986_CR47","doi-asserted-by":"publisher","first-page":"e0008634","DOI":"10.1371\/journal.pntd.0008634","volume":"14","author":"S Mazamay","year":"2020","unstructured":"Mazamay S, Broutin H, Bompangue D, Muyembe J-J, Gu\u00e9gan J-F. The environmental drivers of bacterial meningitis epidemics in the Democratic Republic of Congo, central Africa. PLoS Negl Trop Dis. 2020;14(10):e0008634. https:\/\/doi.org\/10.1371\/journal.pntd.0008634.","journal-title":"PLoS Negl Trop Dis."},{"key":"6986_CR48","unstructured":"Global Task Force on Cholera Control. Ending Cholera: A Global Roadmap to 2030. Geneva: World Health Organization. 2017. http:\/\/www.who.int\/cholera\/publications\/global-roadmap\/en\/"}],"container-title":["BMC Infectious Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12879-021-06986-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12879-021-06986-9\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12879-021-06986-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,12,19]],"date-time":"2021-12-19T18:04:46Z","timestamp":1639937086000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcinfectdis.biomedcentral.com\/articles\/10.1186\/s12879-021-06986-9"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,12]]},"references-count":48,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2021,12]]}},"alternative-id":["6986"],"URL":"https:\/\/doi.org\/10.1186\/s12879-021-06986-9","relation":{},"ISSN":["1471-2334"],"issn-type":[{"value":"1471-2334","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,12]]},"assertion":[{"value":"25 September 2021","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"16 December 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"19 December 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This study was conducted in strict accordance with the ethical principles of the Declaration of Helsinki. We used routinely collected epidemiological surveillance data that are anonymized and aggregated at the HZ level. As human subjects were not involved, ethics approval was therefore not required.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent for participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"1261"}}