{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,10]],"date-time":"2026-02-10T13:14:30Z","timestamp":1770729270852,"version":"3.49.0"},"reference-count":43,"publisher":"Public Library of Science (PLoS)","issue":"1","license":[{"start":{"date-parts":[[2024,1,30]],"date-time":"2024-01-30T00:00:00Z","timestamp":1706572800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100010269","name":"Wellcome Trust","doi-asserted-by":"publisher","award":["221963\/Z\/20\/Z"],"award-info":[{"award-number":["221963\/Z\/20\/Z"]}],"id":[{"id":"10.13039\/100010269","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100006242","name":"Universiti Malaysia Sabah","doi-asserted-by":"publisher","award":["AM 18006"],"award-info":[{"award-number":["AM 18006"]}],"id":[{"id":"10.13039\/501100006242","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosglobalpublichealth.org"],"crossmark-restriction":false},"short-container-title":["PLOS Glob Public Health"],"abstract":"<jats:p><jats:italic>Vibrio cholerae<\/jats:italic> remains a notable public health challenge across Malaysia. Although the Malaysian state of Sabah is considered a cholera-affected area, gaps remain in understanding the epidemiological trends and spatial distribution of outbreaks. Therefore, to determine longitudinal and spatial trends in cholera cases data were obtained from the Sabah State Health Department for all notified cases of cholera between 2005\u20132020. A cholera outbreak is defined as one or more confirmed cases in a single locality with the evidence of local transmission. All records were geolocated to village level. Satellite-derived data and generalised linearized models were used to assess potential risk factors, including population density, elevation, and distance to the sea. Spatiotemporal clustering of reported cholera cases and zones of increased cholera risk were evaluated using the tau statistic (\u03c4) at 550m, 5km and 10km distances. Over a 15-year period between 2005\u20132020, 2865 cholera cases were recorded in Sabah, with a mean incidence rate of 5.6 cases per 100,000 (95% CI: 3.4\u20137.9). From 2015\u20132020, 705 symptomatic cases and 727 asymptomatic cases were reported. Symptomatic cases primarily occurred in local Malaysian populations (62.6%, 441\/705) and in children and adolescents under 15-years old (49.4%, 348\/705). On average, cases were reported in areas with low population density (19.45 persons\/km<jats:sup>2<\/jats:sup>), low elevations (19.45m) and near coastal areas. Spatiotemporal clustering of cholera cases was identified up to 3.5km, with increased village-level cholera risk within 500m and 5 days of initial case presentation to a health facility (Risk Ratio = 9.7, 95% CI: 7.5\u201312.4). Cholera incidence has high spatial and temporal heterogeneity within Sabah, with some districts experiencing repeated outbreaks. Cholera cases clustered across space and time, with village-level risk of cholera highest within 5 days and within close proximity to primary case villages, suggesting local transmission.<\/jats:p>","DOI":"10.1371\/journal.pgph.0002861","type":"journal-article","created":{"date-parts":[[2024,1,30]],"date-time":"2024-01-30T18:30:38Z","timestamp":1706639438000},"page":"e0002861","update-policy":"https:\/\/doi.org\/10.1371\/journal.pgph.corrections_policy","source":"Crossref","is-referenced-by-count":5,"title":["The incidence, and spatial trends of cholera in Sabah over 15 years: Repeated outbreaks in coastal areas"],"prefix":"10.1371","volume":"4","author":[{"given":"Marilyn Charlene Montini","family":"Maluda","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5460-1715","authenticated-orcid":true,"given":"Emilia","family":"Johnson","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6844-5063","authenticated-orcid":true,"given":"Fredie","family":"Robinson","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Muhammad","family":"Jikal","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Siat Yee","family":"Fong","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohammad Jeffree","family":"Saffree","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5484-241X","authenticated-orcid":true,"given":"Kimberly M.","family":"Fornace","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1869-3701","authenticated-orcid":true,"given":"Kamruddin","family":"Ahmed","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2024,1,30]]},"reference":[{"issue":"6","key":"pgph.0002861.ref001","first-page":"e000383","article-title":"Updated global burden of cholera in endemic countries.","volume":"9","author":"M Ali","year":"2015","journal-title":"PLoS Negl Trop Dis"},{"key":"pgph.0002861.ref002","first-page":"489","article-title":"Cholera, 2017.","volume":"93","author":"World Health Organization","year":"2018","journal-title":"Weekly Epidemiological Record"},{"issue":"1","key":"pgph.0002861.ref003","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1128\/CMR.8.1.48","article-title":"Cholera","volume":"8","author":"JB Kaper","year":"1995","journal-title":"Clin Microbiol Rev"},{"key":"pgph.0002861.ref004","doi-asserted-by":"crossref","first-page":"203","DOI":"10.3389\/fpubh.2019.00203","article-title":"Revisiting the global epidemiology of cholera in conjunction with the genomics of Vibrio cholerae","volume":"7","author":"T Ramamurthy","year":"2019","journal-title":"Front Public Health"},{"issue":"1","key":"pgph.0002861.ref005","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1186\/s12889-018-6299-3","article-title":"A cholera outbreak in a rural north central Nigerian community: an unmatched case-control study","volume":"19","author":"CC Dan-Nwafor","year":"2019","journal-title":"BMC Public Health"},{"issue":"3","key":"pgph.0002861.ref006","first-page":"162","article-title":"A five-year study on the epidemiological approaches to cholera","volume":"7","author":"M Mafi","year":"2016","journal-title":"Iran. 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