{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T18:12:33Z","timestamp":1779387153167,"version":"3.53.1"},"reference-count":19,"publisher":"Public Library of Science (PLoS)","issue":"5","license":[{"start":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T00:00:00Z","timestamp":1779321600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000060","name":"National Institute of Allergy and Infectious Diseases","doi-asserted-by":"publisher","award":["5R01AI123422"],"award-info":[{"award-number":["5R01AI123422"]}],"id":[{"id":"10.13039\/100000060","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000865","name":"Bill and Melinda Gates Foundation","doi-asserted-by":"publisher","award":["OPP153556"],"award-info":[{"award-number":["OPP153556"]}],"id":[{"id":"10.13039\/100000865","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>Uganda has been endemic for cholera since 1971. To reduce the threat of cholera, Uganda reviewed its approach to cholera, emphasizing surveillance, continued using single dose doxycycline for cholera patients and their households, and conducted 16 oral cholera vaccine campaigns in high-risk districts between 2018 and 2021.To understand recent changes in cholera patternsand the impact of the OCV campaigns, we classified districts as endemic, eliminated, or relapsed using the method as defined by the \u201ccholera elimination scorecard\u201d for the years 2018\u20132024 using cholera surveillance data from the Ministry of Health. We also reviewed Uganda\u2019s policy regarding cholera surveillance and antibiotic use for cholera patients and their immediate households. To understand risks from cross-border cholera transmission, we reviewed cholera reports from the other countries in the East African Community. During the 16 campaigns with OCV (each campaign with two rounds), 2,263,790 people living in high risk subcounties of the hotspot districts were targeted for vaccination. Overall administrative vaccine coverage was 94% for the first round and 84% for the second round. Based on national surveillance data, the number of endemic districts fell from 36 prior to the campaigns to six after the campaigns. To identify new outbreaks and reduce the threat from cholera, Uganda implemented enhanced cholera surveillance, especially in the border areas, and administered single dose doxycycline to all cholera patients and their households with the intention to treat them and prevent spread of the outbreak. Since 2021, all cholera outbreaks in Uganda have been epidemiologically linked with cross-border spread from neighboring countries.Uganda has eliminated endogenous cholera (that is, cholera originating from within the country), but it remains vulnerable to cholera from neighboring countries in the region. Uganda\u2019s experience to control cholera may be useful for other countries in Africa which are attempting to eliminate this disease.<\/jats:p>","DOI":"10.1371\/journal.pgph.0006020","type":"journal-article","created":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T17:28:01Z","timestamp":1779384481000},"page":"e0006020","update-policy":"https:\/\/doi.org\/10.1371\/journal.pgph.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Uganda\u2019s cholera elimination journey in a cholera endemic region of Africa"],"prefix":"10.1371","volume":"6","author":[{"given":"Godfrey","family":"Bwire","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9338-5119","authenticated-orcid":true,"given":"David A.","family":"Sack","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Allan","family":"Muruta","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles","family":"Olaro","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jane Ruth Aceng","family":"Ocero","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diana","family":"Atwine","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Henry G.","family":"Mwebesa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francis","family":"Ongole","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bonny","family":"Kintu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne","family":"Nakinsige","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ampaire","family":"Immaculate","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Buyinza Ambrose","family":"Wabwire","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rhoda K.","family":"Wanyenze","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amanda K.","family":"Debes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher Garimoi","family":"Orach","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,5,21]]},"reference":[{"key":"pgph.0006020.ref001","unstructured":"World_Health_Organization. Multi-country outbreak of cholera, external situation report #30 -26 September 2025. Geneva: WHO; [October 27, 2025]. Available from: https:\/\/www.who.int\/publications\/m\/item\/multi-country-outbreak-of-cholera--external-situation-report--30--26-september-2025"},{"key":"pgph.0006020.ref002","unstructured":"GTFCC. Roadmap 2030: WHO. 2017 [cited 2023 January 2, 2023]. Available from: https:\/\/www.gtfcc.org\/about-gtfcc\/roadmap-2030\/"},{"key":"pgph.0006020.ref003","volume-title":"Uganda Bureau of Statistics 2024: The National Population and Housing Census 2024 \u2013Final Report - Volume 1 (Main)","author":"Uganda_Bureau_of_Statistics","year":"2024"},{"key":"pgph.0006020.ref004","unstructured":"East_African_Community_Partner_States. EAC Partner States. [September 23, 2025]. Available from: https:\/\/www.eac.int\/eac-partner-states"},{"key":"pgph.0006020.ref005","unstructured":"Concern_Worldwide. 13 countries in conflict where Concern is responding in 2025. Dublin Ireland: o ncern_worldwide; 2025 [cited September 23, 2025]. Available from: https:\/\/www.concern.net\/news\/countries-in-conflict"},{"key":"pgph.0006020.ref006","unstructured":"UNHCR. Operational Data Portal. Refugees and Asylum-seekers in the East and Horn of Africa and the Great Lakes Region: UNHCR. 2025 [November 21, 2025]. Available from: https:\/\/data.unhcr.org\/en\/regions\/rbehagl"},{"key":"pgph.0006020.ref007","volume-title":"Global Cholera and Acute Watery Diarrhoea (AWD)","author":"World_Health_Organization","year":"2025"},{"key":"pgph.0006020.ref008","unstructured":"Republic_of_Uganda. National Integrated Comprehensive Cholera Prevention and Control Plan, Fiscal Years (2017\/18-2021\/22). Kampala: Republic of Uganda; 2017 [November 21, 2025]. Available from: https:\/\/www.medbox.org\/document\/national-integrated-comprehensive-cholera-prevention-and-control-plan-fiscal-years-201718-202122"},{"key":"pgph.0006020.ref009","unstructured":"Uganda_Ministry_of_Health. 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Available from: https:\/\/health.go.ug\/download\/prevention-control-and-elimination-of-cholera-operational-guidelines-for-national-and-district-health-workers-and-planners_2025\/"},{"issue":"12","key":"pgph.0006020.ref010","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pntd.0006118","article-title":"Identifying cholera \u201chotspots\u201d in Uganda: An analysis of cholera surveillance data from 2011 to 2016","volume":"11","author":"G Bwire","year":"2017","journal-title":"PLoS Negl Trop Dis"},{"issue":"1","key":"pgph.0006020.ref011","doi-asserted-by":"crossref","first-page":"726","DOI":"10.1186\/s12879-017-2824-8","article-title":"Alkaline peptone water enrichment with a dipstick test to quickly detect and monitor cholera outbreaks","volume":"17","author":"G Bwire","year":"2017","journal-title":"BMC Infect Dis"},{"issue":"4","key":"pgph.0006020.ref012","doi-asserted-by":"crossref","first-page":"797","DOI":"10.1093\/cid\/ciaf418","article-title":"Epidemiology of Vibrio cholerae Infections in the Households of Cholera Patients in the Democratic Republic of the Congo: PICHA7 WASHmobile Prospective Cohort Study","volume":"81","author":"CM George","year":"2025","journal-title":"Clin Infect Dis"},{"issue":"5","key":"pgph.0006020.ref013","doi-asserted-by":"crossref","first-page":"954","DOI":"10.4269\/ajtmh.23-0007","article-title":"Development of a Scorecard to Monitor Progress toward National Cholera Elimination: Its Application in Uganda","volume":"108","author":"G Bwire","year":"2023","journal-title":"Am J Trop Med Hyg"},{"key":"pgph.0006020.ref014","unstructured":"GTFCC. 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Available from: https:\/\/www.gtfcc.org\/resources\/identification-of-priority-areas-for-multisectoral-interventions-pamis-for-cholera-control\/"},{"issue":"1","key":"pgph.0006020.ref015","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1186\/s41182-021-00376-2","article-title":"Threats and outbreaks of cholera in Africa amidst COVID-19 pandemic: a double burden on Africa\u2019s health systems","volume":"49","author":"O Uwishema","year":"2021","journal-title":"Trop Med Health"},{"key":"pgph.0006020.ref016","article-title":"Cholera Outbreak Associated wiht Consumption of Contaminated Lake Water at Kasensero Landing Site, Kyotera District, April - May 2024","author":"BME Ainembabazil","journal-title":"Kampala: Uganda National Institute of Public Health"},{"issue":"34","key":"pgph.0006020.ref017","first-page":"477","article-title":"Cholera vaccines: WHO position paper - August 2017","volume":"92","year":"2017","journal-title":"Wkly Epidemiol Rec"},{"issue":"12","key":"pgph.0006020.ref018","doi-asserted-by":"crossref","first-page":"1050","DOI":"10.1016\/S1473-3099(13)70273-1","article-title":"5 year efficacy of a bivalent killed whole-cell oral cholera vaccine in Kolkata, India: a cluster-randomised, double-blind, placebo-controlled trial","volume":"13","author":"SK Bhattacharya","year":"2013","journal-title":"Lancet Infect Dis"},{"issue":"9","key":"pgph.0006020.ref019","doi-asserted-by":"crossref","DOI":"10.1016\/S2214-109X(18)30284-5","article-title":"Long-term effectiveness of one and two doses of a killed, bivalent, whole-cell oral cholera vaccine in Haiti: an extended case-control study","volume":"6","author":"MF Franke","year":"2018","journal-title":"Lancet Glob Health"}],"container-title":["PLOS Global Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pgph.0006020","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T17:28:06Z","timestamp":1779384486000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pgph.0006020"}},"subtitle":[],"editor":[{"given":"Mavis Pearl","family":"Kwabla","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,5,21]]},"references-count":19,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2026,5,21]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pgph.0006020","relation":{},"ISSN":["2767-3375"],"issn-type":[{"value":"2767-3375","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,21]]}}}