{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T04:04:31Z","timestamp":1784001871539,"version":"3.55.0"},"update-to":[{"DOI":"10.1371\/journal.pmed.1004404","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2024,6,4]],"date-time":"2024-06-04T00:00:00Z","timestamp":1717459200000}}],"reference-count":54,"publisher":"Public Library of Science (PLoS)","issue":"5","license":[{"start":{"date-parts":[[2024,5,10]],"date-time":"2024-05-10T00:00:00Z","timestamp":1715299200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"BHA\/USAID","award":["720FDA19GR00205"],"award-info":[{"award-number":["720FDA19GR00205"]}]}],"content-domain":{"domain":["www.plosmedicine.org"],"crossmark-restriction":false},"short-container-title":["PLoS Med"],"abstract":"<jats:sec id=\"sec001\"><jats:title>Background<\/jats:title><jats:p>Cholera outbreaks are on the rise globally, with conflict-affected settings particularly at risk. Case-area targeted interventions (CATIs), a strategy whereby teams provide a package of interventions to case and neighboring households within a predefined \u201cring,\u201d are increasingly employed in cholera responses. However, evidence on their ability to attenuate incidence is limited.<\/jats:p><\/jats:sec><jats:sec id=\"sec002\"><jats:title>Methods and findings<\/jats:title><jats:p>We conducted a prospective observational cohort study in 3 conflict-affected states in Nigeria in 2021. Enumerators within rapid response teams observed CATI implementation during a cholera outbreak and collected data on household demographics; existing water, sanitation, and hygiene (WASH) infrastructure; and CATI interventions. Descriptive statistics showed that CATIs were delivered to 46,864 case and neighbor households, with 80.0% of cases and 33.5% of neighbors receiving all intended supplies and activities, in a context with operational challenges of population density, supply stock outs, and security constraints.<\/jats:p><jats:p>We then applied prospective Poisson space-time scan statistics (STSS) across 3 models for each state: (1) an unadjusted model with case and population data; (2) an environmentally adjusted model adjusting for distance to cholera treatment centers and existing WASH infrastructure (improved water source, improved latrine, and handwashing station); and (3) a fully adjusted model adjusting for environmental and CATI variables (supply of Aquatabs and soap, hygiene promotion, bedding and latrine disinfection activities, ring coverage, and response timeliness). We ran the STSS each day of our study period to evaluate the space-time dynamics of the cholera outbreaks.<\/jats:p><jats:p>Compared to the unadjusted model, significant cholera clustering was attenuated in the environmentally adjusted model (from 572 to 18 clusters) but there was still risk of cholera transmission. Two states still yielded significant clusters (range 8\u201310 total clusters, relative risk of 2.2\u20135.5, 16.6\u201319.9 day duration, including 11.1\u201356.8 cholera cases). Cholera clustering was completely attenuated in the fully adjusted model, with no significant anomalous clusters across time and space. Associated measures including quantity, relative risk, significance, likelihood of recurrence, size, and duration of clusters reinforced the results. Key limitations include selection bias, remote data monitoring, and the lack of a control group.<\/jats:p><\/jats:sec><jats:sec id=\"sec003\"><jats:title>Conclusions<\/jats:title><jats:p>CATIs were associated with significant reductions in cholera clustering in Northeast Nigeria despite operational challenges. Our results provide a strong justification for rapid implementation and scale-up CATIs in cholera-response, particularly in conflict settings where WASH access is often limited.<\/jats:p><\/jats:sec>","DOI":"10.1371\/journal.pmed.1004404","type":"journal-article","created":{"date-parts":[[2024,5,10]],"date-time":"2024-05-10T17:43:52Z","timestamp":1715363032000},"page":"e1004404","update-policy":"https:\/\/doi.org\/10.1371\/journal.pmed.corrections_policy","source":"Crossref","is-referenced-by-count":13,"title":["Case-area targeted interventions during a large-scale cholera epidemic: A prospective cohort study in Northeast Nigeria"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0787-8126","authenticated-orcid":true,"given":"Jennifer","family":"OKeeffe","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2124-1191","authenticated-orcid":true,"given":"Lindsay","family":"Salem-Bango","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2789-5460","authenticated-orcid":true,"given":"Michael R.","family":"Desjardins","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6594-0261","authenticated-orcid":true,"given":"Daniele","family":"Lantagne","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3410-0427","authenticated-orcid":true,"given":"Chiara","family":"Altare","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3605-4812","authenticated-orcid":true,"given":"Gurpreet","family":"Kaur","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Heath","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kanaganathan","family":"Rangaiya","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-4952-663X","authenticated-orcid":true,"given":"Patricia Oke-Oghene","family":"Obroh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmadu","family":"Audu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Baptiste","family":"Lecuyot","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timoth\u00e9e","family":"Zoungrana","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emmanuel Emeka","family":"Ihemezue","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Solomon","family":"Aye","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6977-7913","authenticated-orcid":true,"given":"Mustafa","family":"Sikder","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2363-7998","authenticated-orcid":true,"given":"Shannon","family":"Doocy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qiulin","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melody","family":"Xiao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6158-6661","authenticated-orcid":true,"given":"Paul B.","family":"Spiegel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2024,5,10]]},"reference":[{"key":"pmed.1004404.ref001","unstructured":"Global Task Force on Cholera Control. gtfcc.org [Accessed 2023 Sept 20]. Available from: https:\/\/www.gtfcc.org."},{"key":"pmed.1004404.ref002","unstructured":"World Health Organization. Disease Outbreak News; Cholera\u2013Global situation. 2023 Dec 16 [Accessed 2023 Jun 1]. Available from: https:\/\/www.who.int\/emergencies\/disease-outbreak-news\/item\/2022-DON426."},{"key":"pmed.1004404.ref003","unstructured":"World Health Organization. Cholera Global Overview Dashboard [Accessed 2023 Sep 21]. Available from: https:\/\/worldhealthorg.shinyapps.io\/page1cholera_global_overview\/."},{"key":"pmed.1004404.ref004","unstructured":"World Health Organization. Disease Outbreak News; Cholera\u2013Global situation. 2022 Feb 11 [Accessed 2023 Jun 1]. Available from: https:\/\/www.who.int\/emergencies\/disease-outbreak-news\/item\/2022-DON426."},{"issue":"12","key":"pmed.1004404.ref005","doi-asserted-by":"crossref","first-page":"2472","DOI":"10.3201\/eid2812.212398","article-title":"Association between Conflict and Cholera in Nigeria and the Democratic Republic of the Congo","volume":"28","author":"GEC Charnley","year":"2022","journal-title":"Emerg Infect Dis"},{"issue":"8","key":"pmed.1004404.ref006","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pntd.0011597","article-title":"Drivers of the dynamics of the spread of cholera in the Democratic Republic of the Congo, 2000\u20132018: An eco-epidemiological study","volume":"17","author":"HC Kayembe","year":"2023","journal-title":"PLoS Negl Trop Dis"},{"issue":"7","key":"pmed.1004404.ref007","doi-asserted-by":"crossref","first-page":"599","DOI":"10.1056\/NEJMoa1204927","article-title":"Cholera surveillance during the Haiti epidemic\u2014the first 2 years","volume":"368","author":"EJ Barzilay","year":"2013","journal-title":"N Engl J Med"},{"issue":"1","key":"pmed.1004404.ref008","doi-asserted-by":"crossref","first-page":"1338","DOI":"10.1186\/s12889-018-6227-6","article-title":"The cholera outbreak in Yemen: lessons learned and way forward","volume":"18","author":"F Federspiel","year":"2018","journal-title":"BMC Public Health"},{"issue":"7","key":"pmed.1004404.ref009","doi-asserted-by":"crossref","first-page":"1164","DOI":"10.1093\/infdis\/jiy283","article-title":"Micro-Hotspots of Risk in Urban Cholera Epidemics","volume":"218","author":"AS Azman","year":"2018","journal-title":"J Infect Dis"},{"issue":"9","key":"pmed.1004404.ref010","doi-asserted-by":"crossref","first-page":"e1002120","DOI":"10.1371\/journal.pmed.1002120","article-title":"Potential for Controlling Cholera Using a Ring Vaccination Strategy: Re-analysis of Data from a Cluster-Randomized Clinical Trial","volume":"13","author":"M Ali","year":"2016","journal-title":"PLoS Med"},{"issue":"6","key":"pmed.1004404.ref011","first-page":"2134","article-title":"Cholera cases cluster in time and space in Matlab, Bangladesh: implications for targeted preventive interventions","volume":"45","author":"AK Debes","year":"2016","journal-title":"Int J Epidemiol"},{"issue":"11","key":"pmed.1004404.ref012","doi-asserted-by":"crossref","first-page":"e3314","DOI":"10.1371\/journal.pntd.0003314","article-title":"Household Transmission of Vibrio cholerae in Bangladesh","volume":"8","author":"JD Sugimoto","year":"2014","journal-title":"PLoS Negl Trop Dis"},{"issue":"10133","key":"pmed.1004404.ref013","doi-asserted-by":"crossref","first-page":"1908","DOI":"10.1016\/S0140-6736(17)33050-7","article-title":"Mapping the burden of cholera in sub-Saharan Africa and implications for control: an analysis of data across geographical scales","volume":"391","author":"J Lessler","year":"2018","journal-title":"Lancet"},{"key":"pmed.1004404.ref014","first-page":"2019","volume-title":"Global review of water, sanitation and hygiene (WASH) components in rapid response mechanisms and rapid response teams in cholera outbreak settings\u2013Haiti, Nigeria, South Sudan and Yemen","author":"UNICEF"},{"issue":"1","key":"pmed.1004404.ref015","doi-asserted-by":"crossref","first-page":"226","DOI":"10.1186\/s12879-020-4916-0","article-title":"Description of the targeted water supply and hygiene response strategy implemented during the cholera outbreak of 2017\u20132018 in Kinshasa, DRC","volume":"20","author":"D Bompangue","year":"2020","journal-title":"BMC Infect Dis"},{"issue":"6","key":"pmed.1004404.ref016","doi-asserted-by":"crossref","first-page":"e0005652","DOI":"10.1371\/journal.pntd.0005652","article-title":"Neighborhood-targeted and case-triggered use of a single dose of oral cholera vaccine in an urban setting: Feasibility and vaccine coverage","volume":"11","author":"LA Parker","year":"2017","journal-title":"PLoS Negl Trop Dis"},{"issue":"5","key":"pmed.1004404.ref017","doi-asserted-by":"crossref","first-page":"1088","DOI":"10.4269\/ajtmh.18-0863","article-title":"Feasibility of a Comprehensive Targeted Cholera Intervention in The Kathmandu Valley, Nepal","volume":"100","author":"M Roskosky","year":"2019","journal-title":"Am J Trop Med Hyg"},{"key":"pmed.1004404.ref018","unstructured":"Global Task Force on Cholera Control. Ending cholera: A global roadmap to 2030. 2017."},{"issue":"3","key":"pmed.1004404.ref019","doi-asserted-by":"crossref","first-page":"e37","DOI":"10.1016\/S1473-3099(20)30479-5","article-title":"Highly targeted spatiotemporal interventions against cholera epidemics, 2000\u201319: a scoping review","volume":"21","author":"R Ratnayake","year":"2021","journal-title":"Lancet Infect Dis"},{"issue":"1","key":"pmed.1004404.ref020","doi-asserted-by":"crossref","first-page":"e0226549","DOI":"10.1371\/journal.pone.0226549","article-title":"Prevention and control of cholera with household and community water, sanitation and hygiene (WASH) interventions: A scoping review of current international guidelines","volume":"15","author":"L D\u2019Mello-Guyett","year":"2020","journal-title":"PLoS ONE"},{"issue":"3","key":"pmed.1004404.ref021","doi-asserted-by":"crossref","first-page":"S137","DOI":"10.1093\/infdis\/jiy486","article-title":"Global Cholera Epidemiology: Opportunities to Reduce the Burden of Cholera by 2030","volume":"218","author":"D Legros","year":"2018","journal-title":"J Infect Dis"},{"key":"pmed.1004404.ref022","first-page":"8","article-title":"Estimating effectiveness of case-area targeted response interventions against cholera in Haiti","author":"E Michel","year":"2019","journal-title":"Elife"},{"issue":"2","key":"pmed.1004404.ref023","first-page":"63","article-title":"Large-scale selective antibiotic prophylaxis during the 2004 cholera outbreak in Douala (Cameroon)","volume":"17","author":"E Guevart","year":"2007","journal-title":"Sante"},{"issue":"2","key":"pmed.1004404.ref024","doi-asserted-by":"crossref","first-page":"e1002509","DOI":"10.1371\/journal.pmed.1002509","article-title":"The potential impact of case-area targeted interventions in response to cholera outbreaks: A modeling study","volume":"15","author":"F Finger","year":"2018","journal-title":"PLoS Med"},{"issue":"2","key":"pmed.1004404.ref025","doi-asserted-by":"crossref","first-page":"233","DOI":"10.3201\/eid2202.151175","article-title":"Randomized Controlled Trial of Hospital-Based Hygiene and Water Treatment Intervention (CHoBI7) to Reduce Cholera","volume":"22","author":"CM George","year":"2016","journal-title":"Emerg Infect Dis"},{"issue":"37","key":"pmed.1004404.ref026","first-page":"453","volume":"97","author":"World Health Organization","year":"2022","journal-title":"Weekly Epidemiological RecordWkly Epidemiol Rec."},{"key":"pmed.1004404.ref027","volume-title":"ArcGIS Desktop: Release 10.3. Redlands","author":"ESRI","year":"2022"},{"key":"pmed.1004404.ref028","unstructured":"World Imagery [Internet]. 2024 [Accessed 2024 Mar 14]. Available from: https:\/\/www.arcgis.com\/home\/item.html?id=10df2279f9684e4a9f6a7f08febac2a9."},{"key":"pmed.1004404.ref029","unstructured":"Kobo Toolbox. 2019. Available from: https:\/\/www.kobotoolbox.org."},{"key":"pmed.1004404.ref030","unstructured":"mWater. 2021. Available from: https:\/\/www.mwater.co."},{"key":"pmed.1004404.ref031","volume-title":"R: A language and environment for statistical computing.","author":"R Core Team","year":"2022"},{"key":"pmed.1004404.ref032","volume-title":"RStudio: Integrated Development Environment for R. Boston","author":"Posit team","year":"2023"},{"key":"pmed.1004404.ref033","unstructured":"Google Earth Pro, 7.3.6.9345. 2022."},{"key":"pmed.1004404.ref034","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1007\/978-3-662-05294-5_11","volume-title":"Ordinary Kriging. Multivariate Geostatistics: An Introduction with Applications.","author":"H. Wackernagel","year":"2003"},{"key":"pmed.1004404.ref035","unstructured":"The Sphere Project. Sphere Handbook, Ch. 6 Water Supply, Sanitation, and Hygiene Promotion. 2018 Contract No.: Mar 15."},{"key":"pmed.1004404.ref036","unstructured":"UNHCR. Emergency Handbook, WASH in Emergencies 2024. [Accessed 2024 Mar 15]. Available from: https:\/\/emergency.unhcr.org\/emergency-assistance\/water-and-hygiene\/wash-emergencies."},{"key":"pmed.1004404.ref037","unstructured":"WHO\/UNICEF Joint Monitoring Programme for Water and Sanitation. WASH in the 2030 Agenda. 2017."},{"key":"pmed.1004404.ref038","doi-asserted-by":"crossref","unstructured":"Ken Kleinman SH, Amer Moosa. rsatscan: Tools, Classes, and Methods for Interfacing with \u2019SaTScan\u2019 Stand-Alone Software. 2015.","DOI":"10.32614\/CRAN.package.rsatscan"},{"key":"pmed.1004404.ref039","unstructured":"SaTScan v10.1. 2022. Available from: https:\/\/www.satscan.org\/."},{"issue":"8","key":"pmed.1004404.ref040","doi-asserted-by":"crossref","first-page":"e0135676","DOI":"10.1371\/journal.pone.0135676","article-title":"The Impact of Water, Sanitation and Hygiene Interventions to Control Cholera: A Systematic Review","volume":"10","author":"DL Taylor","year":"2015","journal-title":"PLoS ONE"},{"issue":"2","key":"pmed.1004404.ref041","doi-asserted-by":"crossref","first-page":"534","DOI":"10.4269\/ajtmh.17-0897","article-title":"A Systematic Review and Meta-Analysis of the Association between Water, Sanitation, and Hygiene Exposures and Cholera in Case-Control Studies","volume":"99","author":"M Wolfe","year":"2018","journal-title":"Am J Trop Med Hyg"},{"key":"pmed.1004404.ref042","unstructured":"Global Task Force on Cholera Control. 9TH Meeting of the global task force on cholera control working group on oral cholera vaccine. Annecy, France: 2022."},{"issue":"11","key":"pmed.1004404.ref043","doi-asserted-by":"crossref","first-page":"e27060","DOI":"10.1371\/journal.pone.0027060","article-title":"Chemoprophylaxis in contacts of patients with cholera: systematic review and meta-analysis","volume":"6","author":"L Reveiz","year":"2011","journal-title":"PLoS ONE"},{"issue":"11","key":"pmed.1004404.ref044","first-page":"596","article-title":"Routine use of antimicrobial drugs during the 2004 cholera epidemic in Douala, Cameroon","volume":"83","author":"J Noeske","year":"2006","journal-title":"East Afr Med J"},{"issue":"12","key":"pmed.1004404.ref045","doi-asserted-by":"crossref","first-page":"e0010042","DOI":"10.1371\/journal.pntd.0010042","article-title":"Case-area targeted preventive interventions to interrupt cholera transmission: Current implementation practices and lessons learned","volume":"15","author":"M Sikder","year":"2021","journal-title":"PLoS Negl Trop Dis"},{"issue":"4","key":"pmed.1004404.ref046","doi-asserted-by":"crossref","first-page":"e0007263","DOI":"10.1371\/journal.pntd.0007263","article-title":"The case-area targeted rapid response strategy to control cholera in Haiti: a four-year implementation study","volume":"13","author":"S Rebaudet","year":"2019","journal-title":"PLoS Negl Trop Dis"},{"issue":"3","key":"pmed.1004404.ref047","doi-asserted-by":"crossref","first-page":"170","DOI":"10.2471\/BLT.22.288885","article-title":"Implementation of targeted cholera response activities, Cameroon","volume":"101","author":"JP Ouamba","year":"2023","journal-title":"Bull World Health Organ"},{"issue":"5","key":"pmed.1004404.ref048","doi-asserted-by":"crossref","first-page":"432","DOI":"10.1016\/j.jinf.2012.11.013","article-title":"The incubation period of cholera: a systematic review","volume":"66","author":"AS Azman","year":"2013","journal-title":"J Infect"},{"issue":"6889","key":"pmed.1004404.ref049","doi-asserted-by":"crossref","first-page":"642","DOI":"10.1038\/nature00778","article-title":"Host-induced epidemic spread of the cholera bacterium","volume":"417","author":"DS Merrell","year":"2002","journal-title":"Nature"},{"issue":"3","key":"pmed.1004404.ref050","doi-asserted-by":"crossref","first-page":"S147","DOI":"10.1093\/infdis\/jiy488","article-title":"Household Water Treatment and Cholera Control","volume":"218","author":"D Lantagne","year":"2018","journal-title":"J Infect Dis"},{"issue":"8","key":"pmed.1004404.ref051","doi-asserted-by":"crossref","first-page":"e0008661","DOI":"10.1371\/journal.pntd.0008661","article-title":"Household spraying in cholera outbreaks: Insights from three exploratory, mixed-methods field effectiveness evaluations","volume":"14","author":"K Gallandat","year":"2020","journal-title":"PLoS Negl Trop Dis"},{"issue":"1","key":"pmed.1004404.ref052","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1186\/s13031-022-00445-1","article-title":"Identifying transferable lessons from cholera epidemic responses by Medecins Sans Frontieres in Mozambique, Malawi and the Democratic Republic of Congo, 2015\u20132018: a scoping review","volume":"16","author":"L D\u2019Mello-Guyett","year":"2022","journal-title":"Confl Health"},{"issue":"4","key":"pmed.1004404.ref053","doi-asserted-by":"crossref","first-page":"e0011298","DOI":"10.1371\/journal.pntd.0011298","article-title":"Implementation considerations in case-area targeted interventions to prevent cholera transmission in Northeast Nigeria: A qualitative analysis","volume":"17","author":"G Kaur","year":"2023","journal-title":"PLoS Negl Trop Dis"},{"key":"pmed.1004404.ref054","unstructured":"World Health Organization. Cholera Fact Sheet [Accessed 2023 Sep 15]. Available from: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/cholera."}],"updated-by":[{"DOI":"10.1371\/journal.pmed.1004404","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2024,6,4]],"date-time":"2024-06-04T00:00:00Z","timestamp":1717459200000}}],"container-title":["PLOS Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pmed.1004404","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,11,18]],"date-time":"2024-11-18T16:45:56Z","timestamp":1731948356000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pmed.1004404"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,5,10]]},"references-count":54,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2024,5,10]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pmed.1004404","relation":{"new_version":[{"id-type":"doi","id":"10.1371\/journal.pmed.1004404","asserted-by":"object"}]},"ISSN":["1549-1676"],"issn-type":[{"value":"1549-1676","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,5,10]]}}}