{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T11:22:19Z","timestamp":1785410539830,"version":"3.56.0"},"update-to":[{"DOI":"10.1371\/journal.pntd.0010928","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2023,5,30]],"date-time":"2023-05-30T00:00:00Z","timestamp":1685404800000}}],"reference-count":25,"publisher":"Public Library of Science (PLoS)","issue":"5","license":[{"start":{"date-parts":[[2023,5,17]],"date-time":"2023-05-17T00:00:00Z","timestamp":1684281600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000865","name":"Bill and Melinda Gates Foundation","doi-asserted-by":"publisher","award":["OPP1148763"],"award-info":[{"award-number":["OPP1148763"]}],"id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000865","name":"the Bill & Melinda Gates Foundation","doi-asserted-by":"crossref","award":["INV-002667"],"award-info":[{"award-number":["INV-002667"]}],"id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"crossref"}]},{"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"}]}],"content-domain":{"domain":["www.plosntds.org"],"crossmark-restriction":false},"short-container-title":["PLoS Negl Trop Dis"],"abstract":"<jats:p>Kenya has experienced cholera outbreaks since 1971, with the most recent wave beginning in late 2014. Between 2015\u20132020, 32 of 47 counties reported 30,431 suspected cholera cases. The Global Task Force for Cholera Control (GTFCC) developed a <jats:italic>Global Roadmap for Ending Cholera by 2030<\/jats:italic>, which emphasizes the need to target multi-sectoral interventions in priority cholera burden hotspots. This study utilizes the GTFCC\u2019s hotspot method to identify hotspots in Kenya at the county and sub-county administrative levels from 2015 through 2020. 32 of 47 (68.1%) counties reported cholera cases during this time while only 149 of 301 (49.5%) sub-counties reported cholera cases. The analysis identifies hotspots based on the mean annual incidence (MAI) over the past five-year period and cholera\u2019s persistence in the area. Applying a MAI threshold of 90<jats:sup>th<\/jats:sup> percentile and the median persistence at both the county and sub-county levels, we identified 13 high risk sub-counties from 8 counties, including the 3 high risk counties of Garissa, Tana River and Wajir. This demonstrates that several sub-counties are high level hotspots while their counties are not. In addition, when cases reported by county versus sub-county hotspot risk are compared, 1.4 million people overlapped in the areas identified as both high-risk county and high-risk sub-county. However, assuming that finer scale data is more accurate, 1.6 million high risk sub-county people would have been misclassified as medium risk with a county-level analysis. Furthermore, an additional 1.6 million people would have been classified as living in high-risk in a county-level analysis when at the sub-county level, they were medium, low or no-risk sub-counties. This results in 3.2 million people being misclassified when county level analysis is utilized rather than a more-focused sub-county level analysis. This analysis highlights the need for more localized risk analyses to target cholera intervention and prevention efforts towards the populations most vulnerable.<\/jats:p>","DOI":"10.1371\/journal.pntd.0010928","type":"journal-article","created":{"date-parts":[[2023,5,17]],"date-time":"2023-05-17T17:42:02Z","timestamp":1684345322000},"page":"e0010928","update-policy":"https:\/\/doi.org\/10.1371\/journal.pntd.corrections_policy","source":"Crossref","is-referenced-by-count":11,"title":["Prioritizing interventions for cholera control in Kenya, 2015\u20132020"],"prefix":"10.1371","volume":"17","author":[{"given":"Waqo","family":"Boru","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shaoming","family":"Xiao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick","family":"Amoth","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Kareko","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Langat","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ian","family":"Were","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammad","family":"Ali","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David A.","family":"Sack","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth C.","family":"Lee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4006-073X","authenticated-orcid":true,"given":"Amanda K.","family":"Debes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2023,5,17]]},"reference":[{"issue":"24","key":"pntd.0010928.ref001","doi-asserted-by":"crossref","first-page":"3418","DOI":"10.1016\/j.vaccine.2017.09.034","article-title":"Cholera vaccine: WHO position paper, August 2017\u2014Recommendations","volume":"36","author":"O. World Health","year":"2018","journal-title":"Vaccine"},{"issue":"11","key":"pntd.0010928.ref002","doi-asserted-by":"crossref","first-page":"1211","DOI":"10.1016\/S1473-3099(18)30362-1","article-title":"Estimates of the global, regional, and national morbidity, mortality, and aetiologies of diarrhoea in 195 countries: a systematic analysis for the Global Burden of Disease Study 2016","volume":"18","year":"2018","journal-title":"The Lancet Infectious diseases"},{"issue":"6","key":"pntd.0010928.ref003","doi-asserted-by":"crossref","first-page":"e0003832","DOI":"10.1371\/journal.pntd.0003832","article-title":"Updated global burden of cholera in endemic countries.","volume":"9","author":"M Ali","year":"2015","journal-title":"PLoS neglected tropical diseases."},{"issue":"10133","key":"pntd.0010928.ref004","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"},{"issue":"Suppl 1","key":"pntd.0010928.ref005","doi-asserted-by":"crossref","first-page":"S55","DOI":"10.1093\/infdis\/jit201","article-title":"National surveillance data on the epidemiology of cholera in Kenya, 1997\u20132010","volume":"208","author":"D Mutonga","year":"2013","journal-title":"The Journal of infectious diseases"},{"issue":"3","key":"pntd.0010928.ref006","doi-asserted-by":"crossref","first-page":"68","DOI":"10.15585\/mmwr.mm6503a7","article-title":"Notes from the Field: Ongoing Cholera Outbreak\u2014Kenya, 2014\u20132016","volume":"65","author":"G George","year":"2016","journal-title":"MMWR Morbidity and mortality weekly report"},{"key":"pntd.0010928.ref007","article-title":"Cholera outbreaks in sub-Saharan Africa during 2010\u20132019: A Descriptive Analysis.","volume":"2021","author":"Q Zheng","year":"2021","journal-title":"medRxiv"},{"issue":"38","key":"pntd.0010928.ref008","first-page":"433","article-title":"Cholera, 2015.","volume":"91","year":"2016","journal-title":"Wkly Epidemiol Rec"},{"key":"pntd.0010928.ref009","volume-title":"Overview of Ending Cholera\u2014A Global Roadmap to 2030","author":"Global Task Force on Cholera Control G","year":"2017"},{"issue":"6","key":"pntd.0010928.ref010","doi-asserted-by":"crossref","first-page":"1270","DOI":"10.4269\/ajtmh.16-0427","article-title":"What is a Hotspot Anyway?","volume":"96","author":"J Lessler","year":"2017","journal-title":"The American journal of tropical medicine and hygiene"},{"key":"pntd.0010928.ref011","author":"Global Task Force on Cholera Control G","year":"2019","journal-title":"FRAMEWORK FOR THE DEVELOPMENT AND MONITORING OF A MULTISECTORAL NATIONAL CHOLERA PLAN."},{"key":"pntd.0010928.ref012","author":"GTFCC","year":"2021","journal-title":"Guidance and tool for countries to identify priority areas for intervention Geneva: GTFCC"},{"issue":"4","key":"pntd.0010928.ref013","doi-asserted-by":"crossref","first-page":"e001427","DOI":"10.1136\/bmjgh-2019-001427","article-title":"Integrated Disease Surveillance and Response (IDSR) strategy: current status, challenges and perspectives for the future in Africa.","volume":"4","author":"IS Fall","year":"2019","journal-title":"BMJ Glob Health"},{"key":"pntd.0010928.ref014","unstructured":"GADM maps and data [cited 2021 September 15]. Available from: https:\/\/gadm.org\/."},{"key":"pntd.0010928.ref015","volume":"4","author":"Statistics KNBo","year":"2019","journal-title":"2019 Kenya Population and Housing Census Results."},{"issue":"2","key":"pntd.0010928.ref016","doi-asserted-by":"crossref","first-page":"e31743","DOI":"10.1371\/journal.pone.0031743","article-title":"Population distribution, settlement patterns and accessibility across Africa in 2010.","volume":"7","author":"C Linard","year":"2012","journal-title":"PloS one."},{"key":"pntd.0010928.ref017","unstructured":"SDI W. [cited 2022 March 9]. Available from: http:\/\/www.worldpop.org."},{"key":"pntd.0010928.ref018","author":"D. Baston","year":"2021","journal-title":"exactextractr"},{"issue":"6","key":"pntd.0010928.ref019","doi-asserted-by":"crossref","first-page":"e831","DOI":"10.1016\/S2214-109X(22)00007-9","article-title":"The seasonality of cholera in sub-Saharan Africa: a statistical modelling study","volume":"10","author":"J Perez-Saez","year":"2022","journal-title":"The Lancet Global health"},{"key":"pntd.0010928.ref020","article-title":"Kenya Demographic and Health Survey 2008\u20132009.","author":"Macro\u2019 KNBoSKaI","year":"2010","journal-title":"Calverton, Maryland"},{"key":"pntd.0010928.ref021","article-title":"Progress on household drinking water, sanitation and hygiene 2000\u20132020: five years into the SDGs.","author":"Organization UaWH","year":"2021"},{"key":"pntd.0010928.ref022","article-title":"2019 Kenya Population and Housing Census: Volume II. DISTRIBUTION OF POPULATION BY ADMINISTRATIVE UNITS","author":"Statistics KNBo","year":"2019","journal-title":"Nairobi"},{"key":"pntd.0010928.ref023","first-page":"29","article-title":"Stakeholders\u2019 Conference on Prevention, Control and Elimination of Cholera in Uganda.","volume":"2018","author":"Health TRoUMo","year":"2018"},{"key":"pntd.0010928.ref024","article-title":"The micro-hotspots of cholera in Kano State, Nigeria, 2010\u20132019\u2014analysis of patient characteristics, Spatio-temporal patterns and contextual determinants at the ward level.","volume":"2021","author":"MC Ngwa","year":"2021","journal-title":"medRxiv"},{"issue":"6","key":"pntd.0010928.ref025","doi-asserted-by":"crossref","first-page":"2017","DOI":"10.4269\/ajtmh.20-1280","article-title":"Laboratory and Field Evaluation of the Crystal VC-O1 Cholera Rapid Diagnostic Test","volume":"104","author":"AK Debes","year":"2021","journal-title":"The American journal of tropical medicine and hygiene"}],"updated-by":[{"DOI":"10.1371\/journal.pntd.0010928","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2023,5,30]],"date-time":"2023-05-30T00:00:00Z","timestamp":1685404800000}}],"container-title":["PLOS Neglected Tropical Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pntd.0010928","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,5,30]],"date-time":"2023-05-30T17:48:55Z","timestamp":1685468935000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pntd.0010928"}},"subtitle":[],"editor":[{"given":"Elsio","family":"Wunder","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2023,5,17]]},"references-count":25,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2023,5,17]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pntd.0010928","relation":{"new_version":[{"id-type":"doi","id":"10.1371\/journal.pntd.0010928","asserted-by":"object"}]},"ISSN":["1935-2735"],"issn-type":[{"value":"1935-2735","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,5,17]]}}}