{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T12:47:14Z","timestamp":1788353234643,"version":"build-2803163510"},"reference-count":39,"publisher":"Public Library of Science (PLoS)","issue":"12","license":[{"start":{"date-parts":[[2025,12,8]],"date-time":"2025-12-08T00:00:00Z","timestamp":1765152000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:p>Cholera remains one of the most rapidly fatal infectious diseases globally, with untreated cases leading to death within hours due to severe dehydration. Despite being preventable and treatable, it continues to pose a significant public health threat, especially in low and middle-income countries where water, sanitation, and hygiene (WASH) services are inadequate. This study aimed at investigating the rapid progression and short-term mortality during the January 2023 to July 2024 Cholera Outbreaks in Zambia. We conducted a retrospective cross-sectional study using national cholera surveillance data from Zambia\u2019s January 2023 to July 2024 outbreak to examine delays in care and associated outcomes. All suspected and confirmed cases with complete records on symptom onset, admission, and outcome were included. Key time intervals were calculated and analyzed using descriptive statistics and non-parametric tests, with subgroup comparisons by age, sex, and outcome status. Ethical approval was obtained, all data were anonymized, and analyses were performed using Stata version 14.2. A total of 3,655 cases were analyzed, of whom 52.2% were male and 37.8% were under 15 years. Nearly all patients (99%) were admitted as inpatients, and the overall mortality rate was 4.2%. The median time from symptom onset to death was 3 days, underscoring the rapid progression of the disease. Of the 3,655 cholera patients enrolled in the study, 2,162 patients were included in the survival analysis, the death rate was 0.85 per 100 person-days, with higher rates observed among males (1.05) and adults aged 50 years and above (2.71). Confirmed cases experienced the highest mortality, and survival probabilities were significantly lower among males (p\u2009=\u20090.0498), older adults (&lt;0.0001), and confirmed cholera cases (&lt;0.0001). Many cholera deaths in this outbreak happened within just a few days of admission, showing the need for quick assessment and urgent fluid treatment as soon as patients arrive. Older adults and men faced a higher risk of dying, which calls for triage protocols that pay closer attention to these groups. Laboratory confirmation was limited, with very few patients receiving rapid diagnostic tests, revealing a serious gap in surveillance and case management. Strengthening early warning systems, improving access to rapid tests, and focusing on high-risk groups are key steps to lowering deaths in future outbreaks.<\/jats:p>","DOI":"10.1371\/journal.pone.0330969","type":"journal-article","created":{"date-parts":[[2025,12,8]],"date-time":"2025-12-08T18:30:36Z","timestamp":1765218636000},"page":"e0330969","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":1,"title":["Rapid progression and short-term mortality during the January 2023 to July 2024 Cholera outbreaks in Zambia: A retrospective facility-based study"],"prefix":"10.1371","volume":"20","author":[{"given":"Deborah","family":"Tembo","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nedah Chikonde","family":"Musonda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miyanda","family":"Simwaka","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chipo","family":"Nkwemu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5473-9332","authenticated-orcid":true,"given":"Samson","family":"Shumba","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2025,12,8]]},"reference":[{"issue":"3","key":"pone.0330969.ref001","doi-asserted-by":"crossref","first-page":"174","DOI":"10.5603\/IMH.2017.0031","article-title":"Pre-employment medical examinations - what is the issue?","volume":"68","author":"K Seidenst\u00fccker","year":"2017","journal-title":"Int Marit Health"},{"issue":"3","key":"pone.0330969.ref002","doi-asserted-by":"crossref","first-page":"169","DOI":"10.3390\/tropicalmed8030169","article-title":"Global patterns of trends in cholera mortality","volume":"8","author":"I Ilic","year":"2023","journal-title":"Trop Med Infect Dis"},{"key":"pone.0330969.ref003","first-page":"471","article-title":"Vibrio cholerae and cholera biotypes","volume-title":"Global Water Pathogen Project","author":"M Momba","year":"2017"},{"issue":"3","key":"pone.0330969.ref004","doi-asserted-by":"crossref","first-page":"268","DOI":"10.3748\/wjg.v30.i3.268","article-title":"Calcium\/calcimimetic via calcium-sensing receptor ameliorates cholera toxin-induced secretory diarrhea in mice","volume":"30","author":"L-Q Tang","year":"2024","journal-title":"World J Gastroenterol"},{"issue":"1","key":"pone.0330969.ref005","doi-asserted-by":"crossref","first-page":"958","DOI":"10.15212\/ZOONOSES-2023-0027","article-title":"The threat of cholera in Africa","volume":"3","author":"GA Erkyihun","year":"2023","journal-title":"Zoonoses"},{"issue":"5","key":"pone.0330969.ref006","first-page":"965","article-title":"The causes, diagnosis, and current course of medical care for cholera","volume":"6","author":"Y Srivastav","year":"2023","journal-title":"Int J Medical Science in Clinical Res Review"},{"key":"pone.0330969.ref007","doi-asserted-by":"crossref","DOI":"10.1093\/infdis\/jiy444","article-title":"Individual and Household Risk Factors for Symptomatic Cholera Infection: A Systematic Review and Meta-analysis","volume":"218","author":"A Richterman","year":"2018","journal-title":"J Infect Dis"},{"issue":"5","key":"pone.0330969.ref008","doi-asserted-by":"crossref","first-page":"332","DOI":"10.1111\/tmi.14106","article-title":"Risk factors for cholera mortality: A scoping review","volume":"30","author":"D Pampaka","year":"2025","journal-title":"Trop Med Int Health"},{"issue":"6","key":"pone.0330969.ref009","article-title":"Updated global burden of cholera in endemic countries","volume":"9","author":"M Ali","year":"2015","journal-title":"PLoS Negl Trop Dis"},{"key":"pone.0330969.ref010","article-title":"Cholera surveillance and estimation of burden of cholera","author":"D Ganesan","year":"2020","journal-title":"Vaccine"},{"issue":"1","key":"pone.0330969.ref011","doi-asserted-by":"crossref","first-page":"20","DOI":"10.4103\/2773-0344.389607","article-title":"Emerging and re-emerging diseases: A narrative review","volume":"3","author":"M Ranjit","year":"2023","journal-title":"One Health Bull"},{"key":"pone.0330969.ref012","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1007\/82_2014_369","article-title":"Cholera outbreaks in Africa","author":"MA Mengel","year":"2014","journal-title":"Cholera Outbreaks. Springer"},{"key":"pone.0330969.ref013","doi-asserted-by":"crossref","first-page":"04151","DOI":"10.7189\/jogh.15.04151","article-title":"Global distribution and health impact of infectious disease outbreaks, 1996-2023: a worldwide retrospective analysis of World Health Organization emergency event reports","volume":"15","author":"Q Liu","year":"2025","journal-title":"J Glob Health"},{"issue":"1","key":"pone.0330969.ref014","doi-asserted-by":"crossref","DOI":"10.59846\/ajbas.v4i1.724","article-title":"Cholera Overview \u2013 National , Regional and Global\u00a0: A Narrative Review","volume":"4","author":"Kamarany Mohammed Amood Al","year":"2025","journal-title":"AJOBAS"},{"issue":"1","key":"pone.0330969.ref015","doi-asserted-by":"crossref","DOI":"10.1136\/bmjgh-2024-017055","article-title":"Building resilience against cholera: lessons from the implementation of integrated community strategy for cholera control in Zambia","volume":"10","author":"M Mwale","year":"2025","journal-title":"BMJ Glob Health"},{"issue":"5","key":"pone.0330969.ref016","doi-asserted-by":"crossref","DOI":"10.1093\/ofid\/ofaf215","article-title":"Clinical characteristics and factors associated with severe outcomes of 1891 pediatric patients admitted to the referral cholera treatment centers in Lusaka, Zambia, December 2023\u2013March 2024","volume":"12","author":"N Kalima","year":"2025","journal-title":"Open Forum Infectious Diseases"},{"issue":"6","key":"pone.0330969.ref017","article-title":"Clinical characteristics of 6578 adult patients with cholera admitted to community and referral cholera treatment centers in Lusaka, Zambia, October 2023 to April 2024","volume":"12","author":"Nyuma","year":"2025","journal-title":"Open Forum Infectious Diseases"},{"issue":"1","key":"pone.0330969.ref018","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1016\/j.trstmh.2008.07.016","article-title":"Asymptomatic Plasmodium parasitaemia in pregnant Nigerian women: almost a decade after Roll Back Malaria","volume":"103","author":"UI Nwagha","year":"2009","journal-title":"Trans R Soc Trop Med Hyg"},{"key":"pone.0330969.ref019","author":"Ministry of Health Zambia","year":"2024"},{"issue":"6","key":"pone.0330969.ref020","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pntd.0012422","article-title":"Navigating the cholera elimination roadmap in Zambia - A scoping review (2013-2024)","volume":"19","author":"N Mbewe","year":"2025","journal-title":"PLoS Negl Trop Dis"},{"issue":"6","key":"pone.0330969.ref021","doi-asserted-by":"crossref","first-page":"1287","DOI":"10.4269\/ajtmh.16-0300","article-title":"Factors Associated with Fatal Outcomes Following Cholera-Like Syndrome in Far North Region of Cameroon: A Community-Based Survey","volume":"95","author":"FN Djouma","year":"2016","journal-title":"Am J Trop Med Hyg"},{"issue":"12","key":"pone.0330969.ref022","doi-asserted-by":"crossref","first-page":"2257","DOI":"10.2166\/wh.2024.094","article-title":"Zambia\u2019s battle against cholera outbreaks and the path to public health resilience: a narrative review","volume":"22","author":"BH Gulumbe","year":"2024","journal-title":"J Water Health"},{"key":"pone.0330969.ref023","article-title":"Determinants of cholera fatalities in Malawi: A case-control study","author":"R Chitatanga","year":"2025","journal-title":"medRxiv"},{"issue":"1","key":"pone.0330969.ref024","doi-asserted-by":"crossref","first-page":"433","DOI":"10.1186\/s13104-017-2756-9","article-title":"Health seeking behaviour among suspected cases of cholera in Cameroonian health districts in Lake Chad basin","volume":"10","author":"MN Yakum","year":"2017","journal-title":"BMC Res Notes"},{"issue":"2","key":"pone.0330969.ref025","article-title":"Cholera-free Zambia 2025: A distant dream or an achievable reality?","volume":"8","author":"B Siamalube","year":"2024","journal-title":"Public Health Open Access"},{"issue":"20","key":"pone.0330969.ref026","doi-asserted-by":"crossref","first-page":"2768","DOI":"10.1016\/j.vaccine.2018.04.011","article-title":"Lipopolysaccharide-specific memory B cell responses to an attenuated live cholera vaccine are associated with protection against Vibrio cholerae infection","volume":"36","author":"DJ Haney","year":"2018","journal-title":"Vaccine"},{"issue":"3","key":"pone.0330969.ref027","doi-asserted-by":"crossref","DOI":"10.1128\/cmr.00211-21","article-title":"Diagnosis, Management, and Future Control of Cholera","volume":"35","author":"F Chowdhury","year":"2022","journal-title":"Clin Microbiol Rev"},{"key":"pone.0330969.ref028","first-page":"1","article-title":"Cholera pathophysiology: have we missed the boat?","volume":"9766","author":"D Nalin","year":"2021","journal-title":"Academic Letters"},{"key":"pone.0330969.ref029","author":"World Health Organisation","year":"2023"},{"key":"pone.0330969.ref030","volume-title":"Ending cholera: A global roadmap to 2030","author":"World Health Organization","year":"2017"},{"issue":"1","key":"pone.0330969.ref031","doi-asserted-by":"crossref","first-page":"1264","DOI":"10.1186\/s12889-019-7559-6","article-title":"Descriptive epidemiology of cholera outbreak in Nigeria, January-November, 2018: implications for the global roadmap strategy","volume":"19","author":"KO Elimian","year":"2019","journal-title":"BMC Public Health"},{"issue":"8","key":"pone.0330969.ref032","doi-asserted-by":"crossref","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":"6","key":"pone.0330969.ref033","doi-asserted-by":"crossref","first-page":"621","DOI":"10.4155\/fmc.13.40","article-title":"Boron medicinal chemistry and synthetic aspects","volume":"5","author":"JT Ahmet","year":"2013","journal-title":"Future Med Chem"},{"key":"pone.0330969.ref034","author":"MC Ngwa","year":"2019","journal-title":"Cold Spring Harbor Laboratory"},{"issue":"4","key":"pone.0330969.ref035","doi-asserted-by":"crossref","first-page":"645","DOI":"10.4269\/ajtmh.11-0696","article-title":"Community mortality from cholera: urban and rural districts in Zimbabwe","volume":"88","author":"D Morof","year":"2013","journal-title":"Am J Trop Med Hyg"},{"issue":"1","key":"pone.0330969.ref036","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1016\/S1201-9712(00)90059-6","article-title":"Epidemic cholera in Guinea-Bissau: the challenge of preventing deaths in rural West Africa","volume":"4","author":"G Gunnlaugsson","year":"2000","journal-title":"Int J Infect Dis"},{"issue":"4","key":"pone.0330969.ref037","doi-asserted-by":"crossref","first-page":"845","DOI":"10.4269\/ajtmh.24-0558","article-title":"Increased Prevalence of Antimicrobial Resistance in Vibrio cholerae in the Capital and Provincial Areas of Zambia, January 2023-February 2024","volume":"112","author":"TM Phiri","year":"2025","journal-title":"Am J Trop Med Hyg"},{"issue":"12","key":"pone.0330969.ref038","doi-asserted-by":"crossref","DOI":"10.1016\/S2214-109X(16)30200-5","article-title":"Efficacy of a Russian-backbone live attenuated influenza vaccine among young children in Bangladesh: a randomised, double-blind, placebo-controlled trial","volume":"4","author":"WA Brooks","year":"2016","journal-title":"Lancet Glob Health"},{"issue":"19","key":"pone.0330969.ref039","doi-asserted-by":"crossref","first-page":"556","DOI":"10.15585\/mmwr.mm6719a5","article-title":"Cholera epidemic - Lusaka, Zambia, October 2017-May 2018","volume":"67","author":"N Sinyange","year":"2018","journal-title":"MMWR Morb Mortal Wkly Rep"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0330969","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,8]],"date-time":"2025-12-08T18:30:43Z","timestamp":1765218643000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0330969"}},"subtitle":[],"editor":[{"given":"Olushayo Oluseun","family":"Olu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2025,12,8]]},"references-count":39,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2025,12,8]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0330969","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,8]]}}}