Case-area targeted preventive interventions to interrupt cholera transmission: Current implementation practices and...

Area of Science:

• Public Health
• Infectious Disease Epidemiology
• Global Health

Background:

• Cholera poses significant mortality and morbidity risks, particularly in resource-limited and humanitarian settings.
• Transmission occurs via the fecal-oral route, with close contacts of infected individuals at higher risk.
• Targeted interventions around cholera cases may efficiently limit outbreak expansion.

Purpose of the Study:

• To investigate the implementation and effectiveness of cholera case-area targeted interventions (CATIs).
• To identify challenges and propose improvements for consistent and effective CATI strategies.
• To synthesize evidence from systematic reviews and case studies on CATI implementation.

Main Methods:

• Systematic reviews of 11 peer-reviewed and 8 grey literature articles.
• 30 key informant interviews conducted in case studies (DRC, Haiti, Yemen, Zimbabwe).
• Analysis of 15 outbreaks across 12 countries where CATIs were documented.

Main Results:

• CATIs were implemented with varied team compositions and intervention types (predominantly water, sanitation, and hygiene).
• Alert systems and high-risk household selection criteria were inconsistent across documented outbreaks.
• Challenges included coordination among actors, inter-sectoral integration, and delays in case information sharing.

Conclusions:

• CATIs show potential for reducing cholera outbreaks, but evidence on effectiveness is limited and context-specific.
• Standardized cholera case definitions and evidence-based intervention packages are needed.
• Improved coordination, data sharing, and household selection criteria are crucial for strengthening CATI approaches.