Cholera Epidemic in South Sudan and Uganda and Need for International Collaboration in Cholera Control

Abdinasir Abubakar1, Godfrey Bwire1, Andrew S. Azman, Malika Bouhenia, Lul L. Deng, Joseph F. Wamala, John Rumunu, Atek Kagirita, Jean Rauzier, Lise Grout, Stephen Martin, Christopher Garimoi Orach, Francisco J. Luquero, and Marie-Laure Quilici

Author affiliations: World Health Organization, Cairo, Egypt (A. Abubakar); Uganda Ministry of Health, Kampala, Uganda (G. Bwire, A. Kagirita); Médecins Sans Frontières, Geneva, Switzerland (A.S. Azman); Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA (A.S. Azman, F.J. Luquero); Epicentre, Paris, France (M. Bouhenia, L. Grout, F.J. Luquero); Republic of South Sudan Ministry of Health, Juba, South Sudan (L.L. Deng, J. Rumunu); World Health Organization, Juba (J.F. Wamala); Institut Pasteur, Paris, France (J. Rauzier, M.-L. Quilici); World Health Organization, Geneva (S. Martin); Makerere University School of Public Health, Kampala (C.G. Orach)

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Figure 1

Locations and molecular analysis of 2014 epidemic in Uganda and South Sudan. A) Affected areas in both countries. Light brown indicates districts where we did not obtain any isolate for molecular analysis; red, orange, and blue areas represent affected districts with cholera isolates included in the analysis. B) Multilocus variable-number tandem-repeat (MLVA) analysis. Minimum spanning tree using pairwise difference was generated using Bionumerics version 6.6 (Applied Maths, Inc., Austin, TX, US

Figure 1. Locations and molecular analysis of 2014 epidemic in Uganda and South Sudan. A) Affected areas in both countries. Light brown indicates districts where we did not obtain any isolate for molecular analysis; red, orange, and blue areas represent affected districts with cholera isolates included in the analysis. B) Multilocus variable-number tandem-repeat (MLVA) analysis. Minimum spanning tree using pairwise difference was generated using Bionumerics version 6.6 (Applied Maths, Inc., Austin, TX, USA). Circles represent the 8 distinct MLVA profiles we identified, numbered chronologically by the earliest isolate of each profile. The MLVA profiles differ by variations at a single variable-number tandem-repeat locus located in the small chromosome only (VCA 0171, VCA 0283). The size of the circles is proportional to the number of isolates in each profile. Colors represent the location of the isolates and correspond with the colors of the areas in Panel A.

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1These authors contributed equally to this article.