The incidence, and spatial trends of cholera in Sabah over 15 years: Repeated outbreaks in coastal areas

Marilyn Charlene Montini Maluda and Emilia Johnson and Fredie Robinson and Muhammad Jikal and Siat, Yee Fong and Mohammad Saffree Jeffree and Kimberly M. Fornace and Kamruddin Ahmed (2024) The incidence, and spatial trends of cholera in Sabah over 15 years: Repeated outbreaks in coastal areas. PLOS Glob Public Health, 4. pp. 1-16. ISSN 2767-3375

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Abstract

Vibrio cholerae remains a notable public health challenge across Malaysia. Although the Malaysian state of Sabah is considered a cholera-affected area, gaps remain in understanding the epidemiological trends and spatial distribution of outbreaks. Therefore, to determine longitudinal and spatial trends in cholera cases data were obtained from the Sabah State Health Department for all notified cases of cholera between 2005–2020. A cholera outbreak is defined as one or more confirmed cases in a single locality with the evidence of local transmission. All records were geolocated to village level. Satellite-derived data and generalised linearized models were used to assess potential risk factors, including population density, elevation, and distance to the sea. Spatiotemporal clustering of reported cholera cases and zones of increased cholera risk were evaluated using the tau statistic (τ) at 550m, 5km and 10km distances. Over a 15-year period between 2005–2020, 2865 cholera cases were recorded in Sabah, with a mean incidence rate of 5.6 cases per 100,000 (95% CI: 3.4–7.9). From 2015–2020, 705 symptomatic cases and 727 asymptomatic cases were reported. Symptomatic cases primarily occurred in local Malaysian populations (62.6%, 441/705) and in children and adolescents under 15-years old (49.4%, 348/705). On average, cases were reported in areas with low population density (19.45 persons/km2), low elevations (19.45m) and near coastal areas. Spatiotemporal clustering of cholera cases was identified up to 3.5km, with increased village-level cholera risk within 500m and 5 days of initial case presentation to a health facility (Risk Ratio = 9.7, 95% CI: 7.5–12.4). Cholera incidence has high spatial and temporal heterogeneity within Sabah, with some districts experiencing repeated outbreaks. Cholera cases clustered across space and time, with village-level risk of cholera highest within 5 days and within close proximity to primary case villages, suggesting local transmission.

Item Type:	Article
Keyword:	Vibrio cholerae, Public health, Sabah
Subjects:	R Medicine > RA Public aspects of medicine > RA1-1270 Public aspects of medicine > RA421-790.95 Public health. Hygiene. Preventive medicine R Medicine > RC Internal medicine > RC31-1245 Internal medicine > RC109-216 Infectious and parasitic diseases
Department:	FACULTY > Faculty of Medicine and Health Sciences
Depositing User:	SITI AZIZAH BINTI IDRIS -
Date Deposited:	16 Nov 2024 14:57
Last Modified:	16 Nov 2024 14:57
URI:	https://eprints.ums.edu.my/id/eprint/41902

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