Weekly notification of suspected cholera cases.

<p>The Disease Surveillance Service of the Ghana Health Service reports 20,120 cholera cases according to the WHO case definition between May 2014 and December 2014 with a peak number of 2,853 cases in the 35^th calendar week (25–31 August).</p

Spatial and temporal location of suspected cholera cases (Mai 2014-December 2014; n = 20,120).

<p>As notified to the Disease Surveillance Service of the Ghana Health Service according to the WHO case definition suspected cholera cases are plotted by district by 5-week period panels. The figure was produced with Arc GIS 10.0 (ESRI: ArcGis Desktop: Release 10.2011).</p

Pulse-field gel electrophoresis (PFGE) dendrogram for <i>Vibrio cholerae</i> isolates (n = 45).

<p>The three clusters A, B and C (bold letters) are based on a similarity cut-off of 95% (Dotted line; Dice coefficient, represented by UPGMA, 1.0% optimization and 1.5% tolerance). The geographical location, year of disease onset, serogroup, serotype and multilocus variable-number tandem-repeat (VNTR) analysis (MLVA) results are given for each <i>V</i>. <i>cholerae</i> isolate. Regional three-letter codes: ASH, Ashanti region; CEN, Central region; GAR, Greater Accra region; VOL, Volta region. District three-letter codes: AAN, Asante Akim North; ACC, Accra; ADE, Adentan; AGW, Agona-Swedru; AWS, Awutu-Senya; ASA, Ashaiman; GAE, Ga East; GAS, Ga South; GAW, Ga West; GOE, Gomoa East; GOW, Gomoa West; HOH, Hohoe; HOV, Ho; KPK, Kpone-Katamanso; LEK, Ledzekuku-Krowor; TEM, Tema.</p

Antimicrobial resistance for each antibiotic (A) and resistance profile (B) of <i>Vibrio cholerae</i> isolates, by year of disease onset (n = 92).

<p>Antimicrobial resistance for each antibiotic (A) and resistance profile (B) of <i>Vibrio cholerae</i> isolates, by year of disease onset (n = 92).</p

Minimum spanning tree of multilocus variable-number tandem-repeat (VNTR) analysis (MLVA) for <i>Vibrio cholerae</i> isolates (n = 45) by year of disease onset.

<p>Clonal complexes (CC 1, CC 2, CC 3) were defined as isolates connected through a chain of single-locus variants. Grey figures indicate the number of different alleles. Three-digit codes present the laboratory isolate number.</p

Weekly evolution of cholera epidemics, rainfall levels, and the tested <i>V</i>. <i>cholerae</i> isolates in Greater Accra Region from 2011 to 2014.

<p>Suspected cholera cases are indicated in red (right y-axis), and rainfall is indicated in blue (left y-axis). The corresponding year is labeled on the x-axis. To integrate the epidemiological and MLVA/MST data, the three major MST clusters identified in Accra are indicated below the histogram of suspected cholera cases. GAR1 = the Ghana 2011 cluster (which gave rise to a few strains in 2012), GAR2 = the main Ghana 2012 cluster, and GAR3 = the Ghana 2014 cluster identified on the MST.</p

Strains from Ghana, Togo, and Guinea situated on the maximum likelihood phylogenetic tree of the third wave of the seventh pandemic lineage of <i>V</i>. <i>cholerae</i>.

<p>The tree is based on the SNP differences across the whole core genome. An isolate from the first wave, Bangladesh 1975, was included as an outgroup to root the tree. An isolate from the second wave was also included (India 1990). The color of the branch tips indicates the country of origin, and the year of isolation is specified. The strains from Ghana, Togo, and Guinea are indicated using the same colors as in the Minimum Spanning Tree (Ghana in pink and red, Togo in orange and yellow, and Guinea in bright green). Labels A through G indicate the isolates from Ghana, Togo, and Guinea included on the MST in <a href="http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0006379#pntd.0006379.g003" target="_blank">Fig 3</a>. Scale is provided as the number of substitutions per variable site, and the SNPs are indicated on the branches.</p

The number of suspected cholera cases reported in each country included in the study per year.

<p>The number of suspected cholera cases reported in each country included in the study per year.</p

Minimum Spanning Tree based on the MLVA types of 257 <i>V</i>. <i>cholerae</i> isolates from several recent West African cholera outbreaks.

<p>Each MLVA type is represented by a node (and a unique number), and the size of the nodes reflects the number of isolates of each MLVA type. The solid lines indicate the most likely single locus variant, while dashed lines indicate the most likely double locus variant. The colors reflect the distinct country and year of isolate origin. Pie charts indicate strains from different time periods or countries displaying an identical MLVA type. The two strains represented by MLVA types #1 and #44 were isolated from environmental samples in Guinea (encircled in red). Labels A through G indicate the isolates from Ghana, Togo, and Guinea included on the phylogenic tree in <a href="http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0006379#pntd.0006379.g004" target="_blank">Fig 4</a>.</p

Additional file 1: of An outbreak of pneumococcal meningitis among older children (≥5 years) and adults after the implementation of an infant vaccination programme with the 13-valent pneumococcal conjugate vaccine in Ghana

The weekly distribution of suspected meningitis cases in the hardest hit districts. (A) Jaman North District, (B) Tain District, (C) Techiman Municipal District and (D) Wenchi District. (JPG 609 kb