Andreasen, V.

Davidsen, E.

Jensen, P. K. M.

Perner, M. L.

Phelps, M.

Simonsen, L.

English

Copenhagen University Research Information System

u n i ve r s i t y  o f  co pe n h ag e n  Københavns UniversitetEpidemiological description of unmitigated cholera epidemics in 19th century DenmarkPhelps, M.; Perner, M. L.; Davidsen, E.; Andreasen, V.; Jensen, P. K. M.; Simonsen, L.Publication date:2016Citation for published version (APA):Phelps, M., Perner, M. L., Davidsen, E., Andreasen, V., Jensen, P. K. M., & Simonsen, L. (2016).Epidemiological description of unmitigated cholera epidemics in 19th century Denmark. Poster sessionpresented at American Society of Tropical Medicine and Hygiene Annual Meeting, Atlanta, United States.Download date: 03. Feb. 2020See	discussions,	stats,	and	author	profiles	for	this	publication	at:	https://www.researchgate.net/publication/311674975Epidemiological	description	of	unmitigatedcholera	epidemics	in	19th	century	DenmarkPoster	·	November	2016DOI:	10.13140/RG.2.2.12206.51522CITATIONS0READS126	authors,	including:Some	of	the	authors	of	this	publication	are	also	working	on	these	related	projects:Historic	Cholera	Epidemiology	View	projectMatthew	PhelpsUniversity	of	Copenhagen3	PUBLICATIONS			0	CITATIONS			SEE	PROFILELone	SimonsenGeorge	Washington	University260	PUBLICATIONS			12,695	CITATIONS			SEE	PROFILEAll	content	following	this	page	was	uploaded	by	Matthew	Phelps	on	10	January	2017.The	user	has	requested	enhancement	of	the	downloaded	file.4. Results1. Context• Mathematical models are used to evaluate potential interventions in endemic and epidemics settings and need empirical parameterizations[1].• Historical outbreak data are underutilized as a source of empirical data for model parameterization.• In 1853 & 1857 singular cholera outbreaks occurred across Denmark in populations with no previous exposure and no effective interventions were implemented.3. Data & methods• Daily cholera morbidity & mortality data from three cities digitized from municipal cholera commission reports.• All-cause monthly mortality data for Copenhagen, 1852 – 1854 digitized from the “Statistisk Tabelværk”.• Transmission chains reconstructed from physician narratives of index cases.Acknowledgments• Funding generously provided by the Changing Disasters 2016 project: changingdisasters.ku.dk• Additional support provided by: Copenhagen City Archives and the Royal Danish ArchivesM. Phelps1, M. L. Perner1, E. Davidsen1 V. Andreasen2, P.K.M. Jensen1, L. Simonsen11COPE Copenhagen Center for Disaster Research, Department of Public Health; 2Roskilde UniversityEpidemiological Description of Unmitigated Cholera Epidemicsin 19th Century Denmark• The outbreak was severe for all age groups.• A 14-fold increase in monthly all-cause mortality was seen among those aged 50+ in Copenhagen.2. Objectives• Describe unmitigated cholera outbreaks in immunological naïve populations.• To infer key parameters such as the serial interval and the reproductive number (R0)from the data.• To compare key metrics of the Danish outbreaks with Haitian 2010 outbreak.5. Conclusions• Severe unmitigated cholera epidemics in entirely susceptible populations provide a unique opportunity to describe the natural course of a cholera outbreak.• Despite a focus on water supply interventions in cholera outbreak response, the role of non-waterborne transmission routes in epidemic settings merits further consideration. • In spite of dissimilar water infrastructurein the three towns, the reproductive numbers (R0) and age distribution of cases/deaths were comparable, suggesting non-waterborne transmission routes were important.• The serial interval estimate of 3.1 days is the first to our knowledge from an outbreak setting• High morbidity & mortality in adults and low among the young is the inverse of endemic settings. The is likely due to the lack of acquired immunity and under-reporting of moderate cases in the young due to the strict case-definition used at the time.• Outbreaks all occurred in late summer / autumn.• Copenhagen's outbreak was likely an amalgamation of multiple outbreaks in sub-populations resulting in a flatter epidemic curve.• Adults were at highest risk of infections and death in all three locations.Literature cited1. Grad YH, Miller JC, Lipsitch M. Cholera modeling: challenges to quantitative analysis and predicting the impact of interventions. Epidemiology 2012; 23: 523–30.2. Mukandavire Z, Smith DL, Morris JG Jr. Cholera in Haiti: reproductive numbers and vaccination coverage estimates. Sci Rep 2013; 3: 997.3. Barzilay EJ, Schaad N, Magloire R, et al. Cholera Surveillance during the Haiti Epidemic — The First 2 Years. N Engl J Med 2013; 368: 599–609.4. Luquero FJ, Rondy M, Boncy J, et al. Mortality Rates during Cholera Epidemic, Haiti, 2010-2011. Emerg Infect Dis 2016; 22: 410–6.• Copenhagen and Haiti outbreaks have comparable reported attack rates & reproductive numbers (R0).• Improvement in case-management and interventions likely lowered the CFR and excess mortality in Haiti.LocationCopenhagen 1853Haiti 2010-11R0 (1.5 – 1.8)1.9 (2.1 – 1.6)* [2]Reported attack rate (95% CI)5.2% (5.1% – 5.4%) 6%*† [3]Adjusted attack rate using R0 58% - 69% NAExcess mortality as % of population (95% CI) 2.4%0.4% (0.3% -0.7%)** [4]Reported CFR 66% ~2%† [3]Adjusted CFR using R0 5% - 6% >2%†% of cases in patients<5 years 8.4% 15.5%*‡ [3]*Port-au-Prince; **Gonaives; †first 4 months; ‡first 2 yearsCopenhagen• The serial interval was estimate to be 3.1 days(95% CI: 1.9 – 4.5) and is the first estimate from an outbreak setting to our knowledge.• The reproductive numbers were comparable across the locations despite dissimilar water supply infrastructure.Daily incidence ratesMonthly all-causemortality countsAge-based morbidity & mortality rates Reproductive number (R0) estimatesView publication stats

Epidemiological description of unmitigated cholera epidemics in 19th century Denmark

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Epidemiological description of unmitigated cholera epidemics in 19th century Denmark

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