The usefulness of school-based syndromic surveillance for detecting malaria epidemics: experiences from a pilot project in Ethiopia.
BACKGROUND Kenya has experienced multiple cholera outbreaks since 1971. Cholera remains an issue of major public health importance and one of the 35 priority diseases under Kenya's updated Integrated Disease Surveillance and Response strategy. METHODS We reviewed the cholera surveillance data reported to the World Health Organization and the Kenya Ministry of Public Health and Sanitation from 1997 through 2010 to determine trends in cholera disease for the 14-year period. RESULTS A total of 68 522 clinically suspected cases of cholera and 2641 deaths were reported (overall case-fatality rate [CFR], 3.9%), affecting all regions of the country. Kenya's largest outbreak occurred during 1997-1999, resulting in 26 901 cases and 1362 deaths (CFR, 5.1%). Following a decline in disease occurrence, the country experienced a resurgence of epidemic cholera during 2007-2009 (16 616 cases and 454 deaths; CFR, 2.7%), which declined rapidly to 0 cases. Cases were reported through July 2010, with no cases reported during the second half of the year. About 42% of cases occurred in children aged <15 years. Vibrio cholerae O1, serotype Inaba, was the predominant strain recorded from 2007 through 2010, although serotype Ogawa was also isolated. Recurrent outbreaks have most frequently affected Nairobi, Nyanza, and Coast provinces, as well as remote arid and semiarid regions and refugee camps. DISCUSSION Kenya has experienced substantial amounts of reported cases of cholera during the past 14 years. Recent decreases in cholera case counts may reflect cholera control measures put in place by the National Ministry of Health; confirmation of this theory will require ongoing surveillance.