National Surveillance Data on the Epidemiology of Cholera in Togo

Background. Togo is a cholera-endemic country bordered by other countries where this disease is endemic. We describe the epidemiology of cholera in Togo, using national surveillance data. Methods. We reviewed national surveillance data housed in the National Ministry of Health. Districts submitted reports of summary weekly case counts and deaths at the national level. Data were available at the district level during 2008-2010 and at the national level from 1996 onward. Microbiological confirmation usually was not performed, and case identification was based on clinical suspicion. Results. From 1996 through 2010, Togo had 12 676 reported cholera cases and 554 deaths. Annual national cholera incidence varied from 0.9 to 66 cases per 100 000 population, with little variation except for 2 large epidemics during 1998 and 2001. The case-fatality ratio declined from 12%-17% during 1996-1997 to < 1% during 2008-2010. During 2008-2010, 85% of 26 district-level outbreaks occurred in the capital Lome or the coastal Maritime Region. The average outbreak duration was 6 weeks, and only 2 lasted > 15 weeks. Discussion. While cholera control remains elusive in Togo, reductions in case-fatality ratios have occurred, possibly due to improvements in case management. The short duration of outbreaks may preclude reactive vaccination; however, the restricted geographic location may make preventive immunization attractive.