Climate variability and the outbreaks of cholera in Zanzibar, East Africa: A time series analysis

Rita Reyburn, Deok Ryun Kim, Michael Emch, Ahmed Khatib, Lorenz Von Seidlein, Mohammad Ali

Research output: Contribution to journalArticle


Global cholera incidence is increasing, particularly in sub-Saharan Africa. We examined the impact of climate and ocean environmental variability on cholera outbreaks, and developed a forecasting model for outbreaks in Zanzibar. Routine cholera surveillance reports between 1997 and 2006 were correlated with remotely and locally sensed environmental data. A seasonal autoregressive integrated moving average (SARIMA) model determined the impact of climate and environmental variability on cholera. The SARIMA model shows temporal clustering of cholera. A 1° C increase in temperature at 4 months lag resulted in a 2-fold increase of cholera cases, and an increase of 200 mm of rainfall at 2 months lag resulted in a 1.6-fold increase of cholera cases. Temperature and rainfall interaction yielded a significantly positive association ( P <0.04) with cholera at a 1-month lag. These results may be applied to forecast cholera outbreaks, and guide public health resources in controlling cholera in Zanzibar.

Original languageEnglish (US)
Pages (from-to)862-869
Number of pages8
JournalAmerican Journal of Tropical Medicine and Hygiene
Issue number6
Publication statusPublished - Jun 2011


ASJC Scopus subject areas

  • Parasitology
  • Infectious Diseases
  • Virology

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