Cholera trends and climate sensitive early warning modeling in Yemen 2015 2034 using an integrated epidemiological climatic and genomic risk framework

Abstract Cholera remains one of Yemen’s most persistent public health threats, driven by fragile WASH systems, climate variability, population displacement, and the environmental persistence of Vibrio cholerae. The study provides a comprehensive retrospective analysis of cholera trends from 2015 to 2024 and generates a 10 year forecast (2025–2034) using the EWS_ClimateHealth_GenomicYemen_IntegratedMegaSystem an integrated early warning framework combining epidemiological surveillance, climate indicators, and genomic metadata. The system incorporates a Unified Relative Time (URT) model, climate‑epidemiological coupling, and genomic‑risk indices to produce graded (Green/Yellow/Orange/Red) alerts. Results show strong associations between rainfall anomalies, temperature extremes, and cholera surges, with major peaks in 2016–2017 and 2019. Genomic analysis indicates the continued dominance of V. cholerae O1 El Tor Ogawa with limited diversification.Genomic data (n ≈ 45 isolates, 2016–2019) were incorporated as secondary inputs for risk scoring. Forecasts suggest recurrent seasonal waves, amplified during years with strong ENSO/IOD activity and intensified rainfall. Strengthening WASH systems, expanding genomic surveillance, and operationalizing early warning outputs are essential for long term cholera control in Yemen.