Global & Disaster Medicine

Archive for the ‘Cholera’ Category

Cholera in Somalia: The cumulative total of cases is 6394, including 42 associated deaths (case-fatality rate 0.7%) since the beginning of the current outbreak in December 2017

WHO

Outbreak update – Cholera in Somalia, 4 October 2018

04 October 2018 – The Ministry of Health of Somalia has announced 30 new cases of cholera and no deaths for week 38 (17 to 23 September) of 2018. Since week 28, there has been a decreasing trend in the number of cholera cases reported. The cumulative total of cases is 6394, including 42 associated deaths (case-fatality rate 0.7%) since the beginning of the current outbreak in December 2017. Of 276 stool samples collected since the beginning of this year and tested in the National Public Heatlh Laboratory in Mogadishu, 80 tested positive for Vibrio cholerae, serotype O1 Ogawa.
The cholera outbreak started in December 2017 in Beletweyne along river Shabelle and has spread to Jowhar, Kismayo, Afgoye Merka and Banadir. Over the past five weeks, there has been a decrease in the number of cases reported in Banadir and Lower Jubba, while during week 38 active transmission was reported in Kismayo district of Lower Jubba, and 7 districts of Banadir region (Darkenly, Daynile, Hodan, Madina, Waberi, Hamarjabjab, and Heliwa districts).
During week 38, Banadir accounted for 90% (27) of the newly reported cases. Banadir also has the highest concentration of IDPs living with limited safe water and sanitation. Among the new cases, 44% are children below 5 years old. The oral cholera vaccination campaign that was implemented in 11 high risk districts in 2017 and 2018 across Somalia has greatly contributed to the reduction in the number of new cholera cases compared to the same period in 2017. All cases reported for week 38 had not received vaccination before.
WHO provides leadership and support for activities with the Ministry of Health (MoH) to respond to this outbreak. Coordination meetings were held in the flood-affected districts with MoHs at Federal and State levels including Health Cluster partners for effective collaboration on the outbreak response.
WHO has continued to support clinical care delivery, including building capacity for health care workers. On-the-job trainings on case management were conducted at cholera treatment centers (CTCs) in Kismayo, Farjano, Banadir and Marka. Disease surveillance data was collected through the early warning alert and response network (EWARN) with support from WHO, contributing to early detection of new cases and a prompt response to outbreaks.
WHO worked with WASH cluster partners on chlorination of water sources in cholera-affected areas, including Hnati-wadaaq, Bulo-sheikh, Allenley and Fanole, to ensure safe water in the communities.  1500 hygiene kits were distributed in villages in Kismayo, and hygiene promotion for cholera prevention and control is on-going in Farjano, Allanley, Gulwada, Shaqalaha and Kismayo district.

Cholera in Niger: As of 1 October 2018, 3692 cases (14% of these were cases in Nigerian residents seeking care in Niger) with 68 deaths (case fatality rate = 1.8%) have been reported.

WHO

Cholera – Niger

Disease outbreak news: Update
5 October 2018

On 15 July, the outbreak of cholera was officially declared by the Ministry of Public Health of Niger. The first three cases were residents of Nigeria from Jibiya Local Government Area (LGA) in Katsina State on the border with Niger. The cases were all from the same family and reportedly had an onset of symptoms in Jibiya LGA before seeking treatment on 5 July 2018 at a health facility in a bordering town in Niger. Vibrio cholerae serotype O1 Inaba was confirmed in stool samples from all three cases, one of which died within minutes of admission. In addition to these cases, six cases were reported in the following two days from villages in Niger located approximately 4km away from Jibiya LGA. Since then, the outbreak has continuously expanded geographically and in magnitude with peaks of around 400 cases reported in two weeks in August and in early September.

As of 1 October 2018, 3692 cases (14% of these were cases in Nigerian residents seeking care in Niger) with 68 deaths (case fatality rate = 1.8%) have been reported from twelve health districts in four regions: Dosso, Maradi, Tahoua, and Zinder. Four affected districts (Aguié, Guidam Roumji, Madarounfa, and Maradi commune) in Maradi Region and two affected districts (Birni Koni, and Mabalza) in Tahoua Region are on the border with Nigeria, while Gaya District in Dosso Region is close to the border with both Benin and Nigeria. Overall, 34 cases from four regions have been confirmed for Vibrio cholerae O1 Inaba at the Centre for Medical and Health Research (CERMES) in Niamey: Dosso Region (1), Zinder Region (3), Maradi Region (10) and Tahoua region (20).

Poor sanitary conditions in the affected areas have been implicated in the spread of the outbreak. Frequent population movement between Niger and neighbouring Katsina State in Nigeria, which is also experiencing an upsurge in cases of cholera, is likely impacting on the outbreak.

Public health response

The following public health response sections have been implemented:

    • Multisectoral cholera outbreak coordination structures have been set up at the district, regional and national levels. A regular National Epidemic Management Committee (NEMC) meeting is being held under the leadership of the Ministry of Health (MoH).In addition, WHO is finalizing the WHO action plan to support the MoH.
    • WHO is supporting the deployment of eight epidemiologists to the Maradi and Tahoua regions to support surveillance activities.
    • Surveillance activities are being scaled up with support from WHO and other partners and the daily reporting and line listing of cases have been established.
    • Cholera treatment centres have been put in place by the Ministry of Health with the support of Médecins Sans Frontières, and the Non-governmental Organization (NGO) ALIMA (partnered with the local NGO Bien Être de la Femme et l’Enfant au Niger (BEFEN)). In total, six treatment sites have been set up in the affected districts and initial medical supplies have been dispatched. Niger has laboratory capacity through the national laboratory (CERMES) which confirmed Vibrio cholerae serotype O1 Inaba.
    • Social mobilization and risk communication activities are being scaled-up with support from UNICEF and Niger Red Cross, focusing on hygiene messages.
    • Currently, water, sanitation and hygiene (WASH) activities are focusing on the distribution of aqua tabs.

WHO risk assessment

The current outbreak started in Madarounfa district in Maradi Region, one of the known hotspots for cholera along the Niger – Nigeria border, and has since spread to three geographically dispersed regions, including some of the most affected districts during previous cholera outbreaks. These areas are classified as high-risk areas for the spread of cholera given the presence of local risk factors such as poor hygiene and sanitary conditions coupled with significant population movement and trade between these districts and neighbouring areas in Nigeria. With the ongoing rainy season and the increase in cases in neighbouring Katsina State in Nigeria, the potential for further spread of the disease both within Niger and across the border with Nigeria is high. The population in the capital city Niamey as well as neighbouring Benin are at risk of being affected given the confirmation of cases in the Dosso Region which is a major trading hub on the border with Benin but also links the capital city Niamey. The bridge connecting Niger to Benin across the Niger River close to Gaya town has collapsed on 5 September, which may slow down population movement across this particular border but also forces the population to travel longer distances (possibly through Burkina Faso and Nigeria) to maintain economic and personal links with the other countries in the region.

The recent upsurge of cholera cases in Borno State in Nigeria also puts the population in Niger’s Diffa Region at risk given porous borders and mass movement in this area.

The last major cholera outbreak reported in Niger occurred in 2014 and involved more than 2000 cases.

WHO advice

WHO recommends proper and timely case management in Cholera Treatment Centres. Improving access to potable water and sanitation infrastructure, and improved hygiene and food safety practices in affected communities, are the most effective means of controlling cholera. Key public health communication messages should be provided.

WHO advises against any restriction to travel to and trade with the international community based on the information available on the current outbreak.


Cholera in Zimbabwe: As of 3 October 2018, 8535 cumulative cases, including 163 laboratory-confirmed cases, and 50 deaths have been reported (case fatality rate: 0.6%).

WHO

Cholera – Zimbabwe

Disease outbreak news: Update
5 October 2018

Since the last Disease Outbreak News was published on 20 September (with data as of 15 September), an additional 4914 cases have been reported including 92 laboratory-confirmed cases.

The cholera outbreak in Harare was declared by the Ministry of Health and Child Care (MoHCC) of Zimbabwe on 6 September 2018 and notified to WHO on the same day. As of 3 October 2018, 8535 cumulative cases, including 163 laboratory-confirmed cases, and 50 deaths have been reported (case fatality rate: 0.6%). Of these 8535 cases, 98% (8341 cases) were reported from the densely populated capital Harare (Figure 1). The most affected suburbs in Harare are Glen View and Budiriro.

Of the 8340 cases for which age is known, the majority (56%) are aged between 5 and 35 years old. Males and females have been equally affected by the outbreak. From 4 September through 3 October, the majority of deaths were reported from health care institutions.

The pathogen is known to be Vibrio cholera O1 serotype Ogawa. Since confirmation on 6 September 2018, a multi-drug resistant strain has been identified and is in circulation; however, this does not affect the treatment of most cases, where supportive care such as rehydration solutions are used. Antibiotics are only recommended for severe cases. Furthermore, the antibiotic which is being used for severe cases in Harare is Azithromycin which remains effective in the majority of cases.

Contaminated water sources, including wells and boreholes are suspected as the source of the outbreak.

Figure 1: Cholera cases in Harare, Zimbabwe from 4 September through 3 October 2018

igure 2: Cholera cases in Zimbabwe from 4 September through 1 October 2018

Public health response

    • On 3 October 2018, an oral cholera vaccine mass vaccination campaign started in Harare City and surrounding areas such as Chitungwiza and Epworth. WHO is supporting the MoHCC on a strategy for rolling out the vaccination campaign, as well as implementing the campaign and sensitizing the public about the vaccine. More than 600 health workers have been trained to carry out the campaign. On 27 September 2018, 500 000 doses have arrived in Harare. In total, 2.7 million doses have been approved for two rounds of vaccination.
    • WHO and experts from the Global Outbreak Alert and Response Network (GOARN) are providing technical oversight into case management and providing guidance on the interpretation of laboratory findings to guide the choice of antibiotics.
    • Four cholera treatment centres (CTCs) have been established. UNICEF has prepositioned seven tents at Glenview for the CTC and Oxfam is providing mobile toilets in three CTCs.
    • The key risk communication and community engagement interventions have been on raising awareness on cholera prevention through the mass media and social media, and working with specific community groups, including Apostolic sect leaders and Apostolic women’s groups.
    • Sixty volunteers have been deployed to provide risk communication, community engagement and social mobilization support to CTCs in Budiriro and Glen View. Health and hygiene promotion is taking place through drama shows at schools and business centres, roadshows and door-to-door visits, which also focuses on identification and case referral.
    • Water, sanitation and hygiene (WASH) activities include enforcement of regulations for food vendors, City of Harare fixing burst water pipes and increasing the water supply to hotspots, with private sector players supporting installation of water tanks and water trucking.
    • UNICEF is supporting distribution of non-food items (soap, buckets), along with Oxfam, Christian Care, Mercy Corps and Welthungerhilfe (WHH), as well as key components of community mobilization.
    • WHO has sent supplies to treat 3800 people and arrangements are in place for additional supplies to arrive in the coming days. In addition, more than 44 000 litres of ringers lactate from South Africa have arrived in country and the RDTs are being cleared from the airport.
    • Since the cholera outbreak was declared on 6 September 2018, weekly meetings of the Inter-Agency Coordination Committee on Health (IACCH) have been held.
    • On 12 September 2018, following the declaration of the cholera outbreak as a state of disaster, the Cabinet Committee on Emergency Preparedness and Disaster Management was reactivated.
    • On 18 September 2018, the national government set up an inter-ministerial committee on the cholera outbreak, involving all major government stakeholders, to provide leadership and to monitor the cholera response efforts and provide regular briefs to the President.
    • On 21 September 2018, the National Emergency Operations Centre (EOC) was activated, with support provided by local business organizations. The Incident Command Structure (ICS) was finalized and will be published by the EOC.
    • On 1 October 2018, Econet began fixing Information and Communications Technology equipment in the EOC in MoHCC of Zimbabwe to support real time reporting.
    • On 29 September 2018, a rapid assessment of surveillance was conducted in coordination with the United States Centers for Disease Control and Prevention (US CDC).

WHO risk assessment

The outbreak started on 5 September and the number of cases notified per day continues to rapidly increase, particularly in Glen View and Budiriro suburbs of Harare. Cases with epidemiological links to this outbreak have been reported from other provinces across the country. Glen View, which is the epicentre of the outbreak, is an active informal trading area where people come from across the city and the rest of the country to trade. Key risk factors for cholera in Zimbabwe include the deterioration of sanitary and health infrastructure and increasing rural-urban migration which further strains the water and sanitation infrastructure. Since the beginning of the outbreak, 135 cases have been reported from provinces outside Harare. With the upcoming rainy season in November, there is a concern that cases may increase in the hotspots. In Harare, contaminated water from boreholes and wells is suspected to be the source of the outbreak. Sixty-nine percent of the population in Harare relies on these boreholes and wells as a source of water. The water supply situation in Harare remains dire due to the high demand of water that is not being met by the city supply though this is a focus of response efforts. The country’s available response capacities are overstretched as authorities are already responding to a large typhoid outbreak which started in August 2018. WHO assessed the overall public health risk to be high at the national level and moderate at the regional and low at global levels.

WHO advice

WHO recommends proper and timely case management in CTCs. Increasing access to potable water, improving sanitation infrastructure, and strengthening hygiene and food safety practices in affected communities are the most effective means to prevent and control cholera. Key public health communication messages should be provided to the affected population.

WHO advises against any restrictions on travel or trade to or from Zimbabwe based on the information currently available in relation to this outbreak.

For further information, please refer to:


Cholera and survival


What’s in a Cholera Kit?

 

Overview: In 2016 WHO introduced the Cholera Kits. These kits replace the Interagency Diarrhoeal Disease Kit (IDDK) which had been used for many years. The Cholera Kit is designed to be flexible and adaptable for preparedness and outbreak response in different contexts. The overall Cholera Kit is made up of an Investigation Kit, Laboratory materials, 3 Treatment Kits (community, periphery and central) and a Hardware Kit. The Treatment and Hardware Kits are each composed of individual modules. Each of the kits and modules can be ordered independently based on field need. To support orders, a Cholera Kit Calculation Tool was developed. This course is made up of two parts: a short introduction to the Cholera Kits and modules, and a demonstration of the Cholera Kit Calculation Tool.

Cholera Kit


WHO and partners is launching today an oral cholera vaccination (OCV) campaign to protect 1.4 million people at high risk of cholera in Harare.

WHO

The Government of Zimbabwe with the support of the World Health Organization (WHO) and partners is launching today an oral cholera vaccination (OCV) campaign to protect 1.4 million people at high risk of cholera in Harare.

The immunization drive is part of efforts to control a cholera outbreak, which was declared by the health authorities on 6 September 2018.The vaccines were sourced from the global stockpile, which is funded by Gavi, the Vaccine Alliance. Gavi is also funding operational costs for the campaign.

The government, with the support of WHO and partners, has moved quickly to implement key control efforts, including enhanced surveillance, the provision of clean water and hygiene promotion, cleaning of blocked drains and setting up dedicated treatment centres. The cholera vaccination campaign will complement these ongoing efforts.

“The current cholera outbreak is geographically concentrated in the densely populated suburbs of Harare,” said Dr Matshidiso Moeti, WHO’s Regional Director for Africa. “We have a window of opportunity to strike back with the oral cholera vaccine now, which along with other efforts will help keep the current outbreak in check and may prevent it from spreading further into the country and becoming more difficult to control.”

The campaign will be rolled out in two rounds, focusing on the most heavily affected suburbs in Harare and Chitungwiza, which is 30 km southeast of the capital city. To ensure longer-term immunity to the population, a second dose of the vaccine will be provided in all areas during a second round to be implemented at a later stage.

“Cholera is a disease that can be prevented with clean water and sanitation: there is no reason why people should still be dying from this horrific disease,” said Dr Seth Berkley, CEO of Gavi, the Vaccine Alliance. “Gavi has worked hard to ensure the global cholera vaccine stockpile remains fully stocked and ready to help stop outbreaks such as this. The government of Zimbabwe have done a great job in fighting this outbreak; we must now hope that these lifesaving vaccines can help to prevent any more needless deaths.”

WHO is supporting the Ministry of Health and Child Care on a strategy for rolling out the vaccination campaign, as well as implementing the campaign and sensitizing the public about the vaccine.  More than 600 health workers have been trained to carry out the campaign.

The vaccination drive will take place at fixed and mobile sites including health facilities, schools and shopping centres.

WHO experts in collaboration with partners are supporting the national authorities to intensify surveillance activities, improve diagnostics, and strengthen infection and prevention control in communities and health facilities. They have also provided cholera supplies of oral rehydration salts, intravenous fluids and antibiotics sufficient to treat 6000 people.

The health sector alone cannot prevent and control cholera outbreaks. This requires strong partnerships and a response across multiple sectors, especially in the investment and maintenance of community-wide water, sanitation and hygiene facilities.

Zimbabwe has experienced frequent outbreaks of cholera, with the largest outbreak occurring from August 2008 to May 2009 and claiming more than 4000 lives.


Yemen’s cholera outbreak – the worst in the world – is accelerating again, with roughly 10,000 suspected cases per week

Fox

  • “….for the first eight months of the year, 154,527 suspected cases of cholera…. were recorded across the country, with 196 deaths…..”


Cholera in Zimbabwe: Current status

WHO

 

Disease outbreak news
20 September 2018

On 6 September 2018, a cholera outbreak in Harare was declared by the Ministry of Health and Child Care (MoHCC) of Zimbabwe and notified to WHO on the same day. Twenty-five patients were admitted to a hospital in Harare presenting with diarrhoea and vomiting on 5 September. The first case, a 25-year-old woman, presented to a hospital and died on 5 September. A sample from the woman tested positive for Vibrio cholerae serotype O1 Ogawa. All 25 patients had typical cholera symptoms including excessive vomiting and diarrhoea with rice watery stools and dehydration. The MoHCC declared the outbreak after 11 cases were confirmed for cholera using rapid diagnostic test (RDT) kits and the clinical presentation. Thirty-nine stool samples were collected for culture and sensitivity, 17 of which tested positive for V. cholerae serotype O1 Ogawa.

There has been rapid increase in the number of suspected cases reported per day since 1 September; there was a peak with 473 suspected cases notified on 9 September. As of 15 September 2018, 3621 cumulative suspected cases, including 71 confirmed cases, and 32 deaths have been reported (case fatality ratio: 0.8 %); of these, 98% (3564 cases) were reported from the densely populated capital Harare. The most affected suburbs in Harare are Glen View and Budiriro.

Cases with epidemiological links to cases from Harare have been recently reported from across the country, including in Mashonaland Central Province (Shamva District), Midlands Province (Gokwe North District), Manicaland Province (Buhera and Makoni districts), Masvingo Province and Chitungwiza City.

Public health response

    • The MoHCC declared the cholera outbreak in Harare City on 6 September; the Government declared the outbreak an emergency and subsequently a disaster on 13 and 14 September, respectively.
    • Outbreak coordination committees at the national and district levels have been established.
    • WHO and the WHO Country Office (WCO) are supporting the MoHCC with coordination, scaling up the response, strengthening surveillance and mobilizing both national and international health experts to form a cholera surge team.
    • WHO experts are providing technical support to laboratories, improving diagnostics and strengthening infection and prevention control (IPC) in communities and health clinics.
    • The Government is assessing the potential benefits of conducting an oral cholera vaccine (OCV) campaign; WHO is deploying an expert in OCV campaigns to Harare to support this assessment.
    • A cholera treatment centre (CTC) was established by Médecins Sans Frontières (MSF) in Glen View, Harare; MSF has provided extra nurses to support the response.
    • The recruitment of additional nurses to strengthen the response is ongoing.
    • WHO is providing supplies which contain oral rehydration solution, intravenous fluids and antibiotics for the treatment of patients in CTCs set up by partners.
    • Risk communication activities in affected and at-risk districts are being conducted by the Government and health partners.

WHO risk assessment

The outbreak started on 5 September and the number of cases notified per day continues to rapidly increase, particularly in Glen View and Budiriro suburbs of Harare. Cases with epidemiological links to this outbreak have been reported from other provinces across the country. Glen View, which is the epicentre of the outbreak, is an active informal trading area where people come from across the city and the rest of the country to trade. Key risk factors for cholera in Zimbabwe include the deterioration of sanitary and health infrastructure and increasing rural-urban migration which further strains the water and sanitation infrastructure. In Harare, contaminated water from boreholes and wells is suspected to be the source of the outbreak. The water supply situation in Harare remains dire due to the high demand of water that is not being met by the city supply. The country’s available response capacities are overstretched as authorities are already responding to a large typhoid outbreak which started in August 2018. WHO assessed the overall public health risk to be high at the national level and moderate at the regional and low at global levels.

WHO advice

WHO recommends proper and timely case management in CTCs. Increasing access to potable water, improving sanitation infrastructure, and strengthening hygiene and food safety practices in affected communities are the most effective means to prevent and control cholera. Key public health communication messages should be provided to the affected population.

WHO advises against any restrictions on travel or trade to or with Zimbabwe based on the information currently available in relation to this outbreak.

For further information, please refer to:


Zimbabwe: An outbreak of cholera has so far killed 25 people, mostly in the capital, Harare.

BBC

“……The current outbreak began on 6 September after water wells were contaminated with sewage in Harare.

Tests found the presence of cholera and typhoid-causing bacteria which has so far infected over 3,000 people, Health Minister Obadiah Moyo told reporters on Thursday.

According to the World Health Organization (WHO), patients were not responding to first-line antibiotics……The cholera outbreak can be traced to Harare city council’s struggle to supply water to some suburbs for more than a decade, forcing residents to rely on water from open wells and community boreholes……”

 


WHO in Zimbabwe: 2,000 suspected cholera cases have been reported, 58 of them confirmed and 24 fatal.

WHO

Harare/Brazzaville 13 September 2018 – The World Health Organization (WHO) is scaling up its response to an outbreak of cholera in Zimbabwe, which is expanding quickly in Harare, the country’s capital with a population of more than two million people.

Cholera is an acute waterborne diarrhoeal disease that is preventable if people have access to safe water and sanitation and practice good hygiene, but can kill within hours if left untreated. Authorities report that the outbreak began on 1 September in Harare and as of that date to 11 September, the Ministry of Health and Child Care reports that there have been nearly 2000 suspected cholera cases, including 58 confirmed cases and 24 deaths.

Glenview, a high density suburb of Harare with an active trading area and a highly mobile population is at the epicentre of the outbreak. The area is vulnerable to cholera because of inadequate supplies of safe piped water, which has led people to use alternative unsafe supplies such as wells and boreholes. Cases that are linked to the epicenter in Harare have been confirmed in 5 additional provinces.

The Government of Zimbabwe has declared a state of emergency and is working with international partners to rapidly expand recommended cholera response actions, including increasing access to clean and safe water in the most affected communities and decommissioning contaminated water supplies. Authorities and partners are also intensifying health education to ensure that suspect cases seek care immediately and establishing cholera treatment centres closer to affected communities.

“When cholera strikes a major metropolis such as Harare, we need to work fast to stop the spread of the disease before it gets out of control,” said Dr Matshidiso Moeti, the WHO Regional Director for Africa. “WHO is working closely with the national authorities and partners to urgently respond to this outbreak.”

WHO is supporting the Ministry of Health and Child Care to fight the outbreak by strengthening the coordination of the response and mobilizing national and international health experts to form a cholera surge team. In collaboration with health authorities and partners, WHO experts are helping to track down cases, providing technical support to laboratories and improving diagnostics and strengthening infection and prevention control in communities and health facilities. In addition to such measures and efforts to improve water and sanitation, the government is assessing the benefits of conducting an oral cholera vaccine (OCV) campaign and WHO is deploying an expert in OCV campaigns to Harare.

WHO is providing cholera kits which contain oral rehydration solution, intravenous fluids and antibiotics to cholera treatment centres.

Zimbabwe has experienced frequent outbreaks of cholera, with the largest outbreak occurring from August 2008 to May 2009 and claiming more than 4000 lives.

Cholera is a major public health problem in the African region and just two weeks ago Health Ministers from the region committed to ending cholera outbreaks by 2030 by implementing key strategies. Forty-seven African countries adopted the Regional Framework for the Implementation of the Global Strategy for Cholera Prevention and Control at the 68th session of WHO’s Regional Committee for Africa.


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