Global & Disaster Medicine

Archive for the ‘Cholera’ Category

Cholera in Zambia: From 28 September through 7 December 2017, 547 cases including 15 deaths (case fatality rate = 1.8%), have been reported since the beginning of the outbreak.


Cholera – Zambia

Disease Outbreak News
11 December 2017

On 6 October 2017, the Minister of Health declared an outbreak of cholera in the Zambian capital, Lusaka. From 28 September through 7 December 2017, 547 cases including 15 deaths (case fatality rate = 1.8%), have been reported since the beginning of the outbreak. The initial outbreak period was from 28 September through 20 October. From 21 October through 4 November 2017 there were less than five cases reported each week. However, from 5 November 2017 an increase in the number of cases was observed with a total of 136 cases reported in the week beginning 26 November.

Figure 1: Number of cholera cases in Zambia reported by date of illness onset from 28 September to 2 December 2017

The cholera outbreak initially started in the Chipata sub-district and spread to Kanyama sub-district around 9 October 2017. The outbreak has spread from the peri-urban townships on the Western side of Lusaka City to the Eastern Side with a new case reported in Chelstone sub-district. As of 7 December, the affected sub-districts include Chipata, Kanyama, Chawama, Matero, Chilenje and Chelston. Sixty-two cases are currently receiving treatment in Cholera Treatment Centres in Chipata, Kanyama, Matero and Bauleni. One third of the cases are children under five years old and two thirds are persons five years and older.

A total of 282 Rapid Diagnostic Tests were performed, of which 230 were positive. Of 310 culture tests, 53 were positive for Vibrio cholerae O1 Ogawa (48 from Chipata, four from Kanyama and one from Bauleni). Water quality monitoring is ongoing in all sub-districts, with intensified activity in Kanyama, Matero and Chipata. The results so far show that nearly 42% of tested water sources are contaminated with either Faecal Coliforms or Escherichia coli.

Public health response

The following public health measures are currently being implemented:

  • The Ministry of Health is collaborating with WHO and other partners to control the outbreak.
  • Five Cholera Treatment Centres have been established in Chawama, Chipata, Kanyama, Matero and Bauleni sub-districts to manage cases. So far, 441 cases were successfully treated and discharged.
  • Cholera Outbreak Guidelines and standard operating procedures have been updated and shared with health workers.
  • The facilities in Lusaka District have continued with active surveillance, health education, chlorine distribution, contact tracing and environmental health monitoring.
  • The local authorities in collaboration with the Ministry of Health have embarked on closing contaminated water points and has implemented Water Sanitation and Hygiene (WASH) interventions to improve water supplies in affected areas. This includes provision of household chlorine, disinfection of pit latrines, erection of water tanks, installation of water purifiers and intensification of water quality monitoring.
  • The Lusaka City Council has intensified collection of garbage and emptying of septic tanks in Kanyama and Chipata as priority areas.

WHO risk assessment

The current outbreak is occurring in Zambia’s largest city, Lusaka. The main affected sub-districts, Chipata and Kanyama, are densely populated and have an inadequate water and sanitation infrastructure, which may favour the spread of the disease. The sources of infection transmission in this outbreak have been associated with contaminated water supplies, contaminated food, inadequate sanitation and poor hygiene practices.

The coming of the rainy season, coupled with inadequate water supply and sanitation increases the risk of outbreaks in Lusaka and other parts of the country. Adequate supplies for cholera response should be obtained as part of preparedness activities.

Zambia hosts about 60 000 refugees (as of September 2017) from neighbouring countries. A large proportion of refugees are from the Democratic Republic of the Congo (DRC) and are mostly residing in Nchelenge refugee camp located more than 1000 km distant from Lusaka. The influx of refugees has led to overcrowded settlements with high needs for shelter, healthcare and WASH facilities. Most refugees are in poor health condition, especially children; therefore, risk of disease outbreaks is high. Sanitation is a challenge at hosting sites. Given the security situation in DRC, further influx of refugees is expected.

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. Use of oral cholera vaccine may also be used for outbreak control. Key public health communication messages should be provided.

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

For more information on cholera, please see the link below:

Kenya: From 1 January though 29 November 2017, a total of 3967 laboratory-confirmed and probable cases including 76 deaths (case fatality rate = 1.9%) were reported by the Ministry of Health


Cholera – Kenya

Disease Outbreak News
11 December 2017

From 1 January though 29 November 2017, a total of 3967 laboratory-confirmed and probable cases including 76 deaths (case fatality rate = 1.9%) were reported by the Ministry of Health to WHO. Of the cases reported, 596 were laboratory confirmed.

Figure 1: Number of confirmed and probable cases in Kenya reported by week of illness onset from 1 January through 25 November 20171

1Date of illness onset is missing for 92 cases.

From 1 January 2017 through 29 November, 20 of 47 counties (43%) in Kenya have reported cases. As of 29 November, seven counties continue to have active cholera outbreaks (Embu, Garissa, Kirinyaga, Mombasa, Nairobi, Turkana, and Wajir).

The epidemiology of cholera for Kenya in 2017 is characterized by continuous transmission in affected communities coupled with outbreaks in camp settings and institutions or during mass gathering events. Continuous transmission in the community accounts for around 70% of the total cases with the majority of cases coming from the capital county, Nairobi. Transmission in camp settings occurred mainly within Garissa and Turkana counties, accounting for around 23% of the total reported cases. Both counties host big refugee camps, namely Dadaab and Kakuma refugee camps. Refugees in these camps come from countries currently experiencing complex emergencies and large cholera outbreaks. Seven percent of cases occurred in institutions and mass gathering events, where a number of people get infected from a point source.

The country experiences cholera outbreaks every year; however, large cyclical epidemics occur approximately every five to seven years and last for two to three years.

Public health response

The country has activated the national task force to coordinate the outbreak response activities. Since January 2017, WHO and other partners have been providing technical support to the country to control of the outbreak. Following the development of the national response plan, WHO and other partners supported the country to scale-up the outbreak response activities such as surveillance, case management, and social mobilization. This was also coupled with the improvement of food hygiene standards and promotion of safe food handling, besides scaling-up Water, Sanitation, and Hygiene (WASH) related activities. This resulted in a decline in the number of cholera cases.

WHO risk assessment

Despite the decline in the number of cases reported, the outbreak appears to be clustered around two major types of settings. First, the refugee camps particularly Kakuma and Dadaab, and second in the populous Nairobi capital county. Both settings are concerning, considering the overcrowded conditions and limited access to care in the first setting, and the high population density in the second setting. This could enable the spread of the outbreak to other districts. Also, previous outbreaks have shown that cases increase during the rainy season, which has started recently.

In addition, various physical, social, political, and environmental factors increase the vulnerability and the susceptibility of the country’s population to the cholera outbreaks. These include regional drought, conflict, and insecurity in the Horn of Africa, and the increased movement within and to the country by people fleeing conflicts in Somalia and South Sudan.

Overall, the risk of the current outbreak is assessed as high at the national level and low at the regional and global levels.

WHO advice

WHO recommends proper and timely case management in cholera treatment centres. The affected communities should have improved access to water, effective sanitation, proper waste management, and enhanced hygiene and food safety practices. Key public health communication messages should be provided. WHO encourages travellers to the affected area to take proper hygiene precautions to prevent potential exposure.

WHO does not recommend any restriction on travel and trade to Kenya based on the information available on the current outbreak.

For more information on cholera, please see the link below:

Cholera in Yemen, 26 October 2017: The world’s largest cholera outbreak has slowed some.


Outbreak update – cholera in Yemen, 26 October 2017

26 October 2017 – The Ministry of Public Health and Population of Yemen has reported a cumulative total of 862858 suspected cases of cholera including 2177 associated deaths as of 26 July for the outbreak which started in October 2016.

The overall case-fatality rate remains low (0.25%). There has been a modest decrease in the number of suspected cholera cases and deaths compared to previous weeks, and the overall trend appears to be stable.

While cholera is endemic in Yemen, the country has experienced a surge in cholera cases since April this year, with nearly 5000 cases reported per day. Ongoing conflict, destroyed health, water and sanitation infrastructure and malnutrition have caused the people to be more vulnerable to diseases, including cholera and other endemic infectious diseases.

WHO and health partners support the Ministry through the cholera task force to improve cholera response efforts at the national and local levels. This includes delivering 20 tonnes of medicines and intravenous (IV) fluids to Ibb governorate; the establishment of diarrhoea treatment facilities and oral dehydration centres; training of health workers to manage cases, water purification in communities, deployment of rapid response team to manage cholera cases investigations and respond to the outbreak, and enhancement of Yemen’s disease early warning surveillance systems.

Related links

Weekly cholera updates

Yemen situation reports

Yemen: Cholera outbreak now largest and fastest on record, 600,000 children infected by Christmas

Save The Children

“….About 4,000 suspected cases are still being reported every day, more than half of them children under the age of 18. Of those infected, 25% of cases are children under the age of five……”


WHO: The death toll of the cholera epidemic in war-ravaged Yemen has risen to 2,151 since it broke out in late April.


Port of Aden, Yemen

NASA:  Post of Aden


Ending Cholera—A Global Roadmap to 2030 operationalises the new global strategy for cholera control at the country level and provides a concrete path toward a world in which cholera is no longer a threat to public health.

Global Task Force on Cholera Control

The road map address six interventions to tackle cholera in its hot spots:

  • Water, sanitation, and hygiene
  • Leadership and coordination
  • Health system strengthening
  • Surveillance and reporting
  • Use of oral cholera vaccine
  • Community engagement

“….By implementing the strategy between now and 2030, the Global Task Force on Cholera Control (GTFCC) partners will support countries to reduce cholera deaths by 90 percent……”

The Global Task Force on Cholera Control (GTFCC) launches new anti-cholera campaign



October 2017 | Geneva – An ambitious new strategy to reduce deaths from cholera by 90% by 2030 will be launched tomorrow by the Global Task Force on Cholera Control (GTFCC), a diverse network of more than 50 UN and international agencies, academic institutions, and NGOs that supports countries affected by the disease.

Cholera kills an estimated 95 000 people and affects 2.9 million more every year. Urgent action is needed to protect communities, prevent transmission and control outbreaks.

The GTFCC’s new plan, Ending Cholera: A Global Roadmap to 2030, recognizes that cholera spreads in endemic “hotspots” where predictable outbreaks of the disease occur year after year.

The Global Roadmap aims to align resources, share best practice and strengthen partnerships between affected countries, donors and international agencies. It underscores the need for a coordinated approach to cholera control with country-level planning for early detection and response to outbreaks. By implementing the Roadmap, up to 20 affected countries could eliminate cholera by 2030.

“WHO is proud to be part of this new joint initiative to stop deaths from cholera. The disease takes its greatest toll on the poor and the vulnerable – this is quite unacceptable. This roadmap is the best way we have to bring this to an end,” said Dr Tedros Adhanom Ghebreyesus, Director-General of WHO.

“Every death from cholera is preventable with the tools available today, including use of the Oral Cholera Vaccine and improved access to basic safe water, sanitation and hygiene as set out in the Roadmap,” said Dr Tedros Adhanom Gebreyesus. “This is a disease of inequity that affects the poorest and most vulnerable. It is unacceptable that nearly two decades into the 21st century, cholera continues to destroy livelihoods and cripple economies. We must act together. And we must act now.”

Advances in the provision of water sanitation and hygiene (WASH) services have made Europe and North America cholera-free for several decades. Today, although access to WASH is recognized as a basic human right by the United Nations, over 2 billion people worldwide still lack access to safe water and are potentially at risk of cholera. Weak health systems and low early detection capacity further contribute to the rapid spread of outbreaks.

Cholera disproportionally impacts communities already burdened by conflict, lack of infrastructure, poor health systems, and malnutrition. Protecting these communities before cholera strikes is significantly more cost-effective than continually responding to outbreaks.

The introduction of the oral cholera vaccine has been a game-changer in the battle to control cholera, bridging the gap between emergency response and longer-term control. Two WHO-approved oral cholera vaccines are now available and individuals can be fully vaccinated for just US$6 per person, protecting them from the disease for up to three years.

The Global Roadmap provides an effective mechanism to synchronize the efforts of countries, donors, and technical partners. It underscores the need for a multi-sectoral approach to cholera control with country-level planning for early detection and response to outbreaks.

By strengthening WASH in endemic “hotspots”, cholera outbreaks can be prevented. By detecting cholera outbreaks early, and responding immediately, large-scale uncontrolled outbreaks like the one observed in Yemen can be avoided – even in crisis situations.

Note to editors

The Global Task Force on Cholera Control (GTFCC) is a network of more than 50 organizations bringing together partners involved in the fight against cholera across all sectors and providing a strong framework to support countries in intensifying efforts to control cholera.

The Launch of the Global Roadmap is supported by the Bill and Melinda Gates Foundation, the Fondation Mérieux and WaterAid.

Yemen’s cholera outbreak has infected 612,703 people and killed 2,048 since it began in April.


“….The United Nations has said the epidemic is man-made, driven by a civil war that has left 15.7 million people without clean water or sanitation. ….”



A slow death in Yemen: War, malnutrition, cholera and no end in sight

NY Times


Somalia in crisis: Measles, Cholera, Drought, Famine


WHO and Federal Ministry of Health of Somalia call for urgent support to address measles outbreak in Somalia

16 August 2017 – As millions of people in Somalia remain trapped in a devastating cycle of hunger and disease, WHO and health partners are working with national health authorities to save lives and reach the most vulnerable with essential health services.

More than 2 years of insufficient rainfall and poor harvests have led to drought, food insecurity and a real risk of famine. Malnutrition, mass displacement as a result of the drought, and lack of access to clean water and sanitation have created ideal conditions for infectious disease outbreaks.

“Somalia is facing one of the worst humanitarian crises in the world. Millions of people, already on the brink of famine, are now at risk of rapidly spreading infectious diseases like cholera and measles. Normally, these diseases are easy to treat and prevent, but they can turn deadly when people are living in overcrowded spaces and are too weak to fight off infection,” said Dr Ghulam Popal, WHO Representative in Somalia.

Drought has led to a lack of clean water and the largest cholera outbreak in the last 5 years, with more than 57 000 cases and 809 cumulative deaths reported as of 31 July 2017. Health partners, together with national health authorities, scaled up its efforts to respond to this event by setting up cholera treatment centers in affected districts and providing support in water and sanitation to prevent the spread of the disease. In March, WHO and partners conducted Somalia’s first national oral cholera vaccination campaign, and successfully reached over 450 000 vulnerable people. Due to ongoing efforts, the number of cholera cases in Somalia has declined, from 13 656 cases of acute watery diarrhoea/cholera in May 2017 to 11 228 cases in June 2017.

Somalia is also facing its worst measles outbreak in 4 years, with over 14 823 suspected cases reported in 2017 (as of 31 July), compared to 5000–10 000 cases per year since 2014. The situation is especially critical for millions of under-vaccinated, weak and hungry children who are more susceptible to contracting infectious diseases. More than 80% of those affected by the current outbreak are children under 10 year of age.

In early 2017, WHO and partners, in collaboration with national health authorities, vaccinated almost 600 000 children aged 6 months to 5 years for measles in hard-to-reach and hotspot areas across the country. Despite these efforts, the transmission of measles continues, compounded by the ongoing pre-famine situation, continued mass displacement, and undernourished children living in unhygienic conditions.

In order to contain the outbreak, a nationwide campaign is planned for November 2017 to stop transmission of the disease, targeting 4.2 million children. The campaign will also intensify efforts to strengthen routine immunization and reach unvaccinated children to boost their immunity. As shown by the response to the cholera outbreak, with the right interventions, health authorities are confident that similar success may be seen in controlling the measles outbreak.

US$ 14.4 million (a cost of US$ 3.36 per child) is required by WHO and health partners to conduct the measles vaccination campaign in November 2017, of which WHO required US$ 6.8 million. To date, no funding has been received.


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