WHO

Cholera – 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 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:

• WHO fact sheet on cholera

SIGA

“…..If approved, the oral drug would be the first FDA-approved treatment for smallpox, a disease that has been eradicated but could be used as a bioterror weapon. The news comes on the heels of media reports that North Korea could be building a bioweapons program that might include smallpox.….”

NY Times

• The ship was prepared to support 250 hospital beds
• Over its 53-day deployment, which included travel to and from the island, it admitted an average of only six patients a day, or 290 in total.
• An additional 1,625 people were treated aboard the ship as outpatients, all at no cost.

The Hill

CIDRAP

Express

BBC

“…..Lactalis is one of the world’s biggest dairy producers. Company spokesman Michel Nalet told AFP “nearly 7,000 tonnes” of production may have been contaminated….”

NY Times

CNN

“……  A man wearing a homemade pipe bomb detonated his explosive in a walkway at the Port Authority Bus Terminal near Times Square on Monday….”

• Akayed Ullah is of Bangladeshi descent and lives in Brooklyn
• A pipe bomb, was attached to Ullah with Velcro and zip ties
• Ullah is now at Bellevue Hospital for lacerations and burns to his hands and abdomen
• Two victims at Mount Sinai West and one at Mount Sinai Queens are being treated for headaches and ringing in the ears

Chatham House

Authors

“Summary
• In some parts of the world it is common practice for patients to be detained in hospital for non-payment of healthcare bills.
• Such detentions occur in public as well as private medical facilities, and there appears to be wide societal acceptance in certain countries of the assumed right of health providers to imprison vulnerable people in this way.
• The true scale of these hospital detention practices, or ‘medical detentions’, is unknown, but the limited academic research to date suggests that hundreds of thousands of people are likely to be affected every year, in several sub-Saharan African countries and parts of Asia. Women requiring life-saving emergency caesarean sections, and their babies, are particularly vulnerable to detention in medical facilities.
• Victims of medical detention tend to be the poorest members of society who have been admitted to hospital for emergency treatment, and detention can push them and their families further into poverty. They may also be subject to verbal and/or physical abuse while being detained in health facilities.
• The practice of detaining people in hospital for non-payment of medical bills deters healthcare use, increases medical impoverishment, and is a denial of international human rights standards, including the right not to be imprisoned as a debtor, and the right to access to medical care.
• At the root of this problem are the persistence of health financing systems that require people to make high out-of-pocket payments when they need healthcare, and inadequate governance systems that allow facilities to detain patients.
• Universal health coverage (UHC) cannot be achieved while people are experiencing financial hardship through their inability to pay for healthcare, so by definition any country that allows medical detention is failing to achieve UHC.
• Health financing systems should be reformed by moving towards publicly financed UHC, based on compulsory progressive pre-payment mechanisms. This would enable hospitals to become financially sustainable without the need to charge significant user fees……”

NY Times

“…..With large areas of Puerto Rico still in the dark three months after the first of the storms — according to government reports, only 60.4 percent of the pre-storm power grid load has been restored — older residents and those with chronic medical conditions are suffering in even more ways than their neighbors. Many nursing homes have no power. The failure to re-establish functioning telephone networks and transportation systems in many areas makes it difficult to get regular medical care. Fire safety systems are inoperable, posing special dangers for those who cannot easily escape.….”