Global & Disaster Medicine

Archive for the ‘Cholera’ Category

The economics of cholera

“…..Our analysis included 14 Asian countries that were estimated to have a total of 850,000 cholera cases and 25,500 deaths in 2015. While, the WHO cholera report documented around 60,000 cholera cases and 28 deaths. We estimated around $20.2 million…. in out-of-pocket expenditures, $8.5 million…in public sector costs, and $12.1 million… lost productivity in 2015. Lost productivity due to premature deaths was estimated to be $985.7 million…… Our scenario analyses excluding mortality costs showed that the economic burden ranged from 20.3% ($8.3 million) to 139.3% ($57.1 million) in high and low scenarios when compared to the base case scenario ($41 million) and was least at 10.1% ($4.1 million) when estimated based on cholera cases reported to WHO……”


Victims of the 2010 cholera outbreak in Haiti, which killed at least 10,000 people and infected hundreds of thousands more, are petitioning the US supreme court on Tuesday to hold the UN accountable for having brought the disease to the stricken country.

The Guardian

“……The UN has admitted that cholera was introduced to Haiti by peacekeepers in 2010 after about 1,000 troops were redeployed from Nepal to help in emergency work following a devastating earthquake. Basic health measures that could have been taken to prevent the transfer of the disease at the cost to the UN of only $2,000 were not taken, and instead raw sewage from the peacekeepers’ camps was dumped directly into rivers from which thousands of Haitians routinely drew water for cooking and drinking.

A leaked report carried out by the UN itself a month after the initial outbreak of cholera found serious sanitation flaws in the Haiti peacekeeping mission. Yet for six years the world body continued to deny it had anything to do with the health catastrophe……”

computer generated depiction of a cholera organism

5/16/1849: The NYC Board of Health establishes a hospital to deal with a cholera epidemic that, before it ends, kills more than 5,000.


Dashboard: International Coordinating Group (ICG) on Vaccine Provision on cholera


Doses shipped by year
2018 2019
6,323,410 1,860,621


No. of doses, 2019
Requested 1,372,798
Shipped 1,860,621


Mozambique    #1, 2019   MOH    Approved      Humanitarian crisis      884,975   2 April   3 April



Zimbabwe #2, 2019 MOH Approved Humanitarian crisis 975,646


Mozambique: A successful six-day emergency cholera vaccination campaign that reached more than 800 000 people


10 April 2019, Maputo – The Ministry of Health in Mozambique has concluded a successful six-day emergency cholera vaccination campaign that reached more than 800 000 people in four districts affected by Cyclone Idai.

The campaign was supported by around 1200 community volunteers and partners including the World Health Organization (WHO), UNICEF, Médecins Sans Frontières (MSF), International Federation of the Red Cross and Red Crescent Societies (IFRC) and Save the Children.

“From start to finish, this campaign was one of the fastest ever, thanks to experienced people at the Ministry of Health, who knew there was a high risk of a cholera outbreak and made a rapid request for the vaccines as soon as the cyclone hit,” says Dr Djamila Cabral, Head of the WHO office in Mozambique. “The Ministry did an excellent job organizing the campaign and reaching so many people in such a short time. The oral cholera vaccine is one of the vital measures that can help save lives and stop the spread of this terrible disease during an outbreak.”

The oral cholera vaccines, donated by Gavi from the Global Cholera Vaccine Stockpile, arrived in Beira on Tuesday 2 April and, within 24 hours, began reaching people in need.

The vaccines were given to communities identified by the Government at highest risk – those without access to safe water and sanitation – in Beira, Dondo, Nhamatanda and Buzi districts.

Vaccine uptake has been very high and the campaign has been well received by the communities. Remaining vaccines will be used for other at-risk communities that were not reached by the initial campaign.

People develop protection against cholera approximately 7 days after receiving the vaccine. One dose of this oral vaccine provides around 85% protection against cholera for 6 months.

“Controlling cholera in these areas will reduce the risk to the rest of the population because fewer people will be taking it back and forth into the wider community,” says WHO cholera vaccination expert, Kate Alberti, who was deployed to Beira to support the Ministry of Health to organize the campaign.

Dr Nazira Abdula, Minister of Health of Mozambique, acknowledged the great support of WHO and partners for the vaccination campaign. “It’s very difficult to roll out a campaign of this scope in only three days,” she says.

WHO’s Dr Cabral adds: “This campaign would not have been possible without the strong engagement of the local authorities and the communities themselves. The number of volunteers is impressive and, wherever they go, there has been very strong uptake of the vaccine. Everyone is very keen to make this a success to stop cholera in its tracks.”

Since Cyclone Idai struck Mozambique on 14 March, hundreds of thousands of people have been living in temporary settlements without access to safe water and sanitation. The Ministry of Health declared a cholera outbreak on 27 March and, as of 8 April, had reported more than 3577 cases and 6 deaths.

The cholera vaccine is just one tool for the outbreak response. Currently 12 cholera treatment centres, with 500-bed capacity, have been set up by the national authorities and international partners to serve the affected communities. Partners are also supporting the local authorities to provide access to safe water and sanitation in settlements and communities across Sofala Province.

Cholera is endemic in several parts of Sofala province and the cholera outbreak that developed post-Cyclone Idai acts as a reminder that sustainable access to safe water, sanitation, and hygiene (WASH) is the long-term solution to controlling cholera. Acknowledging that every case of cholera is preventable, the Global Task Force on Cholera Control is implementing a Cholera Global Roadmap to 2030, which calls upon development partners and donors to support countries to reduce cholera deaths by 90% by 2030.


3 April 2019: An oral cholera vaccination campaign to protect survivors of Cyclone Idai begins today in Beira, Mozambique.


An oral cholera vaccination campaign to protect survivors of Cyclone Idai begins today in Beira, Mozambique. Funded by Gavi, the Vaccine Alliance, the campaign will be carried out by the Mozambique Ministry of Health, with support from WHO and other partners, including UNICEF, the International Federation of the Red Cross and Red Crescent Societies (IFRC), Médecins Sans Frontières (MSF) and Save the Children.

There has already been one reported cholera death and almost 1500 reported cases following the cyclone, which caused severe flooding in Mozambique, Zimbabwe, Malawi and Madagascar after making landfall in March. Nine cholera treatment centres, with 500-bed capacity, are already admitting patients.

“Cyclone Idai’s trail of devastation has left the city of Beira’s water and sanitation infrastructure in ruins, providing the perfect conditions for cholera to spread,” said Gavi CEO, Dr Seth Berkley. “This cyclone has already caused enough devastation and misery across south east Africa; we have to hope these vaccines will help stop a potentially major outbreak and prevent yet more suffering.”

“Hundreds of thousands of people are living in terrible conditions in temporary settlements without safe drinking water and sanitation, putting them at serious risk of cholera and other diseases,” said Dr Tedros Adhanom Ghebreyesus, Director-General of WHO. “The key thing is to make sure that people can access rapid treatment and clean water and sanitation. The oral cholera vaccine is a vital emergency measure that will help save lives and stop the spread of this horrible disease.”

WHO is supporting the Ministry of Health to coordinate the oral cholera vaccination campaign, including working with partners to ensure an appropriate cold chain storage and providing logistical support.  

Cholera is endemic to Mozambique, which has had regular outbreaks over the past five years. About 2 000 people were infected in the last outbreak, which ended in February 2018.

The 884 953 doses of oral cholera vaccine arrived in Mozambique on Tuesday. They were taken from the global cholera vaccine stockpile, which is fully-funded by Gavi. Gavi is also supporting operational costs of the campaign. The use of the stockpile for outbreak response is managed by the International Coordinating Group (ICG), which features representatives from WHO, UNICEF, IFRC and MSF.

Since the stockpile was launched in 2013, millions of doses every year have helped tackle outbreaks across the globe. In the fifteen years between 1997 and 2012, just 1.5 million doses of oral cholera vaccine were used worldwide. In 2018 alone, the stockpile provided 17 million of doses to 22 different countries. Since the beginning of 2019, more than 6 million doses have already been shipped to respond to outbreaks or address endemic cholera in many countries including Democratic Republic of the Congo, Nigeria, Somalia and Zimbabwe.

More than 500 cases of cholera have since been reported in Beira, Mozambique with 1 death


“…….The World Health Organization (WHO) said that at least 900,000 vaccine doses would be arriving in the port city this week. …..
Nearly 90,000 Mozambicans are thought to be sheltering in temporary sites……..”

Weekly Epidemiological Report from the Nigeria CDC

Nigeria CDC

In the reporting week ending on September 30, 2018:

o There were 173 new cases of Acute Flaccid Paralysis (AFP) reported. None was confirmed as polio. The last reported case of polio in Nigeria was in August 2016. Active case search for AFP is being intensified with the goal to eliminate polio in Nigeria.

o There were 2052 suspected cases of Cholera reported from 42 LGAs in seven States (Adamawa – 107, Borno – 702, Gombe – 90, Kaduna – 2, Katsina – 585, Yobe – 162 and Zamfara – 404). Of these, 26 were laboratory confirmed and 18 deaths were recorded.

o Nine suspected cases of Lassa fever were reported from seven LGAs in five States (Bauchi – 1, Edo – 5, FCT – 1, Nasarawa – 1 & Rivers – 1). Four were laboratory confirmed and no death was recorded.

o There were eight suspected cases of Cerebrospinal Meningitis (CSM) reported from five LGAs in five States (Ebonyi – 1, Edo – 2, Ondo – 2, Taraba – 1 & Yobe – 2). Of these, none was laboratory confirmed and no death was recorded.

o There were 124 suspected cases of measles reported from 30 States. None was laboratory confirmed and one death was recorded.


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


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.


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.


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