Global & Disaster Medicine

Archive for the ‘Cholera’ Category

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

Reuters

“….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

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.


The total number of suspected cholera cases in Yemen this year hits 500 000!

WHO

Cholera count reaches 500 000 in Yemen

News release

The total number of suspected cholera cases in Yemen this year hit the half a million mark on Sunday, and nearly 2000 people have died since the outbreak began to spread rapidly at the end of April.

The overall caseload nationwide has declined since early July, particularly in the worst affected areas. But suspected cases of the deadly waterborne disease continue to rage across the country, infecting an estimated 5000 people per day.

The spread of cholera has slowed significantly in some areas compared to peak levels but the disease is still spreading fast in more recently affected districts, which are recording large numbers of cases.

Yemen’s cholera epidemic, currently the largest in the world, has spread rapidly due to deteriorating hygiene and sanitation conditions and disruptions to the water supply across the country. Millions of people are cut off from clean water, and waste collection has ceased in major cities.

A collapsing health system is struggling to cope, with more than half of all health facilities closed due to damage, destruction or lack of funds. Shortages in medicines and supplies are persistent and widespread and 30 000 critical health workers have not been paid salaries in nearly a year.

“Yemen’s health workers are operating in impossible conditions. Thousands of people are sick, but there are not enough hospitals, not enough medicines, not enough clean water. These doctors and nurses are the backbone of the health response – without them we can do nothing in Yemen. They must be paid their wages so that they can continue to save lives,” said Dr. Tedros Adhanom Ghebreyesus, WHO Director-General.

WHO and partners are working around the clock to set up cholera treatment clinics, rehabilitate health facilities, deliver medical supplies, and support the national health response effort.

More than 99% of people sick with suspected cholera who can access health services are surviving. Furthermore, nearly 15 million people are unable to get basic healthcare.

“To save lives in Yemen today we must support the health system, especially the health workers. And we urge the Yemeni authorities – and all those in the region and elsewhere who can play a role – to find a political solution to this conflict that has already caused so much suffering. The people of Yemen cannot bear it much longer – they need peace to rebuild their lives and their country,” said Dr. Tedros.


Somalia has 3 new cholera deaths & more than 1,000 new cases

WHO

Cholera in Somalia, 27 July 2017

27 July 2017 – The Ministry of Health of Somalia has reported 1068 AWD/cholera cases and 3 deaths for week 28 (10 – 16 July 2017) with a case-fatality rate of 0.3%. Of these, the highest number of cases (286/27%) was reported in Middle Shebelle region, followed by Mudug, Sool and Banadir.

The cumulative number of cases stands at 58 524, including 812 deaths, in 15 regions across the country. The overall case-fatality rate of 1.4% remains above the emergency threshold of 1%. However, the cholera outbreak which started in January 2017 is slowing down, thanks to timely interventions by WHO, national health authorities and health partners.

WHO and health partners have been working in partnership with the Ministry of Health and local authorities to bring much needed relief to the populations.

Cholera response and prevention efforts are being continued throughout the country. With improvements to the surveillance systems in the country, a total of 265 sentinel health facilities are now able to report on health alerts, in addition to existing reporting mechanisms.

Chlorination of water sources was conducted in selected villages and IDP camps in Lower Jubba among returnees. Community sensitisation was conducted in IDP camps in Kismayo. Nearly 60 tonnes of essential medical supplies have been distributed to all regions since the start of the outbreak.

Somalia has been experiencing a severe drought due to lack of rains for consecutive seasons and poor rainfall. With livestock and crops destroyed and hundreds of thousands of Somalis displaced, around 6.7 out of 12.3 million people are in urgent need of humanitarian assistance. Nearly 5.5 million people are at risk of contracting water-borne diseases like cholera.

Related Links

Weekly cholera updates

Somalia situation updates


Cholera: Life and Death in yemen

WHO

The life and death struggle against cholera in Yemen

July 2017

Cholera continues to spread in Yemen, causing more than 390 000 suspected cases of the disease and more than 1800 deaths since 27 April.

WHO and its partners are responding to the cholera outbreak in Yemen, working closely with UNICEF, local health authorities and others to treat the sick and stop the spread of the disease.

Each of these cholera cases is a person with a family, a story, hopes and dreams. In the centres, where patients are treated, local health workers work long hours, often without pay, to fight off death and help their patients make a full recovery.

WHO/S. Hasan

Fatima Shooie sits between her 85-year-old mother and 22-year-old daughter who are both receiving treatment for cholera at the crowded 22 May Hospital in Sana’a.

“We have no money even for transportation to the hospital. My husband works as a street cleaner but he hasn’t received a salary for 8 months and he is our only breadwinner,” Fatima said. “I’m afraid that the disease will transmit to other family members.


WHO/S.Hasan

Dr Adel Al-Almani is the head of the diarrhoea treatment centre in Al-Sabeen Hospital in Sana’a. He and his team often work 18 hours a day to deal with the influx of patients.

More than 30 000 Yemeni health workers have not been paid in more than 10 months. Yet many, like Dr Al-Almani, continue to treat patients and save lives.


WHO/S. Hasan

Eight-year-old Mohannad has overcome cholera following 3 days of treatment in the diarrhoea treatment centre at Al-Sabeen Hospital in Sana’a. Mohannad lost his mother and sister when a bomb went off near their home in Hajjah. He and his father have since fled to Sana’a.

“Mohannad is all I have in this life after my wife and daughter died. When he was infected with cholera I was very anxious that he would have the same fate of his mother and sister,” said Mohannad’s father


WHO/S. Hasan

A health worker tends to Khadeeja Abdul-Kareem, 20. Khadeeja was forced to flee the conflict in Al-Waziya District, Taiz. Displaced from her home, she struggles to make ends meet – a situation compounded by her illness.


WHO/S. Hasan

It was a long and painful journey in search of treatment for Abdu Al-Nehmi, 53. The road from his village in Bani Matar District to Sana’a City was bumpy and the car broke down along the way. The whole time he was suffering from kidney pain in addition to severe diarrhoea and vomiting.

“There is no health centre in our area. We have to spend 2-3 hours to arrive at a proper health facility in Sana’a,” he said.

To date, WHO, UNICEF, and partners have supported the establishment of 3000 beds in 187 diarrhoea treatment centres and 834 fully operational oral rehydration therapy corners.


WHO/S. Hasan

Nabila, Fatima, Amal, Hayat and Hend are working as nurses in Azal Health Centre in Sana’a and have dedicated themselves to treating patients arriving with severe dehydration.

“Every day, we receive severe cases that come with complicated conditions, but we manage to save the lives of most of them. Sometimes, a new severe case arrives while we’re so busy treating another case,” said Nabila Al-Olofi, one of nurses working in the centre.

“Yes, we have no regular salaries as nurses, but saving lives is our biggest gain.”

WHO, together with UNICEF, is also delivering medical supplies and paying incentives, travel costs and overtime payments for health workers to enable them to continue to treat patients.


UNICEF Executive Director, Anthony Lake, WFP Executive Director, David Beasley and WHO Director-General, Dr Tedros Adhanom Ghebreyesus visit Yeme

WHO

Joint WHO/UNICEF/WFP statement
26 July 2017

“As the heads of three United Nations agencies – UNICEF, the World Food Programme (WFP) and WHO – we have travelled together to Yemen to see for ourselves the scale of this humanitarian crisis and to step up our combined efforts to help the people of Yemen.

“This is the world’s worst cholera outbreak in the midst of the world’s largest humanitarian crisis. In the last 3 months alone, 400 000 cases of suspected cholera and nearly 1900 associated deaths have been recorded. Vital health, water and sanitation facilities have been crippled by more than 2 years of hostilities, and created the ideal conditions for diseases to spread.

“The country is on the brink of famine, with over 60 per cent of the population not knowing where their next meal will come from. Nearly 2 milllion Yemeni children are acutely malnourished. Malnutrition makes them more susceptible to cholera; diseases create more malnutrition. A vicious combination.

“At one hospital, we visited children who can barely gather the strength to breathe. We spoke with families overcome with sorrow for their ill loved ones and struggling to feed their families.

“And, as we drove through the city, we saw how vital infrastructure, such as health and water facilities, have been damaged or destroyed.

“Amid this chaos, some 16 000 community volunteers go house to house, providing families with information on how to protect themselves from diarrhea and cholera. Doctors, nurses and other essential health staff are working around the clock to save lives.

“More than 30 000 health workers haven’t been paid their salaries in more than 10 months, but many still report for duty. We have asked the Yemeni authorities to pay these health workers urgently because, without them, we fear that people who would otherwise have survived may die. As for our agencies, we will do our best to support these extremely dedicated health workers with incentives and stipends.

“We also saw the vital work being done by local authorities and NGOs, supported by international humanitarian agencies, including our own. We have set up more than 1000 diarrhoea treatment centres and oral rehydration corners. The delivery of food supplements, intravenous fluids and other medical supplies, including ambulances, is ongoing, as is the rebuilding of critical infrastructure – the rehabilitation of hospitals, district health centres and the water and sanitation network. We are working with the World Bank in an innovative partnership that responds to needs on the ground and helps maintain the local health institutions.

“But there is hope. More than 99 per cent of people who are sick with suspected cholera and who can access health services are now surviving. And the total number of children who will be afflicted with severe acute malnutrition this year is estimated at 385 000.

“However, the situation remains dire. Thousands are falling sick every day. Sustained efforts are required to stop the spread of disease. Nearly 80 percent of Yemen’s children need immediate humanitarian assistance.

“When we met with Yemeni leaders — in Aden and in Sana’a — we called on them to give humanitarian workers access to areas affected by fighting. And we urged them – more than anything – to find a peaceful political solution to the conflict.

“The Yemeni crisis requires an unprecedented response. Our 3 agencies have teamed up with the Yemeni authorities and other partners to coordinate our activities in new ways of working to save lives and to prepare for future emergencies.

“We now call on the international community to redouble its support for the people of Yemen. If we fail to do so, the catastrophe we have seen unfolding before our eyes will not only continue to claim lives but will scar future generations and the country for years to come.”


Yemen: From 27 April to 25 July 2017, 402,484 suspected cholera cases and 1,880 deaths (CFR: 0.5%) have been reported in 91.3% (21/23) of Yemen governorates, and 88.9% (296/333) of the districts.

WHO

A physician checking a patient for dehydration    Person washing hands over a bucket of water

 


The Story of Cholera: A Video

Summary: A short animated film produced by the Global Health Media Project in collaboration with Yoni Goodman. This film makes visible the invisible cholera germs as a young boy shows how to help the sick and guides his village in preventing the spread of cholera.

The film shows how to make the basic homemade oral rehydration solution using sugar, salt, and safe water as these items were felt to be most widely available. However, a solution prepared with a readymade ORS packet is the first choice if supplies are available.

 


Kenya: As of Jul 17, a total of 1,216 suspected cholera cases including 14 deaths (case-fatality rate of 1.2%) have been reported since the first of the year.

WHO

Cholera – Kenya

Disease Outbreak News
21 July 2017

Since the beginning of 2017, Kenya is experiencing an upsurge of cholera cases. The first cholera outbreak reported in 2017 was in Tana River County. The outbreak started on 10 October 2016 and was controlled by April 2017.

Map of Kenya

A second wave of cholera outbreaks started in Garissa County on 2 April 2017 and was reported later in nine other counties including Nairobi, Murang’a, Vihiga, Mombasa, Turkana, Kericho, Nakuru, Kiambu, and Narok. The outbreak is being reported in the general population and in refugee camps. In Garissa County, the outbreak is affecting mainly Dadaab refugee camps and cases and deaths are being reported from Hagadera, Dagahaleh, and IFO2 camps. In Turkana county, the disease is also affecting Kakuma and Kalobeyei refugee camps.

In addition to the outbreak reported in the general population, there have been two point source cholera outbreaks in Nairobi County. One occurred among participants attending a conference in a Nairobi hotel on 22 June 2017. A total of 146 patients associated with this outbreak have been treated in different hospitals in Nairobi. A second outbreak occurred at the China Trade Fair held at the KICC Tsavo Ball between 10 and 12 July 2017. A total of 136 cases were reported and one death.

Currently, the outbreak is active in two counties, namely Garissa and Nairobi. As of 17 July 2017, a total of 1216 suspected cases including 14 deaths (case fatality rate: 1.2%) have been reported since 1 January 2017. In the week ending 16 July 2017, a total of 38 cases with no deaths were reported.

A total of 124 cases tested positive for Vibrio cholerae in the reference laboratory. In the week ending 25 June 2017, 18 samples out of 25 tested positive for Vibrio cholerae Ogawa by culture at the National Public Health Laboratory in Nairobi.

The main causative factors of the current outbreak include the high population density that is conducive to the propagation and spread of the disease, mass gatherings (a wedding party held in Karen and in a hotel during an international conference), low access to safe water and proper sanitation and the massive population movements in country and with neighbouring countries.

Since December 2014, the Republic of Kenya has been experiencing continuous large outbreaks of cholera, with a cumulative total of 17 597 cases reported (10 568 cases reported in 2015 and 6448 in 2016).

Public health response

The country has activated the national task force to coordinate the response to the outbreak. Since January 2017, WHO and partners are providing technical support to the country for the control of the outbreak. The country will develop a response plan with focus on the preparedness interventions to avert further spread of the outbreak. The WHO country office will repurpose their staff members and experts deployed in Nairobi for the management of the post El Niño effects in the Horn of Africa to support the quick control of this outbreak. WHO will also support the five most at risk counties with disease surveillance and response coordination. Partners on the ground are committed to provide support to the ongoing response efforts including support to primary health care and social mobilization by United Nations Children’s Fund (UNICEF).

WHO risk assessment

Cholera is an acute enteric infection caused by the ingestion of bacterium Vibrio cholerae present in faecally contaminated water or food. It is primarily linked to insufficient access to safe water and adequate sanitation. Cholera is always considered a potentially serious infectious disease and can cause high morbidity and mortality. It has the potential to spread rapidly, depending on the exposure frequency, population exposed and the context.

Cholera outbreaks have been reported in the Republic of Kenya every year with large cyclical epidemics every five to seven years.

The risk of the current outbreak is assessed as high at national and regional levels and moderate at global level. The outbreak occurred in the context of a sub-regional drought, conflicts and insecurity in the Horn of Africa. In addition, the outbreak is affecting the densely populated capital city Nairobi, and two large refugee camps (Kakuma and Dadaab) with massive population movements within country and between neighbouring countries. Previous large outbreaks in the Republic of Kenya have originated from similar settings, and the risk for propagation of cholera within the affected area as well as to other parts of the country is high. The country has identified a limited capacity for response and low access to safe water. There is an opportunity to implement early preparedness and response measures to contain the outbreak and prevent spread.

The current outbreaks linked to mass gathering activities poses additional risk of food safety as well as the need to conduct sanitary inspection in restaurants and hotels.

WHO recommendations

WHO recommends improving the readiness of counties and health facilities to early detect and respond to the cholera outbreak as well as the reinforcement of coordination and multisectoral approaches. In addition, hygiene practices in households, restaurant, hotels, refugee camps and health facilities should be improved and food safety interventions should be strengthened.

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


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