The World Health Organization (WHO) is responding to multiple cholera outbreaks that could flare-up and threaten the health of more people if control measures are not intensified. More than 10 700 cholera cases and 170 deaths have been reported in five countries in the WHO Eastern Mediterranean and African Regions as of 21 October 2015. WHO urgently requires more than US$ 5 million to ramp up its response to stem the tide of the cholera outbreaks ahead of the rainy season.
“Five countries – Iraq, Bahrain, Kuwait, Tanzania, and the Democratic Republic of the Congo (DRC) – have reported cholera cases. The cholera situation in Kuwait and Bahrain is under control, however we are concerned about the current cholera outbreaks in the Democratic Republic of Congo, Tanzania and Iraq. If not properly contained, cases could spike and spread across borders,” warns Coordinator, WHO Control of Epidemic Diseases, Dr William Augusto Perea Caro.
“The deteriorating security situation in Iraq coupled with the disruption of public health services and increased population displacement makes the conditions favourable for transmitting the disease. Equally in Africa, with El Niño conditions predicted, torrential rains can exacerbate this situation in Tanzania and DRC,” he added.
In Iraq, as of 20 October 2015, 1811 laboratory confirmed cases have been reported in 15 of the country’s 18 governorates. Cholera has since spread to neighbouring countries in Kuwait (4 cases) and Bahrain (1 case), where it is now under control. Increased population movement is expected with thousands of pilgrims coming for Ashura – a religious mass gathering commemorated on 23 October in Kerbala and on 2 December in Arbaciniya – which may pose an additional risk. Consequently, cholera could spread to neighbouring countries. Approximately US$ 2.8 million is needed to stop the cholera outbreak in Iraq.
In the Africa Region, Tanzania and DRC are battling intense cholera outbreaks. In Tanzania, 4922 cases of cholera and 74 deaths were recorded as of 21 October 2015. The outbreak has spread to 14 regions, including Zanzibar with 140 cases. Dar es Salaam is the most severely affected accounting for 3 499 cases. Tanzania requires US$2 million to scale up its health response in order to urgently control the current outbreak ahead of the rainy season.
“The cholera situation in the African Region is especially worrisome. WHO is working closely with national authorities and partners to manage the cases and provide access to safe water, adequate sanitation and basic hygiene needs,” said Dr Ibrahima-Socé Fall, Director of the Health Security and Emergencies Cluster at the WHO Regional Office for Africa.
In DRC, 3973 cases including 95 deaths have been recorded since mid-September. Of major concern is the cholera situation in Tshopo Province along the Congo River, as this could result in outbreaks in the densely populated capital Kinshasa.
The threat of cholera outbreaks in the African Region is worrisome with weather forecasts announcing the worst El Niño conditions in the past 20 years. With torrential rains expected in the coming months, WHO has urged governments and local officials to prepare for an intense rainy season.
In all affected countries, WHO and health partners are supporting the Ministries of Health to step up their response efforts to treat and prevent the further spread of the disease. Patients are being treated with Oral Rehydration Salts, infusions and antibiotics, as appropriate.
Interventions to control the outbreak include increased surveillance at the community level for case finding, provision of safe drinking water, improving sanitation through disinfecting septic tanks and better waste disposal. As part of the containment effort, WHO and partners are supporting widespread communication campaigns to encourage families to purify water, prepare food carefully and wash their hands.
In Iraq, the Ministry of Health in partnership with WHO will undertake an Oral Cholera Vaccination (OCV) campaign from 31 October – 1 November 2015 to prevent further spread. Using 510 000 doses from a one million global stockpile, 255 000 internally displaced people and refugees in 14 governorates will receive two doses of the vaccine. Fifteen Inter-Agency Diarrhoeal Diseases Kits and 600 000 chlorine tablets have also been prepositioned in the affected governorates.
To strengthen the country’s health system, WHO has trained approximately 48 national health staff on cholera case management and laboratory confirmation and has deployed a team of international experts under the Global Outbreak Alert and Response Network (GOARN) to support the Iraqi Ministry of Health respond to the outbreak.
In Tanzania, WHO and partners have helped the Ministry of Health and Social Welfare (MOHSW) establish five cholera treatment centres in Dar es Salaam and Morogoro regions. In addition, the MOHSW, WHO and the U.S. Centers for Disease Control and Prevention (CDC) are working together to establish an emergency operations centre for cholera control.
In DRC, WHO has provided 10 Inter-Agency Emergency Health Kits. These kits include Oral Rehydration Salts, other essential drugs and medical equipment. Each of these kits can meet the needs of 10 000 people for three months. A risk assessment mission will review the entire situation and examine the feasibility of vaccinating specific groups in an effort to prevent further spread of the outbreak.
WHO does not recommend any travel or trade restrictions.
Cholera is an acute intestinal infection caused by ingestion of food or water contaminated with the bacterium Vibrio cholerae. It has a short incubation period and can quickly lead to severe dehydration and death if treatment is not promptly given. Vomiting also occurs in most patients. Cholera remains a global threat in many developing countries. Access to safe drinking water and adequate sanitation is one of the most effective measures to prevent cholera outbreaks.