‘Curtail and contain’ is new rule as cholera outbreak worsens with rains
The rains are here, and so is cholera. In the last one week alone, 832 suspected cases of cholera have been reported from across 16 council areas in six states, according to weekly epidemiological reports from the Nigeria Centre for Disease Control.
Eight cases tested positive for cholera, eight people died.
The figures in the preceding week were even bleaker: 190 cases in 11 council areas in seven states; 17 positive for cholera; 17 dead. This time last year, only three cases suspected to be cholera were reported, from Kaduna south.
At least 5,659 infections suspected to be cholera have been reported since January. In total, the reports have come from 61 local government areas across 19 states.
Among them, 162 reports tested positive for cholera-and 84 of the patients died. This time last year, only four people died among 85 suspected cases of cholera across 11 states.
Latest outbreaks have been reported in Adamawa, Bauchi, Borno, FCT, Kaduna, Kano and Zamfara, with bases ranging from 100 in Adamawa to just the one in FCT and Zamfara.
The numbers are increasing, and the spread of the disease is widening-thanks to a lethal combination of uncontrolled sewage disposal, open defecation, and rainfall.
Epidemiological data over years shows through history that acute diarrhoeal cases rise when rains begin, says Ifeanyi Okodu, of health emergencies at WHO.
“Having this knowledge helps collaborations to put down preparedness plan and preposition supplies, train health care workers, set up efficient surveillance to pick this and respond,” he says.
Response to the outbreak has been massive. The United Nations approved N720m through the Nigerian Humanitarian Fund to manage the outbreak in Yobe.
Groups like Medecins Sans Frontieres, which first reported pockets of outbreaks have helped set up treatment centres. After that, attention has widened to trace sources of infections and individuals that patients infected may have been in contact with. Another dimension is water source-and likely sources of infection.
The ease of spread of cholera is tied to the lifestyle of communities. Many people infected with cholera-causing bacteria Vibrio cholera do not develop any symptoms. But the bacteria is present in their faeces up to 10 days after they are infected and is shed during defecation back into the environment.
This is where the rains come in. Water mixes up the bacteria in sand, and rainfall moves things around. So the bacteria end up in areas far away and possible where open defecation isn’t a problem but water source is. Then a new outbreak begins.
At least 25 different teams of 13 members each are working with Borno state government alone to ensure they “curtail and contain” the outbreak, according to Ngozi Azodoh, director of special projects at the federal health ministry.
“It is not something that the health sector alone can deal with. The health commissioner is working with other sectors, as water, to ensure we don’t keep going through this cycle.”
It is a lesson learnt from last year’s outbreak, says Rex Mpazanje, who represented WHO country director Wondi Alemu on a panel at the dialogue convened in Abuja on the north east.
“Last year, it took longer. This time we have upfront deployed the capacities necessary to contain the cholera situation,” he says.
“We trace every contact, the source of infection and control sources, and manage every person afflicted in treatment centres. This is being done heavier up front that it was last time we had cholera in this area.”
The disease kills an estimated 143,000 people around the world, according to some estimates.
Six in 10 of those deaths occur in sub-Saharan Africa. It comes with acute diarrhoea, which can kill within hours if left untreated.
Cholera has a clear link to water, sanitation and hygiene. It can be treated, but it can also be prevented.
A new study has been considering targeted vaccination guided by the risk factors for cholera. It concludes that better targeting anticholera efforts at district and neighbourhood levels could much more effectively reduce the burden of the disease.
For the study, researchers collected datasets showing locations of outbreaks in 37 African countries from 2010 to 2016. The cholera cases averaged 141,988 cases, and researchers in a study published in the Lancet, mapped them down to “hotspots” of infection.
The researchers are also looking to develop a global map updated real time at each reported infection.
“We really want to understand where we could go to have the greatest impact in vaccinating populations at risk,” says Duncan Steele, deputy director and strategic lead for enteric vaccines in the Enteric and Diarrhoeal Diseases team of the Bill & Melinda Gates Foundation.
Born in Zimbabwe, with time spent in Tanzania, Steele has seen outbreaks of cholera in both countries. In one outbreak in Tanzania, schools shut down, routine immunisation clinics for children and family planning clinics for women closed because the healthworkers were needed to help address incoming cases from the outbreak, Steele recalls.
Spending N720m on cholera control is a cost-effective intervention, he says. “It is not only preventing illness for people involved but it also has a broader impact on social populations around it.”
Think of the cost of illness and lost wages, economic disruptions and hospitalization expenses.
With rains again, 18 states are battling an outbreak of cholera. The difference is more people have died already than this time last year. Only quick “curtail and contain” move might mark real change.