All hands on deck as cholera strikes Kenya, killing four

Tuesday July 25 2017

A woman fetches water for her domestic use from

A woman fetches water for her domestic use from a wetland. PHOTO| TOM OTIENO 

By VERAH OKEYO

Kenya is battling a resistant strain of cholera that researchers and health experts fear, could spell doom for the region.

The strain of cholera, which is circulating in Nairobi and 11 other counties, is a “special” kind of vibrio cholerae inaba, according to researchers at the Kenya Medical Research Institute (Kemri). This strain has acquired a resistant characteristic — extended-spectrum beta-lactamases (ESBL) — which makes it extremely difficult to kill with the available antibiotics.

The ESBL cholera, whose origin is traced to India, has since been responsible for mass casualties in Haiti, Rwanda and the Democratic Republic of Congo.

Kemri’s Dr John Kiiru, an expert on infectious diseases, who has been studying the genes of the bacteria with the ESBL trait since it was traced in Kenya’s Dadaab refugee camp in 2015, said the current outbreak may be especially devastating for the region.

Cholera, by its very nature, is an instant killer when poorly managed. Once ingested, it clings to the intestines and releases poisons that shock the body into concentrating its water on ejecting it, hence the sustained vomiting and diarrhoea, where patients lose as much as 30 litres in just six hours.

The latest outbreak in Kenya has claimed at least four lives, while 79 patients are admitted to hospital, according to official figures released by the Cabinet Secretary for Health, Dr Cleopa Mailu.

Alarm bells were first sounded in December when several guests were taken ill and three died soon after attending a wedding in Nairobi. Then, Ministry of Health officials ruled out cholera and blamed the deaths on gastroenteritis, a mild food-borne condition.

It was the same case of denial last month, when 40 medics attending a conference in Nairobi were admitted with signs of cholera.

But early this month, when two CSs and several senior government officials were hospitalised with the same symptoms, the ministry finally spoke: It was cholera.

According to Director of Medical Services Dr Jackson Kioko, Nairobi alone has had 96 confirmed cases of cholera and over 330 suspected ones reported so far.

The Health Cabinet Secretary ordered two high-end hotels closed. One of the two hotels, had been contracted to offer outside catering services at the event where the two CSs got infected. He also announced that the ministry would put up six health centres in the areas the city worst affected by the outbreak, in addition to vetting water vendors.

Perhaps this is too little an intervention, but not too late.

With an enabling environment in the public health systems, including poor laboratory capacity, lack of trained personnel or diagnosis and response to an outbreak and the nature of the cholera bacteria itself, this strain threatens more lives.

Dr Thumbi Mwangi, an epidemiologist, told The EastAfrican of R0 — pronounced R nought — a number assigned to any disease to determine how contagious it is, and its ability to move from one person to another.

Cholera’s R0 is estimated to be between 1.95 and 6; meaning, one person can infect six other people, then each of those six would infect six others and so on. The effect would be catastrophic for this strain.

Last month, a World Bank-funded report, “The East African Public Health Laboratory Networking Project,” revealed the absence of surveillance of antimicrobial resistance in the region.

The report also found that most of the enteric pathogens circulating in Kenya, Uganda and Tanzania — salmonella, shigella and cholera — are resistant to antibiotics. To handle them, public hospitals will need even stronger antibiotics, which governments will find more expensive.

One of the biggest hurdles to fighting and preventing the spread of the disease is silence, with governments fearing loss of revenue from tourism or just national pride. In 2009, Ethiopia refused to declare a suspected outbreak of cholera that killed 684 people and infected nearly 60,000 others in less than a year.

The failure to label the disease with its name and its magnitude, caused a less urgent response from donors in terms of funding and mobilisation.