Oral vaccine, quicker response reduce cholera cases: WHO

Monday December 16 2019

Sewer flows from an open bust line towards Nairobi River.

Sewer flows from an open bust line towards Nairobi River on April 10, 2018. Dirty water raises the risk of cholera outbreaks. PHOTO | FILE | NATION MEDIA GROUP 

VERAH OKEYO
By VERAH OKEYO
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Africa’s cholera cases in 2018 reduced by a commendable 37 per cent from more than 165,000 to 120,652 cases, partly due to containing a protracted outbreak in Somalia and South Sudan, as well as reducing cases in the Democratic Republic of Congo, reports the World Health Organisation.

In its weekly epidemiological record of November 29, the WHO attributed this to the oral vaccine and a quicker response. The global health body said that Somalia reported more than 75,000 cases in 2017, which reduced to just 6,761 in 2018. This led to a 25 per cent reduction of deaths to 2,436 in 2018.

The report said there was “a nearly 40 per cent decrease in the number of cases in the DRC each year and no reported cases in South Sudan after 16 000 cases in 2017.”

SERIOUS OUTBREAK

Unrest in the Horn of Africa and Central Africa has complicated the cholera situation in the region; five of the 17 countries that experienced outbreaks in 2018 said the cases were imported, mostly through refugees.

These were serious outbreaks, and WHO assigned the proportion of deaths in the cases reported as high as two per cent in Uganda. It is recommended that the figure stays below one per cent.

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Burundi, Kenya, Somalia, Uganda and Tanzania — reported 21,789 cases, approximately one fifth (18 per cent) of all 120,652 cases reported in Africa. Now experts are drawing a clear line between this situation and the tens of thousands of cases reported in Congo-Brazzaville and the DRC.

CHOLERA HOTSPOTS

Dr Geoffrey Bwire, who heads Uganda’s response team to diarrhoeal diseases, told The EastAfrican that the refugee camps such as Kyegegewa, a four-hour drive west of Kampala, experienced outbreaks, and “since we allow refugees to integrate with the locals, it is possible that the outbreaks come to the Ugandans as well.”

Uganda receives quite a number of refugees. The United Nations agency mandated to protect refugees recorded that as of October 2018, Uganda had 1,154,352 migrants.

Some of the refugee camps such as Bidibidi in Yumbe District in North Western Uganda hold as many as nearly a quarter of a million people, arguably the world’s second largest according to the UNHCR.

With expected congestion, sanitation is often poor, predisposing the people to water borne diseases.

Uganda’s ministry of Health arrived at the conclusion that refugees contributed to the diarrhoeal disease’s burden after mapping of all the Cholera hotspots in 22 high risk districts where more than seven million people lived.

Kenya, which recorded 5,719 cases and 78 deaths in 2018, has attributed some of the cholera cases to refugees, according to the Division of Disease Surveillance and Response at the ministry of Health.

Apart from the capital city Nairobi’s contributing more than 70 per cent of all cases of cholera in 2017-2018, the northern part of Kenya (Garissa and Turkana counties which host Dadaab and Kakuma refugee camps) accounted for more than 20 per cent of all the cases in Kenya.

In Uganda, the fishing communities further complicated the matter. While they are less than 10 per cent of Uganda’s population, fishing communities account for about 56 per cent of cases and deaths from cholera in the country.

Dr Bwire and his team attributed this to using contaminated lake water, poor sanitation as well as the poverty and illiteracy in the communities.

SEVENTH PANDEMIC

Uganda was one of the nine countries — including DRC, Malawi, Niger, Nigeria, Somalia, South Sudan, Uganda, Zambia and Zimbabwe — that deployed the oral cholera vaccine.

The first cholera outbreak was in 1817 from its endemic area in South-East Asia.

In 1961, the world faced what became known as the seventh pandemic and there have been concerns of strains of cholera circulating in East Africa that have not been encountered before.

Maite Guardiola, a water and sanitation expert from Médecins Sans Frontières, told The EastAfrican that “cholera response in East Africa has improved over the last four to five years”.

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INTERVENTIONS

The Ministries of Health in Kenya and Uganda have increased the lab examinations to identify the strains of the cholera responsible for outbreaks to know which strain — serotypes Inaba and Ogawa — and where they came from.