Zimbabwe: 2018 Cholera

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Source: http://www.who.int/csr/don/20-septem...a-zimbabwe/en/
Cholera ? Zimbabwe

Disease outbreak news
20 September 2018

On 6 September 2018, a cholera outbreak in Harare was declared by the Ministry of Health and Child Care (MoHCC) of Zimbabwe and notified to WHO on the same day. Twenty-five patients were admitted to a hospital in Harare presenting with diarrhoea and vomiting on 5 September. The first case, a 25-year-old woman, presented to a hospital and died on 5 September. A sample from the woman tested positive for Vibrio cholerae serotype O1 Ogawa. All 25 patients had typical cholera symptoms including excessive vomiting and diarrhoea with rice watery stools and dehydration. The MoHCC declared the outbreak after 11 cases were confirmed for cholera using rapid diagnostic test (RDT) kits and the clinical presentation. Thirty-nine stool samples were collected for culture and sensitivity, 17 of which tested positive for V. cholerae serotype O1 Ogawa.
There has been rapid increase in the number of suspected cases reported per day since 1 September; there was a peak with 473 suspected cases notified on 9 September. As of 15 September 2018, 3621 cumulative suspected cases, including 71 confirmed cases, and 32 deaths have been reported (case fatality ratio: 0.8 %); of these, 98% (3564 cases) were reported from the densely populated capital Harare. The most affected suburbs in Harare are Glen View and Budiriro.
Cases with epidemiological links to cases from Harare have been recently reported from across the country, including in Mashonaland Central Province (Shamva District), Midlands Province (Gokwe North District), Manicaland Province (Buhera and Makoni districts), Masvingo Province and Chitungwiza City.
Public health response

• • The MoHCC declared the cholera outbreak in Harare City on 6 September; the Government declared the outbreak an emergency and subsequently a disaster on 13 and 14 September, respectively.
  • Outbreak coordination committees at the national and district levels have been established.
  • WHO and the WHO Country Office (WCO) are supporting the MoHCC with coordination, scaling up the response, strengthening surveillance and mobilizing both national and international health experts to form a cholera surge team.
  • WHO experts are providing technical support to laboratories, improving diagnostics and strengthening infection and prevention control (IPC) in communities and health clinics.
  • The Government is assessing the potential benefits of conducting an oral cholera vaccine (OCV) campaign; WHO is deploying an expert in OCV campaigns to Harare to support this assessment.
  • A cholera treatment centre (CTC) was established by M?decins Sans Fronti?res (MSF) in Glen View, Harare; MSF has provided extra nurses to support the response.
  • The recruitment of additional nurses to strengthen the response is ongoing.
  • WHO is providing supplies which contain oral rehydration solution, intravenous fluids and antibiotics for the treatment of patients in CTCs set up by partners.
  • Risk communication activities in affected and at-risk districts are being conducted by the Government and health partners.

WHO risk assessment

The outbreak started on 5 September and the number of cases notified per day continues to rapidly increase, particularly in Glen View and Budiriro suburbs of Harare. Cases with epidemiological links to this outbreak have been reported from other provinces across the country. Glen View, which is the epicentre of the outbreak, is an active informal trading area where people come from across the city and the rest of the country to trade. Key risk factors for cholera in Zimbabwe include the deterioration of sanitary and health infrastructure and increasing rural-urban migration which further strains the water and sanitation infrastructure. In Harare, contaminated water from boreholes and wells is suspected to be the source of the outbreak. The water supply situation in Harare remains dire due to the high demand of water that is not being met by the city supply. The country?s available response capacities are overstretched as authorities are already responding to a large typhoid outbreak which started in August 2018. WHO assessed the overall public health risk to be high at the national level and moderate at the regional and low at global levels.
WHO advice

WHO recommends proper and timely case management in CTCs. Increasing access to potable water, improving sanitation infrastructure, and strengthening hygiene and food safety practices in affected communities are the most effective means to prevent and control cholera. Key public health communication messages should be provided to the affected population.
WHO advises against any restrictions on travel or trade to or with Zimbabwe based on the information currently available in relation to this outbreak.


For further information, please refer to:

• WHO fact sheet on cholera
• The Global Task Force on Cholera Control

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Source: https://www.zimeye.net/2018/09/26/ch...alth-minister/
Cholera Death Toll Now 49: Health Minister
September 26, 2018

Terrence Mawawa|Health and Child Care Minister, Obadiah Moyo has said the cholera death toll has risen to 49 and 6645 cases have been recorded in the capital.

Moyo has conceded that the cholera epidemic is surprisingly resistant to commonly available drugs...

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Source: http://www.zbc.co.zw/manicaland-reco...holera-deaths/


Manicaland records three cholera deaths
Sep 28, 2018

Manicaland has so far recorded 4 cholera deaths.

Three of the four people who died are from Buhera and one is from Makoni district.

The province has recorded 170 suspected cases of cholera and 17 cases have been confirmed.

All the cases are suspected to have been caused by people who recently visited areas in Harare where the epidemic started.

Speaking during a Manicaland Provincial Development Committee meeting held in Mutare, Manicaland Provincial Administrator Mr Edgar Seenza raised concern over the alarming rate of the increased cholera cases in the province...

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Source: https://www.zimlive.com/2018/10/hara...being-treated/

Harare man dies of cholera in Bulawayo, 2 others being treated
'If it looks like cholera, behaves like cholera and walks like cholera we treat like cholera'
ByLulu Brenda Harris
13:07, 01 Oct 2018

BULAWAYO ? A traveler exhibiting symptoms of cholera died at Thorngrove Isolation Hospital in Bulawayo hospital on September 25.

The 88-year-old man, a religious minister whose name has been withheld, is originally from Budiriro in Harare.

Dr Edwin Sibanda, the Bulawayo City Council?s Director of Health Services, said the man travelled to Francistown in Botswana and fell ill with diarrheal symptoms.

?He was not a Bulawayo resident but a resident of Budiriro. He had gone to Botswana and we are unsure on what duties he was doing there but developed symptoms on his way back from Botswana on Sunday, August 23, enroute to Harare,? Dr Sibanda told ZimLive...

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Source: https://263chat.com/cholera-hits-mutare/


Cholera hits Mutare
HealthNews
By Moses Chibaya On Oct 5, 2018

Mutare City Council has confirmed two cholera positive cases, one of which imported from one of the cholera epicentres, Budiriro high density suburb in Harare.

At least 49 people have died from cholera since its Outbreak on the 6th of September 2018.

In a statement Mutare City Council said the total number of cases to date has risen to two.

?One more confirmed Cholera case has (been) reported in Mutare, bringing to two confirmed cases,? the council said in a statement.

The City said the first case is of a male Bakers Inn delivery truck driver from Budiriro in Harare who had come to Mutare City on duty.

?He is admitted at Mutare infectious Diseases Hospital where he is receiving treatment.?

The City of Mutare said that there are no diarrhoeal cases linked to cholera in the City of Mutare suburbs ?where the driver delivered Bakers Inn bread nor is there any other case linked to his Cholera disease in any part of City of Mutare.?

Mutare City added that the second case is of a one-year nine months old baby from Zvipiriri area in Marange, Mutare rural District Council...

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Source: http://www.who.int/csr/don/05-octobe...a-zimbabwe/en/
Cholera ? Zimbabwe

Disease outbreak news: Update
5 October 2018

Since the last Disease Outbreak News was published on 20 September (with data as of 15 September), an additional 4914 cases have been reported including 92 laboratory-confirmed cases.
The cholera outbreak in Harare was declared by the Ministry of Health and Child Care (MoHCC) of Zimbabwe on 6 September 2018 and notified to WHO on the same day. As of 3 October 2018, 8535 cumulative cases, including 163 laboratory-confirmed cases, and 50 deaths have been reported (case fatality rate: 0.6%). Of these 8535 cases, 98% (8341 cases) were reported from the densely populated capital Harare (Figure 1). The most affected suburbs in Harare are Glen View and Budiriro.
Of the 8340 cases for which age is known, the majority (56%) are aged between 5 and 35 years old. Males and females have been equally affected by the outbreak. From 4 September through 3 October, the majority of deaths were reported from health care institutions.
The pathogen is known to be Vibrio cholera O1 serotype Ogawa. Since confirmation on 6 September 2018, a multi-drug resistant strain has been identified and is in circulation; however, this does not affect the treatment of most cases, where supportive care such as rehydration solutions are used. Antibiotics are only recommended for severe cases. Furthermore, the antibiotic which is being used for severe cases in Harare is Azithromycin which remains effective in the majority of cases.
Contaminated water sources, including wells and boreholes are suspected as the source of the outbreak.
Figure 1: Cholera cases in Harare, Zimbabwe from 4 September through 3 October 2018




Figure 2: Cholera cases in Zimbabwe from 4 September through 1 October 2018




Public health response

• • On 3 October 2018, an oral cholera vaccine mass vaccination campaign started in Harare City and surrounding areas such as Chitungwiza and Epworth. WHO is supporting the MoHCC on a strategy for rolling out the vaccination campaign, as well as implementing the campaign and sensitizing the public about the vaccine. More than 600 health workers have been trained to carry out the campaign. On 27 September 2018, 500 000 doses have arrived in Harare. In total, 2.7 million doses have been approved for two rounds of vaccination.
  • WHO and experts from the Global Outbreak Alert and Response Network (GOARN) are providing technical oversight into case management and providing guidance on the interpretation of laboratory findings to guide the choice of antibiotics.
  • Four cholera treatment centres (CTCs) have been established. UNICEF has prepositioned seven tents at Glenview for the CTC and Oxfam is providing mobile toilets in three CTCs.
  • The key risk communication and community engagement interventions have been on raising awareness on cholera prevention through the mass media and social media, and working with specific community groups, including Apostolic sect leaders and Apostolic women?s groups.
  • Sixty volunteers have been deployed to provide risk communication, community engagement and social mobilization support to CTCs in Budiriro and Glen View. Health and hygiene promotion is taking place through drama shows at schools and business centres, roadshows and door-to-door visits, which also focuses on identification and case referral.
  • Water, sanitation and hygiene (WASH) activities include enforcement of regulations for food vendors, City of Harare fixing burst water pipes and increasing the water supply to hotspots, with private sector players supporting installation of water tanks and water trucking.
  • UNICEF is supporting distribution of non-food items (soap, buckets), along with Oxfam, Christian Care, Mercy Corps and Welthungerhilfe (WHH), as well as key components of community mobilization.
  • WHO has sent supplies to treat 3800 people and arrangements are in place for additional supplies to arrive in the coming days. In addition, more than 44 000 litres of ringers lactate from South Africa have arrived in country and the RDTs are being cleared from the airport.
  • Since the cholera outbreak was declared on 6 September 2018, weekly meetings of the Inter-Agency Coordination Committee on Health (IACCH) have been held.
  • On 12 September 2018, following the declaration of the cholera outbreak as a state of disaster, the Cabinet Committee on Emergency Preparedness and Disaster Management was reactivated.
  • On 18 September 2018, the national government set up an inter-ministerial committee on the cholera outbreak, involving all major government stakeholders, to provide leadership and to monitor the cholera response efforts and provide regular briefs to the President.
  • On 21 September 2018, the National Emergency Operations Centre (EOC) was activated, with support provided by local business organizations. The Incident Command Structure (ICS) was finalized and will be published by the EOC.
  • On 1 October 2018, Econet began fixing Information and Communications Technology equipment in the EOC in MoHCC of Zimbabwe to support real time reporting.
  • On 29 September 2018, a rapid assessment of surveillance was conducted in coordination with the United States Centers for Disease Control and Prevention (US CDC).

WHO risk assessment

The outbreak started on 5 September and the number of cases notified per day continues to rapidly increase, particularly in Glen View and Budiriro suburbs of Harare. Cases with epidemiological links to this outbreak have been reported from other provinces across the country. Glen View, which is the epicentre of the outbreak, is an active informal trading area where people come from across the city and the rest of the country to trade. Key risk factors for cholera in Zimbabwe include the deterioration of sanitary and health infrastructure and increasing rural-urban migration which further strains the water and sanitation infrastructure. Since the beginning of the outbreak, 135 cases have been reported from provinces outside Harare. With the upcoming rainy season in November, there is a concern that cases may increase in the hotspots. In Harare, contaminated water from boreholes and wells is suspected to be the source of the outbreak. Sixty-nine percent of the population in Harare relies on these boreholes and wells as a source of water. The water supply situation in Harare remains dire due to the high demand of water that is not being met by the city supply though this is a focus of response efforts. The country?s available response capacities are overstretched as authorities are already responding to a large typhoid outbreak which started in August 2018. WHO assessed the overall public health risk to be high at the national level and moderate at the regional and low at global levels.
WHO advice

WHO recommends proper and timely case management in CTCs. Increasing access to potable water, improving sanitation infrastructure, and strengthening hygiene and food safety practices in affected communities are the most effective means to prevent and control cholera. Key public health communication messages should be provided to the affected population.
WHO advises against any restrictions on travel or trade to or from Zimbabwe based on the information currently available in relation to this outbreak.
For further information, please refer to:

• WHO fact sheet on cholera
• The Global Task Force on Cholera Control

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Source: https://www.newzimbabwe.com/cholera-...die-in-buhera/


Cholera death toll hits 54 as five die in Buhera
12th October 2018 News Headlines
By Audience Mutema

THE death toll from the recent cholera outbreak has risen to 54 with five deaths having been recorded last week in Manicaland province?s Buhera area.

This was revealed by Health and Child Care Minister Obadiah Moyo during a Friday donation ceremony of drugs, blankets and disinfectants towards combating the scourge...

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Source: https://reliefweb.int/report/zimbabw...0-october-2018

Zimbabwe: Cholera outbreak snapshot (as of 10 October 2018)
Infographic
from UN Office for the Coordination of Humanitarian Affairs
Published on 12 Oct 2018

By 10 October, 8,980 cholera cases (8,786 suspected and 194 confirmed cases), including 54 deaths (case fatality ratio 0.60 per cent), had been reported in seven provinces across Zimbabwe. Between 3 October and 10 October, 445 new cases were registered, including both new cases and older cases that were newly verified. New cases were recorded in four areas - Harare City, Chitungwiza (Harare), Buhera (Manicaland) and Bulawayo City (Bulawayo). Bulawayo City had not previously reported any infections. However, transmission is declining, with significantly fewer cases reported from 1 to 11 October (974) compared to the same period in September (2,793). Harare City remains the epicentre of the outbreak, accounting for 97 per cent (8,721) of all cases and the majority of new cases. An estimated 22 per cent of all suspected and confirmed cases are children under age five...

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Source: https://www.businesslive.co.za/bd/wo...hern-zimbabwe/


Another cholera outbreak hits northern Zimbabwe
27 November 2018 - 21:24 Kevin Samaita

Harare ? Zimbabwe has been hit by another cholera outbreak, hardly three months after more than 50 people died of the disease.

More than 20 people have reportedly been infected in the rural town of Mt Darwin, near the border with Mozambique. Authorities recently announced that the disease had been contained.

At the height of the outbreak in September, authorities enforced a state of emergency, banned public gatherings and shut down schools before World Health Organisation and other organisations provided help to control the disease.

On Tuesday, The Herald reported that all 20 cases were reported at Mukaradzi Mine. The state daily report said all the patients were being treated at Mt Darwin District Hospital.

Health minister Dr Obadiah Moyo was expected to give details on the severity of the outbreak...

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Source: https://zwnews.com/latest-cholera-ki...-in-mt-darwin/


LATEST: Cholera kills 3 illegal gold miners in Mt Darwin
By Samson Muchirahondo
- 28th November 2018


The Cholera outbreak in Mt Darwin has claimed three people in space of three days, an official has confirmed.

Mt Darwin district nursing officer Sister Anna Chinyemba confirmed the deaths

Sister Chinyemba said the first victim died on Sunday, while the other two yesterday one in the morning and evening in that order.

She said the affected people are artisanal miners from Mukaradzi mining area which is 25 kilometres from Mt Darwin...

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Source: https://www.newzimbabwe.com/sect-for...o-congregants/


Sect forced to disband annual gathering after cholera claims two congregants
22nd December 2018 News Headlines
By Robert Tapfumaneyi

Murewa: Thousands of a Johanne Marange apostolic sect members have been forced to abandon their annual spiritual union in this Mashonaland East area after a cholera outbreak has claimed two congregants and invited pressure from Zimbabwean authorities to disband.

Two members of the sect passed on Monday this week at a local Dandara clinic while two others have since been taken ill at Murewa district hospital with cholera symptoms.

Health authorities have confirmed the deaths were caused by cholera with the hospitalised pair said to be related to the two now deceased...