Niger - Cholera outbreak 2021 - 2022

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WEEKLY BULLETIN ON OUTBREAKS
AND OTHER EMERGENCIES

Week 34: 16 - 22 August 2021
Data as reported by: 17:00; 22 August 2021
...

Cholera Niger

1 404 Cases
54 Deaths
3.8% CFR

EVENT DESCRIPTION

On 9 August 2021, the Ministry of Public Health of Niger officially
declared a cholera outbreak in the country. The first cases were
reported in week 23 (week ending 13 June 2021) in Birni N’Konni
district, Tahoua region which shares a border with Nigeria. The
region also has some districts that share borders with Mali in
the north but no cases have been reported thus far. During week
26 (week ending 4 July 2021), districts in the Zinder and Maradi
regions reported cholera cases and subsequently Dosso region
reported cases in week 30 (week ending 1 August 2021). The capital
city of Niamey, which is also the most populated area in the country,
has also reported at least 58 cases of cholera.

As of 20 August 2021, a total of 1 404 cases and 54 deaths (CFR
3.8%) have been reported from 22 (31%) out of 72 health districts in
Niger. Currently, 17 of the 22 health districts are reporting ongoing
transmission of the outbreak. Districts reporting the most cases
thus far are Madarounfa (475 cases) and Maradiville (315 cases)
both in Maradi region, followed by Magaria (135 cases) in Zinder
region. Of the 109 samples tested, 60% of them were confirmed
positive with the isolated serotype identified as Vibrio cholerae O1
Ogawa. Overall, 735 cases (52%) have been reported among females
while 643 cases (45%) have been among males. Proportionally, the
highest death rate has occurred among children below five years of
age. Death rates have also been higher in Niamey region (Niamey
Urban Community) (28% death rate) and Tahoua region (25% death
rate), while the other regions’ death rates all remain lower than 6%.
The rainy season in Niger is seasonal and usually lasts between June
and October. All regions reporting cholera cases have also reported
floods making conditions even worse. According to the Ministry of
Humanitarian Action and Disaster Management, 69 515 people from
7 812 households have been affected by the floods throughout the
country facilitating the spread of cholera.

In addition, many of the affected districts share borders with other
countries and outbreaks in the past have been linked to cross-border
cases. Nigeria’s northern states are currently known to have active
cholera outbreaks and imported cases from Katsina and Sokoto
states have been detected in Tahoua and Maradi regions. There
is much population movement across borders in this area which
is a major threat to the spread of cholera within the West African
subregion. The current outbreak in Gaya district of the Dosso region
in Niger poses a major threat to Benin and other neighbouring
countries considering that it is a major trade and transportation hub
in the subregion.

PUBLIC HEALTH ACTIONS

An incident management coordination committee was formed
and meets daily

A One Health committee is being established.
Response teams at all levels (district, regional, and national)
have been activated.

Case investigations are being carried out in the affected regions.
Laboratory and infection prevention control supplies have been
prepositioned to all health districts.

Contacts of cases are being traced and receiving preventative
treatment.

Cholera isolation and treatment units were established in
affected health areas.

Safe and dignified burials have been conducted for the deceased.

Affected regions were provided with water treatment supplies
for household drinking water.

Water points were rehabilitated in villages in the Zinder region
with more planned for the future.

Risk communication and community outreach is being
conducted.

Preparations are underway for a reactive vaccination campaign.

SITUATION INTERPRETATION

The cholera outbreak has deteriorated rapidly in Niger. Although an
outbreak has not been reported in more than a year, the country is
known to be endemic for the disease. The ongoing rainy season has
contributed to the precarious situation as floods have been reported
in all the regions where they have been reported cases of cholera.
Similar seasonal flooding is commonplace at this time of the year
across the West African subregion and have been reported in
neighbouring Nigeria, a country also currently experiencing a large
outbreak of cholera. Furthermore, frequent population movement
between nearby countries for travel and trade have in the past
accounted for subregional spread of outbreaks and has the potential
for much wider regional spread of the current cholera outbreak. A
case has already been documented in Burkina Faso which was from
Niger.

...

https://apps.who.int/iris/bitstream/handle/10665/344445/OEW34-1622082021.pdf

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WEEKLY BULLETIN ON OUTBREAKS
AND OTHER EMERGENCIES

Week 38: 13 - 19 September 2021
Data as reported by: 17:00; 19 September 2021
...

Cholera Niger

4 283 Cases
144 Death
3.4% CFR

EVENT DESCRIPTION

The cholera outbreak in Niger, which was declared on the 9 August
2021, is rapidly worsening. As of 14 September 2021, a total of
4 283 cases of cholera with 144 deaths (case fatality ratio (CFR
3.4%) have been reported. This CFR is high compared to the
expected of < 1%. The outbreak is currently affecting 6 out of 8
(75%) regions of the country. A total of 29 (40%) health districts
out of 72 have reported at least one case of cholera and 20 (69%) of
these 29 health districts are currently active.

Among the total cases, females 55% (2 347) have been more
affected than the males 45% (1 936). The most affected age group
is 15 years or older with 2 822 cases (66%) followed by 5-14 years
with 549 cases (13%). Majority of the deaths, 117 (81%) have been
recorded among the same age group of 15 years or older. Regarding
deaths, men are more affected with 77 deaths (53%) against 67
deaths among women (47%).

Since the onset of the outbreak, a total of 278 stool samples have
been collected and tested, of which 156 are positive, a positivity rate
of 56%. The Vibrio cholerae Ogawa 01 serotype has been isolated.

The Maradi region is leading in number of cases with 2 381 cases
(55.6%), and is considered the epicenter of the outbreak, followed
by Tahoua with 981 cases (23%), Zinder 498 (11.6%), Tillabery 236
(5.5%), Niamey 107 (2.5%) then Dosso 80 (1.8%). Niamey has
recorded the highest CFR with 11 deaths out of 107 reported cases
(CFR 10%), followed by Tahoua 6.0% (58/2 381), Zinder 4.0%
(20/498), and Tillabery 3.4% (8/236).

Regarding the dynamics of the outbreak, Dosso region has not
reported new cases for the last 10 days and is therefore no longer
considered as a hotspot given that two incubation periods of 5 days
for cholera has been reached. The 3 regions of Maradi, Tahoua and
Tillabery have at least one health district that have reported case of
cholera every day for the past 10 days.

The rainy season is still ongoing and its resulting floods, which are
the main factor for the spread of this outbreak, have already affected
nearly 195 851 people and killed 66 people as of 6 September 2021.
About 12 475 houses have collapsed, 5 960 hectares of cropland
buried, and more than 10 000 cattle were lost.

Imported cases of cholera from Nigeria are still reported in the
affected regions mainly in Maradi region. In addition to BurkinaFaso
that reported 2 cases so far imported from Niger, Mali has
just declared the cholera outbreak in the Gao region linked to the
ongoing outbreak in Tillabery region of Niger. The strain isolated
in Mali is the same as the one causing outbreak in Niger (Vibrio
cholerae Ogawa 01).

PUBLIC HEALTH ACTIONS

The national incident management coordination committee
continues to meet on regular basis; weekly meetings of this
committee with the national One Health committee are also
taking place.

High-level joint visit led by the Minister of Public Health, to the
of the outbreaks affected regions of Maradi and Zinder with WHO
and others UN agencies has been conducted, the main objective of
this mission was to assess the quality of the response activities.

Regular meetings of regional One Health Committees in the
affected regions are ongoing

Deployment of five multidisciplinary support teams to the
affected regions took place

Case management and investigation in the affected areas as
well as strengthened surveillance activities are ongoing
Daily transmission of data from health districts to the regional
level as well as data analysis at all levels are also ongoing
Collection tubes and laboratory supplies have been prepositioned in all health districts
Strengthened water, hygiene and sanitation activities including
regular treatment of water points, distribution of Aquatab tablets,
cholera treatment centers and environmental disinfections are
ongoing in the affected areas.

With the WHO support, the country has submitted the
vaccination request at the International Coordination Group on
7 September 2021.

SITUATION INTERPRETATION

The ongoing cholera outbreak in Niger seems to be more severe
compared to the last major outbreak the country experienced in
2018, especially in terms of caseload and deaths counts as well as
its spreading pattern. The ongoing rainy season has contributed
to the dangerous situation as floods have been reported in all the
regions where cases of cholera have been reported. Among some of
the hypotheses for the high CFR are late visits to health care facilities,
advanced age of patients and low quality of case management,

Children, a priority target of the cholera vaccination campaign.
however, an in-depth assessment on the high lethality is necessary
to confirm these hypotheses. Two neighboring countries (Burkina
Faso and Mali) have already declared cholera outbreaks linked to
the one in Niger, causing concern of further international spread
throughout the region. Cases imported from Nigeria also continue
to be reported. The epidemic is still active in Niamey, the capital
city of the country and which has the highest population density,
potentially causing risk to even more disease spread. It is therefore
paramount to double efforts deployed so far to overcome this
outbreak.

PROPOSED ACTIONS

Multisectoral response to the cholera outbreak in Niger should
be prioritized because it facilitates the harmonization of actions
and promotes the effectiveness of the response. An in-depth
assessment to understand the causes of the high death rates
should be conducted urgently and appropriate remedies put
in place. Awareness-raising activities for the population about
the disease remain essential and should be intensified in the
areas most affected and at risk. A reactive cholera vaccination
campaign must be organized as quickly as possible targeting
those at risk.

It is also important to think for a sustainable solution since
cholera is endemic in Niger. It is therefore necessary to
strengthen the health system, carry out hygiene promotion
activities, and all structures put in place for prevention and
response to cholera outbreaks in the areas at risk. Communities
should be availed with access to safe drinking water and
adequate sanitation and hygiene facilities. The national action
plan for long-term cholera control and elimination should be
developed and must include recommendations of the global
cholera control group’s roadmap.

https://apps.who.int/iris/bitstream/handle/10665/345306/OEW38-1319092021.pdf

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WEEKLY BULLETIN ON OUTBREAKS
AND OTHER EMERGENCIES

Week 6: 31 January – 6 February 2022
Data as reported by: 17:00; 6 February 2022
...

Cholera Niger

5 591 Cases
166 Deaths
3.0%CFR

EVENT DESCRIPTION

On 31 January 2022, the Ministry of Health of the Niger Republic
declared an end of the cholera outbreak that affected seven regions
(Diffa, Dosso, Niamey, Tahoua, Tillabery, Maradi, Zinder) out of
eight in the country. Only the Agadez region was not affected. The
declaration followed eight silent weeks since the last confirmed
case reported on 4 December 2021 in Say health district of Tillabery
Region.

Since the start of the outbreak, on 13 March 2021 to 4 December
2021, a total of 5 591 cholera cases and 166 deaths (CFR =3.0%)
have been reported from 35 (49%) health districts out of 72 across
seven regions in the country. The first confirmed cholera case was
imported from Nigeria and reported on 13 March 2021 from Konni
health district following confirmation of Vibrio Cholerae, Ogawa
01 serotype. This case was a 65 year-old Nigerian citizen admitted
at Konni district hospital with severe diarrhoea and vomiting. The
cholera outbreak later spread to other regions of the country, mainly
driven by the flooding following the overflow of Niger River during
the heavy rain season. The last known confirmed case was reported
on 4 December 2021 from Say health district in Tillabery Region.
Among the 5 591 cases reported, females were most affected with
3 081 cases and 78 deaths (CFR=2.5%) compared to males with
2 510 cases and 88 deaths (CFR) =3.5%). The 15 years and above
age-group was the most affected, with 3 671 (65.6%) cases and
137 deaths (82.5%), followed by 5 to 14 years age-group with
1 251 cases and 20 deaths. The total number of recovered cases is
5 425, with the recovery rate of 97%. A total of 355 stool samples
were analysed and 195 (55%) of these tested positive for Vibrio
Cholerae Ogawa 01 serotype.

Regarding the affected regions, Maradi Region reported most cases
with 3 038 cases (54.3%), followed by Tahoua with 1 309 (23.4%),
then Zinder with 600 cases (10.7%), Tillabery with 309 cases
(5.5%), Dosso region with 150 cases (2.7%), Niamey with 112
cases (2.0%) and Diffa with 73 cases (1.3%). Concerning deaths,
Tahoua region reported the highest number (67 deaths), followed
by Maradi with 49 deaths, Zinder with 20 deaths, Niamey with 12
deaths, Tillabery with 11 deaths, and Dosso with 7 deaths. The
Diffa region did not record any death. Niamey region recorded the
highest case fatality ratio (10.7%), followed by Tahoua with 5.1%,
Dosso with 4.7%, Tillabery 3.6%, Zinder 3.3%, and Maradi 1.6%.

PUBLIC HEATH ACTIONS

The declaration of the cholera outbreak was made on 9
August 2021 with immediate activation of national, regional
and districts cholera incident management committees.
Regular meetings of regional One Health Committees in the
affected regions were conducted throughout the outbreak
period.

The country committed to the cholera elimination approach
through the development and implementation of the cholera
elimination plan in Niger.

Case management in cholera treatment centers has been
done throughout the outbreak period as well as infection
and prevention control activities at community and health
facilities levels.

Cholera surveillance activities (community and health
facilities-based) as well as information sharing and
transborder meetings with neighboring countries are still
ongoing

The first round of cholera vaccination campaign has been
conducted and additional cholera vaccines request has been
submitted to the International Coordination Group.

SITUATION INTERPRETATION

The rapid spread of the cholera outbreak was mainly driven by
the floods that occurred during the rainy season. The case fatality
ratio for this outbreak was above the acceptable level of less
than 1.0%. The fact that the city of Niamey recorded the highest
case fatality ratio is concerning since it is supposed to be most
equipped for case detection and management compared to other
semi-urban or rural regions. The usual trend of high fatality seen
at the beginning of a cholera outbreak was observed for this
outbreak, which calls for improving preparedness measures for
future outbreaks.

PROPOSED ACTIONS

It is highly recommended to conduct an Intra-Action review
to assess the overall response implemented for this outbreak
in order to identify any weakness to be improved for future
outbreaks

Awareness-raising activities for the population about the
disease as well as strengthened surveillance remain essential
and should continue in the areas most affected and at risk.

Trans-border collaboration with neighboring countries on
cholera should also be maintained.

The fact that Niger has embarked on cholera elimination
approach is very appreciated and the necessary efforts
should be deployed to achieve this.
...

https://apps.who.int/iris/bitstream/handle/10665/351606/OEW06-310106022022.pdf?sequence=1&isAllowed=y

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Speedy vaccination campaign helps stop cholera outbreak in Niger

29 April 2022

Niamey – "What I experienced with this disease is terrible. I saw death at close range."

Amadou Elh Mamoudou counts himself fortunate. The 35-year-old survived a cholera outbreak in his village of Maradi, in south-central Niger, one of the areas most affected by the outbreak between March and December 2021.

Once recovered, Amadou joined health workers in his district to convince people there to get vaccinated, ultimately helping his district to achieve a 98% vaccination coverage.

Vaccination contributed to the fight against the cholera epidemic that affected seven regions of Niger, causing 5591 infections and 166 deaths, with a case-fatality rate of 3%. Vaccination coverage of 95%, combined with good patient management and hygiene and sanitation awareness, led to a significant decrease in the number of new cases, until the epidemic was declared over in the following weeks.

Two key interventions enabled health authorities, supported by the World Health Organization (WHO) and its partners, to rapidly deploy the vaccine in the four most affected regions (Dosso, Maradi, Tahoua, and Zinder) and administer it to nearly 1.9 million people.

The first intervention was to deploy the vaccine as close to the population as possible, instead of holding vaccination sessions at fixed locations.

"The adoption of the door-to-door strategy avoided massive gatherings, which would have increased close contact between patients and populations at risk of contracting the disease," explains Dr Blanche Anya, WHO Resident Representative in Niger. "This strategy also improved the delivery of vaccination to communities in hard-to-reach locations.”

Another intervention was the rapid deployment of the vaccine to three refugee camps in the Maradi region, thanks to a partnership between the government, WHO, and the International Red Cross Federation.

These interventions were preceded by major awareness-raising efforts to overcome people’s hesitancy towards the vaccine. Here, the participation of former patients like Amadou and other locals was pivotal.

"We deployed local town criers and used local radio stations to spread messages. Mosques and other places of worship were also engaged. In each team, we had a mobilizing agent who helped encourage target populations to get vaccinated," explains Djibo Moukaïla Djibo, mayor of Gaya, the capital of a health district in the Dosso region.

Although the epidemic was declared over last December, three of the four regions targeted for vaccination are still scheduled for a second round in May, as per WHO recommendations. The cholera vaccination campaign plays a preventive role, by strengthening the population's immunity ahead of the next rainy season, which is conducive to the spread of cholera.

"Even if the epidemic is over, we remind people that the risk of new epidemics exists. Receiving two doses of the vaccine protects against cholera for at least three years,” says Dr Mahaman Maman Sani, Regional Director of Public Health for the Dosso region.

A combination of prevention and treatment measures for cholera, such as access to clean water and adequate sanitation, hand washing, safe food preparation, vaccine administration and prompt treatment with oral rehydration, “has a huge advantage: the prospect of being protected against cholera for several years,” says Dr Sani.

https://www.afro.who.int/countries/niger/news/speedy-vaccination-campaign-helps-stop-cholera-outbreak-niger

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Source: https://reliefweb.int/report/niger/n...september-2022


Niger - Cholera outbreak (DG ECHO, Niger Ministry of Health) (ECHO Daily Flash of 07 September 2022)

Format News and Press Release
Source ECHO
Posted 7 Sep 2022
Originally published 7 Sep 2022

On 6 September, the Ministry of Health has confirmed cholera cases in two District in Maradi and Zinder region. From 29 August to 5 September, a total of 20 cases were registered, 5 people are still in hospital and no deaths have been reported so far...

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WEEKLY BULLETIN ON OUTBREAKS
AND OTHER EMERGENCIES

Week 36: 29 August - 4 September 2022
Data as reported by: 17:00; 4 September 2022
...

All events currently being monitored by WHO AFRO

Niger Cholera Ungraded

Date notified to WCO 3-Sep-22
Start of reporting period 1-Sep-22
End of reporting period 4-Sep-22

Total cases 14
Cases Confirmed 7
Deaths 0
CFR 0,00%

The Direction Régionale de la Santé Publique (DRSP) of Maradi, Niger, notified 10 suspected cases of cholera, including three positive cases by rapid diagnostic test on 1 September 2022 in Madaroufa district, Maradi region. Further testing identified Vibrio cholerea O1 Ogawa. As of 4 September 2022, 14 suspected cases have been reported, of whom seven tested positive for cholera, five recovered, and no deaths were recorded. Of the 14 reported cases, nine are female and nine are within the 5-14 year age range.

https://apps.who.int/iris/bitstream/handle/10665/362389/OEW36-290804092022.pdf