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Mali - Cholera outbreak 2021

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  • Mali - Cholera outbreak 2021


    Week 39: 20 - 26 September 2021
    Data as reported by: 17:00; 26 September 2021

    Cholera Mali

    10 Cases
    4 Death
    40% CFR


    The cholera outbreak which was declared by the Malian health
    authorities on 11 September 2021 continues. The epicenter of the
    outbreak is currently in the health area of Labbezanga, Ansongo
    health district in the Gao region. As of 19 September 2021, 10
    suspected cases with two confirmed and four deaths (case fatality
    ratio (CFR) = 40%), have been reported. This current CFR is high
    compared to the expected ratio of <1%.

    Preliminary investigations have shown that the index case was a
    Nigerien male from Ayorou town in the Tillabery region in Niger
    where a cholera outbreak is ongoing with nearly 5 000 cases and
    151 deaths reported so far. Ayorou also borders the Malian region
    of Gao. He stayed with a family in Labbezanga for two days. After
    his departure, a 17-year-old girl from the host family died on 5
    September 2021, from diarrhoea and vomiting which is consistent
    with a clinical picture suggesting cholera.

    The onset date of this event was 8 September 2021, when the
    Chief Medical Officer of Ansongo health District was alerted by
    Labbezanga Community Health Center of two suspected cases of
    cholera received at a health facility in Labbezanga city. These two
    suspected cases revealed that they were from the same home as
    the 17-year-old girl who died on 5 September 2021. They suffered
    an acute illness with onset on 7 September 2021. They then
    sought medical care at Labbezanga Community Health Center on 8
    September 2021 presenting with diarrhoea and vomiting and died
    the same evening.

    On 11 September 2021, cholera was confirmed with the isolation
    of Vibrio cholerae Ogawa 01 at National Institute of Public Health
    laboratory, the same serotype causing the ongoing cholera outbreak
    in Niger and Nigeria. Among the 10 reported cases, seven cases are
    female (70%) and three cases are male (30%), the male-female sex
    ratio is 2.3. The 25 and over age group is the most affected with
    6 cases (60%). Regarding deaths, females are more affected with
    three deaths (75%) against one death for males (25%). The age
    groups affected by deaths are those of 25 years and over (2 deaths),
    15-24 years (1 death) and 6-14 years (1 death).

    The investigation team deployed in the affected area identified
    several challenges, including the need for drugs and medical
    supplies for the case management, inadequate sampling kits, and
    poor community surveillance.


    Emergency meeting of the Gao regional and Ansongo health
    district incident management committees was held

    The Ministry of health deployed an investigation team to the
    affected areas

    The National Institute of Public Health laboratory is currently
    collecting stool samples for confirmation of cholera

    Response teams are strengthening surveillance activities at
    points of entries and health facilities.

    A cholera treatment unit was set up at Labbezanga health center
    and assigned a medical team for case management.

    Regional and local teams sensitized communities around
    Labbezanga city.


    Since 1990, Mali regularly faces cholera outbreaks occurring in the
    dry season or in the rainy season. However, during the rainy season
    which runs from June to October, an increase in cases is seen. The
    spread of these outbreaks to a large part of the country is often along
    the Niger and Senegal rivers. Insufficient access to drinking water
    as well as poor hygiene conditions especially in rural areas, have
    been identified as the main risk factors of cholera outbreaks in Mali.
    The current outbreak is the result of cross-border transmission from
    Niger where another large-scale outbreak is underway. Although still
    localized, the risk of this outbreak spreading throughout the country
    is high because the implementation of the effective control measures
    may be impeded given the volatile security situation in the affected


    It is urgent that the main gaps identified by the investigation
    team be quickly addressed, by increasing the supply of
    medicines and medical supplies for the case management, as
    well as strengthening of surveillance, especially at the points of
    entries to prevent national and regional spreads of the outbreak.
    Cross-border collaboration between Mali, Burkina-Faso, and
    Niger, particularly in the border regions and districts, should
    be reinforced.

    At the same time, in areas at risk but not yet affected,
    preparedness and response plans must be developed and
    implemented. Sustainable programs for access to drinking
    water, sanitation and hygiene must be considered as a priority
    in all areas regularly affected especially in rural areas.
    "Safety and security don't just happen, they are the result of collective consensus and public investment. We owe our children, the most vulnerable citizens in our society, a life free of violence and fear."
    -Nelson Mandela