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Malawi: 2022 - 2023 Cholera outbreak

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  • #31
    WEEKLY BULLETIN ON OUTBREAKS
    AND OTHER EMERGENCIES

    Week 42: 10 - 16 October 2022
    Data as reported by: 17:00; 16 October 2022

    ...
    ...
    All events currently being monitored by WHO AFRO
    ...

    Malawi Cholera Ungraded

    Date notified to WCO 3-Mar-22
    Start of reporting period 3-Mar-22
    End of reporting period 14-Oct-22

    Total cases 4 604
    Cases Confirmed 4 107
    Deaths 132
    CFR 2.9%


    A total of 25 districts have reported Cholera cases since the confirmation of the first case in March 2022 in Machinga district. As of 14 October 2022, the cumulative confirmed cases and deaths reported since the onset of the outbreak is 4 604 and 132 respectively, with Case Fatality Rate at 2.9%.

    "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

    Comment


    • #32
      Source: https://www.laprensalatina.com/chole...ves-in-malawi/

      Cholera outbreak has claimed 183 lives in Malawi
      Online News EditorNovember 1, 2022

      Lilongwe, Nov 1 (EFE).- A cholera outbreak has claimed 183 lives in Malawi since March this year.

      Health Minister Khumbize Kandodo Chiponda said the landlocked African nation has accumulated more than 6,000 cases of the debilitating disease that spreads mainly through contaminated food and water.

      Deaths reported since the onset of the outbreak is 183, with a case fatality rate of 3 percent, the minister said in a statement late on Monday.

      Twenty-seven of 28 districts have reported the disease outbreak since the confirmation of the first case in March in Machinga.

      Chiponda claimed the outbreak is under control in four districts.

      “A total of 5,721 people have recovered and 147 are currently in the treatments centers,” Chiponda said..

      Comment


      • #33
        WEEKLY BULLETIN ON OUTBREAKS
        AND OTHER EMERGENCIES


        Week 44: 24 to 30 October 2022
        Data as reported by: 17:00; 30 October 2022

        ...
        All events currently being monitored by WHO AFRO
        ...

        Malawi Cholera Ungraded

        Date notified to WCO 3-Mar-22
        Start of reporting period 3-Mar-22
        End of reporting period 28-Oct-22

        Total cases 5 724
        Cases Confirmed 5 724
        Deaths 177
        CFR 3.1%


        A total of 25 districts have reported Cholera cases since the confirmation of the first case in March 2022 in Machinga district. As of 28 October 2022, the cumulative
        confirmed cases and deaths reported since the onset of the outbreak is 5 724 and 177 respectively, with Case Fatality Rate at 3.0%.

        "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

        Comment


        • #34
          Source: https://www.who.int/emergencies/dise...em/2022-DON419

          Cholera - Malawi

          7 November 2022

          Situation at a glance
          Cholera is endemic in Malawi with seasonal outbreaks reported during the wet season. Since 1998, cholera cases have been reported in the country with significant morbidity and mortality in affected populations, especially in the southern region, which is low-lying, flat, and prone to flooding during the rainy season.
          The current outbreak, which started in March 2022 has affected 27 of 29 districts of Malawi and represents the largest outbreak reported in the country in the past ten years. The outbreak is taking place in the context of tropical storm Ana (January 2022) and Cyclone Gombe (March 2022) which caused floods leading to the displacement of a population with low pre-existing immunity that now lacks access to safe water, sanitation, and hygiene.
          Description of the cases
          On 3 March 2022, the Ministry of Public Health of Malawi notified WHO of a cholera outbreak after laboratory confirmation of a cholera case in Machinga district hospital on 2 March 2022.
          Between 3 March through 31 October 2022, a cumulative total of 6056 cases including 183 deaths have been reported from 27 of 29 districts in Malawi (overall case fatality rate (CFR) 3.0%) with active transmission ongoing in 23 districts as of 31 October. Five districts account for 79% of the reported cases and 68% of the deaths: Nkhata Bay (1128 cases and 31 deaths), Nkhotakota (811 cases and 40 deaths), Rumphi (783 cases and 13 deaths), Karonga (683 cases and 14 deaths), and Blantyre (650 with 26 deaths).
          The outbreak originated in the Southern region of Malawi with cases reported in Nsanje and Machinga districts. Currently, the most affected districts in Malawi are in the Northern part of the country. The most affected age groups are 21-30 years, and males are disproportionately affected.
          Figure 1. Number of suspected and confirmed cholera cases (n=6056) and deaths (n=183) in Malawi by month, 1 January to 31 October 2022.

          Source: Malawi Ministry of Health and Population

          Figure 2. Geographical distribution of confirmed and suspected cholera cases (n=6056) in Malawi, 1 January to 31 October 2022

          Source: Malawi Ministry of Health and Population

          Figure 3. Distribution of confirmed and suspected cholera cases (n=6056) by age group and gender in Malawi, 1 January to 31 October 2022

          Source: Malawi Ministry of Health and Population

          Epidemiology of Cholera
          Cholera is an acute enteric infection caused by ingesting the bacteria Vibrio cholerae present in contaminated water or food. It is mainly linked to inadequate sanitation and insufficient access to safe drinking water. It is an extremely virulent disease that can cause severe acute watery diarrhoea resulting in high morbidity and mortality, and can spread rapidly, depending on the frequency of exposure, the exposed population and the setting. Cholera affects both children and adults and can be fatal within hours if untreated.
          The incubation period is between12 hours and five days after ingestion of contaminated food or water. Most people infected with V. cholerae do not develop any symptoms, although the bacteria are present in their faeces for 1-10 days after infection and are shed back into the environment, potentially infecting other people. The majority of people who develop symptoms have mild or moderate symptoms, while a minority develop acute watery diarrhoea and vomiting with severe dehydration. Cholera is an easily treatable disease. Most people can be treated successfully through prompt administration of oral rehydration solution (ORS).
          The consequences of a humanitarian crisis – such as disruption of water and sanitation systems, or the displacement of populations towards inadequate and overcrowded camps – can increase the risk of cholera transmission, should the bacteria be present or introduced.
          A multi-sectoral approach including a combination of surveillance, water, sanitation and hygiene (WaSH), social mobilization, treatment, and oral cholera vaccines is essential to control cholera outbreaks and to reduce deaths.

          Public health response

          Emergency response activities are being conducted by the Ministry of Health, WHO and other partners since the declaration of the outbreak in March 2022.
          Coordination and response:
          • A costed national cholera response plan has been drafted to manage the outbreak. WHO and other partners are supporting the implementation of various activities aligned with the plan.
          • National and district-level emergency operation centres (EOCs) have been operationalized to coordinate the response in collaboration with other health sectors and partners.
          Surveillance:
          • National rapid response teams (RRT) have been deployed to the affected districts.
          • Surge staff have been deployed and additional staff have been hired to strengthen surveillance and case management in affected districts.
          • Active case search for suspected cholera cases is ongoing in communities in all affected districts.
          Health System Strengthening:
          • Cholera kits and other supplies including oral rehydration salt, IV Fluids, antibiotics, rapid diagnostic test kits, personal protective equipment, tents, and cholera beds have been provided by WHO in affected districts.
          • Supplies for case management and laboratory confirmation of cholera are being distributed to health facilities and the district laboratories although additional supplies are needed.
          • Case management has been strengthened through the establishment of treatment structures and the provision of equipment.
          • Treatment structures have been established in affected districts and private facilities have been engaged to facilitate prompt referrals.
          • Cross-border meetings are held with health officials in Mozambique and Zambia.
          Reactive Vaccination Campaigns:
          • As a part of the outbreak response, reactive vaccination campaigns of Oral Cholera Vaccination (OCV) were implemented in eight districts (Balaka, Blantyre, Chikwawa, Nsanje, Mangochi, Mulanje, Machinga, Phalombe) between 23 to 27 May 2022, targeting individuals aged one year and older. Cumulative coverage of 69% was achieved but in Blantyre district the coverage was 42%.
          • In Neno district, two campaigns were implemented in August 2022 with 84% and 72% coverage achieved in each round respectively.
          • The country applied to the International Coordinating Group (ICG) on Vaccine Provision for OCV vaccines and has been awarded 2.9 million doses for use in areas with ongoing outbreaks. Preparations towards a reactive campaign have been initiated.


          WHO risk assessment

          Cholera is endemic in Malawi with seasonal outbreaks occurring during the wet season. The first major outbreak occurred in 1998 and was widespread in the southern region, with 25 000 cases reported. The country reported its largest outbreak occurring from October 2001 to April 2002, which affected 26 of the 29 districts, with 33 546 cases and 968 deaths (CFR 3%). A more recent outbreak occurred in 2019 – 2020 with a total of 26 cases and one death.
          Since the beginning of 2022, 27 districts have reported cholera cases. The outbreak was largely confined to the south of the country, including the areas affected by the cyclones until after July 2022, when the outbreak spread to the North of the country resulting in a surge in cases. This upsurge in the number of cases is being reported during the country’s dry season when normally there is low or no transmission of cholera in Malawi. The upcoming rainy season in November poses the threat of further disease spread nationwide.
          There is a continued risk for further increases in the number of cases and international spread. Confirmed cases had been reported across the border in Mozambique during the initial period of the current outbreak. In late September, a cholera outbreak was declared in Lago district in Mozambique which borders Malawi (through Lake Malawi). Currently, the most affected districts in Malawi are in the Northern part of the country some of which are on the border with Tanzania and Zambia. There is significant cross-border movement in the region with bordering countries and beyond. Given the history of cross-border spread of cholera during this outbreak, WHO considers the risk of further spread of the disease very high at national and regional level.


          WHO advice

          WHO recommends improving access to proper and timely case management of cholera cases, improving access to safe drinking water and sanitation infrastructure, as well as improving infection, prevention, and control in healthcare facilities. These measures along with the promotion of preventive hygiene practices and food safety in affected communities are the most effective means of controlling cholera. Targeted public health communication messages are a key element for a successful campaign.
          OCV should be used in conjunction with improvements in water and sanitation to control cholera outbreaks and for prevention in targeted areas known to be at high risk for cholera.
          WHO recommends Member States to strengthen and maintain surveillance for cholera, especially at the community level, for the early detection of suspected cases and to provide adequate treatment and prevent its spread. Early and adequate treatment limits the CFR of hospitalized patients to less than 1%.
          WHO does not recommend any travel or trade restrictions on Malawi based on the currently available information. However, as the outbreak is taking place in border areas where there is a significant cross-border movement, WHO encourages Malawi and its neighbouring countries to ensure cooperation and regular information sharing so that any spread across the border is quickly contained.

          Further information

          Citable reference: World Health Organization (7 November 2022). Disease Outbreak News; Cholera – Malawi. Available at: https://www.who.int/emergencies/dise...em/2022-DON419



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          • #35
            Translation Google

            Malawi: "safety first" for tourists in the face of cholera

            By Writing Africanews with AFP
            Last update: 14/11 - 15:53

            Malawi has recorded 7,499 cases of cholera since March, including 214 deaths, in what the United Nations says is the biggest outbreak to hit the country in 10 years.

            Cholera has killed 214 people in Malawi, but infections from one of the worst outbreaks in a decade have started to decline after peaking last month, the health ministry said on Wednesday.

            In the region of Salima, one of the districts most affected by the epidemic, no less than 764 cases have been recorded in just one month.

            " We started to have cholera cases on October 8, 2022. Until yesterday, November 12, we registered 764 cases and among them, we lost 22 ," said Angela Sakwata, responsible for the promotion of the Salima district health.

            " For the people who manage the lodges and hotels, they have been asked to inform their guests that we have an epidemic of cholera in Salima and that they must follow the preventive measures so that they do not contract the disease, because most people visit Salima because of the lake " adds Angela Sakwata,

            Cholera is contracted from a bacterium that is usually spread through contaminated water or food. It causes diarrhea and vomiting, and can be particularly dangerous for young children.

            Compliance with basic hygiene rules is currently the most effective method of prevention.

            ...
            Le Malawi a enregistré 7 499 cas de choléra depuis le mois de mars, dont 214 décès, dans ce qui, selon les Nations unies, est la plus grande épidémie à frapper le pays depuis 10 ans.
            "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

            Comment


            • #36
              Translation Google

              Malawi: the cholera epidemic delays the start of the school year

              By Writing Africanews

              Last update: 5 hours ago

              Malawi on Monday postponed the opening of primary and secondary schools for at least two weeks due to an outbreak of cholera.

              The new term was due to start on January 3, but rising cholera infections and deaths forced the government to cancel reopening plans.
              ...
              The current outbreak, which began in March 2022, has affected 27 of Malawi's 29 districts.

              In its latest update released on December 22, the government said cholera had killed 410 people since February.

              In November, Malawi received 2.9 million doses of cholera vaccine from the United Nations .

              The second phase of vaccination has not yet started although some clinics are administering the remaining doses from a previous campaign dating from May.

              Le Malawi a reporté lundi l'ouverture des écoles primaires et secondaires pour au moins deux semaines en raison d'une épidémie de choléra.
              "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

              Comment


              • #37
                Source: https://www.bnnbloomberg.ca/worst-ch...lawi-1.1865706


                20h ago
                Worst Cholera Outbreak in Two Decades Kills 625 People in Malawi
                Janice Kew and Frank Jomo, Bloomberg News

                (Bloomberg) -- Malawi’s worst cholera outbreak in two decades has left 643 people dead after the disease spread to all districts of the southeastern African country.

                The landlocked nation, prone to tropical storms and cyclones, has been battling a resurgence of the water-borne diarrheal disease since March. The rainy season, which began in November, worsened the situation. Floods have led to the displacement of people, who often lack access to safe water and sanitation.

                With the case fatality rate climbing to 3.4%, government has delayed the opening of schools for the year in both the political capital Lilongwe and in Blantyre, the nation’s center of finance and commerce. An outbreak that started in April 2001 killed 968 people in the country, according to the World Health Organization...


                Comment


                • #38
                  Ministry Of Health - Malawi. 102,680 likes · 278 talking about this. welcome to the Ministry of Health Malawi face book page. we have established this page to interact more with the public on matters...


                  CHOLERA UPDATE AS OF 12TH JANUARY, 2023





                  Last edited by Pathfinder; January 18, 2023, 12:06 PM. Reason: Image
                  "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

                  Comment


                  • #39
                    Malawi: Cholera prevention guidelines for schools

                    By Rédaction Africanews with Agencies
                    Last updated: 7 hours ago
                    ...
                    The Ministry of Education announced the resumption of classes in some areas on Tuesday and has set up a task force through the relevant ministries to monitor the spread of the virus.
                    ...
                    Statistics from the Public Health Institute of Malawi show that as of Thursday, the disease had killed 773 people, including 104 children, and resulted in 23,217 cholera cases since the outbreak started in March last year.

                    The Malawi ministry of health says the fatality rate of the outbreak is now at 3.33%, much higher than the recommended 1% global threshold.

                    The Ministry of Education announced the resumption of classes in some areas on Tuesday and has set up a task force through the relevant ministries to monitor the spread of the virus.


                    -------------------------------------------





                    Ministry Of Health - Malawi. 102,680 likes · 278 talking about this. welcome to the Ministry of Health Malawi face book page. we have established this page to interact more with the public on matters...
                    "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

                    Comment


                    • #40
                      UN aid agencies ramp up cholera fight in Malawi after 800 deaths

                      January 19 2023

                      Lenin Ndebele

                      Schools in Lilongwe and Blantyre, Malawi's two biggest cities, reopened this week following a brief closure because of the country's biggest cholera outbreak in 20 years.

                      The World Health Organisation (WHO), which was working with the Malawian government and other partners to curb the outbreak, said schools would be equipped with sanitation equipment.

                      ... Rebecca Adda-Dontoh, the new United Nations coordinator in Malawi, started work at the beginning of January. The cholera outbreak, which was declared in March last year, resulted in more than 23 000 cases and nearly 800 deaths.

                      In December, ahead of her arrival, 7 000 cases were recorded in a month, which forced the authorities to declare a health emergency.

                      Adda-Dontoh's office said in a statement:

                      Unicef and [the] World Health Organisation (WHO) are working with authorities to train healthcare workers on cholera case management.

                      "They also provided nearly 60 urgently needed staff, nearly 440 000 oral rehydration solution doses, and over 1.3 million water purification tablets."

                      The UN groups have also helped Malawi with its nationwide oral cholera vaccination programme, which administered over three million doses to at-risk groups.

                      Additional life-saving equipment, including tents, acute watery diarrhoea kits and medications, totalling about US$300 000 (R5.2 million), have been handed over to Unicef for distribution to cholera treatment facilities.

                      Schools in Lilongwe and Blantyre, Malawi's two biggest cities, reopened this week following a brief closure because of the country's biggest cholera outbreak in 20 years.



                      Comment


                      • #41
                        Source: https://www.aljazeera.com/news/2023/...tbreak-spreads

                        Malawi cholera death toll passes 1,000 as outbreak spreadsCases have risen to 30,621, the highest on record, as Malawi suffers its worst cholera outbreak in 20 years.
                        Malawi Cholera
                        25 Jan 2023

                        Malawi’s worst cholera outbreak on record has left more than 1,000 people dead even as cases have reached 30,621, health minister Khumbize Chiponda has said.

                        The death toll announced on Tuesday breached a grim milestone and surpassed the largest recorded outbreak, which killed 968 people between 2001 and 2002, according to the World Health Organization (WHO)...

                        Comment


                        • #42
                          Source: https://malawi24.com/2023/02/06/resi...-over-cholera/

                          Residents in Lilongwe attack health centre over cholera
                          Feb 06, 2023 Malawi24 Reporter Health

                          Community members from Mgona in Lilongwe have attacked Area 25 Health Centre following the death of a cholera patient.

                          The angry residents blocked traffic with stones, tree branches and burning tyres near the health facility and they also pelted stones at the facility.

                          According to hospital officials, a man was taken to the hospital by relatives but he died at the Out-Patients Department after severe diarrhea and vomiting which was diagnosed as cholera.

                          The hospital expected that relatives of the man would collect the dead body this morning but health workers were surprised to see an angry mob.

                          The angry residents accuse health workers at the facility of being behind the death of the man. They also claim that there is no cholera in the country and that the disease is being used as a scapegoat to kill people...

                          Comment


                          • #43
                            Cholera - Malawi

                            9 February 2023

                            Situation at a glance

                            Malawi is experiencing a widespread cholera outbreak, with 36 943 cases and 1210 associated deaths reported from all 29 districts since 3 March 2022. This is the deadliest outbreak of cholera in the country’s history.

                            Cholera has been endemic in Malawi since 1998 with seasonal outbreaks reported during the rainy season (November through May). However, the current outbreak has extended through the dry season, with cases being reported since March 2022.


                            In light of the ongoing rainy season, wide geographical spread, and a consistently high case fatality rate (CFR) of above 3%, the ongoing cholera outbreak was declared a public health emergency by the Malawi government on 5 December 2022. Currently, the large geographic spread and the high number of reported cases in the country are stretching all capacity to respond to the outbreak, increasing the risk of serious public health impact. The outbreak in Malawi is occurring against a backdrop of a surge in cholera outbreaks globally, which has constrained the availability of vaccines, tests, and treatments.


                            With a sharp increase of cases seen over the last month, fears are that the outbreak will continue to worsen without strong interventions.

                            Description of the cases

                            On 3 March 2022, the Ministry of Public Health of Malawi notified WHO of a cholera outbreak after laboratory confirmation of a cholera case in Machinga district hospital on 2 March 2022.

                            Between 3 March 2022 through 3 February 2023, a total of 36 943 cases, including 1210 deaths, have been reported from all 29 districts in Malawi (overall case fatality rate (CFR) 3.3%) with active transmission ongoing in 27 of 29 districts. There was a 143% increase in the number of cases in January (17 078) compared to December (7017 cases). As of 3 February, Mangochi district bordering Lake Malawi is the most affected area, reporting 6974 cases and 114 deaths (CFR 1.6%).

                            The current outbreak started in March 2022 from Machinga district following tropical storm Ana (January 2022) and Cyclone Gombe (March 2022) which caused floods leading to the displacement of a population with low pre-existing immunity and had lack of access to safe water, sanitation, and hygiene. The outbreak was mainly limited to the flood-affected areas in the southern region until August 2022 when it spread to the northern and central parts of the country. Since December 2022 cases have spread back towards the south of the country with all regions affected including Blantyre and Lilongwe, the two main cities of the country.

                            Since the beginning of the outbreak, and as of 3 February 2023, the age group 21 to 30 years is the most affected (27.7% of cases) followed by the 11 to 20 age group (22.8%). Of all the cases,17 943 are males representing 57% of the caseload. Most deaths have been reported among those aged 60 years and above as of 29 January 2023. Most deaths have occurred among males (66%).

                            From 1998 to date, cholera cases have been reported in the country, especially in the southern region, which is low-lying, flat, and prone to flooding during the rainy season. The highest numbers of cases and deaths were reported in 1998/99 (25 000 cases, 860 deaths, CFR 3.4%), 2001/02 (33 546 cases, 968 deaths, case fatality rate 2.3%), and 2008/09 (5751 cases, 125 deaths, CFR 2.2%).


                            Figure 1: Number of suspected and confirmed cholera cases (n=36 943) and deaths (n=1210) per day in Malawi, 3 March 2022 to 3 February 2023.



                            Source: Malawi Ministry of Health and Population


                            Figure 2: Geographical distribution of confirmed and suspected cholera cases (n=36 943) and deaths (n=1210) by District in Malawi, 3 March 2022 to 3 February 2023.



                            Source: Malawi Ministry of Health and Population

                            Figure 3. Age-sex distribution of confirmed and suspected cholera cases (n=36 943) in Malawi, 3 March 2022 to 3 February 2023.



                            Source: Malawi Ministry of Health and Population

                            Epidemiology of Cholera

                            Cholera is an acute enteric infection caused by ingesting the bacteria Vibrio cholerae present in contaminated water or food. It is mainly linked to inadequate sanitation and insufficient access to safe drinking water. It is an extremely virulent disease that can cause severe acute watery diarrhoea resulting in high morbidity and mortality, and can spread rapidly, depending on the frequency of exposure, the exposed population and the setting. Cholera affects both children and adults and in its’ severe form can be fatal within hours if untreated.


                            The incubation period is between 12 hours and five days after ingestion of contaminated food or water. Most people infected with V. cholerae do not develop any symptoms, although the bacteria are present in their faeces for 1-10 days after infection and are shed back into the environment, potentially infecting other people. Most people who develop symptoms have mild or moderate symptoms, while a minority develop severe forms of the disease with acute watery diarrhoea and vomiting leading to severe dehydration. Cholera is an easily treatable disease. Most people can be treated successfully through prompt administration of oral rehydration solution (ORS) and successful rehydration therapy can keep the CFR below 1%.

                            The consequences of a humanitarian crisis – such as disruption of water and sanitation systems, or the displacement of populations towards inadequate and overcrowded camps – can increase the risk of cholera transmission, should the bacteria be present or introduced.


                            A multi-sectoral approach including a combination of surveillance, water, sanitation and hygiene (WASH), social mobilization, treatment, and oral cholera vaccines is essential to control cholera outbreaks and to reduce deaths.

                            Public health response


                            Emergency response activities are being conducted by the Ministry of Health, WHO and other partners since the declaration of the outbreak in March 2022.

                            Coordination and response:
                            • The ongoing cholera outbreak has been declared a public health emergency by government of Malawi on 05 December 2022. This led to the incorporation of cholera into its Presidential Taskforce on Coronavirus Disease, to be responsible for coordination of the outbreak response. The Presidential Task Force members on COVID-19 and cholera have been visiting all affected district to understand the situation.
                            • A costed national cholera response plan to manage the outbreak was drafted and is being updated regularly. WHO and other partners are supporting the implementation of various activities aligned with the plan. National- and district-level emergency operation centres (EOCs) have been operationalized to coordinate the multisectoral response with other partners.
                            • Multisectoral coordination group for cholera response has been established in the affected districts.
                            • The National Incident Management Team (IMT) continues to coordinate technical response to the outbreak. The IMT meets twice a week at the Public Health Emergency Operations Centre (PHEOC) in Lilongwe. The WHO IMT team is meeting three times a week for updates in between the National IMT to coordinate how to provide support efficiently across all response pillars.
                            • All technical thematic areas led by the Ministry of Health with support from WHO and partners continue to routinely provide technical support and coordinate field-level implementation.
                            • Cross-border preparedness is ongoing, with meetings held by health officials from MOH, WHO and Partners in Mozambique and Zambia through inter-district committees.

                            Surveillance:
                            • National rapid response teams (RRT) have been deployed to all the affected districts.
                            • Health Surveillance Assistants have been trained on active case investigation and surveillance.
                            • Detection of cases at community and health facilities levels continue. Rapid response team established in each districts continue to investigate cases.
                            • Data collection and analysis is ongoing, and situation reports are being produced and published regularly. Deep-dive epidemiological analysis of the cholera situation is ongoing.
                            • Data collection tools have been harmonized, printed and distributed to all districts. More tools are being printed to meet the rising demand of reporting with the high volume of cases.
                            • The Ministry of Health with support from WHO and partners have strengthened community-based surveillance for early detection of cases through the utilization of community health volunteers. Lilongwe district which is one of the most affected districts has initiated integrated community interventions to interrupt transmission and reduce cholera-related deaths. The same interventions have been implemented in six high-burden districts and then rolled out across all the districts.
                            • Joint Ministry of Health and WHO field operational visits are ongoing in districts with high case load and deaths.
                            • The recruitment and deployment of surveillance officers and data analysts in high-burden districts to improve reporting and data quality is ongoing.
                            • Currently a team of local and international surge staff is in country to support strengthening of information management, surveillance and data management. The team continues to produce information products in form of daily and weekly situation reports, maps detailing case and mortality burden, location of cholera treatment centers (CTCs)/ cholera treatment units (CTUs), profiling of deaths by age group, location and treatment facilities they are occurring to guide targeted interventions.

                            Health System Strengthening/Case Management:
                            • Case management was initially conducted through very large numbers (345) of cholera treatment units (CTUs) across all affected districts. As the extent and geography of cases has become clearer, this has been rationalised, with fewer centres. This presents an opportunity to strengthen the quality of care while respecting the decentralised approach. In some areas of high need, new structures have been set up or expanded (for example Bwaila and Area 25 in Lilongwe).
                            • Review and assessment of CTUs has been conducted across four regions in the last week (Salima, Blantyre, Lilongwe, Balaka), and more than 20 sites, with immediate needs identified and logistical input sought. This included the establishment of improved water and electricity supplies, improved waste management, and provision of beds and medical equipment for dealing with critical illness.
                            • Staff training has included, in collaboration with partners and Ministry of Health, 13 doctors, 46 trainer-of-trainers, and approximately 200 nursing staff ready to deploy to areas of need.
                            • Core standardised materials for patient care have been created and agreed with the MoH to enable the recording of treatment and response (including fluids and observation charts).
                            • To establish patient-level data to inform on care quality and to enhance our understanding of cholera presentations, a paper and electronic data capture form has been agreed with MoH, and begun to be deployed to CTCs.
                            • A network of supportive supervision from the tertiary hospitals has been created, with provision for outreach from specialist centres into patient treatment areas in order to enhance quality of care delivered, and support CTU staff.
                            • Partner and centre mapping continues, with the identification of formal and informal referral pathways. This includes those from high-burden areas, and specific demographics (e.g. under 2-year-olds), and has informed the strengthening of CTC staff numbers.
                            • WHO and partners supporting the establishment of oral rehydration points (ORPs) in high burden communities, inclusive of area 25, area 18, Likuni and Bwaila communities. Currently, 47 (ORPs) have been established in 10 high burden districts to serve as primary care points for cases in the communities. Church leaders, chieves, village headmen and community health workers and volunteers were orientated on the operation of ORPs and emphasis on their community engagement. The provision of ORPs needs to be scaled rapidly to provide early intervention and avoid admission with severe dehydration.
                            • Supportive supervision visits are being conducted on infection prevention and control and water, sanitation, and hygiene in CTCs in three districts. Main areas mentored on include patient segregations according to severity of disease during care in the CTC, handling of inserted devises, waste management, linen management, management of chlorine, use of personal protective equipment (PPE), management of guardians, and environmental cleaning.
                            • The teams also visited three communities in the three districts to assess WASH, including sanitary inspections of water sources, sanitation facilities, safe water accessibility, household water chlorination and conducted health education in communities.

                            Capacity Building/IPC:
                            • Training of trainees has been conducted on cases management in Nkhotakota, Rumphi, Likoma, Chitipa, Nkhatabay, Mzimba North, Mzimba South and Karonga.
                            • Ongoing community field visits to assess WASH, including sanitary inspections of water sources, sanitation facilities, safe water accessibility, household water chlorination and conducted health education in communities.
                            • On-site IPC training and mentorship has been conducted amongst health care workers in CTCs/CTUs across all the districts in Northern Districts.

                            Human Resource:
                            • Ministry of Health has advertised on recruitment of surge staff to support cholera response in the districts Blantyre, Karonga, Lilongwe, Mangochi, Nkhatabay, Nkothakota, Rumphi, and Salima.
                            • WHO is supporting the recruitment of 40 medical doctors (21 already reported for duty as of 03 February 2023), 80 clinical technicians and 160 nurses to support in the CTCs/CTUs across the country.

                            Laboratory:
                            • WHO is supporting the Ministry of Health in increasing laboratory testing capacity and diagnostics to continue to monitor incidence in all affected areas with a focus on early detection and confirmation of new cases in unaffected areas, as well as genomic sequencing of Vibrio cholerae.
                            • The WHO is supporting capacity building, provision of reagents, and standard operating procedures.
                            • Collection of samples for sequencing is ongoing. Meanwhile, periodic testing of cases is being done with 5-10 samples being collected systematically every week from CTCs/CTUs.

                            Logistics and Supplies:
                            • Cholera kits and other supplies including oral rehydration salt, IV Fluids, antibiotics, rapid diagnostic test kits, personal protective equipment, tents, and cholera beds have been provided by WHO and partners in affected districts.
                            • Treatment structures and ORS points have been established in the affected districts. Currently, 345 CTC and CTUs were established with 140 being active, and 47 ORPs set up in 10 districts serving over 180 000 population at high risk.
                            • WHO has provided cholera kits and other supplies which are being distributed to the affected districts, supporting 48 000 cholera cases since the beginning of the outbreak. Additional supplies are being mobilized.
                            • As of 03 February 2023, 35 cholera kits (drug module) composed of 17 600 litres of ringers are in shipment to arrive in country.
                            • 1271 ringers lactate (500 ml) and 5300 bags of ORS have been dispatched by WHO to District Hospitals with a high burden of disease including Lilongwe.

                            Reactive Vaccination Campaigns:

                            Two oral cholera vaccine (OCV) vaccination campaigns have been conducted across 21 districts since the onset of the outbreak.
                            • Following a request for OCV to the International Coordinating Group on Vaccine Provision (ICG) and approval in May 2022, a total of 1 947 696 doses were received as the first batch. Reactive vaccination campaign for one round of OCV was implemented in eight districts including Balaka, Blantyre, Chikwawa, Machinga, Mangochi, Mulanje, Nsanje and Phalombe between 23 through 27 May 2022. The cumulative vaccination coverage achieved was 69%.
                            • A second request for OCV was submitted to the ICG in October 2022, and 2 941 982 doses were approved for a single dose campaign. The campaign was implemented from 28 November through 2 December 2022 in 13 districts: Chitipa, Kasungu, Nsanje, Rhumphi, Salima, Karonga, Zomba, Mzimba North and South, Nkhatabay, Nkhotakota, Lilongwe, Likoma. The cumulative coverage achieved was 83.6%.
                            • Ongoing provision of OCV continued beyond the campaign period with additional campaigns in Mangochi and Blantyre (beyond the 13 targeted district). In total, 96.8% (2 825 229 doses) of the population residing in communities with high risk and burden of cholera were reached with OCV.

                            Risk Communication and Community Engagement:
                            • Community and national radios are being used for spreading awareness in the affected communities and spreading message for cholera prevention. Four community radios (Nkhotakota, Nkhatabay, Mzimba and Rumphi) produced jingles, airing radio programs and live panel discussion with support from UNICEF.
                            • WHO has supported the creation of Information, education and communication materials (WASH cholera brochure, cholera poster, leaflet for health workers, posters on waste management, OCV campaign posters).
                            • Local leaders and health-based leaders have been engaged by health promotion officers with support from Red Cross.
                            • Districts authorities have been communicated to write letters to churches, chiefs and local community structures to strengthen cholera prevention measures in the community and during gatherings.
                            • Knowledge, Attitude and Perception survey has been conducted in Blantyre, Salima Nkhatabay to understand the drivers of the cholera outbreak and guide targeted interventions in the affected communities.

                            WASH Interventions:
                            • Provision of mobile latrines in the cholera treatment camps and installation of prefabricated latrines in five camps.
                            • Households in the affected districts are being sensitized on WASH promotion including water treatment and hand hygiene.
                            • House-to-house chlorination is ongoing in affected communities in all the districts.
                            • Water quality monitoring tests have been donated by UNICEF and have been distributed across the districts to strengthen water quality surveillance.
                            • Water quality surveillance have been conducted in Balaka, Blantyre, Chikwawa, Karonga, Machinga, Mangochi, Mwanza, Neno, Nsanje, Mwanza, Salima, Nkhotakota, and Nkhatabay.
                            • Supply of High-Test Hypochlorite by The Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) to Nkhotakota, Nkhatabay, Rumphi, Karonga and Mzimba
                            • A total of 9579 chlorine dispensers have been installed in four districts including Zomba, Blantyre, Balaka and Mangochi.
                            • Continued distribution of 1% stock solution is being done to community members in all districts by Health Surveillance Assistants.


                            WHO risk assessment


                            Cholera is endemic in Malawi with seasonal outbreaks occurring during the wet season. The first major outbreak occurred in 1998 and was widespread in the Southern Region, with 25 000 cases reported. Prior to the current outbreak, the largest outbreak in Malawi occured from October 2001 to April 2002, and affected 26 of the 29 districts, with 33 546 cases and 968 deaths (CFR 3%).

                            Following floods in the southern region in January 2022, the Ministry of Health confirmed a cholera outbreak on 3 March 2022. This outbreak, which was initially limited to the Southern Region and the flood-affected areas, has now spread to all the regions and districts in the country. Transmission has continued during the dry season (June to October), which is traditionally a low transmission period for Malawi. With the onset of the rainy season from November through May, the number and spread of cholera cases is expected to increase further. Therefore, the risk is considered to be very high at the national level. The poor WASH capacities in the affected districts, especially in the fishing communities along Lake Malawi, pose risk for the continuous propagation of the cholera outbreak nationally, to neighbouring countries and in the region.

                            Two reactive single-dose OCV campaigns have been carried out in parts of 21 affected districts, however unvaccinated sub-districts and districts still remain at risk. Other identified challenges from the most at-risk districts include inadequate capacity for case management and diagnosis in the affected areas resulting in delayed case detection and poor outcomes. This is further exacerbated due to delayed care-seeking behaviour of the community.

                            There is a continued risk for further increase in the number of cases and international spread. Confirmed cases have been reported across the border in Mozambique and the risk for cross-border transmission between Malawi and Mozambique remains high during the current outbreak.

                            The country has experience in controlling cholera outbreaks. However, due to concurrent outbreaks (polio, COVID-19), the large geographic spread of the outbreak (with cases reported in all districts) and the high case numbers, the current burden is overstraining existing national response capacity and resources as well as the capacity of partners’ support. In addition, there are multiple ongoing large cholera outbreaks worldwide. This is stretching limited global stocks of cholera supplies and OCV, which limits available resources for Malawi and the region.

                            WHO assesses the risk of this outbreak to be very high at national and regional level. On 21 January 2023, WHO assessed the risk of the global cholera outbreak as very high due to ongoing multiple cholera outbreaks in many WHO regions.

                            WHO advice


                            There is an urgent need to improve access to safe water sanitation and hygiene. WHO recommends improving access to safe drinking water and sanitation infrastructure, improving access to proper and timely case management of cholera cases as well as improving infection, prevention, and control in healthcare facilities. Promotion of preventive hygiene practices and food safety in affected communities are the most effective means of controlling cholera. Targeted public health communication messages are a key element for a successful response. OCV should be used in conjunction with improvements in water and sanitation to control cholera outbreaks and for prevention in targeted areas known to be at high risk for cholera.

                            One of the factors contributing to the high CFR in Mangochi, Blantyre, Machinga, Lilongwe was late presentation to a health facility. Delay in health-seeking behaviour, and limited community sensitization can lead to treatment delays and increased deaths, as well as an underestimation of the scale of the outbreak (cases and related deaths). WHO recommends Member States to strengthen and maintain surveillance for cholera, especially at the community level, for the early detection of suspected cases and to provide adequate treatment and prevent its spread. Early and adequate treatment limits the CFR of hospitalized patients to less than 1%. Inter-district and cross-border coordination and collaboration, risk communication, and community engagement are crucial in the prevention and containment of this cholera outbreak.


                            WHO does not recommend any travel or trade restrictions on Malawi based on the currently available information. However, as the outbreak is taking place in border areas where there is a significant cross-border movement, WHO encourages Malawi and its neighbouring countries to ensure cooperation and regular information sharing so that any spread across the border is quickly contained.


                            ...
                            "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

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                            • #44
                              Vaccines help battle cholera outbreak in Malawi

                              22 February 2023

                              Lilongwe, Malawi – In late 2022 staff at Tukombo health centre, a stone’s throw away from the shores of Lake Malawi, were stretched to the limit. The small facility in northern Malawi had been repurposed to serve as a cholera treatment centre to care for hundreds of patients as cases surged amid the country’s worst outbreak.

                              At the peak of the infection wave, Tukombo area (in Nkhata Bay District) accounted for 60% of the 1500 cases recorded then in the whole of Malawi’s Northern Region. “We had to work double shifts. It was a stressful situation,” recalls Dyson Tchuwa, a health surveillance assistant at the health centre.

                              Now operations at Tukombo have almost returned to normal after several hectic weeks, thanks in part to a vaccination campaign in November 2022 that helped stem the tide of infections.

                              Since the onset of the cholera outbreak in Malawi in March 2022, World Health Organization has supported the country to access 4.9 million doses of oral cholera vaccines from the International Coordinating Group—the body that manages emergency supplies of vaccines— with funding from Gavi, the Vaccine Alliance. To date, vaccines have been deployed in 21 out of Malawi’s 29 districts. In May and June 2022, 1.95 million doses were administered during a campaign in nine of the most affected districts, in the country’s Southern region. A second batch of 2.9 million doses arrived in October and WHO together with UNICEF supported a vaccination campaign in 14 more districts. In Nkhata Bay District, the number of news cases decreased from 381 in October 2022 to only 43 in December 2022.

                              For both campaigns, only one dose was administered instead of two, due to the global shortage in oral cholera vaccines.

                              “I know the dark side of cholera”

                              “I almost lost my life,” says Jones Chinula, a fisherman in Tukombo, as he shows his vaccination certificate. “I spent five days in hospital fighting for my life. I know the dark side of cholera, and this is why I am happy that the vaccine has been made available in my area.”

                              Since March 2022, Malawi has reported over 44 500 cases and nearly 1440 deaths. The first cholera cases were reported in the country’s south following floods. A total of 10 districts were affected as of July 2022. The disease then quickly spread to the north of the country and by the end of October 2022 all 29 districts were affected. The government declared the outbreak as a national public health emergency on 5 December 2022.

                              Cholera is an acute intestinal infection caused when someone consumes food or water contaminated with the bacterium Vibrio cholerae. Untreated, cholera can kill within hours. People living in places with poor sanitation and unsafe drinking water are most at risk.

                              “The trend of cholera changed significantly in the Southern region after the oral cholera vaccination campaign, and this helped the government to focus on other aspects of rebuilding the health system post-floods,” says Dr Charles Mwansambo, Secretary for Health in the Ministry of Health. In Nsanje, one of the most affected districts in the Southern region, cholera cases dropped from an average of 10 cases a day to less than three cases a day between May and December 2022. Despite the rainy season, which saw an upsurge of cases in a number of districts, Nsanje is still reporting low case numbers.

                              Cholera vaccination is crucial in outbreak control but should be complemented by measures to address the triggers of the disease. In Malawi, cases continue to increase in many districts, including some where cholera cases are usually not reported as the rainy season continues.

                              Multi-sectoral interventions

                              “Oral cholera vaccination should be used in conjunction with improvements in water and sanitation to control cholera outbreaks and for prevention in targeted areas known to be at high risk for cholera,” says Dr Neema Kimambo, WHO Representative in Malawi. “We will continue to engage with partners and donors to ensure that if a need for additional oral cholera doses arise, we are well prepared and support the Ministry of Health accordingly.”

                              A surge in cholera outbreaks globally has strained the supply of cholera vaccines, prompting the International Coordinating Group to temporarily suspend the standard two-dose vaccination regimen in cholera outbreak response campaigns, using instead a single-dose approach.

                              “Vaccine is an additional tool for the response, and in the absence of it, we are working with the Ministry of Health and partners to employ multi-sectoral interventions to effectively control cholera,” says Dr Kimambo.

                              In Tukombo, where health surveillance assistant Tchuwa and his colleagues expended huge efforts to vaccinate the population, the fight is not over. “Apart from the vaccination, we have intensified chlorine distribution in households for water purification and we are engaging fishing villages on water, hygiene and sanitation to ensure that we contain the cholera outbreak,” he says.

                              In late 2022 staff at Tukombo health centre, a stone’s throw away from the shores of Lake Malawi, were stretched to the limit. The small facility in northern Malawi had been repurposed to serve as a cholera treatment centre to care for hundreds of patients as cases surged amid the country’s worst outbreak.
                              "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

                              Comment


                              • #45
                                Source: https://www.afro.who.int/countries/m...olera-outbreak


                                WHO Africa CountriesMalawiNews

                                Malawi contains cholera outbreak
                                16 August 2023

                                Lilongwe- Today, the Malawi Ministry of Health has officially declared that Cholera is no longer a national public health emergency in the country. The Minister of Health, Honourable Khumbize Kandodo-Chiponda, MP accompanied by Minister of Water and Sanitation Honourable Abida Mia, MP made the announcement at a press briefing held in Lilogwe. This follows the milestone that the country has attained in containing the cholera outbreak in 26 out of 29 districts. Currently, the country is recording sporadic cases in selected areas of Chikwawa, Mangochi and Zomba especially in Cyclonne Freddy affected areas with less than five patients a day. The Health Minister also informed the public that COVID-19 is no longer a public health emergency of international concern, citing that COVID-19 cases have remained equally low. The data and trends evidence continued and significant decline in new cases and deaths over the past three months achieving a decline in threat level from 3 to 1. She detailed the decision is guided by National Public Health Emergency grading and the World Health Organization (WHO)classification systems for public Health threats.

                                Kandodo Chiponda stated that Malawi’s Cholera success story is owed to government efforts, development partners and communities themselves in the fight against the outbreak. The two ministers have called for increased and collaborative water sanitation and hygiene interventions as a preventive measure to Cholera in the three remaining districts and country at large to maintain the status quo. The Minister of Health highlighted that Malawi secured 1.4 million doses of Oral Cholera Vaccine this year; she stressed that cholera vaccines are not a preventative measure but a complimentary approach to fighting the disease.

                                WHO Technical Officer, Ishmael Nyasulu congratulated the government and people of Malawi for the hard-fought milestone in containing the biggest Cholera outbreak in history. Nyasulu underscored on the need for intensive water sanitation and behaviour change interventions to maintain the situation and improve on emergency preparedness for the future. He reaffirmed WHO’s commitment to continue working on residual risk of Cholera and sporadic cases until completely contained. He said as the country is moving from the response phase to recovery and preparedness phases, WHO will continue to work hand-in-glove to improve the government’s preparedness and operational readiness to protect the lives of its citizens and prevent public health emergencies of this scale from happening in the future.

                                “In the surge of the outbreak, we have seen great unity and strengthened efforts in working together. Our initiatives are now aimed at strengthening these efforts towards making the country more resilient and develop mitigation capacities to avoid having future cholera outbreaks and any other public health emergencies” Nyasulu said.

                                The country has been battling Cholera outbreak since February 2022. The Outbreak was declared a national public health emergency in December 2022. Following which, President Lazarus Chakwera launched the Tithetse Cholera campaign in February 2023 to garner collective support towards the outbreak. As of August 2023, a total of 58,982 cholera cases including 1,768 deaths have been reported. On the COVID-19 front, no cases of deaths have been reported in the country’s hospitals in the past 4 months, however the country has cumulatively reported 88,835 cases and 2,686 deaths.


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