Mozambique - Cholera outbreak 2023-2024

[Shiloh]

Source: https://allafrica.com/stories/202302170128.html

Mozambique: Two Cholera Deaths in Manica
17 February 2023

Chimoio (Mozambique), 16 Feb (AIM) - Two people have died of cholera, and a further 30, suffering from diarrheal diseases, are hospitalized in Tambara district, in the central Mozambican province of Manica.

The two deaths occurred on Tuesday, in the Tambara district hospital. They were among the three people diagnosed on Monday as having contracted the disease. The Tambara district administrator, Mario Doa, confirmed the deaths in a brief phone contact with AIM on Wednesday...

 

[Shiloh]

Source: https://www.who.int/emergencies/disease-outbreak-news/item/2023-DON443

Cholera - Mozambique

24 February 2023


Situation at a glance
In Mozambique, an outbreak of cholera has been growing exponentially since December 2022 with geographic spread to new districts. Heavy rainfall in the first weeks of February threatens to further worsen the situation.
The first case of cholera in the current outbreak was reported to the Ministry of Health and WHO from Lago district in Niassa province on 14 September 2022. As of 19 February 2023, a cumulative total of 5237 suspected cases and 37 deaths (Case Fatality Ratio (CFR) 0.7%) have been reported in 29 districts from six out of 11 provinces in the country. Of the at least 182 cases tested, 99 cases (54%) were laboratory confirmed for cholera by culture.
All six provinces currently affected by cholera are flood-prone areas. As the rainy season continues, it is anticipated that more districts will be affected. With this outbreak, cholera has affected many districts that had not reported any cases in over five years and where, as a result, the response capacity is limited.
In addition, there is inadequate access to sources of safe drinking water for the population that is already challenged with poor hygiene and sanitation.
Mozambique is one of many countries in the region facing a cholera outbreak at the moment. Notably, neighbouring Malawi is facing the deadliest cholera outbreak in its history. Considering the frequency of cross-border movement and the history of cross-border spread of cholera during this outbreak, WHO considers the risk of further disease spread as very high at the national and regional levels.
Description of the outbreak
The first case of cholera in the current outbreak was reported to the Ministry of Health and WHO from Lago district in Niassa province on 14 September 2022.
As of 19 February 2023, a cumulative total of 5237 suspected cases and 37 deaths (CFR 0.7%) have been reported in 29 districts from six of 11 provinces in the country. Of at least 182 cases tested, 99 cases (54%) were laboratory confirmed for cholera due to the identification of Vibrio cholerae Ogawa by culture. As of 19 February, eight districts (Chimbonila, Lago, Lichinga, Mandimba, Mecanhelas, Muembe, Ngauma and Sanga) of Niassa province (north of the country) reported 2525 cases and 16 deaths (CFR 0.6 %). In the central region of the country, nine districts (Beira, Buzi, Caia, Cheringoma, Chibabava, Gorongoza, Maringue, Marromeu, Muanza) of Sofala province reported 1354 cases and three deaths (CFR 0.2 %). Nine districts (Angonia, Cahora Bassa, Chiuta, Doa, Marara, Moatize, Mutarara, Tete, Tsangano) from Tete province, reported 1271 cases with 12 deaths (CFR 0.9%) since December 2022. Zambezia province (Milange district) bordering Malawi reported 14 cases. In the southern region of the country, one district (Xai-Xai) in Gaza province, reported 42 cases and four deaths (CFR 9.5%). In addition, one district (Tambara) in Manica province, reported 34 cases and two deaths (CFR 5.9%).
Additionally, four districts from three provinces (Tete – two, Zambezia – one, and Cabo-Delgado – one) have reported cases of Acute Watery Diarrhoea (AWD) that were positive for cholera by Rapid Diagnostic Test (RDT) with culture results pending. Notably, in the last 30 days the districts reporting cholera and AWD are increasing, with three new provinces reporting confirmed cholera.
Prior to the current outbreak, there were cholera outbreaks in eight districts in three provinces during the first half of 2022, which were declared over. The current outbreak of cholera in Mozambique covers a wider geographic area and has a higher CFR compared with the previous outbreak. Moreover, most of the affected districts, especially in Niassa province, had not reported cholera cases for more than five years and many of the health professionals do not have experience in responding to a cholera outbreak. Weak surveillance with late reporting, inadequate WASH conditions (lack of access to safe drinking water, poor sanitation and hygiene practices), a weak health system and exhausted workforce responding to multiple emergencies pose a threat to continued disease progression, as do the ongoing heavy rains of the season.

Figure 1.Cholera cases reported by week and province in Mozambique from 14 September 2022 to 19 February 2023[SUP]*[/SUP] [SUP]*[/SUP] The 14 cases from Zambezia district are not indicated figure 1​

Figure 2. The cumulative number of cholera cases per 100 000 population in Mozambique by reporting districts as of 19 February 2023


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 insufficient access to safe drinking water and inadequate sanitation. 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 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. 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 or disasters like flooding– 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 multisectoral 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

Since the outbreak was declared in September 2022, a national cholera task force was activated and WHO, along with other partners, is supporting the response. Specific actions undertaken include:
Coordination:

• The national cholera task force was activated with the involvement of the different working groups and cooperation partners, and weekly meetings are held.
• Health Cluster meetings on the cholera outbreak to discuss partner support are ongoing. Health and WASH clusters are maintaining a 4W (Who, What, Where and When) matrix to map partners interventions, gaps, needs and response for each affected district.
• Multisectoral coordination meetings are held weekly at district level and daily at provincial level. Cross-border coordination mechanisms are in place. Three cross-border meetings with Malawi have so far been conducted.

Epidemiological surveillance and laboratory:

• Case detection continues at the community and health facility level. The National Rapid Response Teams (RRT) was established in each district continue to investigate the cases. Data collection is being done daily and a daily bulletin is being produced.
• Rapid test kits were allocated to priority districts. Testing of suspected cases is being carried out with support from the National Institute of Health.

Case management:

• RRT are available and deployed in affected states.
• Training in case management was conducted for all 16 districts in Niassa province.
• WHO has provided six tents, cholera kits (central, periphery, community), Intravenous (IV) cannulas, cholera RDT kits and other consumables.
• Cholera treatment centers and cholera treatment units were set up in affected districts.

Infection Prevention and Control (IPC)/Water, Hygiene and Sanitation (WASH):

• Additional surge staff deployment to strengthen surveillance, Infection Prevention and Control (IPC), case management and logistics is underway.
• Advocacy was conducted with the other partners supporting WASH functions. UNICEF and MSF have allocated water purifiers (CERTEZA), chlorine and bleach.
• Support visits on IPC and WASH in cholera treatment centres have been conducted.

Risk communication and community engagement:

• Messages on cholera prevention and control have been translated into local languages and distributed door-to-door and in market places.
• Risk communication and community mobilization sessions are taking place in the communities.

Vaccination:

• A request for approximately 700 000 doses of Oral Cholera Vaccine (OCV) was approved by the International Coordinating Group (ICG) on Vaccine Provision and a vaccination campaign in affected districts in Gaza, Niassa, Sofala and Zambezia provinces is in preparation and will start on 27 February 2023.

WHO risk assessment

Cholera is endemic in Mozambique and cholera outbreaks have been reported in the country every year during the hot and rainy season (October to April), mainly from Nampula, Cabo Delgado, Sofala and Tete provinces. However, the current outbreak has greater geographical extent than outbreaks reported in 2019-2022, when no more than three provinces were affected during the year.
The first cholera case of the current outbreak was reported from Lago district on 14 September 2022, Niassa province, located in the northern region of the country, which shares a border with Malawi and Tanzania.
All six provinces currently affected by cholera are located in the Zambezia Valley, which is a flood-prone area. As the rainy season continues, it is anticipated that more districts will be affected. The rainy season lasts until March-April, usually with a peak of rainfall recorded in January and early February. Heavy rainfall has already been reported in seven out of eleven provinces in the first weeks of February (31 January to 9 February), with flooding in Maputo province leading to displacement and disruption of the water supply system. There is inadequate access to safe drinking water sources for the population that is already challenged with poor hygiene and sanitation and the current rainy season could contribute to sustained disease transmission.
Several affected provinces, such as Niassa, Tete and Zambezia, are bordering Malawi, which is currently facing its deadliest cholera outbreak in history. The borders with Malawi are porous with frequent movement across the border between the two countries.
On 26 January 2023, Zambia notified WHO of a cholera outbreak in its Eastern Province bordering Malawi and Mozambique, where one of the two index cases had just returned from Mozambique. There remains a high risk of spread to other countries in the region, including Tanzania and Zimbabwe and further to South Africa. Considering the history of cross-border spread of cholera during this outbreak, the risk of further disease spread is therefore considered very high at the national and regional levels.

WHO advice

A multi-pronged approach is essential to combat cholera and reduce mortality. The measures used combine surveillance, improvement of water supply, sanitation and hygiene, risk communication and community engagement, treatment of the disease and use of oral cholera vaccines. Countries affected by cholera are advised to strengthen disease surveillance and national preparedness to rapidly detect and respond to possible outbreaks.
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.
Promotion of preventive hygiene practices and food safety in affected communities are the most effective means of controlling cholera. Targeted public health risk communication messages are a key element for a successful response. Promoting hand hygiene, use of toilets and food safety are effective means of preventing cholera. Serious symptoms and deaths can be prevented by ensuring communities understand the importance of ensuring people with cholera symptoms are well hydrated using oral rehydration solution and rapidly seeking care. Socio-behavioural data should be collected to understand community knowledge, risk perception, levels of trust, rumours and misinformation, behaviours, attitudes and practices; this data should be used to drive risk communication and community engagement activities and to inform those of other response pillars. Feedback systems should be established to enable those affected by the outbreak and response efforts to have two way communication with responders, with regular responses to their feedback to maintain trust.
Measures aimed at improving environmental conditions include applying long-term sustainable solutions for safe water supply, sanitation and hygiene in cholera-prone areas. Communities should be proactively engaged in the planning and implementation of these solutions. In addition to cholera, these interventions can also prevent a wide range of other water-borne diseases and contribute to achieving goals in education and the fight against poverty and malnutrition. Solutions for safe water supply, sanitation and hygiene related to cholera are in line with the Sustainable Development Goals.
Rapid access to treatment is essential during a cholera outbreak. Oral rehydration solution should be available in communities and not just in larger health centers that can offer intravenous infusions and management at any time. Where these are not easily available, communities should be informed of how to make the solution at home and of the importance of keeping hydration high while seeking care for people with cholera. With rapid and appropriate care, the case fatality rate should remain below 1%.
The 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. Risk communication and community engagement activities should be conducted to manage vaccine demand and raise awareness of vaccination campaigns. If a single dose schedule is being used, communication is needed to inform communities of why the dose schedule has changed and to share information on safety and efficacy.
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.
As this outbreak is occurring in border areas where there is significant cross-border movement, WHO encourages the countries concerned to ensure cooperation and regular information sharing.
WHO does not recommend any restrictions on travel and trade to and from Mozambique.

 

[Shiloh]

Source: https://www.saltwire.com/cape-breto...lera-cases-malawi-sees-decline-who-100834373/

Mozambique records rise in cholera cases, Malawi sees decline - WHO
Reuters | Posted: 9 hours ago | Updated: 9 hours ago | 1 min Read

(Reuters) - Mozambique recorded an increase in the number of cholera cases in the last few weeks, the World Health Organization said on Wednesday, even as many other African countries reported a decline...

 

[Shiloh]

Source: https://www.zawya.com/en/world/afri...-worst-cholera-outbreak-in-years-who-hufex2u4

Mozambique battling worst cholera outbreak in years: WHO
Staff Writer, Agence France-Presse (AFP)
April 1, 2023

Mozambique is going through its worst cholera outbreak in more than a decade in the wake of Cyclone Freddy, the World Health Organization said Friday.

"While cholera outbreaks regularly occur in Mozambique between October to April, with almost 21,000 cases and 95 deaths, this is the largest outbreak in more than a decade," said Severin von Xylander, the WHO's representative in the southeast African country.

"The outbreak is still expanding geographically," he told reporters in Geneva in a briefing via video link from Maputo. Eight of the country's 11 provinces have been affected.

Quelimane is the worst-affected city and in the last 24 hours, 132 people have been admitted to cholera treatment centres and 350 people have received cholera care visits.

"After the landfall of Freddy, the number of cases exploded from less than 20 a day and increased tenfold" in the city, Von Xylander said.

A first cholera vaccination campaign started in late February in four provinces. More than 715,000 people were given a single shot...

 

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Translation Google

Mozambique: Cholera outbreak spreads to ninth province

APA News By APANEWS 07 April 2023 - 20:15

The cholera epidemic in Mozambique has spread to a ninth province. Health authorities in the Nampula region announced on Thursday that the disease had affected more than 150 people in the region.

Nampula joins eight other Mozambican provinces to report cholera outbreaks since the end of 2022 after Gaza, Inhambane, Manica, Maputo, Niassa, Sofala, Tete and Zambezia.

At least 24,075 cases had been reported in the other eight provinces as of April 4.

Celma Xavier, chief medical officer for Nampula province, said the majority of cases have been recorded in the Nacala Porto area, where at least one person has died from the disease and an average of 15 cholera cases are reported. each day.

“We are undertaking community case-finding and follow-up activities to ensure cases do not spread,” Ms Xavier told reporters late Thursday.

She said the cases came mainly from the neighborhoods of Matapue, Ontupaia and Mucone.

The official said Nacala Porto district has seen a spike in diarrhea cases in the past two weeks, which led health authorities to send samples to the National Public Health Laboratory, where the cholera vibrio was confirmed. April 1 .

Some 32 patients are currently hospitalized at a treatment center set up at the Nacala Port District Hospital.

The outbreak comes in the wake of the devastation caused by Tropical Cyclone Freddy, which contaminated water and destroyed other infrastructure in eight of Mozambique's ten provinces in February.

JN/lb/APA

https://fr.apanews.net/now/mozambique-lepidemie-de-cholera-setend-a-une-neuvieme-province/

 

[Shiloh]

Source: https://www.bbc.com/news/world-africa-65707334

Mozambique cholera: Why outbreaks have sparked unrest
Published 16 hours ago

By Peter Mwai and Paul Brown
BBC News

False claims about the spread of a cholera outbreak in northern Mozambique have led to violent protests and deaths, according to health officials.

The World Health Organization (WHO) has highlighted instances in which misinformation about the disease has contributed to the unrest.

Through social media posts and local media reports, we've looked into some of these protests to understand what was behind the trouble...​

 

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WEEKLY BULLETIN ON OUTBREAKS
AND OTHER EMERGENCIES

Week 28: 10 - 16 July 2023
Data as reported by: 17:00; 16 July 2023
...

Mozambique

Cholera

33 344 Cases
141 Deaths
0.4 % CFR
3 Grade

EVENT DESCRIPTION

New cases in the ongoing cholera outbreak in
Mozambique, which started in September 2022, have
declined consecutively over several weeks. During
epidemiological week 28 (week ending 16 July 2023),
103 new cholera cases with zero deaths were reported
from four (4) provinces across the country. This is a slight
decline in new cases compared to the preceding week,
when 109 cases were reported. Most of the new cases
were reported from Nampula (n=54) and Cabo Delgado
(n=42) provinces. The other two provinces with cases
were Zambézia (n=4) and Sofala (n=3). No cholera
deaths have been reported for five consecutive weeks
in the country.

Cumulatively, 33 344 cases with 141 deaths (CFR 0.4%)
have been reported from 66 districts across all of the
country’s 11 provinces. Zambézia Province has been
the most affected, accounting for 40% (n=13 400) of
the cumulative cases, followed by Sofala (n=7 527),
Niassa (n=3 501), Tete (n=2 966), and Nampula (n=2
796) provinces which together constitute 91% of all
cases reported across the country since the onset of
the outbreak. Most (n=112, 79%) of the deaths have
occurred in four provinces, namely, Zambézi (n=38),
Sofala (n=30), Niassa (n=25), and Tete (n=19).

The current outbreak peaked in epidemiological week 12
(week ending 26 March 2023), with 6 288 cases reported
in the aftermath of Cyclone Freddy, which traversed
the southern Indian Ocean for more than five weeks
and made landfall in Mozambique’s northern province
of Zambézi on 11 March 2023, causing flooding,
destruction of structures and massive displacement
of the local population. A bimodal peak in deaths was
observed in epidemiological weeks 11 and 14, with 22
deaths reported respectively.

The outbreak epicentre has shifted and is now largely
concentrated in three districts (Nampula City, Meconta,
and Erati) in Nampula Province and two districts
(Macomia and Mueda) in Cabo Delgado. Mueda District
in Cabo Delgado Province is the latest to be affected by
the cholera outbreak in the country, with its first cases
(n=15) reported just in the last epidemiological week.
Nampula Province is the most densely populated in
Mozambique and together with Cabo Delgado, harbours
known hotspots for cholera in the country. Cabo Delgado
has been plagued with insecurity in recent years due
to insurgency from armed groups, which has further
challenged efforts to provide basic services, including
clean water sanitation and hygiene to the local population.
Many of the province’s local population have been forced
to flee their homes and live in internally displaced persons
(IDP) camps where living conditions are suboptimal and
water-borne disease outbreaks such as cholera can
quickly spread as the population remain highly vulnerable.

PUBLIC HEALTH ACTIONS

At the national level, a cholera task force was
activated under the leadership of the National Public
Health Directorate to coordinate the response to the
outbreak. There are ongoing weekly coordination
Cholera Task Force meetings in the four provinces
(Sofala, Nampula, Zambezia, and Cabo Delgado).

The Health Cluster meeting was held in Cabo
Delgado, where the cholera situation in the province
was discussed extensively, with greater emphasis
on Mueda district, which was the latest to declare
an outbreak. Advocacy for greater engagement of
partners was highlighted.

Regular coordination meetings between the partners
involved in the response at the national level and in
the provinces with active outbreaks (Sofala, Nampula,
Zambezia, and Cabo Delgado) are being held, as well
as the weekly provincial cholera outbreak response
coordination meeting in Sofala, Nampula and Cabo
Delgado.

Response activities are underway, including field
investigations, enhanced surveillance, laboratory
testing, case management, risk communication and
community engagement, and WASH activities to
control the spread of the disease.

The cross-border response between Mozambique and
Malawi is being strengthened to reduce transboundary
transmission of the disease as well as improve access
to care for patients in border communities through
the set-up of an ORP in Morrumbala district hospital (Zambezia)

Essential supplies for the management of cholera cases have
been pre-positioned in at-risk and affected districts.
These include peripheral and community cholera kits.

Public messages about cholera and the current situation are being disseminated through media and digital
platforms to raise awareness of cholera prevention measures and encourage early treatment seeking.

A total of 233 families have been reached with key messages on WASH through the Case Area Targeted Intervention
(CATI) approach in Nampula (90) and Sofala (143) provinces. Another 4 900 people have been reached with
cholera preventive messages disseminated through Mobile Multimedia Units in Cabo Delgado (3,700) and
Zambezia (1,200) provinces.

SITUATION INTERPRETATION

Mozambique’s cholera outbreak which began in 2022, was exacerbated by the devastation caused by Cyclone
Freddy. However, much efforts have been put into response activities, thus contributing to the downward trend being
experienced. Reports of outbreaks in new areas are worrisome and threaten to reverse the gains made. The government
of Mozambique and its partners will need to review current response efforts and probably readapt tailored-made
strategies to prevent a resurgence and bring the outbreak to an end.

https://apps.who.int/iris/bitstream/handle/10665/371502/OEW28-1016072023.pdf
​

 

[Shiloh]

Source: https://www.macaubusiness.com/mozam...17-cases-150-deaths-recorded-since-sept-2022/


Mozambique: Cholera escalating with 36,617 cases, 150 deaths recorded since Sept 2022
By LUSA
November 10, 2023

The cholera outbreak in Mozambique has worsened in recent weeks, with 2,200 new cases and six deaths, bringing the number of deaths since September 2022 to 150, according to official figures available to Lusa on Thursday.

According to the most recent bulletin on the progression of the disease, drawn up by the National Directorate of Public Health, the current cholera outbreak in Mozambique has seen an accumulation of 36,617 cases, from 14 September 2022 to 8 November 2023, which have caused 150 deaths.

In the previous 24 hours there were 75 new cases and 50 people hospitalised due to the disease.

The bulletin with data up to 5 September – after stabilising in August – reported 144 deaths and an accumulated 34,352 cases of the disease, with only one district with an active outbreak.

Mozambique now has 2,265 cases in about two months, and six more deaths, rising to seven districts with an active outbreak on 8 November, which marks the beginning of the country’s rainy season.

Since 14 September 2022, the province of Zambézia continues to be the worst affected, with a total of 13,972 cases of the disease and 38 deaths, followed by Sofala, with 7,527 cases and 30 deaths, Tete, with 3,775 cases and 24 deaths, and Niassa, with 3,501 cases and 25 deaths.

The Mozambican government announced on Tuesday that it was sending brigades to four provinces in the country affected by cholera to monitor the situation and look for solutions to stop the disease, a day after outbreaks were announced in some districts.

The brigades will be sent from Friday to Nampula and Cabo Delgado (in the north of the country) and Zambézia and Tete (in the centre), provinces that “show signs of the need for a sharper approach to the outbreak of vomiting and diarrhoea” associated with cholera, said Filimão Suaze, spokesperson for the Cabinet, during a press conference after the executive meeting in Maputo....


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WEEKLY BULLETIN ON OUTBREAKS
AND OTHER EMERGENCIES
Week 16: 15 - 21 April 2024
Data as reported by: 17:00; 21 April 2024
...
All events currently being monitored by WHO AFRO
...
Mozambique

Cholera

Grade 3
Date notified to WCO 14-Sep-2022
Start of reporting period 12-Oct-2023
End of reporting period 18-Apr-2024
Total cases 47 561
Cases Confirmed 47 561
Deaths 173
CFR -

The current cholera outbreak in the country started in Niassa province on 14 September 2022. As of 7 April 2024, 47 561 cholera cases have been recorded, with 173 deaths (CRF 0.4%) in 11 affected provinces. The outbreak is currently active in eight provinces.

https://www.afro.who.int/countries/...emergencies-bulletin-week-16-15-21-april-2024

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See also:

Mozambique: Wave of disinformation about the causes of cholera has led to murder

https://flutrackers.com/forum/forum/emerging-diseases-other-health-threats-alphabetical-a-thru-h/cholera-incl-haiti-cholera-disaster/984242-mozambique-wave-of-disinformation-about-the-causes-of-cholera-has-led-to-murder​