Outbreaks and Emergencies Bulletin, Week 24: 07 - 13 June 2021
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Nigeria Cholera
6 738 Cases
221 Deaths
3.3% CFR
EVENT DESCRIPTION
Since the start of 2021 there have been frequent short cholera
outbreaks recorded in 16 states in Nigeria. Cholera was laboratory
confirmed by culture in 11 of these states and by rapid diagnostic
test (RDT) in three states, and the outbreak was controlled before
confirmation in a further three states (Adamawa, Cross River and
Kebbi). As of 1 June 2021, active cholera outbreaks have been
reported in five states: Bauchi, Gombe, Kano, Plateau and
Zamfara.
As of 31 May 2021, a total of 6 738 suspected cases of cholera,
with 221 deaths (case fatality ratio 3.3%) have been reported from
16 states. Kano (1 855) and Zamfara (1 859) states have the
highest number of reported cases in northern Nigeria. Bayelsa
and Delta states had the highest number of cases in the southern
regions, but these outbreaks have since been controlled.
In Kano State, as of 1 June 2021, a total of 1 855 cases including
78 deaths (CFR 4.0%) had been reported by 28 local government
areas (LGAs) since the start of 2021. Out of 90 samples tested, 35
were positive for cholera by RDT and ten were positive for Vibrio
cholerae 01 by culture. There was a sharp increase in the number
of weekly reported cases in week 11 (week ending 13 March
2021) with more than 400 cases reported, some cases reported in
week 14 and cases reported consistently in weeks 16-20. The
most affected age group has been 5-10 years. Since 8 April 2021
there was only one day with no reported cases.
In Zamfara State, as of 7 June 2021, a total of 1 859 cases including
11 deaths (CFR 0.6%) have been reported from five LGAs. The
majority (1 758; 95.0%) of the cases were from Gusau (state
capital) LGA.
In Bauchi State, as of 30 May 2021, a total of 709 cases with 28
deaths (CRF 4.0%) have been reported from 10 local governmental
areas (LGAs) since 1 April 2021. The majority of cases (487;
69.0%) were reported from Bauchi LGA, which includes the state
capital city. A total of 19 out of 21 samples tested have been
confirmed for cholera by culture. The peak in the number of
weekly reported cases was observed in week 21 when 376 cases
were reported, including 21 deaths. An oral cholera vaccine (OCV)
campaign was carried out in one LGA in Bauchi State in 2018.
In Plateau State, the outbreak was first reported on the 11 May
2021. As of 6 June 2021, a total of 464 cases and 7 deaths (CFR
1.5%) from seven LGAs. Jos north and Jos (metropolitan) LGAs
account for 440 (95%) of the reported cases. A total of 53
samples had been confirmed by RDT and four by culture.
Active case search for suspected cholera cases is ongoing in
affected local government areas.
PUBLIC HEALTH ACTIONS
Outbreak response has been supported by agencies and
partners, including WHO, RUWASSA, Médicines Sans
Frontièrs, UNICEF, BASEPA, BSWB, and SEMA.
Several states have drafted a cholera mitigation plan.
Water sanitation and hygiene activities include well chlorination and
decontamination of affected households, as well as
referral of detected cases to cholera treatment centres, in
Bauchi State.
Risk communication and community engagement activities are
ongoing, along with active case search and hygiene promotion
in affected areas.
National authorities are being supported in increasing capacity
for early case detection and investigation.
SITUATION INTERPRETATION
Cholera is endemic in Nigeria, and some states, mainly in the
north of the country, report cases around twice a year.
However,
the number of cases reported so far in 2021 has already exceeded
the total number of cases reported in the whole of 2019 (3 513)
and 2020 (1 803). Oral cholera vaccine (OVC) campaigns carried
out in the north east of the country in 2019 and 2020 possibly
contributed to relatively low numbers in these two years. Cases
have been reported from both densely populated urban areas as
well as rural areas and it appears that
inadequate water sanitation
and hygiene conditions remain the main risk factors for surging
cases. Late care seeking also contributes to spread of the disease
through communities. While most states have been able to
contain outbreaks, challenges have been identified around poor
coordination between state and national response, inadequate
health facilities, poor capacity for sample collection and transportation
and problems with diagnosis in affected states. Additionally,
there has been inadequate and delayed reporting of cases from
affected LGAs.
Response to the COVID-19 pandemic has added
an additional burden to the health system and its ability to
respond to other outbreaks. Local and national authorities and
partners need urgently to address these challenges to prevent
spread of the disease both within already affected LGAs and
beyond.
https://apps.who.int/iris/bitstream/handle/10665/341808/OEW24-0713062021.pdf
