WEEKLY BULLETIN ON OUTBREAKS AND OTHER EMERGENCIES
Data as reported by: 17:00; 09 July 2023
Week 27: 03 - 09 July 2023
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Zimbabwe
Cholera
3 430 cases
78 Deaths
2.3 % CFR
Grade 3
EVENT DESCRIPTION
Zimbabwe is currently grappling with a concerning
surge in cholera cases and deaths after a dip in the
previous week. In epidemiological week 27, the week
ending 9 July 2023, 233 new cases with six (6) deaths
were reported across Zimbabwe. This represents a
35% increase in new cases compared to the previous
week, when 172 cases with one death were reported.
Most (n=156, 66.9%) of the new cases were reported
from Harare Province, which appears to be currently at
the epicentre of the outbreak. The other three provinces
with new cases were Manicaland (n=73), Mashonaland
South (n=3), and Mashonaland East (n=1). Deaths also
increased by 500% from one (1) in the previous week
to six (6) in week 27. All six deaths were reported from
Manicaland.
Cumulatively, 3 430 cases with 78 deaths (case fatality
ratio 2.3%) have been reported from all 10 provinces
across Zimbabwe since the onset of the outbreak on 12
February 2023. Of 2 667 cases with known age and sex
characteristics, males are slightly more affected than
females, constituting 50.5% (n=1 347) of the cases.
Children below five years and those aged 35 years and
above are the most affected, constituting 21.0% (n=558)
and 29.0% (n=768) respectively of cases with known age.
Most cases have been reported from Manicaland (1 397)
and Harare (1 375) provinces which together constitute
80.8% of all cases reported across the country. Deaths
in Manicaland Province are the highest in the country,
accounting for 55.1% (n=43) of the cumulative deaths
reported. Of 2 557 stool samples cultured for Vibrio
cholerae, 804 returned with growth of the bacteria.
The ongoing transmission of cholera appears to be
increasing in intensity and geographic spread, with new
epi-centres in hotspot areas of Harare Province driving
the current upsurge reported. With the outbreak now
seeded in traditional hotspot districts where perennial
issues of limited access to clean water sanitation and
hygiene (WASH) persist, the risk of increased incidence
in the coming weeks cannot be ruled out. The outbreak
remains driven by limited access to WASH services
in densely-populated urban, peri-urban and informal
settlements.
The recent spike in deaths, with all from Manicaland
Province, highlights a worrying development pointing to
sub-optimal capacities for early detection and treatment
of cases. The 78 deaths already reported in the current
outbreak put the
case fatality ratio (CFR) above the 1%
threshold set by the World Health Organization, which
indicates an unacceptably high CFR in the current
outbreak. The last major outbreak of cholera in Zimbabwe
occurred between September 2018 and March 2019 when
more than 10 678 cases with 69 deaths were reported.
PUBLIC HEALTH ACTIONS
The national response is being coordinated from
the Public Health Emergency Operations Centre
(PHEOC), through the Incident Management Team.
Provincial and district coordination mechanisms,
which are intersectoral in nature and referred to as
Civil Protection Committees are also in place to
coordinate field activities.
Routine surveillance activities for case detection are
ongoing in healthcare facilities across the country.
In healthcare facilities, health workers are being
sensitized on the case definitions for detecting the
reporting cases of cholera. Community workers and
leaders have also been engaged to report suspected
cases in the communities.
Rapid diagnostic tests (RDT) are routinely being
performed for persons suspected of cholera. As of
9 July 2023, at total of 1 479 RDTs were performed,
of which 215 were positive. Culture of stool samples
are also being performed for the pathogen, Vibrio
cholerae.
Essential supplies for the management of cholera
cases have been pre-positioned in high risk
districts. These include investigation kits, RDTs, Oral
rehydration salts (ORS), laboratory kits and peripheral
and community kits.
A total of 39 Cholera Treatment Centres (CTCs) have
been set up across the country. On 9 July 2023, there
were 31 patients in admission in eight (8) CTCs across
the country. Oral rehydration points (ORPs) have
also been set up in hotspot communities in Harare
Province for early management of cases.
Risk communication and community engagement activities are ongoing. Awareness campaigns through local
community radios broadcast, as well as religious and local community gatherings are being implemented to
sensitize the population.
UNICEF in collaboration with local authorities and influential leaders are providing safe water and sanitation
facilities in some areas.
SITUATION INTERPRETATION
Cholera is endemic in Zimbabwe, with the last major outbreak reported from 2018 to 2019.
The current outbreak
trends remain worrying, with the spread to new hotspot areas and deaths already having surpassed those reported
in the last major outbreak. Despite the concerted efforts of government and partners, the current response seems
to be dogged by sub-optimal coordination and limited resources to mount an effective response. The new spike
in cases and deaths underscores the urgency of robust concerted and coordinated efforts to bring the outbreak
under control. The strengthening of the surveillance system, including at the community level for early detection and
prompt referral and treatment of cases, must be prioritized, as well as addressing risk factors for outbreak spread
among the affected population.
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https://apps.who.int/iris/bitstream/handle/10665/370961/OEW27-0309072023.pdf
