06 APRIL 2019
DE FAAKTO OUTBREAK INTELLIGENCE
SITUATION-CHOLERA MOZAMBIQUE
BACKGROUND-TROPICAL CYCLONE IDAI-CENTRAL MOZAMBIQUE-Caused heavy rains, strong winds, severe flooding
Warning from the U.S. Center for Disease Control,
- CDC recommends that US residents avoid nonessential travel to Beira City, Mozamique, and the surrounding area because serious health and safety risks may be present and medical care may be limited or unavailable
- Postponing travel to these areas would also prevent further straining already limited local resources
- Travelers to other affected parts of Mozambique, Malawi, and Zimbabwe should take steps to prevent illness and injury (CDC)
Damage from the cyclone has caused problems with,
- Water conditions (have caused cholera outbreaks)
- Food supplies
- Sanitation
- Electrical power grid
- Public transportation
- Shelter
- Communications
- Security
- Medical care
- Mosquito control (CDC)
Report from European Commission’s Directorate-General for European Civil Protection and Humanitarian Aid Operations
Cholera in Mozambique
- 1741 Cholera cases
- 313 news cases in last 24 hours
- 598 people have died from Cholera
- 32 000 people have been vaccinated with assistance from World Health Organization (WHO)
- The European Commission is coordinating assistance from Italy, Spain, Portugal, Austria, Luxembourg, Germany
About Cholera
- Cholera is an acute diarrhoeal infection caused by ingestion of food or water contaminated with the bacterium Vibrio cholerae
- Cholera remains a global threat to public health and an indicator of inequity and lack of social development
- Researchers have estimated that every year, there are roughly 1.3 to 4.0 million cases, and 21 000 to 143 000 deaths worldwide due to cholera (WHO)
Symptoms
- Cholera is an extremely virulent disease that can cause severe acute watery diarrhoea
- It takes between 12 hours and 5 days for a person to show symptoms after ingesting contaminated food or water
- Cholera affects both children and adults and can kill within hours if untreated
- Most people infected with V. cholerae do not develop any symptoms
- Bacteria are present in their faeces for 1-10 days after infection and are shed back into the environment, potentially infecting other people
- A minority develop acute watery diarrhoea with severe dehydration
- This can lead to death if left untreated (WHO)
Prevention & Control
- A multifaceted approach is key to control cholera, and to reduce deaths
- A combination of surveillance, water, sanitation and hygiene, social mobilization, treatment, and oral cholera vaccines are used (WHO)
Treatment
- Prompt administration of oral rehydration solution (ORS)
- The WHO/UNICEF ORS standard sachet is dissolved in 1 litre (L) of clean water
- Adult patients may require up to 6 L of ORS to treat moderate dehydration on the first day
- Severely dehydrated patients are at risk of shock and require the rapid administration of intravenous fluids
- Appropriate antibiotics to diminish the duration of diarrhoea
- Oral re-hydration should be available in communities, in addition to larger treatment centres that can provide intravenous fluids and 24 hour care
- With early and proper treatment, the case fatality rate should remain below 1%.
- Zinc is an important adjunctive therapy for children under 5, which also reduces the duration of diarrhoea and may prevent future episodes of other causes of acute watery diarrhoea
- Breastfeeding should also be promoted (WHO)
Hygiene
- Promote the adoption of appropriate hygiene practices such as hand-washing with soap
- Safe preparation and storage of food and safe disposal of the faeces of children (WHO)
- Funeral practices for individuals who die from cholera must be adapted to prevent infection among attendees
Oral Vaccines
- Currently there are three WHO pre-qualified oral cholera vaccines (OCV): Dukoral®, Shanchol™, and Euvichol-Plus®. All three vaccines require two doses for full protection
- Based on the available evidence
- OCV should be used in areas with endemic cholera, in humanitarian crises with high risk of cholera, and during cholera outbreaks; always in conjunction with other cholera prevention and control strategies
- Vaccination should not disrupt the provision of other high priority health interventions to control or prevent cholera outbreaks (WHO)
CDC https://wwwnc.cdc.gov/travel/notices/warning/cyclone-idai
European Commission’s Directorate-General for European Civil Protection and Humanitarian Aid Operations https://reliefweb.int/report/mozambique/mozambique-tropical-cyclone-idai-and-floods-update-dg-echo-un-ocha-wfp-govmz-0
WHO Fact Sheet-Cholera https://www.who.int/en/news-room/fact-sheets/detail/cholera
