Date: Tue 16 Apr 2019
Source: UN OCHA, ReliefWeb, UNICEF report [edited]
<https://reliefweb.int/report/mozambique/bulletin-cholera-and-awd-outbreaks-eastern-and-southern-africa-regional-update-0>

Bulletin: Cholera and AWD outbreaks in Eastern and Southern Africa, regional update for 2019 -- as of 16 Apr 2019
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Highlights
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Almost half of the countries in Eastern and Southern Africa region (ESAR) have been affected by cholera outbreaks since the beginning of 2019. More than 8258 cholera/AWD [acute watery diarrhoea] cases including 29 deaths have been reported in 10 countries in the region, with an average case fatality rate of 0.4%, since the beginning of 2019. These countries include Angola, Burundi, Kenya, Malawi, Mozambique, Tanzania, Somalia, Uganda, Zambia, and Zimbabwe. Mozambique accounts for 69.5% (5656) of the total case load reported this year [2019], followed by Kenya at 16.3% (1350).

Currently 5 out of the 10 countries with reported cholera/AWD outbreaks in ESAR since week 1 of 2019, have active transmission and they include; Mozambique, Somalia, Kenya, Tanzania, and Malawi. During the week under review, Mozambique reported the highest number of new cases (1584 cases). Of the countries with active transmission, Tanzania has recorded the highest case fatality rates (CFR) in 2019 at 1.6%.

Mozambique: a new surge in the disease has produced roughly a cumulative total of 5656 reported cholera cases including 8 deaths in a span of 3 weeks (from week 13 [week ending 31 Mar 2019] to week 15 [week ending 14 Apr 2019]). These cases emerged from 4 districts affected by Cyclone Idai: Beira, Dondo, Nhamatanda, and Buzi. A 47.6% decrease in the weekly incidence has been noted in the last 2 weeks. During week 15, 1584 new cases including 1 death (CFR, 0.06%) were reported compared to 3024 cases including 6 deaths (CFR, 0.2%) reported in week 14 (week ending 7 Apr 2019). The emergency cholera vaccination campaign which ended on 10 Apr 2019 covered 98.7% (814 293 people) of the targeted population in four districts affected by Cyclone Idai.

Somalia: an increase in the epidemic trend has been noted in the last 2 weeks. During week 13 [ending 31 Mar 2019], 40 new cases were reported from Banadir region compared to 32 cases reported in week 12 (week ending 24 Mar 2019). Cumulatively a total of 707 cases with no deaths have been reported since the beginning of 2019. Children under 5 years bear the brunt of the cholera outbreak, representing 45% of the total case load reported in both epidemiological weeks 12 and 13 [18-31 Mar 2019]. During the week under review, the most affected districts in Banadir were Hodan accounting for 25% (10/40) of the total number of cases reported during week 13, followed by Daynile accounting for 22.5% (9/40).

Kenya: in reporting week 15, 132 new cases including 1 death (CFR, 0.8%) were reported from 3 counties -- Nairobi (102), Kajiado (24), and Garissa (6); compared to 14 cases reported during epidemiological week 14. Since 1 Jan 2019 to 16 Apr 2019, cholera outbreaks have been reported in Narok, Kajiado, Nairobi, Garissa, and Machakos counties with a cumulative total of 1350 cases including 6 deaths (CFR, 0.4%). Of these 72 were confirmed positive.

Malawi: from weeks 13 to 15, 5 confirmed cases of cholera were registered in 3 districts: 1 in Nsanje from TA Tengani, 2 in Mchinji, and 2 in Mwanza. There is confirmed evidence of cross-border transmission with Mozambique. The Mwanza district cases had history of travel from Moatize, Tete province in Mozambique where they experienced symptoms. The outbreak was first detected on 30 Mar 2019. The index case started having signs of watery diarrhea and vomiting on 29 Mar 2019 on their way back to Malawi from Moatize district in Mozambique. Following investigations the index case was confirmed positive. The second case from Moatize in Mozambique turned positive by RDT at Mwanza Hospital in Malawi on 12 Apr 2019. This was a 20-year old Malawian national (female) who lives with her husband in Moatize, she developed symptoms on 9 Apr 2019, before she started traveling to Malawi. This case also tested positive for _Vibrio cholera_ by culture.

Tanzania: 11 new cases were reported from Tanga region during epidemiological week 15, bringing the total number of cases reported since the beginning of 2019 to 190 cases including 3 deaths (CFR, 1.6%)

Urban-rural disaggregation of cholera cases
Overall, more cholera cases emerge from urban areas (77.6%; 5711) as compared to rural areas (22.4%; 1648). This is according to an analysis of cholera cases reported since the beginning of 2019 from seven countries (Angola, Kenya, Malawi, Mozambique, Tanzania, Uganda, and Zimbabwe). Of the total number of cases reported in urban areas (5711), Mozambique accounts for the majority (92.65%; 5291), followed by Kenya (5.22%; 298), Uganda (0.93%; 53), Tanzania (0.84%; 48), Angola (0.33%; 19), Malawi (0.02%; 1), and Zimbabwe (0.02%; 1). All cases reported in Uganda (53) and Angola (19) emerged from urban areas. Apart from Mozambique, Uganda, and Angola; collectively, the remaining 4 countries (Kenya, Zimbabwe, Tanzania, and Malawi) have more cholera cases emerging from rural areas (78.7%; 1283) as compared to urban areas (21.3%; 348).
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[HealthMap/ProMED-mail maps:
Eastern Africa: <http://healthmap.org/promed/p/64351>
Southern Africa: <http://healthmap.org/promed/p/54783>]
Date: Wed, 10 Apr 2019 13:52:04 +0200

Harare, April 10, 2019 (AFP) - The death toll from Cyclone Idai, which devastated Mozambique and Zimbabwe last month, is nearing 1,000, according to the latest figures released by the two governments.   Zimbabwe on Tuesday updated its toll to 344 while Mozambique said recorded fatalities stood at 602, taking the combined tally to 946.

Zimbabwean Information Minister Monica Mutsvangwa told reporters that 257 people listed as missing when heavy winds and floods struck the country on the night of March 14-15 were now considered dead.   "The search and recovery process is now confined to recovery. The missing persons can now be presumed dead," she said.

More than two million people -- 1.85 million of them in Mozambique -- were affected by Idai.   The UN has described the cyclone as "one of the deadliest storms on record" in the southern hemisphere."   It is seeking $282 million (251 million euros) to fund emergency assistance over the next three months.   Before the cyclone hit, floods in Malawi affected about 900,000 people and claimed 60 lives, according to the government.
Wednesday 10th April 2019
https://www.afro.who.int/news/fast-rollout-cholera-vaccines-people-need-mozambique

10 April 2019 / MAPUTO - The Ministry of Health in Mozambique has concluded a successful six-day emergency cholera vaccination campaign that reached more than 800 000 people in four districts affected by Cyclone Idai.

The campaign was supported by around 1200 community volunteers and partners including the World Health Organization (WHO), UNICEF, Médecins Sans Frontières (MSF), International Federation of the Red Cross and Red Crescent Societies (IFRC) and Save the Children.

“From start to finish, this campaign was one of the fastest ever, thanks to experienced people at the Ministry of Health, who knew there was a high risk of a cholera outbreak and made a rapid request for the vaccines as soon as the cyclone hit,” says Dr Djamila Cabral, Head of the WHO office in Mozambique. “The Ministry did an excellent job organizing the campaign and reaching so many people in such a short time. The oral cholera vaccine is one of the vital measures that can help save lives and stop the spread of this terrible disease during an outbreak.”

The oral cholera vaccines, donated by Gavi from the Global Cholera Vaccine Stockpile, arrived in Beira on Tuesday 2 April and, within 24 hours, began reaching people in need.

The vaccines were given to communities identified by the Government at highest risk – those without access to safe water and sanitation - in Beira, Dondo, Nhamatanda and Buzi districts.

Vaccine uptake has been very high and the campaign has been well received by the communities. Remaining vaccines will be used for other at-risk communities that were not reached by the initial campaign.

People develop protection against cholera approximately 7 days after receiving the vaccine. One dose of this oral vaccine provides around 85% protection against cholera for 6 months.

“Controlling cholera in these areas will reduce the risk to the rest of the population because fewer people will be taking it back and forth into the wider community,” says WHO cholera vaccination expert, Kate Alberti, who was deployed to Beira to support the Ministry of Health to organize the campaign.

Dr Nazira Abdula, Minister of Health of Mozambique, acknowledged the great support of WHO and partners for the vaccination campaign. “It’s very difficult to roll out a campaign of this scope in only three days,” she says.

WHO’s Dr Cabral adds: “This campaign would not have been possible without the strong engagement of the local authorities and the communities themselves. The number of volunteers is impressive and, wherever they go, there has been very strong uptake of the vaccine. Everyone is very keen to make this a success to stop cholera in its tracks.”

Since Cyclone Idai struck Mozambique on 14 March, hundreds of thousands of people have been living in temporary settlements without access to safe water and sanitation. The Ministry of Health declared a cholera outbreak on 27 March and, as of 8 April, had reported more than 3577 cases and 6 deaths.

The cholera vaccine is just one tool for the outbreak response. Currently 12 cholera treatment centres, with 500-bed capacity, have been set up by the national authorities and international partners to serve the affected communities. Partners are also supporting the local authorities to provide access to safe water and sanitation in settlements and communities across Sofala Province.

Cholera is endemic in several parts of Sofala province and the cholera outbreak that developed post-Cyclone Idai acts as a reminder that sustainable access to safe water, sanitation, and hygiene (WASH) is the long-term solution to controlling cholera. Acknowledging that every case of cholera is preventable, the Global Task Force on Cholera Control is implementing a Cholera Global Roadmap to 2030, which calls upon development partners and donors to support countries to reduce cholera deaths by 90% by 2030.

Related links:

Photo Feature - Combating cholera in Mozambique
https://www.who.int/news-room/feature-stories/detail/combating-cholera-in-mozambique

Cyclone Idai - events as they happen
https://www.who.int/emergencies/cyclone-idai/events-as-they-happen

Cyclone Idai homepage
https://www.who.int/emergencies/cyclone-idai/en/

Cholera Vaccination Video

Download link
https://we.tl/t-GIw6KuCgRJ

For Additional Information or to Request Interviews, Please contact:

MOREIRA Maria Da Gloria
Tel: +258 21492733
Email: moreirag@who.int

Sarah Cumberland
WhatsApp: +41 79 206 1403
Email: cumberlands@who.int

Collins Boakye-Agyemang
Tel: + 242 06 520 6565
Email: boakyeagyemangc@who.int
Date: Mon 8 Apr 2019
Source: The Independent [edited]
<https://www.independent.co.uk/news/world/africa/cyclone-idai-mozambique-cholera-outbreak-deaths-relief-beira-a8859431.html>

Mozambique has confirmed more than 3100 cases of cholera since the outbreak was declared in the wake of Cyclone Idai. Six people have died from the acute diarrheal disease in the last 2 weeks after the floods left tens of thousands of people stranded in camps with few toilets and little clean water. Health workers are now battling to carry out a mass vaccination in the storm-hit city of Beira following a delivery of nearly 900 000 doses last week.

It has been described as "the most ambitious campaign ever conducted using the one-dose oral cholera vaccine strategy" by the humanitarian organization Doctors Without Borders. The UN specialist coordinating the relief effort, Julien Graveleau, said he was "quite optimistic" of success despite the challenges. "Of course, the numbers will be increasing, but I believe we're ready for it," he added.

Mozambique's health ministry said that more than 70 percent of the vaccines had been administered by Sunday morning [7 Apr 2019], partly thanks to megaphone-wielding promoters handing out doses in busy streets in Beira and elsewhere.

Outside one cholera treatment centre in the Beira neighbourhood of Pioneros, a woman sold bottled water while passers-by stepped carefully around fetid pools of water in the street. "It's a big problem," said Rosa Zimbane, who reported herself healthy so far, as an ambulance arrived carrying 2 women with small children.

Treatment for cholera can involve simple rehydration, but the disease can kill within hours, and more severe cases need intravenous drips. Inside the centre, more than a dozen people lay on beds with 2 buckets at the ready. One was for vomiting.

Dr Katrien Duquet, also of Doctors Without Borders, said that they had seen fewer cases of cholera than expected overall. "It never spiked to the level we thought," she said. "But people are still afraid of cholera. We are not claiming this is over."  [Byline: Peter Stubley]
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[Aggressive interventions to stem outbreaks of cholera include providing sources of clean water and a vaccination campaign. The following is extracted from Lutwick LI, Preis J, Choi P: Cholera. In: Chronic illness and disability: the pediatric gastrointestinal tract. Greydanus DE, Atay O, Merrick J (eds). NY: Nova Bioscience, 2017, pp 113-136:

"For a variety of logistic, financial, and historical reasons, vaccines have not been available for cholera control programs outside of Viet Nam. Given as 2 or 3 dose courses, efficacy can be as high as 60-80 percent for at least 2-3 years but much shorter protection lengths in children younger than 5 years of age. Cost-effectiveness, especially once an outbreak has occurred, had remained unproven until reports from Guinea (57) and Haiti (58) demonstrated utility.

"The current vaccines prequalified for use by WHO (59) are:
- Dukoral (produced in Sweden) that contains several biotypes of O1 with recombinant cholera toxin B subunit, which also offers some protection against enterotoxigenic _E. coli_;
- Shanchol (produced in India) that contains biotypes of both O1 and O139 without the recombinant B unit. In a large study in Kolkata, India, a cluster-randomized, double blind, placebo-controlled study of this product (60), the cumulative efficacy of the vaccine at 5 years was 65% (95% CI 52-74, p less than 0.0001). A locally-produced vaccine similar to this vaccine (mORCVAX) is produced in Viet Nam;
- Euvichol (produced in South Korea) that, like Shanchol, contains both O1 and O139 without recombinant B subunit. This vaccine has been reported to be non-inferior to Shanchol in a Philippine study (61).

In June 2016, the US FDA for the 1st time approved a cholera vaccine for use locally in travelers to cholera-endemic areas. This vaccine, Vaxchora, is an oral live, attenuated biologic (62) that is a reformulation of a previous product. This product, a single dose immunization also referred to as CVD 102-HgR, must be stored in the frozen state and as a live, attenuated bacterial vaccine is not given until at least 14 days after antibacterials were used and should be given at least 10 days before oral chloroquine antimalarial prophylaxis. Single dose use is an advantage over the older inactivated products which are given in 2 doses. Studies, however, have suggested that one dose of these inactivated oral vaccines can be effective when the vaccines are in short supply in both endemic and outbreak situations (63, 64).

References
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Available on request. - ProMED Mod.LL]

[HealthMap/ProMED map available at:
Mozambique: <http://healthmap.org/promed/p/177>]
Date: Wed, 3 Apr 2019 19:29:39 +0200

Maputo, April 3, 2019 (AFP) - A vaccination campaign was launched in Mozambique's central city of Beira on Wednesday after a cyclone slammed into the region and unleashed an outbreak of cholera, authorities said.   International relief agencies and the health ministry are hoping to immunise nearly 900,000 people against the water-borne intestinal disease, which has already killed two people and infected more than 1,700.   Around 313 new cases, mostly in the coastal city of Beira, were reported on Wednesday, bringing the total number of infections to 1,741.

The vaccination target represents around 80 percent of the people affected by the cyclone, said Marie Benigna, a deputy director in the health ministry.   "With this number of people vaccinated, it will greatly reduce the spread of the disease," she said at the launch of the drive.   Cholera is transmitted through contaminated drinking water or food and causes acute diarrhoea. It is especially dangerous for infants.   Cyclone Idai hit the coast of central Mozambique on March 15 with hurricane-force winds and rains flooding the hinterland and drenching eastern Zimbabwe.

In Mozambique, 598 people have been killed, and another 268 have died in Zimbabwe, according to the toll as of Wednesday.   Hundreds of thousands of survivors have been placed in temporary and crowded shelters, many of them lacking clean water and adequate sanitation.   Destruction of water systems and sanitation infrastructure has created "perfect conditions for cholera to spread," said Seth Berkley, CEO of the vaccine alliance Gavi, which provided the doses.   "The oral cholera vaccine is a vital emergency measure that will help save lives and stop the spread of this horrible disease," said World Health Organization (WHO) chief Tedros Ghebreyesus.   The vaccinations will be administered at health centres, shelters for the displaced and at schools and markets.
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