Cholera: We should not let our guard down

Rumbidzayi Zinyuke Health Buzz

Zimbabwe is on high alert following the identification of two cholera cases in Chegutu last week.

While the cases have been contained, it goes without saying that activating health emergency response mechanisms was the best thing to do by the Government.

Zimbabwe last had a cholera outbreak in 2018 which the country managed to contain.

Seeing that the better part of the African continent has been affected by the cholera epidemic since last year, Zimbabwe will not be spared if these systems are not strengthened.

In 2022 alone, at least 29 African countries reported cases of cholera to the World Health Organisation, a notable increase from the average of fewer than 20 countries over the past five years.

For 2023, 10 countries have so far reported cases of cholera with the highest number being reported in Malawi where more than 43 000 out of the total of 119 554 cases that had been reported by February.

Malawi on its own has reported 1 412 deaths with a case fatality rate of 3,3 percent, higher than the region’s average case fatality rate of 2,3 percent.

Other countries that have reported cases include DRC, Nigeria, Cameroon, Kenya, Mozambique, Ethiopia, Burundi, Zambia and South Africa.

With regards to the SADC region, the outbreaks in Malawi, Mozambique and Zambia are a cause for concern for Zimbabwe owing to the high level of interaction through cross border movements.

“Due to the high human traffic across our borders, there is a high risk of importation of cases into the country especially considering that Zimbabwe is a transit route for most SADC countries.

“The public are therefore advised to be vigilant for symptoms of watery diarrhoea among travellers from Malawi, Mozambique and Zambia and alert their nearest health facilities for treatment,” the Ministry of Health and Child Care this week warned.

According to WHO regional director Dr Matshidiso Moeti, it is critical for African countries to scale up readiness to quickly detect cases and mount comprehensive and timely responses.

If the current trend continues, WHO estimates that cases could surpass the number recorded in 2021 – the worst year for cholera in Africa in nearly a decade.

While exercising caution during travel is vital, knowing about the disease and the dangers it poses for the population is also more important.

Cholera is an acute diarrhoeal infection characterised, in its severe form, by extreme watery diarrhoea and potentially fatal dehydration. It is caused by the ingestion of food or water contaminated with the bacterium Vibrio cholerae.

Health officials say most of the people affected by cholera will develop only mild or no symptoms with less than 20 percent of ill persons likely to develop acute watery diarrhoea with moderate or severe dehydration.

However, these people are at risk for rapid loss of body fluids, dehydration, and death.

Cholera is an easily treatable disease. The majority of people can be treated successfully through prompt administration of oral rehydration solution (ORS).

Severely dehydrated patients are at risk of shock and require the rapid administration of intravenous fluids.

These patients are also given appropriate antibiotics to diminish the duration of diarrhoea, reduce the volume of rehydration fluids needed, and shorten the amount and duration of Vibrio cholerae excretion in their stool.

However, prevention remains better than cure.

For prevention of cholera people are advised to: “Make sure to drink and use safe water and boil it at all times. Practice hygiene at all times including washing hands before eating, after visiting the toilet and desist from eating unhygienic prepared food. Use proper latrines or other sanitation systems. Cook food well, keep it covered and eat it hot,” said the Ministry of Health and Child Care.

“If one suspects cholera he or she is advised to visit the nearest health facility for prompt treatment. If anyone presents with watery diarrhoea immediately report to the nearest health facility or call the Ministry’s Public Health Emergency Operations Centre toll free number 2019 for assistance.”

Despite being easily treatable, cholera remains a global threat due to its high morbidity and mortality in vulnerable populations with a lack of access to adequate health care.

According to experts, the main drivers and challenges for controlling and containing the current cholera outbreaks include climate change, floods and drought.

Africa has for years been experiencing natural disasters such as cyclones which have caused major flooding as well as droughts.

Countries in the southern African region are still experiencing these cyclonic activities and this could be fuelling the current outbreak.

Those countries that experience droughts can experience cholera due to poor access to water and expansion of informal urban settlements among their humanitarian situations.

Other challenges could include delayed surveillance by countries and this calls for the strengthening of systems to be able to collect and record the correct data.

Following the 2018 cholera outbreak in Zimbabwe, the Government launched the oral cholera vaccination programme that targeted affected communities and those that are vulnerable across the country.

The vaccine is a necessary tool in the fight against cholera but global shortages could derail roll out in many African countries who are forced to give one dose of the vaccine instead of two at times.

But while using a single dose instead of two doses will allow more people to be protected in the short term, this strategy has its limitations, as it remains unclear how long immunity will last.

Hence, investments into increased production of the vaccine is critical for Africa.

To beat the outbreak, 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.

These measures along with the promotion of preventive hygiene practices and food safety in affected communities are the most effective means of controlling cholera.

“Effective risk communication and community engagement strategies are needed to encourage behavioural change and adoption of appropriate preventive measures. 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,” said the WHO.

In October 2017, Global Task Force on Cholera Control (GTFCC) partners launched a strategy for cholera control Ending Cholera: A global roadmap to 2030. The country-led strategy aims to reduce cholera deaths by 90 percent and to eliminate cholera in as many as 20 countries by 2030.

The Global Roadmap focuses on three strategies that include early detection and quick response to contain outbreaks, a targeted multi-sectoral approach to prevent cholera recurrence, and an effective mechanism of co-ordination for technical support, advocacy, resource mobilisation, and partnership at local and global levels.

Zimbabwe is part of the countries that endorsed this roadmap and implementation of this will go a long way to ensure the country ends the epidemic.

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