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Too many countries are still facing large outbreaks with high case fatality rates when containment is possible. In settings where basic infrastructure is not available and minimum requirements for safe water and basic sanitation have not yet been met, including during humanitarian crises, the presence or introduction of Vibrio cholerae in the environment results in huge cholera outbreaks, evolving very quickly with devastating consequences.

The first step in controlling cholera and dramatically reducing the number of cholera deaths is to support countries to strengthen their capacities for preparedness, early detection, laboratory confirmation, and immediate and effective response to outbreaks in order to reduce their impact.

The containment of outbreaks can be achieved by the effective implementation of the following activities at the country level:

• Strengthening of integrated early warning surveillance systems, including the confirmation of suspected cholera cases (requiring laboratory culture capacity and rapid diagnostic tests) at the peripheral level. Well-performing laboratories are critical to confirm Vibrio cholerae as the causative agent and to monitor outbreaks, including testing for antibiotic susceptibility of the bacteria and tracking strains. Surveillance data is a key element to help all sectors prioritize areas for intervention.
• Pre-positioning stocks of essential supplies (ORS, IV fluids, cholera kits, High Test Hypochlorite), cold chain equipment, and other treatment and infection prevention and control supplies for patients’ care at strategic locations in order to strengthen national rapid response capabilities.
• Preparedness of WASH systems, including monitoring of water quality in community water supplies and piped networks.
• Preparedness of the health care system, set-up of dedicated health care facilities (Cholera Treatment Centres (CTCs) and Cholera Treatment Units (CTUs)) and training of health workers.
• Preparedness for implementation of WASH response through strengthening of chlorination of community water supplies and monitoring water quality in piped networks.
• Improved health care facility infrastructure, including WASH in facilities, availability of supplies, infection prevention and control, medical technologies, and decentralized access to health care (Oral Rehydration Points (ORP)), together with better community awareness and mobilisation. Early detection and timely and effective case management of cholera reduce the case fatality rate to less than one percent.
• Establishment of WASH and Health Rapid Response Teams for field investigation, risk evaluation, and immediate response.
• Maintenance of stocks of WASH supplies (rapid microbial test kits, chlorine tests, water disinfection technologies including chlorine, water tanks, and hygiene kits), and monitoring and enforcing food safety and water quality standards at all levels.
• Specific WASH interventions to prevent disease spread, such as increased use of safe water and effective water treatment at point of use, implemented effectively at large scale without delay.
• Community engagement and community-based interventions promoting hygiene practices.
• Implementation of reactive large-scale mass vaccination campaigns with OCV, to be initiated as soon as cases are confirmed for maximum impact.
• Establishing contingency agreements with governments, agencies and suppliers to ensure efficient planning and coordination for effective supply management, including rapid procurement, importation, warehousing and prompt distribution of equipment and other resources for immediate response.