Angola Cholera Fact Sheet

Cholera Overview

Seventh pandemic cholera was first reported in Angola in the early 1970s. Since 1990, large-scale outbreaks were reported in 1990-1991, 2006-2008 and 2013. The overall yearly trend shows a significant decrease in case numbers since 2006 (Fig. 1).1

Between 2006 and 2018, epidemiological surveillance reported 112,545 cases with 4,279 fatalities (case fatality rate (CFR) ≈ 3.8%).

From 2006 to 2018, the province reporting the majority of suspected cases was Luanda (29%). After Luanda, Benguela Province reported 15.4% of all cholera cases.2

Angola has been affected by cross-border outbreaks, especially among communities located in northern provinces bordering Democratic Republic of the Congo (DRC) (Figs. 2 and 4).3

Cholera Distribution

Luanda Province reported 29% of all cases over the course of nine outbreaks, although most outbreaks in Luanda occurred between 2006 and 2013 (Fig. 2, Table I).2

In the southwest, the provinces of Benguela, Huíla and Cunene accounted for a combined 31.1% of all suspected cholera cases. The large majority of cases (99.4%) in these three provinces were reported between 2006 and 2013 (Fig. 2, Table I).2

In the north along the DRC border, the provinces of Uíge, Zaire, Cabinda, Malanje and Lunda Norte reported a combined 20.9% of all cholera suspected cases. All five provinces were repeatedly affected, especially Uíge Province, which reported nine outbreak events. Uíge, Zaire and Cabinda reported 99% of all cases from 2015 to 2018 (Fig. 2, Table I).2

Cholera case numbers in Angola tended to increase between October and December, which coincides with the onset of the rainy season (Fig. 3).2,4 Extended drought followed by onset of the rainy season likely played a role in the 2013 outbreak in the southern provinces; case numbers peaked in Huíla and Cunene with the onset of the rainy season in late-2013.2, 3

Strategic Recommendations

Cross-border cholera transmission from DRC likely plays a major role in cholera dynamics in Angola (Table II, Fig. 4). Since 2011, the majority of outbreaks in Angola have coincided with the spread of cholera into the southwestern provinces of DRC.3,5,6 This highlights the importance of cross-border surveillance and coordinated response between countries in the region. Cross-border collaboration with DRC should be strengthened, with regular data and information sharing, especially when cholera outbreaks spread into the western provinces of DRC.

In cholera hotspots (Type 1-4), preparedness and response plans should be developed and implemented including: (1) strengthening early detection and rapid response including community-based surveillance and cross-border alerts; (2) establishing multisectoral and cross-border coordination mechanisms; (3) building outbreak management capacity; (4) targeted pre-positioning of supplies and (5) developing risk communication, social mobilization and community engagement plans with harmonized approaches and messaging (Table II).

Sustainable water, sanitation, hygiene (WASH) and social mobilization activities should be implemented in five priority provinces regularly affected by outbreaks of extended duration, especially at-risk provinces along the border with DRC (Table II – Type 1-2 hotspots). Sustainable WASH and social mobilization activities should include hard-to-reach and remote populations. Prepositioning of supplies is critical for hotspots located far from Luanda. To reduce the CFR in rural areas where access to health facility is restricted, community surveillance including active case search, and early referral to healthcare should be strengthened through community cadres. Furthermore, oral rehydration points should be established, and oral rehydration solutions should be distributed. Identification of transmission foci at a finer scale (i.e., municipality) within the priority provinces is necessary to best target at-risk communities.