AXIS 2—Prevention of disease occurrence by targeting multi-sectoral interventions in cholera hotspots

The core of this renewed strategy is to break the silos at national and global levels to implement integrated, multi-sectoral actions in cholera hotspots. This requires cholera to be elevated as a priority in affected countries through its inclusion in national policies and plans, either as a stand-alone plan or embedded within broader disease control initiatives, or within national health, WASH and development, and SDG implementation plans where relevant. The GTFCC has developed a guidance tool to support countries in the update or development of multi-sectoral, costed, national cholera control plans in alignment with the principles of the Global Roadmap.

The implementation of interventions at country level is defined by two characteristics:

1. 1. Targeted: Identifying of hotspots requiring priority action and analysis of local transmission pattern

• Accurate morbidity, mortality and environmental data on cholera are fundamental for cholera control as they form the basis for the development of national plans, allowing the prioritization of vulnerable populations and high-risk areas.
• Risk and vulnerability assessment in hotspots should include the identification of vulnerable populations and specific local risk factors, as well as a mapping of existing safe water sources, sanitation systems, capacities for surveillance (including laboratory), existing isolation treatment facilities and quality of health service delivery (including community-based ORPs and referral systems for severe cholera cases), and community engagement.

2. 2. Multi-sectoral: Implementing a package of selected effective control measures adapted to the local transmission pattern

• Once identified, cholera hotspots must become the primary targets of multi-sectoral interventions that include:
• Strengthening of epidemiological surveillance of clinically suspect cholera cases, complemented by a strong laboratory capacity at the peripheral level to detect outbreaks early and monitor cholera burden accurately. Strengthening routine surveillance, including through capacity building for laboratory staff, is essential to understand the burden and risk, inform the response, and track progress towards control and elimination.
• Implementation of adapted long-term sustainable WASH solutions to ensure use of safe water, basic sanitation and good hygiene practices to populations most at risk of cholera. In addition to cholera, such interventions prevent a wide range of other water-related illnesses like typhoid and dysentery, while contributing to achieving goals related to poverty, malnutrition, and education.
• Strengthening of health care systems to anticipate cholera outbreaks (readiness) through capacity building of staff involved in all aspects of cholera response, and pre-positioning of resources for patient diagnostics (lab reagents, rapid tests), patient care (ORS, IV fluids) and emergency WASH intervention (chlorine and other types of water treatment, soap).
• Large-scale use of OCV combined with WASH interventions such as water treatment at the point of use and handwashing promotion, to immediately reduce the disease burden while longer-term cholera control strategies are put in place.
• Implementation of hygiene promotion, risk communication and social mobilization strategies for strong community engagement.
• Cross-border collaboration and building of a strong sub-regional preparedness and response strategy.