Cholera and AWD outbreak bulletin in Eastern and Southern Africa, as of 3 October 2018,13 Issue

Highlights
10 out of the 21 countries in Eastern and Southern Africa Region (ESAR) have reported more than 34,109 cholera / AWD cases and 412 deaths (Case Fatality Rate, 1.2%), since the beginning of 2018. These countries include; Angola, Kenya, Malawi, Mozambique, Rwanda,
Somalia, Tanzania, Uganda, Zambia and Zimbabwe. Zimbabwe accounts for 25.7 % of the total case load reported this year, followed by Somalia at 17.9%. Currently, 4 out of the 21 countries in ESAR are reporting active transmission of cholera / AWD (Zimbabwe, Tanzania, Somalia and Kenya). During the week under review, Zimbabwe reported the highest number of new cases (1,275 cases including 3 deaths). Of the four countries with active transmission, Tanzania has recorded the highest CFR (at 1.9%) in 2018.
Zimbabwe: The current outbreak continues to accelerate in a span of the last four weeks with a cumulative total of 8, 435 cases and 49 deaths reported as of 2nd October 2018. These cases have emerged from the following 7 provinces: Harare (Harare: 8,245 including 43 deaths, Chitungwiza: 86), Mashonaland Central (Shamva: 2, Mazowe: 8, and Rushinga:1), Mashonaland East (Marondera:13, Murehwa: 5, Mutoko:3, Wedza: 4, Chikomba: 4, and Seke: 6), Manicaland (Buhera: 29 including 4 deaths, Makoni: 3 including 1 death, and Mutare city: 13), Midlands (Gokwe north: 10), Masvingo (Masvingo: 2 cases including 1 death), and Matabeleland South (Beitbridge: 1). Of the total cases, 162 were confirmed positive for V. cholerae. The latest outbreak was declared on 5th September 2018. During the week under review, week 39 (week ending 30 September 2018), 1,275 cases including 3 deaths were reported
Tanzania: A decline in the epidemic trend has been noted. During week 39, 96 new cases including 3 deaths (CFR, 3.1) were reported compared to 150 cases including 6 deaths (CFR, 4%) reported in week 38 (week ending 23 September 2018). These new cases emerged from Ngorongoro district in Arusha region (80 including 2 deaths), Simanjiro district in Manyara region (3) and in Rukwa region (13 cases including 1 death). Cumulatively a total of 32,729 cases including 544 deaths have been reported since the beginning of the outbreak in August 2015. Of these, a total of 4,098 cases and 78 deaths have been reported in 2018. Ngorongoro district is inhabited by Maasai community, traditional believed to live in harmony with wild animals. Inadequate access to improved water sources, cultural practices, inadequate number of qualified personnel to support the response, and over-reliance on traditional medicines as the 1st line of treatment; are factors that hinder cholera control and prevention interventions in this district.
Somalia: During week 38, 30 new cases were reported compared to 34 cases reported in week 37. These new cases are concentrated in the following regions; Banadir (27) and Lower Jubba (3). Cumulatively a total of 6,485 cases including 42 deaths have been reported since the beginning of the outbreak in December 2017. Of these, a total of 6,080 cases and 41 deaths have been reported in 2018.
Kenya : The cholera outbreak had seemed to lull for three weeks (Weeks: 34, 35 and 36), until one cholera case was confirmed from Kalobeyei village in Turkana West sub-county during week 37. 6 cases have been confirmed since then, as of 2nd October 2018.