Cholera and AWD Outbreaks Bulletin in Eastern and Southern Africa Region, as of 18 February 2019, 3 Issue

Highlights

Approximately, 1,409 cholera / AWD cases including 12 deaths have been reported in 7 out of the 21 countries in Eastern and Southern Africa Region (ESAR); with an average Case Fatality Rate of 0.9%, since the beginning of 2019. These countries include; Angola, Burundi, Kenya, Tanzania, Somalia, Uganda and Zimbabwe. Apart from Kenya, outbreaks from the rest of the countries spilled over from 2018. Kenya accounts for 59.8 % (843) of the total case load reported this year, followed by Somalia at 22% (316). However, highest Case Fatality Rates (CFR) in 2019 have been recorded in Zimbabwe (6.5%) and Uganda (5.7%).

Of the 7 countries with reported cholera / AWD outbreaks in ESAR since week 1 of 2019, 5 (Kenya, Somalia,Tanzania, Uganda and Zimbabwe) have ongoing cholera outbreaks. During the week under review, Somalia reported the highest number of new cases (64 cases).

Kenya: An additional 42 cholera cases including 1 death (CFR, 2.4%) have been reported during epidemiological week 7 (week ending 17 February 2019). This is a decrease in the number of cases compared to the previous week (week 6; week ending 10 February 2019) when 149 cases were reported. Cumulatively, a total of 843 cases with 34 confirmed and 3 deaths (CFR, 0.4%) have been reported since the onset of the latest wave of the cholera outbreak on 2 January 2019. Communities living along the EWASO Nyiro river from Narok and Kajiado counties remain the epicenter of the outbreak, accounting for 85.2% (718 cases and 3 deaths) of total reported cases. Risks of transmission have been amplified by; unfavourable behaviours such as open defecation, inadequate or no sanitation coverage, over reliance on already contaminated EWASO Nyiro river for domestic water supply and lack of alternative water sources.

Zimbabwe: The current outbreak is unusual because of its vast geographical spread. Since the beginning of 2019, 6 out of 10 provinces have reported cholera cases including; Mashonaland East (38), Mashonaland Central (15), Masvingo (5), Midlands (2), Manicaland (1), and Matabeleland South (1). During week 7, 3 new cases were reported compared to 20 cases reported in week 6. These new cases emerged from Murehwa district in Mashonaland East province. Cumulatively, a total of 10,724 cases including 69 deaths have been reported since the beginning of the outbreak on 5 September 2018. Of these, a total of 62 (0.6%) cases and 4 (5.6%) deaths have been reported since the beginning of 2019.

Uganda: The cholera outbreak in Uganda’s capital, Kampala continues to be closely monitored. The outbreak started in December 2018 and was declared earlier in 2019. A cumulative total of 53 cases including 3 deaths (CFR, 5.7%) have been reported since the onset of the outbreak. These cases emerged from the overcrowded informal settlements of Sembabule zone and Katwe (Rubaga division) and Kisenyi (Central division) in Kampala. During the week under review (week 6), 6 new cases including 1 death (CFR, 16.7%) were reported compared to 9 cases including 1 death (CFR, 11.1%) reported in week 5 (week ending 3 February 2019). Lack of toilets and poor sanitation, worsened by heavy rains are factors associated with the current outbreak.

Tanzania: The cholera outbreak seemed to lull for two weeks (Weeks: 2 and 3, 2019), until during epidemiological week 4 (week ending 27 January 2019) when 5 cholera cases were reported in Uvinza district of Kigoma region. Since then 47 cases including 1 death (CFR, 2.1%) have been reported, as of 10 February 2019. This raises the total number of cholera cases reported since the beginning of 2019 to 51, including 1 death (CFR, 2 %). Cumulatively a total of 33,372 cases including 551 deaths have been reported since the beginning of the outbreak in August 2015. Tanga (Korogwe DC) and Kigoma (Uvinza Dc), are the most affected regions currently.

Somalia: An increase in the epidemic trend has been noted, 64 new cases of AWD/cholera were reported in week 5 compared 54 cases reported in week 4. These cases emerged from across Somalia including Somaliland. Cumulatively a total of 7,168 cases including 45 deaths have been reported since December 2017. Of these, a total of 316 cases have been reported since the beginning of 2019.

Urban - Rural Disaggregation of Cholera Cases
An analysis of cholera cases reported since the beginning of 2019 from five countries (Angola, Kenya, Tanzania, Uganda and Zimbabwe) reveals that overall, rural areas account for 80.8 % (831 cases) of the total caseload while urban areas account for the remaining 19.2% (197 cases). All cases reported in Zimbabwe (62) and Tanzania (51) emerged from rural areas; while all cases reported in Uganda (53) and Angola (19) emerged from urban areas. 85.2% (718) of cases reported in Kenya emerged from rural areas and the remaining 14.8% (125) emerged from urban areas