Cholera and AWD Outbreaks Bulletin for Eastern and Southern Africa Region, as of 5 March 2019, 4 Issue

Highlights

Approximately, 1,681 cholera / AWD cases including 13 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 0.8%, 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 51.3 % (863) of the total case load reported this year, followed by Somalia at 31.2% (524). Highest Case Fatality Rates (CFR) in 2019 have been recorded in Zimbabwe (6.2%), Uganda (5.7%) and Tanzania (2.9%). Of the 7 countries with reported cholera / AWD outbreaks in ESAR since week 1 of 2019, 5 (Somalia, Kenya, Tanzania, Zimbabwe and Burundi) have ongoing cholera outbreaks. During the week under review, Somalia
reported the highest number of new cases (61 cases).

Somalia: An increase in the epidemic trend has been noted in the last two weeks. During week 8 (week ending 24 February 2019), 61 new cases were reported from Banadir Region compared to 43 cases reported in week 7 (week ending 17 February 2019). Cumulatively a total of 524 cases with no deaths have been reported since the beginning of 2019. All cases emerged from the following districts in Banadir region including; Hamra Jabja (15; Attack Rate 0.02), Shingani (15; Attack Rate 0.03), Karaan (9; Attack Rate 0.0) and Hawlwadag (8; Attack Rate 0.01). Majority (59%) of the recorded cases in week 7 and 8 were children Under five years.

Kenya: A decline in the epidemic trend has been noted in the last two weeks. During week 8, 19 new cases were reported compared to 42 cases including 1 death (CFR, 2.4%) reported in week 7. These new cases emerged from Kajiado County. Cumulatively, a total of 863 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. 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: An additional 3 cholera cases were reported from Murehwa (2) and Mt. Darwin (1) districts during epidemiological week 8. The same number of cases (3 cases) were reported during the previous week - epidemiological week 7. Cumulatively, a total of 10,722 cases including 69 deaths have been reported since the beginning of the outbreak on 5 September 2018. Of these, a total of 65 (0.6%) cases and 4 (5.8%) deaths have been reported since the beginning of 2019. Cases reported since the beginning of 2019 have emerged from, 6 out of 10 provinces in Zimbabwe including; Mashonaland East (40), Mashonaland Central (16), Masvingo (5), Midlands (2), Manicaland (1), and Matabeleland South (1).

Tanzania: A decline in the epidemic trend has been noted in the last two weeks. During week 8, 7 new cases including 1 death (CFR, 14.3%) were reported compared to 12 cases reported in week 7. This raises the total number of cholera cases reported since the beginning of 2019 to 70, including 2 deaths (CFR, 2.9 %). New cases emerged from Simanjiro district in Manyara region (6 cases) and Korogwe district in Tanga region (1 Case). The one case that was reported in Korogwe district died. Cumulatively a total of 33,391 cases including 552 deaths have been reported since the beginning of the outbreak in August 2015.

Burundi: The new outbreak which was declared on 28 December 2018 has been on a natural decline in the past 3 weeks (Week 6 to week 8). During week 8, 1 new case was reported from Cibitoke compared to 2 cases reported in week 7. Cumulatively, as of 25 February 2019, a total of 189 cases including 2 deaths (CFR, 1.1%) were reported since the beginning of the outbreak. The outbreak was attributed to heavy rains that led to flooding in the coastal
areas of Lake Tanganyika.

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 81.6 % (872 cases) of the total caseload while urban areas account for the remaining 18.4% (197 cases). All cases reported in Zimbabwe (65) and Tanzania (70) emerged from rural areas; while all cases reported in Uganda (53) and Angola (19) emerged from urban areas. 85.5% (737) of cases reported in Kenya emerged from rural areas and the remaining 14.5% (125) emerged from urban areas.