Cholera and AWD Outbreaks in Eastern and Southern Africa Region, as of 3 June 2019, 10th Issue

Highlights

Almost half of the countries in Eastern and Southern Africa region (ESAR) have been affected by cholera outbreaks since the beginning of 2019. More than 11,434 cholera / AWD cases including 48 deaths have been reported in 10 countries in the region, with an average Case Fatality Rate of 0.4%, since the beginning of 2019. These countries include; Angola, Burundi, Kenya, Malawi, Mozambique, Tanzania, Somalia, Uganda, Zambia and Zimbabwe. Mozambique accounts for 61.4% (7,015) of the total case load reported this year, followed by Kenya at 22.7% (2,601).

Currently 5 out of the 10 countries with reported cholera / AWD outbreaks in ESAR since week 1 of 2019, have active transmission and they include; Kenya, Mozambique, Tanzania, Zambia and Somalia. During the week under review, Kenya reported the highest number of new cases (284 cases including 3 deaths). Of the countries with active transmission, overall Zambia has recorded the highest Case Fatality Rates (CFR) in 2019 at 3%.

Kenya: An increase in the epidemic trend has been noted in the last two weeks. During week 22 (week ending 2 June 2019), 284 new cases including 3 deaths (CFR, 1.1%) were reported compared to 174 cases reported in week 21 (week ending 26 May 2019). New cases emerged from the following five Counties: Garissa (116), Nairobi (115), Wajir (27) and Mombasa (26). Cumulatively, since January 2019, a total of 2,601 cases including 17 deaths (CFR, 0.7%) have been reported from nine Counties (Narok, Kajiado, Nairobi, Garissa, Mandera, Machakos, Embu, Wajir and Mombasa). High risk areas are characterized by unavailability of potable water, poor sanitation and hygiene practices and the situation is likely to be exacerbated in view of the current long rains.

Mozambique: The cholera outbreak is on a downward trend following the effective cholera vaccination campaign. During week 21, 39 new cases were reported compared to 45 cases reported in week 20 (week ending 19 May 2019). This raises the total number of cholera cases reported since the declaration of the cholera outbreak on 27 March 2019 to 7,015 including 8 deaths (CFR, 0.1%). These cumulative number includes; 6,766 cases and eight deaths reported from the Cyclone Idai affected districts (Beira, Buzi, Dondo and Nhamatanda) in Sofala Province; and 249 cases reported from Cyclone Kenneth affected districts (Metuge, Mecufi and Pemba city) of Cabo Delgado province . The new outbreak in Cabo Delgado province started on 1 May 2019.

Tanzania: During week 22, 21 new cases including 1 death (CFR, 4.8%) were reported from Dar es Salaam. Cumulatively a total of 33,587 cases including 555 deaths have been reported in the United Republic of Tanzania since August 2015.

Zambia: A decline in the epidemic trend has been noted in the last two weeks. During week 21, 14 new cases were reported compared to 106 cases including 1 death (CFR, 0.9%) reported in week 20. All new cases emerged from Northern province. Cumulatively a total of 337 cases including 10 deaths have been reported since the beginning of 2019.

Somalia: A decline in the epidemic trend has been noted in the last two weeks. During week 19 (week ending 12 May 2019), 8 new cases were reported from Banadir region compared to 47 cases reported in week 18 (week ending 5 May 2019). Cumulatively a total of 937 cases with no deaths have been reported since the beginning of 2019. Children under five years bear the brunt of the cholera outbreak, representing 81% of the total case load reported in week 19. During the week under review (week 19), the most affected districts in Banadir were Daynile, Hodan and Madina.

Urban - Rural Disaggregation of Cholera Cases
Overall, more cholera cases emerge from urban areas (76.6%; 7,704) as compared to rural areas (23.4%; 2,352). This is according to an analysis of cholera cases reported since the beginning of 2019 from seven countries (Angola, Kenya, Malawi, Mozambique, Tanzania, Uganda and Zimbabwe). Of the total number of cases reported in urban areas (7,704), Mozambique accounts for the majority (87.3%; 6,729), followed by Kenya (10.4%; 803), Tanzania (1.3%; 99), Uganda (0.7%; 53), Angola (0.2%; 19), and Zimbabwe (0.01%;1). All cases reported in Uganda (53) and Angola (19) emerged from urban areas. Apart from Mozambique, Uganda and Angola; collectively, the remaining four countries (Kenya, Zimbabwe, Tanzania and Malawi) have more cholera cases emerging from rural areas (69.6%; 2,066) as compared to urban areas (30.4%; 903).