Cholera and AWD Outbreaks n Eastern and Southern Africa Region, as of 17 May 2019, 9th 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 10,437 cholera / AWD cases including 35 deaths have been reported in 10 countries in the region, with an average Case Fatality Rate of 0.3%, since the beginning of 2019. These countries include; Angola, Burundi, Kenya, Malawi, Mozambique, Tanzania, Somalia, Uganda, Zambia and Zimbabwe. Mozambique accounts for 66.5% (6,931) of the total case load reported this year, followed by Kenya at 19.4% (2,020).

Currently 4 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, Somalia and Tanzania. During the week under review, Kenya reported the highest number of new cases (130 cases). Of the countries with active transmission, overall Tanzania has recorded the highest Case Fatality Rates (CFR) in 2019 at 1.3%.

Kenya: An increase in the epidemic trend has been noted in the last two weeks. During week 19 (week ending 12 May 2019), 130 new cases including 1 death (CFR,0.8%) were reported compared to 155 cases reported in week 18 (week ending 5 May 2019). New cases emerged from the following five Counties: Mandera (64), Garissa (34), Nairobi (25), Embu (6) and Kajiado (1). Nairobi County cases emerged from Embakasi East (Tassia, Pipeline and Kayole North), Embakasi West (Umoja1, Umoja 2) and pockets of Starehe, Ruaraka and Kibra Sub Counties. Garissa County cases emerged from Hagadera and IFO refugee camp while those of Mandera County emerged from Kutulo Sub County. Cases from Embu County were reported from Manyatta and Mbeere South sub counties. The new case from Kajiado County emerged from Ongata Rongai in Kajiado North Sub County. Cumulatively, since January 2019, a total of 2,020 cases have been reported out of which 105 were confirmed. There have been 12 deaths with a case fatality rate of 0.6%. 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: An increase in the epidemic trend has been noted in the last two weeks. During week 19, 117 new cases were reported compared to 96 cases reported in week 18. This raises the total number of cholera cases reported since the declaration of the cholera outbreak on 27 March 2019 to 6,931 including 8 deaths (CFR, 0.1%). These cumulative number includes; 6,743 cases and eight deaths reported from the Cyclone Idai affected districts of Beira, Buzi, Dondo and Nhamatanda in Sofala Province. A new outbreak of cholera was reported in Cabo Delgado province since 1 May 2019, affecting Pemba city and surrounding districts of Metuge and Mecufi. All areas were affected by the Cyclone Kenneth, with a cumulative total of 178 cholera cases reported.

Somalia: An increase in the epidemic trend has been noted in the last two weeks. During week 18, 47 new cases were reported from Banadir region compared to 36 cases reported in week 17 (week ending 28 April 2019). Cumulatively a total of 889 cases with no deaths have been reported since the beginning of 2019. Children under five years bear the brunt of the cholera outbreak, representing 62% of the total case load reported in week 18. The Banadir districts with the highest under-5 case load in Week 18 were Hodan (11), Medina (7), Darkeneley (4) and Daynile (4). During the week under review (week 18), the most affected districts in Banadir were Hodan (15 cases), Darkeneley (8 cases), Daynile (7 cases) and Medina (7 cases). Overall, the most affected Banadir districts (Week 1-18, 2019) are Medina (71 cases; AR 0.11), Hodan (70; AR 0.05), Daynile (57; AR 0.09) and Darkeneley (48; AR 0.06)

Tanzania: In week 17 (week ending 28 April 2019), 17 new cases and zero death were reported from: Handeni DC (7 cases), Pangani DC (9 cases) and Tanga city (1 case) in Tanga region.

Urban - Rural Disaggregation of Cholera Cases

Overall, more cholera cases emerge from urban areas (79.3%; 7,397) as compared to rural areas (20.7%; 1,933). 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 (7,397), Mozambique accounts for the majority (90.58%; 6,700), followed by Kenya (7.76%; 574), Uganda (0.72%; 53), Tanzania (0.66%; 49), Angola (0.26%; 19), Malawi (0.01%; 1) 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 (73.1%; 1,702) as compared to urban areas (26.9%; 625).