Sierra Leone cholera factsheet
CHOLERA OVERVIEW
The seventh cholera pandemic was first reported in Sierra Leone in 1970. Since 1990, large-scale epidemics occurred in 1994, 1995 and 20121. The general trend shows that the country has only been intermittently affected by cholera outbreaks (Fig. 1).
During the period 2008-2017, epidemiological surveillance reported 22,738 suspected cholera cases2. A lack of cases reported during certain years may be due to gaps in the surveillance system. The majority of cases were reported in Western Area Province (49.1%) followed by Northern Province (34.9%)2 (Table 1).
Cross-border cholera transmission between Sierra Leone and Guinea has been reported3.
STRATEGIC RECOMMANDATIONS
Cross-border cholera transmission between Sierra Leone and Guinea has been reported. During the 2012 cholera outbreak in Guinea, the index case was found to be a fisherman who had recently arrived by boat from a coastal district of Sierra Leone (Yeliboyah Island, Kambia District), where a cholera outbreak had recently occurred. The fishermen arrived in Khounyi fishing village, on Kaback Island in Guinea. Cholera then spread along the Guinean coast, likely carried by other infected fishermen, before exploding during the rainy season in Conakry and subsequently spreading inland3. Possible importation events by fishermen traveling to Sierra Leone from Liberia and Ghana have also been reported6. These findings highlight the importance of establishing a cross-border early warning system in these coastal areas and promoting surveillance of mobile and vulnerable populations, including fishermen.
In regularly affected districts, preparedness and response plans should include (1) strengthened early warning and rapid response systems including community-based surveillance and cross-border alerts; (2) the establishment of cross-sectoral and cross-border coordination mechanisms; (3) epidemic management capacity building; (4) targeted supply prepositioning; and (5) communication plans and messages. Sustainable access to water, sanitation and hygiene programs should be prioritized in areas often affected by outbreaks (Fig. 5, Table II).
A study assessing the clinical management of patients admitted to cholera wards in 2012 has highlighted the need to improve the quality of triage, adherence to clinical guidance, and record keeping during cholera epidemics. Blacklock et al. have found that many patients were treated for additional diagnoses such as malaria. Furthermore, although nearly all patients admitted received intravenous fluids, the dehydration status of many patients was not documented. Variations in prescribing practices were also observed, including antibiotic choice7.