WHO Zimbabwe Background

Home , Buhera, Chikomba District, Gokwe South District, Kariba (District), Kwekwe District, Makoni District

CHOLERA UPDATE 20/02/06

• Diarrhoeal disease caused by bacterium Vibrio cholerae (Type 01 or 0139 Ogawa). • Transmitted through faecally contaminated water or food. • Easily treated with rehydration (IV or Orally),give antibiotic in severe cases. • Mainly associated with poor sanitation, unsafe water supplies, poor hygiene practices-(greatest risk in over pop communities). Background • The first outbreak was reported in 1972 from Mashonaland East (Nyamapanda district) and Mashonaland Central (Mt Darwin District). • There after outbreaks were experienced after every 10 years up to 1992. • As from 1993, outbreaks occurred after five years. • Since the millennium, cholera occurrence was annually. • Outbreaks have been persistent in Zimbabwe in the last 5 years Epidemiology of Current Outbreak • Outbreak started in Chikomba on 28/11/05, and only reported on 13/12/05 • Buhera started on 17/12/05 • Chikomba district established one treatment camp –Mushipe treatment camp Epidemiology of Current Outbreak • Buhera district established 4 treatment camps at – Murambinda hospital – Munyanyi Health centre. – Rambanapasi health centre – Chiwenga health centre • Harare outbreak reported on 29 December 2005 in Glenview 8, not linked to Chikomba and Buhera cases. • Makoni reported suspected cases 21/01/06, confirmed. Current outbreak contd

MIDLANDS • Kwekwe District first suspected case 08/01/06 died on 14/01/06 • Gokwe South District first case death on 26/01/06 relatives of Kwekwe index case visited to pay condolences MASH EAST Epworth suspected case reported on 09/02/06. Laboratory confirmed Cholera affected areas since 2000 Summary of cases as of 14/02/06

District Cases Deaths Case Fatality (%)

Chikomba 296 5 3.9

Buhera 104 8 7.7

Harare 14 3 21.4

Makoni 35 2 5.7

Gokwe South 75 5 6.7

Kwekwe 71 0 0 Epworth 44 5 11.3

Chimanimani 13 0 0 Kariba 1 0 0 Total 653 30 4.6 NATIONAL CHOLERA EPICURVE (CHIKOMBA, BUHERA AND MAKONI)

25 The t wo had at t anded f uneral in Chikomba developed signs and lef t f or National home (Buhera), died and rect al swab response Index case both died - dealing t aken, conf irmed posit ive. Mashonaland 20 with M arange sect which is East inf ormed of t he out break and t he secretive cholera spread in Buhera Cholera spreads to 15 Makoni district

Number 10 Died and Buhera relatives came for funeral developed signs, left for 5 Buhera

0 38364 38423 38484 38545 38607 38668 38749 38808 38869 38930 38991 39052 21/11/2005 23/11/2005 25/11/2005 27/11/2005 29/11/2005 13/12/2005 15/12/2005 17/12/2005 19/12/2005 21/12/2005 23/12/2005 25/12/2005 27/12/2005 29/12/2005 31/12/2005 14/01/2006 16/01/2006 18/01/2006 20/01/2006 22/01/2006 24/01/2006 26/01/2006 28/01/2006 30/01/2006 Date of Onset

Buhera Chikomba Makoni Chikomba Cholera Cases and Deaths Epi-curve

15 Number 10

0 21/11/2005 24/11/2005 27/11/2005 30/11/2005 3/12/2005 6/12/2005 9/12/2005 12/12/2005 15/12/2005 18/12/2005 21/12/2005 24/12/2005 27/12/2005 30/12/2005 2/1/2006 5/1/2006 8/1/2006 11/1/2006 14/01/2006 17/01/2006 20/01/2006 23/01/2006 26/01/2006 29/01/2006 1/2/2006 4/2/2006 7/2/2006

Dates

Chikomba Cases Chikomba Deaths Buhera cholera epicurve

12 10 8 6

Number 4 2 0 4/2/2006 3/1/2006 7/1/2006 11/1/2006 2/12/2005 15/01/2006 19/01/2006 23/01/2006 27/01/2006 31/01/2006 28/11/2005 17/12/2005 22/12/2005 26/12/2005 30/12/2005 Data of onset Cholera Epicurve - Gokwe South

15 Number 10

0 ?? 1/2/2006 2/2/2006 3/2/2006 4/2/2006 5/2/2006 6/2/2006 7/2/2006 8/1/2006 8/2/2006 9/2/2006 7/2/2006 8/1/2006 9/2/2006 10/2/2006 11/2/2006 12/2/2006 13/02/2006 19/01/2006 20/01/2006 21/01/2006 22/01/2006 23/01/2006 24/01/2006 25/01/2006 26/01/2006 27/01/2006 28/01/2006 29/01/2006 30/01/2006 31/01/2006 Date of onset

Alive Died Cholera Epicurve - Kwekwe

9 8

Number 4

0 ?? 1/2/2006 2/2/2006 3/2/2006 4/2/2006 5/2/2006 6/2/2006 7/2/2006 8/1/2006 8/2/2006 9/2/2006 7/2/2006 8/1/2006 9/2/2006 10/2/2006 11/2/2006 12/2/2006 19/01/2006 20/01/2006 21/01/2006 22/01/2006 23/01/2006 24/01/2006 25/01/2006 26/01/2006 27/01/2006 28/01/2006 29/01/2006 30/01/2006 31/01/2006 13/02/2006 Last WeekLast Date of onset Makoni cholera epicurve

9 8 7 6 5

Number 4 3 2 1 0 1/2/2006 3/2/2006 7/2/2006 12/1/2006 10/2/2006 12/2/2006 14/01/2006 16/01/2006 18/01/2006 20/01/2006 22/01/2006 24/01/2006 26/01/2006 28/01/2006 30/01/2006 14/02/2006 16/02/2006 18/02/2006 20/02/2006 Date of onset Chimanimani cholera epicurve 4

3 r 2 Numbe

0 1/2/2006 3/2/2006 7/2/2006 10/2/2006 12/2/2006 14/02/2006 16/02/2006 18/02/2006 20/02/2006 16/01/2006 18/01/2006 20/01/2006 22/01/2006 24/01/2006 26/01/2006 28/01/2006 30/01/2006 Date of onset Epworth Cholera Epicurve 10 9 8 7

r 6 5 4 Numbe 3 2 1 0 21.01.06 23.01.06 25.01.06 27.01.06 29.01.06 31.01.06 03.02.06 05.02.06 08.02.06 10.02.06 12.02.06 14.02.06 16.02.06 18.02.06 Date of onset

Alive Died Risk factors identified

• Poor sanitation coverage in the affected areas and use of pit latrines which are filling-up • Poor safe water supplies coverage • Use of River water and unprotected shallow wells • Religious beliefs (Mainly Marange Apostolic Sect Chikomba and Buhera.) • Community knowledge on cholera (first time to experience cholera). • Illegal vending Response to Epidemic • Coordination meetings.(Inter-Agency) • Technical and logistical support from MOH&CW HQ and WHO(see list of distributed items ) • Deployment of Health personnel to affected areas. • Establishment of treatment centres. • Surveillance, and contact tracing. • Case management. • Social mobilisation and supply of IEC materials. • Water chlorination Gaps identified by supporting team • Inadequate infection control at treatment centres. • Incomplete Epidemiological investigations • Low community participation • No construction of temporary sanitary facilities in the community Gaps identified Partners contribution • The following organisations supported MOH&CW with Drugs and material resources. –WHO – UNICEF –MSF – Red Cross – Civil Protection Committee (DDF working on water requirements) • Coordination meeting held and partners sensitized on additional resources which might be required. Partners contribution

• Other Organisations are in the process of identifying needs. (short and long term). Partners contribution Challenges • Low water and sanitation coverage in affected areas. • Participation of Apostolic sects in the control programme. • Establishment of community based surveillance groups. • Hygiene practices. Challenges Challenges Way Forward • Mobilize resources for future outbreaks (drugs, IV fluids, gas, Lab consumables, disinfectants) • Provision of Water and sanitation facilities in affected areas. (Provinces to submit water and sanitation projects for funding, to be shared with partners). • Establish community based surveillance groups. • Continue training of Health Workers at sub- district level in Integrated Disease Surveillance and Response. • PHHE training