Cholera Outbreak Situation Report No. 66: 26th November-2nd December 2018 Yobe State Ministry of Health

Highlights: Cholera reactive vaccination exercise conducted between 26th November-2nd December, 2018 in LGA 12 new suspected cholera cases were reported between 26th November- 2nd December from 2 LGAs ( and Gulani) 12 new samples were collected and tested, and yielded positive result for cholera using RDT. 0 death was reported.

Epidemiological Summary: The total number of suspected cholera cases reported in Yobe state is 1,812 with 61 associated deaths (CFR 3.37%). In the state, up to 591 cases have been reported in Gulani LGA, 485 cases in LGA and 488 cases in Damaturu LGA. In Fune LGA, 181 cases were reported and 67 cases were reported in LGA.

Out of 147 samples collected and tested using cholera RDTs, 132 (89.8%) were positive and 15 (11.1%) were negative. Again, 13 (57%) out of 23 samples cultured were positive for Vibrio Cholerae. However, 9 positive samples were taken to national reference laboratory for quality checks and further analysis samples. Vibrio Cholerae O1 (Inaba) serotype was isolated in 4 out of the 9 samples.

Table 1: Summaries of suspected cholera cases in Yobe State from July to 2nd December 2018. Gulani Gujba Damaturu Fune Potiskum Total

Cases

New suspected cholera cases 1 0 11 0 0 12

Cumulative suspected cholera 591 485 488 181 67 1812 cases Number of wards in the LGA 12 10 11 13 10 56 Number of wards affected 10 8 11 9 10 48 Deaths New deaths 0 0 0 0 0 0 Cumulative deaths 20 19 6 12 4 61

Laboratory

Number of specimen tested (RDT) 39 13 83 12 0 147 Specimen Positive RDT 36 12 75 9 0 132 Pending result for RDT 0 0 0 0 0 0 Number of samples cultured 8 8 6 1 0 23 Specimen Positive Culture 5 4 3 1 0 13 Pending result for 0 0 0 0 0 0 Culture

Twelve new suspected cholera case were reported in Yobe state between 26th November- 2nd December 2018, showing the consistent decrease in number of cases compared to that previous week (Fig. 2). Eleven cases were reported from Damaturu (Fig 10). One case was reported from Gulani (Fig 4). No new case was reported from Gujba (Fig 6) in 5 weeks, no new case from Fune (Fig 8) in 6 weeks and Potiskum LGA has not reported any case in 11 weeks (Fig. 12). 1

Figure 1: Map of Yobe State showing number of suspected cholera cases in affected wards and LGAs

60 350 300 50 250 40 200 150 30 100

20 state 50

in Yobes tate 0 10 2-8 Jul 16-22 Jul 30-5th Aug 13-19 Aug 27-2 Sept 10-16 Sept 24-30 Sept 8-14 Oct 22-28 Oct 5-11 Nov 19-25 Nov **

0 7-Jul number of suspected cholera cases in in Yobe cases cholera suspected of number number suspected of cholera cases 5-Oct 8-Sep 3-Aug 16-Jul 25-Jul 1-Nov 14-Oct 23-Oct 17-Sep 26-Sep 12-Aug 21-Aug 30-Aug 10-Nov 19-Nov 28-Nov

Cases Deaths Cases Deaths

Figure 2: Epi-curve of suspected cholera cases in Yobe state. Figure 3: Epi-curve of suspected cholera cases in Yobe state.

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25 90 80 20 70 60 15 50 40 10 30 Gulani 20 5 10 0 0 number of suspected in cholera suspected number cases of number of Suspected Cholera cases in in Gulani cases Cholera Suspected of number 5-Oct 7-Sep 3-Aug 20-Jul 27-Jul 2-Nov 9-Nov 12-Oct 19-Oct 26-Oct 14-Sep 21-Sep 28-Sep 10-Aug 17-Aug 24-Aug 31-Aug 16-Nov 23-Nov 30-Nov

Cases Deaths Cases Deaths

Figure 4: Epi-curve of suspected cholera cases in Gulani LGA. Figure 5: Weekly Epi-curve of suspected cholera cases in Gulani LGA.

35 140 30 120 25 100 80 20 60 15 40 Gujba 10 20 0

in Gujba 5 0 number of suspected in cholera suspected number cases of 7-Jul 3-Oct 1-Sep 9-Sep 8-Aug 15-Jul 23-Jul 31-Jul 4-Nov 11-Oct 19-Oct 27-Oct 17-Sep 25-Sep 16-Aug 24-Aug 12-Nov 20-Nov 28-Nov number suspected of cholera cases Cases Deaths Cases Deaths

Figure 6: Epi-curve of suspected cholera cases in Gujba LGA. Figure 7: Weekly Epi-curve of suspected cholera cases in Gujba LGA.

18 50 45 16 40 14 35 30 12 25 10 20 8 15 10 6 5 4 0 2 0 3-9 Sep 1-7 Oct 27-2 Sep 8-14 Oct 5-11 Nov 10-16Sep 17-23Sep 20-26Aug 15-21Oct Oct22-28 12-18Nov 19-25Nov 24-30Sept 5-Oct 7-Sep 2-Nov 9-Nov 12-Oct 19-Oct 26-Oct 14-Sep 21-Sep 28-Sep number of suspected cholera cases in in Fune cases cholera suspected of number 26Nov-2 Dec 24-Aug 31-Aug 16-Nov 23-Nov 30-Nov 29Oct-4 Nov number of Suspected Cholera cases in in Fune cases Cholera Suspected of number

Cases Deaths Cases Deaths

Figure 8: Epi-curve of suspected cholera cases in Fune LGA. Figure 9: Weekly Epi-curve of suspected cholera cases in Fune LGA

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25 90 80 20 70 60 50 15 40 30 10 20 Damaturu Damaturu 10

in Damaturu 5 0

0 in cases cholera suspected of number 3-9 Sep 1-7 Oct 27-2 Sep 8-14 Oct 5-11 Nov 10-16Sep 17-23Sep 20-26Aug 15-21Oct 22-28Oct number suspected of cholera cases 12-18Nov 19-25Nov 24-30Sept 3-Oct 9-Oct 3-Sep 9-Sep 2-Dec 2-Nov 8-Nov 15-Oct 21-Oct 27-Oct 15-Sep 21-Sep 27-Sep 22-Aug 28-Aug 26Nov-2 Dec 14-Nov 20-Nov 26-Nov 29Oct-4 Nov

Cases Death Cases Deaths

Figure 10: Epi-curve of suspected cholera cases in Damaturu LGA. Figure 11: Weekly Epi-curve of suspected cholera cases in Damaturu LGA

7 25 6 20

5 15 4 10 3

Potiskum 5 2 Potiskum 0 1 0 number of suspected cholera cases in in cases cholera suspected of number 1-7 Oct 3-9 Sept Jul 6-12 Aug 8-14 Oct number of Suspected Cholera cases in in cases Cholera Suspected of number Oct Oct Oct Oct - 27-2 Sept Sep Sep Sep Sep 5-11 Nov Aug Aug Aug Nov Nov Nov Nov 13-19Aug 20-26Aug - - - - 22-28Oct ------10-16Sept 17-23Sept 12-18Nov 15-21Oct 30-5th Aug 24-30 Sept24-30 3 1 9 8 4 31 11 19 27 17 25 19-25Nov ** 16 24 26Nov-2 Dec 12 20 28 29Oct-4 Nov

Cases Death Cases Deaths

Figure 12: Epi-curve of suspected cholera cases in Potiskum LGA. Figure 13: Weekly Epi-curve of suspected cholera cases in Potiskum LGA.

Response Activities

Surveillance: Conducted sporadic testing of new suspected cholera cases using RDT and culture.

WHO have supplied additional cholera test kits to all affected LGAs and prepositions some in the state. The

commodities include; carrier Blair, culture plates and RDT pack.

Continues line listing of all new suspected cholera cases within the city and neighboring communities Surveillance teams comprising MSF-Spain supported volunteers, WHO-supported EHAs, HTR teams and LGA RRT team have continued active case search in communities and health facilities in Gulani, Gujba, Fune and Damaturu. WHO- and MSF-Spain -supported teams conducted house-house visits in affected LGAs reaching up to 325 households in three days. No suspected cholera case was identified. Priority areas have been identified and communicated to WASH and risk communication teams to scale-up interventions.

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Case Management:

Gulani Gujba Damaturu Fune Potiskum Total Admissions

New admissions 1 0 11 0 0 12

New Discharges 1 0 11 0 0 12

On admission 0 0 0 0 0 0

No suspected cholera case was reported in Potiskum LGA since 24th September 2018. No mortality was reported over two months in all affected LGAs.

Risk Communication: Risk communication teams are supporting community sensitization by religious leaders during mosques and churches sermon WHO communications team is collaborating with Yobe State Broadcasting Corporation (YBC) and Yobe State Television (YTV) to continue awareness creation and risk mitigation campaigns through mass media in the state Action Against Hunger (AAH), MSF-Spain, International Rescue Committee (IRC) and UNICEF- supported volunteers continue to sensitize community members on hygiene promotion and risk mitigation. Teams are also demonstrating to community members proper hand washing and water purification, and are educating them on dangers of open defecation around homes and water sources. The teams have collectively reached up to 2145 households in Damaturu, Gujba, Fune and Gulani LGAs between 26th- November-2nd December 2018.

WASH: Community health volunteer supported by WHO continue to strengthening house-house hygiene promotions, health educations as well as disinfections of household in Damaturu, Gulani and Gujba LGAs UNICEF, AHH, MWR and RUWASA supported teams are intensifying response activities through bucket-to bucket chlorination, clearing of drainages and refuse dumps, and disinfecting households in Gulani and Damaturu LGAs.

Coordination: LGA RRTs in Gulani and Damaturu LGAs are conducting regular local coordination meetings to ensure targeted response in few areas that reported cases in the past 3-4 days. SMOH and SPHCMB with the support from NPHCDA monitor and coordinate the cholera reactive vaccination in Gulani State RRT meetings take place on Mondays, Wednesdays and Fridays to review the situation in the state, mobilize resources and offer technical guidance to LGAs team to halt transmission of infection in the few remaining areas.

Reactive Vaccination: SMOH, WHO, MSF-Spain and partners conducted review and planning meeting for Oral Cholera Vaccination (OCV) campaign which is set to commence on 26th November, 2018, in Gulani LGA. MSF-Spain, SMOH and WHO conducted necessary resources and personnel for implementation and supervision of 5- day vaccination exercise. LGA level training of the personnel has been conducted NPHCDA has deployed staff to provide supervisory support during the exercise.

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Completed first round of cholera reactive vaccination exercise in Gulani LGA through collaboration of SMOH, NPHCDA, SPHCMB, WHO, UNICEF and MSF-Spain. Total people targeted for vaccination in Gulani LGA with (Oral Cholera Vaccine) is 102,528. Total people vaccinated after 5- days of implementation is 68,620, achieving a coverage of 67%. The intervention was constrained by BHT attacks on some communities around Gulani LGA during implementation, insecurity in the general area and bad geographical terrain

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