Email: [email protected]

Toll free number for alert is 08089001 or 08089002 or 08089000 Office of the WHO Representative in

Mobile number for alerts is 0912 104 257 Date of issue:04th January, 2008

DAILY CHOLERA UPDATE 4th January, 2009 * Please note that daily information collection is a challenge du to communication and staff constraints. On-going data cleaning may result in an increase or decrease in the numbers. Any change will then be explained. ** Daily information on new deaths should not imply that these deaths occurred in cases reported that day. Therefore daily CFRs >100% may occasionally result

1- Highlights of the day: • 379 cases and 32 deaths added today (in comparison 693 cases and 9 deaths yesterday) • 50 % of the districts affected have reported today (27 out of 54 affected districts) • 87 % of districts reported to be affected (54 districts/62) • All 10 of the country's provinces are affected

Districts reported an high Districts with a daily CFR > 5% : Districts with high number of Districts which have not reported for more than 3 number of cases today (cases 1. Chitungwisa deaths outside health days: added today> 30) 2. Goromonzi facility/ CTC > 3 Goromonzi Gokwe North 1. Goromonzi 3. Hwedza Nil 2. Makonde 4. Makonde Chikomba 3. Norton 5. Zwimba UMP Chivi

6. Norton 7. Makoni 8.

2- Conclusion of the day: High priority districts to investigated today Priority districts to call back on the phone (as delay of more than 3 days to report) and in red High priority districts which needs field visit (no report for more than 7 days) • Goromonzi • Chitungwisa Goromonzi Gokwe North • Makonde • Hwedza Mutoko Shurugwi Chikomba Buhera • Norton • Zwimba UMP Chivi • Zvishavane • Makoni

Source: Ministry of Health and Child Welfare Rapid Disease Notification System 1

3- Follow up actions District Flagged as a priority on Action taken and next step (when and who will be doing what) Status of the follow up Makonde • 27/12/08 (CFR High) • Contacted them again by phone on 29/12/08 On-going • Flag again on 31/12/09 • Coordinator C4 has advised MoH+WHO to contact District Medical Officer and district (CFR High) environment health officer tomorrow • Need fuel. PMD currently visiting districts to assess situation • No communication, data sent by e mail • 27/12/08 (High Number • Contacted them again by phone on 28/12/08 On-going of cases) • There was a problem of data reporting • Flag again on 31/12/09 • But still after correction more than 30 cases reported on one day (High number of cases) • Action ? • Need fuel. PMD currently visiting districts to assess situation Kadoma • 03/01/09 (High CFR) • Communication problem On-going • 03/01/09 • 4 cases reported in new area (). PNO relayed information. PMD office following On going up • Communication problem 04/01/09 • 03/12/08 (High CFR) • PMD aware and still investigating. High CFR believed to be due to late presentation and Done weak active case finding • The increase in cases and deaths was as a result of influx of cases last week in Human Ranch, Ingus and Mukati farms (New Resettlement). The cases were reported at Odzi and (Bikita District) and Porepore, Nyangombe and Tshovani Polyclinic (). The area is under close monitoring and the province is on alert of new areas and proactive Bikita • 03/01/09 • Four cases reported from Mangezi area. CTC set up Done • The increase in cases and deaths was as a result of influx of cases last week in Human Ranch, Ingus and Mukati farms (New Resettlement). The cases were reported at Odzi and Mashoko (Bikita District) and Porepore, Nyangombe and Tshovani Polyclinic (Chiredzi District). The area is under close monitoring and the province is on alert of new areas and proactive Chivi • 03/01/09 (No reported • Communication problem On-going cases) Mberengwa • 03//01/2009 (High CFR) • Communication Problems On-going Mwenezi • 03//01/2009 (High CFR) • PMD aware and still investigating. High CFR believed to be due to late presentation and On-going weak active case finding City • 29/12/08 • Communication problem On-going • Flag again on 31/12/08 Nyanga • 03/01/09 • Cholera cases reported from Chikore (bordering Makoni and Mudzi) Districts. District Done • Flag again 04/01/09 quantifying the problem. Will appraise District coordinating committee on Monday. Partners to be dispatched from Provincial level if need arise • To folloup on updates • Chikore (in Nyanga) data was captured under Makoni where the CTC was available (10 cases and 1 death). In response to Nyanga cases being attended in Makoni, a CTC was opened at Nyanómbe. Supplies collected from PMD on 03 January 2009 and CTC was to

Source: Ministry of Health and Child Welfare Rapid Disease Notification System 2 District Flagged as a priority on Action taken and next step (when and who will be doing what) Status of the follow up be in place on 03/01/2009 Guruve • 29/12/08 • Communication problem. Radio not working, No fuel, only 1 vehicle in PMDs office On-going • 03/01/09 • Cases from Chiturapasi area were there have been no cholera cases for two weeks. On-going • Flag again 04/01/09 DEHO and CHS have gone for investigation. To update tomorrow • CTC not yet opened in Bubi area. District to decide where to establish the CTC and update • No report from Chituripasi but there were 9 cases admitted. Flora farm is on the border between Mat South and . MSF in Mat South is limited to Beitbridge and setting of CTC is difficult . Mwenezi not responding to the call for SOS. Contacted PHO Masvingo, nearest CTC is at Mwenezi. There is MSF in Masvingo as well. Response team will be sent to assess situation. Conditions permitting a CTC will be set. • Beitbridge has a comparative advantage in terms of transport and being a district hospital, patients prefer going there. Shurugwi • 30/12/08 • Communication problem On-going Zvishavane • 03/01/09 • Out of stock of Ringers lactate On-going • Flag again 04/01/09 • Logistician to liaise with province on quantity required • Out of stock of Chloride of lime. Asked to list everything which is out of stock and quantify rural • 30/12/08 • No communication, data sent by e mail On-going • Flag again on 02/01/09 • Follow up with Save the Children and PMD • Alert – increase of cases in Mola received on 02/01/2009 – Dr Charimari to FU • Communication problem as of 03/01/09 Hurungwe • 30/12/08 • No communication, data sent by e mail On-going • Flag again on 31/12/08 • Follow up with PMD (03/01/09) • 03/01/09 (High number of • Communication problem cases) Goromonzi • 31/12/08 • Communication problem On-going Centenary • 31/12/08 • No update because of communication problems. On-going • Flag again 03/01/09 • Access to Muzarabani still a problem because of floods. Patients failing to get through to (High CFR) the treatment centres Seke • 31/12/08 • Update received On-going • Run out of Chloride of lime, protective clothing and spray pumps • List forwarded to Logistician Chikomba • 04/01/09 • There are no CTCs set up at Sadza and areas. No fuel, tents and supplies although On-going there are some cases being reported.

Source: Ministry of Health and Child Welfare Rapid Disease Notification System 3 4- Epidemiological data Today's update Province District/area Cases Deaths CFR of Communit Cumulativ Cumulativ Lethality/ Communit Proportion Date last Number affected added added cases y Deaths e Cases e Deaths Cumulativ y Deaths Communit updated of days today today added added e CFR (%) (included y Deaths since today today in the (%) previous (%) total) report 5 1 20.0 879 148 16.8 4/01/2009 0 Harare 25 0 0.0 0 10419 234 2.2 16 6.8 4/01/2009 0 Bulawayo 0 0 0.0 - 375 12 3.2 8 66.7 4/01/2009 0 urban Mashonalan Shamva - - - - 39 8 20.5 8 100.0 4/01/2009 0 d Central Centenary - - - 2 117 13 11.1 9 69.2 2/01/2009 2 Mazowe - - - 0 131 4 3.1 3 75.0 4/01/2009 0 Guruve - - - - 44 7 15.9 7 100.0 4/01/2009 0 Mbire - - - - 7 0 0.0 0 - 4/01/2009 0 Mt Darwin - - - - 36 2 5.6 1 50.0 4/01/2009 0 - - - 0 129 8 6.2 6 75.0 4/01/2009 0 Rushinga - - - - 78 4 5.1 4 100.0 4/01/2009 0 Mashonalan Mudzi - - - - 1966 120 6.1 60 50.0 3/01/2009 1 d East Murehwa - - - -9814 14.3 10 71.4 31/12/200 4 8 Goromonzi 113 8 7.1 5 502 34 6.8 24 70.6 4/01/2009 0 Mutoko - - - - 154 32 20.8 25 78.1 31/12/200 4 8 1 0 69 7 10.1 5 71.4 4/01/2009 0 Chikomba - - - 67 5 7.5 5 100.0 31/12/200 4 8 Hwedza 9 1 11.1 1 24 2 8.3 1 50.0 4/01/2009 0 UMP - - - 47 19 40.4 5 26.3 31/12/200 4 8 Seke - - - 0 437 20 4.6 16 80.0 4/01/2009 0 Mashonalan Makonde 113 11 9.7 7 2766 87 3.1 37 42.5 4/01/2009 0 d West Kariba - - 0 233 5 2.1 1 20.0 2/01/2009 2 Mahombekomb e

Source: Ministry of Health and Child Welfare Rapid Disease Notification System 4 Today's update Province District/area Cases Deaths CFR of Communit Cumulativ Cumulativ Lethality/ Communit Proportion Date last Number affected added added cases y Deaths e Cases e Deaths Cumulativ y Deaths Communit updated of days today today added added e CFR (%) (included y Deaths since today today in the (%) previous (%) total) report Kariba Rural - - 0 289 18 6.2 10 55.6 2/01/2009 2 Zvimba 4 1 25.0 1 150 12 8.0 6 50.0 4/01/2009 0 Kadoma - - 0 1061 50 4.7 27 54.0 2/01/2009 2 Hurungwe 2 0 0.0 0 527 27 5.1 18 66.7 4/01/2009 0 Norton 45 3 6.7 0 739 31 4.2 11 35.5 4/01/2009 0 Chegutu 25 00.0 0 2027 141 7.0 29 20.6 4/01/2009 0 Manicaland Mutasa - - - - 9 5 55.6 5 100.0 3/01/2009 1 Mutare City 0 0 - - 16 1 6.3 0 0.0 4/01/2009 0 Buhera - - - - 756 31 4.1 27 87.1 29/12/200 6 8 - - - - 657 42 6.4 27 64.3 3/01/2009 1 Makoni 17 3 17.6 3 363 48 13.2 40 83.3 4/01/2009 0 Mutare - 3 - - 1239 67 5.4 65 97.0 4/01/2009 0 Chimanimani - - - 658 35 5.3 15 42.9 3/01/2009 1 Matebelelan Lupane 0 0 - - 2 0 0.0 0 - 4/01/2009 0 d North Matabelelan 0 0 0 69 7 10.1 3 42.9 4/01/2009 0 d South Plumtree 0 0 - - 3 0 0.0 0 - 4/01/2009 0 Beitbridge 19 00.0 0 3780 119 3.1 39 32.8 4/01/2009 0 Masvingo Masvingo - - - 0 437 45 10.3 17 37.8 3/01/2009 1 Gutu - - - 0 26 3 11.5 1 33.3 3/01/2009 1 Chivi - - - - 441 54 12.2 42 77.8 30/12/200 5 8 Bikita - - - - 303 31 10.2 21 67.7 3/01/2009 1 Chiredzi - - - 0 620 31 5.0 18 58.1 3/01/2009 1 Mwenezi - - 0 179 18 10.1 12 66.7 2/01/2009 2 Zaka - - 0 111 21 18.9 21 100.0 2/01/2009 2 Midlands City 0 0 - - 182 4 2.2 2 50.0 4/01/2009 0 (Mkoba) Zvishavane 1 1 100.0 1 116 11 9.5 8 72.7 4/01/2009 0 Mberengwa - - 4 103 20 19.4 18 90.0 2/01/2009 2

Source: Ministry of Health and Child Welfare Rapid Disease Notification System 5 Today's update Province District/area Cases Deaths CFR of Communit Cumulativ Cumulativ Lethality/ Communit Proportion Date last Number affected added added cases y Deaths e Cases e Deaths Cumulativ y Deaths Communit updated of days today today added added e CFR (%) (included y Deaths since today today in the (%) previous (%) total) report Gokwe North - - - - 12 5 41.7 5 100.0 31/12/200 4 8 Gokwe South - - 1 32 1 3.1 1 100.0 2/01/2009 2 Kwekwe - - - 0 30 1 3.3 0 0.0 3/01/2009 1 Shurugwi - - - - 23 6 26.1 6 100.0 12/12/200 23 8 Chirumhanzu - - - - 2 1 50.0 1 100.0 3/01/2009 1 Total 379 32 8.4 25 33579 1671 5.0 746 44.6

Source: Ministry of Health and Child Welfare Rapid Disease Notification System 6