Cholera Outbreak Situation Report No. 68: 10th -16th December 2018 Yobe State Ministry of Health

Highlights: 0 case was reported 0 death was reported.

Epidemiological Summary: The total number of suspected cholera cases reported in Yobe state is 1,813 with 61 associated deaths (CFR 3.36%). In the state, up to 591 cases have been reported in LGA, 485 cases in LGA and 489 cases in Damaturu LGA. In LGA, 181 cases were reported and 67 cases were reported in LGA.

Out of 148 samples collected and tested using cholera RDTs, 133 (89.9%) were positive and 15 (10.1%) 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 16th December 2018. Gulani Gujba Damaturu Fune Potiskum Total

Cases

New suspected cholera cases 0 0 0 0 0 0

Cumulative suspected cholera 591 485 489 181 67 1813 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 39 13 84 12 0 148 (RDT) Specimen Positive 36 12 76 9 0 133 RDT Pending result for 0 0 0 0 0 0 RDT 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

No new suspected cholera case was reported in Yobe state between 10th – 16th December 2018, showing a possible end to the outbreak. The last case reported was on the 3rd December 2018. No case was reported from Damaturu (Fig 10) in thirteen days while Gulani (Fig 4) didn’t report any case more than two weeks. No new case was reported from Gujba (Fig 6) in 7 weeks as well as no new case from Fune (Fig 8) in 8 weeks and Potiskum LGA has not reported any case in 13 weeks (Fig. 12).

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

60 350 300 50 250 40 200 30 150 100 20 state 50 in Yobes tate 10 0 0 2-8 Jul 3-9 Dec 7-Jul number of suspected cholera cases in in Yobe cases cholera suspected of number 16-22 Jul number suspected of cholera cases 8-14 Oct 5-Oct 8-Sep 27-2 Sept 5-11 Nov 7-Dec 3-Aug 16-Jul 25-Jul 1-Nov 13-19 Aug 13-19 22-28 Oct 14-Oct 23-Oct 17-Sep 26-Sep 10-16 Sept 19-25 Nov 19-25 16-Dec 12-Aug 21-Aug 30-Aug 30-5th Aug 30-5th 10-Nov 19-Nov 28-Nov 24-30 Sept

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 cases suspected ofnumber 3-9 Dec 27-2 Sep 16-22 Jul number of Suspected Cholera cases in in Gulani cases Cholera Suspected of number 8-14 Oct 8-Oct 6-Sep 5-11 Nov 3-Dec 5-Aug 20-Jul 28-Jul 1-Nov 9-Nov 10-16 Sep 13-19 Aug 22-28 Oct 24-30 Sep 16-Oct 24-Oct 14-Sep 22-Sep 30-Sep 11-Dec 13-Aug 21-Aug 29-Aug 19-25 Nov 17-Nov 25-Nov 30-5th Aug 30-5th

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 Jul 8 2 Sep 2 - 9 Dec 9 22 Jul - - 16 Sep 30 Sep 2 - 19 Aug 14 Oct 14 Oct 28 Oct - - 3 11 Nov 11 Nov 25 Nov - 5th 5th Aug number of suspected in cholera suspected number cases of - - - - - 16 8 7-Jul 5 10 24 13 5-Oct 22 8-Sep 7-Dec 3-Aug 16-Jul 25-Jul 1-Nov 19 14-Oct 23-Oct 17-Sep 26-Sep 16-Dec 12-Aug 21-Aug 30-Aug 10-Nov 19-Nov 28-Nov number suspected of cholera cases 27 Aug Cases Deaths 30 Jul 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 16 45 40 14 35 12 30 25 10 20 8 15 10 6 5 4 0 2 0 3-9 Sep 3-9 Dec 1-7 Oct 27-2 Sep 8-14 Oct 5-11 Nov 10-16Sep Sep17-23 10-16Dec 20-26Aug 15-21Oct 22-28Oct 12-18Nov Nov 19-25 24-30Sept 5-Oct 7-Sep 7-Dec 2-Nov 9-Nov 12-Oct 19-Oct 26-Oct 14-Sep 21-Sep 28-Sep 14-Dec 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 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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90 90 80 80 70 70 60 60 50 50 40 40 30 30 20 Damaturu Damaturu Damaturu Damaturu 20 10 10 0 0 number of suspected cholera cases in in cases cholera suspected of number number of suspected cholera cases in in cases cholera suspected of number 3-9 Sep 3-9 Dec 1-7 Oct 27-2 Sep 8-14 Oct 5-11 Nov 10-16Sep 17-23Sep 20-26Aug 15-21Oct 22-28Oct 12-18Nov 19-25Nov 24-30Sept 26Nov-2 Dec 29Oct-4 Nov

Cases Deaths 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

Potiskum 2 5

1 0 0 number of suspected cholera cases in in cases cholera suspected of number number of Suspected Cholera cases in in cases Cholera Suspected of number Jul Oct Oct Oct Oct Sep Sep Sep Sep - Dec Dec Aug Aug Aug Nov Nov Nov Nov ------3 1 9 6 8 4 31 11 19 27 17 25 14 16 24 12 20 28

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.

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 206 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 0 0 0 0 0 0

New Discharges 0 0 0 0 0 0

On admission 0 0 0 0 0 0

No suspected cholera case was reported in Potiskum LGA since 24th September 2018. No case reported in the state since 3rd December 2018 No mortality was reported over two months in all affected LGAs.

Risk Communication: Airing of radio jingles on health seeking behavior and cholera prevention with Yobe State Broadcasting Corporation (YBC) and Yobe State Television (YTV) to continue along with chrismas day messages. WHO communications team is collaborating 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. The teams have collectively reached up to 187 households in Damaturu, Gujba, Fune and Gulani LGAs between 10th -16th December 2018.

WASH: Routine WASH activities has been sustained 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. 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 in order to sustained the gain recorded.

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