Content uploaded by Anthony B. Nd.
Author content
All content in this area was uploaded by Anthony B. Nd. on Mar 05, 2019
Content may be subject to copyright.
Content uploaded by Anthony B. Nd.
Author content
All content in this area was uploaded by Anthony B. Nd. on Mar 05, 2019
Content may be subject to copyright.
Evidence of cholera outbreaks in 2018 from News Reports
Below is a collection of news reports that document the outbreak of cholera in
Cameroon and neighbouring Nigeria, in 2018, hence validating the first
prediction of the study on cholera cyclicity and El Nino-based prediction. The
news articles all of which are in the public domain are provided here without
any modification of their contents in order to maintain their authenticity. The
purpose is simply to guide the reader to the various sources.
Note: all credit goes to the various publishers, and further information on the
reports is available at the accompanying web-links.
Cameroon: Cholera Outbreak - Jul 2018
Ongoing
Glide: EP-2018-000142-CMR
https://reliefweb.int/disaster/ep-2018-000142-cmr
Overview
The cholera outbreak in Cameroon, officially declared by the Ministry of Health on 15 July
2018, is steadily declining, after peaking in week 29 with 42 cases. In week 32 (week ending 12
August 2018), four new suspected cholera cases were reported, compared to 21 cases reported in
week 31 and 40 cases in week 30. Three of the new cases reported during the reporting week
came from Central Region and one case from North Region...Insecurity in parts of the country
(especially South West Region), where there are reports of frequent kidnappings and attacks by
organized group of bandits, may have implications on surveillance and response efforts.
Additionally, the presence of large number of refugees (from Central African Republic and
Nigeria) living in unsanitary and unhygienic conditions, and with limited access to healthcare
services, is an important factor. The rainy season, which began in May, is expected to last until
September and could facilitate further spread of the disease. (WHO, 10 Aug 2018)
The cholera outbreak that started on 18 May 2018 (Week 20) in Cameroon is persisting. The
outbreak initially spread from the North region of the country to the Central and Littoral regions.
Although the North and Littoral regions continue to report new suspected cases, the Central
region has not reported suspected cases since 27 August 2018 (Week 35). Since our last report on
7 September 2018 (Weekly Bulletin 36) and as of 24 September 2018, an additional 116
suspected cases and 11 deaths have been reported, raising the total number of suspected cholera
cases to 367, including 31 deaths (case fatality ratio 8.4%), 14 of which occurred in the
community. (WHO, 1 Oct 2018)
Cholera has been detected in Far North region, bringing to four the number regions where the
disease has erupted. Seven of the 38 suspected cases reported between 3 – 12 October were in
Far North, where two deaths were also recorded. Humanitarian organizations and the Ministry of
Health are working to curb the spread of infection. However, the area where the disease has been
detected in Far North is hard to reach due to insecurity and bad roads. Since cholera broke out in
July, 470 cases and 34 deaths have been registered. (OCHA, 15 Oct 2018)
Outbreak is showing a decreasing trend. Between 12 to 16 October 2018, one case was
confirmed in the Littoral region and thirty seven new suspected cases notified in North (n=36)
and Littoral. Two deaths were reported in the North. No new case was confirmed in the Central
region since the 27 august 2018. (WHO, 19 Oct 2018)
From 23 to 29 October 2018, 44 new suspected cases were reported from the Far North (8 cases
with zero deaths) and North (36 cases with three deaths) regions. No new confirmed case has
been reported from the Central and Littoral regions since the 27 August 2018 and 11 October
2018 respectively. (WHO, 2 Nov 2018)
The cholera outbreak in Cameroon continue to improve. From 1 January 2019 to date, five new
cases were reported in the north region.The Central and Littoral regions have not reported new
cases since 27 August 2018 and 11 October 2018, respectively. The outbreak has affected four
out of 10 regions in Cameroon, these include North, Far North, Central and Littoral region.
(WHO, 25 Jan 2019)
Plan national de réponse à l’épidémie de choléra au Cameroun, Août -
Octobre 2018
https://reliefweb.int/report/cameroon/plan-national-de-r-ponse-l-pid-mie-de-chol-ra-au-
cameroun-ao-t-octobre-2018
REPORT from Government of Cameroon Published on 31 Jul 2018 — View Original
Download PDF (3 MB)
1. Contexte /Justification
Le choléra, maladie diarrhéique à fort potentiel épidémique est en nette recrudescence dans les
pays en voie de développement. En effet, les estimations font état de 1,4 milliard de personnes à
risque dans les pays endémiques, et chaque année 1,3 à 4 millions de cas de choléra et 21 000 à
143 000 décès dus à la maladie chaque année dans le monde. Ce fléau reste étroitement associé à
un accès insuffisant à l’eau potable, l’absence de mesures d’hygiène et d’assainissement. Cette
maladie reste à l’échelle mondiale un indicateur de l’absence d’équité et de l’insuffisance du
développement. Selon l’OMS, 132 121 cas de choléra dont 2 420 décès ont été déclarés par 38
pays en 2016. La charge morbide de cette maladie reste donc encore forte.
En 2014, le Groupe Spécial Mondial de Lutte contre le Choléra (GTFCC), dont le secrétariat est
hébergé par l’OMS, a été relancé. Il s’agit d’un réseau de plus de 50 parties prenantes actives
dans la lutte contre le choléra à l’échelle mondiale, qui réunit des établissements universitaires,
des Organisations Non Gouvernementales (ONG) et des organismes des Nations Unies. En
octobre 2017, les partenaires du GTFCC ont lancé une stratégie intitulée «Mettre fin au choléra:
une feuille de route jusqu’à 2030». Cette stratégie qui relève des pays vise à faire baisser de 90%
le nombre des décès dus au choléra et à éliminer la maladie dans 20 pays d’ici 2030. La feuille
de route mondiale comporte 3 axes stratégiques :
une détection précoce et une riposte rapide pour endiguer les flambées
une approche multisectorielle ciblée pour éviter une résurgence du choléra
un dispositif efficace de coordination couvrant l’appui technique, la sensibilisation, la
mobilisation des ressources et le partenariat aux niveaux local et mondial.
Le Cameroun, pays d’Afrique Centrale, n’est pas en reste face à cette recrudescence des cas de
choléra, avec une population de 24 863 337 habitants en 2018 (OMS 2018).
Depuis 1971, date à laquelle les premiers cas de maladie ont été notifiés (2000 cas), l’incidence
de la maladie est en nette croissance au fil des périodes épidémiques (4 000 cas en 1991, 5 786
cas en 1996, 8 000 cas en 2004, 10 759 cas en 2010, 23 152 cas en 2011). Les régions les plus
sensibles étant le Littoral et la zone Septentrionale (Extrême-Nord, Nord et Adamaoua). En effet,
les mouvements de populations aussi bien nationaux que transfrontaliers avec le Nigéria ainsi
que les faibles mesures d’hygiènes et l’accès à l’eau potable font de la région septentrionale une
zone à risque d’épidémie de choléra. Il en est de même avec les régions métropolitaines telles
que celles du Centre et du Littoral qui présente des risques liés à l’engorgement, la promiscuité,
les faibles mesures d’assainissement et d’accès à l’eau potable.
Fort de ce retour d’expérience, un plan de contingence a été élaboré en 2015 avec la participation
de tous les acteurs institutionnels et non institutionnels impliqués dans la lutte contre le cholera.
Cholera outbreak in Cameroon: Seventeen die so far
Published on 04.09.2018 at 10h50 by Journal du Cameroun
https://www.journalducameroun.com/en/cholera-outbreak-
cameroon-seventeen-die-far/
Seventeen people have died of cholera in Cameroon’s center and northern regions since the
outbreak was declared in mid-July, the country’s Public Health ministry said monday.
In the same regions, where the cholera vibrio case fatality rate is 1.6 percent and 9.9 percent
respectively, 235 suspected cases were reported, of which 23 were confirmed while five other
regions are considered at “high risk.”
Faced with growing risks, Cameroonian authorities, with the support of the World Health
Organization (WHO) and the United Nations Children’s Fund (UNICEF), say they are updating
the linear list, continuing prevention, surveillance, investigations and sanitation operations and
strengthening the capacities of medical staff.
Nationwide cholera outbreak continues as of mid-November 2018; 54 deaths
reported since May 2018
22 Nov 07:33 PM UTC
TIMEFRAME expected from 11/22/2018, 12:00 AM until 11/28/2018, 11:59 PM
(Africa/Douala). COUNTRY/REGION Cameroon, Far North, North
https://www.garda.com/crisis24/news-alerts/178651/cameroon-nationwide-cholera-
outbreak-continues
As of November 22, at least 863 suspected cases of cholera have been reported in an
outbreak ongoing since May in four regions of the country. At least 54 associated deaths
have been reported. The most affected areas include the Far North
and North
regions.
Context
Cholera, an infectious disease caused by the Vibrio cholerae bacterium, is endemic in
Cameroon. Cholera is typically spread via infected water supplies and induces acute
diarrhea leading to severe dehydration, frequently resulting in death.
Advice
To reduce the risk of contracting cholera, wash hands regularly, drink only bottled or
purified water, and avoid eating raw or undercooked foods. Individuals who believe they
may have contracted cholera should seek immediate medical attention.
Regional cholera outbreak threat in west Africa as cases increase eight-fold in
Lake Chad basin
Aisha Majid, 22 August 2018 • 12:02pm
https://www.telegraph.co.uk/news/2018/08/22/regional-cholera-outbreak-threat-west-africa-
cases-increase/
There are an estimated 1.3 - 4 million cases of cholera worldwide each year
A cholera outbreak is threatening to sweep further into west Africa's Lake Chad basin after the
start of this year’s rainy season led to an unusually high spike in cases of the disease, UNICEF
has warned.
Although the rainy season has just started, cases of the disease in Nigeria, Niger, Mali and
Cameroon – known collectively as the Lake Chad basin – are already up eight-fold compared to
the average caseload over the past four years, with more than 23,000 people affected and 388
deaths reported so far. More than 5 million people are living in outbreak areas.
Nigeria is currently the most impacted country with some 90 per cent of cases.
Under-reporting by governments could mean, however, that real figures are much higher
– particularly in Nigeria where cases could be eight times more than official numbers suggest.
Julien Graveleau, a UNICEF cholera specialist for the region said that the wet weather was
helping the outbreak to spread. “It’s creating an ideal environment for the propagation of
cholera,” he said.
How can someone take care of their hygiene – for example by buying soap – if they live on less
than a dollar a day? Foura Sassou Madi, Medicins Sans Frontiers
A lack of access to clean drinking water and poor sanitation conditions mean that the region is
prone to repeated cholera outbreaks with the most serious recent outbreaks occurring in 2010
when 62,000 people were affected and in 2014 when 41,000 people contracted the disease.
High rates of poverty - with some 60 per cent of people in the four affected countries living on
less than $1.25 a day - means few people can afford basic hygiene measures.
"The real problem is the poverty," said Foura Sassou Madi, medical coordinator for Medicins
Sans Frontiers in Niger. "How can someone take care of their hygiene – for example by buying
soap – if they live on less than a dollar a day?"
War and displacement in Nigeria in particular have also exacerbated the poor hygiene situation in
the area and made conditions for the disease's spread ripe. The ongoing conflict with Boko
Haram has led to the collapse of basic water and sanitation facilities and some 2.4 million people
have fled their homes. Hundreds of thousands of people are living in overcrowded camps
without access to sufficient water or clean toilets.
The current outbreak has already reached a number of major cities including Cameroon’s capital
Yaounde, home to almost 2.5 million people, Daounde in the country’s south and Maradi, a
transport hub of 270,000 people in Niger.
“The next few weeks will define if we have a major outbreak in southern Cameroon,” said
Dr Graveleau.
“One of the concerns we have is we are on track to reach the numbers in the 2014 outbreak - and
we could possibly could reach the numbers in the 2010 outbreak,” he added. “We have clear
concerns about propagation in Yaounde and Daounde and possibly up to Mali and Burkino
Faso.”
Dr Sassou Madi said that Maradi's road link to other parts of the country could lead the outbreak
to spread further into Niger too if it was not quickly contained.
"Maradi is the main road route in the country with a lot of buses travelling from Maradi to other
regions which could spread the outbreak to other parts of the country," he said.
Each time there’s an outbreak we arrive with emergency packages... but cholera is both an
emergency and a development issueDr Julien Graveleau, UNICEF cholera specialist
Cholera is a serious bacterial infection that causes severe watery diarrhoea and stomach cramps
which can lead to dehydration and even death. Around 75 per cent of people who get the disease
do not develop any symptoms making the infection easy to unwittingly pass on. Each year, up to
140,000 people worldwide die from the condition.
Cholera, which can kill within hours if left untreated can be prevented by a vaccine. The
vaccine’s efficacy however, deteriorates over time and is usually only given during outbreaks to
stop the disease's spread, rather than as a longer-term preventative measure.
No large-scale vaccination campaigns have been carried out in the affected areas in Niger and
Cameroon, although Dr Sassou Madi said he was hopeful vaccines could soon arrive in Niger.
He said that with stepped up actions to improve the sanitation situation more generally, the
outbreak could be contained but that so far the response was lagging.
From its origins in east India in the nineteenth century cholera has spread worldwide and cases of
the disease have risen again since 2005.
Although war-torn Yemen is currently home to the world’s largest cholera outbreak with one
million suspected cases, the Lake Chad Basin is one of several regions in Africa where the
disease remains a particular concern year after year.
Dr Graveleau said that the only way to stop the disease from returning to the region was through
more permanent improvements in water and sanitation such as consistent access to clean water
and decent toilets.
“It’s the only way we can stop the cycle of cholera in Africa and especially in the Lake Chad
Basin which is becoming an endemic area,” he said.
“Cholera is not a new disease. It was a very concerning disease a century ago in Europe and we
know how to get rid of it. As a humanitarian community and governments we run from one
outbreak to another. Each time there’s an outbreak we arrive with emergency packages – this is
saving lives – but cholera is both an emergency and a development issue and on the development
side not enough has been done," he said.
"We know where the cholera hotspots are – by targeting four per cent of the population in Africa
(35 million people) we could decrease cholera by 50 per cent.”
“This is the only way we can get out of the continuous cycle of cholera,” he added.
Nigeria: Cholera Outbreak - 2017-2019
https://www.humanitarianresponse.info/ru/disaster/ep-2017-000077-nga
On 7 June 2017, the Nigeria Federal Ministry of Health notified WHO of an outbreak of cholera
in Kwara State in the western part of the country. The initial cases of acute watery diarrhoea
(AWD) started insidiously during the last week of April 2017. Seven stool samples obtained from
the initial cases and analysed at the University of Ilorin Teaching Hospital (UITH) laboratory
isolated Vibrio cholerae O1 as the causative agent. The number of cases and deaths subsequently
increased from the first week of May 2017. As of 14 June 2017, a total of 1,178 suspected cases
and nine deaths (case fatality rate 0.8%) have been reported. Four local government areas have
been affected, including Ilorin West (508 cases), Ilorin East (303 cases), Ilorin South (96 cases),
and Moro (37 cases). ([WHO, 23 Jun 2017](https://reliefweb.int/node/2095509)) The Borno
State Ministry of Health in northeastern Nigeria reported suspected cholera in Muna Garage, a
camp hosting about 20,000 internally displaced persons on the outskirts of the state capital
Maiduguri. A total of 152 cases of suspected cholera, including 11 deaths, as of 31 August 2017,
have been reported. ([OCHA, 1 Sep 2017](https://reliefweb.int/node/2199219)) Over 530
suspected cases had been registered as of 5 September 2017, including 23 deaths (4.3 per cent
fatality rate), mainly in Muna Garage[.] ([OCHA, 6 Sep 2017]
(https://reliefweb.int/node/2204494)) A [Cholera Response and Prevention Plan]
(https://reliefweb.int/node/2225759), seeking US$9,9 million, has been developed to address
the immediate needs of 3.7 million people that could be affected by the outbreak. ([OCHA, 18
Sep 2017](https://reliefweb.int/node/2224814)) There is an ongoing outbreak since the
beginning of 2017. Between 1 January and 31 December 2017, a cumulative total of 4 221
suspected cholera cases and 107 deaths (CFR 2.5%), including 60 laboratory-confirmed were
reported from 87 LGAs in 20 States. Between weeks 1 and 9 of 2018, there have been 210
suspected cases including two laboratory-confirmed and 16 deaths (CFR 7.6%) from 28 LGAs in
9 States. ([WHO, 30 Mar 2018](https://reliefweb.int/node/2538474)) North-east Nigeria is
experiencing recurrent cholera outbreaks, with three states: Adamawa, Borno and Yobe currently
having active transmission... Since February 2018, the three states in north-east Nigeria have
reported a total of 1 664 suspected cholera cases and 31 deaths (case fatality rate 1.9%), as of 27
May 2018. ([WHO, 28 May 2018](https://reliefweb.int/node/2625369)) With more than 14
days since the last reported case of cholera, Yobe State Ministry of Health has declared that the
outbreak is over on 12 June 2018. ([WHO, 12 June 2018](https://reliefweb.int/node/2653139))
The outbreak of cholera in Nigeria has remained persistent since the beginning of 2018. In epi-
week 28 (week ending 15 July 2018), 367 new suspected cases with four deaths (case fatality
ratio 1.1%) were reported from six states – Adamawa (42), Bauchi (56), Katsina (68), Niger (14),
Plateau (11), and Zamfara (176)...As of 18 July 2018, a total of 16 892 suspected cases with 201
deaths (case fatality ratio 1.2%) have been reported from 17 states (Adamawa, Anambra, Bauchi,
Borno, FCT, Gombe, Jigawa, Ebonyi, Kaduna, Kano, Katsina, Kogi, Nasarawa, Niger, Plateau,
Yobe, and Zamfara) since the beginning of 2018...With no new cases reported in the last four
weeks in Anambra, Nasarawa, Borno, and Yobe States the outbreak is considered to be under
control in these states. The decrease in the number of cases has also been reported from
Adamawa State, which has been one of the epi-centres of this outbreak. This is contributing to
the overall declining trend across the country except in Zamfara and Katsina States where the
number of cases reported is still high. ([WHO, 27 Jul 2018]
(https://reliefweb.int/node/2720314)) The Borno State Ministry of Health in northeast Nigeria
has reported 380 cases of suspected cholera in eight local government areas (LGAS) in the state,
including 14 deaths, as of 5 September 2018. Since the outbreak started on 19 August 2018 the
following cases have been recorded: Magumeri (139); Chibok (78); Maiduguri Metropolitan
Council (MMC) (67); Konduga (36); Kaga (28); Jere (18); Damboa (8) and Shani (6). The deaths
are in Magumeri (4); MMC (3); Konduga (3); Chibok (3) and Kaga (1). Of the 380 cases, 250
people have already been treated, the majority with in-patient care, and discharged. ([OCHA, 6
Sep 2018](https://reliefweb.int/node/2775774)) A total of 889 cases of suspected cholera have
been recorded in eight local government areas (LGAs), including 19 deaths, as of 10 September
2018. This represents a fatality rate of 2.1 per cent...The number of cases has increased by 30
percent between 7 September and 10 September 2018, including one additional death. Jere,
Magumeri and Maiduguri Metropolitan Council (MMC) have seen the largest spike in case
numbers, largely due to the poor water, sanitation and hygiene conditions in these areas that are
also congested. ([OCHA, 11 Sep 2018](https://reliefweb.int/node/2781864)) In week 36 (week
ending 9 September 2018), 1 306 suspected cases including 24 deaths (CFR: 1.8%) were
reported from five states: Zamfara (588 cases with 12 deaths), Katsina (377 cases with 12
deaths), Borno (280 cases), Adamawa (55 cases), and Kano (6 cases). As of 9 September 2018, a
total of 27 927 suspected cases including 517 deaths (CFR 1.9%) have been reported from 19
States since the beginning of 2018. There is an overall increasing trend in the number of reported
cases. No new cases were reported in the last three or more weeks from Anambra, Bauchi,
Ebonyi, FCT, Gombe, Jigawa, Kaduna, Kogi, Nasarawa, Niger, Plateau, Sokoto and Yobe states.
There is an almost equal proportion of males and females affected. ([WHO, 14 Sep 2018]
(https://reliefweb.int/node/2790324)) As of 26 September 2018, a total of 3703 cases with 68
deaths (CFR 1.8%) have been reported from twelve health districts in four regions of the country,
namely, Maradi, Dosso, Zender, and Tahoua regions. Madarounfa District in Maradi Region
remains the most affected with 90% of the cumulative cases reported. The majority of cases are
age 5 and above and females constitute 56.2% of the cases reported. A total of 34 samples have
tested positive by culture for Vibrio cholerae 01 inaba. Fourteen percent of the cumulative cases
reported are residents from Nigeria ([WHO, 5 Oct 2018](https://reliefweb.int/node/2821534))
In week 43 (week ending 28 October 2018), 173 new suspected cases with one death were
reported from five states: Adamawa (92 cases with one death), Zamfara (37 cases), Borno (35
cases), Yobe (6 cases), and Katsina (4 cases). There is an overall downward trend in the number
of cases across the country. ([WHO, 23 Nov 2018](https://reliefweb.int/node/2890193)) The
total number of suspected cholera cases in Borno reported between 26th November and 2nd
December 2018 stands at 6,307 with 73 associated deaths ([Gov't Nigeria, 2 Dec 2018.]
(https://reliefweb.int/node/2906648)) 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 Gujba LGA and 488 cases in Damaturu LGA. In
Fune LGA, 181 cases were reported and 67 cases were reported in Potiskum LGA ([Gov't
Nigeria, 2 Dec 2018.](https://reliefweb.int/node/2906663)) There is an overall downward trend
in the number of cases across the country. In week 49 (week ending 9 December 2018), seven
new confirmed cases were reported from Edo (1 case), Ondo (2 cases), Bauchi (1 case), Plateau
(1 case) and Kaduna (2 cases) states. Two new deaths were reported in Kaduna (1) and Ondo (1)
states. No new cases were identified amongst healthcare workers ([WHO, 21 Dec 2018]
(https://reliefweb.int/node/2929874/)) Borno and Yobe States officially declared the end of
cholera outbreaks on 15 January 2019 following zero new cases for more than two consecutive
weeks. Across the country, a declining trend was noted since early November with zero cases
reported in the last three weeks. In 2018, twenty states reported outbreaks of cholera across
Nigeria with Bauchi, Zamfara, Borno, and Katsina states accounting for 74% of the cumulative
cases. ([WHO, 11 Jan 2019](https://reliefweb.int/node/2949644/)) ### Appeals & Response
Plans - [
OCHA: Nigeria 2017 Cholera Response and Prevention Plan (September 2017)]
(https://reliefweb.int/node/2225759) ### Useful Links - [Nigeria Centre for Disease Control:
Weekly Epidemiological Report](http://ncdc.gov.ng/reports/weekly) - [Nigeria Federal
Ministry of Health](http://www.health.gov.ng)
