Clinical Updates
3 August 2009
Cholera activity 2009: global update
Cholera is an acute diarrhoeal disease, caused by the Gram negative bacillus Vibrio cholerae serogroup O1 or O139. Cholera is endemic to large parts of Africa, Eurasia, South and South East Asia [1,2] and usually occurs in areas where food and water hygiene and sanitation are inadequate. Sporadic outbreaks and epidemics occur in low income countries throughout the world, particularly where large populations are displaced following natural disasters or conflict.
This update reports on a number of recent verified cholera outbreaks; it is not a comprehensive listing. Further information on reported and suspected outbreaks can be accessed via the NaTHNaC Outbreak Surveillance Database and by searching for previous Clinical Updates on cholera.
Africa
Angola
Since January 2009, 1,250 cases with 35 deaths have been reported countrywide [3]. As of the week of 12 July 2009 15 new cases, with no deaths had been reported from the provinces of Bengo, Benguela, Huila, and Malange [3].
DR Congo
As of 20 July 2009, 4,326 cases with 63 deaths have been reported in South Kivu, and 2,342 cases with 27 deaths in North Kivu [3].
Kenya
As of 20 July 2009, 4,269 suspected cases with 94 deaths have been reported from 32 districts countrywide [3].
Malawi
Between 15 November 2008 and 20 July 2009, 5,269 cases were reported [4]. The most recent reports of new cases were during the period of 18 to 24 May, with 17 cases reported from Machinga district [4].
Mozambique
As of 16 May 2009, 17,761 cases with 140 deaths were reported from 54 districts [4].
South Africa
As of 1 June 2009, 12,752 cases with 65 deaths have been reported. Cases were from all 9 provinces with most cases from Limpopo (5,520), Mpumalanga (6,855), and Gauteng (286) [4].
Swaziland
Between December 2008 and 1 June 2009, 17,448 cases of Acute Watery Diarrhoea (AWD) were reported [4]. Two of the AWD cases have been confirmed as cholera [4].
Zambia
Between 10 September 2008 and 7 May 2009, the cumulative number of cases reported was 8,219 with 173 deaths [5].
Zimbabwe
The cholera outbreak that started in August 2008 continues to diminish. Since 13 June 2009, only one case has been reported (UMP district) [6], bringing the cumulative number of cases to 98,592 with 4,288 deaths [7].
South Asia
Nepal
As of 30 July 2009, there have been 27,456 cases of diarrhoeal illness in the remote Jajarkot district, with 197 deaths [8]. The infection has spread to adjoining districts including Rukum, Salyan, Surkhet, Rolpa, Dailekh, and Dang (mid-western region), and to Bajura and Dadeldhura (far-west region) [8,9]. This outbreak of diarrhoea is being treated as cholera following the isolation of Vibrio cholerae in some samples examined by the National Public Health Laboratory of Nepal [9].
Advice for travellers
Cholera is transmitted through contaminated food and water in areas of poor sanitation. Travellers should practise food and water hygiene precautions. Those at higher risk, for whom cholera vaccination is usually recommended, include humanitarian aid workers and those travelling to areas experiencing an outbreak who will have limited access to safe drinking water or medical care [10,11].
Recommendations for cholera vaccination can be found on the NaTHNaC Country Information Pages.
References
1. World Health Organization. International travel and health 2009. Cholera: countries reporting outbreaks and cases 2006-2008 [Accessed 30 July 2009]. Available at: http://gamapserver.who.int/mapLibrary/Files/Maps/Global_
2. World Health Organization. Cholera: global surveillance summary 2008. Wkly Epidemiol Rec. 31. 2009;34:309-324
3. World Health Organization, Africa Region. Weekly Emergency Situation Update. 20 July 2009; Vol 2. No.29. [Accessed 29 July 2009]. Available at: http://www.reliefweb.int/rw/RWFiles2009.nsf/FilesByRWDocUn
idFilename/MWAI-7U92SK-full_report.pdf/$File/full_report.pdf
4. United Nations Office for the Coordination of Humanitarian Affairs (OCHA). Regional Update No. 10 – Cholera/Acute Watery Diarrhoea Outbreaks in Southern Africa 1 June 2009. [Accessed 29 July 2009]. Available at: http://ochaonline.un.org/rosa/HumanitarianSituations/Cholera
Update/tabid/5122/language/en-US/Default.aspx
5. United Nations Office for the Coordination of Humanitarian Affairs (OCHA). Cholera Outbreaks/Acute Watery Diarrhoea in Southern Africa – cumulative cases and deaths by province. 1 June 2009 [Accessed 3 August 2009]. Available at: http://www.reliefweb.int/rw/fullMaps_Af.nsf/luFullMap/BC25F0D
3260EB89DC12575CA00494DF5/$File/map.pdf?OpenElement6. Ministry of Health and Child Welfare, Zimbabwe. Daily cholera update and alerts 10 July 2009. [Accessed 30 July 2009]. Available at: http://www.reliefweb.int/rw/RWFiles2009.nsf/FilesByRWDoc
UnidFilename/PSLG-7TYGR8full_report.pdf/$File/full_report.
7. Ministry of Health and Child Welfare, Zimbabwe. Daily cholera update and alerts 27 July 2009. [Accessed 30 July 2009]. Available at: http://www.reliefweb.int/rw/rwb.nsf/db900sid/myai-7ud5ej
8. World Health Organization. Regional Office for South-East Asia. Diarrhoea outbreak in Nepal. Situation report: 30 July 2009. [Accessed 3 August 2009]. Available at: http://www.searo.who.int/LinkFiles/EHA_OS_300709.pdf
9. International Federation of Red Cross and Red Crescent Societies. Information bulletin no.01. 24 July 2009. Nepal: acute watery diarrhoea. [Accessed 30 July 2009]. Available at: http://www.reliefweb.int/rw/RWFiles2009.nsf/FilesByRWDocUn
idFilename/JBRN-7U9HA4-full_report.pdf/$File/full_report.pdf
10. Hill DR, Ford L and Lalloo, DG. Oral cholera vaccines: use in clinical practice. Lancet Infect Dis 2006;6:361-73.
11. Salisbury D, Ramsay M, Noakes K. [eds.] Immunisation against infectious disease. 2006. Chapter 14 Cholera. Department of Health, London. Available at: http://www.dh.gov.uk/en/Publichealth/Healthprotection/Immuni
Links
NaTHNaC Health Information Sheet: Cholera
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