Epidemiology of Cholera Outbreak and Summary of the Preparedness and Response Activities in Addis Ababa, Ethiopia, 2016

Abstract

Background. Cholera is a major public health problem in Ethiopia. This study aimed to generate evidence to better understand the epidemiology of cholera as well as chronicle the city administration’s emergency management efforts during the Addis Ababa cholera outbreak in 2016. Method. A descriptive analysis was performed using the cholera outbreak data collected from June 8 to October 31, 2016. A case was defined as a patient aged 5 years or older who develops acute watery diarrhea with or without vomiting. Administrative and laboratory finding reports were also used, as well as documented situational updates. Result. A total of 8,083 cases (AR of 0.24 percent) with 15 deaths (CFR of 0.18 percent) were reported. Males in unskilled manual occupations and housewives accounted for 2,198 (27.2%) and 1,195 (14.8%), respectively, of the total. A total of 6,908 cases (85.46 percent) sought medical attention within two days of the onset of the condition. The presence of the Kolfie river as well as the relatively confined living conditions of the residents aided in the emergence and rapid spread of the disease. The increased in-and-out movement of people, combined with the city administration’s deficient development infrastructure of water, hygiene, and sanitation, contributes to higher morbidity and a longer duration of the outbreak. Multiple command posts established in various locations as well as a lack of collaboration among relevant stakeholders resulted in inefficient information and resource management. Furthermore, there is a lack of risk factor surveillance for the early detection of cholera-causing agents. Conclusion and Recommendations. This outbreak caused significant morbidity and mortality. Prioritizing early risk detection, implementing preventive measures, and developing positive working relationships with relevant parties are all critical. A well-established community-based surveillance system and incident management system (IMS) will be required for future emergency management. It is recommended that the city administration make critical adjustments to its developmental infrastructures related to water, sanitation, and hygiene and implement risk factor surveillance from sewerage lines for the early detection of agents that cause cholera.

Outbreak investigation of cholera in a rural community, Rivers State Nigeria: an interventional epidemiological study

“…This is in agreement with the previous studies done in Nigeria, South Africa, Ethiopia, and India. 6,38,39 However, the reverse was the case in earlier studies carried out in Nigeria, some other West African countries (Benin, Burkina Faso, Cameroon, Mali, Niger, Togo), Pakistan and Malta. 25,28,29,31,37,41,44 The cases of acute watery diarrhoea can be classified into two distinct waves; with a greater frequency of cases and deaths occurring in the second wave following the diagnosis of cholera as opposed to a less eventful first wave with a low attack rate but a high case fatality rate than most of the previous studies.…”

“…6,31,35,36 Contrarily, studies carried out in Nigeria, Ethiopia, Bangladesh, and Malta revealed that cases of acute watery diarrhoea were observed more among patients in their middle adolescence, early adulthood and older age groups as opposed to younger children. 25,28,[37][38][39][40][41] Additionally, a greater proportion of all line-listed patients were slightly more males than females. This is in agreement with the previous studies done in Nigeria, South Africa, Ethiopia, and India.…”

“…25,28,42,44,45 On the flip side, a global review reported lower case fatality rates in countries within Africa (Nigeria, Burkina Faso, Democratic Republic of Congo, Ethiopia, Kenya, Mozambique, Somalia, South Sudan, Tanzania) and Asia (Afghanistan, Bangladesh, Iraq, Pakistan, Philippines, Syria) and Europe. 31,38,46 Although, in a country like India one of the cholera epidemics experienced a zero fatality rate. 6 The findings observed in countries with lower case fatality rates (0 to <1%) as compared to those with higher rates were most probably due to the prompt institution of intervention measures to curb the epidemics, especially regarding cholera vaccination.…”

A Molecular and Epidemiological Study of Cholera Outbreak in Sulaymaniyah Province, Iraq, in 2022

“…More than 200 serogroups of the bacteria have been identified so far, and cholera outbreaks mainly occur during the hot months of summer elicited by the O1 or O139 biotype ( Ali et al 2015 ; Ramazanzadeh et al 2015 ). Severe watery diarrhea, known as “rice-watery” stool, odorless or of a mild fishy smell, with or without vomiting, are the major symptoms of the disease ( Harris et al 2012 ; Endris et al 2022 ). Among different age groups, children below five years old are the most vulnerable to cholera compared to adults or the elderly ( Deen et al 2008 ).…”

“…Cholera is considered a global health issue, and it has affected most parts of the world since the early of the nineteenth century ( Harris et al 2012 ). A majority (~ 99%) of cholera cases have been recorded in Africa and Southern Asia ( Deen et al 2008 ; Endris et al 2022 ). In 2006, more than two million cholera cases with 6,311 deaths were recorded in 52 countries ( WHO 2007a ).…”