Weekly Situation Report on Cholera in Zimbabwe No. 07, 24 Dec 2008

Source: United Nations Office for the Coordination of Humanitarian Affairs (OCHA)

Date: 24 Dec 2008

Full_Report (pdf* format – 594.6 Kbytes)

Summary

The cholera emergency continues to be a key challenge and major humanitarian crisis in Zimbabwe. The latest outbreak, as of 23 December 2008 has been reported in Binga district in Matabeleland North. Until recently, Matabeleland North had been spared of the outbreak.

Cumulatively, as of 23 December 2008, 24,792 suspected cases and 1,400 deaths with a case fatality rate of 5.6% have been reported. The latest summary of cholera outbreaks is tabulated below:

Province	Suspected Cases	Total Deaths	Case Fatality Rate (%)	Community Deaths (part of total)	Community Deaths as % of total
Harare	9,943	331	3.33	16	4.83
Mashonaland Central	2,029	130	6.41	74	56.92
Mashonaland East	620	78	12.58	69	88.46
Mashonaland West	5,041	245	6.06	140	57.14
Matabeleland South	3,622	104	2.87	30	28.85
Manicaland	1,668	136	8.25	112	82.35
Masvingo	1,226	153	10.85	102	76.69
Bulawayo	419	15	3.58	10	66.67
Midlands	224	31	26.4	29	93.55
Grand Total	24,792	1400	5.6	582	48.38

Note: Community deaths data are not complete for all locations.

I. Situation analysis As highlighted on the table above, the outbreak continues to expand geographically and in terms of numbers. The Matabeleland North Province outbreak statistics are not included on the table because WHO is still investigating in order to establish the scale and dimension of the outbreak. Specific areas affected by cholera outbreak countrywide are shown on the map below and the 3Ws and Donor response matrix are annexed to this report.

II. Response

Health response

The health cluster is responding through provision of drugs and overall coordination of health response in collaboration with the MoH. Recently, WHO flew into Harare 21mt of medical supplies, including 8 diarrhoeal disease kits, and it also plans to airlift 10mt of Ringer lactate which could be expected in the country in the last week of December 2008.

MDM has been supporting cholera control activities in Chipinge. It has since distributed 47 cholera kits to 47 CTCs. MSF Spain, Holland and Luxembourg have established three rapid assessments/response/monitoring teams with a medical officer, logistician and Environmental Health Officer to follow-up on alerts and communication from crisis centres.

Noted Health urgent needs and areas of focus during the Christmas and New Year holidays;

- Need to strengthen cholera prevention and control due to anticipated increased movements during festive holidays

- Ensure adequate staffing and capacity for response during the festive holiday

- Reinforce capacity within WHO office for cholera response.

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Zimbabwe cholera warning from Doctors without boarders – BBC

Charity warns on Zimbabwe cholera

The UN has warned the total number of cases could reach 60,000

The international medical charity, Medecins Sans Frontieres, predicts that the cholera epidemic in Zimbabwe will last well into 2009.

Manuel Lopez, the head of MSF in the country, told the BBC the epidemic was still at a critical level and would not subside until the rains end in March.

Even then, he said, the lack of clean drinking water means that cholera will be endemic in Zimbabwe.

The disease has claimed 1,123 lives and infected more than 20,000 people.

Mr Lopez says so many clinics and hospitals have closed that large sections of the population have no access to medical care.

“The ministry of health has declared a national emergency,” said Mr Lopez.

“So it is very clear that the situation is very, very critical in terms of health people’s access to health care.”

Latest UN figures include a new outbreak of hundreds of cases in Chegutu, near the capital Harare, which has been worst hit by the disease.

MSF says that when it arrived in Chegutu 10 days ago, it found the local facilities completely overwhelmed.

Patients were lying on the floor, some next to dead bodies, sanitation services were non-existent, and there was no water and no food to be found.

“The situation was absolute chaos,” said Luis Maria Tello, the MSF Emergency Team Medical Coordinator.

“There were no beds and patients everywhere. People were dying of thirst because there was no water.”

The disposal of the dead was one of the first priorities set by the emergency team.

“Dead people were lying everywhere,” said Mr Tello.

‘War words’

The easily preventable disease has spread because of the collapse of health services and water sanitation in Zimbabwe.

The UN World Health Organization has said the total number of cases could reach 60,000 unless the epidemic is stopped.

South Africa’s Red Cross is rushing much-needed medicine to Zimbabwe

A week ago Mr Mugabe said the outbreak had been “arrested”.

He claimed Western powers wanted to use an epidemic as an excuse to invade Zimbabwe and topple him.

Meanwhile, South African ruling ANC leader Jacob Zuma said in a radio interview there was no reason for sending troops to Zimbabwe.

“Why military intervention when there is no war?” he told South Africa’s 702 Talk Radio.

“We should be pressurising them to see the light.”

Zimbabwe claimed earlier this week that Botswana, which has joined growing international calls for Mr Mugabe to quit, was hosting military training camps for MDC rebels.

But the current chairperson of the the Southern African Development Community, South African President Kgalema Motlanthe, said on Wednesday: “We never believed that.”

Death toll passes 1,000 as Zimbabwe continues to battle cholera

Since the start of a massive cholera outbreak that has spread throughout Zimbabwe, the cholera death toll has increased to 1,123 and the number of cases has risen to 20,896, according to figures from the World Health Organization (WHO) as of Friday (December 19). The country’s capital, Harare, has reported the highest number of cases, with 224 casualties and 9,072 thought to be afflicted by the disease, The News said. In response, the International Committee of the Red Cross announced that it has begun disinfecting home of cholera patients in Harare, the Agence France-Presse (AFP) said. The UN health agency is attributing the continued spread of the disease in Zimbabwe to the badly maintained sanitation systems, rampant inflation that has affected doctors and nurses and a lack of clean drinking water.  Dominique Legros, a cholera expert with the WHO, told the AFP that the situation would remain the same unless the WHO and Zimbabwe’s government determine a way to improve salaries for local health workers. Zimbabwe’s cholera fatality rate is at 5.4 percent, the WHO reports, but the UN agency said it needs to be below one percent for the outbreak to be under control. Additionally, the Associated Press (AP) reported that the outbreak has spread to neighboring countries, with South Africa treating hundreds of Zimbabwean cholera victims at the border. Health authorities in Mozambique told the AP on Thursday (December 18) that cholera cases had been detected in six of the country’s 11 provinces, saying that in provinces bordering Zimbabwe, the suspected source was believed to have been Zimbabweans or Mozambicans traveling to Zimbabwe. However, cholera does surface in Mozambique regularly due to poor sanitation and lack of clean drinking water as well. Cholera treatment centers were being mobilized by the International Organization for Migration near borders with South Africa and Botswana to prevent the disease from spreading across borders, the AFP said. Meanwhile, Xinhua news agency reported on Thursday that the Zimbabwe government welcomed a US$19 million Cholera Outbreaks Coordinated Preparedness and Operation Plan, enabling the country to conduct a predictable and coordinated response to the epidemic. The Zimbabwe Health Cluster produced this plan, which was constituted by Zimbabwe’s Ministry of Health and Child Welfare and agencies such as the WHO, UN Children’s Fund, UN Office for the Coordination of Humanitarian Affairs, and local non-governmental organizations. US$3.8 million is an estimated earmark for surveillance, information management and coordination, US$11.2 million for stockpiling and responding to cholera and other health emergencies, US$348,000 for the procurement of equipment and supplies to strengthen outbreak investigation, monitoring and evaluation capacity, and US$4 million will be allocated to water, sanitation, hygiene and infection control in health facilities, Xinhua reported. To assist in Zimbabwe’s worst cholera epidemic yet, this plan mandates the humanitarian and development agencies with mobilization of funds for emergency interventions, while the Cholera Command and Control Center will establish reserve funds to provide any operational support.

http://news.yahoo.com/s/ap/20081218/ap_on_re_af/un_un_zimbabwe_cholera
http://www.khaleejtimes.com/DisplayArticle.asp?xfile=data/international/2008/December/international_December1260.xml§ion=international&col=
http://news.xinhuanet.com/english/2008-12/18/content_10524721.htm

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CHOLERA, DIARRHEA & DYSENTERY UPDATE 2008 (54)

In this update:

Africa

[1] Cholera – Zimbabwe

[2] Cholera – South Africa (Western Cape province) NOT ex Zimbabwe [3] Cholera – Uganda (Arua) [4] Cholera – Nigeria (Niger state) [5] Cholera – Congo DR (eastern provinces) [6] Cholera – Malawi (Central Region) [7] Cholera – Botswana (Northeast, Central provinces) ex Zimbabwe Americas [8] Shigellosis, day care centers – USA (Ohio)

*****

[1] Cholera – Zimbabwe

Date: Thu 18 Dec 2008

Source: Associated Press [edited]

<http://www.google.com/hostednews/ap/article/ALeqM5hv0mXrSPZaqaNrRGTYuxAu1cBPWAD9552O1O0>

The cholera death toll in Zimbabwe has risen above 1000, the United Nations said Thursday [18 Dec 2008]. A total of 1111 deaths were recorded by Wednesday [17 Dec 2008], an increase of 133 in 2 days, the UN humanitarian office in Geneva said.

The latest figures, which are compiled by the WHO, also show that the number of cases has risen to 20 581 since the start of the cholera outbreak in August 2008. On Monday [15 Dec 2008], health officials had spoken of 18 413 cases and 978 deaths.

–

Communicated by:

ProMED-mail

<promed@promedmail.org>

[The number of cases of cholera in this catastrophic situation in Zimbabwe continues to rise dramatically, underscoring the need for rapid intervention. Since the last posting on 15 Dec 2008, there were

2168 more cases reported, with 133 more deaths.

[A map of Zimbabwe with provinces can be found at:

<http://www.un.org/Depts/Cartographic/map/profile/zimbabwe.pdf>.

The HealthMap/ProMED-mail interactive map of Zimbabwe is available at:

<http://healthmap.org/promed/en?v=-19,29.9,6>. - Mod.LL]

*****

[2] Cholera – South Africa (Western Cape province) NOT ex Zimbabwe

Date: Thu 18 Dec 2008

Source: Independent Online [edited]

<http://www.iol.co.za/index.php?set_id=1&click_id=125&art_id=nw20081218161227791C711028>

A 4-month-old baby is being treated for cholera at the Karl Bremer Hospital in Western Cape, the province’s health department said on Thursday [18 Dec 2008]. Spokesperson Faiza Steyn said the child from Wallacedene informal settlement in Kraaifontein had been stabilized.

He was admitted on 6 Dec 2008.

“The specimen of this case was forwarded to the National Institute for Communicable Diseases (NICD) for further laboratory analysis, to ascertain the strain of cholera that was identified,” said Steyn.

The child had no history of recent travel to Zimbabwe and or close contact with a cholera case. Laboratory investigations on contacts of this case were negative for the disease, said Steyn.

“It is not known at this stage where he could have got the disease from; but hot weather and poor environmental living conditions could be some of the factors,” she said.

–

Communicated by:

ProMED-mail

<promed@promedmail.org>

[In the report of cholera in South Africa, the Western Cape province was not included. This case appears clearly to have been acquired in the province which can be seen on a map of the country at:

<http://www.un.org/Depts/Cartographic/map/profile/southafr.pdf>.

The HealthMap/ProMED-mail interactive map of South Africa can be seen at:

<http://healthmap.org/promed/en?g=1085597&v=-26,29.5,5>. - Mod.LL]

*****

[3] Cholera – Uganda (Arua)

Date: Wed 17 Dec 2008

Source: The Monitor Online [edited]

<http://www.monitor.co.ug/artman/publish/health-and-living/Arua_battling_cholera_outbreak_76996.shtml>

The poor Arua residents are grappling with endemic cholera as the Oli Division in the Municipality is facing an outbreak of the disease in low-income neighborhoods.

In just a month, over 38 cases have been registered, mainly in the division, including 3 deaths district-wide. Statistics indicate that

28 people have been admitted at Oli Health Centre with one death case. “Oli Health Centre has become Arua’s referral hospital with overcrowding of patients,” the Municipal Health officer Dr Paul Onzubo said.

[Byline: Warom Felix Okello]

–

Communicated by:

ProMED-mail

<promed@promedmail.org>

[The Arua district is in northwestern Uganda and can be seen on a map at:

<http://www.un.org/Depts/Cartographic/map/profile/uganda.pdf>. The area borders with eastern Congo DR where cholera has also been occurring. - Mod.LL]

*****

[4] Cholera – Nigeria (Niger state)

Date: Thu 18 Dec 2008

Source: Nigerian Tribune [edited]

<http://www.tribune.com.ng/18122008/news/news16.html>

An outbreak of cholera in the Egbagi Majin village in Kede district of Mokwa Local Government Area of Niger State has reportedly claimed

8 lives, one of them being the wife of the village head. A majority of those who died, according to a report from the village, were women.

Nigerian Tribune has learned that about 15 others were hospitalized as a result of the outbreak. According to a source in the area, the outbreak could have been as a result of contaminated water being drunk by the villagers who were just relocating after a flood disaster 2 months ago.

–

Communicated by:

ProMED-mail

<promed@promedmail.org>

[The Niger state of Nuigeria is in the west-central part of the country and can be seen on a map at:

<http://www.un.org/Depts/Cartographic/map/profile/nigeria.pdf>. - Mod.LL]

*****

[5] Cholera – Congo DR (eastern provinces)

Date: Tue 16 Dec 2008

Source: Int Fed of Red Cross And Red Crescent Societies (IFRC) [edited] <http://reliefweb.int/rw/rwb.nsf/db900SID/EDIS-7MEM7V?OpenDocument>

Since early October 2008, high morbidity and mortality rates associated with a cholera epidemic outbreak have been registered in the Maniema, Katanga, North and South Kivu provinces. Ministry of Health (MoH) statistics show that more than 25 503 cholera cases had been registered, including 515 deaths in the localities mentioned below. The following are statistics from the MoH.

In Katanga province, more than 10 214 cases and 229 deaths have been registered and Red Cross efforts will be concentrated on towns such as Lubumbashi, Likasi, Kolwezi, Bukama and Kasenga localities where the mortality rate is very high. In the last week of November 2008, the Kipushi health zone was noted as one of the most affected, with several cases registered. A Red Cross team was sent to the field to assess the situation in the Kipushi health zone which is also reported to be badly affected.

In Maniema province the focus is on the Kailo, Alunguli, Kindu and Basoko health zones, where according to the Maniema provincial committee of the RCDRC, 189 cases and 11 deaths have been registered over the past weeks. This information has been confirmed by the World Health Organization (WHO).

In North Kivu, where ICRC is working, the health zones of Binza, Bwambizo, Goma, Karisimbi, Kirotche, Masisi, Rutchuru and Walikale are most affected, with nearly 8826 cases and more than 229 deaths registered out of a total population of 1 272 981 inhabitants. The possibility to carry out sensitization, disinfection, environmental hygiene and water chlorination is more difficult in this region due to the ongoing conflict. The numbers registered are those recorded in the local hospital and do not include those occurring in other health centres or at home. By the same period, well more than 5000 cases have been registered in South Kivu, with the most affected health zones including Minova (which shares boundaries with North Kivu), Nundu, Baraka/Fizi (which is an endemic zone), Kalehe, Ruzizi, Katana, Kabare, the town of Bukavu, Kadutu and Bagira. 1229 cases have been registered so far in these localities alone, and there are indications that this number is growing rapidly.

Overall, there is clear concern that the numbers are of a significant level and there is a serious risk of the disease further spreading in the 4 provinces already affected and also beyond. In which case, the RCDRC, supported by the International Federation, needs to be prepared to respond in those provinces not supported by the ICRC.

–

Communicated by:

ProMED-mail

<promed@promedmail.org>

[The provinces involved are along the eastern border of Congo DR and can be found on a map at:

<http://www.un.org/Depts/Cartographic/map/profile/drcongo.pdf>. - Mod.LL]

*****

[6] Cholera – Malawi (Central Region)

Date: Wed 17 Dec 2008

Source: African Press Agency [edited]

<http://www.apanews.net/apa.php?page=show_article_eng&id_article=83244>

(subscription required)

Cholera in Malawi has claimed 5 lives and more than 80 cases have been recorded at the country’s privately-run Likuni Hospital owned by the Catholic Church in the capital Lilongwe, Director for Preventive Health in the Ministry of Health, Stone Kabuluzi, confirmed here on Wednesday [17 Dec 2008].

He told APA during an interview that the disease was fast spreading among the rural community and that the number of cholera cases had doubled at the hospital since the onset of the rainy season. “Today

[17 Dec 2008] the hospital has received 8 cases to increase the number to 88 cholera cases with 5 deaths,” he said.

–

Communicated by:

ProMED-mail

<promed@promedmail.org>

[The area is located in the Central Region of Malawi and can be seen on a map at:

<http://www.un.org/Depts/Cartographic/map/profile/malawi.pdf>. - Mod.LL]

*****

[7] Cholera – Botswana (Northeast, Central provinces) ex Zimbabwe

Date: Thu 18 Dec 2008

Source: Daily News Online [edited]

<http://www.mcst.gov.bw/dailynews/newsdetails.php?id=11842>

Botswana has so far recorded 8 suspected cases of cholera. Speaking at a media briefing at the Ministry of Health, Mrs. Shenaz El-Halabi, Director of Public Health said of the 8, only 3 have been confirmed to be cholera not 4 as reported in the media.

She said 1 case was confirmed in the Serowe/ Palapye area (Sekgoma

hospital) while the remaining 2 cases were confirmed in Francistown (Nyangabwe Hospital). All 3 cholera victims are from neighbouring Zimbabwe.

[Bylines: Kesentse Ketumile and Tshegofatso Sentsho]

–

Communicated by:

ProMED-mail

<promed@promedmail.org>

[Francistown is in the Northeast and Serowe in the Central Province of Botswana and can be seen on a map at:

<http://www.mapsofworld.com/botswana/maps/botswana-map.jpg>. - Mod.LL]

*****

[8] Shigellosis, day care centers – USA (Ohio)

Date: Tue 16 Dec 2008

Source: Dayton (OH) Daily News [edited]

<http://www.daytondailynews.com/n/content/oh/story/news/local/2008/12/16/ddn121608shigellaweb.html>

The Greene County Combined Health District is tracking an outbreak of the intestinal illness shigellosis that has hit several city daycare centers. The county had 36 cases of the bacterial infection so far in 2008. 20 of those have been reported since 1 Nov 2008 in a handful of Xenia daycare centers, said Amy Schmitt, communicable disease nurse for the health district.

Health officials are working with day care operators to combat the spread of the infections. “It’s never our mission to close anyone down,” Schmitt said. “We work with day cares to decrease transmission and prevent further infection.”

Greene County’s 3 dozen cases also seem minuscule compared with Montgomery County where 325 cases were reported in 2008, Schmitt said. Greene saw 8 cases of Shigella in 2007 and only 2 in 2006.

Warren County has had 4 cases reported in 2008, none of them in the past 2 months.

[Byline: Christopher Magan]

–

Communicated by:

ProMED-mail

<promed@promedmail.org>

[Greene county in Ohio is located in the southwestern part of this east-central state and can be found on a map at:

<http://quickfacts.census.gov/qfd/maps/ohio_map.html>. - Mod.LL]

[see also:

Cholera, diarrhea & dysentery update 2008 (53) 20081216.3949 Cholera, diarrhea & dysentery update 2008 (52) 20081215.3940 Cholera, diarrhea & dysentery update 2008 (51) 20081212.3906 Cholera, diarrhea & dysentery update 2008 (50) 20081208.3854 Cholera, diarrhea & dysentery update 2008 (49) 20081203.3803 Cholera, diarrhea & dysentery update 2008 (48) 20081201.3776 Cholera, diarrhea & dysentery update 2008 (47) 20081125.3716 Cholera, diarrhea & dysentery update 2008 (46) 20081124.3708 Cholera, diarrhea & dysentery update 2008 (45) 20081120.3662 Cholera, diarrhea & dysentery update 2008 (40) 20081014.3253 Cholera, diarrhea & dysentery update 2008 (30) 20080702.2019 Cholera, diarrhea & dysentery update 2008 (20) 20080404.1240 Cholera, diarrhea & dysentery update 2008 (10) 20080212.0563 Cholera, diarrhea & dysentery update 2008 (01) 20080104.0047

2007

----

Cholera, diarrhea & dysentery update 2007 (67) 20071231.4200 Cholera, diarrhea & dysentery update 2007 (60) 20071126.3824 Cholera, diarrhea & dysentery update 2007 (50) 20071023.3450 Cholera, diarrhea & dysentery update 2007 (40) 20070924.3164 Cholera, diarrhea & dysentery update 2007 (30) 20070830.2856 Cholera, diarrhea & dysentery update 2007 (20) 20070511.1509 Cholera, diarrhea & dysentery update 2007 (10) 20070302.0737 Cholera, diarrhea & dysentery update 2007 (01) 20070105.0047

2006

----

Cholera, diarrhea & dysentery update 2006 (52) 20061229.3646 Cholera, diarrhea & dysentery update 2006 (50) 20061215.3528 Cholera, diarrhea & dysentery update 2006 (40) 20061006.2862 Cholera, diarrhea & dysentery update 2006 (30) 20060724.2037 Cholera, diarrhea & dysentery update 2006 (20) 20060512.1352 Cholera, diarrhea & dysentery update 2006 (10) 20060303.0675 Cholera, diarrhea & dysentery update 2006 (01) 20060106.0040] ……………………………..ll/ejp/dk

Cholera has infected 18,000 people in Zimbabwe – SkyNews

Cholera has infected 18,000 people in Zimbabwe and £4m in donations is desperately needed for it to be stopped, a charity has said.

Two Zimbabwean men rest in a cholera rehydration tent

The British charity Oxfam is asking the public and international donors for nearly £4m to fight cholera and hunger in Zimbabwe.

The disease is affecting nine out of the country’s ten provinces and is likely to spread further if, as expected, there are more heavy rains in the next month.

Oxfam Zimbabwe Country Director Peter Mutoredzanwa said: “The average Zimbabwean woman can only expect to live 33 years.

The tragic fact is that unless we respond now, many more people will not live to see their 30s.

Oxfam Zimbabwe Country Director Peter Mutoredzanwa

“Zimbabweans are no strangers to food shortages but we have now reached desperate levels.

“Some children only eat a meagre portion of food once every three days and people scavenge in rubbish dumps for anything they can eat.”

The charity has recently been forced to cut the amount of food rations it gives out after a fall in the amount of donations it receives.

Humanitarian Director of Oxfam Jane Cocking said: “The rapid deterioration of the situation in Zimbabwe makes this an extremely grave humanitarian crisis which could deteriorate even further in 2009.

“While the international community battles for a political solution in the country, millions of Zimbabweans are going hungry.

“Oxfam is able to get clean water and food through to people who need it most. We need to respond now, there is no time to lose.”

The charity is currently handing out water purification tablets and soap to 620,000 people as well as providing food rations for 250,000.

Latest figures from the United Nations show cholera, which is a waterborne disease, has infected 18,000 people and killed about 800 in Zimbabwe with many more deaths and infections believed to have gone unrecorded.

Southern Africa: Immediate needs of children and women affected by the cholera outbreak

1. CRITICAL ISSUES FOR CHILDREN AND WOMEN

The humanitarian crisis in Zimbabwe is increasingly taking on a regional dimension. The outbreak of cholera which started in Zimbabwe is now spreading to neighboring countries, namely Mozambique, South Africa and Botswana. According to the UN in Zimbabwe, as of 9 December, there were 13,960 suspected cases of cholera and 589 related deaths. In South Africa, the first case was registered on 15th November in Musina town in Limpopo Province situated 15 km from the Zimbabwe border and with a population size of approximately 50,000. Since November, cholera has spread to all nine provinces in South Africa. According to a joint Government of South Africa/WHO report, as of 10 December 2008, there were a total of cumulative 720 cases of cholera since 15 November and 11 deaths (1.5% CFR). The most affected province is Limpopo which has recorded 664 out of a total of 721 cases in the country.

Full_Report (pdf* format – 282.9 Kbytes)

Zimbabwe cholera death toll nears 1,000, UN reports

The death toll from Zimbabwe’s worst-ever cholera outbreak is approaching 1,000, the United Nations reported today, as Secretary-General Ban Ki-moon warned that the country’s leadership is not doing enough to address the dire situation in the Southern African nation.

“We continue to witness a failure of the leadership in Zimbabwe to address the political, economic, human rights and humanitarian crisis that is confronting the country and to do what is best for the people of Zimbabwe,” Mr. Ban told a closed-door session of the Security Council.

The UN said today the number of suspected cholera cases has risen to 18, 413 with 978 deaths. The outbreak is now affecting nine out of ten provinces in the country and spilling across borders into South Africa, Botswana, and Mozambique.

About half of all cases in Zimbabwe are in one suburb of the capital, Harare, and another 26 per cent in a town on the border with South Africa.

UN agencies have been scaling up their efforts in recent weeks to tackle the crisis, which is the most serious ever registered in Zimbabwe, as well as the effects of collapsing social services.

The UN World Health Organization (WHO) has drawn up a comprehensive cholera response operation plan, and is in the process of procuring and distributing emergency stocks of supplies to run health centres. The Government has accepted the plan and has also declared a state of emergency.

Zimbabwe is mired in a crisis brought about by a confluence of factors, including three years of failed harvests, bad governance and hyperinflation, among others.

The country has endured months of political tensions after disputed presidential elections in March involving the incumbent Robert Mugabe and the opposition figure Morgan Tsvangirai. A power-sharing deal on the formation of a new government was reached in September with the help of regional leaders, but outstanding issues remain, jeopardizing the deal’s implementation.

In his briefing to the Council today, Mr. Ban noted that the lack of progress on the political front is accompanied by a “dramatic” deterioration in living conditions and of the humanitarian situation.

“The current cholera epidemic is only the most visible manifestation of a profound multi-sectoral crisis, encompassing food, agriculture, education, health, water, sanitation and HIV/AIDS.”

He reported that close to 80 per cent of the country has no access to safe drinking water, and the vast majority of the population does not have adequate sanitary facilities – the very conditions that have allowed the acute intestinal infection caused by contaminated food or water to develop and flourish.

CHOLERA, DIARRHEA and DYSENTERY UPDATE 2008 (53)

A ProMED-mail post

<http://www.promedmail.org>

ProMED-mail is a program of the

International Society for Infectious Diseases <http://www.isid.org>

In this update:

Africa

[1], [2] Cholera – Zimbabwe

[3] Cholera – South Africa

[4] Cholera – Botswana (Central Province) [5] Cholera – Zambia

******

[1] Cholera – Zimbabwe

Date: Mon 15 Dec 2008

Source: UN Office for the Coordination of Humanitarian Affairs (OCHA), ReliefWeb, World Health Organization (WHO) report [edited] <http://www.reliefweb.int/rw/rwb.nsf/db900SID/JBRN-7MDCSP?OpenDocument>

Cholera in Zimbabwe: epidemiological bulletin No. 1 — 15 Dec 2008

——————————————————————

This is the 1st epidemiological bulletin to be issued since the August 2008 onset of a countrywide cholera epidemic in Zimbabwe.

Further bulletins are planned with a weekly frequency, coinciding with the end of each epidemiological week (Sunday to Saturday). In addition, daily short epidemiological updates are envisaged: these will eventually integrate and supplement the current OCHA daily cumulative caseload updates.

This epidemiological bulletin aims to provide an overview of the epidemic throughout Zimbabwe, including province-by-province data, so as to inform and improve the ongoing public health response. It also provides guidance to agencies on issues relating to data collection, analysis, and interpretation, and suggests operational strategies on the basis of epidemiological patterns so far.

Readers will find that, for most provinces, the bulletin relies on incomplete and somewhat outdated data, with the last date of reporting being between 2 and 21 days before its date of publication.

The WHO Cholera Outbreak Response Team is working hard to improve surveillance. The challenges are daunting, due to the countrywide nature of the epidemic (56 districts affected; more than 100 cholera treatment centres or units estimated to be operating); human resource and material shortages at province and district level; communications problems; and the fulminant nature of cholera outbreaks.

So as to improve surveillance, agencies directly engaged in case management are strongly encouraged to share daily data with the respective District Health Teams: this will ensure consistency and reliability of data. While focus must be on strengthening Zimbabwe’s surveillance system, the WHO Cholera Outbreak Response Team greatly welcomes feedback and data provided by individual agencies, and will take these into account when producing further bulletins. Given the scope of this epidemic, errors and omissions are almost inevitable:

we will be grateful for any information that helps to rectify these.

Overview of the epidemic

————————

A countrywide epidemic of cholera has been occurring in Zimbabwe since August 2008. The epidemic currently affects 9 out of the 10 provinces in the country, and at least 57 (67.9 percent) out of a total of 84 rural and urban districts (see the Annexes and Figure 1 [see full document URL below. - Mod.LL]) As of 15 Dec 2008, a total of 18 413 suspected cases had been reported to the World Health Organization (WHO), by way of the Ministry of Health and Child Welfare (MoHCW)’s surveillance department. Table 3 [see below] in the Annexes details the districts affected and the dates on which the 1st cases were reported.

In all provinces affected, _Vibrio cholerae_ has been isolated from suspected cases. Two serotypes have been found: Ogawa in Harare urban and Beitbridge city, Matabeleland South; and both Ogawa and Inaba in Chegutu and Makonde districts, Mashonaland West. Drug sensitivity testing was carried out in some of the affected provinces, but to date, results of these investigations have not been consolidated.

Tests on Mudzi samples are currently being carried out at the National Reference Laboratory.

Timeline

——–

Cholera epidemics have been occurring every year in Zimbabwe since 1998. Between January and April 2008, a relatively small epidemic occurred in 16 districts of Mashonaland East, Mashonaland Central, Mashonaland West, Harare, and Manicaland, with less than 2000 cases recorded in total.

Cholera resurfaced on 20 Aug 2008 in Chitungwiza city, just south of Harare. There is no evidence that the 2 epidemics are independent: in the present context of low access to health care, low-level transmission could have gone on undetected.

During September 2008, cholera cases began to be reported in Makonde and Chinhoyi urban districts (Mashonaland West). By the end of October 2008, outbreaks were reported 2 more districts of the same province (Kariba rural and urban districts); 2 districts of Mashonaland East (Mudzi and Murehwa); and, critically, in Harare city, where explosive outbreaks began, centered around Budiriro suburb, in the southwest. As of the end of October 2008, however, only 3 provinces and 8 districts were affected.

Between 1 and 15 Nov 2008, the epidemic swept through Zimbabwe, affecting 6 more provinces and 46 more districts. After that time, the expansion appears to have slowed down, with only 3 further districts reporting outbreaks. However, this may partly be attributable to inadequate surveillance.

–

Communicated by:

ProMED-mail

<promed@promedmail.org>

[The full report can be found at

<http://www.reliefweb.int/rw/rwb.nsf/db900sid/JBRN-7MDCSP/$File/full_report.pdf>.

The following table shows cases in each province and district

Province:

District / Suspected cases to 15 Dec 2008 / Deaths / Case Fatality Rate (percent)

----------------------------------------------------------------------

Harare:

-------

Chitungwiza / 551 / 99 / 18.0

Epworth / 158 / 1 / 0.7

Harare / 8454 / 208 / 2.5

Bulawayo:

---------

Bulawayo / 152 / 11 / 7.2

Mashonaland West:

-----------------

Chegutu / 378 / 99 / 27.1

Hurungwe / 14 / 1 / 7.1

Kadoma / 361 / 5 / 1.4

Kariba / 224 / 11 / 4.9

Mahombakombe / 193 / 8 / 4.1

Makonde / 208 / 29 / 13.9

Zvimba / 13 / 0 / 0.0

Mashonaland East:

-----------------

Chikomba / 16 / 1 / 6.3

Goromonzi / 194 / 17 / 8.8

Hwedza / 2 / 0 / 0.0

Marondera / 23 / 5 / 21.7

Mudzi / 1550 / 41 / 2.6

Murehwa / 56 / 4 / 7.1

Mutoko / 104 / 17 / 16.3

Seke / 83 / 11 / 13.3

UMP / 17 / 2 / 11.8

Midlands:

---------

Gokwe North / 3 / 0 / 0.0

Gokwe South / 5 / 0 / 0.0

Gweru / 167 / 3 / 1.8

Kwekwe / 10 / 1 / 10.0

Mberengwa / 52 / 9 / 17.3

Shurungwi / 23 / 6 / 26.1

Zvishavane / 93 / 9 / 9.7

Masvingo:

---------

Bikita / 32 / 16 / 50.0

Chiredzi / 56 / 9 / 16.1

Chivi / 28 / 14 / 50.0

Gutu / 5 / 4 / 80.0

Masvingo / 120 / 13 / 10.8

Mwenezi / 40 / 7 / 17.5

Manicaland:

-----------

Buhera / 302 / 24 / 7.9

Chinanimani / 200 / 12 / 6.0

Chipinge / 49 / 13 / 26.5

Makoni / 261 / 36 / 13.8

Mutare / 7 / 0 / 0.0

Mutasa / 7 / 5 / 71.4

Matabeleland South:

-------------------

Beitbridge / 3456 / 91 / 2.6

Gwanda / 19 / 0 / 0.0

Mangwe (Plumtree) / 1 / 0.0

[A map of Zimbabwe with provinces can be found at <http://www.un.org/Depts/Cartographic/map/profile/zimbabwe.pdf>.

The HealthMap/ProMED-mail interactive map of Zimbabwe is available at <http://healthmap.org/promed/en?v=-19,29.9,6>. - Mod.LL]

******

[2] Cholera – Zimbabwe

Date: Mon 15 Dec 2008

Source: BBC News [edited]

<http://news.bbc.co.uk/2/hi/africa/7784392.stm>

The United Nations says 978 people have now been killed by the cholera outbreak in Zimbabwe, an increase of 25 percent from the last figure given 3 days ago. The UN’s office for humanitarian affairs says 18 413 suspected cases have been reported across the country since the outbreak began in August 2008.

The UN’s Office for the Coordination of Humanitarian Affairs (OCHA) said the worst hit area was the capital, Harare, with 208 confirmed deaths and 8454 suspected cases.

The UN has said it estimates up to 60 000 people may eventually be affected.

–

Communicated by:

ProMED-mail

<promed@promedmail.org>

[The number of cases of cholera in this catastrophic situation in Zimbabwe continues to rise dramatically, underscoring the need for rapid intervention. Since the last posting on 12 Dec 2008, there were

2272 more cases reported, with 203 more deaths. - Mod.LL]

******

[3] Cholera – South Africa

Date: Tue 16 Dec 2008

Source: United Nations Children’s Fund (UNICEF) [edited] <http://www.reliefweb.int/rw/rwb.nsf/db900sid/JBRN-7MDKC7/$File/full_report.pdf?>

Epidemiological data as of 10 Dec 2008

Province / Cumulative cases / Cumulative deaths / Lab confirmed Limpopo / 664 / 8 / 21 Gauteng / 40 / 2 / 15 Mpumalanga / 1 / 0 / 1 KwaZulu Natal / 2 / 1 / 2 Northwest / 1 / 0 / 1 East Cape / 1 / 0 / 1 Northern Cape / 1 / – / 1 Total / 720 / 11 / 41

–

Communicated by:

ProMED-mail

<promed@promedmail.org>

[It is not clear from any of these posts from Zimbabwe's neighboring countries whether any of the cases reported were acquired in that country or whether all the cases were indeed imported from Zimbabwe.

A map of South Africa showing the proximity of the mentioned areas of Limpopo province (referred to as northern province on the map) can be found at <http://www.un.org/Depts/Cartographic/map/profile/southafr.pdf>.

The HealthMap/ProMED-mail interactive map of South Africa can be seen at <http://healthmap.org/promed/en?g=1085597&v=-26,29.5,5>. - Mod.LL]

******

[4] Cholera – Botswana (Central Province)

Date: Tue 16 Dec 2008

Source: The Daily News, Botswana Press Agency (BOPA) report [edited] <http://www.mcst.gov.bw/dailynews/newsdetails.php?id=%2011829>

One confirmed and 3 suspected cases of cholera have been reported in the Tutume Sub-district, making it the 3rd district in Botswana to be affected by cholera. Confirmed cases have already been reported in the North East and Serowe/Palapye areas.

According to the Senior Nursing Officer, Ms Tebogo Gabathusi, the cases in the sub-district occurred at the small village of Mafungo/Hubona near Mathangwane. She said all the cases, which were recorded last week, were initially evaluated at Mathangwane clinic and later referred to Nyangabgwe Referral Hospital for admission and treatment.

Health authorities have complained that Mafungo/Hubona has a large influx of Zimbabwean illegal immigrants, and that lack of law enforcement officers in the village significantly contributes to the situation.

[Byline: Olekantse Sennamose]

–

Communicated by:

ProMED-mail

<promed@promedmail.org>

[The cases may well be imported from Zimbabwe but that is not stated.

The area involved is in the Central province of Botswana, which borders on Zimbabwe and South Africa and can be found on a map at <http://www.mapsofworld.com/botswana/maps/botswana-map.jpg>.

The HealthMap/ProMED-mail interactive map of Botswana is available at <http://healthmap.org/promed/en?g=933851&v=-22,26,5>. - Mod.LL]

******

[5] Cholera – Zambia

Date: Tue 16 Dec 2008

Source: AllAfrica, The Times of Zambia report [edited] <http://allafrica.com/stories/200812160408.html>

Only 19 cases of cholera are currently under treatment in Lusaka District, which recorded 176 patients in the last 2 months, the Ministry of Health has said.

Speaking at a Press briefing in Lusaka yesterday [15 Dec 2008], Health Deputy Minister Mwendoi Akakandelwa said cholera in Northern, Luapula, and Southern provinces had been brought under control.

Mr Akakandelwa said some of the cholera treatment centres that were set up in Northern and Luapula provinces had been closed while Southern Province had no case of cholera as the 3 patients who were receiving treatment in Mazabuka had recovered and were discharged.

“In Lusaka District, over the past 2 months we have seen 176 patients and successfully treated 153. The 4 that we lost died because of getting to our health facilities late, 3 in Kanyama and one in Chawama,” he said.

Mr Akakandelwa said Lusaka District had 19 patients under treatment with 17 of the patients admitted to Kanyama Health Centre and the other two admitted to Chipata Health Centre.

–

Communicated by:

ProMED-mail

<promed@promedmail.org>

[It is not stated how many of the cases were linked to the outbreak in Zimbabwe.

A map at of Zambia showing the provinces can be accessed at <http://www.un.org/Depts/Cartographic/map/profile/zambia.pdf>.

The HealthMap/ProMED-mail map of Zambia is available at <http://healthmap.org/promed/en?v=-14,27.8,5>. - Mod.LL]

[see also:

Cholera, diarrhea & dysentery update 2008 (52) 20081215.3940 Cholera, diarrhea & dysentery update 2008 (51) 20081212.3906 Cholera, diarrhea & dysentery update 2008 (50) 20081208.3854 Cholera, diarrhea & dysentery update 2008 (49) 20081203.3803 Cholera, diarrhea & dysentery update 2008 (48) 20081201.3776 Cholera, diarrhea & dysentery update 2008 (47) 20081125.3716 Cholera, diarrhea & dysentery update 2008 (46) 20081124.3708 Cholera, diarrhea & dysentery update 2008 (45) 20081120.3662 Cholera, diarrhea & dysentery update 2008 (40) 20081014.3253 Cholera, diarrhea & dysentery update 2008 (30) 20080702.2019 Cholera, diarrhea & dysentery update 2008 (20) 20080404.1240 Cholera, diarrhea & dysentery update 2008 (10) 20080212.0563 Cholera, diarrhea & dysentery update 2008 (01) 20080104.0047

2007

----

Cholera, diarrhea & dysentery update 2007 (67) 20071231.4200 Cholera, diarrhea & dysentery update 2007 (60) 20071126.3824 Cholera, diarrhea & dysentery update 2007 (50) 20071023.3450 Cholera, diarrhea & dysentery update 2007 (40) 20070924.3164 Cholera, diarrhea & dysentery update 2007 (30) 20070830.2856 Cholera, diarrhea & dysentery update 2007 (20) 20070511.1509 Cholera, diarrhea & dysentery update 2007 (10) 20070302.0737 Cholera, diarrhea & dysentery update 2007 (01) 20070105.0047

2006

----

Cholera, diarrhea & dysentery update 2006 (52) 20061229.3646 Cholera, diarrhea & dysentery update 2006 (50) 20061215.3528 Cholera, diarrhea & dysentery update 2006 (40) 20061006.2862 Cholera, diarrhea & dysentery update 2006 (30) 20060724.2037 Cholera, diarrhea & dysentery update 2006 (20) 20060512.1352 Cholera, diarrhea & dysentery update 2006 (10) 20060303.0675 Cholera, diarrhea & dysentery update 2006 (01) 20060106.0040] ……………………………..ll/mj/dk

CHOLERA, DIARRHEA and DYSENTERY UPDATE 2008 (52)

A ProMED-mail post

<http://www.promedmail.org>

ProMED-mail is a program of the

International Society for Infectious Diseases <http://www.isid.org>

In this update:

Africa

[1] Cholera – South Africa (Gauteng) ex Zimbabwe [2] Cholera – Malawi (Southern Region) [3] Cholera – Congo (Pool, Bouenza)

******

[1] Cholera – South Africa (Gauteng) ex Zimbabwe

Date: Fri 12 Dec 2008

Source: Xinhua News Agency [edited]

<http://news.xinhuanet.com/english/2008-12/12/content_10496180.htm>

South Africa’s KwaZulu-Natal and Eastern Cape health departments were confident that they have the Zimbabwe cholera spillover under control in their regions, but Gauteng hospitals are still seeing new cases.

Gauteng had confirmed cholera in 16 of the 46 people who presented the symptoms of the curable intestinal infection since November 2008.

Only 2 people who sought treatment were South African, and the [majority] came from Zimbabwe, said Dr Chika Esomugha, medical advisor to the Gauteng department of health in a statement.

–

Communicated by:

ProMED-mail

<promed@promedmail.org>

[Gauteng, formerly known as Pretoria-Witwatersrand-Vereeniging (PWV), is the smallest province in South Africa, with only 1.4 percent of the land area, but it is highly urbanized. It lies below Limpopo (formerly Northern Province). From the posting, it appears that most of the cases may have come from Zimbabwe but local transmission could have occurred.

Gauteng can be seen on the map at

<http://www.un.org/Depts/Cartographic/map/profile/southafr.pdf>.

The HealthMap/ProMED-mail interactive map of South Africa is available at <http://healthmap.org/promed/en?g=1085594&v=-26.083,28.25,5>. - Mod.LL]

******

[2] Cholera – Malawi (Southern Region)

Date: Fri 12 Dec 2008

Source: Nyasa Times [edited]

<http://www.nyasatimes.com/national/2130.html>

Barely a day after Balaka district reported the 1st death of a man suffering from cholera, the government has admitted the disease is fast spreading and 4 people have so far died in Lilongwe alone.

However, the government says it has put in place all procedures to control the cholera outbreak, which is slowly sweeping across Malawi.

In Zimbabwe, the outbreak has claimed 746 lives with over 14 000 new cases being reported. The disease has also been traced in Zambia and South Africa.

Though minister of health, Khumbo Kachali, said yesterday [11 Dec 2008] there were no confirmed cases of cholera in government hospitals, his director of Preventive Health Services in the Ministry of Health, Dr Stone Kabuluzi, confirmed of 36 cholera at Likuni Mission Hospital in Lilongwe out of which 4 people have lost their lives.

“Reports from the hospital indicate that 2 patients died right at the hospital because they came a bit late while 2 others are also suspected to have died at their homes from cholera,” he said.

Dr Kabuluzi however said his ministry has instituted necessary measures to contain the disease not to further spread to other parts of the country. He said cholera quarantine shelters were also present in all district health centers.

Apart from Lilongwe and Balaka other cases of cholera, an infectious disease characterized by serious vomiting and diarrhea, have been reported in Mwanza, Chikwawa, and Mangochi.

–

Communicated by:

ProMED-mail

<promed@promedmail.org>

[The Southern Region of Malawi where all the cases are reported from lies just east of the Tete province of Mozambique, where cholera is also active.

The area can be seen on a map at

<http://www.un.org/Depts/Cartographic/map/profile/malawi.pdf>.

The HealthMap/ProMED-mail interactive map of Malawi is available at <http://healthmap.org/promed/en?g=923817&v=-14.5,35,6>. - Mod.LL]

******

[3] Cholera – Congo (Pool, Bouenza)

Date: Fri 12 Dec 2008

Source: UN Office for the Coordination of Humanitarian Affairs (OCHA), Integrated Regional Information Networks (IRIN) News [edited] <http://www.irinnews.org/Report.aspx?ReportId=81934>

The lack of clean drinking water and proper hygiene fueled the spread of cholera in the south and southwest of the Republic of Congo, says the Congolese Red Cross, which has just completed a campaign to teach people how to recognize and stem the spread of the disease.

It said the cholera outbreak began in the Bouenza region in February

2008 and that by the end of November 2008 127 cases of the disease and 3 deaths had been registered. At least 22 other cases have been reported in the Kinkassa area and in the Pool region, which surrounds the capital, Brazzaville.

“In Kinkassa, the patients are under observation. In Bouenza, the disease has been halted and the number of deaths limited thanks to the rapid intervention of the authorities, NGOs, and other organizations such as UNICEF [UN Children's Fund],” said Yvette Mbazo’o Mve of the International Federation of Red Cross and Red Crescent Societies.

She said the lack of hygiene and clean drinking water explained the rise of cholera, which is sometimes called the “dirty-hands disease.”

In Congo, only 14 percent of people have access to clean drinking water in rural areas, while in the towns and cities this rises to nearly 60 percent.

–

Communicated by:

ProMED-mail

<promed@promedmail.org>

[The Pool and Bouenza regions are in southeastern Congo and can be seen on a map at <http://www.un.org/Depts/Cartographic/map/profile/congo.pdf>.

The HealthMap/ProMED-mail interactive map of the Republic of Congo is available at <http://healthmap.org/promed/en?g=2255404&g=2260668&v=-1.5,14,6>. - Mod.LL]

[see also:

Cholera, diarrhea & dysentery update 2008 (51) 20081212.3906 Cholera, diarrhea & dysentery update 2008 (50) 20081208.3854 Cholera, diarrhea & dysentery update 2008 (49) 20081203.3803 Cholera, diarrhea & dysentery update 2008 (48) 20081201.3776 Cholera, diarrhea & dysentery update 2008 (47) 20081125.3716 Cholera, diarrhea & dysentery update 2008 (46) 20081124.3708 Cholera, diarrhea & dysentery update 2008 (45) 20081120.3662 Cholera, diarrhea & dysentery update 2008 (40) 20081014.3253 Cholera, diarrhea & dysentery update 2008 (30) 20080702.2019 Cholera, diarrhea & dysentery update 2008 (20) 20080404.1240 Cholera, diarrhea & dysentery update 2008 (10) 20080212.0563 Cholera, diarrhea & dysentery update 2008 (01) 20080104.0047

2007

----

Cholera, diarrhea & dysentery update 2007 (67) 20071231.4200 Cholera, diarrhea & dysentery update 2007 (60) 20071126.3824 Cholera, diarrhea & dysentery update 2007 (50) 20071023.3450 Cholera, diarrhea & dysentery update 2007 (40) 20070924.3164 Cholera, diarrhea & dysentery update 2007 (30) 20070830.2856 Cholera, diarrhea & dysentery update 2007 (20) 20070511.1509 Cholera, diarrhea & dysentery update 2007 (10) 20070302.0737 Cholera, diarrhea & dysentery update 2007 (01) 20070105.0047

2006

----

Cholera, diarrhea & dysentery update 2006 (52) 20061229.3646 Cholera, diarrhea & dysentery update 2006 (50) 20061215.3528 Cholera, diarrhea & dysentery update 2006 (40) 20061006.2862 Cholera, diarrhea & dysentery update 2006 (30) 20060724.2037 Cholera, diarrhea & dysentery update 2006 (20) 20060512.1352 Cholera, diarrhea & dysentery update 2006 (10) 20060303.0675 Cholera, diarrhea & dysentery update 2006 (01) 20060106.0040] ……………………………..ll/mj/dk