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Nigeria: Cholera Outbreak - Jun 2017

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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)

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)

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

A Cholera Response and Prevention Plan, 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)

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)

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)

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)

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)

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)

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)

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)

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)

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)

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.) 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.)

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)

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)

No new suspected case of cholera has been reported since 19 November 2018. A total of 125 639 persons were vaccinated (administrative coverage: 82.5%) during the second round of the OCV campaign from 21 to 24 December 2018 in Aguie Gazaoua and Tchadoua Districts. (WHO, 01 Feb 2019)

Suspicious cases remain concentrated in the states of Bayelsa (41) and Kano (6). Since the beginning of the year, 579 suspected cases have been reported, including 24 recorded deaths. (UNICEF, 24 May 2019)

On 18 June 2019, the State Ministry of Health of Adamawa State in north-east Nigeria officially declared a cholera outbreak in three local government areas (LGAs). The cholera outbreak started on 15 May 2019 (week 19) in Yola North LGA and spread to Girei LGA in week 22 and eventually to Yola South LGA in week 23 (week ending 9 June 2019). In week 24 (week ending 16 June 2019), 37 new suspected cholera cases were reported, with no deaths. (WHO, 23 Jun 2019)

From 15 May to 28 June 2019, a cumulative total of 156 cases with one death (CFR 0.6%) have been reported from three LGAs with the caseload distributed as follows: Yola North (74 cases with one death), Girei (79 cases with zero deaths), and Yola South (three cases with zero deaths). (WHO, 21 Jul 2019)