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WHO EMRO Weekly Epidemiological Monitor: Volume 10, Issue 52 (24 December 2017)

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Current major event

Declining trend of cholera in Somalia

Data from the Ministry of Health in Somalia suggests that the cholera outbreak reported in 2017 in the country is gradually levelling off. The number of cholera cases and deaths have significantly decreased in recent months and no deaths were recorded from August up to November.
The number of cases reported during the month of November is the lowest in 2017.

Editorial note

Cholera is an acute diarrhoeal infection caused by ingestion of food or water contaminated with the bacterium Vibrio cholerae.

Majority of infected individuals develop moderate to mild symptoms, whereas a minority develop acute watery diarrhea, which can lead to death within hours if left untreated. Cholera is an endemic disease in Somalia.

The current surge of cholera cases began in November 2016 when the country was reeling through a severe drought situation. As the coverage of the early warning surveillance system is limited in the country owing to inaccessibility and other security concerns, the cholera data reported from Somalia, so far, may be have been an underestimation of what actually plausibly been occurred.

Between January and November 2017, a total of 78,784 cholera cases including 1,159 associated deaths (CFR: 1.47%) were reported across 52 districts of the country. Majority of the cases and deaths occurred in April. There is a remarkable decrease in the reported cases and number of deaths after the month of August (see graph). Moreover, less districts have been reporting cases in the month of November compared to previous months (see table). This reported decline might have been attributed to the use of oral cholera vaccine in Somalia to prevent and contain the outbreak.

The country implemented the first oral cholera vaccination campaigns in which over 1,015,406 people aged 1 year and above were targeted for vaccination with two doses administered at least two weeks apart in 9 hotspots of central and southern regions of Somalia. To establish the performance of the campaign, OCV coverage surveys were also conducted to determine the OCV coverage in phase 1 and phase II implementations. Approximately 92.7% coverage for the two doses of OCV was achieved during phase 1 while during phase II, the coverage for two doses of OCV was 94.1%. The oral vaccination campaign was preceded by extensive social mobilization efforts to inform the community of the benefits, availability and necessity of the vaccine.

These effort has led to successful containment of the outbreak. Despite the declining trend of cholera in the country, surveillance and response efforts should continue in all hot spots. Vigilance must be continued to sustain the progress achieved in controlling the outbreak.
Coordination and collaboration between all agencies and local communities should continue.