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WHO EMRO Weekly Epidemiological Monitor: Volume 14, Issue no 7; 14 February 2021

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Current major event

An overview of the Cholera outbreak response in Yemen, 2020

In 2020, Ministry of Public Health and Population (MOPHP) reported cumulatively a total of 233,720 cases and 85 deaths (CFR 0.04%). Total 22,488 stool specimens were tested, 8,543 were positive by rapid test (RDTs) and 134 were positive by culture with 10% positivity rate. Fewer cases were reported in 2020 compared with previous years (See table and graph) following the implementation of control and prevention measures by MOPHP with the support of both health and water, sanitation and hygiene (WASH) clusters.

Editorial note

MOPHP with the support from health and WASH cluster partners has implemented effective cholera prevention and control interventions that rely on a multisectoral approach guided by effective coordination mechanism. Leadership and Coordination of the response have been maintained through 2 central and 26 governorate emergency operating centers (EOCs).

Real time surveillance to detect new cases and monitor the cholera situation in the context of COVID-19 pandemic was enhanced. The electronic integrated Disease Early Warning System (eIDEWS) platform was upgraded to improve the speed and efficiency of data collection, analysis and public health response from 1991 reporting sites. Several trainings for rapid response teams and early warning surveillance were conducted to build their capacity in detecting, verifying, and responding to any public health alert or outbreak. In Yemen, there are 2 central, 23 governorate, and 333 districts RRTs who are deployed effectively and efficiently to respond to any alert or suspected outbreak. Case management for cholera patients was improved through multiple hand-on trainings. WHO and partners continue to support MOPHP in operating 138 diarrhoea treatment centers (DTCS) and 58 Oral rehydration centers (ORCs). The diagnostic capacity was improved in the 6 central public health laboratories and provision of RDTs.

WASH interventions have been scaled up. More than two thirds of reported cases were targeted by WASH Interventions. WASH RRT distributed around 900,000 consumable hygienic kits (CHK), chlorine tabs, and raised hygiene awareness focusing on 20 high-risk sub-districts. Fuel operational support were provided to public water systems and Waste Water Treatment Plants, reaching 3M people per month. Water quality and surveillance were evaluated reaching 3.7 million in Al Hodeidah, Amran, Dhamar, Ibb, Sana’a City, and Taiz. A daily chlorination of private water sources and water tankers continued in Dhamar, Sana’a, and Sana’a City.
In 2020, cholera hotspot mapping exercise was conducted using the Global Task Force on Cholera Control (GTFCC) tool. Two indicators in terms of mean annual suspected cholera incidence for last 5 years and persistence as the proportion of weeks with reported cases were used. 38 districts were identified as high-risk areas. OCV risk assessment was updated using nine indicators including Attack rate score, Mean Annual incidence, Ongoing transmission, WASH indicators, Culture and RDT positivity, persistency of reporting, population density, internal displacement, and functionality of health facilities. 18 priority districts were recognized as high risk areas among which Al Hali district in Alhudaydah and Hamdan district in Sana’a were identified to be targeted by vaccination activities. GTFCC approved 4,832,000 doses, targeting 4.8 million people in 32 districts in Amran, Al Mahwit & Al Hudaydah

Risk communication and community engagement activities were strengthened. Since January, over 2 million people were reached with Cholera prevention messages through various interpersonal communication approaches. The mobile TVs were used to reach people in IDP gatherings with Cholera messages through 22 community Radios and 10 TV channels. Adopting innovative RCCE approaches including use of WhatsApp groups, branding of commodities with stickers, roaming cars with megaphones, and mosques announcement.