Nigeria has Africa’s largest cholera surge

Nigeria is leading in Africa with the highest number of reported cholera cases in a pandemic that has seen cases double to 472 697 in 2022.

The country reported 23,839 cases, including 597 deaths, to the World Health Organization (WHO), placing it ahead of the Democratic Republic of the Congo, Cameroon, Malawi, and Somalia, which recorded significant cases.

According to new data released by the WHO, 80 per cent of the deaths occurred in local communities in Nigeria.

The trend shows not so much improved since 2021 when Nigeria accounted for 78% of reported cases and 88% of reported deaths in Africa.

Africa generally saw a 29 per cent decrease in reported cases, a 52 per cent decrease in reported deaths compared to 2021, and a reduction in the said case fatality ratio from 2.9 to 1.9 per cent.

“More work is necessary to record the number of community deaths and the risk factors for high CFRs to orient control measures and improve access to treatment to ensure that people who live in affected countries do not die of a readily treatable disease,” WHO stated.

The epidemiology report also shows that in 2022, the demand for oral cholera vaccine (OCV) doubled compared with 2021, with 24 requests from 12 countries for 72 million doses.

Only 40 million doses were approved.

Also, in 2022, only one request from Nigeria was made through the Global Task Force on Cholera Control mechanism for preventive campaigns, and 10 million doses were approved (25 per cent of requested quantities).

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The WHO said Nigeria did not receive all the approved doses for preventive campaigns because of supply constraints.

The strain on the global supply of OCV was due to an unprecedented decision taken in October 2022 by the International Coordinating Group (ICG) to temporarily suspend the standard 2-dose vaccination regimen in the cholera outbreak response.

It instead decided to use a single-dose approach, as recommended by the Strategic Advisory Group of Experts on immunization.

Evidence on the duration of protection is limited; however, the 1-dose strategy has proven effective in responding to outbreaks.

Additional primary vaccination may be necessary to ensure more extended protection should the risk of cholera persist.

Due to greater demand than supply, this restriction has continued into 2023.

Cholera is an acute intestinal infection that spreads through food and water contaminated with faeces containing the bacterium Vibrio cholerae.

It is closely linked to inadequate safe water and sanitation due to underdevelopment, poverty and conflict. Climate change, too, is playing a role in this upsurge as extreme climate events like floods, droughts, and cyclones trigger new outbreaks and worsen existing ones.

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Current data for 2023 suggest that this global upsurge is continuing. Twenty-four countries are reporting active outbreaks, with some in acute crises.

Due to this, the WHO is seeking $160 million to respond to cholera through the global strategic preparedness, readiness, and response plan. It has $16 million has been released from the WHO Contingency Fund for Emergencies for cholera response in 2022 and 2023.

WHO said it supports countries to respond to cholera outbreaks on an emergency footing by strengthening public health surveillance, case management, and prevention measures; providing essential medical supplies; coordinating field deployments with partners; and supporting risk communication and community engagement.