Africa by Country

Cholera Outbreaks: August 2009, September 2010

CDC at Work: On May 6th, 2010, suspect cholera cases were reported from the district of Makary in the Far North region of Cameroon. By October, 7,822 cases and 518 had been confirmed in the Far North region. The Cameroon Ministry of Public Health (MoPH) invited CDC and the World Health Organization (WHO) to provide technical assistance during the cholera epidemic.

Publications

• Cartwright EJ, Patel MK, Mbopi-Keou FX, Ayers T, Haenke B, Wagenarr BH, Mintz E, Quick R. Recurrent epidemic cholera with high mortality in Cameroon: persistent challenges 40 years into the seventh pandemic. Epidemiol Infect. 2013;141(10):2083-93.
• Murphy J, Cartwright M, Johnson B, Ayers T, Worthington W, Mintz E. An Evaluation of a bucket chlorination campaign during a cholera outbreak in rural Cameroon. Waterlines. 2018; 37(4):266-279.

Cholera Outbreaks: 2019, July 2012, July 2011, 2008, June 2003, September 2002, March 2002

CDC at Work: DRC is endemic for cholera and has experienced frequent outbreaks.  CDC provided technical assistance to USAID/OFDA in responding to an outbreak in North Kivu in 2008 and in 2019 conducted a post-vaccine coverage survey in the Kasai Region.

Publications

• Bompangue D, Giraudoux P, Handschumacher P, Piarroux M, Sudre B, Ekwanzala M, Kebela I, Piarroux R. Lakes as source of cholera outbreaks, Democratic Republic of Congo. Emerg Infect Dis. 2008;14(5):798-800.

Cholera Outbreaks: 2019, 2017

CDC at Work: In 2017, CDC provided technical assistance to the WASH Cluster in the Somali Region to improve chlorination of drinking water sources and created a water quality monitoring application in collaboration with UNICEF Ethiopia, the WASH cluster, and local government for reporting free residual chlorine in piped network and other water sources.

In 2019, while in Ethiopia for a laboratory capacity building mission, CDC was informed of an outbreak of cholera in the Southern Nations, Nationalities, and Peoples’ Region (SNNPR) of Ethiopia. The Ethiopian Public Health Emergency Management (PHEM) team requested CDC assistance with water quality monitoring during the outbreak. CDC travelled to Hawassa, Ethiopia to train local PHEM staff on the utilization of chlorine monitoring in drinking water during outbreaks of cholera.

Cholera Outbreak: June 2005

Publications

• Cavallaro EC, Harris JR, da Goia MS, et al. Evaluation of pot-chlorination of wells during a cholera outbreak , Bissau, Guinea-Bissau, 2008. J Water Health. 2011;9(2):394-402.
• Harris JR, Cavallaro EC, de Nóbrega AA, Dos S Barrado JC, Bopp C, Parsons MB, Djalo D, Fonseca FG, Ba U, Semedo A, Sobel J, Mintz ED. Field evaluation of Crystal VC® Rapid Dipstick test for cholera during a cholera outbreak in Guinea-Bissau. Trop Med Int Health. 2009;14(9):1117-21.
• Gunnlaugsson G, Angulo FJ, Einarsdóttir J, Passa A, Tauxe RV. Epidemic cholera in Guinea-Bissau: The challenge of preventing deaths in rural west Africa. Int J Infect Dis. 2000;4(1):8-13.

Cholera Outbreaks: April – June 2015 November 2011, December 2009, July 2008

CDC at Work: In 2009, multiple areas in Kenya experienced cholera outbreaks. The Kenya Ministry of Public Health and Sanitation–Division of Disease Surveillance and Response (MoPHS – DDSR) requested CDC technical assistance to (a) provide assistance with describing the epidemiology of cholera outbreaks in Kenya nationally during 2009-2010;(b) evaluate the surveillance and response efforts during the 2009-2010 outbreaks; and, (c) evaluate water quality in select Nairobi informal settlements.

For more information see the Full trip report from the CDC Outbreak Investigation. [PDF – 148 pages]

Publications

• Curran KG, Wells E, Crowe SJ, Narra R, Oremo J, et al. Systems, supplies, and staff: a mixed-methods study of health care workers’ experiences and health facility preparedness during a large national cholera outbreak, Kenya 2015. BMC Public Health. 2012;18:723.
• CDC. Notes from the Field: Ongoing Cholera Outbreak — Kenya, 2014–2016. MMWR Morb Mortal Wkly Rep 2016;65:68–69.
• Mohamed AA, Oundo J, Kariuki SM, Boga HI, Sharif SK, Akhwale W, Omolo J, Amwayi AS, Mutonga D, Kareko D, Njeru M, Li S, Breiman RF, Stine OC. Molecular epidemiology of geographically dispersed Vibrio cholerae, Kenya, January 2009–May 2010. Emerg Infect Dis. 2012;18(6): 925-31.
• Mugoya I, Kariuki S, Galgalo T, Njuguna C, Omollo J, Njoroge J, Kalani R, Nzioka C, Tetteh C, Bedno S, Breiman RF, Feikin DR. Rapid spread of Vibrio cholerae O1 throughout Kenya, 2005. Am. J. Trop. Med. Hyg. 2008;78(3): 527–33.
• Feikin DR, Tabu CW, Gichuki J. Does water hyacinth on east African lakes promote cholera outbreaks? Am. J. Trop. Med. Hyg. 2010; 83(2): 370–3.
• Shikanga O, Mutonga D, Abade M, Amwayi S, Ope M, Limo H, Mintz E, Quick RE, Breiman RF, Feikin DR. High mortality in a cholera outbreak in western Kenya after post-election violence in 2008. Am. J. Trop. Med. Hyg. 2009;81(6): 1085–90.

Cholera Outbreaks: April 2019

CDC at Work: In March and April of 2019 Mozambique was hit by two massive cyclones, Idai and Kenneth, which let to outbreaks of cholera resulting in over 7,000 cases and 8 deaths.  CDC provided technical assistance to the Ministry of Health and Institute of Public Health to strength cholera surveillance.  CDC also supported UNICEF and the WASH cluster to set up water quality monitoring programs in Beira and Pemba and to train WASH Rapid Response Teams in Beira.

Cholera Outbreaks: November 2010, November 2009, December 2004, November 2001

Publications

• Hutin Y, Luby S, Paquet C. A large cholera outbreak in Kano City, Nigeria: the importance of hand washing with soap and the danger of street-vended water. J Water Health. 2003;1(1):45-52.

Cholera Outbreak: August 2012

CDC at Work: On 16 August 2012, President Koroma declared the cholera outbreak a “public health emergency,” paving the way for a more robust national and international response. On August 24, 2012, the Centers for Disease Control and Prevention (CDC) received a request for assistance from the Sierra Leonean Ministry of Health and Sanitation (MoHS) to investigate risk factors for cholera and to provide laboratory support.

Publications

• Epidemic Associated with Consumption of Unsafe Drinking Water and Street-Vended Water — Eastern Freetown, Sierra Leone, 2012. Nguyen VD, Sreenivasan N, Lam E, et al. Am. J. Trop. Med. Hyg. 2014;90(3):518–523 doi:10.4269/ajtmh.13-0567.

Cholera Outbreaks: 2017, 2014, 2006

CDC at Work: South Sudan has experienced several cholera outbreaks over the past decade and a half. CDC supported UNICEF in assessing the WASH response in Juba and Malakal in 2006 and provided support to the USAID Office of Foreign Disaster Assistance in response to outbreaks in 2014 and 2017.

Cholera Outbreaks: August 2015

CDC at Work: In 2015, Tanzania experienced cholera outbreaks, including Dar es Salaam. CDC, along with other partner organizations, assisted the Tanzanian Ministry of Health, Community Development, Gender, Elderly and Children (MOHCDGEC), with enhancing cholera response activities, including strengthening cholera surveillance, laboratory training, and strengthening infection prevention and control in health care facilities. Additionally, CDC supported the MoHCDGEC and UNICEF Tanzania in the implementation, monitoring, and evaluation of bulk chlorination targeting drinking water vendors in cholera-affected areas.

Publications

• Rajasingham A, Hardy C, Kamwaga S, et al. Evaluation of an Emergency Bulk Chlorination Project Targeting Drinking Water Vendors in Cholera-Affected Wards of Dar es Salaam and Morogoro, Tanzania. Am J Trop Med Hyg. 2019;100(6):1335-1341.
• Notes from the Field: Ongoing Cholera Epidemic — Tanzania, 2015–2016.
• McCrickard LS, Massay A, Narra R, et al. Cholera Mortality during Urban Epidemic, Dar es Salaam, Tanzania, August 16, 2015–January 16, 2016. Emerging Infectious Diseases. 2017;23(13). doi:10.3201/eid2313.170529.

Cholera Outbreaks: October 2017

CDC at Work: On 6 October, 2017, an outbreak of cholera was declared in Zambia. CDC along with other partner organizations, collaborated with the Zambia Ministry of Health (MoH) to launch a multifaceted public health response that included increased chlorination of the Lusaka municipal water supply, provision of emergency water supplies, water quality monitoring and testing, enhanced surveillance, epidemiologic investigations, a cholera vaccination campaign, aggressive case management and health care worker training, and laboratory testing of clinical samples.

Publications

• CDC. Cholera Epidemic — Lusaka, Zambia, October 2017–May 2018. MMWR Morb Mortal Wkly Rep 2018;67:556–559.
• Kapata N, Sinyange N, Mazaba ML, Musonda K, Hamoonga R et al. A multisectoral emergency response approach to a cholera outbreak in Zambia: October 17-February 2018. JID. 2018:218(Suppl 3).

Cholera Outbreaks: 2016

CDC at Work: In 2015-16 Zanzibar experienced an outbreak of cholera with over 4000 cases reported.  CDC provided technical assistance to the WHO Country office and the liaison Office in Zanzibar to strengthen surveillance, laboratory and WASH aspects of the response.  CDC also supported prevention efforts leading up to the Jitimai mass gathering to reduce potential exposure to the those attending the gathering.

Cholera Outbreaks: 2018, August 2008

CDC at Work: In 2018, the urban and peri-urban areas of Chegutu, Zimbabwe experienced a cholera outbreak. CDC assisted the Zimbabwe Ministry of Health and Child Care (MoHCC) with a coordinated rapid response, including surveillance, health promotion, laboratory testing, and emergency water, sanitation, and hygiene (WASH) activities. The Zimbabwe outbreak was contained to this area. A second outbreak began in Harare in late 2018, and CDC proved the MoHCC and City of Harare with additional support in all pillars.  WASH support included a rapid assessment of boreholes and other alternative drinking water sources, post distribution monitoring of NFIs,  training and support for monitoring activities to the joint rapid response teams, and a routine monitoring system for the piped network.

Publications

• Winstead A, Strysko J, Relan P, et al. Notes from the Field: Cholera Outbreak — Zimbabwe, September 2018–March 2019. MMWR Morb Mortal Wkly Rep 2020;69:527–528. DOI: http://dx.doi.org/10.15585/mmwr.mm6917a3
• CDC. Notes from the Field: Outbreak of Vibrio cholerae Associated with Attending a Funeral — Chegutu District, Zimbabwe, 2018. MMWR Morb Mortal Wkly Rep 2018;67:560–561.
• Morof D, Cookson ST, Laver S et al. Community Mortality from Cholera: Urban and Rural Districts in Zimbabwe. Am J Trop Med Hyg. 2013. 88(4);645-650.