Cholera epidemic in Africa: Largest yet

By Dr. Ananya Mandal, MDOct 12 2011

The United Nations Children's Fund (UNICEF) has announced in a statement that the cholera epidemic in West and Central Africa is one of the worst the area has ever seen. So far this year more than 85,000 cases have been reported in the region, including 2,466 deaths.

With such number of cases of cholera this year reported in 10 countries from Mali to Congo, “the region is facing one of the biggest epidemics in its history”, the agency said. And UNICEF spokeswoman Marixie Mercado said Tuesday that above-average rainfall predicted for the coming weeks raises the likelihood that cholera will continue to spread.

UNICEF adds that the “case-fatality rates” or CFR are “unacceptably high”, ranging from 2.3% to 4.7%, but spiking much higher in places, such as parts of Cameroon, which have reported CFRs as high as 22%. The group warned that children, especially malnourished ones, are more vulnerable to cholera, because they are more prone to dehydration.

Chad, Cameroon, and the western Democratic Republic of the Congo have experienced the most striking increases in cholera activity this year, according to UNICEF. Three areas of major cross-border cholera activity include the Lake Chad Basin, West Congo Basin, and Lake Tanganyika. Smaller cholera epidemics are under control in several countries, including Benin, Cote d’Ivoire, Ghana, Guinea, Liberia, and Togo, the agency reported.

UNICEF is urging governments to coordinate preparedness and response activities within their own borders and also to collaborate closely with neighboring countries. “It is clear in this emergency that authorities can play a key role to save lives. Information exchange between cross-border districts on caseloads and population movements, as well as cross-border inspections for disinfection and chlorination are proven ways to contain the disease and save lives,” the agency said. Poor access to water and sanitation is the underlying cause of cholera outbreaks in West and Central Africa, according to UNICEF, which pointed out that none of the 24 countries in the region are on track to reach the UN Millennium Development Goals for sanitation.

Gaetan Drossart, head of the Doctors Without Borders mission in Haiti, said in the statement that in the past month, treatment center admissions have risen from less than 300 per week to more than 850, which he said is a worrisome sign that the outbreak could worsen over next weeks. The group also has treatment centers in Artibonite, North, and West departments.

Another Doctors Without Borders official, Pascale Zintzen, linked rising cholera cases in Haiti's capital to the year's second rainy season, which causes flooding and the spread of the waterborne disease in the crowded city, which lacks sanitation. So far the outbreak in Haiti has sickened about 440,000 people and led to more than 6,200 deaths.

Cholera is an infectious disease caused by the bacterium Vibrio cholera. It tends to occur in places with poor sanitation, crowding, war, and famine. In addition to severe diarrhea, symptoms include abdominal cramps, dry skin and mucous membranes, lethargy, nausea, vomiting, and rapid heart rate. The goal of treatment - typically the administration of fluids orally or intravenously - is to replace fluid and electrolytes lost through diarrhea.