Epidemiological description of a protracted cholera outbreak in Tonj East and Tonj North counties, former Warrap State, South Sudan, May-Oct 2017

Abstract

BackgroundOn 18th May 2017, State Ministry of Health of former Warrap State received a report from Tonj East County of an outbreak of acute watery diarrhoea and vomiting in Makuac payam. We conducted this investigation to confirm the causative organism and describe the epidemiology of the outbreak in order to support evidence-based control measures.MethodsWe defined a suspected case as a resident of Tonj East or Tonj North County with sudden onset of acute watery diarrhoea and vomiting between May 1 and October 15, 2017. A probable case was defined as a suspected case with a positive rapid test for Vibrio cholerae; a confirmed case was a probable case with a positive stool culture for V. cholerae. We conducted systematic case finding by visiting health facilities and villages in the affected payams. We reviewed patient records from 1 May 2017 to 15 October 2017, to identify suspected cholera case-patients. We conducted a descriptive epidemiologic study, examining the distribution of the cases. We computed the attack rates by age, sex, and payam of residence. Case fatality rate was calculated as the ratio of the total number of suspected cholera death to the total number of cholera case-patients. We conducted an oral cholera vaccination campaign after the peak of the outbreak to control and prevent the spread to other payams.ResultsWe identified 1451 suspected cholera cases between May and October 2017. Of these, 81% (21/26) had a positive rapid diagnostic test for V. cholerae; out of the 16 rectal swabs transported to the National Public Laboratory, 88% (14/16) were confirmed to be V. cholerae O1 serotype Inaba. The epidemic curve shows continuous common source outbreak with several peaks. The mean age of the case-patients was 24 years (Range: 0.2-75y). The clinical presentations of the case-patients were consistent with cholera. Males had an attack rate of 9.9/10000. The highest attack rate was in ≥30y (14 per 10,000). Among the six payams affected, Makuac had the highest attack rate of 3/100. The case fatality rate (CFR) was 3.0% (44/1451). Paliang and Wunlit had an oral cholera vaccination coverage of ≥100%, while 4 payams had a vaccination coverage of < 90%.ConclusionThis was a continuous common source cholera outbreak caused by V. cholerae 01 sero type Inaba. We recommended strengthening of the surveillance system to improve early detection and effective response.

Uptake of Modern Contraceptive Methods among Burundian Women and Associated Factors: Analysis of Demographic and Health Survey Data, Burundi 2016–2017

“…This may be explained by the fact that type two diabetes is common in old age people compare to young age people and the possibility of inheriting DM traits. Our findings are similar to the study conducted in Dar es salaam Tanzania, Kenya and Ethiopia 11 – 32 – 33 , but contrary to that of Nigeria 34 where no difference in the odds of DM was found.…”

“…The prevalence of DM among TB patients in this study is comparable with that reported in Dar es salaam Tanzania, (9.7%), Nigeria (9.4%), and a pooled prevalence of a meta-analysis study of SSA (9.0%). 11 , 16 , 25 However, the prevalence is lower compared to that reported in Pakistan (14.8%), India (13.9%) and Bangladesh (12.8) 26 – 28 Other studies have reported lower prevalence as compared to our study; Uganda (8.5%), Tanzania (4.5) Lusaka Zambia (2.3%), Mozambique (1%). 19 - 29 - 30 , 31 The possible explanations for the difference could be difference in study setting and screening method used in DM diagnosis, for example, in the study conducted in Pakistan 26 , both FBG and HBA1C were used for DM screening which is more effective as compared to the method used in the current study.…”

“…DM is an independent risk factor which cause poor TB treatment response as well as death. 11 , 12 The relationship between DM and TB is assisted by the fact that patients with DM have impaired cell mediated immunity, renal failure, micronutrient deficiency, and pulmonary microangiopathy, all of which increases the susceptibility of myco-bacterium tuberculosis . 13 …”

Epidemiological Description of a Protracted Cholera Outbreak in Hagadera Refugee Camp and the Surrounding Host Community within Fafi Sub County and Garissa County in Kenya during March-September 2019

“…6 Oral cholera vaccines (OCVs) have been recommended in cholera-endemic settings and pre-emptively during outbreaks and complex emergencies. 7 This study reveals the challenges and gaps experienced in countries with insecurity regarding, prevention, early detection and effective response to public health threats. However, it also has limitations: Owing to surveillance challenges and insecurity in the area, several cases could have been missed at the beginning of the outbreak, which limits the reliability of our descriptive epidemiology.…”

The Chronic Cholera Situation in Africa: Why Are African Countries Unable to Tame the Well-Known Lion?

“…Similar experiences have been documented in South Sudan and elsewhere. 53 Many countries that eventually declare outbreaks refer to the disease as "Acute Watery Diarrhea" or "AWD" for economic and political reasons; this creates distortions in response efforts.…”