WHO Plans Global War on Cholera as Yemen Caseload Soars

WHO Plans Global War on Cholera as Yemen Caseload Soars

By Tom Miles, Reuters on September 19, 2017


GENEVA (Reuters) - The World Health Organization will next month launch a strategy to stop cholera transmission by 2030, it said on Monday, as an unprecedented outbreak in Yemen raced towards 700,000 suspected cases with little sign of slowing down.

The WHO is also trying to keep the lid on a flare-up in Nigeria while tackling many entrenched outbreaks in Africa and an epidemic in Haiti, where almost 10,000 people have died since 2010.

“Once it’s out of the box, once it has spread, it’s very, very difficult to contain and we have a huge number of cases and deaths,” said Dominique Legros, the cholera focal point at WHO’s department for pandemic and epidemic diseases.

Epidemics often arise in war zones. The WHO is sending an expert to Bangladesh to assess the risk for Rohingya Muslims fleeing from violence in Myanmar.

“The risk is probably relatively high,” Legros said.

In Yemen, the most explosive outbreak on record has caused 686,783 suspected cases and 2,090 deaths since late April. The number of deaths has slowed but the spread of disease has not: in the past week there were 40,000 suspected cases, the most for seven weeks.

Legros said it was impossible to predict how any outbreak would evolve, but Yemen’s was likely to continue for a long time. The low death rate suggested the outbreak was not severe, although there may be many uncounted deaths in the community.

The number of suspected cases in Yemen cannot be checked accurately, and many may be acute watery diarrhea, which has similar symptoms and treatment but is not caused by the cholera bacterium, which is spread by contaminated food and water.

The WHO estimates there are 2.9 million cases and 95,000 deaths globally each year, far more than officially reported.

Equipped with a vaccine stockpile that it created in 2013, it plans to launch a global strategy on Oct. 4.

“The objective of the new strategy is to stop transmission by 2030,” Legros said. “Overall, we expect reduction of mortality by 90 percent by 2030.”

The strategy will aim to use the vaccine to contain outbreaks as fast as possible, while addressing deeper problems.

In Africa, growing urbanization, climate change, conflict, displacement camps - as well as sanitation investment that is a third of what it should be - mean there is no reason to expect any improvement without deliberate action, he said.

Yemen cholera cases pass 300,000 as outbreak spirals - ICRC

Media caption

A cholera outbreak in war-torn Yemen is thought to have infected 300,000 people in the past 10 weeks, the International Committee of the Red Cross says.

The situation has continued to "spiral out of control", with about 7,000 new cases every day, the ICRC warned.

More than 1,700 associated deaths have been reported, according to the UN.

Yemen's health, water and sanitation systems are collapsing after two years of conflict between pro-government forces and the rebel Houthi movement.

Cholera is an acute diarrhoeal infection caused by ingestion of food or water contaminated with the bacterium Vibrio cholera.

Most of those infected will have no or mild symptoms but, in severe cases, the disease can kill within hours if left untreated.

On 24 June, the World Health Organisation declared that Yemen was facing "the worst cholera outbreak in the world", with more than 200,000 suspected cases.

In just over two weeks, another 100,000 people have been infected - an increase the ICRC's Middle East regional director Roberto Mardini called "disturbing".

Image copyrightEPA

Image captionThe war has left less than half of Yemen's medical facilities functional

The WHO said on Saturday that 297,438 cases had been recorded, but the agency was still analysing the latest figures from the Yemeni health ministry on Monday.

The outbreak has affected all but one of Yemen's 23 provinces. The four most affected provinces - Sanaa, Hudaydah, Hajja and Amran - have reported almost half of the cases.

UN agencies say the outbreak is the direct consequence of the civil war, with 14.5 million people cut off from regular access to clean water and sanitation.

More than half of health facilities are no longer functioning, with almost 300 having been damaged or destroyed, and some 30,000 local health workers who are key to dealing with the outbreak have not been paid for 10 months.

Rising rates of malnutrition have weakened the health of vulnerable people - above all children under the age of 15 and the elderly - and made them more vulnerable to the disease.

Last week, the UN's humanitarian co-ordinator in Yemen warned that humanitarian organisations had been forced to divert resources away from combating malnutrition to deal with the cholera outbreak, raising the risk of a famine.

"If we don't get these resources replaced, then using those resources for cholera will mean that food insecurity will suffer," Jamie McGoldrick said. "We're trying to do our best, but it's very much beyond what we can cope with."