Working Against the Clock to Stop Cholera in Mozambique

On March 14, 2019, Cyclone Idai, which is being labeled one of the worst tropical cyclones ever to hit Africa, made landfall in Mozambique, leaving flood waters and destruction in its wake.

Although the full impact of the cyclone cannot be definitively measured, the natural disaster has resulted in the destruction and/or flooding of 110,000 homes, resulting in a high number of displaced individuals. Current estimates from the United Nations Office for the Coordination of Humanitarian Affairs (OCHA) indicate that as of March 31, approximately 33,000 individuals have been provided with shelter.

As relief personnel work around the clock to reach individuals in need of food, water, and shelter, a new threat has emerged that is no stranger to natural disaster aftermath—cholera.

“The risk for outbreaks is often presumed to be very high in the chaos that follows natural disasters, a fear likely derived from a perceived association between dead bodies and epidemics. However, the risk factors for outbreaks are associated primarily with population displacement,” John Watson, MBBS, of the World Health Organization (WHO), and colleagues wrote in a perspective in Emerging Infectious Diseases.

According to the Mozambique Ministry of Health, 1052 cases of cholera had been recorded as of April 1. The majority of the cases have been reported in the urban port city of Beira, but cases are also being documented in rural areas where access to clean water is scarce and sanitation systems and infrastructure have been severely damaged. One death has been confirmed in Beira.

OCHA reports that 11 treatment centers have been established in attempts to ward off waterborne diseases. Doctors Without Borders/Médecins Sans Frontiéres (MSF) reported that their teams are working inside 3 health centers to care for individuals suffering from cholera and other waterborne diseases. It has also been noted that vector-borne diseases, including malaria, have been reported in the aftermath of the cyclone.

Additionally, outside of the treatment centers, MSF has teams running mobile clinics to provide health services to people living in rural areas where damage to roads and flooding has impeded transportation to treatment centers. The mobile health teams comprise doctors, clinical officers, nurses, health promoters, and counselors. They are visiting transit centers where displaced people are sheltering.

MSF East Africa reports that 10 tons of equipment that is needed during a cholera response, including antibiotics, cholera beds, cleaning equipment, infusion and catheters, oral rehydration salts, chlorine, protective clothing, and plastic sheeting, has arrived in Mozambique.

According to the UN, 900,000 cholera vaccines, funded by Gavi, arrived in the African nation on April 2, just in time for a vaccination campaign to begin on April 3. The vaccinations will be introduced in Beira, along with the Dondo district, Nhamatanda district, and Buzi district.

900,000 @Gavi-funded cholera vaccine doses have now arrived in Beira, Mozambique. Vaccination will begin tomorrow afternoon. #VaccinesWork #CycloneIdai

(Photo: @WHO) pic.twitter.com/o413Q2Uf0C

— Seth Berkley (@GaviSeth) April 2, 2019

The UN indicates that at-risk communities will initially be given 1 dose of the cholera vaccine providing protection for at least 6 months. The 2 main priorities of WHO are to make a second dose of the vaccine available later this year and to prevent people from drinking dirty water

According to the WHO, there are 3 pre-cholera oral vaccines. Shanchol and Euvichol-Plus are reportedly “essentially the same vaccine produced by 2 different manufacturers,” and are the only vaccines available for mass vaccination campaigns through the global oral cholera vaccine stockpile.

The 2 vaccines can be given to all individuals over the age of 1 year. There must be a minimum of 2 weeks’ delay between each dose and 2 doses of either vaccine will provide protection against cholera for 3 years.

Cholera is a growing concern in the cyclone aftermath, with nearly 260 cases reported in a 24-hour window on April 1. Although cholera is quick to spread, it is also quick to kill—death can occur in just a few short hours when left untreated. But as health teams work around, and against, the clock to intervene before the disease becomes deadly, there is hope. Up to 80% of cases can be successfully resolved through treatment with oral rehydration solution.

In October 2017, the Global Task Force on Cholera Control (GTFCC) and partners launched a strategy for cholera control, aiming to reduce cholera deaths by 90% and to eliminate cholera in as many as 20 countries by 2030.

The campaign first focuses on early detection and quick response to containing outbreaks of cholera. Further, the campaign calls on countries to focus on preventing cholera recurrence by focusing on hotspots of cholera and implementing hygiene procedures and encouraging vaccination. To achieve all of this, the GTFCC offers and encourages their partners to provide technical support, advocacy, and resource mobilization.

For the most recent case counts in the cholera outbreak in Mozambique, check out the Contagion® Outbreak Monitor.