Chad: Hepatitis E Outbreak - Sep 2016
From 1 September 2016 until 13 January 2017, a total of 693 cases including 11 deaths of acute jaundice syndrome (AJS) have been reported from Am Timan, Chad. Based on the available information, there appears to be a plateau in the number of cases reported in the past 5 weeks from the affected area with an average of 70 cases reported weekly where only a minor proportion (7.2%) requires hospitalization. The infectious risk seems confined to Am Timan and immediate surroundings. However, the event remains under close monitoring at all levels of WHO. (WHO, 24 Jan 2017)
As part of the UNICEF response to the Hepatitis E suspected epidemic, WASH supplies for disinfection and water treatment were made available to the Amtiman Health District. (UNICEF, 31 Dec 2016) MSF, in addition to providing medical care, has also implemented hygiene and sanitation activities since this virus is primarily transmitted from one person to another through contaminated water and in areas where access to quality water is limited. More than 600 MSF staff have been working to test for new cases, treat patients and improve water supplies and sanitation in the city of Am Timan, including chlorination of the city’s water towers. (MSF, 9 Feb 2017)
The outbreak of hepatitis E in the Salamat region of Chad continues to evolve, with one new district being affected. The potential of the outbreak to escalate is high given the prevailing predisposing factors. Only 25% of the 63,000 people in Am Timan, the epicenter of the outbreak, have access to clean and safe water. Meanwhile, about 30% of the 13,000 people in Aboudeïa have access to safe water. The local community continues to fetch and drink water from rain pools (ponds), sharing with animals and birds. The affected communities also have poor sanitation, commonly practicing free range open defecation. With these factors, in addition to the onset of rainy season expected soon, the risk of further spread of hepatitis E, as well as of cholera, remains very high. (WHO, 14 Apr 2017)
Since September 2016, 1,684 suspected cases of Hepatitis E (77 in July) have been reported in the 3 health districts of Salamat, of which 230 cases were tested and 130 of these confirmed positive (positive rate of 52.2%); 16 deaths have so far been reported (no death this month). As the Ministry of Public Health officially declared a Hepatitis E epidemic in the region of Salamat, the epidemiologic surveillance has been extended to the region’s 3 health districts and the 42 areas of responsibility (12 in Aboudeia, 18 in Am Timan, and 12 in Haraze health districts). (UNICEF, 31 Jul 2017)
Outbreaks occurred in the Salamat Region, predominantly affecting North and South Am Timan, Amsinéné, Mouraye, Foulonga, and Aboudeia. The number of cases decreased since week 39. Of the 64 cases in pregnant women, five died (CFR: 7.8%) and 20 were hospitalized. Water chlorination activities were stopped at the end of September 2017 due to a lack of partners and financial means. No cases have been reported since week 48 of 2017 and the outbreak was declared over by the Ministry of Health on 14 February 2018. (WHO, 02 Mar 2018)
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Preliminary results of the SMART were published showing an increase in the national prevalence of the global acute malnutrition (from 11.9% to 13.9%). This rate exceed the emergency threshold of 15% in 12 out of 23 regions of the country.
• A cholera outbreak is reported in Sila Region, eastern Chad, near the border with Sudan. 152 cases have been reported with 23 deaths by the end of August 2011
• 11 million USD have been allocated by the UFE CERF to Chad. 6.5 million USD will be used to support refugees and returnees from CAR with multipurpose cash, 3 million USD will ensure availability of basic services for CAR refugees and returnees (health, nutrition, education), and 1.5 million USD will be allocated to UNHAS to allow continued humanitarian access.
Since 22 July, an estimated 1,300 households totalling approximately 6,000 people arrived from Niger to a new site named Dar al-Kheir. These Arab nomads explained that they fled from the Diffa region out of fear of attacks following the recent withdrawal of Chadian soldiers protecting the area. As of end of July, their status (refugees, returnees or other) was still being discussed.
The 2017 nutrition SMART survey was launched with a pilot survey on 25 July, and data will be collected through smartphones, reducing errors.
• From 7 to 9 June, a multi-sectoral inter-agency assessment mission was carried out in five villages in the Sub-Prefecture of Kangalom, to assess the conditions of areas of return of formerly displaced persons (around 11,000) returning to the islands. The mission recommended that urgent interventions are needed in the areas of WASH and education since there are no existing facilities.
An increase in attacks and incursions of armed elements is witnessed in the Lac region: 4 main incidents left almost 60 people dead, several injured, and destruction of livelihoods. Following the attacks, several displacements of people have been reported (at least 700 people seeking refuge in IDP sites)
According to the latest available data on internal displacements, there are 127,084 displaced people in the Lac Region and 8,280 Nigerian refugees. IOM, which had suspended displacement tracking at the beginning of the year, has announced that it will update its displacement tracking matrix in May.
Despite the official closure of the border with the Central African Republic, 1,209 Central African refugees, more than 80% of whom were women and children, arrived in southern Chad in April.
179 new suspected cases of Hepatitis E have been reported in the 3 health districts of Salamat. Since September 2016, the total of cases is 1,314 of which 201 cases were tested and 96 of these confirmed positive and 13 deaths reported (0 this month).
Chad’s pipeline of Ready to Use Therapeutic Food (RUTF) is facing an alarming strain. The current pipeline covers up to June 2017. Chad is a landlocked country and new supplies take four months to arrive in country - unless new funds are received by end of March, the country will be facing an RUTF shortage.
No new major population movements have been reported. As of January 2017, there are 124,683 displaced persons, including IDPs, Chadian returnees from Nigeria and Niger, refugees and third-country nationals.
A suspected Hepatitis E epidemic continues to affect the Salamat Region, With 265 new cases reported in January 2017, out of which 18 cases have been confirmed. In total, since September 2016, 817 cases have been registered and 67 confirmed, with a death toll of 11 people.
No major new displacement has taken place in the Lake region during December. At the end of 2016, there are 129,481 displaced persons, including IDPs, Chadian returnees from Nigeria and Niger, refugees and third-country nationals.
More than 120 sites and displacement locations are scattered around this remote region, making humanitarian assistance a logistical challenge.
Despite incidents reported in Kaiga-Kindjiria area, the security situation remains relatively calm in the Lake region. A decrease in incidents has coincided with the surrender of elements associated with armed groups in recent weeks.
Results from the most recent national SMART survey indicate an 11.2% prevalence of global acute malnutrition (GAM). 153,738 children with severe acute malnutrition (SAM) have been admitted and treated in nutritional units so far in 2016, reaching 79% of the annual target.
Heavily pregnant, Miriam rests on the bed as an MSF gynaecologist performs an ultrasound of her growing belly. She seems surprised when, unexpectedly, the outline of a baby appears on the monitor, and her expression quickly turns to relief as the translator confirms that Miriam’s unborn child is progressing well.
Miriam is one of 44 patients with hepatitis E who have been admitted to Am Timan hospital in Chad since September. More than 320 other potential cases have been identified.
31 October 2016
• As of end of October 2016, there are 123,293 people displaced by the Nigerian crisis in Chad’s Lac region. Three additional sites were discovered this month.
• A Hepatitis E outbreak has been reported in the Salamat Region. A total of 128 cases, including 20 positive cases (16% positivity rate) and 2 deaths (1.6% case-fatality) were registered in Amtiman, the main city of Salamat Region.