Chad: Hepatitis E Outbreak - Sep 2016Ongoing
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)
The outbreak of hepatitis E in the Salamat region of Chad remains serious, with a high risk of escalation. During week 33, 23 new suspected cases and zero deaths were reported from four areas: Amtiman Nord (3), Amtiman Sud (2), Amsinéné (2), and Aboudeia (16). Of the 19 deaths reported, ve were pregnant women. ere was a resurgence of cases in Aboudeia in the reporting week. Active case detection and chlorination of water in Amtiman and Aboudeia continues. (WHO, 25 Aug 2017)
As of 3 September, hepatitis E outbreaks are ongoing in the Salamat Region predominantly affecting North and South Am Timan, Amsinéné, South Am Timan, Mouraye, Foulonga and Aboudeia. Of the 64 cases occurring in pregnant women, ve died (case fatality rate 7.8%) and 20 were hospitalized. (WHO, 29 Sep 2017)
• 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.
Contexte actuel (août 2017)
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.
This weekly bulletin focuses on selected acute public health emergencies occurring in the WHO African Region. The WHO Health Emergencies Programme is currently monitoring 49 events in the region.
This week, three new events have been reported:
- Crimean-Congo haemorrhagic fever (CCHF) in Mauritania and cholera in Burundi and Chad. This week’s edition also covers key ongoing events, including:
• Cholera in Kenya
• Hepatitis E in Niger
• Floods/mudslide in Sierra Leone
• 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.
The situation is marked by a deterioration in the protection of civilians in the border areas of Kaiga Kindjiria and Tchoukoutalia, where several villages have reportedly been attacked.
New displacements were observed as a result of security incidents.
At the same time, return dynamics continue: 11,000 people in need that returned to their villages of origin were identified following a multisector assessment in Kangalom subprefecture.
La situation est marquée par une détérioration de la protection des civils dans les zones frontalières de Kaiga Kindjiria et Tchoukoutalia, où ont été rapportées plusieurs attaques contre des villages.
De nouveaux déplacements ont été observés suite à des incidents sécuritaires.
En parallèle, les dynamiques de retour continuent : 11 000 personnes dans le besoin retournées dans leurs villages d’origine ont été identifiées suite à une mission d’évaluation multisectorielle dans la souspréfecture de Kangalom.
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)
Ongoing military operations in Niger and Nigeria are accompanied by a resurgence of attacks and incursions of armed elements, leading to protection incidents.
A significant increase in cases of genderbased violence (GBV) reported by partners was observed in April.
US $ 3.5 million were allocated by the Central Emergency Response Fund (CERF) for a rapid response to the urgent needs of 40,000 people in the island areas and villages south of Bol.
Contexte actuel (mai 2017)
Les opérations militaires actuellement en cours au Niger et au Nigeria s’accompagnent d’une recrudescence d’attaques et d’incursions d’éléments armés, occasionnant des incidents de protection.
Une hausse significative des incidents de protection et de violences basées sur le genre (VBG) rapportés par les partenaires a été observée en avril.
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.
The south of Chad remains deeply affected by the impact of the Central African crisis, which has lead to the displacement of 142,000 people. This influx leads to increased pressure on scarce resources and basic infrastructure, thus deteriorating living conditions and livelihoods for already vulnerable host communities. The prospects of return are low due to ongoing insecurity.
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).
100,000 NOUVEAUX DEPLACES DEPUIS SEPTEMBRE 2016
De nouveaux affrontements entre groupes armés ont entraîné une recrudescence de la violence et de nouveaux déplacements dans les préfectures de la Ouaka au centre, de la Haute Kotto à l'est et de Mbomou dans le sud-est. Les évaluations des besoins sont en cours. De septembre 2016 à février 2017, 100 000 personnes nouvellement déplacées ont été enregistrées à travers le pays.
CENTRAL AFRICAN REPUBLIC
100,000 NEWLY DISPLACED SINCE SEPTEMBER 2016
Fresh clashes between armed groups led to an upsurge of violence and new displacements in the prefectures of Ouaka in the centre, Haute Kotto in the east, and Mbomou in the southeast. Needs assessments are ongoing. From September 2016 to February 2017, 100,000 newly displaced persons were registered across the country.
1,4 MILLION FACE SEVERE FOOD INSECURITY
After three years of assistance at the Gaoui site, the humanitarian community advocates for durable solutions to facilitate the reintegration of returnees.
The Oslo Humanitarian Conference allowed the countries of the Lake Chad Basin to receive pledges of US $ 672 million, including US $ 458 million in 2017.
Toward sustainable solutions for Gaoui returnees
Decreasing humanitarian response in the site
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.
Après trois ans d’assistance sur le site de Gaoui, la communauté humanitaire plaide des solutions durables pour faciliter la réinsertion des retournés.
La Conférence humanitaire d’Oslo a permis aux pays du Bassin du Lac Tchad de recevoir des promesses de dons à hauteur de 672 millions de dollars américains, dont 458 millions en 2017.
Vers des solutions durables pour les retournés de Gaoui
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.