Outbreak update – Cholera in Somalia, 22 November 2020

30 November 2020 – The Ministry of Health of Somalia has announced 54 new suspected cases of cholera, with one reported death, for epidemiological week 47 (16–22 November 2020). The cumulative total number of suspected cholera cases since the beginning of this year is 6279, including 33 associated deaths (CFR 0.5%). So far in 2020, active transmission has been reported from the regions of Banadir, Bay, Hiran and lower Shabele. The last cholera cases in Jowhar district of middle Shabelle were reported in week 17. Of the 6279 reported cases, 2904 (46%) are aged 2 years and below, while 18 (55%) of the 33 registered deaths are aged 2 years and below.

The current cholera outbreak started in December 2017 following floods that affected districts in the basins of Jubba and Shabelle rivers. It was contained in five of the six regions while active transmission has continued to be reported from Banadir. Flash floods caused by heavy Gu rains in April 2020 led to the contamination of water sources that led to an increase in the number of cholera cases in Banadir (3830 cases), Hiran (948 cases), Middle Shabelle (560 cases), Bay (832 cases) and Lower Shabelle (109). Of the 33 deaths reported since week 1 of 2020, 20 (65%) were reported in Banadir region.

Of the 501 stool samples tested since January 2020, a total of 166 samples came out positive for Vibrio cholerae, Serotype V. Cholerae Inaba was isolated from stool samples collected from Baidoa. This strain in sensitive to tetracycline, chloramphenicol and ciprofloxacin.

The overall reduction in the number of new cholera cases as compared to the numbers at the beginning of the outbreak is attributed to improved implementation of preventive interventions including oral cholera vaccination (OCV) campaigns and the strengthening of water, sanitation and hygiene (WaSH) activities in hot spots. However, the current floods and cholera outbreak occurred at a time when COVID-19 cases are increasing in all regions of Somalia, stretching the already limited capacity to respond to the cholera alerts.

WHO continues to provide leadership and support to health authorities and partners in implementing activities that can mitigate the outbreak. Disease surveillance is being managed with the support of WHO through an electronic system known as the Early Warning Alert and Response Network (EWARN) and is currently being expanded to all health facilities across the country. WHO and the Ministry of Health continue to monitor outbreak trends through EWARN and promptly investigate and respond to all alerts.