Outbreak update – Cholera in Somalia, 6 June 2021

17 June 2021 – The Ministry of Health of Somalia has announced 211 new suspected cases of cholera, with 5 reported deaths, for epidemiological week 22 (31 May – 6 June 2021). All cases were reported from Banadir, Bay and lower Shabelle regions.

The cumulative total number of suspected cholera cases in 2021 is 2761, including 24 associated deaths with a case fatality ratio (CFR) of 0.9%. Of the total cases reported from Somalia since the first week of this year, 60.3% (1666) were children under 5 years of age and 43.3% cases were females. All suspected cholera cases were reported from 22 districts from Hirshabelle, South West states and Banadir region. In 2021, a cumulative attack rate of 79 persons per 100 000 populations was reported. The highest attack rate was reported from the districts of Adale (554 per 100 000 population), Danyile (519 per 100 000 population), and Madina (233 per 100 000 population). The majority of the deaths have been reported from Banadir.

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. Recurrent flash floods caused by heavy Gu rains occur in early summer of every year, leading to the contamination of water sources that result an increase in the number of cholera cases.

Since January 2021, a total of 424 stool samples were collected, out of which 123 tested positive for Vibrio Cholerae Ogawa. The overall reduction in the number of new cholera cases as compared to the numbers at the beginning of the outbreak is attributed to the 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 its already limited capacity to respond to the cholera alerts. Currently, Somalia has 18 cholera treatment centres, with 9 in Southwest, 4 in Jubbaland, 3 in Hirshabelle and 2 in Banadir.

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.