Tanzania: Cholera Emergency Plan of Action operation update - Update n°1 (MDRTZ018)

Situation Report
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A. Situation analysis Description of the disaster On 15 August 2015 a cholera outbreak was reported in Dar es Salaam in Kinondoni district; one person died and four family members were screened and classified as suspected cholera cases. Cholera began spreading throughout the Dar es Salaam region and twelve other regions: Morogoro, Kigoma, Dodoma, Geita, Mwanza, Mara, Arusha, Tabora,
Tanga, Shinyanga, Singida and Coast as well as the island of Zanzibar. As of 26 November 2015, there were 9,871 reported cases and 150 deaths (WHO), and 19 out of 30 regions have detected and reported cholera cases on mainland Tanzania and Zanzibar (UNRCO and MoHSW). The contributing factors, as reported by the MoHSW and Red Cross volunteers on the ground include contaminated water sources, poor sanitation and poor hygiene practices.

Tanzania has previously experienced three major cholera epidemics: in 1977-78, 1992, and 1997. In 1997, Tanzania had one of the highest case-fatality rates in East Africa (5.6%), with 2,268 deaths in 40,226 cases (CDC). The first major outbreak occurred in 1992 when 18,526 cases including 2,173 deaths were recorded (CFR 11.7%). In 1997, an epidemic which started in Dar es Salaam accounted for 40,249 cases and 2,231 deaths (CFR 5.54%). Seven regions were affected and Vibrio cholerae El Tor Ogawa was confirmed (WHO). More recently, on May 2015, a cholera outbreak was declared in Nyarugusu refugee camp on the Tanzanian/Burundi border, home to around 175,000 Burundian refugees, with 4,833 cases and 40 deaths reported. The outbreak was contained through a vaccination campaign, the provision of safe water and health education. Neighbouring countries have also reported cholera cases in October. The current outbreak follows the same pattern as the outbreak in 1997 which led to more than 40,000 cases and 2,231 deaths (CFR 5.54%). Historically Tanzania has seen an increase in caseloads during the rainy seasons, and the meteorological department has issued a warning that El Nino similar to the one of 1997 should be expected this year. Although 50% of the cases are reported in Dar es Salaam region, the population is highly mobile and the widespread and scattered nature of the current outbreak has challenged response and containment efforts.
The beginning of the rainy season, and strong probability of serious floods from El Niño, will further exacerbate the cholera outbreak. Failing to contain the spread of cholera means there is a high risk that caseloads will reach levels of the 1997 outbreak.