Yemen + 7 more

WHO EMRO Weekly Epidemiological Monitor: Volume 10, Issue 48 (26 November 2017)

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Cholera Roadmap

Cholera morbidity and mortality continues in communities with high vulnerability imposed by tragedies such as disasters and conflicts. Currently Yemen is facing the world’s largest cholera outbreak, with over 900,000 suspected cases and more than 2,200 associated deaths reported since April 2016. Over 1000 cholera associated deaths were reported globally from the cholera endemic countries this year.

Editorial note

Cholera remains a global threat to public health and an indicator of inequity and lack of social development. The global burden of cholera is largely unknown because the majority of cases are not reported. However the current Cholera outbreak in Yemen is one of the worst cholera epidemics not only in the history of Yemen but by looking at the cholera counts reported so far, this could well be the biggest and the worst cholera epidemic on record since the seventh cholera pandemic began in 1961.

The true reality is that every death from cholera is preventable with the tools available today, putting the goal of ending its public health impact within the reach. Cholera can be controlled with a multi-sectoral approach. The proven interventions are cost effective such as improving the basic water, sanitation, and hygiene (WASH) services. In addition, the use oral cholera vaccines (OCV), as a supplementary public health intervention has also proved to be effective drawn on evidence that have been drawn in countries where these vaccines have been used either to eliminate the risk of occurrence or reoccurrence of cholera or to contain the geographic spread of a full-blown outbreak. Ending cholera is a moral obligation and an important health equity achievement in its own right as it is critical to achieving the Sustainable Development Goals (SDGs).

MULTI-SECTORAL INTERVENSIONS TO CONTROL CHOLERA

  • Implementation of adapted long-term sustainable WASH solutions for populations most at risk of cholera
  • Inter-sectoral collaboration and building of a strong preparedness and response strategy
  • Enhanced readiness for cholera outbreaks through capacity building for staff, and prepositioning of resources for diagnostics, patient care, and emergency WASH intervention
  • Effective routine surveillance and laboratory capacity at the peripheral level to confirm suspected cases, inform the response, and track progress towards control and elimination
  • Large-scale use of OCV to immediately reduce disease burden while longer-term cholera control strategies are put in place
  • Communication on cholera control strategies, hygiene promotion, and cholera risk, by mobilizing community leaders as agents of change

The ‘Global Roadmap to 2030’ serves as an operational framework for the new global strategy for cholera control at the country level and serves as a tangible way towards a world in which cholera is no longer a threat to public health. The strategy focuses on the 47 countries affected by cholera globally. At-least 11 of these countries are from the Eastern Mediterranean Region of WHO.

The Global Task Force on Cholera Control (GTFCC) partners are committed to support countries to reduce cholera deaths up to 90 percent by providing technical support and also assist the countries and donors in resource allocation and mobilization. The implementation of this roadmap by the choleraaffected countries supported by technical partners, and donors may lead to elimination of the disease transmission by 2030 in more than 40% of the affected countries.

The efficacious implementation of the roadmap is indeed a long term investment.
But it may significantly reduce the impact of cholera as well as all other water-related diseases. The success of the roadmap is related to putting efforts for the improvements in poverty, malnutrition, and education, which will be leading towards the achievement of the SDGs in the vulnerable population.