Outbreak Declaration
- On July 8, 2024, multiple media sources reported a cholera outbreak in the Houthi-controlled areas of Al-Hudaydah Governorate, western Yemen.
- A significant increase in cholera-related deaths was reported, predominantly among children.
- More than 20 cholera-related deaths were recorded in the past week, with the highest fatalities in Bajil District.
- The United Nations estimates over a quarter of a million cholera cases nationwide by September 2024.
Surveillance Data as of July 8, 2024
- Total reported cases: 63,000
- Total confirmed cases: 271
- Total deaths: 160
- Case Fatality Rate (CFR): 0.25%
Cholera
- Cholera is an acute diarrheal illness caused by infection of the intestine with Vibrio cholerae bacteria. People can get sick when they ingest food or water contaminated with cholera bacteria. The infection is often mild or asymptomatic but can sometimes be severe and life-threatening.
- There are many serogroups of Vibrio cholerae, but only toxigenic strains of serogroups O1 and O139 have caused widespread epidemics.
- Disease Transmission
- Cholera bacteria are typically found in water or food contaminated with feces from an infected person. Cholera is likely to spread in areas with inadequate water treatment, poor sanitation, and insufficient hygiene.
- The bacteria can also live in slightly salty rivers and coastal waters, and raw shellfish can be a source of infection.
- Direct person-to-person transmission is unlikely; therefore, casual contact with an infected person is not a significant risk factor.
Symptoms and Diagnosis
Approximately 1 in 10 people infected with cholera will experience severe symptoms such as:
- Profuse watery diarrhea
- Vomiting,
- Thirst
- Leg cramps
- Restlessness
- Dehydration
- Rapid loss of body fluids can lead to kidney failure. Without treatment, severe dehydration can cause shock, coma, and death within hours.
- To test for cholera, physicians must take a stool sample or rectal swab and send it to a laboratory to look for cholera bacteria.
- Treatment
- Rehydration Therapy: The primary treatment for cholera patients, aiming to promptly restore lost fluids and salts.
- Antibiotic Treatment: Reduces fluid loss and shortens the duration of the illness, used in severe cholera cases.
- Zinc Treatment: Helps reduce cholera symptoms in children.
Vaccinations
- Vaxchora: A single-dose oral vaccine approved by the FDA for use in individuals aged 2-64 traveling to an area with active cholera transmission. Currently not available.
- Dukoral, ShanChol, Euvichol-Plus: Oral vaccines administered in two or three doses for individuals over two years old.
Prevention
- Improve access to safe drinking water, sanitation infrastructure, and promote preventive hygiene practices and food safety in affected communities to control cholera.
- Enhance and monitor cholera surveillance to detect suspected cases early, provide appropriate treatment, and prevent spread. Early and adequate treatment reduces hospital case fatality rates to less than 1%.
- Healthcare Providers
- All staff shall be trained in cholera prevention and infection control measures, such as handwashing and safe disposal of human waste.
- Hands shall be washed with soap and clean water or 0.05% chlorine solution before and after patient contact. If soap and water are unavailable, use hand sanitizer containing at least 60% alcohol, or if neither is available, use a 0.05% chlorine solution.
- Disinfect surfaces with chlorine-based solutions.
Public Health Response
- Develop a multi-sectoral response plan focusing on case management, water, sanitation and hygiene (WASH), vaccination, communication, psychosocial support, and enhancing preparedness in unaffected areas. Advocate for improved security conditions to facilitate the response.
- Provide updated event information to other Member States through the National Focal Points (NFPs) of the International Health Regulations (IHR).
Sources
- World Health Organization (WHO)
- Centers for Disease Control and Prevention (CDC)