Prevention for a cholera free world

September 2017

Despite having severe diarrhoea, 53-year-old Abdu al-Nehmi travelled for 3 hours from his village to Sana’a City, Yemen, for treatment. He was vomiting and the car broke down, but he had no other choice but to make the difficult journey, “There is no health centre in our area,” says Abdu. Since Yemen’s conflict escalated in 2015, more than half of all health facilities have closed or are only partially functional, leaving 14.8 million people without basic healthcare.

Abdu finally gets treatment.
Abdu finally gets treatment.
WHO / Sadeq Hasan

Abdu’s plight is shared by millions of people, whose lives have been severely impacted by cholera. The disease still regularly affects 47 countries across the world; despite the fact that cholera can be prevented if people have access to safe water and sanitation. Each year an estimated 2.9 million people worldwide contract cholera and 95 000 people die from the disease. Climate change, urbanization, and globalization are all contributing factors that continue to further increase the risk of cholera.

To treat people like Abdu, WHO has airlifted hundreds of cholera kits to Yemen containing tonnes of supplies, including intravenous solutions and other fluids that replenish the large amount of water that people lose when they suffer from severe diarrhoea. Dehydration is major cause of death among those with cholera. A door-to-door campaign in Yemen has brought cholera prevention messages and disinfecting water tablets to over 90% of the population.

Cholera is inherently linked to water supply and is spread when people consume contaminated food or water. “Cholera is a disease of inequity. The poverty map of the world is the same as the cholera map,” says Dominique Legros, a cholera expert at WHO. “It impacts communities that are already burdened by conflict, lack of infrastructure, poor health systems and malnutrition - people who do not have access to safe drinking water.”

Response to cholera in affected countries

In Africa alone 40 to 80 million people live in cholera “hotspots”, highly endemic areas where outbreaks of the disease occur year after year.

From January to August 2017, more than 60 000 cases of suspected cholera have been reported in Somalia with the disease claiming more than 800 lives. In response, WHO and partners support more than 50 mobile teams in the country who are deployed to more than 500 settlements for internally displaced people in Puntland. In Somalia, from 3 to 25 May this year, more than 800 000 people were vaccinated against the disease in Jowhar and Baidoa, the worst affected areas.

“We are now seeing a decrease in the number of cholera cases and a remarkable reduction in the number of deaths,” says Ghulam Rabani Popal, WHO Representative for Somalia. “We will continue to combat the spread of cholera through integrated health, water, sanitation and hygiene interventions.”

In northeastern Nigeria, In another effort to halt the spread of a cholera outbreak, WHO together with the Ministry of Health and other key partners, completed an Oral Cholera Vaccination campaign (OCV) in September this year, targeting 900 000 people. The early detection of cholera cases in this region of Nigeria, which is suffering from an ongoing humanitarian crisis, allowed for a rapid response to the outbreak and effective use of OCV.

So far in 2017 more than 1.5 million doses of OCVs were given to help protect people from the disease in 2 separate campaigns in South Sudan. The country provides a good example of how a multifaceted approach to cholera that focuses on preventative vaccination campaigns together with programmes to improve water and sanitation, work well to prevent and control the spread of the disease. “Transmission has been successfully interrupted in areas where OCV has been deployed,” says Dr Joseph Wamala, a WHO epidemiologist in South Sudan.

Increasing demand for the cholera vaccine

The Oral Cholera Vaccine is a useful additional tool to prevent and respond to cholera and demand for its use has increased in recent years across many countries. As of September 2017, more than 13.9 million doses of the vaccine have been shipped from the global stockpile that was developed in 2013 for emergency vaccination campaigns.

“Campaigns have been implemented to prevent the occurrence of cholera outbreaks, in highly endemic areas,” explains Dominique Legros. “The vaccine is also effective to stop the spread of ongoing outbreaks if the campaign is organized promptly.”

One of 463000 persons who were vaccinated against cholera during the second round of the campaign in Baidoa & Jowhar
WHO Somalia

Targeted preventive interventions are affordable and cost effective

Today more than 2 billion people worldwide drink water from sources contaminated with faeces, which can carry the cholera bacterium. Yet global water and sanitation aid has declined in recent years, dropping from US $10.4 billion in 2012 to US$8.4 billion in 2015. To meet the 2030 Sustainable Development Goal of clean water and sanitation for all, investment needs to be 3 times what it is today.

Targeted cholera interventions can save lives, and are both affordable and cost effective.

The Global Task Force on Control Cholera (GTFCC) brings together partners working to combat the disease, including WHO, WaterAid, the Gavi Alliance, the International Federation of the Red Cross and Red Crescent Societies (IFRC), UNICEF, and the Bill and Melinda Gates Foundation (BMGF).

The task force brings together different sectors to work closely with affected countries to prevent, detect and respond to outbreaks. In a new strategy to end cholera, the GTFCC aims to lower deaths from the disease by 90% by 2030.

People like Abdu are counting on it.