2023-07-05-世界卫生组织-Multi-country_outbreak_of_cholera,_External_situation_report_4_-_6_July_2023_18页_1mb

Summary of the Multi-country Outbreak of Cholera (External Situation Report #4, 6 July 2023)

Core Content

The multi-country outbreak of cholera continues to pose a significant global health risk, with 24 countries reporting cases as of 15 June 2023. The World Health Organization (WHO) has maintained a global risk assessment of "very high" due to the simultaneous nature of outbreaks, geographic expansion, and resource limitations, particularly in the availability of the Oral Cholera Vaccine (OCV) and cholera supplies.

Main Points

Global Overview

• 24 countries have reported cholera cases since the start of 2023, compared to 16 in the same period in 2022.
• The CFR has been higher than the target rate (<1%) in many countries, with an average of 1.9% globally in 2021 and 2.9% in Africa.
• Africa remains the most affected region, with 14 countries reporting cases.
• South Africa has seen a surge in cases since mid-May 2023, with 924 cases and 38 deaths (CFR 4%) reported as of 15 June 2023.
• Malawi has shown significant improvement, with an 80% decrease in cases and deaths over the last four weeks.
• Mozambique and Zimbabwe continue to report ongoing outbreaks, though some areas are stabilizing.
• Kenya and Ethiopia have reported over 10,000 cases each, with ongoing spread to new areas.
• Somalia is also heavily affected, with a reported CFR of 0.3%.
• Lebanon declared the outbreak over on 11 June 2023, with 8,008 cases and 23 deaths (CFR 0.3%).

Key Challenges

• Resource shortages: Limited availability of OCV and cholera supplies.
• Overstretched personnel: Public health and medical staff are dealing with multiple outbreaks and health emergencies.
• Security issues: In the Mandera Triangle (Ethiopia, Kenya, Somalia), security concerns and population movements among internally displaced persons and refugees hinder response efforts.
• Data variability: Differences in case definitions, reporting systems, and underreporting make cross-country comparisons difficult.
• Environmental factors: Flooding and heavy rains in several countries contribute to the spread of cholera.

Operational Updates

• WHO coordination: WHO is supporting Member States through global, regional, and country-level partnerships.
• Expert deployment: As of 29 June 2023, 7 experts have been deployed to Malawi, Mozambique, and Kenya through the Global Outbreak Alert and Response Network (GOARN). 6 experts have also been deployed to Cameroon, Haiti, and others through Standby Partners (SBP).
• Vaccination efforts: 42.1 million doses of OCV have been requested, with 16.4 million approved for 11 countries. Only one-dose courses have been implemented in reactive campaigns due to limited global stockpile.
• Surveillance and lab support: WHO is promoting updated guidelines and tools for surveillance, data collection, and laboratory testing. Efforts are ongoing to strengthen surveillance systems and laboratory capacities.
• Case management and WASH: WHO is supporting the decentralization of treatment and promoting the use of community health worker programs. A package of tools for Oral Rehydration Points (ORPs) is being developed.

Key Information

• Cholera cases and deaths are reported as suspected and confirmed, with no local transmission in the European Region.
• Data reliability is noted as being subject to verification and change due to differences in reporting systems.
• Global OCV stockpile as of 4 July 2023 is 2.6 million doses, with additional requests from Kenya and Ethiopia under assessment.
• Haiti has reported 48,653 suspected cases and 750 deaths (CFR 1.5%) since September 2022, with a recent resurgence in cases during June.
• Northwest Syria has reported 92,461 suspected cases and 23 deaths (CFR <1%), with a peak in cases observed between 4-10 June 2023.

Next Steps

• Continued monitoring of outbreaks in affected regions, particularly in South Africa, the Horn of Africa, and the Middle East.
• Strengthening surveillance systems and laboratory capacities in cholera-affected countries.
• Enhancing vaccination programs and addressing the global OCV stockpile limitations.
• Supporting case management and WASH initiatives to reduce transmission and improve treatment outcomes.
• Coordinating with regional and international partners to address cross-border transmission risks, especially in the Mandera Triangle.