Yemen: Cholera Outbreak Response Situation Report #1 (27 April - 18 May 2017)

Highlights

• A cholera outbreak has reignited in Yemen, spreading with unprecedented speed across 18 out of 23 governorates and causing a total of 23 425 suspected cases and 242 deaths between 27 April 2017 and 18 May 2017.

• This is the second wave of an outbreak which first emerged in September 2016 and had previously shown signs of slowing. The cumulative total number of cases reported across both waves of the outbreak has reached 49 096 with 361 related deaths.

• The current rate of spread is alarming, with 44% of the total cases reported over the last 7.5 months and 65% of the total deaths reported in May 2017 alone.

23,425 Suspected cases

301 Confirmed cases

242 Deaths

18 Governorates

1 % Case fatality rate

The World Health Organization (WHO) has supported health authorities in revising the overall response strategy, summarized in the points below:

a. Provision of health services free of charge to remove financial barriers to the treatment of cases of suspected cholera;

b. Enhancement of emergency operation centres at the national and governorate levels, including full adoption of the incident command system and improvements to the timeliness and quality of data management;

c. The timely use of surveillance information to identify priority areas for health and WASH interventions;

d. Support to Rapid Response Teams (RRTs) at the governorate level, and the establishment of RRTs at the district level;

e. The scale up of health education and health promotion activities for diarrhoea prevention;

f. Substantial increase in the number of Oral Rehydration Corners (ORC), with referral of severe cases to Diarrhoea Treatment Centres (DTC);

g. The improvement of triage in both DTCs and ORCs to enhance the use of oral rehydration therapy, limit the use of intravenous fluids to cases with severe dehydration, and reduce congestion in the DTCs;

h. On-the-job training for health workers on the classification of dehydration, and protocols for the use of oral rehydration salts and intravenous (IV) therapies, in order to reduce the case fatality rate and the mismanagement of IV fluids;

i. The targeting of districts with the highest attack rates and cholera case numbers with technical and operational support and fast direct provision of resources for local scaling up of the response.

Situation

• Since 28 September 2016, 49 096 suspected cholera cases and 361 related deaths have been reported.

• A resurgence of the outbreak has seen a total of 23 425 suspected cholera cases and 242 deaths reported in 18 governorates since 27 April.

• The current rate of spread is alarming, with 44% of the total cases over the last 7.5 months and 65% of the total deaths reported in May 2017 alone.

• While the disease is spreading rapidly in 18 governorates, Sana’a City (Amant Al-Asimah) is particularly affected, with more than 7 000 suspected cholera cases. This represents nearly one-third of all cases in the last 20 days.

• The number of deaths recorded over the last three weeks is almost two times higher than deaths reported from October 2016 to March 2017.

• A total of 301 stool samples tested positive for Vibrio Cholera, serotype Ougawa.

• The upsurge in cases comes as the health system and civil infrastructure, including water and sanitation facilities in most Yemeni governorates have been seriously affected due to the ongoing conflict. Recent heavy rains contributed in the contamination of water sources. In addition, warmer weather is creating a favorable environment for the pathogens that cause diarrheal disease to spread.