By Kemi Olatunde

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It is no longer news that there is an outbreak of Cholera in Nigeria as many states have been battling with it.

According to the Nigeria Center for Disease Control and Prevention (NCDC) for Epidemiology in the reporting month, some states have reported 576 suspected cases of Cholera, Lagos (533), Ogun (19), Rivers (9), Katsina (8), Oyo (2), Abia (2), Bayelsa (2), and Sokoto (1) whereby 32 deaths were recorded.

As of June 23, 2024, a total of 1,579 suspected cases, including 54 deaths, have been reported from 32 states.

The center noted that with regards to the suspected cases since the beginning of the year, age groups  less than five years are mostly affected, followed by the age groups 5 – 14 years in aggregate of both males and females noting that of all suspected cases, 50 percent are males and 50 percent are females.

It stated that Lagos with 537 cases accounts for 34 percent of all suspected cases in the country of the 32 States that have reported cases of cholera adding that Southern Ijaw LGA (151 cases) in Bayelsa State accounts for 10 percent of all suspected cases reported in the country.

For other States accordingly, it stated that “Bayelsa (466 cases), Abia (109), Zamfara (64 cases), Bauchi (46 cases),

Katsina (45 cases), Cross River (43 cases), Ebonyi (38 cases), Rivers (37 cases), Delta (34 cases), Imo (28), Ogun (21), Nasarawa (19 cases), Ondo (17 cases), Kano (13 cases), Niger (11 cases) and Osun (11 cases) account for 97.5% of the suspected cases this year.

“Comparatively, suspected cases of Cholera in the current year have decreased by 37 percent compared to what was reported as at Epi-week 25 in 2023. Likewise, cumulative deaths recorded have decreased by 21 percent in 2024.”

With the above facts, there has been an increasing trend of cholera cases across the country in the outbreak and all states have measures put in place to have it curtailed.

Cholera is an acute epidemic infectious disease. It is characterized by watery diarrhea, extreme loss of fluid and electrolytes, and severe dehydration. It can be fatal.

It is caused by the bacterium Vibrio cholera (V. cholera).

Despite being easy to treat, cholera is estimated to affect between 3 and 5 million people each year, and it causes over 100,000 deaths worldwide.

Due to severe dehydration, fatality rates are high when untreated, especially among children and infants. Death can occur in otherwise healthy adults within hours according to findings.

The cause of cholera is infection by the V. cholera bacteria. These bacteria were discovered in 1883.

V. cholera bacteria live in shallow, salty water on microscopic crustaceans. They can also exist as colonies of biofilms that coat the surface of the water, plants, stones, shells, and similar items, and they can live among the eggs of midges, which serve as a reservoir for cholera bacteria.

Toxic strains of cholera bacteria produce a poison that triggers violent diarrhea in humans.

When the bacteria enter areas where humans live, they can quickly cause severe epidemics. Weather changes, population loss, and improved sanitation can all end an outbreak.

Symptoms: Only around 1 in 20 cholera infections are severe, and a high percentage of infected people show no symptoms.

If symptoms appear, they will do so between 12 hours and 5 days after exposure. They range from mild or asymptomatic to severe.

They typically include: Large volumes of explosive watery diarrhea, sometimes called “rice water stools” because it can look like water that has been used to wash rice.

A person with cholera can quickly lose fluids, up to 20 liters a day, so severe dehydration and shock can occur.

Signs of dehydration include: Loose skin, sunken eyes, dry mouth, decreased secretion, for example, less sweating, fast heartbeat, low blood pressure, dizziness or lightheadedness and rapid weight loss.

Shock can lead to the collapse of the circulatory system. It is a life-threatening condition and a medical emergency.

Causes

Cholera bacteria enter the body through the mouth, often in food or water that has been contaminated with human waste, due to poor sanitation and hygiene.

They can also enter by eating seafood that is raw or not completely cooked, in particular, shellfish native to estuary environments, such as oysters or crabs.

Poorly cleaned vegetables irrigated by contaminated water sources are another common source of infection.

In situations where sanitation is severely challenged, such as in refugee camps or communities with highly limited water resources, a single affected victim can contaminate all the water for an entire population.

NCDC earlier reported that as of June 11, 2024, 1,141 suspected cholera cases had been recorded across 30 states in Nigeria since January 1, 2024. The 10 states that recorded 90 percent of the cases are mostly located in the South (Bayelsa—over 400 cases, Lagos, Abia, Cross River, Delta, Imo States), with some situated further north (Katsina, Nasarawa, Zamfara States).

Cholera is an acute diarrhoeal disease caused by Vibrio cholerae bacteria. It is passed on from feces through contaminated food, drinks, and unhygienic environments, and causes severe dehydration. Infected people can die if their illness is not quickly managed with oral rehydration.

Symptoms of cholera include acute, painless watery diarrhea of sudden onset, with or without vomiting. It may be associated with nausea, profuse vomiting, and fever.

The Lagos State government at the onset of the outbreak confirmed 17 cholera cases out of 350 suspected cases in 29 wards in the state.

According to a statement, the state government said it has recorded 15 fatalities from the cholera outbreak.

The statement signed by the Director of Public Affairs at the state Ministry of Health, Tunbosun Ogunbanwo, noted that the government has activated its Public Health Emergency Operations Centre at Mainland Hospital, Yaba, Lagos.

It said the PHEOC was convened to address the increasing number of severe gastroenteritis cases across multiple LGAs in the state.

Due to the nature of the disease, a lot of calls have been made to Nigerians on the need to prevent it.

The National Biosafety Management Agency called on people to exercise caution over the recent cholera outbreak in some states across Nigeria.

Head, of Information and Communications for NBMA, Mrs Gloria Ogbaki, in a statement in Abuja recently quoted the Director-General, NBMA, Dr Agnes Asagbra, as saying there was a need for carefulness.

Asagbra said Nigerians must exercise caution as Nigeria records 30 deaths and 1,141 suspected cases from the disease.

Asagbra said NBMA, in collaboration with health authorities, was actively monitoring the situation and implementing measures to contain the spread of the disease.

She also called on Nigerians to imbibe various hygiene practices such as boiling drinking water or using certified water purification methods.

According to her, there is a need to wash hands thoroughly with soap and water, especially before eating or preparing food.

The Director-General also urged Nigerians to always wash their hands with soap and water after using the toilet, cook food thoroughly, and consume it while it was hot.

She advised that Nigerians avoid raw foods, such as fruits and vegetables unless they could be peeled or washed with safe water and to always keep the environment clean and dispose of waste properly to prevent contamination.

She said, “NBMA urges all Nigerians to be vigilant and adhere to these hygiene practices to protect themselves and their loved ones from cholera.”

She called on Nigerians to be alert and report any case of cholera to the nearest hospital.

Ondo State Government on its part has assured residents that efforts are in top gear to combat it in the state even as its outbreak ravages two states in the South West of Nigeria.

Commissioner for Health, Dr. Banji Awolowo Ajaka stated this while speaking with journalists in Akure

According to him, the state has activated its surveillance for immediate response to any case of cholera in the state.

He noted that there were two cases in Okitipupa Local government Areas in the state at the beginning of the year stating that it was curtailed by the Rapid Response team of the state.

Ajaka explained that the state has strengthened the Rapid Response Team which includes PHC coordinators, lab focal persons, and Disease Surveillance officers in the three senatorial districts of the state through the COPREP program.

His words; “The surveillance team has been  strengthened with community informants/contact tracers trained.

Ajaka hinted that the Governor Lucky Orimisan Aiyedatiwa has approved the emergency preparedness fund to prevent it in the state, noting that it would be put in place to work on issues such as the provision of potable water, sanitation, strengthening of the health institutions and other relevant sectors which would be a collaborative effort between all the Agencies in the health sector and other MDAs such as Ministries of Environment, Agriculture, information, Water Resources, and Waste Management Agency.

He assured of the government’s readiness to play its part by sensitizing and creating awareness in the mass media and through community engagement.

He appealed to citizens of the state to maintain a high level of personal and food hygiene adding that they should report promptly to the hospital in case of diarrhoea and vomiting.

He stressed the need for all to take necessary precautions saying “It is important to drink safe water, embrace regular hand washing often with soap and clean running water,  undercooked, maintain cleanliness in surroundings, including proper waste disposal and toilet hygiene.”

Speaking with The Hope, Ondo State Epidemiology, Dr. Ayodele Orimolade explained that there has not been an outbreak in the state noting that all hands are on deck to prevent it in the state.

He said that an approach is on the ground to screen, isolate, and treat suspected patients.

His words; “In Ondo State, there is a structure on the ground which has been strengthened. It is an incident management structure with the surveillance unit spread across the 18 Local Government Areas (LGAs). They ensure that everywhere, the disease Surveillance officers work with community health officers to ensure that suspected cases are screened and tests conducted. The state has a Rapid Diagnostic Kit to screen immediate cases in all the LGAs. We also have the laboratory pillar with the public laboratory in Akure. They work with focal leads in all the LGAs to conduct tests for infectious diseases.

“In the last three years, there have been few cases of cholera. Between February and March 2024, there were a few cases in Okitipupa where we had two cases but it was managed and curtailed.

“With the national outbreak, 31 states have recorded cases so far in the country but Ondo State has been in alert mode. We have been moving around health facilities to pick and screen suspected cases of cholera. The screened cases are moved to the public laboratory in Akure but there have not been any confirmed cases.

“There is the risk communication and management unit that works with media organizations to enlighten the public on cholera prevention.

“We are also working with the Ministry of Water Resources and the Environment Ministry. All these form our EOC as it is a multi-sectoral approach to the management of the outbreak of Cholera.

“Ondo State has had it so good so far; no mortality or had any confirmed case.”

While reacting to the speculation that it is caused by the intake of handmade drinks including tiger nuts and zobo drinks to mention a few, he explained that there has been an ongoing investigation in Lagos State to ascertain the cause.

“In Lagos State, no report said tiger nut was implicated but it was observed that some people who were infected took a part of tiger nut drink and there is still ongoing investigation on it. In the case of Ondo State few months ago, we found out that those affected took spiritual water from a particular church we traced the water source of the church for investigation.

“In the state as of today, there is no cholera outbreak yet, but we are monitoring food and fruit vendors closely,” he said.

He called on residents of the state to maintain personal hygiene and good sanitation of the environment saying “Let us wash our hands at all times and also fruits.”

He called on fruit sellers to wash fruits with portable water before selling adding that people should drink only portable water too.

A Nurse, Mrs Thompson Olayemi while speaking with The Hope stressed the need for people especially nursing mothers to embrace proper sanitation of their environment noting that they should eat well-prepared food.

“Mostly, it is spread through contaminated water, hence mothers should give their children portable water. They can always boil their water before drinking if they don’t trust the one within their reach. They should also make sure that they cook their food properly and avoid buying cooked food for now. They should embrace hand washing after using the toilet and teach their children to follow suit. They should make sure their surroundings are kept clean and also dispose of waste properly.”

A Nutritionist, Abiodun Apata stressed the need for all to shun the consumption of purchased handmade drinks.

“With the outbreak of cholera, it is crucial that all take precautions. Those who can’t do without buying handmade drinks including kunu, zobo, etc should take a break because there is no guarantee for the water used for their preparation. Cholera is transmitted through water, hence all should take precautions. These drinks can be prepared by everyone in their houses if must be consumed.”

The World Health Organization ( WHO) as part of the efforts to help in the preparedness against the Cholera outbreak has donated IPC materials to the state.

Speaking during the donation, Ondo State coordinator for the World Health Organization (WHO) Dr Dele David noted that their organization has always been at the forefront of preventing outbreaks and death in communities and among healthcare workers which necessitated the donation of the Infection and Prevention and Control  (IPC) materials to the state to keep the healthcare workers and the communities safe.

The state coordinator said further that the WHO has always been sustaining the Emergency Operations Centre (EOC) during and after the Epidemic for proper planning and informed decisions.

He also explained that WHO has also been supporting pillars to develop action plans in case of any outbreak and has integrated with communities in the state to create awareness of diseases through communities and media engagement

Dr. David promised that the WHO would continue to support states in the country to ensure the highest sustainable level of health for all people living in the country through collaboration with the government and other partners working in the health sector.

Ondo State Commissioner for Health, Dr Banji Awolowo while receiving the IPC materials emphasized that Ondo State had recorded two cases of cholera in March this year and the state was able to curtail the outbreak in Okitipupa Local Government Area of the State as a result of its preparedness to combat the disease.

The donated items include; 15 cartons of Apron( PEP Gowns), 15 cartons of face shield, 46 cartons of Medline( isolation gowns), 25 cartons of Examination large gloves, and 52 cartons of medical face mask.