The Nigeria Center for Disease Control and Prevention (NCDC) has warned that cholera transmission is still active nationwide and urged continued efforts to prevent more infections and deaths.
The warning was given by the Director-General of NCDC, Dr Jide Idris, at a press briefing in Abuja on the current situation, response and measures needed to contain the cholera and diphtheria outbreaks.
He said more than 65,000 suspected cases of cholera have been recorded this year in 35 States and about 195 Local Government Areas in Nigeria.
He said the weekly number of cholera cases had fallen sharply from the peak recorded earlier in the season and the proportion of cases resulting in death was far lower than the same period last year, but the situation required a sustained response.
“This is a huge step forward. “But I want to be very clear, the outbreak is not over,” NCDC Director General warned.
Experience in recent years had demonstrated that cholera transmission could peak between late August and October, while the current rainy season and the threat of flooding could contaminate water sources and swamp sanitation systems, he said.
“We are particularly concerned about conditions that continue to put communities at exposure to cholera like unsafe water, open defecation, damaged water distribution systems, poor hygiene infrastructure and inadequate sanitation in schools, markets and other public institutions,” Idris said.
“Treatment saves lives but we can’t treat our way out of cholera,” he insisted, calling for sustained action on water, sanitation, hygiene, environmental health and community behavior.
One of the clearest lessons from the current outbreak was early access to treatment, said the NCDC chief, particularly in Borno State where most of this year’s cases had been reported.
He said better outcomes had been recorded where treatment was brought closer to affected communities and people sought care early.
Diphtheria Still a Concern
The NCDC also reported more than 10,000 confirmed cases of diphtheria recorded in Nigeria this year.
The Director-General noted that while the disease remains a major health concern, the proportion of confirmed cases that have resulted in death has decreased substantially compared with the same period last year.
However, he said that most of the confirmed cases are still concentrated in a few states, notably Kano, Borno and Bauchi.
The NCDC said low vaccination coverage is another concern, as too many children are not vaccinated or incompletely vaccinated.
“Vaccine hesitancy, insecurity, hard-to-reach communities, displacement and population movement have also made it more difficult to reach every child who needs protection,” he said.
“The importance of vaccination cannot be over-emphasised. Diphtheria is preventable with vaccines. We must ensure we improve vaccination coverage and work to ensure that no eligible child is left behind to receive their vaccination,” the Director General of NCDC said.
NCDC Ramps Up Response
NCDC said it continues to coordinate the public health response to both outbreaks with State Governments and partners, offering technical support where it is most needed.
It said the capacity for surveillance and laboratories is being strengthened and healthcare workers are being supported on case management, infection prevention and control. Information on prevention and early care seeking are also being provided to affected communities.
National Rapid Response Teams have been deployed to impacted States to assist with investigation and response activities, the agency said.
The cholera response focuses on ensuring early access to treatment and addressing the water, sanitation and hygiene conditions driving transmission.
Teams from Borno and the NCDC have investigated sources of transmission and studied water supply points to ascertain deficiencies in water quality, sanitation and chlorination.
The agency worked with the State Government in Bauchi to set up oral rehydration points, increase treatment capacity and step up active case searches.
In addition to water chlorination, rehabilitation of water sources and hygiene promotion, oral cholera vaccination has also been introduced in high-burden areas.
The response for diphtheria is centered on scaling up vaccination, and rapid case detection and management.
Reactive vaccination is under way in affected areas and provision of essential treatment and laboratory commodities continues.
States urged to step up efforts
Federal action alone is not sufficient to control the outbreaks, the NCDC Director-General said, stressing that many of the interventions that will make the biggest difference have to take place at the State, Local Government, health facility, community and household levels.
He therefore called on the State and Local Governments to identify the most vulnerable communities, to fill critical gaps and to deploy available resources and response capacity where they are most needed.
For cholera, he called on governments to improve access to safe water and sanitation, strengthen water quality monitoring, repair critical water infrastructure, address open defecation and ensure that high-risk Local Government Areas have functional treatment and rapid-response capacity.
He called for better vaccination coverage in diphtheria, especially in affected, hard-hit and underserved communities, as well as increased routine and targeted immunization.
Nigerians, Healthcare Workers Urged to Act
The NCDC also advised health care workers to maintain a high index of suspicion for both diseases, ensure early recognition and reporting and observe standard infection prevention and control precautions.
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For cholera, the agency said dehydration should be rapidly diagnosed and treatment started immediately.
‘It’s dehydration that kills,’ the Director-General of NCDC told the healthcare workers, stressing the need for prompt management.
He urged health facility managers to ensure health care workers had functional triage and isolation systems, appropriate personal protective equipment, hand-hygiene facilities and systems for timely notification and referral of suspected cases.
The NCDC also appealed to traditional and religious leaders, community leaders and civil society organizations to support the dissemination of correct information, advocacy for preventive measures, early seeking of care and fighting misinformation.
Nigerians were also advised to take care of safe drinking water, to keep the environment clean, to use proper toilets and avoid open defecation and practice regular handwashing with soap and clean running water to prevent cholera.
The agency also recommended that anyone who develops frequent watery diarrhea with or without vomiting should immediately begin oral rehydration solution and seek care at the nearest health facility.
Parents and caregivers have been urged to ensure that their children are fully vaccinated against diphtheria, while those who missed recommended doses should be taken to the nearest health facility to complete their vaccination.
The NCDC said that diphtheria vaccines were safe and effective and were available free of charge through routine immunization services and vaccination campaigns.
Media urged to help response
The NCDC also called on the media to help support the public health response by providing accurate, actionable information that can help protect communities and save lives.
The Director-General urged journalists to emphasize the importance of safe water and sanitation, oral rehydration and early treatment in preventing deaths from cholera, while helping parents and caregivers understand the importance of vaccination against diphtheria.
He stressed that the outbreak is not over even if cases of cholera are declining, and that diphtheria is vaccine-preventable.
There is need for sustained action by the Federal, State and Local Governments, healthcare workers, traditional and religious leaders, partners, communities, families and individuals to prevent further infections and bring the two outbreaks under control, the NCDC said.
