June 25, 2024

NCDC declares cholera crisis, sets up emergency measures


By Chioma Obinna, Olasukanmi Akoni, Joseph Erunke & James Ogunnaike

LAGOS — The Nigeria Centre for Disease Control and Prevention, NCDC, yesterday activated a national cholera emergency centre, following the outbreak of the disease in the country.

It also said 53 deaths and 1,528 suspected cholera cases were recorded across 31 states and 107 local government areas, with a case fatality rate of 3.5 per cent since the beginning of 2024.

This is even as Lagos State government yesterday disclosed that the cholera death toll had risen to 29 from the previously reported 24 last week, adding that the total number of suspected cases had risen to 579.

Director-General of NCDC, Dr Jide Idris, who spoke in an update on the cholera epidemiological situation in Nigeria yesterday, expressed fears that the situation might be compounded as the rainy season intensifies.

As part of ongoing prevention and response efforts at the national and sub-national levels, Idris assured that a National Cholera Emergency Operation Centre has been activated.

“Cholera, a highly contagious food and water-borne disease, has in the recent past reared its devastating head in several states across our country. It is caused by the ingestion of the bacterium, Vibrio cholerae in contaminated water and food.

“As of 24th June 2024, 1,528 suspected cases and 53 deaths have been recorded across 31 states and 107 local government areas with a case fatality rate of 3.5 per cent since the beginning of the year.

“These fatalities are not just statistics but a significant loss of a loved family member, a spouse, a parent, and often a seasoned healthcare worker and team member. This situation may be compounded as the rainy season intensifies,” Idris said.

He expressed regrets that the country is facing another public health emergency as it was just coming out of the Lassa fever and meningitis outbreaks.

In response to the rapidly increasing cholera cases, a dynamic risk assessment was conducted by subject matter experts on cholera outbreak situation in Nigeria last week.”

“The subject matter experts were drawn from relevant ministries (health, environment, agriculture, water resources etc.), departments, agencies, stakeholders, and major partners.

‘Cholera emergency operations activated’

“The outcome of the risk assessment placed the country at ‘high risk’ of cholera transmission and impact. This demands our immediate and coordinated actions and, therefore, necessitated the activation of the National Cholera Multi-Sectoral Emergency Operations Centre, EOC, in Nigeria today.

“The decision to activate the Cholera Emergency Operation Centre underscores the gravity of the situation and our unwavering commitment to protect the health and well-being of every Nigerian,” he said.

Idris described the Emergency Operation Centre as the central hub for coordinating the nationwide response, noting that it would support affected states, speed up communication and data analysis, and help with decision-making.

“Additionally, it will mobilize resources and expertise from the NCDC, our partners, and all levels of government.

“ It will ensure efficient deployment of needed resources, strengthen surveillance and diagnostic capacity and capabilities, enhance case management, training and intensify public awareness and community engagement activities.

“To effectively do this, an Incident Manager has also been appointed, who will coordinate the day-to-day activities involving several pillars such as surveillance (data collection, analysis and dissemination), case management, oral cholera vaccine issues, coordination, infection prevention & control, IPC, logistics support, and research,’’ he said.

The NCDC boss explained that before activating the EOC, the NCDC, working through the National Cholera Technical Working Group, had already taken preventative and responsive actions, including pre-positioning and distributing medical supplies for case management, infection prevention and control, and laboratory diagnosis to all 36 states and the Federal Capital Territory, FCT.

He sympathized with the families and friends who have lost their loved ones to the outbreak, just as he acknowledged the efforts of all stakeholders, including ministries departments and agencies, MDAs, state and local governments, local and international partners, healthcare workers, community leaders, and individuals that have worked hard in responding to this outbreak.

Death toll hits 29 with 579 suspected cases in Lagos, 30 on admission — Abayomi

In a related development, Lagos State government has disclosed that the total number of cholera cases has increased to 579, with Lagos Island, Kosofe, and Eti Osa Local Government Areas, LGAs, recording the highest numbers.

The death toll has also risen to 29, an increase of five from the previously reported 24 fatalities.
Lagos State Commissioner for Health, Prof. Akin Abayomi, who disclosed this at the Lagos State multi-agency briefing and update on the cholera outbreak yesterday, said the state’s surveillance was yet to tie the outbreak to a specific cause, although efforts were ongoing to unravel the sources of samples tested.

“So far, we have not been able to identify a source yet, but investigations are ongoing. Moving forward, we are going to keep active surveillance around our water sources and beverages in Lagos State,” he stated.

Abayomi further revealed that 30 patients were currently being hospitalised for varying degrees of the disease at the Infectious Disease Hospital, IDH, Yaba, adding that about 579 suspected cases had been identified, 43 of whom were confirmed through laboratory analysis.

He explained: “Most of these deaths were caused by patients presenting very late at a stage where we could not resuscitate them because they had severe rehydration and many patients were actually brought in dead.

‘’Out of all the samples we were able to collect, we were able to identify Vibrio cholera. So this is indeed a confirmed case of a cholera outbreak by a subtype O1 that is known to us to be very contagious and to cause significant sickness in those that contract it.’’

Speaking on cholera vaccine, the commissioner said the government had not included oral cholera vaccine in the routine national immunization programme.

While acknowledging the effectiveness of the oral vaccine, the commissioner highlighted several factors for the decision.

He said: “Firstly, introducing a new vaccine requires careful consideration, especially in the current climate of vaccine sensitivity. Secondly, the low incidence of cholera cases in the country doesn’t justify a nationwide rollout.”

Abayomi emphasised that the situation would be different if cholera cases surged, adding that in such a scenario, immediate action would be taken, including importing vaccines.

He added that currently, a limited supply of the oral cholera vaccine was available in the private sector but not through public health facilities.

Prof. Abayomi said the discussions should be at the federal level to determine whether to integrate this vaccine into the national immunisation programme.

On efforts to halt the spread of the disease, the commissioner said the state government was in complete control, even as he disclosed that it was offering cholera treatment free of charge to any suspected cases.

He, therefore, urged patients who are having symptoms of cholera to rush to any public hospitals for treatment.

“The state government has also adopted one health approach to response as relevant ministries and agencies and departments of the Lagos State government, including health, environmental and water resources, education, information and strategy, physical planning and agriculture are working together to curb the outbreak, prevent future occurrence.

“Directorate of Environmental Health and Lagos State Environmental Protection Agency are collecting samples of water, food, and beverages to determine the source of the outbreak; ongoing inspections of facilities in affected areas; prepositioning cholera kits in health facilities statewide; distribution of Oral Rehydration Solutions (ORS) and risk Communication and Public health education campaigns commenced and intensified,” he stated.

The commissioner, however, urged residents to consume safe water, practice good personal hygiene such as hand washing, especially after using the toilet and before eating; washing of raw fruits and vegetables; cook food properly; thoroughly reheat leftover food before consuming; avoid unregulated and unregistered Street beverages and ensure general environmental sanitation.

To prevent similar outbreaks, he said the state government would introduce an initiative, called safe plate and Safe Beverage to prevent the recurrence of outbreaks such as cholera.

The initiative, according to him, will ensure that all street food vendors and beverage sellers will be monitored to and given a modus operandi of operation.

In his remarks, General Manager, of Lagos State Environmental Protection Agency, LASEPA, Dr Tunde Ajayi, said open defecation was primarily a behavioural problem which had no link with the cost of rents in Lagos.

“As a matter of fact most of the places where you have publicly visible open defecation also have public toilets around them. There’s virtually no commercial facility or business particularly for instance, that doesn’t have the publicly accessible toilets that people can use.
‘’So I think one easy way that we are backing on to tackle it is community-led behavioral change and sensitization.

“So you need to continuously tell people, you need to continuously educate them and you need to use proper toilets and these things usually don’t have to be very expensive. A proper toilet, it doesn’t have to be waterproof, with a good bowl on it. You know what I mean by the bowl? A good bowl on it and the people are trained,’’ he said.

Lagos engages Danish firm for 100 borehole-less public toilets

Meanwhile, Lagos State has engaged a Danish firm to construct 100 bo
rehole-less public toilets.

The Commissioner for Environment and Water Resources, Mr. Tokunbo Wahab, announced this yesterday.

“We are in rainy season, and I tell people climate change is real and there is a cholera outbreak, We must know that all these things are Interwoven, cholera outbreak, when the water is stagnant it just comes to add up.

“We must all be responsible and responsive as a people. You saw those houses yourself. People just chose to brazenly do those things, believing there won’t be consequences. And this era of indiscipline is over. It simply must stop.

“On the construction of 100 public toilets, the Exco discussed it last Friday at the meeting. We want to construct 100 public toilets but we do not want to go the regular way of building toilets with a borehole.

“The system destroys the water base. So what we are doing is to find a new constructive way of getting water to those public toilets that will minimise the impact of digging boreholes.

“How do we get it functional round 24 hours? That’s what we are having conversations on. We are already having conversations with a Danish firm for the modalities of constructing the toilets. We had a conference meeting with the firm yesterday, on how to get the water recycled. It’s an ongoing narrative.

“We need to solve the problem of supplying water to the toilet to minimize contamination. Human beings cannot continue to brazenly abuse the environment and expect that there will be no consequences.”

Wahab appealed to residents to always take ownership of their environment, desist from unwholesome act of illegal waste disposal, illegal construction of buildings on drainage/drainage setback/right of way and endeavour to say something whenever they notice an infraction in order to ensure that the environment remained habitable and safe for all.

Ogun records one death, 25 suspected cases

In a related development, Ogun State Commissioner for Health, Dr. Tomi Coker, yesterday disclosed that the state has recorded 25 suspected cholera cases in seven local government areas.

Coker, who explained that nine cases had been confirmed, while one death was recorded, told newsmen in Abeokuta yesterday the state epidemiology unit had been put on red alert.

He listed affected local government areas to include Ado Odo/Ota; Remo North; Odeda; Sagamu; Ijebu North; Ewekoro and Obafemi Owode.

‘’The ministry is coordinating the outbreak response in conjunction with other stakeholders from the ministry of environment, information and education.

“As of today (yesterday) June 24, 2024, Ogun State has recorded 25 suspected cases of Cholera in seven LGAs namely, Ado-Odo/Ota, Remo North, Odeda, Sagamu, Ijebu North, Ewekoro, and Obafemi Owode, with nine confirmed case and unfortunately, one death.

‘’At inception, we received the alert on June 12, 2024, about the first two cases. Both cases tested positive with a Cholera rapid diagnostic kit and were managed at the State Hospital, Ota. The two cases had travel history to Lagos State 24 hours prior to presentation.

“Also, cholera test kits and other consumables needed for treatment have been distributed to all LGAs and designated treatment centres to ensure prompt diagnosis and treatment. The treatment of Cholera is free across all government facilities in Ogun State.

“Local government areas, including Abeokuta South, Abeokuta North, Ijebu North, Obafemi Owode, Ifo, and Ado-Odo/Ota have been identified to be high-risk areas,’’ she said.

Coker stated that the fluid movement of people from neighbouring states, especially Lagos, which is the epicentre of the cholera outbreak, had made the disease spread in border LGs areas of the state.
She equally said cholera vaccines were not currently available in the state, urging the citizens to adhere to precautionary measures to ward off this disease.

Speaking during the briefing, the Commissioner for Environment, Ola Oresanya, said the state government has constructed over 60 public toilets across the state to address open defecation, adding that the ministry has improved on waste management collection across the state, while promising that the ministry would continue to monitor water channels in areas densely populated.

He noted that since cholera would be transmitted through untreated water, his ministry has despatched its officials with testing kits to test boreholes and other sources of water supply, just as attention would be paid to those producing sachets water.

He said public toilets were being built across the state to discourage open defecation, while landlords and house owners were being encouraged to provide toilet facilities in their houses.
The representative of the Ministry of Education, Science and Technology, Oluwole Majekodunmi, said no death had been recorded, while monitoring of schools had been intensified, with teachers and learners encouraged to make hand washing a habit.

Also speaking, the General Manager, Ogun State Water Corporation, Engr Muinat Jaji, said the government has procured enough chemicals for water treatment in major water works in the state, adding that as water had been increased from 82 million litres to 162 million litres to ensure people in Abeokuta had access to portable water.

Chairman of ARCON’s AIC Committee, Prof. Rotimi Olatunji, said the programme would yield better outcomes than its previous edition.

Olatunji said that the colloquium would include a job fair that allows participants to benefit from the opportunities in the Nigerian marketing communications industry.