Cholera Outbreak: FG shopping for emergency vaccine

Following the country’s cholera epidemic, Nigeria’s Federal Government yesterday commenced discussions with the Global Alliance for Vaccines and Immunization, or GAVI, to secure emergency supply of the oral cholera vaccine, or OCV, as the country fights the disease in the face of a global vaccine shortage.

Dr. Jide Idris, the director-general of the Nigeria Centre for Disease Control and Prevention (NCDC), made this announcement in Abuja. Prof. Muhammad Ali Pate, the Coordinating Minister of Health and Social Welfare, is in charge of the talks with GAVI.

The development came as NCDC yesterday announced an increase in the death toll and spread of the disease across 32 states and 115 local government areas of the federation.

Nigeria utilises three World Health Organization, WHO, pre-qualified oral cholera vaccines, including Dukoral, Shanchol, and Euvichol-Plus.

Two doses of any of the three vaccines are required for full protection and are administered only to persons and groups at high risk, such as travellers to areas with active cholera transmission or people living in areas experiencing outbreaks.

On the request for emergency doses of cholera vaccine,, Idris said: “GAVI, a global health partnership, plays a pivotal role in improving access to vaccines in low-income countries. Through these negotiations, Nigeria aims to secure an emergency supply of cholera vaccines to curb the outbreak.

“Cholera vaccines are not stocked in our public facilities, though they are available in limited quantities in the private sector. But vaccines alone are not the only preventative measures we have at the moment; we must also ensure environmental cleanliness and proper hand hygiene.”

Idris explained further that there is a surge in global demand for cholera vaccines, leading to severe shortage, even though he noted that the limited supply has strained efforts to control outbreaks in endemic regions, including Nigeria.

“Poor sanitation, inadequate clean water supply, and limited healthcare infrastructure have exacerbated the spread of the disease, but in response to the crisis, the NCDC has intensified its public health campaigns, emphasising hygiene practices and the importance of clean water.

“However, these measures alone are insufficient without adequate vaccination coverage. The shortage of vaccines has hampered mass immunisation campaigns, crucial for preventing the spread of cholera.

“The situation in Nigeria underscores broader issues of global health equity and preparedness. It highlights the necessity for increased vaccine production and distribution infrastructure investment,” Idris stated.

While noting that more vaccines were being ordered because of the scale of the problem, the NCDC D-G called for stronger international collaboration to ensure that life-saving vaccines reach the most vulnerable populations promptly.

He regretted that cholera, an acute diarrheal disease caused by ingestion of contaminated water or food, remained a persistent health threat in Nigeria, with the outbreak significantly impacting several states, leading to deaths and overwhelming healthcare facilities.

In 2021, Nigeria received approval from WHO for over 3.5 million doses of the oral cholera vaccine. In 2022, the country requested an additional nine million doses of the vaccines.
The effectiveness of the cholera vaccine varies, depending on the type of vaccine and the number of doses given.

As recommended by the World Health Organisation, WHO, experts say a single dose offers protection, but two doses are generally more effective.

While significant protection lasts at least three years, a single dose for young children might need a booster in the third year.

Nigeria records 54 deaths, 1,579 cases in 32 states — NCDC

In a related development, the NCDC has announced an increase in the death toll and spread of cholera across 32 states and 115 local government areas of the federation.

Giving an update yesterday, the Deputy Director of Surveillance of the NCDC, and National Incident Manager for cholera at the Centre, Dr. Muntari Hassan, said a total 54 deaths and 1,579 suspected cases havd been documented since the beginning of the year.

On Monday, the agency announced that as of June 24, 2024, 53 deaths and 1,528 suspected cases of cholera across 31 states and 107 LGAs were recorded in Nigeria since the beginning of the year with a case fatality rate of 3.5 per cent.

“The current number of people that died is at 54 right now, it’s gone up from 53 and the total number of cases that we have today is 1,579 across 32 states of the Federation, covering 115 local government areas.

“The situation is getting worse in terms of when you look at the number and when you look at the deaths, you can say it is getting worse, but when you look at the total number of reported cases and suspected cases, in this week of 25, it has reduced from what it was in the week of 24, but we are still having cases across the country.

“The worst affected states are Lagos, Bayelsa, Abia, Katsina and about two others, are the six top states that I can say are the worst affected and are the ones with the highest number, but basically,the ones with the highest numbers are Lagos and Bayelsa states.

“It is a multi-factorial; one can’t single out just one problem. Like for example, we may have potable drinking water, but somebody is defecating In the open and he has cholera, so essentially a change of attitude and habits of people, what we need to do ourselves then we can look for support from government. It requires education and that is why we have developed some jingles,” Hassan explained.

It will be recalled that Nigeria had earlier been placed at high risk for increased cholera transmission and impact due to the rainy season.

The NCDC activated its Emergency Operation Centre, EOC, nationally to create a central response system.

Explaining the essence of activating emergency operations, the deputy director noted that Nigeria remains a cholera-endemic country.

He said: “We have been having sporadic cases all through, but when cases rise or we have an upsurge in cases, then there is a concern, which prompted us to conduct what we call dynamic risk assessment.

‘’We rank Nigeria as high risk, then there is a need for us to have a coordinated structure where we can have a multi-disciplinary, multi-sectoral response to any of the epidemic diseases, not only cholera.

“So the Director-General of the NCDC, Dr Jide Idris, inaugurated an Emergency Operations Centre yesterday and appointed an incident manager for the response. The essence of this is to have a well-coordinated response.

“The Emergency Operations Centre comprises the NCDC, the other ministries, departments and agencies like the Federal Ministry of Health, Federal Ministry of Environment, Federal Ministry of Water Resources, WHO, UNICEF, MSF, among a host of others. This response is multi-sectoral.”.

Fewer number of cases reported over the same period in 2023

Nigeria battled with a significant cholera outbreak in the first eight months of 2023, reporting more than 3,000 suspected cases, with some states hit particularly hard. By mid-year, there were over 2,860 suspected cases and 84 deaths across 25 states, with a Case Fatality Ratio of 2.9 per cent. The most affected states were Zamfara (787 cases), Cross River (718 cases), and Katsina (302 cases). In 2024, the NCDC reported a 62 per cent decrease in suspected cases compared to the same period in 2023.

Health watchers attribute the decline to the effectiveness of implemented control measures.

Poor sanitation, contaminated water, reason for spread— Sanwo-Olu

Governor Babajide Sanwo-Olu of Lagos State, yesterday, linked the spread of cholera outbreak to the drop in sanitation at the community level and the intake of contaminated water in the state.
The Governor stated this at ongoing 2024 Lagos International Water Conference, held at Victoria Island.

Sanwo-Olu said the current cholera crisis in the country would have spiraled out of control if the state government had not been proactive in controlling the spread of the water borne epidemic.

The Governor said but for the quick activation of the state’s incident command mechanism and surveillance system to control the contagious disease, the nation would have been grappling with the “catastrophic consequence” that could have resulted from the reoccurrence of the epidemic.

His words: “Today, we are talking about cholera outbreak and we have seen the disease spread in last couple of weeks with not too serious fatalities like we had during COVID-19.

Display product essential information, LASCOPA directs stores

In a related development, Lagos State Consumer Protection Agency, LASCOPA, yesterday directed all supermarkets and stores in the state to ensure essential information about consumable products was prominently displayed as a strategy to curtail the spread of cholera.

Lagos has so far recorded 29 deaths and 579 confirmed cases of cholera as of June 23.
Spokesperson of the agency,Toyin Oni, quoted Afolabi Solebo, General Manager of LASCOPA, as directing that information, such as the NAFDAC registration number, must be displayed on products to ascertain whether they had undergone regulatory approval.

Solebo further directed that dates of manufacture and expiration of products must be conspicuously provided to show transparency on their shelf life.

“Solebo informed that the manufacturer’s address must also be included on products at all supermarkets in the state to facilitate traceability and accountability. He warned that failure to comply with these regulations would result in the immediate closure of affected supermarkets or stores.

“The General Manager maintained that the PLO proactive measure is crucial in preventing the spread of cholera and ensuring consumers have access to safe and regulated products and restated the agency’s commitment to protecting consumers’ rights and ensuring adherence to health standards during this critical period,” he urged.

He also urged all consumers, as part of their responsibilities and rights, to remain vigilant and report any instance of non-compliance to LASCOPA for prompt action.

Why cholera outbreaks persist in Nigeria

Cholera is an infectious disease caused by the bacterium, Vibrio cholerae that primarily spreads through contaminated food and water. Common symptoms include severe diarrhoea (“rice water stool”), dehydration, weakness, muscle cramps, fever, vomiting, etc.

Cholera spreads through poor hygiene, such as not washing hands after using the toilet and then handling food can spread the bacteria. It also spreads through eating contaminated food and drinking untreated water. Open defecation, overflowing sewage systems, and improper waste disposal create opportunities for bacteria to contaminate water sources.

Nigeria is widely regarded as the open defecation capital of the world. Statistics for the 2021 WASH National Outcome Routine Mapping, WASH-NORM, on Nigeria’s sanitation status showed that 48 million Nigerians or over 100 million have no access to basic sanitation services and defecate in the open.

The WASH-NORM report is an annual survey conducted by the Federal Ministry of Water Resources in collaboration with the National Bureau of Statistics, supported by UNICEF, the World Bank, WHO, and other development partners to track progress towards national goals, It revealed a staggering cost from poor sanitation in Nigeria that leads to a yearly loss of 1.3 per cent of GDP, translating to roughly N455 billion. This loss is attributed to impacts on healthcare spending and productivity.

When the rains come, this waste washes into streams and rivers, the very sources of drinking water for many communities. This contaminated water becomes a breeding ground for cholera-causing bacteria. Open defecation is a widespread practice in Nigeria, particularly in rural areas and overcrowded slums. This, coupled with inadequate sanitation facilities and poor hygiene practices, creates a perfect storm for cholera outbreaks.