CHOLERA, DIARRHEA & DYSENTERY UPDATE (28): NIGERIA
A ProMED-mail post
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International Society for Infectious Diseases
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Date: Thu 4 Jul 2024
Source: Medium via Nigeria Health Watch [edited]
https://nigeriahealthwatch.medium.com/cholera-and-climate-change-in-nigeria-an-old-enemy-in-a-modern-world-b1dbecdd1a04
For decades, Nigeria has struggled with recurring cholera outbreaks.
More recently, climate change has exacerbated these outbreaks. This
intersection is most pronounced in Nigeria’s coastal cities, where the
triple threat of rising sea levels, soaring temperatures, and
unpredictable rainfalls has resulted in an increase in cholera cases.
The Lagos State Government declared a cholera outbreak on Sunday, 9
Jun 2024, after multiple suspected cases of cholera were reported. The
Nigeria Centre for Disease Control and Prevention (NCDC) reported that
as of 24 Jun 2024, at least 1528 suspected cases and 53 deaths had
been recorded across 30 states since January [2024]. Ten of the states
that account for 90% of the cases are in the southern part of Nigeria,
along a coastal strip of swamps bordering the Atlantic Ocean.
Previous data also highlighted a disturbing trend — cholera cases in
coastal regions have increased by over 50% in the past decade alone.
There appears to be a potential linkage between the effects of climate
change on cholera incidence, turning what were once manageable issues
into continuous emergencies.
Cholera outbreaks in Nigeria often increase during the rainy season,
which lasts from April to October annually. The heavy rainfall and
subsequent flooding create conditions that are ripe for the spread of
Vibrio cholerae, the bacterium responsible for cholera. Floods often
contaminate water supplies, especially in areas with poor sanitation
leading to the rapid spread of the disease.
Data from the Nigeria Centre for Disease Control and Prevention (NCDC)
revealed that the bulk of cholera cases are reported annually between
June and September. For instance, in 2021, Nigeria experienced one of
its worst cholera outbreaks in years, with over 110 000 reported cases
and more than 3600 deaths.
According to a study, climate change exacerbates the conditions that
contribute to cholera outbreaks. A rise in global temperatures is also
contributing to more extreme weather patterns, including heavier and
more unpredictable rainfall. Coastal erosion and rising sea levels
further exacerbate the already inadequate infrastructure in Nigeria’s
coastal cities, making them more susceptible to flooding.
The primary goal of the cholera outbreak response is to contain the
spread of the disease and lower mortality rate. To achieve this, the
NCDC emphasised surveillance, infection prevention and control, care,
and treatment.
Poor surveillance and response have contributed to the ongoing
outbreaks with high rates of morbidity and death. Drawbacks to
improving surveillance have been attributed to ineffective response
and management of cholera outbreaks in Nigeria. Inadequate number of
healthcare workers with limited training in emergency response, and
limited supply of emergency response kits add to these drawbacks. To
mitigate these, there must be concerted effort geared towards a
coordinated and harmonised approach involving all needed components.
The continuous outbreaks of epidemics in Nigeria are significantly
impacted by the country’s response strategies. Rapid population growth
necessitates that these response strategies evolve accordingly. If
they do not adapt to the increasing population, they become largely
inadequate, failing to effectively manage and control infectious
disease outbreaks.
According to the outcome of a risk assessment conducted in June 2024,
Nigeria was classified as being at “high risk” of increased cholera
transmission. In response, the federal government is collaborating
with Gavi, the Vaccine Alliance, to secure emergency vaccine donations
to control the spread of cholera.
Sania Nishtar, CEO of Gavi, also announced that Gavi and other health
partners in Nigeria are swiftly responding to the cholera outbreak,
including a request for emergency vaccine doses. “The global cholera
stockpile, which is funded by Gavi, is currently fully replenished and
ready to help contain outbreaks and protect those at highest risks,”
Nishtar mentioned.
In addition, a Public-Private Partnership Vaccination Program (PVac)
is in progress and is aimed at streamlining the production and
distribution of cholera vaccines, ensuring timely and efficient
responses to outbreaks. Insights reports from Nigeria Health Watch’s
social listening revealed that there is significant interest in the
availability and cost of the cholera vaccine, reflecting a need for
accessible vaccination information. As a result, strategies should be
put in place to deal with misinformation and disinformation about the
vaccination when they arise.
While the vaccine will go a long way to contain the spread of the
virus, strengthening infrastructure, enhancing climate resilience to
prevent flooding, and fostering community engagement are essential
steps in addressing the recurring cholera outbreaks. As climate change
continues to alter the environmental landscape, proactive and adaptive
measures will be crucial in safeguarding public health and preventing
future outbreaks.
Cholera is primarily caused by poor hygiene, highlighting the
significant work that state health authorities must undertake to
prevent deaths from this preventable disease. To mitigate cholera
outbreaks, it is essential to implement a multisectoral response
anchored on the One Health approach. This involves ensuring continuous
health education, fostering community engagement, and providing safe
water sources. By addressing these factors comprehensively, it would
be possible to significantly reduce the incidence of cholera and
safeguard the health of communities.