CHOLERA OUTBREAK

 CHOLERA OUTBREAK - Caused by unregistered tiger nut drinks 

Cholera cases have been a perpetual occurrence in Nigeria, typically manifesting as isolated incidents that are promptly treated. However, a notable escalation in cholera occurrences was noted between the 10th and 11th of June 2024, indicating an outbreak. The primary local government areas significantly affected by this surge are Lagos Island, Kosofe, and Eti-Osa. Recognizing that cholera outbreaks are anticipated during the rainy season, the Nigeria Centre for Disease Control and Prevention is not surprised by this development and is well-prepared to address it. The outbreak is intricately linked to environmental factors and social determinants of health, particularly in areas lacking access to clean water and resorting to wells for water supply. Open defecation practices exacerbate the situation, leading to fecal contamination of water sources like wells during rainfalls. Additional contributing factors include flooding from overflowing canals and poor sanitation practices. However, the implementation of preventive campaigns and awareness-raising initiatives, emphasizing regular handwashing, has effectively mitigated the outbreak. This summarizes the pivotal aspects of the current situation.

During a health crisis such as the current outbreak, it is imperative that Environmental Health Services officials from the Ministry of Health and the Ministry of Environment are deployed to ensure environmental hygiene. In response to an observed surge in cases in Eti-Osa Local Government Area of Lagos, a thorough investigation was conducted. Through a survey, it was established that a common factor among afflicted individuals was the consumption of a tiger nut drink. Subsequently, samples of the suspected beverage were meticulously analyzed. Upon discovering that the drink was unregistered with the National Agency for Food and Drug Administration and Control, efforts were made to trace its source. Contact tracing activities were initiated, akin to those employed for COVID-19, to locate suppliers of the drink. Despite only finding empty bottles and encountering communication challenges with the labeled phone number, further investigations indicated that the unregistered nature of the beverage was a key factor. The presence of Vibrio cholera subtype 01, a highly contagious strain, was identified in stool samples collected from individuals primarily in Lagos Island, Eti-osa, and Kosofe areas. While efforts are ongoing to address this outbreak and advocate against self-medication with antibiotics, the unfortunate increase in cases post-Ileyah celebrations underscore the need for continued vigilance and community engagement to combat the spread of cholera and prevent further loss of life.

In the latest update, the number of cases has risen. Specifically, as of Thursday morning, there were 21 cases identified. During an emergency meeting held around 11 pm on Wednesday, it was revealed that an individual passed away shortly after arriving at the hospital from home. This person was not only experiencing diarrhea on that particular day but had been at home prior to seeking medical attention. While the timing of the incident may have been before or around the Ileyah period, the report of the death is being made now due to the recent occurrence. It is important to clarify that this is not a new case that transpired on Wednesday; rather, it is a new case that has been brought to attention, unfortunately resulting in a fatality.

Other symptoms residents should know

Commencing with abdominal discomfort, the primary symptom of cholera often progresses to include diarrhoea. In some instances, individuals may also exhibit fever, alongside symptoms such as vomiting, muscle pains, cramps, and a heightened heart rate. Additionally, feelings of general malaise, fatigue, and tiredness may be experienced due to the significant loss of water containing essential electrolytes like potassium, magnesium, and vitamins. These electrolyte depletions can contribute to muscle discomfort and cramping. Despite watery diarrhoea being a hallmark sign of cholera, it is important to acknowledge that not all diarrhoeal conditions signify cholera. In cases of genuine cholera, individuals typically endure profuse watery diarrhoea resembling clear water, induced by the bacterial absorption of bodily water within the small intestine, expediting its passage through the intestines.

Typically, how rapidly do these symptoms manifest following infection, and what is the procedure for diagnosing cholera?

In the human body, the onset of symptoms related to bacterial infections can vary, depending on the level of bacteria present. If one has consumed contaminated food or water and already harbors the bacteria in their system, symptoms could emerge within a few hours. This onset time varies between individuals, akin to the variance seen in COVID-19 infections where virus multiplication rates differ among people. While some individuals may start experiencing symptoms within two to five days, in cases of cholera, symptoms can manifest in as little as 24 hours. Seeking immediate medical attention upon symptom onset is crucial. During outbreaks such as the current one, cholera is typically suspected based on symptoms, although confirmation necessitates a stool specimen. The Nigeria Centre for Disease Control and Prevention has equipped all hospitals with rapid diagnostic tests for on-site testing and also conducts confirmatory tests in laboratories. Upon hospital admission, individuals presenting with symptoms like diarrhoea or vomiting promptly receive intravenous infusion for rehydration, irrespective of test results. Maintaining hydration is a priority to replace lost fluids and essential electrolytes, critical for kidney function and general well-being. Some patients arriving late may need dialysis to address dehydration-related complications. For individuals unable to reach a healthcare facility swiftly, oral rehydration with boiled, clean water, a pinch of salt, and a teaspoon of sugar recommended as a temporary measure. This approach aids in balancing electrolytes until professional medical assistance is available, ensuring the individual's well-being until they can access proper treatment at a hospital.

What is the extent to which the outbreak has influenced the health and daily routines of the affected population in Lagos?

Owing to the ongoing sensitisation efforts and campaigns conducted in various communities, individuals are becoming more aware of the need to exercise caution amidst the current outbreak. Upon revisiting the Eti-osa area, we observed a complete absence of vendors selling tiger nut drinks, indicating a decrease in the availability of such beverages within the communities. This heightened awareness among the populace is a primary objective of our initiatives; we seek to promote vigilance and responsible behavior. We urge the community members to prioritize actions such as boiling water, maintaining proper hand hygiene, and advocating against open defecation. Regrettably, some individuals persist in engaging in unsafe practices in their daily routines. The residents of Lagos showcase remarkable resilience, which may have influenced behavior in other states as well. An incident was reported involving an individual who traveled from Lagos to Oyo State and subsequently exhibited symptoms, leading to cases in Oyo State. The Nigeria Centre for Disease Control (NCDC) is actively monitoring the situation nationwide, extending its oversight beyond Lagos State. Given Lagos State's high population density and influx of visitors, it often serves as a point of origin for infections, with individuals traveling to and from Lagos contributing to the spread to other states. Incidences have been recorded in several states, with Bayelsa being the first to report cases following Lagos. Consequently, the NCDC remains engaged in intensive efforts to offer support to Lagos and all affected states.

The NCDC has stated that it may declare an emergency on cholera. What are the implications of this?

An emergency declaration has not been made yet. The National Center for Disease Control (NCDC) is currently monitoring trends and conducting risk assessments. Our team is actively engaged in these efforts. Dr. Jide Idriss serves as the Director-General of the NCDC, and his team members are located in Lagos. We are closely collaborating with them, as well as with the Ministry of Environment and the Ministry of Education, especially regarding children. Our primary focus is on containing the spread of the situation. Ongoing risk assessments will guide our future actions, depending on whether the NCDC decides to declare an emergency. We are striving to prevent causing unnecessary panic. Daily activities continue as usual, with people going to work, and schools remaining open. School closures would only occur if an emergency is officially declared. Standard protocols are in place, including a quality assurance system within the Ministry of Education to monitor developments. At this moment, there have been no reports of schoolchildren vomiting in schools. Teachers have been briefed on recognizing symptoms and appropriate measures to take. Hydration measures are also being implemented in schools. We remain actively involved in managing the situation, which is a common practice during outbreaks such as this cholera incident in Nigeria. Vigilance is paramount during outbreaks, and we are diligently implementing these measures.

Are there any partnerships established with national or international health organizations to help manage this crisis? If so, could you provide more information on these collaborations?

Numerous individuals have been enlisted in the effort, collaborating with a variety of partners including UNICEF, who has demonstrated exceptional skills in disseminating information. The Red Cross has also been notably supportive. The World Health Organization maintains a consistent monitoring effort to prevent the situation from evolving into a pandemic, although there is confidence that this will not be the case. The current phase involves active monitoring. Anticipating a potential uptick post the Ileyah Festival as individuals return home and settle, this observation has indeed been confirmed. Hence, a vigilant daily monitoring approach is being implemented. Regular meetings are held to discuss unfolding developments, with reports focusing on the established pillars. Utilizing electronic real-time data analysis, risk evaluations, and community surveillance, among other measures, is paramount. Presently, the situation is not considered an emergency, and the public is advised against panic. All treatment for suspected cases of cholera at hospitals is entirely free. Recognizing concerns regarding medical expenses, it is important to clarify that this is a public health issue. Diagnosis, medications, and hospitalization, if required, are provided without any charges at government-owned hospitals and primary healthcare facilities. Payment is not solicited in any form. Acknowledging that hospitalization may not be essential for all cases, the economic hardships individuals encounter could impede them from seeking medical attention.