Cases still rising in cholera outbreak in Lusaka, Zambia

Treating sick people is not enough. In order to cut the spread of the disease hygiene measures have to be implemented in the community and an early and effective detection and referral of new cases has been organized.

Since December 2005, MSF has been responding to a severe cholera outbreak in Lusaka, the capital city of Zambia. The first isolated cases were recorded last August. Since then, the disease has spread little by little.

At the beginning of February, more than 600 new cases were reporting every week. It is estimated that the outbreak has not yet reached its peak. The rainy season - when outbreaks usually occur - started in November and it will last until April.

So far, more than 90% of the cases - of a total of close to 3000, including 62 deaths - have been in Lusaka. However, the situation in the rest of the country has to be monitored closely, given that, in several regions, cholera is considered an endemic disease.

In Lusaka, a city of 1.5 million inhabitants, the first cases were recorded in Kanyama, a poor neighborhood (slum) where the biggest open market in town is situated. The disease spread then to the Chawama and George neighborhoods, in the western part of the city.

Since the outbreak started, an MSF team working in the country on an HIV/AIDS program provided logistical and technical support to local authorities. Given the strong increase of new cases, it was decided in December to reinforce our intervention and send an emergency team.

A Cholera Treatment Centers (CTC), with a capacity of more than 300 beds, has been set up in northern Lusaka. A second one is currently being set up in the southern part of the affected area. A mobile team also ensures that adequate treatment and sanitation conditions are present in the Health Centers of the city.

MSF's teams are notably in charge of the implementation of medical protocols, the supervision of case management, ensuring proper hygiene and sanitation in the CTCs and CTUs, training the local staff, and ensuring the supply of medical and logistical material.

But treating sick people is not enough. In order to cut the spread of the disease hygiene measures have to be implemented in the community and an early and effective detection and referral of new cases has been organized.

MSF also works on ensuring the supply of safe-drinking water to the most affected areas, as well as on the disinfection of patients' houses and ensuring safe burial practices. Sensitization activities - like drama performances in the affected areas and the distribution of leaflets with key information on how cholera is transmitted - are also carried out to promote strict hygiene measures in the community. Finally, MSF is also involved in the epidemiological surveillance.

MSF has faced some difficulties to complete the full deployment of its intervention, mostly due to bureaucratic and political bottlenecks in Zambian administration that have delayed and constrained our original planning. Apart from these difficulties with the authorities, the response is already achieving the expected results.

Cholera is a water born disease, which means that it is spread by contaminated water and food. It produces strong watery diarrhea that can quickly lead to severe dehydration and death if treatment is not promptly given. Most of the cases can be treated adequately by giving a solution of oral rehydration salts and do not require a hospitalization. In case of severe dehydration, however, the patient must be given intravenous fluids.