Cholera outbreak may be one of largest in Zambia's history

"Since August, the intensity and volume of our activities increased and expanded to Lusaka, too. We were invited to participate in the Regional and National Task Forces. Close on-the-spot monitoring of the situation continued alongside the other activities," explained Dolizde.

Since the last week of December, MSF has been coordinating an emergency intervention in Lusaka, the capital city of Zambia, where there has been a severe cholera outbreak. The first isolated cases were recorded last August. Since then, the disease spread little by little. At the end of December, more than 200 new cases were appearing every week.

So far, more than 90% of the almost 1,000 cases, including 29 deaths, occurred 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.

It is thought that the current outbreak has not yet reached its peak. The rainy season - when outbreaks usually occur - has just started and will last until April. In its peak, estimates are that there will be 1,000 new cases every week.

MSF has had a participating role in controlling the outbreak since August, however with the increasing levels, the organisation has now taken on a lead role in treating patients and controlling the spread of the disease.

In Lusaka, a city of 1,5 million inhabitants, the first cases were recorded in Kanyama, a poor neighborhood with the biggest open air market in town. The disease spread then to Chawama and George, in the western part of the city.

Cholera is mainly 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.

"The outbreak is still growing. Its peak is still expected to come in January-February. The estimated total number of cases is 8,000 to 9,000. This may make the current outbreak one of the biggest in the history of cholera in Zambia."

Cholera is a perpetual condition in Zambia, varying only in the number of cases.

"Cholera is endemic in Zambia and separate cases have never really stopped appearing in different areas of the country since December 2004," said MSF Head of Mission, Misha Dolizde.

"(In this outbreak) two commonly affected areas: Kapiri M'Poshi (an area of the Lukanga swamps) and Lusaka, the capital, were the first again to record an increase of cases from August 2005. During December, heavy rains started and the epidemic intensified and accelerated. It then started acquiring the characteristics of a potentially severe outbreak.

"MSF continued participating in controlling the spread of the disease in Kapiri M'Poshi and namely in the Lukanga swamps throughout the year. We were working in the swamps and, in particular, in the fisherman villages and communities; setting up the Cholera Treatment Units (CTUs); and providing medical and logistical supplies; training the staff in the CTUs; providing chlorination; water/sanitation; and undertaking sensitization activities in the communities.

"Since August, the intensity and volume of our activities increased and expanded to Lusaka, too. We were invited to participate in the Regional and National Task Forces. Close on-the-spot monitoring of the situation continued alongside the other activities," explained Dolizde.

Given the strong increase of new cases, it was decided in December to reinforce our intervention and send an emergency team.

"As the epidemic continued escalating and the measures proposed and implemented by the Task Force proved ineffective to control the spread of the disease, it was discussed amongst MSF and concluded that the local response to the outbreak was not sufficient," said Dolizde. "We decided that MSF should take more active - or perhaps leading - role in controlling the epidemic. The MSF Emergency Unit was called for intervention in the country.

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 to be organized. Therefore, MSF will also work on ensuring the supply of chlorinated water to the most affected area and on implementing disinfection measures and proper burials activities. Besides, the team will organize sensitization activities to promote strict hygiene measures in the community, like for instance cooking food thoroughly and washing hands after defecation. Finally, MSF is also involved in the epidemiological surveillance.

"The Emergency Team came in and started working in the 51st week. Now MSF is taking a leading role in controlling the outbreak. Our strategy and actions are aiming at covering almost all aspects of response to the epidemic: individual case management; global organization of the response; community awareness and IEC; water and sanitation in the treatment centers and the community."