Since the beginning of 2021, Cameroon has reported sporadic cases of cholera. During week 43 of 2021, ending on 31 October, health authorities declared a cholera outbreak that is currently active in the South-West region, with cases also reported from the Centre and Littoral regions.
Between 25 October and 10 December 2021, these three regions reported a cumulative number of 309 suspected and 4 laboratory-confirmed cholera cases, with 19 deaths (case fatality ratio (CFR) of 6.1%).
The South-West region, reported the first two cases on 27 October in Kesse area, Bamusso commune in Ekondo Titi health district. Two stool samples were collected from the cases and tested positive for cholera by culture at the Laquintinie Hospital laboratory in Douala. As of 10 December, a cumulative number of 163 suspected cases with 7 deaths (CFR 4.3%) have been identified in Ekondo Titi health district. Sixty-six percent of cases were male and 16.6% were under the age of five. The outbreak has spread to the neighbouring health district of Bakassi, with 95 suspected cases and 11 deaths (CFR 11.6%).
On 28 October 2021, the Centre region, notified a suspected case of cholera with no epidemiological link to cases reported in the South-West region, from the health area of Akok-Ndoe, Biyem-Assi health district part of the urban community of Yaoundé, the capital of Cameroon. A stool sample tested positive for cholera by Rapid Diagnostic Test, and on 29 October was confirmed positive by PCR and culture for Vibrio cholerae at the Pasteur Centre of Cameroon, Yaounde. A cumulative number of 50 suspected cases and one death (CFR 2%) have been reported from Biyem-Assi health district. Of these 52% were male and 8% were under the age of five. The last case to date in the Centre region was reported on 11 November 2021.
In the Littoral region, a cholera case was confirmed by culture on 21 November 2021 in an eight-year-old boy at the Laquintinie Hospital laboratory in Douala. This has remained an isolated case with no further suspected cases. His family and those in his neighbourhood also reported no history of travel.
Public health response
- The incident management systems are activated in affected regions to coordinate the response and support the district’s teams.
- A response plan has been elaborated and the Ministry of Health with health partners including WHO, UNICEF and Médecins sans frontiers (MSF) to support the different areas of the response plan.
- Coordination meetings take place on a twice-weekly basis and situation reports are produced to update the relevant stakeholders on the situation.
- Epidemiological surveillance activities are ongoing including community-based surveillance and active case finding.
- Initial cholera outbreak epidemiological investigations have been completed in the South-West, Centre and Littoral regions.
- Neighbouring health districts and high-risk areas have strengthened surveillance activities.
Laboratory and Case management
- Rapid response teams have been deployed to the South-West (Ekondo Titi) and Centre region.
- Rapid diagnostic test kits and sample transportation media have been deployed to the affected regions.
- A cholera treatment unit (CTU) of 14 beds was set up in Bamusso Health Centre and treatment guidelines have been developed with support from MSF. Cholera case management kits were distributed in health facilities; treatment is free.
- Oral rehydration points (ORP) have been set up by MSF in Bakassi health district in the South West Region.
Water, Sanitation and Hygiene (WASH)
- Community leaders and selected community members have been trained on hand washing, purification of water and disinfection of homes and public spaces.
- Aquatabs have been distributed to the affected areas.
- WASH has been improved in the CTU.
- Community health workers have been trained on safe burial of cholera-related deaths.
Risk Communication and Community Engagement
- The country has developed a request for Oral Cholera Vaccine (OCV) to be sent to the International Coordination Group on Vaccine Provision for Cholera (ICG) for a reactive vaccination campaign.
- Risk communication and community engagement activities are ongoing. Community and faith leaders, together with relevant stakeholders are supporting the team in mobilising the community for vaccination.
- Decontamination in homes of suspected cases coupled with risk communication activities are ongoing inaccessible areas.
WHO risk assessment
Cholera is an acute enteric infection caused by the ingestion of Vibrio cholerae bacteria present in contaminated water or food. In its severe form, it can lead to severe dehydration and death within hours if left untreated. It is primarily linked to insufficient access to safe water and adequate sanitation. It has the potential to spread rapidly, depending on the frequency of exposure, the population exposed, and the context.
Cholera is endemic in Cameroon. Since 2018, cholera outbreaks have been reported annually in various regions of the country including in the currently affected regions (South-West, Centre and Littoral). Several risk factors concur with the circulation of Vibrio cholera in the country, including limited access to safe drinking water and health care facilities in the affected areas of the South-West region and in the capital city of Yaoundé, as well as cultural practices that contribute to unsafe WASH conditions.
The Biyem-Assi health district in the Centre region is a densely populated area with insufficient access to safe drinking water and sanitation, that is located in the heart of the capital city Yaoundè. This may allow a cholera outbreak to spread quickly if swift control measures are not implemented.
The affected health districts in the South-West region (Ekondo Titi, Bakassi and Mobonge) belong to an archipelago in a humanitarian crisis zone with an ongoing armed conflict, and the risk of cholera exportation to other neighbouring districts cannot be excluded. Security constraints, limited geographic accessibility of some areas, and suboptimal communication networks lead to irregular epidemiological updates and potential underreporting of cases. The populations have no or limited access to safe drinking water and latrines, and the overall hygienic conditions are inadequate. There is limited access to health care and patients may have to travel long distances by boat to seek care.
In addition, the affected South-West region borders Nigeria, and there is a frequent and substantial cross-border population movement. In the northern areas, Cameroon is bordered by Adamawa, Borno and Taraba states of Nigeria which are currently affected by a cholera outbreak. There is also a risk of further international spread especially to the Republic of Chad which borders both Nigeria and Cameroon. Therefore, the risk at the national and regional levels is assessed as high. At the global level, the risk is considered low.
WHO recommends the improvement of access to safe water and sanitation, proper waste management, food safety practices and hygienic practices to prevent cholera transmission. Key public health communication messages should be provided.
Reinforcement of surveillance, particularly at the community level, is advised. Appropriate case management, including improving access to care, should be implemented in the areas affected by the outbreak to decrease mortality. Ensuring national preparedness to rapidly detect and respond to the cholera outbreak will be needed to decrease the risk of spread to new areas. As the outbreak is occurring in border areas with active population movements, WHO encourages respective countries to ensure cooperation and regular information sharing.
WHO does not recommend any restriction on travel and trade to and from Cameroon based on the information available on the current outbreak.