The Nigeria Centre for Disease Control and Prevention on Monday said the current outbreak of cholera had spread to 107 local government areas in the country.

The Director General of the NCDC, Dr Jide Idris, who disclosed this at a press briefing in Abuja,  stated that the country had recorded   1,528 suspected cases of cholera and 53 deaths in 31 states.

Idris said this as the Lagos State Government on Monday said for now, it would not administer cholera vaccines to stop the disease.

The state Commissioner for Health, Prof Akin Abayomi, who stated this at a press conference in Ikeja on Monday, said because the current outbreak had declined, there was no justification for cholera vaccination.

 He added that the cholera cases in the state had increased to 579 with 29 deaths.

The current cholera outbreak has notably affected Lagos, Bayelsa, Zamfara, Abia, Cross River, Bauchi, Delta, Katsina, Imo, and Nasarawa states.

The primary cause has been linked to the consumption of contaminated water and inadequate sanitation, exacerbated by the onset of the rainy season, which often leads to increased cholera cases due to flooding and compromised water sources.

Emergency centre

Giving an update on the outbreak,  the Director General of the NCDC, Idris,   noted that the Federal Government had activated the National Emergency Operation Centre of Cholera.

He said, “As of June 24, 2024, 1,528 suspected cases and 53 deaths have been recorded across 31 states and 107 LGAs with a case fatality rate of 3.5 per cent since the beginning of the year.

“These fatalities are not just statistics but a significant loss of a loved family member, a spouse, a parent, and often a seasoned healthcare worker and team member.

“This situation is compounded as the rainy season intensifies.”

He disclosed that experts who conducted the risk assessment conducted last week placed Nigeria at high risk of increased risk of cholera transmission and impact.

“In response to the rapidly increasing cholera cases, a dynamic risk assessment was conducted by subject matter experts on the cholera outbreak situation in Nigeria last week. The subject matter experts were drawn from relevant ministries (health, environment, agriculture, water resources, etc.), departments, agencies, stakeholders, and major partners.

“The outcome of the risk assessment placed the country at ‘high risk” of increased risk of cholera transmission and impact. This demands our immediate and coordinated actions and therefore necessitated the activation of the National Cholera Multi-Sectoral Emergency Operations Centre in Nigeria today (Monday).

“It’s a four-level. The lowest is low level, medium level, high level and very high level, and they advised that it’s a high risk, but the response would be at response level two,” he said.

He said the decision to activate the EOC underscored the gravity of the situation and commitment to protect the health and well-being of every Nigerian.

He explained that the EOC would serve as the nerve centre for the coordination of response across the country,  support affected states, facilitate rapid communication, data analysis, and decision-making processes, and mobilise resources, expertise, and support from across the NCDC, partners, and stakeholders at all levels of government.

Resources deployment

“It will ensure efficient deployment of needed resources, strengthen surveillance and diagnostic capacity and capabilities, enhance case management, training and intensify public awareness and community engagement activities.

“To effectively do this, an incident manager has also been appointed, who will coordinate the day-to-day activities involving several pillars such as Surveillance (data collection, analysis and dissemination), case management, oral cholera vaccine issues, coordination, infection prevention and control, logistics support, and research,” he stated.

He said before the activation of EOC, the NCDC, through the National Cholera Technical Working Group had distributed medical supplies for case management, infection prevention, and control, and laboratory diagnosis, among others to all 36 states and the Federal Capital Territory.

He called on stakeholders and every citizen to stem the tide of the outbreak and redouble their efforts to contain the spread and prevent further loss of lives.

He urged state governments to prioritise action for solutions that ensure access to and use of safe water, basic sanitation, and proper hygiene practices in communities.

The NCDC DG said many states had weak diagnostic capabilities.

“What we’ve discovered is that diagnostic capabilities in many states, especially in laboratories, are very weak. And that’s why the technical working group has advised that we intensify training of these staff. But these people operate in the states. And don’t forget, a lot of these cases are found in those states. They are states’ responsibilities. Our role is just to support them, so we also support them again in training.

“A lot of our partners too are supporting them in training in the various states. So, like I just said, there are many ways of diagnosing cholera. In our situation, if you wait to confirm, more people will die. So, there is  what we call presumptive confirmation.’’

Vaccine shortage

 Speaking on the shortage of cholera vaccines, he said the country had requested from Gavi but he did not know when Nigeria would receive them.

“The fact is that, for most diseases that require vaccines, I have not heard of a situation where adequate vaccines are available. The reason is that the demand for vaccines is far more than supply; Unfortunately, we don’t manufacture those vaccines in our environment. So, we need to depend on the people who manufacture them.

“Unfortunately, for cholera vaccines, very few companies have managed to manufacture them globally. Let us also know that cholera is not only in Nigeria, it’s been found in many other countries. All these countries also now fight to purchase these vaccines.

“I also do know that the Minister for Health approached Gavi, requesting these vaccines. We will not get all we need, let’s be clear.  So, when they come in, the National Primary Healthcare Development Agency will distribute based on their criteria for distribution, not ours but we’ll support them again at the primary healthcare level.”

He noted that of all the states with reported cases, about 16 of them constitute 90 per cent of the burden.

He mentioned Lagos, Bayelsa, Abia, Zamfara, Bauchi, Cross River, Ebony, Rivers, Katsina, Delta, Imo, Nasarawa, and Ondo states.

On the number of deaths recorded from states, he listed, Lagos (29), Bayelsa (2), Abia (4), Cross River (1), Rivers (8), Katsina (3), Delta (4), Nasarawa (1), and Ondo (1).

He also revealed that NCDC would engage the Nigerian Governors Forum this week on the roles the state governments were supposed to play in preventing and mitigating the effects of the disease.

According to him, the state commissioners of health had earlier been contacted through the chairman of the forum when the uptick in the spread of the disease was first noticed, to prepare them for action and to alert their governments to the spread of the disease.

On his part,  the Lagos  State Commissioner for Health, Prof Akin Abayomi, said the state had recorded  29 deaths and 579 cases.

Abayomi explained that the death rate was due to patients being presented late at the hospitals or brought in dead.

On June 11, 2024, Abayomi, in a statement warned that the state had recorded an excess report of severe gastroenteritis cases.

Abayomi disclosed that cases of severe gastroenteritis had been reported in communities around Eti-Osa, Lagos Island, Ikorodu and Kosofe Local Government areas of the state.

He mentioned that out of the 579 cases, 209 patients went to general hospitals, 193 went to the primary health centre, 157 attended private hospitals,  14 visited military, police clinics and eight patients visited tertiary institutions and 12 visited unknown places for treatment.

He added that the majority of the patients admitted had been discharged, saying only 30 patients were currently on admission.

“For the past two weeks, we have recorded 29 deaths and 579 suspected cholera cases. The 29 deaths were caused by patients being presented too late in a state where we couldn’t resuscitate them and some were brought in dead. “

Abayomi assured the public that the situation was declining and that the data recorded between Sunday and Monday showed a decline in the rate, saying that the situation was well monitored.

He urged the residents to support government efforts by adhering to hygiene practices, by drinking safe water, cooking food thoroughly, maintaining personal hygiene and washing hands regularly, using sanitiser and avoiding crowded places.

The commissioner advised them to report symptoms like watery diarrhoea or vomiting immediately and utilise free treatment for suspected cholera at all government facilities.

Abayomi also said that no cholera case had been reported in schools, however, school authorities and health teachers were being sensitised and enlightened on cholera precautions, management, and reporting techniques.

No vaccines

Abayomi also spoke on the circumstances that would warrant the introduction of vaccines.

“As many of you are aware, there used to be an injectable vaccine for cholera, but it has since been phased out. Currently, the cholera vaccine is not included in our routine vaccination schedule. We carefully consider adding new vaccines due to current sensitivities around vaccination. Therefore, introducing the cholera vaccine requires thorough evaluation to ensure it would indeed be beneficial before making it available.

“There is evidence supporting its effectiveness, but it requires repeated doses and provides protection for a limited time. In our current situation, where cholera incidence has decreased, there is not enough justification to launch a cholera vaccination campaign.

“However, if cholera cases were to increase significantly—reaching hundreds or thousands—and resulting in multiple deaths, it would constitute a serious public health emergency. In such a scenario, vaccines would be swiftly brought into the country.

“At present, cholera vaccines are not stocked in our public facilities, though they are available in limited quantities in the private sector. The decision on whether to include cholera vaccine in our routine vaccination program is a subject of ongoing discussions at the federal level.”

In an update regarding schools in Lagos State, the Commissioner of Basic and Secondary Education, Mr Tolani Alli-Balogun, emphasised that there had been no reports of cholera in any schools across Lagos.

He outlined the preventive measures implemented by the Ministry of Education, stating, “We have implemented comprehensive preventive measures in all schools. Water has been provided in every school to ensure children can wash their hands upon arrival in the morning and periodically throughout the day. Additionally, health teams inspect food to ensure its safety, monitor toilet facilities for cleanliness and have trained teachers on protocols to follow in case of any incidents. We have also trained them on the use of Oral Rehydration Solution, which is readily available in schools. Our higher institutions have sanitation managers in place, and I can confirm that there have been no cholera cases reported in any of our schools.”