Africa, Sub-Saharan

Stakeholders’ Conference on Prevention, Control and Elimination of Cholera in Uganda


This is the meeting report from the Stakeholders' Conference on Prevention, Control and Elimination of Cholera in Uganda January 29 - 31, 2018 at Makerere Univeristy in Uganda. 

Revisiting the Broad Street Pump in Cameroon

David A. Sack, MD

Professor | Johns Hopkins Bloomberg School of Public Health

Read Dr. David Sack’s latest reflections of a modern day broad street pump in Cameroon on Bill & Melinda Gates Foundation’s Impatient Optimists blog:  I recently learned the details of events from Cameroon that reminded me of a modern day Broad Street pump. If you work in public health, you’ll remember that in 1854, John Snow removed the handle from the Broad Street water pump in London and – in all likelihood – stopped a cholera outbreak that had killed over 600 people. In Cameroon, the lessons learned from John Snow reverberated loudly….  Read the whole post at Impatient Optimists.

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Cholera is not convenient, but technologies to control it should be

David A. Sack, MD

Professor | Johns Hopkins Bloomberg School of Public Health
Water collection in east Africa. Photo: Lorenz Von Seidlein

Water collection in east Africa. Photo: Lorenz Von Seidlein

I was talking with a health official in Africa this week about an outbreak of cholera in his country.  I asked if vaccine had been considered as a response to the outbreak.  He responded: vaccination would not be possible in this area because it is too remote; the people are farmers living in scattered villages.

 Also, the area is recently recovering from civil war.  It would be too difficult to reach them with vaccine. Finally, he believes that fortunately, the outbreak is not spreading.
In considering his very realistic response, I had to agree.  It would indeed be too difficult to reach this population with oral cholera vaccine.  The vaccine currently requires a cold chain and a trained field team mobilized to this remote area to administer the vaccine.  However, it is difficult to verify the health official’s claim that the cholera outbreak is not spreading; monitoring the spread of cholera is extremely challenging, as confirmation of cases requires special bacteriological supplies and well-equipped microbiology laboratories with trained technicians.  
How to handle this mismatch between actual needs and the practical use of current tools for cholera surveillance, prevention, and control?  
We have an effective, safe vaccine which can easily be taken by mouth.  It is prequalified by the World Health Organization and is now available for free from a global stockpile.  But it does no good for the remote farmers who will never receive it.  Similarly, we have sensitive microbiology methods to monitor the spread of cholera, but they will not be applied in this remote area where the disease is occurring.  
Cholera is not a “convenient” disease, but practical strategies and technologies should be developed to monitor and control the disease for those vulnerable people living in these “inconvenient locations.”    
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Humanitarian Response West and Central Africa - Cholera

The Cholera Library of the Humanitarian Response West and Central Africa website publishes weekly reports of cholera incidence and deaths collected from ministries of health and compiled by the West and Central Africa Office of UNICEF. It is an essential source for up-to-date data on cholera in West and Central Africa.

This website is in French, with documents available in both English and French.

Africhol website

The African Cholera Surveillance Network website contains country-specific information and news on cholera and cholera surveillance. Africhol is a consortium that supports cholera surveillance in several African countries and promotes sustainability. The website also includes project updates, latest research, and publications.

Cholera in Africa

A series of key papers that for the first time describe in depth the epidemiology of cholera in Africa and include findings from on-going laboratory-supported cholera surveillance conducted through the Africhol project and other institutions. This is an excellent overview of the status of cholera in Africa, published as a supplement of the Journal of Infectious Diseases in November 2013. All publications are open source.

First outbreak response using an oral cholera vaccine in Africa: vaccine coverage, acceptability and surveillance of adverse events, Guinea, 2012

Article published in PLoS Neglected Tropical Diseases on 17-Oct-2013 by Luquero, F. J. et al.

BACKGROUND: Despite World Health Organization (WHO) prequalification of two safe and effective oral cholera vaccines (OCV), concerns about the acceptability, potential diversion of resources, cost and feasibility of implementing timely campaigns has discouraged their use. In 2012, the Ministry of Health of Guinea, with the support of Medecins Sans Frontieres organized the first mass vaccination campaign using a two-dose OCV (Shanchol) as an additional control measure to respond to the on-going nationwide epidemic. Overall, 316,250 vaccines were delivered. Here, we present the results of vaccination coverage, acceptability and surveillance of adverse events.

Feasibility of mass vaccination campaign with oral cholera vaccines in response to an outbreak in Guinea

Article published in PLoS Medicine on 10-Sep-2013 by Ciglenecki, I. et al.

Iza Ciglenecki and colleagues from Medecins sans Frontieres report their experience of undertaking a mass vaccination campaign with oral cholera vaccines in response to an outbreak in Guinea. The authors provide the following summary points: