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Centre de traitement du choléra à Maradi, au Niger. Août 2018. © Moctar Abass/MSF


Cholera outbreak in southern Niger

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Since early July, MSF has been responding to a cholera outbreak that continues to spread in the southern region of Maradi, reaching a scale that is large for Niger, where sporadic cases or minor outbreaks are regularly reported. So far, the current epidemic has left 2,283 cases and 42 deaths, according to the latest reports of the Ministry of Health.

    In partnership with local health authorities, MSF teams run cholera treatment centres (CTC) in N’Yelwa, Dan Issa, Madarounfa, Tibiri, Tchidafaoua, Maraka, Guidan Basso and Sarkin Yamma, and a cholera treatment unit (CTU) in Safo, where severe cases are stabilised and receive intravenous hydration. More CTCs may open in the coming weeks to respond to the growing needs. Until now, the centres supported by MSF have received 1,663 cases. 

    Over 300 patients with milder symptoms have been treated at oral rehydration points, directly in the affected communities. People who have been exposed to cholera are administered the antibiotic doxycycline as a preventive measure. Chlorination of drinking water in villages, disinfection of homes and public spaces, and sensitisations on hygiene are integral parts of the response, aimed at breaking the transmission of the disease. 

    A perfect environment for this disease to spread

    The first three cases, reported on 5 July at the health centre in N’Yelwa, came from neighbouring Nigeria. Southern Niger and northern Nigeria share the challenge of difficult access to clean drinking water and safe latrines. Together with high mobility between border villages, heavy rains and seasonal floods that the entire region is facing, it creates a perfect environment for this waterborne disease to spread. Faced with very limited access to healthcare, people continue arriving to Niger to get treatment: around 30% of patients received so far by MSF during the ongoing outbreak have come from Nigeria.

    In Niger, the border district of Madarounfa has been hit hardest. Spreading at first across villages and towns of Madarounfa, the epidemic has since reached other areas of the region – including its capital Maradi, home to more than 300,000 people. The outbreak in the city has been fairly contained, with 158 cases and 7 deaths reported until 28 August, but the risk of swift contamination in this densely populated area remains high.

    Vaccination: a part of the response

    Effective, well-tolerated, and easy-to-administer vaccines against cholera are available, and vaccination is indicated as part of the response to an outbreak. In recent years, we have seen that implementing a vaccination activity in an emergency can be an effective part of the response, by helping to break the transmission cycle and reduce deaths in such outbreaks.

    - Anne-Marie Pegg, vaccination specialist with MSF

    In high risk area where the disease is present, cholera vaccination campaigns can also be conducted on preventive basis to protect populations vulnerable to a future outbreak. “We need to improve capacities to respond to the current outbreak, through medical response, provision of safe water and latrines and by informing communities on how to prevent contracting the disease. A cholera vaccination campaign in this situation could help protect people against the disease in the future, in this region, in particular Madarounfa district, that remains prone to cholera outbreaks”, explains Dr Foura Sassou Madi, medical coordinator with MSF in Niger. 

    Cholera: a highly contagious disease

    Cholera is a highly contagious disease transmitted through contaminated food or water, or through contact with faecal matter or vomit from infected people. It causes severe diarrhoea and vomiting, and may lead to intense dehydration and death within hours without timely and adequate medical care. A cholera patient can lose up to 25 litres of fluid per day. There is no specific treatment for cholera: medical staff rehydrate patients until the infection subside. Most patients respond well to oral rehydration salts. Despite this, it is estimated that over 100,000 people die of cholera every year. In Niger, the last major outbreak occurred in the fall of 2014 and continued into 2015. It was also concentrated in southern parts of the country and affected over 2,600 people. MSF emergency response team for the Sahel treated some 1,000 patients. 

    How does a Cholera Treatment Centre (CTC) work?

    To better understand how patients are accommodated and cared for in the CTC, click on the image below.