The World Health Organisation (WHO) has raised red alert for acute outbreaks of cholera and hepatitis E in Nigeria. The WHO blamed the cholera outbreaks on lack of access to clean drinking water and poor hygiene conditions, and the hepatitis E epidemic on the ongoing humanitarian crisis in north-eastern Nigeria.

The WHO said it was notified of a cholera outbreak in Kwara State, where the event currently remains localised. The first cases of acute watery diarrhoea were reported during the last week of April 2017 and a sharp increase in the number of cases and deaths has been observed since May 1, 2017. However, the number of new cases reported has shown a decline over the last four reporting weeks.

According to the WHO, as of June 30, 2017, a total of 1558 suspected cases of cholera have been reported including 11 deaths (case fatality rate: 0.7 per cent). Thirteen of these cases were confirmed by culture in laboratory. 50 per cent of the suspected cases reported are male and 49 per cent are female (information for gender is missing for one per cent of the suspected cases). The disease is affecting all age groups.

WHO, in a statement, said between May 1 and June 30, 2017, suspected cholera cases in Kwara State were reported from five local government areas; Asa (18), Ilorin East (450), Ilorin South (215), Ilorin West (780), and Moro (50) (information for local government areas is missing for 45 of the suspected cases).

"Poor sanitation conditions observed in the affected communities are one of the predisposing factors for this cholera outbreak. An important risk factor is the lack of access to clean drinking water and poor hygiene conditions," the United Nation (UN) apex health body noted.

According to the WHO, the Nigerian Ministry of Health notified her of an outbreak of hepatitis E located in the north-east region of the country on June 18, 2017.

The first case was detected on May 3, 2017 in Damasak, a locality at the border with the Republic of the Niger. Samples were collected from the case and sent to laboratory for confirmation. Cases were later reported in Ngala, one of the local government areas in Borno State that borders Cameroon. As of July 2, 2017, 146 confirmed and suspected cases were reported including 21 confirmed cases.

According to WHO, in Ngala, 25 infected pregnant women (21 per cent) were reported, including two deaths (case fatality rate = eight per cent). Cases were reported from three local government areas: Ngala (112), Mobbar (19), and Monguno (14). The number of hepatitis E cases is highest in Ngala with 29 cases reported from June 19 to July 2, 2017. Twenty-seven samples were shipped to the virology laboratory in Lagos for further diagnosis. Among the samples collected and tested, 21 tested positive (10 in Ngala, seven in Mobbar, four in Monguno) and six tested negative. Twenty-three samples have been collected and are pending laboratory tests.

The apex UN body said the hepatitis E outbreak could propagate rapidly due to the ongoing humanitarian crisis in the region, which arises from the volatile security situation in north-eastern Nigeria and continues to persist.

It further explained: "This crisis in Nigeria has been ongoing for eight years and as a result 1.9 million people are internally displaced. The region has been facing intense movements of population coming from refugee camps or displaced populations in the areas bordering Chad and Niger.

"In addition, the fresh wave of returnees from neighbouring countries is overwhelming the current humanitarian capacity. Returnees began entering the town in January 2017 and so far the town has an estimated population of 90 000, according to International Committee of the Red Cross (ICRC) and immigration officials. The town has one unofficial camp hosting returnees considered as strangers or people not affiliated to any of the indigenous communities who have settled in the town. As a result there is overcrowding which is overwhelming the already weak systems in place. Lack of access to essential water, sanitation, hygiene, and health services may lead to propagation of this disease at a very rapid rate."

To address the cholera outbreaks, the Kwara State Ministry of Health has established an Emergency Operations Center to coordinate the outbreak response with support from the Nigeria Centers for Disease Control (NCDC), Nigeria Field Epidemiology and Laboratory Training Programme, National Primary Health Care Development Agency (NPHCDA), the University of Ilorin Teaching Hospital, WHO, and partners.

The following response measures are being carried out:

*National multidisciplinary teams were deployed to Kwara State to provide technical support.

*Cases are being managed in local health care facilities in Kwara State. Active case searching is ongoing in the affected and surrounding communities. These have been strengthened with the formation of surveillance teams made up of the above mentioned partners, and the deployment of local government area Disease Surveillance and Notification Officers (DSNOs).

*Collation and data entry of cases is currently ongoing.

*In order to improve laboratory investigations, cholera rapid diagnostic tests are being distributed to selected facilities and health care staff trained on their use.

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