Cholera Daily sitrep as of 15 th September 2017 Borno State Ministry of Health Highlights 167 additional suspected cholera cases were reported as of 15 th September and no death reported The burden of suspected cholera cases has decreased in Jere and Dikwa, while it remains high in Monguno. A large proportion (70%) of the affected population is among children below 10 years and this may guide prevention messages. Epidemiological summary The number of suspected cholera cases is cumulating to 2265, with 1271 cases in the Muna corridor, 579 cases in Dikwa and 415 in Monguno. The total number of deaths is 44 (CFR = 2.1%). A large proportion (70%) of the affected population is among children below 10 years. Among 33 samples collected, 63% were culture confirmed (also for children below 10), this indicates the needs to target specific prevention messages for children. HF// Table 1: Number of suspected cholera cases reported as of 14 September 2017 Muna Muna 2 Dala Jere Muna 7 Muna (sect4) Farm Centre Muna (sect 5) Cases New cholera suspected cases 3 23 2 8 5 12 2 26 81 9 22 9 15 31 77 167 Cumulative cholera suspectes cases 205 103 414 272 79 19 31 148 1271 579 415 2265 Admissions New admissions 3 13 2 18 5 22 22 45 Number on admissions 34 18 13 65 0 65 New discharges 5 4 14 23 5 5 5 33 Deaths New deaths 1 1 1 0 0 0 0 0 3 0 0 0 0 0 0 3 Cumulative deaths 4 1 8 18 1 0 0 3 35 9 2 2 46 Laboratory Number of specimen collected 33 12 45 46 16 1 16 107 Specimen Positive RDT 25 10 35 34 16 1 16 85 Specimen Positive Culture 8 2 10 4 4 4 18 The daily number of suspected cholera cases reported in Borno has exceeded 150 since 4 September 2017. The burden of cases reported at and has decreased over the past week in the Muna corridor and Dikwa, while it is still increasing in Monguno. Custo m Jere Dikwa Monguno GGSS Monguno TOTAL Figure 1: Number of suspected cholera cases reported in Borno State from 16 August to 15 September 2017 1
Response 1. Surveillance and laboratory Active case search The number of cholera suspected cases identified during active case-search is decreasing in Monguno and Dikwa. Date of Visit Name of Settlement Number of Household s Visited Number of Peoples in the Household Number of cases identifie d Number of cases referred Number of Death Number of ORTs Distributed 14th Sep 2017 Monguno 438 2513 2 2 0 181 14th Sep 2017 Dikwa 332 1645 2 2 1 115 Alerts under investigation: - Two suspected cholera cases were identified, one in CBN IDP Camp and another in Dalori - A report indicated 19 cases in Mafa LGA, investigation are ongoing. - One case was reported in the North West part of MMC and investigation should be conducted. IDSR / EWARS training to take place in Jere/MMC on Saturday and Monguno and Dikwa early next week. 2. Case management No specific update 3. WASH Detailed WASH activities are listed in annex. Challenges Need to provide Generator in Muna Risk of fecal contamination is still high New 3442 people relocated in from goni kachallari to Muna 4. Vaccination Vaccines just arrived Nnamdi Azikiwe Airport at 4.00 pm Possible delay in clearance at the airport and bring back vaccine back to the airport if plan A is feasible Need for PHEOC to consider shifting implementation dates with a day or two in view of the above possibilities 5. Risk Communication Press conference conducted by the Honorable Health Minister about the current situation of cholera in Borno and preventive measures including vaccination. Presentation of flyers and communication tools to be used for the vaccination campaign 6. Logistics (see in annex 2 the distribution of drugs and other commodities) 2
WASH updates for SEP, 15th. Muna Corridor WaSH Cholera Response Sitrep CIDAR - CIDAR - CIDAR - CIDAR - - Malteser - Malteser - Malteser - Malteser RUWASSA- RUWASSA- Water Activities Muna Garage Camp: Muna Garage Camp: Batch chlorination of 4 major water sources in Zone-6, 8, 9 and 4 Muna Garage Camp: Free Residual Chlorine monitoring at all 7 water collection points connected to 4 water sources Muna Garage Camp: Deployment of 4 Water Source Operators and 14 Water Attendants in Zone- 4, 6, 7, 8, and 9 Muna Garage Camp: Batch chlorination and residual chlorine monitoring of 112 Water points in Muna Corridor (32 water points in Muna Area) Muna Garage Camp: Batch chlorination of 3 water bladder AT, Zone-3 and 4 Muna Garage Camp: FRC Monitoring of 3 Bladders of 10 M 3 - total 30 M 3 Muna Garage Camp: Water Point Caretakers deployed at all three Water collection points attached to 3 Bladders. Muna Garage Camp: 2 new water bladder installation will commence at Muna Garage camp. Jerrycan cleaning in 1 water point in EL Miskin Extension, Old Maiduguri Jere Batch chlorination in 4 water points in Muna Dalti, Batch chlorination in 1 water point in El Miskin Muna Garage: 3 technicians operated 4 water pumping units with total production of 140 cubic meters of chlorinated water. Niger Location: Bucket chlorination launched at 6 water points Congo Location : Bucket chlorination launched at 5 water points Nile location: Bucket chlorination launched at 5 water points Private vendors: Bucket chlorination launched at 3 entrances to camp FRC Monitoring: 141 Households 282 household drinking water tested for FCR and is within standard of 0.3-0.5 Aqua tabs distributed to 283 households in Muna camp Muna Garage Market : bucket chlorination on going in 2 water points + follow up of an additional one (chlorine already provided by another organization) Muna Koreri : bucket chlorination ongoing in 3 water point : NRC borehole Bulamari + Qatar Muna Ethiopia borehole + private borehole opposite to Kori filling station Muna Asheri : bucket chlorination ongoing in 2 borehole (1 opposite to Jummat Mosque + NRC Borehole opposite Bulamari +) 3
Custom house (subzone A and B) : batch chlorination of the 5 water points Spraying/disinfection 2 HHs suspected case of Cholera sprayed/disinfected in Muna Dalti, Bakasi Village, Jere Niger Location: 18 shelters disinfected Kusheri: 1 shelter disinfected by RR Mobile team Fariya Camp: 12 shelters, 1 clinic disinfected by RR Mobile team Shuwari Sanaweya: 2 Shelters disinfected by RR Mobile team Muna Garage (in link with MoH,, ALIMA and MSF ): 5 shelters disinfected Muna Dalti : 36 shelters disinfected Konan yobe : 5 shelters disinfected Custom House: 74 shelters disinfected (24/24 shifts have started) Sanitation Activities Daily Latrine Cleaning in Simari, Mashamari Jere Daily Latrine Cleaning in MUna Dalti, Jere Daily Latrine Cleaning in El Miskin Daily Latrine Cleaning in Simari, Jere Muna garage: 60 community volunteers carried out general cleaning at zone 3 and 4 including household latrines. Muna garage: Distribution of soap to 60 community volunteers Construction of substructure of a three (3) blocks of five compartment latrines is ongoing in Muna Garage Escavation of pit of the construction of three (3) blocks of five compartment latrines completed in Muna Garage Ensured that six (6) blocks of 5 compartment latrines in Zone 2,3,4 and 6 were cleaned Cleaning of 8 blocks of five compartment latrines cleaned in Mona Monforo Identified locations and deployed contractor for 8 latrines blocks (40 stances) in Muna 47 blocks of latrines disinfected 2 times/day Rehabilitation of doors: 10 doors fixed. Hand washing stand: 50 4
RUWASSA/ BOSEPA RUWASSA/ BOSEPA /NEW SAN /NEW SAN /NEW SAN /NEW SAN Monitoring of 47 blocks of latrine is ongoing, monitoring garbage collectors is ongoing in 5 locations Dislodgement of toilets is currently going in the camp. Awareness on environmental cleanliness continues. Muna garage camp: 1 block of 5 latrines disinfected Muna Dalti : 4 block of 5 latrines disinfected and 2 households latrines disinfected Konan yobe : 1 households latrines was disinfected Custom House : all latrines (subzone A and B) are systematicaly disinfected 3 times per day Custom house: 35 blocks of 5 latrines disinfected after an alert of suspected case of cholera 122 compartments of latrines cleaned and disinfected in zones 1& 2 in Muna garage IDPs camp. 155 compartments were cleaned and disinfected at custom house IDPs camp. Construction of 1 latrines each at unicef clinic A and clinic B have been completed. Ongoing rehabilitation of latrines in Muna customs and Muna harun Alana IDPs camp. Hygiene Promotion / Kit distribution Muna Garage Camp: 18 Hygiene Promotion Volunteers and 1 Supervisor reached 390 Households through door to door sessions in Zone-1, 2 & 5 Muna Garage Camp Muna Garage Camp: 4,052 Hygiene Kits distributed to cover entire Muna Gare Camp population (Started on 27-Aug and completed on 10-Sep) Custom House 1 & 2 Camps: 10 Volunteers and 2 Supervisors conducted Door-to-door Hygiene Promotion in Custom House-1: 458 HHs covered Custom House 1 & 2 Camps: 15 Volunteers and 2 Supervisors conducted Door-to-door hygiene promotion and covered 542 HHs in Custom House-2 Camp Custom House 1 & 2 Camps: 1499 Hygiene Kits were distributed to cover 957 HHs in Custom house 1 and 542 HHs in Custom house - 2 Camp population (Started on 13 - Sep and completed on 14 - Sep) El-Miskin Centre Camp: 10 Volunteers and 2 Supervisors conducted door-to-door hygiene promotion in El-Miskin Centre Camp to cover 101 HHs. Muna Dalti: 249HH 1705 people reached for House to House cholera messaging ; 39 men were reached with cholera messaging using man to man session; 697 people wash their hands during the Handwashing Hour Exercise Custom House: 58 boys and 52 girls (110 children) reached with cholera messaging using Child to child session Muna Garage, Jere: All Zones- 197HH 1071 people reached for House to House cholera messaging in collaboration with RUWASSA; 138 female participated in the small group session discussing cholera; 210 HHs joined the Handwashing hour demonstration Musari Jere: 262HH 1747 people reached for House to House cholera messaging in Musari; 315HH reached CHolera Messaging ; 20 Youth participated in small group sesion for Cholera ; 210 Children joined the Handwashing exercise Benishiek, Kaga: 135HHs, 945 people reached Cholera Messaging; 145Children joined the Handwashing exercise; 641 HHs received Soap Kit (7 pcs. Bathing soap and 6pc. Laundry soap and 1 bucket, 20L) Gubio Town, Kaga: 250HHs, 1750 people reached Cholera Messaging 5
DRC DRC DRC Zone 8: 134HH through house to house hygiene promotion. Zone 9: 118HH through house to house hygiene promotion. 2,200 pcs of bar soap distributed during house to house campaigns. 10 hygiene promotion volunteers conducted door to door sensitization session covered 165 household in zone 3 and 4 in Muna garage 10 volunteers curried hygiene promotion at 12 tap stands at zone 2,3,4,6 and 7 in Muna garage 46 HH (270 people) reached for house to houes cholera sensitization messaging in Muna Monforo 6 hand washing stations filled with 0.05% chlorinated water for hand washing in zone 2,3 and 6 in Muna garage Distribution of 30,000 sachets of aqua tab of 33 mg for Kilagoro and Motor Park IDP camps is ongoing Conducted cholera awareness messaging to 25 households in Zone 5 of Muna IDP Camp Farm centre: 112 HH of 757 in person reached on awareness of critical time of hand washing: In Niger, Congo, Nile and Chad. RUWASSA of 282 Households with a population of 1069. RUWASSA Demonstration of proper handwashing was done in zone 8,9 and 7. RUWASSA Focus group discussion with women conducted in the above mentioned zones with women. RUWASSA Continue hygiene promotion in Kanuri in zone 8 and 7. - RUWASSA Muna Asheri : 8 Community Hygiene Promoters are targeting households in door to door sessions Goni Kachallari : 9 Community Hygiene Promoters are targeting households in door to door sessions Muna MSF : 10 cholera kits distributed to caretakers or discharged patients Muna garage: 1 Soap distributed to visited shelters/householders with suspected cases as soaps was not available during the visits. Muna dalti: 2 soaps distributed to visited shelters/householders with suspected cases as soaps was not available during the visits. Custom House: 6 soaps distributed to visited shelters/householders with suspected cases as soaps was not available during the visits. 1,069 people reached with key hygiene messages, dangers of cholera inclusive in zones 8,9,7. Dikwa WaSH Cholera Response Sitrep Spraying/disinfection Disinfection of 206 households in Bulabulin and Agic camp. Disinfection of 26 pit latrines in Agric and Bulabulin with 2% chlorine. Disinfection of 17 dislodge blocks of latrines in Sangaya Camp total of 85 pit latrines. Disinfection of 7 water points 3 in sangaya 4 Bulabulin and Agric camp. Disinfection of 3 stagnant water log Agricamp: 79 shelters disinfected Bulabulin: 109 shelters disinfected 6
20 houses: 1 house disinfected Sanitation Activities New Camp: Construction of 395 additional household latrine underway. Refilling of 13 hand washing points in Agric and Bulabulin with 0.05% chlorine. Identification of 9 dilapidated latrines and 9 bath rooms showers in Bulabulin and Agric camp together with contractor for rehabilitation. 100 latrines decontaminated in Kilagoro camp in Dikwa continues 16 compartments of latrines desludged in Kilagoro camp, Dikwa 70 bathing shelters decontaminated and cleaned in Kilagoro camp, Dikwa Bulabulin: 665 latrines disinfected (twice a day) Agricamp: 110 latrines disinfected (twice a day) Bulabulin & Agricamp: Selection of 10 sites for new latrines block construction Hygiene Promotion Dikwa 1,000 houses new camp: 10 NRC and 1000 community volunteers conducted hygiene promotional activities including household visits, hygiene campaigns, latrine cleaning, solid waste management and hygiene maintenance at water points. Dikwa Stadium camp: 5 NRCS Volunteers supported by 50 community volunteers carried out door to door hygiene campaigns, latrine cleaning, solid waste management and hygiene maintenance at water points. Batch chlorination at the water tank for water treatment. Bulabulin: 250 persons reached for HP, and active case finding to direct suspected case to FHI Agricamp: 232 persons reached and active case finding to direct suspected case to FHI 20 houses: 96 persons reached for HP and handwashing session (after 3 suspected cases alert in one of the house) Water Activities New Camp: Water supply increased from the current 50,000 liters per day to 75,000 liters Stadium and New Camp: Batch chlorination at the water tank for water treatment Chlorination of 1 water point in Mohammed Kyari. Trained 2 new wash staff and 3 Volunteers on determination of chlorine dose for water treatment at Mohammed kyari water point. Bulabulin (border with IOM shelters camp): 20 M3 of water distributed through water trucking Bulabulin: bucket chlorination at borehole 2 fetching point 20 houses: Bucket chlorination at Private vendors point Agricamp: borehole drilling under construction 7
Monguno WaSH Cholera Response Sitrep Hygiene Promotion / Kit distribution 100 stances of latrines were sprayed with chlorine in GGSS by AAH 250HHs sprayed with chlorine in GGSS by AAH 8,000 sachets of aqua tab distributed in NRC, waterboard, GDSS, GSSSS, Gajiganna, Birimari, Gassarwa. 850 pieces of soaps distributed in NRC, Water Board, GDSS, GSSSS, Gajiganna, Birimari & Gassarwa. 850 hygiene kits distributed in GDSS, NRC, GSSSS, Water board, Birimari and Gasarwa camp in Monguno by AAH. 9 NFI kit distributed in Dalafai to affected HHs 210 HH latrines and surrounding has been disinfected in Dalafi host community 81 hygiene promotion sessions in Monguno (GDSS, GSSSS, Waterboard, and NRC), Birimari and Gassarwa with 5950 people reached. Mongonu, GGSS camp: 3 NRC volunteers supported with 30 community volunteers conducting hygiene promotional activities. Mongonu, GSSS camp: 3 NRC volunteers supported with 12 community volunteers conducting hygiene promotional activities. Charamari camp: 2 NRC volunteers supported with 8 community volunteers conducting hygiene promotional activities. Cholera messaging to 46 households in Ganaali Host Comunity Kuya camp & GDSS camp : 1 community mobilizer and 9 hygiene promoters deployed for active prevention. 137 HH were reached through door to door approach and 15 focus group were conducted. GGSS camp: 1 community mobilizer and 20 hygiene promoters deployed for active case finding and awareness campaign. 440 HH GGSS: 18 hygiene kits distributed +HP messages to suspected case family at ALIMA Water Activities GSSS: Batch water chlorination at the underground tank. Water trucking 50,000 litres to Monguno Stadium IDP Camp Kuya Camp: Buckets chlorination at 3 waters points GDSS Camp: Buckets chlorination at 2 waters points Spraying/disinfection Sprayed 70 latrine stances in Monguno Stadium IDP Camp GGSS: 18 shelters and theirs environment disinfected : 1 community mobilizer and 2 prayers deployed at MSF 12 patients were traced to their houses from the, 2 HH in Gana Ali HC and 10 in GGSS. The 12 HH have been disinfected. Sanitation Activities 8
Kuya: 2 sprayers deployed- 178 latrines and 74 showers disinfected twice a day GDSS: 2 sprayers deployed- 65 latrines and 35 showers disinfected three times a day GGSS: 4 sprayers deployed- Latrines and Showers disinfection shared between SI and Annex 2: Logistic update presented on 14 Septembe DISTRIBUTION OF DRUGS AND OTHER HEALTH COMMODIES FOR BORNO CHOLERA RESPONSE S/ N O DESCRIPTION OF ITEM UNIT PACK MUNA MONGU NO DIKWA ALIMA STOCK BALANCE QUANTITY DATE QUANTITY DATE QUANTITY DATE QUANTITY DATE 1 PARACETAMOL 500MG OF 1000TABS 2 CIPROFLOXACIN 500MG TABS 1000 1 15/09/17 - - - - - - 7,493 10 20 15/09/17 - - - - - - 3,523 3 FACE MASK 50 28 15/09/17 - - - - - - 40 4 ARTEMETHER COMBINATION THERAPHY (ACT) 5 ERYTHROMYCINE 500MG TABS 24 20 15/09/17 - - - - - - 64,410 10 10 15/09/17 - - - - - - 3,020 6 RINGER LACTATE 20 30 15/09/17 - - - - - - 148 7 MICRO NURTRIENT 300 1 15/09/17 - - - - - - 1,448 9