RE: MULTI-COUNTY CHOLERA OUTBREAK ALERT

The Ministry of Health has confirmed a cholera outbreak in six counties namely; Kiambu (31), Nairobi (17), Murang’a (1), Kajiado (2), Nakuru (2) and Uasin Gishu (8) following a wedding festival that was held in Kiambu County.

Of the sixty-one (61) cases so far, thirteen (13) are currently hospitalized, eight (8) have been discharged while forty (40) were treated as outpatients.

The National Public Health Microbiology Laboratory has isolated Vibrio cholera-01-Ogawa as the responsible serotype.

In response to this, the Division of Disease Surveillance and Response (DDSR), Field Epidemiology and Laboratory Program (FELTP) and the County Departments of Health of the affected counties have commenced response activities including field investigations, enhanced surveillance, laboratory testing, case management, risk communication, community engagement and environmental sanitation to prevent further spread of the disease and manage the outbreak.

Noteworthy, the ongoing drought situation in the country may worsen the outbreak; it is therefore the Ministry’s decision to put all counties on high alert for possible cholera outbreaks.

Pursuant to the Health Act 2017, clause 17 on the mandate of the Office of the Director General the Ministry of Health, all County and Sub-County Health Management Teams under the County Directors of Health are directed to immediately;

• Notify all the health workers of this alert
• Watch out for patients presenting with watery diarrhea of acute onset
• Conduct active search for acute watery diarrhoea in health facilities and within the communities for missed/unreported cases

• Strengthen surveillance activities up to the village level and ensure 100% case-based reporting
• Strengthen the involvement of laboratory personnel in disease surveillance for timely confirmation
• Ensure that all health workers are conversant with the case definition and are sensitized on potential Cholera outbreak.
• Step up weekly IDSR reporting to ensure that over 90% of facilities are reporting
• Enhance sharing of information between sub-counties  
• Conduct support supervision on a more regular basis
• Re-activate the outbreak management teams at all levels
• Improve laboratory capacity for specimen collection and shipment

• Enhance involvement of other stakeholders such as county and subcounty commissioners, communities, the water agencies and other partners in surveillance and advocacy activities
• Carry out cholera risk analysis for all areas in the sub-county and take appropriate preventive actions
• Strengthen case management of cases at sub-county and health facility level, so that incase of any suspected or confirmed case they are managed at source without referring to other facilities and this will prevent morbidity and mortality. These include having buffer stocks of ORS, IV fluids and antibiotics
• Develop an appropriate preparedness and response plan for the subcounty to prevent propagation of any potential outbreak and plan for sustained contact tracing
• Ensure isolation of cholera cases if admitted in the wards
• Strengthen community sensitization on safe water practices, use of latrines and prompt treatment for diarrhea cases

You are further requested to relay the aforementioned directives for immediate and strict execution, as well as to cascade the same and the attached cholera fact sheet to all officers serving under you, for wider circulation.

Dr. Patrick Amoth, EBS
Aq. DIRECTOR GENERAL FOR HEALTH

RE: MULTI-COUNTY CHOLERA OUTBREAK ALERT

The Ministry of Health has confirmed a cholera outbreak in six counties namely; Kiambu (31), Nairobi (17), Murang’a (1), Kajiado (2), Nakuru (2) and Uasin Gishu (8) following a wedding festival that was held in Kiambu County.

Of the sixty-one (61) cases so far, thirteen (13) are currently hospitalized, eight (8) have been discharged while forty (40) were treated as outpatients.

The National Public Health Microbiology Laboratory has isolated Vibrio cholera-01-Ogawa as the responsible serotype.

In response to this, the Division of Disease Surveillance and Response (DDSR), Field Epidemiology and Laboratory Program (FELTP) and the County Departments of Health of the affected counties have commenced response activities including field investigations, enhanced surveillance, laboratory testing, case management, risk communication, community engagement and environmental sanitation to prevent further spread of the disease and manage the outbreak.

Noteworthy, the ongoing drought situation in the country may worsen the outbreak; it is therefore the Ministry’s decision to put all counties on high alert for possible cholera outbreaks.

Pursuant to the Health Act 2017, clause 17 on the mandate of the Office of the Director General the Ministry of Health, all County and Sub-County Health Management Teams under the County Directors of Health are directed to immediately;

• Notify all the health workers of this alert
• Watch out for patients presenting with watery diarrhea of acute onset
• Conduct active search for acute watery diarrhoea in health facilities and within the communities for missed/unreported cases

• Strengthen surveillance activities up to the village level and ensure 100% case-based reporting
• Strengthen the involvement of laboratory personnel in disease surveillance for timely confirmation
• Ensure that all health workers are conversant with the case definition and are sensitized on potential Cholera outbreak.
• Step up weekly IDSR reporting to ensure that over 90% of facilities are reporting
• Enhance sharing of information between sub-counties  
• Conduct support supervision on a more regular basis
• Re-activate the outbreak management teams at all levels
• Improve laboratory capacity for specimen collection and shipment

• Enhance involvement of other stakeholders such as county and subcounty commissioners, communities, the water agencies and other partners in surveillance and advocacy activities
• Carry out cholera risk analysis for all areas in the sub-county and take appropriate preventive actions
• Strengthen case management of cases at sub-county and health facility level, so that incase of any suspected or confirmed case they are managed at source without referring to other facilities and this will prevent morbidity and mortality. These include having buffer stocks of ORS, IV fluids and antibiotics
• Develop an appropriate preparedness and response plan for the subcounty to prevent propagation of any potential outbreak and plan for sustained contact tracing
• Ensure isolation of cholera cases if admitted in the wards
• Strengthen community sensitization on safe water practices, use of latrines and prompt treatment for diarrhea cases

You are further requested to relay the aforementioned directives for immediate and strict execution, as well as to cascade the same and the attached cholera fact sheet to all officers serving under you, for wider circulation.

Dr. Patrick Amoth, EBS
Aq. DIRECTOR GENERAL FOR HEALTH