Table 1 Summary of country situation update as reported by country representatives
Thematic/Country | Bangladesh | Cambodia | India | Indonesia |
Epidemiology | Endemic, and seasonal outbreaks CFR 25 to 50% without treatment and 1% with treatment | Not cholera endemic, sporadic cases in 18 provinces. CFR <1% but higher in hard to reach villages | Endemic with an estimated 834,00 cholera cases and 25,000 deaths every year Several states do not report any cholera cases potentially due to limited surveillance system | Low endemic. No outbreaks since 2011 Incidence of diarrheal diseases for all age population is 350/1000 population and 670/ 1000 children < 5 years old |
WASH | Lack of water pipe | Data not available | Open defecation with limited availability of safe drinking water supply mainly in rural area Sharing sanitation facilities with other households | Practice of healthy and hygienic behavior by only 38.7% Open defecation practiced by 9.4% population (2.5 millions), 10.9% use unsafe water, 7.3% drinks uncooked water |
OCV vaccination | OCV included in national plan for at risk groups. Technology transfer for vaccine development in country Locally produced Vaccine (Cholvax) will be implemented | None | Vaccine introduction study done in Odisha state OCV vaccine is not part of the EPI program | None |
Surveillance/Diagnostic | Hospital based surveillance at 2% Nationwide surveillance on- going at 21 sites | Event based surveillance, laboratory confirmed (CamEWARN) Surveillance of Acute Watery Diarrhea through CAM EWARN Reporting of laboratory confirmed cholera cases to CDC Dept Outbreak investigations | Weekly surveillance system in all regions Guidelines and SOP for early case detection Global positioning system & Google Earth in the investigation cholera outbreak. Continuous laboratory surveillance of ADD in all districts Visit of collector to affected sites for monitoring quick action | |
Advocacy | Advocacy meeting: January 2017 | Communications (TV and radio spots, posters, flyers) Community mobilization | Sensitization of PRI members, local PHC staff, ASHA, AWW and community Other modes of community mobilization such as interpersonal Communication by door-to-door visit | |
Challenges | Licensure and funding for locally produced vaccine (Cholvax) deployment, with WHO pre-qualification Inadequate coverage of the surveillance system | Under-reporting of surveillance systems | Marginalized rural and tribal populations Poor availability of safe drinking water supply Inadequate ownership of programs Poor local health infrastructure Inadequate priority setting mechanisms Long incubation periods for research programs Introduction of OCV | Under-reporting Lack of RDT |
Thematic/Country | Malaysia | Nepal | Pakistan | |
Epidemiology | Not Endemic except in Sabah region Incidence rate <1 per 100,000 populations and CFR <1% in recent years Malaysian: Foreigners incidence rate = 80:20. Cycle pick every 3 years | Endemic, frequent outbreaks mainly during rainy season 5042 ADD cases and 169 laboratory confirmed Cholera cases reported mainly from Kathmandu valley (150/169). No deaths occurred. | Endemic 4-6 episodes of diarrhea per child per year < 5 year Under five deaths per year from Diarrhea: 13.2% | |
WASH | Scarce safe water supply in some areas Unresolved environmental issues – excreta, solid waste Poor hygiene & food sanitation with cross border crossing and illegal coastal and urban settlements | Suboptimal WASH status Basic Water Supply coverage: 83.59%, Sanitation: 87.17%. Hand-washing: 72.5% | 16M do not have access to clean drinking water 27% consume tap water, 86% have access to improved water source, 73% have access to sanitation facilities 13% no toilet facility | |
OCV vaccination | Vaccine and antimicrobial prophylaxis OCV not in EPI but available in the private health facilities Oral prophylaxis for close contacts and food handlers | Reactive OCV Vaccination in Rautahat district in 2014. Preventive OCV vaccination campaign in Nuwakot and Dhading in 2015 and in Banke district in 2016 | OCV not registered | |
Surveillance/diagnostic | Mandatory web based within 24-hour notification National guidelines and laboratory diagnostic capacity in all laboratories Regulatory Infrastructure | Cholera is an EWARS reportable disease. Clinical cases reported monthly from health facilities through existing HMIS system. Cholera Surveillance embedded in the existing AMR sentinel surveillance system using 18 sites. Comprehensive Targeted Interventions (CTI) to Control Cholera in Kathmandu Valley in Kathmandu valley in 2016 | Facility based surveillance system in place in the province of Punjab since 2011(which has 60% of the population of Pakistan limited laboratory capacity Passive case- based surveillance from large hospitals of major cities, and WHO EMRO Documents and reports of NGOs working in disaster situations | |
Advocacy | Political commitment, interagency collaboration and coordination Legal approach for child education, case notification and management, food sanitation Subsidy for the poor (rural and urban) Ensure accessibility to affordable healthcare and education Free treatment and quarantine leave for working parents Restructure settlements with affordable homes Hygiene Promotion, community engagement, Social Mobilization campaign adapted to local culture | Door to Door Awareness Campaign. Community Level Intervention: Booth Campaigns – Strategic Locations -Awareness rallies -Miking (In mobile vehicle and also during rallies) -Awareness sessions to community groups and key community actors -Food and food outlet inspection- Food authority and Municipality -Mass communication by various media and special programs -Schools reached to educate and use children on Cholera and prevention | ||
Challenges | Cross border crossing Illegal coastal and urban poor settlements Poverty, illiteracy and language barrier Inadequate financial investment for WASH | Identify risk groups and target mass vaccination by strengthening surveillance. Need to give high priority to improve WASH status. Enhance collaboration and coordination. Advocacy needed to introduce the OCV vaccination Endorse Cholera Prevention and Response National Road Map | Recurrent humanitarian emergencies Weak surveillance system and underreporting Limited laboratory capacity Under resources of the public health control activities Poor water and sanitation condition in conflict affected countries Lack of cross border collaboration between the neighboring countries | |
Thematic/Country | Philippines | Thailand | Vietnam | |
Epidemiology | 14,592 diarrheal and 96 deaths cases in 2016 124 (0.85%) were laboratory confirmed cholera No deaths. | Incidence significantly decreased in the past decades while outbreaks occasionally occurred: 4 outbreaks since 2017 125 cases in 2015 Main transmitters: Employees of the seafood industry, Migrant population No cholera outbreaks post-flood disasters in recent years | No Cholera since 2012 | |
WASH | Zero Open Defecation Program. Environmental Health Program: WASH, Regional Sanitary Engineers, Local Sanitary Inspectors | 100% toilets at all houses Sewage management Chlorinated tap water and/or bottle water | Health education Clean water supplies and Environment sanitation Food hygiene and safety | |
OCV vaccination | OCV in a special setting, population in the temporary shelter at Thai-Myanmar Border | Local vaccine production NRA approved by QWHO; Vaccination deployed in 16 provinces with high incidence and for high risk areas and populations | ||
Surveillance/diagnostic | Event-based Surveillance Epidemiology Bureau of the DOH, Program Manager Regional Epidemiology & Surveillance Units Regional Program Coordinators Collection of human (rectal swab, stool) and environmental (water) samples. Laboratory testing of water samples thru the use of Colilert machine. Records review and active case finding Random inspection of water refilling stations Continuous surveillance of diarrhea cases Food & Water-borne Program. Regional Sanitary Engineers Local Sanitary Inspectors | Hospital-based surveillance system – Early detection of suspected cholera cases – Laboratory confirmation • Timely and proper management of patients • Prompt investigation and control by the trained Surveillance and rapid response teams (SRRTs). Improving Sanitation and Chlorination of Water Supply 12 Regional Laboratory Centers of department of Medical Sciences. Water and Food samples with 1% APW | National guidelines for cholera diagnosis, treatment, surveillance, response, control and prevention Testing in dog slaughter houses and restaurants Mobile teams for early detection and investigation of outbreaks Urgent reporting to higher level of health care system Close collaboration between treatment and preventive systems in reporting, specimen collection, and sharing specimen Laboratory testing at national and regional Level At district level: Specimen collection, storage and transportation; Microscope examination, Gram staining, Testing of water, fresh vegetables in restaurants and markets | |
Advocacy | The Department of Health (DOH) recognized the distinctive link between sanitation and better health, need for a new vision in sanitation, expressed in clearer policy and action programs | Enhance the leadership of political system and of Local Steering Committee on cholera prevention and control Mobilize whole political system in cholera prevention and control. Close collaboration between related sectors on food hygiene and safety, clean water supply and environmental sanitation, education, information, transportation | ||
Challenges | Continuing improvement of sanitation and safe water Limited vaccination. Varying capacity in diagnosis and treatment. | Maintaining and improving the clean water supply and environment sanitation program. Strengthen collaboration among neighboring countries on sharing information and cholera control | ||