Sierra Leone is in the midst of its worst cholera outbreak in 15 years. As of 19 September, there were more than 19 000 cases reported and 274 deaths. WHO and the Ministry of Health and Sanitation have established a cholera control and command centre to coordinate the response to what has turned into a national emergency.
When reports of suspected cholera cases first came into Sierra Leone’s Ministry of Health and Sanitation in February, alarm bells sounded. Cholera outbreaks normally occur in the rainy season. But February is the middle of the dry season, and more than 2000 cases had already been reported from three districts.
WHO’s Representative in Sierra Leone, Dr Wondimagegnehu Alemu reacted immediately, assigning seven staff members from his office to work with the government and other health sector partners on the response.
The first challenge was to confirm that the outbreak was indeed cholera. And this was not easy.
“In the beginning, we had reports of cases of acute diarrhoea and vomiting in a significant number of people aged more than five years,” said Dr Alemu. “This prompted further investigation but unfortunately there is very little laboratory capacity and the disease reporting system is weak in this country.”
Detection, treatment and prevention
In the early stages of the outbreak, WHO worked with the Ministry of Health and Sanitation and partners including UNICEF and Médecins Sans Frontières-Belgium to detect and confirm new cases, train health workers in cholera treatment and prevention and send medical supplies to support specially established cholera treatment units. By mid-June, cases began to decrease to fewer than 40 per week.
In late June, however, it began to rain. The epidemic spread rapidly to other districts and the number of cases reported rose to more than 2000 per week in early August. More than half of all cases were in the Western Area where the capital Freetown is located.
A cholera command and control centre
On 16 August, President Koroma declared the situation a “public health emergency”. Ten days later, the Ministry of Health established, with WHO support, a Cholera Command and Control Centre.
Building on experience from the 2008 cholera outbreak in Zimbabwe, the centre coordinates the response among the many health partners involved in the relief effort. The Minister of Health and WHO co-chair daily meetings at WHO’s office in Freetown at which the partners discuss the day’s case numbers and other information to plan activities.
WHO has brought in experts in epidemiology, surveillance, logistics, social mobilization, water and sanitation from other WHO country offices, from the regional office in Brazzaville and headquarters. Using WHO’s Global Outbreak and Response Network, which brings together an international pool of expertise, three cholera experts have been sent from the International Centre for Diarrhoeal Disease Research, Bangladesh.
These experts have been training health workers and laboratory scientists to improve the country’s capacity to manage cholera patients and perform reliable laboratory testing.