Efforts to curb cholera outbreaks | WHO

Lusaka – One night, Lusaka resident Samuel Zambo suddenly slipped into a disturbing, dream-like state of unconsciousness. When he woke up the next morning, he found himself fighting for his life in a cholera treatment centre, with no memory of anything that had happened in the previous 12 hours.

“I had no idea where I was, there were people all around me in beds,” he says. In fact, Zambo was in a sports stadium that the Zambian Ministry of Health had converted into a state-of-the-art cholera treatment “When the doctor told me I was at the National Heroes Stadium, I couldn't understand why I was in a place where a football match was being played,” he recalls.

Like tens of thousands of his fellow Zambians, he was infected with cholera, an acute and highly virulent infection, during the worst outbreak in the country's recent history. He says his life was saved by the quick response of his family, who rushed him to a treatment centre, and the excellent care he received from health workers.

“When I met my wife, I was so happy that we both made it through this ordeal.” Cholera survivor Samuel Zambo

The outbreak peaked in January 2024, with Lusaka as its epicenter. Between 15 October 2023 and 23 July 2024, Zambia recorded a cumulative total of 23,382 cases and 740 deaths. No new cases have been reported since 11 July 2024. This is a stark change from January, when a 24-hour average of 461 new cases was recorded.

The government's multifaceted response, supported by the World Health Organization (WHO) and other partners, included surveillance, infection prevention and control, case management, testing, community engagement, and improved water, sanitation, and hygiene services to contain the outbreak. WHO deployed 23 international experts to provide technical assistance to each of these response areas, and they trained more than 800 health workers.

WHO has provided 25 tonnes of medical supplies and equipment, including cholera kits, and refurbished seven community-based cholera treatment centres in Chilanga, Chipata, George and Matero districts of Lusaka, and Chipepo, Namoomba and Lumbembe areas of Southern Province. WHO has also provided infection prevention, water, sanitation and hygiene supplies to two other treatment centres.

“We have learned many lessons and will use them to guide our future response,” said Dr. Karima Nawa, clinical manager at Heroes Cholera Treatment Centre.

WHO, in collaboration with Gavi, the Vaccine Alliance, UNICEF and others, has distributed 4.1 million doses of cholera vaccine over two rounds in the hardest-hit areas to immunize at-risk people and stop the epidemic.

“We've learned a lot of lessons, and we hope to use them to guide our future responses,” said Dr. Karima Nawa, who served as clinical manager at Heroes Cholera Treatment Center until it closed in late February 2024. “So ultimately, we hope to be able to use what we've learned here to be able to have a sustainable and rapid response to future outbreaks, not just cholera outbreaks, but other responses as well.”

Early detection and reporting at the community level were key response measures to the outbreak, with active case-finding teams visiting households to confirm cases and ensure early referral to health facilities, thus limiting further spread. WHO provided tools and support for data analysis and interpretation through its Integrated Disease Surveillance and Response Platform.

“WHO plays a key role in Zambia's surveillance system, not only for this cholera outbreak but also for other outbreaks occurring in the country,” said Dr Kapina Muzala, Surveillance Chief at the Zambia National Public Health Institute.

While the outbreak is under control, WHO continues to support the country's health emergency preparedness and response capacity. WHO, in partnership with UNICEF and the European Union, is providing funding until August 2024 to close resource gaps in the cholera response plan, increase oral rehydration points, improve existing referral systems, implement the regional integrated cholera response plan, and procure critical cholera response supplies as part of preparedness for the next cholera season starting in October 2024.

An internal cholera response review conducted in April 2024 found gaps in safety of cholera response supplies and adequate emergency response capabilities.

“The collaborative effort that was able to contain the worst of the outbreak within a few months demonstrates the value of coordinated and coordinated action,” said Dr Nathan Bakyaitha, WHO Representative in Zambia. “We must continue to work together to ensure that lessons learned from this outbreak response strengthen the country's emergency preparedness.”

Zambo's wife, Joyce, also contracted cholera and was treated at a local cholera treatment facility in nearby Kalingalinga while Zambo recuperated at Heroes. The couple were reunited a week later. “When I saw my wife, I felt so happy that we both made it through this ordeal,” Zambo said. Now, the family follows strict guidelines to stay safe from the disease, including boiling household water and washing their hands regularly.