*4.3.2. Chegutu cholera outbreak 2018*

Chegutu cholera outbreak is one of the most recent cholera outbreaks the country faced. This outbreak had the potential to escalate into a massive outbreak because of the prevailing water and sanitation situation in the town, the easy link between the town and the capital, Harare City, which also had worse water and sanitation situation and being a link between the two major cities of the country, Harare and Bulawayo. However because of the built in resilience anchoring on health worker capacity, availability of extension workers, swiftness of response by RRTs and coordination of response through the Civil Protection Committee at district level and IACCH at national level, the outbreak was controlled in 20 days with 106 cases and 4 deaths reported. It should be noted that the four deaths were the alert which occurred before the outbreak was detected.

On the 16th of January 2018, a report was made to the Chegutu District Medical Office of an increase in diarrhea cases at Chegutu Hospital in a male ward in which two cases had died. A follow up visit was made to the male ward and revealed that there were three male cases presenting with watery diarrhea and vomiting. Two deaths had occurred and a stool specimen had been collected from one of the deceased patients and sent to hospital laboratory for culture. The result was received on the 19th of January 2018 confirming *Vibrio cholerae*. The national office was immediately notified on the 19th of January 2018 who also notified WHO on the 22nd of January.

Subsequent investigations revealed that all cases and deaths were associated with a funeral which had occurred in Pfupajena Township of Chegutu on the 8th of January 2018. A visit made to the given address revealed that the deceased (index case) had reported for treatment suffering from diarrhea and vomiting at a local private clinic before her death on the same day. The daughter to the index case also reported for treatment at Chegutu hospital on the 9th of January 2018 where she was admitted and discharged on the 11th. A stool specimen was collected and the results were negative.

It was further established that there was a funeral which occurred on the 29th of December 2017 in the same neighborhood which was attended by two relatives from Zambia (Zambia was at the time experiencing a cholera outbreak). Among those who attended the funeral were members of a religious group who later visited the index case. It is highly possible that the source of infection could have been from those who came from Zambia who could have been healthy carriers.

On notification of the national office, the Minister of Health and Child Care immediately visited the area together with members of the National RRT to assess the situation and advise on the correct course of action in support of actions that had already started. Isolation of patients requiring hospitalization and appropriate rehydration, infection prevention and control in the hospital, safe and dignified burials, water quality monitoring and health promotion activities were already ongoing.

A follow up visit by the Minister of Health and Child Care was on the 20th of January, teaming up with the local member of parliament and a minister colleague in the president's office, in the company of the WHO Officer In Charge, to provide further support to teams on the ground and assess the evolution of the outbreak. On the 20th of January, the National RRT together with the District RRT worked together with the Civil Protection Committee, chaired by the District Administrator and allocated tasks to teams on the following thematic areas: (i) Coordination, (ii) logistics, (iii) Case management and surveillance, (iv) Health and hygiene promotion (v) Water, Sanitation and hygiene. The teams became immediately operational with coordination meetings taking place twice a day at district level. Community members were trained to participate in contact tracing. A treatment camp was set up to receive patients for diagnosis and treatment. Food premises were inspected and those not meeting minimum health requirements closed. Water quality monitoring was carried out and samples taken for testing.

At National level the IACCH started coordination meetings on a weekly basis with the National RRT having daily coordination meetings. A cholera preparedness and response plan was developed and used to guide the response. Gaps in the response were identified and filled by the donor community, UN, NGOs and the private sector.
