**4. The outbreak of cholera**

A high number of cases of cholera were reported in April 2019, after the catastrophic disasters caused by Cyclone Idai in the center of Mozambique. About 4979 cases of cholera and six deaths were confirmed in emergency clinics created by the government of Mozambique aided by NGOs and other institutions [12], but until May the number of cumulative cases increased to 6766 and 8 deaths, according to the Health Cluster of Mozambique. Flooding and house destruction forced 68,974 displaced people living in accommodation places, making some places overcrowded, and increasing the risk of spreading cholera among the people there [1, 21].

The symptoms of cholera vary depending on the period of the infection. Between 18 h and 5 days, it is characterized by incubation period, followed by profuse watery diarrhea, rice-water stools, fishy odor to stools, vomiting, rapid heart rate, loss of skin elasticity, dry mucous membranes, and low blood pressure [24]. Most people are asymptomatic, but they remain carriers of the disease, excreting the bacteria in their faces, usually for 2 weeks but occasionally for several years. Approximately 2.8 million cases and 91,000 related deaths are reported annually, and the spreading of this disease included insufficient access to clean water, reduction of immunity, and taking of antacids [25].

Without the access of clean water and sanitary facilities, thousands of families were at risk of cholera mainly children because they used to play in dirty water which were strewn bodies of humans and animals, and women, during the menstruation period, sometimes needed to clean their bodies and only untreated water were available [8, 16]. In the beginning, the destruction of road and infrastructure corridor that connected Sofala to other parts, it was very difficult to help those people with water, food medical, and relief supplies, forcing the use of helicopters, rescue planes, boats, and ships [1, 3].

According to the Oxford Committee for Famine Relief (OXFAM), the Mozambican government worked quickly to set up cholera treatment centers in the city of Beira [22]. Supported by the WHO and funded by the GAVI (the Vaccine Alliance), more than 800,000 doses of oral cholera vaccines had been distributed in just 6 days, from 3 to 9 April 2019, since a vaccination campaign has launched. Fixed points were created to administrate vaccines to children and adults on schools and health center and on districts of Beira, Dondo, Nhamatanda, and Buzi [26]. It resulted in a decrease of the daily reporting number of cholera cases [1, 3, 14], with a cost of US\$1.85 per dose [27]. They also provided supplies to purify their drinking water and stop to spread the cholera [4], but the sanitization of drinking water can be achieved through boiling, and all food must be well cooked and consumed immediately [8]. After the humanitarian response plan had been created to respond the outbreaks across the globe, millions of doses of oral cholera vaccine have already been shipped in many countries [26].
