1. CHOLERA PREVENTION AND CONTROL CME PRESENTATION 4/2/16 By Dr. Pastory Mondea

2. Strategies for Cholera Prevention and Control Substantial efforts to contain cholera by focusing on responses to outbreaks are often made, but far more than prompt medical treatment of cases are required -interplay between prevention, preparedness, response, and surveillance system

3. Prevention – everyone/sector is involved! Involvement of different stakeholders including community members

4. Why is it important to involve community members and othe stakeholders? The core elements of cholera prevention are community involvement, open and transparent sharing of information, and policy dialogue Proper education about spread of cholera and prevention to the community gives power of greater control of epidemics, Correct misinformation and myths. Community/social Mobilization - Working through social networks, Encouraging people to take action to prevent cholera, Supporting behavior changes, etc Each stakeholder has a role to play based on working thematic area e.g. water, engineering, communication

5. Preparedness Effective and efficient surveillance system to warn cholera outbreak Laboratory Capability to get case confirmation Training and health education Maintain a reserve stock of essential equipment, supplies and financial resources Organize Cholera Epidemic Committees

6. Organization of Cholera Epidemic Committees Multi-sectoral Approach National Cholera Epidemic Committee Regional Cholera Epidemic Committee Council Cholera Epidemic Committee Subcommittees – Surveillance, WASH, Social mobilization, laboratory services, logistics

7. Members of National Cholera Epidemic Committees DPS – Chairperson Asst Director Epid and Disease Control Section - Secretary Director of Curative Services Asst Director, Emergency Preparedness and Response Section Chief Pharmacist Asst Director Environmental health and Sanitation Section Asst Director,Health Promotion and Education Section Head of National School Health Programme Representative from Ministry of water, and land Representative from NGOs- WASH projects Representatives of development partners- UNCEF, WHO, Red Cross, PSI, etc. - Roles: To formulate policy, guidelines and national plans for the control of epidemic outbreaks

8. Members of Regional Cholera Epidemic Committee  RMO - Chairperson  RHO-Secretary  RNO   RLT   Regional Pharmacist  Regional Epidemiologist   Regional Water Engineer   Regional Logistic Officer   Regional Social Welfare Officer   Other related members according to the magnitude of the outbrea k - Roles: To interpret and disseminate policy, guidelines and national plans for the control of cholera outbreaks; plan preparedness, training, coordination, prepare educational messages, etc

9. Members of the Council Cholera Epidemic Committee  DMO - Chairperson   DHO-Secretary   DNO   DLT   District Pharmacist   District Epidemiologist   District Water Engineer   District Logistic Officer   District Social Welfare Officer   Other related members according to the magnitude of the outbreak 

10. Roles and responsibilities of CCEC i.To implement policy, guidelines and national plans for the control of epidemic outbreaks ii.To ensure that there are enough medical and non medical supplies iii.To develop plan for cholera preparedness and management iv.To solicit and coordinate assistance from development partners. v.To prepare educational messages vi.To train health care workers on controlling epidemics

11. Ways you can use to prevent cholera Cholera prevention and control require:  access to safe water, adequate sanitation, adequate food safety, an appropriate level of personal hygiene and cholera vaccine Drink and use safe water- Bottled water with unbroken seal, boiled water, water treated with chlorine product or household bleach to kill cholera bacteria in contaminated water - use chlorine, water guard, aquatab, PUR, Dlo Lavi, etc

12. Safe Water Preparation – use of PUR

13. Safe Water Preparation- Use of Water Guard

14. Safe Water Preparation- Use of Aqua tabs

17. Recommendations for Water Storage Recommendations for Storage o Safe storage is important after water has been made safe to drink and use o Clean, covered storage containers protect the water and keep it safe to drink o Must be closed with a tight container o Should have a tap or small opening that prevents dipping hands, cups, utensils into water

18. Ways you can use to prevent cholera Wash hands with soap and safe water - Before eating or preparing food, before feeding children, after using latrine, after cleaning child’s bottom, after taking care of individual with diarrheal illness

19. Ways you can use to prevent cholera

20. Use latrines or other recommended sanitation systems to dispose stool (e.g. chemical toilets); Bury stool at least 30 meters away from body of water

21. Food Safety Proper handling, cooking, and storage of food can prevent spread of cholera o Clean kitchens and other washing areas with chlorine or bleach solutions o Wash hands often with soap and safe water when preparing food o Use safe water for food preparation and cooking o Cook food thoroughly (especially fish, shellfish, and vegetables) o Clean and peel raw fruits and vegetables

22. Food Safety o Eat cooked food hot o Store cooked food in covered containers o Reheat cooked food until hot all the way through o Clean cooking areas and kitchenware with soap and safe water o Only eat food you have cooked or comes from trusted sources

23. Cholera Vaccines 2 oral vaccines available (approved by WHO) – Dukoral – ShanChol Help to promote immunity to defend against cholera illness Does not provide complete protection Multiple doses required Should not replace standard precautions and preventive measures Consider before an outbreak especially in endemic communities

24. Safe Sanitation and Cleaning - Funerals Balance between preventing more disease with minimum distress to a community Engage community leaders – Ensure acceptance – Understand cultural restrictions After Death in the Home o When a person with cholera dies, the body releases fluid that can contain cholera bacteria o Special care must be taken to prepare the body for burial

25. Home Burial Preparation o Consider cancelling funeral feasts o If cancellation is not possible, ensure those who prepare the body do not prepare the food o Thorough handwashing and hygienic practices for all involved o Wash the body with a solution that is 1:10 part bleach to water o Fill the mouth and anus with cotton that has been soaked in a solution that is 1:10 part bleach to water o Do not empty intestines o Put body in bag to prevent fluids from leaking o Clean all of the deceased person’s clothing and bedding (see slide 115: Safe Cleaning) o Clean any surfaces the body touched with a solution that is 1:10 part bleach water

26. Cholera Prevention – what you don’t need Mass antibiotic prophylaxis Excessive personal protective gear Travel and trade restrictions - quarantine

27. Challenges of Cholera Outbreak in Mwanza Region Persistence of cholera outbreak since Sept 2015- to date average bed state of 18 pts Affected population – fishing centers, fishermen, islands Small latrine coverage Unsafe water Difficult to change behaviour – traditional belief, misconception

28. Strategies Applied to overcome challenges Health education to community members Training of health providers Establishment of CTC Establishment of isolation units at H/F Mobilization for toilet construction Supply of chlorine products for water decontamination

29. Strategies to overcome challenges Cholera epidemic committees formed- multisectoral Treating public water supply to kill microbes Laboratory investigation to confirm cholera cases Taking water sample laboratory investigation Establishment of cholera outbreak committees

30. ROLES OF BMC IN FIGHTING AGAINST CHOLERA OUTBREAK BMC has technical roles to play in Lake Zone BMC is a member of ones of cholera outbreak committees – case management, social mobilization, and surveillance Laboratory services Two teams went Ilemela and Sengerema District Councils to make campaign on prevention and control cholera Training Provision of other technical advices

31. Thanks for listening Questions? Comments?