The NCDC boss stressed the need for the country to embrace the use of vaccines and other preventive measures to curb the spread of the acute diarrhoeal infection.

Cholera is a food and water-borne disease caused by the ingestion of the bacterium, Vibrio cholerae, in contaminated water and food.

No fewer than 4,364 people have died out of the 139,730 Nigerians suspected to have been infected with the disease across the country in the last four years, an investigation by Saturday PUNCH has indicated. The incidence rate was derived from an analysis of the weekly cholera situation reports released by the Nigeria Centre for Disease Control between 2021 and 2024.

Recall that the NCDC recently alerted the public to the increasing trend of cholera cases across the country as the rainy season intensifies. In a statement signed by Idris on Thursday, June 13, 2024, the agency said that from January 1 to June 11, 2024, a total of 1,141 suspected cases, 65 confirmed cases, and 30 deaths from cholera had been reported from 96 local government areas in 30 states of the federation.

The NCDC listed the 10 states that contributed 90 per cent to the burden of cholera as Bayelsa, Zamfara, Abia, Cross River, Bauchi, Delta, Katsina, Imo, Nasarawa, and Lagos. As of then, the Lagos State Ministry of Health said it had recorded 350 suspected cases of the disease in 29 wards across multiple LGAs with 17 confirmed cases and 15 fatalities attributed to severe dehydration caused by delayed presentation.

However, on Friday, the state Commissioner for Health, Prof Akin Abayomi, said the cholera incidence rate in the state had risen to 417 suspected cases, and 35 confirmed cases, with 24 deaths.

In a post made on his Instagram handle on Friday afternoon, Abayomi said, “The situation report as of June 19, 2024, indicated 417 suspected cases, 35 confirmed cases, and 24 recorded deaths.”

“Let’s adhere strictly to personal and environmental hygiene. Let’s stay safe #ForAGreaterLagos.”

He said the cases were reported from the Agege, Badagry, Ikeja, Mushin, Ajeromi-Ifelodun, Epe, Ikorodu, Ojo, Alimosho, and Eti-Osa areas of the state.

Others he mentioned include Kosofe, Oshodi-Isolo, Amuwo-Odofin, Ibeju-Lekki, Lagos Island, Shomolu, Apapa, Ifako-Ijaiye, Lagos Mainland, and Surulere.

Also, the Ogun State Commissioner for Health, Dr Tomi Coker, told our correspondent on Thursday that the state had recorded one death and 14 cases.

This implies that in the last 12 days, the incidence rate of the disease in the country for this year had hit 1,222 suspected cases, 88 confirmed cases, and 40 fatalities.

The NCDC, however, stated that a multi-sectoral National Cholera Technical Working Group, led by the centre and comprising the Federal Ministries of Environment and Water Resources, the National Primary Health Care Development Agency, the World Health Organisation, the United Nations Children’s Fund, and other partners, had been providing support to the affected states.

With the latest incidence rate from Ogun and Lagos, investigations by Saturday PUNCH showed that a total of 4,364 deaths had been recorded out of the 139,730 people suspected to have been infected by the disease across the country since 2021.

Going by one of the NCDC’s cholera situation reports for week 52, there were a total of 111,062 suspected cases of the disease with 3,604 deaths across 435 local government areas in 34 states of the federation in 2021.

Another Cholera Week 52 report published by the NCDC and analysed by our correspondent revealed that in 2022, the country recorded 23,763 suspected cases with 592 deaths across 271 LGs in 33 states of the federation.

In 2023, there was a reduction in the incidence rate of the disease as the country recorded 3,683 suspected cases with 128 deaths across 166 LGs in 31 states of the country.

The prevalence rate of the disease further went down in 2024 with 1,141 suspected cases and 30 deaths recorded across 84 LGs in 30 states of the federation.

The new cases brought the nation’s confirmed COVID-19 infections to 266,665.

According to the agency, four cases were recorded in Rivers State and one case was recorded in Lagos State, from March 25 to March 31, 2023.

It noted that Abia, Kaduna, Kano and Nasarawa states reported no case.

It added that the multi-sectoral national emergency operations centre activated at level two would continue to coordinate the national response activities.

So far, 266,665 COVID-19 cases have been confirmed, 259,951 cases have been discharged and 3,155 deaths have been recorded in 36 states and the Federal Capital Territory.

This is just as it disclosed that six states account for 84 per cent of cholera cases reported in the country.

It listed the states as Borno, Yobe, Katsina, Gombe, Taraba and Kano.

It added that 15 local government areas across five states – Borno (7), Yobe (4), Taraba (2), Gombe (1), and Zamfara (1)—reported more than 200 cases each this year.

The NCDC disclosed these in its latest weekly cholera situation report for weeks 44–47, published on Tuesday on its website.

The News Agency of Nigeria reports that cholera is a highly contagious disease that occurs in environments without clean water and proper sanitation.

It causes profuse diarrhoea and vomiting, and without treatment, it can quickly lead to death by intense dehydration. For most states, the current surge of cholera is due to specific, local conditions.

The public health agency said that the difficulty in accessing some communities due to security concerns, open defecation, and poor hygiene practices in many communities was responsible for the surge in the disease.

It said that at the moment, it is tackling cholera outbreaks in 32 states and the Federal Capital Territory.

The NCDC said a total of 583 deaths have been recorded due to cholera, while 23,550 people were suspected to have been infected with the disease between January and November 27, 2022.

According to the centre, suspected cases of cholera had been reported across 270 local government areas in the 32 states and the FCT.

The NCDC also said that of the suspected cases since the beginning of the year, the age group 5–14 years is the most affected; 49 per cent are males and 51 per cent are females.

The report read partly, “32 states and the FCT have reported suspected cholera cases in 2022. In the reporting month, six states reported 1,393 suspected cases: Borno (1,124), Gombe (165), Bauchi (61), Katsina (16), Adamawa (14), and Kano (13).

“There was a 78 per cent decrease in the number of new suspected cases in November Epi weeks 44–47 (1393) compared with October Epi weeks 40–43 (6306).

In the reporting week, Borno (24), Gombe (14), Bauchi (13), Kano (5), Katsina (1), and Adamawa (1), reported 58 suspected cases. Borno, Gombe, and Bauchi states account for 88 per cent of the 58 suspected cases reported in week 47.

“During the reporting week, two Cholera Rapid Diagnostic tests were conducted in Gombe 2 (100 per cent positive).

“In epi week 47, two stool culture tests were performed in Gombe (one was 100 per cent positive) and Bauchi (one was zero per cent positive).

“Of the cases reported, there were two deaths with a weekly case fatality ratio (CFR) of 3.4 per cent.”

The Public Health Agency said there were no new state-reported cases in week 47.

It, however, said the National Multi-Sectoral Cholera Technical Working Group continues to monitor response across states.

The NCDC said cholera was easy to treat, with oral rehydration for most patients, and intravenous rehydration for more severe cases.

“If treated in time, more than 99 per cent of patients will survive the disease.

“An effective response to cholera involves engaging on several different fronts at the same time—and as fast as possible—to treat sick patients and stop transmission within communities,” it said.

Adetifa claimed that the increase in travel over the holiday season might result in a rise in cases.

He said, “We are prepared to see that there may be a bump in cases just because of the increase in travel and the number of people returning. What we may not expect to see is an increasing number of people who are sick.”

The NCDC boss said vaccination and previous COVID-19 infections provided some degrees of immunity.

The population has quite a bit of immunity due to vaccination, previous COVID-19 infection, or repeated COVID-19 infection. So. COVID-19 is not new. The Omicron is not new like it was in November (2021).

“If you look at our numbers, we haven’t lost people for a while. Even if every single death is a great disaster for people’s families or friends, it’s not anything like the Delta variant when we had a big problem,” he added.

Speaking further, he said the Omicron variant was the dominant strain in the country.

He said, “Omicron took over as the dominant variant in November and December last year, and it has refused to go anywhere. Other minor variants have emerged, but Omicron remains the most dominant.”

The latest data from the NCDC showed that there were 266,283 confirmed cases of COVID-19 with 3,155 deaths, while the number of discharged cases stood at 259,640 as of November 18.

The cases were reported from January 1, 2022, to September 30, 2022.

According to the situation report obtained by our correspondent, on Wednesday, a total of 15 deaths were recorded from suspected cases in 10 of the states.

Yellow fever is an acute viral haemorrhagic disease transmitted by infected mosquitoes. The ‘yellow’ in the name refers to jaundice that affects some patients.

Symptoms of yellow fever include fever, headache, jaundice, muscle pain, nausea, vomiting and fatigue. A small proportion of patients, who contract the virus, develop severe symptoms and approximately half of them die within seven and 10 days.

The report read in part, “Cumulatively from January 1, 2022 – September 30, 2022, a total of 1,601 suspected cases have been reported from 463 LGAs in 36 states including the FCT.

“The cases were reported from the following states: Abia (48), Adamawa (21), Akwa Ibom (9), Anambra (94), Bauchi (81), Bayelsa (25), Benue (28), Borno (139), Cross River (41), Delta (10), Ebonyi (31), Edo (22), Ekiti (44), Enugu (67), FCT (7), Gombe (16), Imo (77), Jigawa (103), Kaduna (14), Kano (15), Katsina (107), Kebbi (33), Kogi (20), Kwara (29), Lagos (6), Nasarawa (27), Niger (27), Ogun (41), Ondo (74), Osun (22), Oyo (94), Plateau (70), Rivers (28), Sokoto (22), Taraba (51), Yobe (41) and Zamfara (17). Total of 15 presumptive positives and eight inconclusive results were recorded from the Nigeria Laboratory network.

These presumptive positives were from UBTH Benin (3), MDH Abuja (2), CPHL Lagos (6), YDMH (2) and NRL Abuja (2). These were reported from Edo -1 (Egor), Cross River -1 (Akabuyo). Niger -1 (Suleja). Rivers-1 (Port-Harcourt), Taraba -1(Karim Lamido), Anambra -1 (Ogabaru), Sokoto-2 (Dange-shuni, Tambuwal), Ogun-1 (Ijebu East) Osun-1 (Atakunmosa East), Ondo-3 (Akure South), Ekiti-1 (Irepodun/Ifelodun), Kwara-1 (Kaiama). The inconclusive cases were reported from Oyo -1 (Olorunsogo) and Anambra-2 (Idemili South (1), Ayamelum (1) and Imo -2 (Nwangele (1), Ahiazu Mbaise (1)), Enugu -1 (Agwu (1), Ogun-1 (Ijebu Ode) and Osun -3 (Irewole (1). These samples have been shipped to IP Dakar for confirmation.

“Seven confirmed cases have been reported from IP Dakar from Anambra-2 [Idemili South (1), Ogbaru (1)], Imo -1 [Nwangele (1)], Ondo-1 [Akure South (1), Osun-2 [Atakunmosa East (1), Irewole (1)], Sokoto-1 [Dange-shuni (1)].

“Fifteen deaths recorded from suspected cases in Abia (1), Bayelsa (1), Benue (1), Imo (1), Kaduna (2), Katsina (2), Kebbi (1), Taraba (2), Yobe (1) and Zamfara (3) States [CFR = 1.0 per cent].

“Male-to-female ratio for suspected cases was 1.2:1 with males 871(54.4 per cent) and females 730(45.6 per cent).

“74 per cent of cases were predominantly aged 30 years and below.

“One hundred and seventy-four (11 per cent) of 1,601 suspected cases received at least one dose of the yellow fever vaccine The NCDC is coordinating response activities through the National Multi-agency Yellow Fever Technical Working Group.”

The NCDC made the announcement in a public health advisory signed by its Director General, Dr Ifedayo Adetifa, and obtained from its website on Monday.

The centre said, “When travel to Uganda is unavoidable, travellers are advised to avoid contact with obviously sick persons or suspected cases of Ebola.

“The Port Health Services of the Federal Ministry of Health has scaled up the screening of passengers returning from Uganda at points of entry.

Persons already in Nigeria but with recent travel history to or transit through Uganda within the past 21 days who experience symptoms such as fever, muscle pain, sore throat, diarrhoea, weakness, vomiting, stomach pain, or unexplained bleeding or bruising should promptly call 6232 or state ministry of health hotlines for assessment and testing. Such persons should not visit health facilities by themselves to avoid further spread through the shared transport system (public or private).

“They would be visited at home by dedicated responders for assessment and transported through the designated transport arrangement to the designated treatment centre when required.

“Inbound travellers to Nigeria with a recent travel history to or through Uganda without symptoms on departure but who become unwell while on transit are required to avoid contact with people and to report to the Port Health Services on arrival at the point of entry to Nigeria.”

The centre’s Week 31 reports indicated the spread has reached 27 states since January.

From January 1 to August 7, 2022, NCDC said four deaths were recorded from four states – Delta (1), Lagos (1), Ondo (1), and Akwa Ibom (1).

The report also showed that there were at least 473 suspected cases of the disease in the country.

The report read in part, “60 new suspected cases were reported in Epi Week 31, 2022 (August 1-7, 2022) from 19 states.

“Of the 60 suspected cases, 15 new confirmed cases have been recorded in Epi Week 31 from 10 states – Imo (3), FCT (2), Ondo (2), Rivers (2), Abia (1), Anambra (1), Ebonyi (1), Edo (1), Ogun (1), and Nasarawa (1).

“From  January 1 to August 7, 2022, there have now been 473 suspected cases with 172 confirmed cases (115 male, 57 female) from 27 states – Lagos (20), Ondo (16), Adamawa (13), Rivers (13), Delta (12), Bayelsa (12), Edo (9), Nasarawa (9), Anambra (7), FCT (7), Imo (7), Plateau (6), Taraba (5), Kwara (5), Kano (5), Abia (4), Cross River (3), Borno (3), Oyo (3), Gombe (3), Katsina (2), Kogi (2), Ogun (2), Niger (1), Bauchi (1), Akwa Ibom (1), and Ebonyi (1). Overall, since the re-emergence of monkeypox in September 2017, 985 suspected cases have been reported from 35 states in the country. Of these 985 suspected cases, 398 (40.4%) were confirmed (263 male, 135 female) from 30 states.

12 deaths have been recorded (CFR = 3.0%) since September 2017 in nine states—Lagos (3), Edo (2), Imo (1), Cross River (1), FCT (1), Rivers (1), Ondo (1), Delta (1), and Akwa Ibom (1).”

The NCDC, however, said there are ongoing efforts to strengthen surveillance at the national and sub-national levels, to increase awareness, and to promptly detect and respond to the outbreak.

Speaking with The PUNCH, the Ondo State Epidemiologist, Dr. Stephen Fagbemi, said people need to visit the hospital once they notice the symptoms.

The symptoms, according to him, are fever, swelling of lymph nodes, back pain, intense headache, muscle aches, and lack of energy.

“There is a need for increased awareness on the steps to reduce the virus exposure and people need to report to hospitals once they notice the symptoms.”

Also, the Senior Vice President for Africa, Human Health Education and Research Foundation, Dr. Ifeanyi Nsofor, said Nigerians must ensure that they protect themselves against the disease.

You must ensure you wash your hands thoroughly, and always avoid contact with animals that could harbour the virus, including sick or dead animals. Personal hygiene is always important,” Nsofor said.

The NCDC disclosed this in its latest monkeypox situation report for week 30.

Monkeypox is a rare viral zoonotic infectious disease transmitted from animals to humans that occur sporadically, primarily in remote villages of Central and West Africa near tropical rainforests.

Nigeria is one of the countries in Africa where the disease is endemic.

The agency said from January 1 to July 31, 2022, four deaths were recorded from 4 states – Delta (1), Lagos (1), Ondo (1) and Akwa Ibom (1).

The report also showed that there were at least 413 suspected cases of the disease in the country.

The report read in part, “There were fifty-six (56) new suspected cases reported in Epi week 30, 2022 (25th to 31st July 2022) from nineteen (19) states – Ondo (13), Plateau (8), Lagos (6), Adamawa (4), Abia (3), Borno (3), Delta (2), Kano (3), Anambra (2), Bayelsa (2) , Kwara (2), Akwa Ibom (1), Gombe (1), Imo (1), Nasarawa (1), Osun (1), Oyo (1), Rivers (1) and Taraba (1)

Of fifty-six (56)suspected cases, there were twenty-four(24) new confirmed positive cases in Epi week 30, 2022 from twelve (12) states – Ondo (5), Kano (3), Lagos (3), Abia (2), Adamawa (2), Bayelsa (2), Kwara (2), Delta (1), Anambra (1), Gombe (1), Rivers (1) and Nasarawa (1).

“From 1st January to 31st July 2022, there have now been 413 suspected cases and 157 confirmed cases (105 male, 52 female) from twenty-six (26) states – Lagos (20), Ondo (14), Adamawa (13), Delta (12), Bayelsa (12), Rivers (11), Edo (8), Nasarawa (8), Plateau (6), Anambra (6), FCT (5), Taraba (5), Kwara (5), Kano (5), Imo (4), Cross River (3), Borno (3), Oyo (3), Abia (3), Gombe (3), Katsina (2), Kogi (2), Niger (1), Ogun (1), Bauchi (1) and Akwa Ibom (1).

“Four deaths were recorded from 4 states – Delta (1), Lagos (1), Ondo (1) and Akwa Ibom (1).

“Overall, since the re-emergence of monkeypox in September 2017 and to 31st July 2022, a total of 925 suspected cases have been reported from 35 states in the country.”

The NCDC disclosed this in its latest monkeypox situation report released on Thursday.

Monkeypox is a rare viral zoonotic infectious disease transmitted from animals to humans that occur sporadically, primarily in remote villages of Central and West Africa near tropical rainforests.

Nigeria is one of the countries in Africa where the disease is endemic.

The agency said from January to July 24, 2022, three deaths were recorded in three states – Delta (1), Lagos (1) and Ondo (1).

The report also showed that there were at least 357 suspected cases of the disease in the country.

The report read in part, “There were 19 new suspected cases reported in Epi week 29, 2022 (July 18 to 24, 2022) from 12 states – Ondo (4), Bayelsa (3), Taraba (2), Lagos (2), Rivers (1), Kogi (1), Kano (1), Imo (1), Delta (1), Anambra (1), Akwa Ibom (1) and Abia (1).

“Of 19 suspected cases, there were 15 new confirmed positive cases in Epi week 29, 2022 from 10 states – Ondo (3), Taraba (2), Lagos (2), Bayelsa (2), Rivers (1), Kogi (1), Imo (1), Delta (1), Anambra (1) and Abia (1).

“From January 1 to July 24, 2022, there have now been 357 suspected cases and 133 confirmed cases (89 male, 44 female) from 26 states – Lagos (17), Adamawa (11), Delta (11), Rivers (10), Bayelsa (10), Ondo (9), Edo (8), Nasarawa (7), Plateau (6), FCT (5), Anambra (5), Taraba (5), Imo (4), Cross River (3), Kwara (3), Borno (3), Oyo (3), Kano (2), Katsina (2), Gombe (2), Kogi (2), Niger (1), Ogun (1), Bauchi (1), Akwa Ibom (1) and Abia (1). Three deaths were recorded from thre states – Delta (1), Lagos (1), and Ondo (1).

“Overall, since the re-emergence of monkeypox in September 2017 and to July 24, 2022, a total of 869 suspected cases have been reported from 35 states in the country.

“Of these 869 suspected cases, there have been 359 (41.3%) confirmed (237 male, 122 female) from 30 states – Rivers (62), Bayelsa (53), Lagos (47), Delta (40), Edo (18), Cross River (17), Imo (12), FCT (11), Adamawa (11), Ondo (9), Nasarawa (9), Oyo (9), Plateau (9), Akwa Ibom (8), Anambra (7), Taraba (5), Enugu (4), Abia (4), Kwara (3), Borno (3), Benue (2), Ekiti (2), Kano (2), Niger (2), Ogun (2), Katsina (2), Gombe (2) Kogi (2), Ebonyi (1), and Bauchi (1).

“In addition, from September 2017 to July 24, 2022, a total of 11 deaths have been recorded (CFR= 3.0%) in eight states – Lagos (3), Edo (2), Imo (1), Cross River (1), FCT (1), Rivers (1), Ondo (1) and Delta (1).”

The NCDC noted that there are ongoing efforts to strengthen surveillance at national and subnational levels.

A Medical Laboratory Scientist at the Department of Microbiology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Obinna Chukwudi, tasked the government on vaccine production and availability.

Chukwudi said, “At the moment, the best thing to do is to make sure vaccines are available; you can’t always be too careful. To tame the infection, the government needs to ensure that everybody is properly vaccinated and the early we start the vaccination, the better for us.

“This is a re-emerging disease and this means that it becomes more dangerous than before; because it keeps mutating. The government needs to ensure that every state in the country has vaccines; establish a task force group to ensure that people are vaccinated and we will have fewer casualties among us.

“We can produce vaccines in the country because we did it before and we can do it again, we have the human resources but there is a lack of political will.”

Also, the immediate past President of the National Association of Resident Doctors, Dr. Uyilawa Okhuaihesuyi, urged the Federal Government to increase funding for the health sector.

“If there is adequate funding, the experts in the country can produce vaccines instead of depending on international bodies for vaccines,” he said.

The NCDC said this following an outbreak of the disease in Ghana confirmed by the World Health Organisation on July 17.

The centre said it was on high alert given the proximity of Ghana to Nigeria as well as the World Health Organisation alert.

The cases in Ghana were reported in two unrelated males – 26 and 51 years old – who both died from the disease.

This is the second time this zoonotic disease has been detected in West Africa following the previous incidence in Guinea in August 2021. The disease was first discovered in 1967 following outbreaks in Marburg and Frankfurt in Germany, and Belgrade, Serbia. Since then, outbreaks and sporadic cases have been reported in some African countries.

The Marburg virus causes a rare, highly infectious disease and severe haemorrhagic fever in humans and non-human primates just like the Ebola virus, its closest relation and only other member of the Filoviridae family of viruses.

The NCDC, however, said Nigeria can test for the virus presently at the National Reference Laboratory in Abuja and the University of Lagos Teaching Hospital laboratory Centre for Human and Zoonotic Virology.

The centre’s Director General, Dr. Ifedayo Adetifa, in a press release published on its website said “Given the proximity of Ghana to Nigeria as well as the WHO alert, the NCDC-led multisectoral National Emerging Viral Haemorrhagic Diseases Working Group (EVHDWG) that coordinates preparedness efforts for MVD, and other emerging viral haemorrhagic diseases has conducted a rapid risk assessment to guide in-country preparedness activities.

“Based on available data, the overall risk of both importation of the disease and its potential impact on the Nigerian population is said to be Moderate as assessed by NCDC experts and partners given the following: the proximity (same region), high traffic from Ghana and countries that share borders with Ghana, the incubation period of 21 days of the virus, heightened surveillance at point of entry, Nigeria’s capacity to respond to the outbreak in the country and the fact that persons with MVD transmit the virus when they become symptomatic unlike for SARS-CoV-2 that causes COVID-19 that can also be transmitted by infected persons without symptoms.

“Nigeria has the capacity to test for the virus presently at the National Reference Laboratory in Abuja and the University of Lagos Teaching Hospital laboratory Centre for Human and Zoonotic Virology. Diagnostic capacity can be scaled up to other laboratories if required. Nigeria has the resources (human, technical, and laboratory) for prompt identification and management in the event of a single imported case.

“However, the risk of importation may be further reduced as the current situation in Ghana is under control as reported by Ghana Health Service. Active case finding is ongoing in Ghana while there is heightened surveillance in Togo and Benin. Therefore, the response situation may change in the coming days with the control efforts in Ghana and advisories as may be issued by the WHO.

“In addition, many of the contacts under follow-up in Ghana will soon exit the 21-day quarantine period and so far, there have been no secondary cases reported.

“Currently, no case of Marburg virus disease has been reported in Nigeria. However, several measures are being put in place to prevent an outbreak of the disease in-country. The National Reference Laboratory has the capacity to test for MVD, point of entry surveillance has been heightened, trained rapid response teams are on standby to be deployed in the event of an outbreak and the NCDC’s Incident Coordination Centre is in alert mode.

“The NCDC is also amplifying risk communication efforts and continues to work with States and partners to strengthen preparedness activities which include– review of risk communication protocols, plans, and messages in the event of an outbreak.”