Lake Chad basin - Cross-border Meeting - Niamey, 2014

Background :

Situation of the cholera outbreak in the Lake Chad Basin area (Week 13, 2014)
As of 30th of March 2014 (S13), 12,531 cases of cholera and 179 deaths (case fatality ratio: 1%) were reported in 14 States and 68 LGAs in Nigeria. On Week 13, the State of Bauchi reported 9,146 cases of cholera, about 75% of all cases reported on a national level since the beginning of the year. 90% of all cases are reported in urban areas. A cholera outbreak is currently reported in the Touboro district (cf. Figure 2), in North Cameroon, at the border with Chad and CAR. Between the 19th and the 28th of March 2014, 9 cases of cholera, including 4 deaths, were reported. Additional in-depth investigation are required to determine how the pathogen was introduced in the North region of Cameroon. Touboro market receives goods originating from Nigeria, namely from the State of Bauchi.

Note that a set of conditions are met highlighting a possible move towards a "complex" outbreak in the Lake Chad Basin area:

• The high number of cases in Northern Nigeria at the end of the dry season, with already over 12,000 cases on Week 13. Spreading potential from the affected urban centres (Kano, Katsina, Bauchi, etc.) to other countries of the subregion via trade activities. Security issues in the State of Borno in Nigeria lead to a partial epidemiological surveillance in LGAs bordering Lake Chad and difficulties to intervene in the border health area on the Far North region of Cameroon.
• The area affected at the CAMEROON-CHAD-CAR border is a high vulnerability area due to the crisis in the Central African Republic (CAR). Proximity of "typical" cholera areas in Chad and Cameroon.
  Toboro is about 300km of Garoua in Cameroon and Pala in Chad. (cf. figure below).
• The presence and mobility of displaced, refugees and return populations in the 5 countries of the subregion due to the crisis affecting North-Eastern Nigeria and CAR
• The decreased immunity acquired by the population in contact with the pathogen, with the last major outbreak in the Lake Chad Basin between 2009 and 2011.

High-risk cross-border areas
An integrated "Water, Hygiene, Sanitation and Epidemiology" study conducted in 2011 in the Lake Chad Basin area identified the high-risk cross-border spreading areas where vulnerability to cholera outbreaks is high (Figure 2) (Annex 1). The study highlights the importance to improve cross-border surveillance, preparedness and collaboration on a national level and at the periphery between Chad,Cameroon, Niger and Nigeria.