Large cholera outbreak in Brong Ahafo Region-Ghana, 2014

Abstract

Introduction : a nationwide outbreak of Vibrio cholera occurred in Ghana in 2014. Accra, the nation’s capital, was the epicenter. The outbreak spread to the Brong Ahafo region (BAR) which is geographically located in the middle belt of the country. In this region a review of data collected during the outbreak was carried out and analyzed descriptively to determine the hot spots in order to make recommendations for effective response to future outbreaks. Methods : a review of patient’s records and line lists of cases of cholera reported in all hospitals during the period of the outbreak (July-December 2014) was conducted. Hospitals used IDSR (integrated disease surveillance and response system) standard case definitions to detect and report cases for management. The GPS coordinates of all districts and health facilities were collected and utilized in the construction of spot maps. We also obtained populations (denominators) from the BAR Health surveillance unit of the Ghana Health service. All the data thus collected was analyzed descriptively and expressed as frequencies and rates. Results : a total of 1,035 cases were reported, 550 (53.4%) were males. Their ages ranged from 1 to 95 years; (mean age of 28.2 ±19.6 years). The most affected (23.5%) was the 20-29-year old age group. On the 30th July 2014, a 26-year old male (recorded as the index case of the cholera outbreak in the Brong Ahafo region) with a travel history to Accra reported to the Nkoranza district hospital and presented with signs and symptoms suggestive of cholera. The outbreak lasted 25 weeks; peaking in the week 15 with 179 (17.3%) cases. An overall attack rate of 71/100,000 population and a case fatality rate of 2.4% were recorded in the region. Asutifi South district, however, recorded a case fatality of 9.1%, the highest amongst all affected districts. The majority of the cases reported in the region were from Atebubu-Amanten (31.1%), Sene West (26.2%), Pru (18.2), and Asunafo North (9.9%) districts. Vibrio cholerae serotype O1 was isolated from rectal swabs/stool samples. Conclusion : vibrio cholerae serotype O1 caused the cholera-outbreak in the Brong Ahafo Region and mainly affected young adult-males. The most affected districts were Atebubu-Amanten, Sene west, Pru (located in the eastern part of the region), and Asunafo North districts (located in the south west of the region). Case Fatality Rate was higher (2.4%) than the WHO recommended rate (< 1%). Active district level public health education is recommended for prevention and effective response to future outbreaks of cholera.