Zimbabwe Cholera Fact Sheet

Cholera Overview

Seventh pandemic cholera was first reported in Zimbabwe in 1973. Since then, significant outbreaks have been reported in 1992-93, 1999, 2002, 2008-2009 (which was the most significant outbreak ever reported in Africa) and 2010-2011. In recent years, no major outbreak had been reported until cholera resurfaced in 2018 (Fig. 1).

Between 1998 and 2018, epidemiological surveillance reported 117,973 cases with 5,198 deaths (case fatality rate ≈ 4.4%)2.

Major outbreaks were reported in the following provinces: Mashonaland West, Mashonaland Central, Mashonaland East, Manicaland and Masvingo (Fig. 2 and Table I).

Cholera Distribution

Geographic distribution of cholera is markedly heterogeneous, with the five most affected provinces reporting 69.5% of the burden.

The northern and eastern provinces reported a combined 75% of all cholera cases between 1998-2018, with the highest proportion reported by Mashonaland West (22.5%), Harare (17.1%), and Manicaland (15.7%) Provinces (Fig. 2 and Table I). The most affected districts tended to be located along the northern and eastern border with Zambia and Mozambique as well as along main routes to Harare.

The southern and western part of the country has been generally less affected and reported only 25% of the total number of cases during the period 1998-2018.

Harare seems to play a role in amplifying cholera outbreaks. During years when Harare urban district was affected, a increased number of cases were reported (>10-fold) and a greater number of districts were affected.

Cholera in Zimbabwe displays a seasonal pattern and an apparent correlation with the rainy season (November to April/May) (Fig. 3).

Outbreaks tended to start between week 45 (November) and week 51 (late-December) (Fig. 3).

Strategic Recommendations

In cholera hotspots, preparedness and response plans should be developed and implemented including: (1) strengthening early detection and rapid response including community based surveillance and cross-border alerts; (2) establishing multisectoral and cross-border coordination mechanisms; (3) building capacity on outbreak management; (4) targeted pre-positioning of supplies and (5) developing risk communication, social mobilization and community engagement plans as well as harmonizing approaches and messaging.

Enhanced access to healthcare and early rehydration (e.g., community oral rehydration points) in remote areas, should be prioritized to prevent cholera-related deaths (Table II – hotspot types T1 - T4).

Sustainable Water, Sanitation and Hygiene and social mobilisation activities should be implemented in 21 high-priority hotspot districts regularly affected with significant outbreak duration (Table II – Types T1 and T2). If implemented in combination with preventive measures, oral cholera vaccine campaigns will reduce the likelihood of cholera epidemics in cholera foci and among high-risk populations.

The type T1 and T2 hotspots accounted for 36.1% of the disease burden2. Those 13 districts host approximately 2.5 million people (18% of the total estimated population). An identification of transmission foci at a finer geographical scale is necessary to better target at-risk populations.