Cholera is endemic in Benin with cases reported annually since 2016. In 2021, Benin reported its first epidemic wave of cholera between March and April, in the commune of So-Ava, Atlantique Department, with 103 cases including three laboratory-confirmed cases and no deaths.
A second epidemic wave began in September 2021, with 1430 cases and 20 deaths (CFR: 1.4 %) reported from 1 September 2021 to 16 January 2022. Of these, stool culture performed on 41 samples at the National Laboratory, Benin, were confirmed as Vibrio cholerae O1 serogroup.
Of the cases reported during the second wave, 53% (n=758) were females and 62% (n=887) were between the ages of 16 and 45 years. Cases have been reported from nine departments in Benin including Alibori, Atacora, Atlantique, Borgou, Collines, Donga, Littoral, Mono and Oueme. Borgou department, the epicenter of the outbreak, reported an increase in cholera cases from week 43 (ending on 31 October) to week 50 (ending on 12 December), with 841 cases reported, of which 71% of cases (n=597) were reported from Parakou district.
Public health response
Coordination
- An incident management system has been activated at the national level and in the affected departments to coordinate the response and support the departmental teams.
- A response plan was developed by the Ministry of Health in coordination with health partners.
- Readiness and preparedness activities, including the deployment of health personnel, have been strengthened.
Monitoring
- Epidemiological surveillance activities are ongoing, including community-based surveillance, active case finding and case investigations.
- Analysis of cholera hotspots is ongoing.
Laboratory and case management
- Collection and analysis of stool samples for confirmation at the National Public Health Laboratory in Cotonou and Parakou is ongoing.
- Case management has been strengthened through the establishment of treatment facilities and the provision of supplies.
Water, Sanitation and Hygiene (WASH)
- WASH activities are in place, including household disinfection, distribution and demonstration of the proper use of Aquatab water treatment tablets in the community, in addition to well water treatment.
Risk Communication
- Community awareness of hygiene measures is ongoing, including hand washing, safe food preparation and safe drinking water.
- Risk communication and community engagement activities are ongoing. This includes mobilizing community leaders, together with relevant stakeholders on cholera prevention measures through using IEC (Information, Education and Communication) material.
Logistics
- Eight cholera kits (including the central reference kit, periphery kit, and community kit) and five laboratory kits have been delivered to support the affected departments. Each kit contains the necessary supplies to help prepare for a potential cholera outbreak and to support the first months of the initial response for 100 cases.
WHO risk assessment
Cholera is an acute enteric infection caused by the ingestion of V. cholerae bacteria in contaminated water or food. It is mainly linked to insufficient access to safe drinking water and adequate sanitation. It is a potentially serious infectious disease that can cause high morbidity and mortality, which can spread rapidly, depending on the frequency of exposure, the exposed population and the setting.
Cholera is endemic in Benin and since 2016, cases continue to be reported every year in various departments across the country. The Parakou district in Borgou department is the epicenter of the current outbreak with high commercial traffic to Cotonou, the capital of Benin.
The main factors attributed to the initiation and ongoing spread of the cholera epidemics in Benin include:
- Inadequate hygiene and sanitation
- The lack of public hygiene infrastructure
- Limited supply of safe drinking water
- Open defecation
- The poor practice of hand washing.
Additionally, Benin shares international borders with Nigeria and Togo, and there is frequent and substantial cross-border population movement. This poses a risk of cross-border transmission of cholera.
Given the porous borders with countries responding to cholera outbreaks and inadequate WASH conditions, the national and regional risks of this outbreak is assessed as high while the risk at the global level is considered to be low.
WHO advice
WHO recommends improved access to safe drinking water and sanitation, good food safety and hygienic practices to prevent the transmission of cholera.
Strengthening surveillance, particularly at the community level, is advised. Appropriate case management, including improved access to care, should be implemented in areas affected by the outbreak to reduce mortality. There is a need to ensure that countries are prepared to rapidly detect and respond to this cholera outbreak to reduce the risk of spread to new areas. As the outbreak is occurring in areas with active cross border population movement, WHO encourages the respective countries to ensure cooperation and regular information sharing.
WHO does not recommend any restrictions on travel and trade to and from Benin based on the information available on the current outbreak.
Further information
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