Investigation of the Cholera Outbreak in Lacs district, Togo, November 2021

Water or foodborne

Background: Togo’s last reported cholera outbreak occurred in 2016 in Lacs district. On November 5, 2021, the Prefectural Hospital Center Laboratory in Lacs reported a new cholera case. We conducted an investigation to measure the extent of the outbreak, describe exposure factors, and implement control and prevention measures.

Methods: This was a descriptive study. A suspected case of cholera was defined as anyone (living or deceased) residing in Lacs district who presented with acute watery diarrhea with or without vomiting from October 18 to November 23, 2021. Stool specimens were collected and tested. AFRICHOL forms were used to collect demographic, clinical, and exposure factors information. We calculated the proportions, median age of suspected cases, and attack rate

Results: The epidemic began on October 21, 2021. A total of 38 cholera cases with 4 deaths (CFR = 10.5%) were recorded. The cumulative attack rate was 6.33 cases per 1,000 people. Females accounted for 53% of cases (n=20). The median age was 28 years (IQR: 19-45) and 31 cases (82%) were ≥15 years. Tradespeople and students accounted for 23.7% and 18.4% of cases, respectively. The most commonly reported symptoms were watery diarrhea (82%) and abdominal pain (45%). The Agouégan health unit recorded 60% of the cases, and the first case came from the Agotivé health unit. Of the 25 patients who were tested, 11 (44%) were confirmed to have Vibrio cholerae O1. Regarding exposure factors, 59% of the cases practiced open defecation, 56% lived near a dumpsite and 60% had contact with a probable case, and 26% had attended a funeral.

Conclusions: The spread of the outbreak was favored by the delay in detection and the absence of hygiene and sanitation measures. It is necessary to implement community-based surveillance and build hygiene and sanitation mechanisms for access to drinking water and safe defecation practices.