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EWARN Report

Report on suspected cases of Cholera in North of Syria

September 2018

Turkey – Gaziantep

• Geographical overview:

Location: on the northern parts of Aleppo governorate- A’zaz District- sub-district, Kaljibrin

village.

Population: estimated 10.000 inhabitants.

Public services: agriculture is the main work field.

Water sources and sanitation: drinking from tanks

collected from many private wells and disseminated

through tankers, some of those wells are monitored by

the local council.

Health services: a primary health center supported from

Turkish ministry of health.

• Description of the alert:

On 29th August 2018, EWARN central team was reported about 4 AWD cases (suspected cholera

cases) by DLO (district level officer) of A’zaz district - Aleppo governorate, who received the

alert as well from the manager of Wasim Ma’az Hospital in Bab Al Salameh – A’zaz.

On Friday 27.08.2018 01:30 AM, a case of 72 years old female ( F. Al Hamdo), from Aleppo city and displaced 2.5 years ago to Kaljubrin village, presented of acute vomiting, abdominal pain, and acute watery diarrhea large volume and frequent. At 1.30 PM of the same day (after 12 hours from the start of the signs in the index case) she came to MSF Hospital with shock, pale, cold extremities, and in very bad condition, she was given IV fluid. According to the physician the condition improved after administrating IV fluids, and the patient discharged the next day.

3 other members of the family (aged 14, 11, 10 years) suffered from the same signs just after

6 hours from the grandmother signs start (27.08.2018 07.30 AM), but one of them (female 11

years old) died at home as a result of dehydration on 28.08.2018 0.30AM, and the other 2 cases

were admitted to Wasim Ma’az Hospital (supported by IDA).

The fifth case (female 12 years) suffered from mild similar signs 0n 31.08.2018, then improved

with ORS. All the details of the suspected cases are line listed in the table below.

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• Investigation and Sampling:

The DLO went to the case in the hospital at the early morning 30.08.2018 to investigate and

collect samples (Figure 1).

RDT was negative for the 4 suspected cases (Figure 2), an adequate stool samples were

collected in carry Blair media. The samples were reserved according to the conditional terms

(Temperature 2-8 degrees) and sent to EWARN lab in Jarablus.

The result of the stool sample came negative for cholera vibrio in the four sampled cases.

An investigation forms were filled for all the reported cases. No travel history for the case nor

the family.

Water source: All the family members drink the house tank water that

collected from private wells and disseminated through tankers, upon

investigation in the family house, the WASH team collected samples from

the house tank on 30.08.2018. Next day the result showed high number

of coliforms (not E.Coli) in the house tank , thus it is not safe for drinking

(Figure 3).

Active search: Through the quick inquiries done by our DLO with the

physicians, health workers, hospital register, and sentinel sites in the, no

other suspected cases were found.

Figure 1 Figure 2

Figure 3

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Health workers education: the DLO educated the health workers in both MSF and IDA hospitals

in the hospital about the correct case definition for suspected cholera, management and

reporting mechanism. An awareness explanation done by the DLO as well for the contacts and

the families about cholera transmission and best prevention methods.

Waste management: all the wastes resulted from sampling (tools and stool) were managed

properly (burning).

Recommendation:

- Encourage the actors in north of Aleppo to report about any similar cases. - Health workers awareness about case definition and case management. - Emphasize the partners to apply and follow the safe treatment procedures for water on

both levels: household and water sources.

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