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Cablegate: Cholera Epidemic in Ethiopia Reaches Addis Ababa

VZCZCXRO5109
PP RUEHROV
DE RUEHDS #2096/01 2431333
ZNR UUUUU ZZH
P 311333Z AUG 09
FM AMEMBASSY ADDIS ABABA
TO RUEHC/SECSTATE WASHDC PRIORITY 6030
RUEHPH/CDC ATLANTA PRIORITY
RUEAUSA/DEPT OF HHS WASHINGTON DC PRIORITY
INFO RUCNIAD/IGAD COLLECTIVE PRIORITY
RUEPADJ/CJTF HOA PRIORITY
RUEAIIA/CIA WASHINGTON DC PRIORITY
RUEKDIA/DIA WASHINGTON DC PRIORITY
RUEWMFD/HQ USAFRICOM STUTTGART GE PRIORITY

UNCLAS SECTION 01 OF 02 ADDIS ABABA 002096

SENSITIVE
SIPDIS

E.O. 12958: N/A
TAGS: TBIO CASC SOCI KHIV ET
SUBJECT: CHOLERA EPIDEMIC IN ETHIOPIA REACHES ADDIS ABABA

SUMMARY
-------

1. (SBU) Since the emergence of initial reports of cholera cases
within Addis Ababa around August 10 the number of cases has risen
sharply. As of August 26, 2,592 cases and four deaths were reported
in Addis Ababa to the Ministry of Health (MOH). The number of cases
continues to increase, although the case fatality rate appears to
remain low. While not yet publicly acknowledging the presence of
cholera -- the Ethiopian Government (GoE) continues to refer to
"Acute Watery Diarrhea (AWD)" -- the GoE has stepped up control
efforts this week and engagement of WHO, UNICEF, MSF, the USG, and
others is increasing. Nevertheless, with another month to go in the
rainy season, we should expect further escalation of the epidemic
before the situation improves. To date there are no reported cases
affecting American citizens and Post has issued a Warden Message and
internal Management Notice advising the American community how to
protect itself. End Summary.

A CHOLERA EPIDEMIC
------------------

2. (SBU) Cholera cases were first detected in the area of Moyale
along the Kenya-Ethiopia border in February 2009 and have continued
to occur in many parts of the country: Afar, Oromiya, Amhara and
Somali regions in particular, with sporadic reports from other
regions. It is unclear whether the current situation is the result
of introduction of the infection from Kenya in the Moyale area or if
cholera was present at low levels and internal factors, such as the
current rainy season and poor water and sanitation, have created
ideal conditions to trigger the current outbreak. Malnutrition and
water shortages are likely exacerbating the situation in many
places.

3. (SBU) Surveillance and reporting is inconsistent, thus the
absence of reports does not necessarily indicate absence of cases.
Laboratory confirmations of Vibrio cholera 01 Inaba by the Ethiopia
Health and Nutrition Research Institute (EHNRI) have been obtained
from several locations including Addis Ababa.

4. (SBU) Data on the outbreak is also being collected by staff from
the MOH's new Public Health Emergency Management (PHEM) Unit and the
first class of trainees from the PEPFAR/CDC-supported Field
Epidemiology and Laboratory Training Program (FELTP). Current
efforts are focusing on determining which sub-cities in Addis Ababa
are most affected through active case finding in collaboration with
sub-city administration personnel. FELTP also has trainees
conducting field investigations currently in West Harerge and West
Arsi (Shashamene) zones within Oromiya region. Related cases are
also being reported from Debre Zeit and Dukem, within 60km of Addis
Ababa where the outbreak has been particularly persistent.

5. (U) On Aug 18 as soon as the first cases were reported, Post
disseminated a Mission-wide Management Notice and Warden Message on
the situation and provided guidance on taking appropriate
precautions against cholera and other diarrheal diseases. The
Ethiopia Country Specific Information page at www.travel.state.gov
already has similar language.

6. (U) Taskforces have been reactivated at the Addis Ababa health
bureau and at all sub-cities. The City Council, chaired by the
Mayor, now meets on a daily basis and the State Minister of Health
Kebede Worku and Dr. Daddi, Deputy Director General in charge of
MOH-PHEM, have joined the taskforce. Public radio reports and
advisories continue and the head of the Addis Ababa Health Bureau
issued a radio alert on August 25 instructing people to seek medical
care early if they develop symptoms, to consume only treated water,
and avoid eating raw vegetables, etc. that could be contaminated.

7. (SBU) There has been concern among officials about the role of
"holy water" in the spread of disease as Orthodox Christians go to
religious sites on holy days and drink unpurified water. Although
there are a number of these sites around Addis Ababa, the site at
Maryam Kaliti just south of Addis, has been the main focus. Large
numbers of "pilgrims" congregate at these sites for varying periods
of time; they have now been evacuated from the holy water sites and
very few (30-50) are said to currently remain there. Police have
reportedly been assigned to keep people from obtaining this water.
Some pilgrims, however, have traveled from as far as Gambella and
Benishangul-Gumuz in the far west of the country.

8. (SBU) Despite the positive laboratory tests, to date the MOH has
labeled the outbreak(s) as "Acute Watery Diarrhea" instead of
"cholera." This is likely due to governmental fears of broad
restrictions on agricultural exports to the Middle East, decreased

ADDIS ABAB 00002096 002 OF 002


regional and local travel, and potential panic in the community that
could result in significant economic losses and social disruption.
An association between "holy water" and cholera, if indeed proven,
could undermine the immense stature of the Orthodox Church in the
Ethiopian community.

TREATMENT AND CASE MANAGEMENT ACTIVITIES
----------------------------------------

9. (SBU) Case Treatment Centers (CTCs) in outdoor tents have been
established in Addis Ababa at Ras Desta and Zewditu Hospitals. An
additional two CTCs operated by Medecins Sans Frontieres (MSF) (at
the TB center and Menilik Hospital) were to be functional as of
August 26. A new site has been identified for MSF to establish at
Kaliti. Six additional sites (youth centers) have been identified
by the City Council and will be ready as resources are availed.
Currently, all CTC sites have adequate drugs and medical supplies.

EMERGENCY FUNDING
-----------------

10. (SBU) The World Health Organization (WHO) estimates a funding
requirement of USD 2.3 million to address the 132,000 new cases
which are predicated to occur in Addis Ababa alone in the coming
five months. There will be a need for drugs, medical supplies, CTC
supplies, strengthening surveillance (field epidemiology and
laboratory), public communication and training. CDC has offered
additional surveillance support to the FELTP trainees and is
awaiting a response from the MOH.

11. (SBU) PEPFAR's Supply Chain Management Systems project (SCMS),
supported through USAID, is coordinating with the Federal MOH and
Regional Health Bureaus to provide 2,640 bottles of disinfectant
solution and 900,000 sachets of oral rehydration salts. These
commodities, from supplies on hand procured for HIV-positive
individuals, can be spared for this emergency situation without
affecting supplies needed for people living with HIV/AIDS.

COMMENT
-------

12. (SBU) The MOH'S weak public health infrastructure and capacity
are being challenged by the growing magnitude of the outbreak. The
Addis Ababa Regional Health Bureau (AAHB) had difficulty providing a
daily breakdown of the cases but seems be improving. Communication
and coordination between MOH and AAHB has been problematic. With
WHO expected to provide technical support and NGOs providing
assistance, there are a number of players involved in the response
further complicating coordination and comprehensive assessment of
the situation. There has been no official confirmation that the
outbreak is due to cholera, although laboratory confirmation in a
number of cases has been obtained. To facilitate trust and
productive government-to-government working relationships, until the
GoE itself acknowledges a cholera outbreak, the USG should continue
to utilize publicly the same language used in the Warden Message;
i.e. "increased risk of acute diarrheal illnesses, including
Salmonella, Shigella, Cholera, and others." End Comment.

MEECE

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