Cholera spread: Fear of school outbreak rises as pupils resume

As the schools resume from the mid-term break and the Sallah holiday on Wednesday, there are fears the pupils may be at risk of contracting cholera, a food and water-borne disease caused by the ingestion of the vibrio cholera bacteria.

Public health experts noted that the disease, which broke across the country last week, could spread fast in schools if preventive measures were not in place to prevent it.

Against this background, the Chief of UNICEF, Lagos Field Office, Celine Lafoucrier, has called for extensive measures to protect school children, noting that concerted efforts must be made to prevent disruption in the academic calendar over the spread of the disease.

The Nigeria Centre for Disease Control and Prevention had recently warned the public of the increasing trend of cholera cases as the rainy season intensifies.

The NCDC stated that from January 1 to June 11, 2024, over 1,141 suspected and over 65 confirmed cases of cholera, resulting in over 30 deaths, had been reported from 96 LGAs in 30 states.

The centre noted that the 10 states contributing 90 per cent to the burden of the current cholera outbreak include Bayelsa, Zamfara, Abia, Cross River, Bauchi, Delta, Katsina, Imo, Nasarawa, and Lagos states.

Explaining the need to prevent the disease outbreak in schools, Lafoucrier noted that children faced substantial health risks, particularly those under five, who are prone to severe dehydration and higher mortality rates.

Lafoucrier, according to the News Agency of Nigeria, in a statement on Monday, stated, “Similarly, post-recovery issues in children can include malnutrition, stunted growth, and weakened immune systems, increasing susceptibility to other diseases. These outbreaks underscore the urgent need for improved access to clean water and sanitation in many areas.

“Despite the state government’s efforts to provide water to its population, the current outbreak demonstrates the need for an urgent government focus on ensuring the water provided to the population is clean and risk-free.’’

The UNICEF official said educational disruption is another critical consequence of cholera outbreaks, as an illness and the need to care for sick family members lead to school closures and reduced attendance, hindering children’s learning and development.

UNICEF advises govt

“Addressing the challenges of cholera outbreaks requires a deliberate focus of state policies to provide high-standard water and sanitation facilities, as well as strengthened healthcare systems capable of responding to the demand in times of outbreaks, and state-led educational campaigns on cholera prevention to protect children and the population at large,” she emphasised.

A professor of public health at the University of Ilorin and Consultant Public Health Physician at the University of Ilorin Teaching Hospital, Kwara State, Prof Kayode Osagbemi, said the infection could spread in schools if measures were not taken to prevent it.

Osagbemi said, “There will be gatherings of people in schools, and the moment they (schoolchildren) are sharing items, it can spread. If any of them is infected, it can spread to others, rather than if they are in their homes.

“Generally, the spread in schools is not a major concern, except maybe in boarding houses. In boarding houses, one person infected may infect others through contamination of the water and their food.”

The public health expert noted that the best way to prevent the spread is with the provision of clean food, water, and hand washing among the students.

“So, for now, the students should go with their water bottles, rather than sharing water. Then, there should be hand-washing facilities in the schools, and even in their toilets.

“When they get home, they should wash their hands and take their baths before eating; and within schools, there should be no sharing of things for now, since there is an outbreak,” he explained.

Cholera spreads fast

A Consultant Paediatrician at the Federal Teaching Hospital, Katsina State, Dr Abdurrazzaq Alege, also stated that cholera could spread fast among students due to the rainy season, holidays, and poor hygiene.

“For the fact that children are coming back to school, they will be more exposed to this, especially those of them that are not taking potable water.

“Most of us use municipal water, and even the so-called sachet water that we take, we cannot guarantee the hygiene around it, even the fruits and other food items that we consume. So, coming back to school is a great risk this season,’’ he warned.

The Team Leader/Chief Executive at Q-Impact Medicare, Dr Lekan Adelakun, said the infection could spread fast in schools, calling for preventive measures to curb it.

He said, “Cholera is a very infectious disease, and there has to be a lot of campaigns among the parents, and school owners. The schools too have to create awareness because of the food served in schools, and the vendors who prepare the food.

“Food hygiene is very important. There should be adequate supervision in the preparation and conservation of their food, and make sure they don’t drink contaminated water. If you are taking fruits, you want to be sure they are washed well.’’

An Osogbo-based medical practitioner, Dr Olurotimi Fagbule, said the reopening of schools after the Sallah holiday was a risk factor that must be addressed.

He called for stringent measures to be adopted to prevent the outbreak of the disease in schools as pupils resume.

Fagbule, who said prevention of cholera outbreak was cheaper than any measures to contain it, told parents to monitor closely whatever their wards would eat at home.

“Pupils returning to school after the holidays can be a risk factor. Osun State doesn’t have any suspected case yet but the situation must not be taken for granted,’’ he counselled.

Also, a former Chairman of the Association of Private Medical Practitioners of Nigeria, Dr Tunji Akintade, noted that there is a need to put up preventive measures in schools.

Akintade said, “School resumption is an event. In resumption, there are crowds and they will need water and they are going to be using the water and these are the indicators that encourage the spread of this.

“We need to be proactive. We don’t know the houses the children are coming from, but we do know that a lot of houses are represented in schools and if a child brings in vibrio cholera into the school, it can spread to other children.’’

The Lagos State Health Commissioner, Prof Akin Abayomi, said laboratory tests carried out on samples had confirmed that the identified cholera strain was highly aggressive and contagious, with potential for widespread dissemination.

According to him, through community-based case finding and contact tracing, the number of cases has peaked and is now declining.

Giving an update on the outbreak via his Instagram page @profakinabayomi on Monday, the Lagos State health commissioner noted that through community-based case finding and contact tracing, the number of cases had peaked and was declining.

The geographical distribution of suspected cases by local government areas shows that Lagos Island is the epicentre of the outbreak with 106 cases; followed by Kosofe 49; Eti-Osa 38; Lagos mainland 30; Ojo 17; Ikorodu 16; Kosofe 16; Shomolu 11.

Others are Surulere -nine; Apapa -eight; Mushin -eight; Ifako Ijaiye -eight; Mushin -five; Alimosho -four; Ajeromi Ifelodun -four; Oshodi-Isolo -three; Ikeja three; Ibeju Lekki -two; Badagry -two; Amuwo-Odofin -one.

Abayomi, however, disclosed that there were 17 confirmed cases out of 350 suspected cases and 15 deaths so far.

He said, “Three hundred and fifty suspected cases of cholera were reported in 29 wards across multiple LGAs in Lagos State with 17 confirmed cases and 15 fatalities attributed to severe dehydration caused by delayed presentation.

“We are receiving support from the Nigeria Centre for Disease Control and international partners, including the WHO and United Nations Children’s Fund.

“Local non-governmental organisations are actively raising awareness and conducting community-based surveillance efforts.”

He also said the state was intensifying its public health campaigns in light of the Sallah celebrations and the associated transmission risks from gatherings and catering services, to prevent a resurgence.

“Suspected cases are receiving free treatment at our public health facilities, in line with public health response protocols,” he added.

Meanwhile, the Lagos state government has said it will activate the guidelines used during the COVID-19 era in a bid to curb the spread of the disease.

As schools are expected to resume on Wednesday after the two-day Sallah break, the Lagos State Commissioner for Information and Strategy, Gbenga Omotoso, said an emergency response committee that included representatives from the education sector, met on Monday.

Emergency committee meets

In a telephone interview with our correspondent on Monday, Omotoso said, “The Emergency Response Committee is going to meet this (Monday) evening and the education (team) will be joining the meeting.

‘’The focus is that, since students are going to be resuming from Wednesday, all of the general warnings that we have given to people will also be given to students and all the precautionary measures that we took during the COVID (period), we are going to be activating them.”

Emphasising personal responsibilities, the commissioner said, “People need to wash their hands as many times as possible, wash fruits before eating, drink clean water, avoid open defecation, and so on.”

The Ogun State Commissioner for Health, Dr Oluwatomi Coker, on Monday, confirmed three reported cases of cholera in the state.

Coker said that two of the cases occurred in the Ado-Odo/Ota Local Government which borders Lagos State, while the third case was reported in the Abeokuta South Local Government.

The commissioner said that the people involved in the three cases had also recently been to Lagos State and that no death had so far been recorded

Speaking with The PUNCH, Coker said that “there is however no need for anyone to panic because we have always been on our toes and proactive to combat any kind of epidemic which comes with the rainy season.

“About four weeks ago, we told the residents of the need to properly dispose of their waste as the rain began, and we have since heightened our sensitisation activities urging everyone to maintain proper hygiene.

“We have nurses in our schools who have also increased their pace of sensitising the students and the teachers on the need to prioritize good personal hygiene and proper waste disposal.

“Even for our food vendors, we have a department in the state ministry that has been interfacing with them to ensure that they all keep faith with personal hygiene, ensuring that they operate in a clean environment among others.”

The commissioner in a statement warned residents to watch what they eat and drink and maintain personal,  environmental and food hygiene during the festivities and beyond.

She advises that “Residents should step up regular hand-washing, avoid open defecation and indiscriminate disposal of wastes.

“Having been alerted of the cholera outbreak in the neighbouring states, the state ministry of health deems it fit to step up surveillance and awareness creation to prevent spread to communities in the state.

“Cholera is a serious bacterial infection that can cause severe diarrhoea and dehydration, and if left untreated, can be fatal.”

Meanwhile, the Ogun State Government had on Saturday mandated every house in the state without toilet facilities to construct one within the next three to six months or risk sanction.

The government has equally ordered all public and private schools, markets, parks and garages, petrol stations and mechanic villages across the state to ensure that they have toilets facilities and running water for proper hygiene and sanitation.

The Special Adviser to Governor Dapo Abiodun on Media and Strategy, Mr Kayode Akinmade, disclosed this in a statement sent to journalists on Saturday.

Akinmade stated that the precautionary measures announced to the residents were to prevent any possible outbreak of cholera in the state.

He explained that the governor was seriously concerned about the development and the need to protect the people in the state, considering the proximity of Ogun to Lagos and the degree of interactions between the two states.

The statement read, ‘’Precautionary measures, including the following, have been put in place: All houses must have toilets. Each house without a toilet should identify a room to be converted to a toilet. Residents are given three to six months of grace for compliance.

“All petrol stations must have functional public toilets with running water as part of their corporate social responsibilities. All garages and parks must have functional toilets with running water.

“All markets must have functional public toilets with running water. Mechanic villages must have functional toilets with running water. All schools (public and private) should have public toilets with running water.”

In addition to these, residents were also advised to drink safe water that is boiled or chlorinated; wash their hands with soap and water after visiting the toilet and before handling food; wash fruits and vegetables properly with safe water before eating and preparing food; and cook food properly.

They were also told to buy and eat only hot food and use water from reliable sources, among other precautions.

The statement added that the Ministry of Environment would ensure strict compliance with all the measures as violators would be made to face the wrath of the law accordingly.

As a precaution, the Osun State Government has activated rapid response centres across the 30 local government areas in the state to prevent the outbreak of cholera.

Although the state has not recorded any case of the disease, but speaking with The PUNCH on Sunday, the state Commissioner for Health, Mr Jola Akintola, said the government was not leaving anything to chance in preventing any untoward situation.

He further explained that the sensitization on radio and television sponsored by the government had become necessary since people would be travelling to Osun from states that had recorded cholera cases.

Akintola also said the government has embarked on public sensitization across the state.

“We don’t have any suspected case not to talk of casualties. And as a matter of fact, we are prepared for any outbreak even though we don’t envisage any because we made a release a couple of days ago to sensitize our people, through print and electronic media.

“We have also activated our rapid response centre for public health, as well as emergency management committee. We have replicated that in all the local government areas too.

“After educating and sanitising our people, so we don’t envisage any, and if for any reason, somebody imports it from Lagos or anywhere, we are prepared for it, even though we don’t pray we would have any case here,” Akintola said.

In Ekiti State, the State Health Commissioner, Dr Oyebanji Filani, said on Monday that personnel of the Ministry of Education were being carried along in the efforts to prevent the spread of cholera in schools.

Filani said, “We are taking all steps, we are not leaving any step behind. We have sent out an advisory which has gone out across to different stakeholder groups.

“We are engaging our colleagues in the Ministry of Education so that we can also capture the different schools and inform them appropriately.’’

“We have been to more than 70 community border wards in different places across the state just to ensure that we can sensitize our residents about the issue and that if should there be any concern, they should let us know as quickly as possible,” he said.

The commissioner also said the state has set up an incident management system.

‘’So, far so good, we are ready and prepared and we hope that we do not have it, but should it come, we should be able to manage it,” Filani assured.

To curtail the cholera outbreak and other deadly diseases, the Sokoto State Government disclosed that it had set up a monitoring team in all the schools and public places, including hospitals.

The state Commissioner for information, Sambo Danchadi, while speaking with our correspondent, said the state government was doing everything humanly possible to avert any outbreak of diseases in the state.

He said the Ahmad Aliyu administration, apart from clearing refuse dumping sites within the town, had also cleared drainages, especially within the metropolis.

The Benue State Commissioner for Health and Human Resources, Dr  Yarman Ortese, revealed that the state had an emergency operation that dealt with any eventuality.

He said the emergency operation had been activated to tackle any contaminant anywhere in the state, adding that the state has not recorded an outbreak of cholera.

The Gombe State Epidemiologist, Dr Bile Nuhu, disclosed that the state had constituted a prevention committee.

Nuhu noted that the state had identified 55 hotspots with poor sources of water, making them susceptible to cholera outbreaks.

He said, “The Commissioner for Health Dr Habu Dahiru, has already activated a cholera prevention committee under the chairmanship of Rural Water and Sanitation Agency. As the focal person, the sector lead of Water Sanitation and Hygiene is working to prevent cholera.

“In Gombe, we have 55  hotspots and their sources of water are in four types of well- shallow boreholes, some ponds, and others dig small pits in gullies to get water. These areas are where we used to have cholera in five to six years.”

Nuhu disclosed that by Wednesday, the committee would embark on decontamination of their sources of water, stressing that the exercise would be carried out every two weeks.

On its part, the Delta State government said it had put under control the recent cholera outbreak in the state.

The state Commissioner for Health, Dr Joseph Onojaeme, said currently there was no cholera in the state, adding that the two cases recorded two weeks ago had been put in check.