On 5 October, the field staff deployed by the World Health Organization (WHO), Country Office for Nepal, in Lumbini Province, were notified about a possible acute water diarrheal (AWD) outbreak in Krishnanagar Municipality of Kapilvastu district.
The local-level hospital in Krishnanagar had recorded a surge in the number of people being admitted with symptoms including diarrhea and vomiting.
As the first step to response, WHO field medical officers based in the province immediately traveled to the site of the outbreak in order to conduct a preliminary investigation. This was followed by joint monitoring visits with local health officials and representatives from the Ministry of Health and Population (MoHP).
Preliminary case investigation by a Field Medical Officer from WHO, Country Office for Nepal, at Shivraj Hospital, Krishnanagar, Kapilvastu; Photo Credit: WHO Nepal/C. K. Tamang
To confirm a potential outbreak, samples collected from the field were sent to the Provincial Public Health Laboratory for testing. Only one out of the five samples tested resulted in a positive for vibrio cholerae while the result of the remaining samples couldn’t be determined. WHO, Country Office for Nepal, then facilitated the transport of samples from the field to the National Public Health Laboratory (NPHL) in Kathmandu for further investigation. The results showed detection of vibrio cholera O1 Ogawa in 4 samples among 17.
Facilitation of RDT testing for Cholera and stool sample packaging before dispatch to NPHL, Kathmandu; Photo Credit: WHO Nepal/M. Pradhan
In order to strengthen the response on the ground, staff from the WHO, Country Office for Nepal, along with officials from the Epidemiology and Disease Control Division, MoHP, traveled to Kapilvastu on 7 October, where they have begun field investigations.
Meeting between MoHP, WHO, and local healthcare workers and officials, to strengthen the response to the outbreak at Shivraj Hospital; WHO Nepal/L. Dahal
Along with providing technical support, WHO has dispatched required logistic items including central reference cholera kit which are tailor-made to respond to outbreaks. The kit contains necessary materials such as drugs including ORS, paracetamol, and antibiotics; renewable supplies such as IV canula, Foley catheter, and gloves; logistical items such as cholera bed, basin to collect water, loincloth, documents, and stationery items. This structure supports the local level to manage the cases.
Each kit can treat 100 cases (80 severe and 20 moderate). The handover of the kit is being done in coordination with the District Health Office.
Cases being treated in the open ground during the initial days of the surge at Shivraj Hospital, Kapilvastu; WHO Nepal/M.Pradhan
As the well-coordinated multi-sectoral response is key to containing and preventing outbreaks, staff from WHO, Country Office for Nepal, have been collaborating closely with different partners and health officials for improving access to clean water and sanitation, establishing treatment centers, delivering supplies, and distributing public health guidance.
WHO, Country Office for Nepal, and MoHP are continuing to monitor and respond to the suspected outbreak.