Dr. Stéphane Hugonnet is a medical epidemiologist. He works in the Emergencies Programme at WHO headquarters in Geneva in the Department of Surveillance, Risk Assessment and Information Management. He was deployed to Mozambique to strengthen the surveillance system and lead a team working with local, national authorities and partners to set up a surveillance system to detect potential epidemics as quickly as possible. At the time of his deployment, he and his team were facing a serious cholera outbreak that has already begun as well as high risks of disease outbreaks of measles, typhoid and possibly polio, which remains a problem in the region.

”We try to reinforce a system that will be as sustainable as possible even once the bulk of the emergency has passed.”

What is the epidemiological situation in the area affected by the cyclone?

After a natural disaster like this, infrastructure, especially health centres, are often destroyed. There is disruption to the supply and delivery of food and medicines.

There is water everywhere, which carries a significant risk of all kinds of diseases, such as diseases that are transmitted or related to water such as cholera, typhoid and hepatitis.

Also, the presence of water creates mosquito breeding sites and increases the risk of diseases such as malaria, dengue and chikungunya, which are already prevalent here.

So, it is very important to detect these diseases in order to be able to intervene appropriately, either with vaccination or through the distribution of impregnated mosquito nets and medicines - especially for malaria, which is probably the most significant disease risk.

What are the biggest challenges currently?

The challenges are essentially that the territory and affected area are extremely wide and access is limited. Fortunately, logistical support by land and air is extremely useful.

The other challenges are obviously the infrastructure and disease surveillance system as well as the state of the health system even before this natural disaster.

So we work a lot to provide materials and teams needed to work on training. We try to build a system that will be as sustainable as possible even once the bulk of the emergency has passed.

And of course, one of the most important current challenges is the response to the cholera outbreak.

What is the state of the cholera epidemic?

The area that has been affected by this cyclone is an endemic region for cholera, there are regular outbreaks. Obviously with the destruction of infrastructure and floods and contamination of drinking water, the risk of cholera was extremely high and there was a cholera outbreak in four districts.

The response to it was extremely fast with mass vaccination. Today, 10 days after the start of the vaccination we have the impression, although it may be early to say, that the epidemic has reached a plateau and we hope to see in the coming days the impact of the vaccination.

What technology do you use that allows you to do this work even after a natural disaster?

Epidemic disease surveillance is one of the main activities that is supported and reinforced by WHO. In order to be able to detect events quickly so we can intervene as quickly as possible, we need to set up systems so information is collected in a standardized way, transmitted as quickly as possible and analyzed and reported to those who can put control measures in place.

And to do this, we have a tool called EWARS in a box, which is a mobile phone system that is used at the health centre level to capture information on cases of different diseases that go directly into a central database. We can do analysis extremely quickly and respond to all kinds of alerts in the space of minutes or hours.

This system is now being introduced in three districts - the fourth district at the moment - in about 80 government health centres, plus cholera treatment centres, plus emergency centres.