Kenya is among top 10 countries in Africa burdened by the cholera outbreak, a situation that might worsen as the El Nino rains start.
The disease has killed 202 Kenyans, the latest figures show.
The World Health Organization said Kenya has the seventh-largest outbreak in Africa, and it might worsen.
The country has only a few weeks to stop this happening.
"As we are getting into the last months of the year, the seasonality of cholera outbreaks are issues for countries to consider and there is need to enhance preparedness and readiness," WHO said in its latest weekly epidemiological report.
The current cholera outbreak began last October in Kiambu, and it is still active.
Health experts also said mosquitoes come 10 to 14 days after heavy rains begin.
"Mombasa has had outbreaks of Dengue alongside malaria in the past. Dengue has come back and it's worse than malaria," said Dr Richard Ayah, a public health expert from the School of Public Health at the University of Nairobi.
He said while Nairobi has been malaria-free for many years, the disease is making a comeback.
"This means stagnant water should be gotten rid of in the estates. People should be proactive about this. This should be a community effort. Mosquitoes come 10-14 days after rains start so from mid-October we could start seeing more insects. People should also cut tall grass," he said.
WHO appeared keener on waterborne diseases because they are infectious and spread fast.
Its latest epidemiological report shows Kenya has reported 12,102 cases of cholera since February this year.
The case fatality rate in Kenya is 1.7 per cent.
The country is also among the 12 in Africa where transmission is ongoing and new cases are being reported.
"Poor sanitation and unreliable water supplies with increased cross-border movements continue to serve as driving factors for the outbreak across the region," WHO said.
The comprehensive cholera statistics for 2022, also published by the WHO, did not place Kenya among the top countries.
According to Kenya’s Ministry of Health, the outbreak in Kenya is still active.
A medical epidemiologist at the ministry, Emmanuel Okunga, two weeks ago said 26 counties reported cases since the outbreak last year.
"Timely detection of cholera cases and prompt initiation of treatment is key in reducing morbidity, mortality and containing transmission," he said.
While data for cholera remain inadequate in most countries, cases reported to WHO in 2022 were more than double those in 2021. Forty-four countries reported cases, a 25 per cent increase from the 35 countries that reported cases in 2021, WHO said.
“The larger the outbreak, the harder it typically is to control,” WHO said in a statement.
Cholera is an acute intestinal infection that spreads through food and water contaminated with faeces containing the bacterium Vibrio cholerae. It is closely linked to the lack of adequate safe water and sanitation, due to underdevelopment, poverty and conflict.
Climate change too is playing a role in this upsurge as extreme climate events like floods, droughts and cyclones trigger new outbreaks and worsen existing ones.
Dr Kepha Ombacho, a former long-serving head of public health at the Ministry of Health said any El Nino rains-related interventions should cover human life, property, animals and infrastructure.
He said the government and individuals have a role to play.
"There is likely to be contamination of clean water sources by latrines, sewer lines, and drainage; treatment works will overflow and may mix water sources such as rivers," Ombacho told the Star.
"All people, the government must work together to ensure we mitigate the problems likely to come. At big levels like treatment works there should be a stocking of chemicals for the treatment of water."
"Agencies like water services should make channels to divert contaminants. People and authorities downstream rivers such as Tana, and Nyando should dig channels to prevent water going to houses."
Ombacho served as head of environment health at the ministry until 2022.
He said families have always been displaced during floods.
Ombacho said county and national governments must have strategies for how such people can be helped.
"There must be food stockings and sanitary items. There must also be temporary housing. But at the community levels, community health promoters must continue sensitising the people about the envisaged problem and provide simple solutions so people don’t panic," he said.
"Planners should stock about and identify the sources of drugs in case of outbreak."
The increased demand for cholera materials has been a challenge for disease control efforts globally, according to the WHO.
Since October 2022, the International Coordinating Group—the body which manages emergency supplies of vaccines—has suspended the standard two-dose vaccination regimen in cholera outbreak response campaigns, using instead a single-dose approach.
WHO said it has appealed for $160.4 million (Sh23.4 billion) to respond to cholera through the global strategic preparedness, readiness and response plan. $16.6 million (Sh2.4 billion) was released from the WHO Contingency Fund for Emergencies for cholera response in 2022 and 2023.
The current outbreak of cholera in Kenya started on October 19, 2022, at a wedding in Kiambu county and later spread across Kiambu, Nairobi, Murang’a, Kajiado Nakuru and Uasin Gishu counties.
According to data from the ministry, Garissa has recorded the highest number of cases with 2,853, Mandera 2,264, Nairobi 2,177, Wajir 945, Tana River 780, Kiambu 539, Machakos 491, Kajiado 398, Homa Bay 335, Mombasa 210, Siaya 162, Meru 138, Uasin Gishu 137 and Marsabit 112.
Other counties include Samburu with 60 cases, Kisumu 56, Nyeri 55, Murang'a 46, Isiolo 31, Kitui 27, Kirinyaga 17, West Pokot and Kwale 16 cases each, Nakuru 15, Busia 11 and Bomet with six cases.
The first campaign was conducted between February 11 and 20 targeting two million people in four counties of Garissa, Wajir, Tana River and Nairobi which had been mapped as high risk.
Public Health Principal Secretary Mary Muthoni said Kenya surpassed its target of vaccinating 1.59 million people in eight high-risk counties during its second 10-day oral cholera vaccine campaign that ran from August 3 to August 13 this year.
"The commitment to proactive public health strategies remains strong, with plans in place for preventive Oral Cholera Vaccine campaigns throughout 2024. This initiative aims to encompass all high-risk counties over a comprehensive three-year period, emphasizing Kenya's dedication to sustained public health enhancements," she said.
According to the ministry, sustained efforts by various stakeholders in the health sector have seen the outbreak contained in 23 out of the 26 counties.
There is an active outbreak of the disease in Mandera, Wajir and Nairobi.
Cholera is caused by ingestion of food or water contaminated with the bacterium Vibrio cholerae.
It takes between 12 hours and five days for a person to show symptoms after ingesting contaminated food or water.
Experts have warned that 75 per cent of cases will not show signs hence infected people may pass the disease to others without knowing.
Among people who develop symptoms, the majority have mild or moderate symptoms, while a minority develop acute watery diarrhoea with severe dehydration. This can lead to death if left untreated.
"If treated quickly you will recover but if left untreated it can easily kill you within minutes, rapidly devastating communities and nations," Ombacho said.