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Republic of South Sudan
Cholera in South Sudan
Situation Report # 65 as at 23:59 Hours, 20 July 2014
Situation Update As of 20 July 2014, a total of 4,668 cholera cases including 106 deaths (CFR 2.3%) had been reported in South Sudan as summarized in Tables 1 and 2. Table 1. Summary of cholera cases reported in Juba County, 23 April - 20 July 2014
Reporting Sites New
admisions today
New discharges
today
New deaths today
Total cases currently admitted
Total facility deaths
Total community
deaths
Total deaths
Total cases discharged
Total cases
JTH CTC 5 0 0 12 16 0 16 1378 1404
Gurei CTC 0 0 0 1 2 0 2 358 361
Tongping CTC 0 0 0 4 2 1 3 56 63
Jube 3/UN House CTC 2 1 0 11 0 0 0 48 59
Nyakuron West CTC Closed 15 July 0 0 0 18 18
Gumbo CTC Closed 5 July 0 0 0 48 48
Nyakuron ORP Closed 5 July 0 0 0 20 20
Munuki ORP Closed 5 July 0 0 0 8 8
Gumbo ORP Closed 15 July 0 3 3 67 70
Other sites 0 0 0 0 1 14 15 1 16
Total 7 1 0 28 21 18 39 2002 2067
N.B. To prevent double counting of patients, transferred cases from ORPs to CTCs are not counted in the ORPs.
Table 2: Summary of cholera cases reported outside Juba County, 23 April – 20 July 2014
States Reporting Sites New
admisions today
New discharges
today
New deaths today
Total cases currently admitted
Total facility deaths
Total community
deaths
Total deaths
Total cases discharged
Total cases
CES Kajo-Keji civil hospital 0 0 0 3 1 2 3 48 54
Yei Hospital 0 0 0 0 0 2 2 45 47
WES Lanyi- Mundri East 0 0 0 0 0 0 0 3 3
Jonglei Kolmanyang, Bor 0 0 0 0 0 0 0 1 1
EES
Nimule Hospital 0 0 0 1 0 0 0 22 23
OTC PHCC, Magwi 0 0 0 5 8 0 8 121 134
Magwi PHCC* 0 0 0 0 0 0 0 1 1
Pajok PHCC, Magwi 0 0 0 1 0 0 0 0 1
Torit Hospital 0 0 0 41 7 9 16 851 908
Idali PHCU, Lafon 1 1 0 0 4 0 4 89 93
Bur Mutram PHCU, Bur Payam, Torit
0 0 0 7 0 1 1 63 71
Ohiri PHCC, Bur Payam, Torit
0 0 0 10 3 0 3 43 56
Ohila PHCC, Bur Payam, Torit
0 0 0 10 0 0 0 0 10
Imurok PHCU, Imurok Payam, Torit
0 0 0 4 2 0 2 2 8
Hiyala PHCC, Torit 0 0 0 23 0 0 0 88 111
Olere PHCU, Imurok Payam, Torit
0 0 0 0 0 0 0 4 4
Osito PHCU, Bur payam, Torit
0 0 0 17 0 0 0 26 43
Ileu PHCU, Hiyala payam, Torit
0 0 0 50 7 0 7 19 76
Hileu PHCC, Himodonge Payam, Torit
0 0 0 0 0 0 0 4 4
Ofiri PHCU, Kudo Payam, Torit
0 0 0 0 0 0 0 5 5
Kudo PHCC, Kudo Payam, Torit
9 0 0 29 1 0 1 15 45
Other sites 0 0 0 0 0 1 1 18 19
Upper Nile
Kaka 0 0 0 0 0 0 0 0 1
Wau Shilluk, Malakal 0 0 0 134 16 1 17 678 829
2
States Reporting Sites New
admisions today
New discharges
today
New deaths today
Total cases currently admitted
Total facility deaths
Total community
deaths
Total deaths
Total cases discharged
Total cases
Malakal PoC 0 0 0 0 2 0 2 52 54
Total 10 1 0 335 51 16 67 2198 2601
*No reports from EES and UNS were received for the 19th
Figure 1: South Sudan cholera epidemic curve, 23 April– 20 July 2014
Figure 2: Central Equatoria State (Juba/Kajo-Keji/Yei counties) Epicurve, 23 April– 20 July 2014
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Figure 3: Distribution of cases by place of residence, Juba County, 14 –20 July 2014
Figure 4: Central Equatoria State (Juba/Kajo-Keji/Yei counties), 14 – 20 July 2014
Figure 5: Eastern Equatoria State (Lafon, Magwi, Torit counties) cholera epidemic curve, 10 June –20 July 2014
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Figure 6: Distribution of cholera cases by age and sex, Eastern Equatoria State, 14 - 20 July
Figure 7: Upper Nile State (Malakal County) cholera epidemic curve, 30 June –20 July 2014
Figure 8: Upper Nile State (Malakal County) distribution per age/gender, 30 June – 20 July 2014
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Table 4. Cholera alerts reported between 1 to 20 July 2014 Date of notification
Details of the alert Area Action
06/07/2014 A suspected cholera case was reported to a health facility close to Lobonok hospital
Lobonok, Juba County, Central Equatoria State
Case verification is underway by Juba county surveillance team. Since the health facility lacked ringer’s lactate; the health facility in-charge was advised to secure them from the nearby Lobonok hospital as arrangements are made to secure fluids for the facility.
05/07/2014 The number of suspected cholera cases in Malakal PoC remains at 53 with two deaths in the last three days.
Malakal PoC Cholera cases are being managed in the MSF CTC in the PoC. Health Cluster meetings are ongoing to coordinate the response. Active surveillance and contact tracing remain a priority in PoC 2&4. Laboratory test results for the four samples sent to the National Reference Laboratory are pending. Two epidemiologists from the WHO are on the ground to support response efforts.
05/07/2014 The number of AWD (suspect cholera cases) in Bol PHCU/CTC has risen to 20 cases with 6 deaths.
Bol, Lul Payam, Fashoda county, Upper Nile State
The set up of MSF and ICRC CTC in Bol has been completed and another in Kodok. Health partners including MSF, CORDAID, & ICRC together with Fashoda county health department team are coordinating preparedness & response efforts through regular health cluster meetings. WHO supported the response with one DDK kit, cholera RDTs, and Cary Blair media.
01/07/2014 A total of 51 suspected cases including two deaths have been reported from at least five payams in Kapoeta North County. There are three patients admitted in Irwoto PHCC CTC
Kapoeta North, Eastern Equatoria State
Case management is ongoing in Irwoto PHCC/CTC where three patients are currently admitted. Laboratory test results for the three samples submitted to the National Public Health Reference Laboratory are still pending.
Surveillance and laboratory An investigation is under way to determine reasons behind the increasing number of cases of cholera
among children under five years of age. Analysis is ongoing and laboratory samples are being collected to confirm cholera.
A review is ongoing to assess factors responsible for the persistent high number of new suspected cholera cases in Tongping & Juba III IDP camps, and other sites like Gumbo, and New Site.
The cholera cases control study in ongoing, and currently case enrollments and environmental assessments are being undertaken.
Cholera risk mapping and caseload estimates are on course and will be presented to the cholera taskforce soon for discussion and approval.
Results of 52 samples were received from the National Public Health Laboratory. Forty four percent (44%), (23/44) were positive and the rest were negative. Six (6) of the positive samples were in children under five years. Three (3) samples were rejected due to inappropriate packaging and/or lack of accompanying documentation.
A total of 152/367 (41%) of samples received have tested positive for cholera positive.
Social mobilization This week, social mobilization activities were implemented in various parts of the county, through a number of strategies listed below:
In Central Equatoria State: In addition to covering Juba town, State Ministry of Health has been working with 106 social
mobilizers in other payams of Juba county. o Forty five trained Social mobilizers in Lokiliri, Lirya and Lobonok payams conducted house-to-
house activities that reached 5,097 households. o Seventy trained social mobilizers in the six western payams of Juba County covered a
cumulative total of 14,220 households through house-to-house mobilization activities and 49 community meetings.
o Activities in schools in the state and street announcements are ongoing in high-risk areas. To date, 155 community meetings have been conducted, reaching 116,251 HHs and 146 schools in Juba county.
6
In Eastern Equatoria State:
o Radio campaigns on hand-washing, early reporting of symptoms and cholera prevention and control practices continue. To date 7,099 HHs have been reached, and 16,890 chlorine tablets, 1,330 tablets of soap and 10,762 PUR sachets distributed by 242 social mobilizers.
In Jonglei: o Cholera sensitization campaigns reached 50 religious leaders, 20 women and 10 men. An
additional 60 community leaders were reached through six meetings conducted by Bor county health department with village health committees at Baidit, Jalle, Akuai Deng PHCUs.
o Radio spots continued to be broadcast daily, eight times on FM 95.7 Radio Jonglei.
In Upper Nile o Four hundred eighty posters, 32 banners, 300 hand washing stickers and 50 job aids were
distributed in Fashoda and Renk counties. o In Malakal POC, house-to-house social mobilization and cholera awareness sessions in
public places were conducted. o In Wau Shilluk, a meeting with 12 chiefs was conducted. In addition, a one-day session on
cholera prevention and control and demonstration of water treatment using PUR was conducted with 30 women. Four hundred and eighty (480) sachets of PUR were handed-over to them.
In Mingkaman, 678 households have benefitted from cholera prevention and control and reached to date.
In Bentiu, Unity state, 2,535 families have been reached with cholera awareness messages, 1,564 soap and 6,188 PUR sachets distributed by 112 trained volunteers.
WASH This week, WASH partners continued to respond in the hotspot areas around the country: In Upper Nile State:
Wau Shilluk: Safe water has been provided to cover needs of 39,000 IDPs, in addition the distribution of jerry cans and soap is ongoing. 100 defecation trenches have been constructed, while the construction of 700 latrines started. The constructions of latrines in the CTC have been completed. Disinfection stations are being installed at entry/exit points to contribute to the containment of the epidemic.
Malakal POC and town Safe water is being provided to POC and town reaching 27,000 beneficiaries including the hospital. A hygiene promotion campaign is ongoing in hot spots, alongside distribution of soap and jerrycans. Disinfection is being conducted at entry/exit points to try and reduce the spread of cholera to other localities.
Kodol/Lul: Water is being provided for Kodol and Lul, benefitting about 41,000 people. WASH support is being provided at the CTCs and ORPs, in addition disinfection points have been set up at entry/exit points.
In Eastern Equatoria State:
Torit: Drilling and the repair of two boreholes and 22 hand pumps is ongoing in Torit county. A total of 126, 231 people have been reached through hygiene campaigns. Over 200 volunteers have been trained, including 50 teachers to conduct hygiene promotion activities. Targeted distribution of soap, PUR, ORS and Aqua tabs on going. Latrines have been constructed in strategic points such as ORS points (12 completed) CTCs and schools, some latrines being constructed at household level.
Lopa/Lafon and Kapoeta North/Magwi: WASH interventions in health structures is being ensured by
partners. Hygiene promotion and chlorine distribution to ensure safe drinking water at household level is on-going in neighborhoods. Technical assistance and capacity building is being provided to affected communities. Training of teachers has been conducted to assist in hygiene promotion in schools and community.WASH partners are supporting mobile government task force working in the repairs of boreholes/handpums in hot spots out of Torit county.
In Central Equatoria State:
Juba: Areas of coverage are being redistributed amongst partners. Activities including hygiene promotion targeting cholera hotspots and communal areas, provision of water purification tablets, trucking of safe water trucking to targeted areas are ongoing.
7
Yei: Hygiene promotion campaigns in cholera awareness and control with distributions of chlorine products and soap has been implemented.
In Bentiu, Unity state WASH activities, especially hygiene promotion, have been scaled up.
Gaps and needs Surveillance and laboratory Inadequate community surveillance activities including active case finding Reporting by health facilities still needs to be strengthened Incorrect filling of laboratory forms Delay in receiving laboratory results
Case management Increase the number of ORPs and monitor the quality of Increase cholera management capacity outside Juba WASH In Eastern Equatoria State: Supply (Pur, aqua tab and ORS) are in short supply. The coverage of hygiene
and sanitation promotion coverage outside Torit town is very limited. Limited partner capacity/presence remains a challenge in the scale up of response activities. In addition, new suspected cases in new counties are not clustered, further complicating the response in those areas.
Open defecation continues to be widely practiced, combined with the limited availability of safe water, is one of the most important risk factors for the spread of the cholera to new areas.
Recommendations
Continue to enhance Water, Sanitation and Hygiene, surveillance and case management interventions in hotspot areas.
Continue to active surveillance and rapid response to new alerts in all areas.
Many thanks to the staff at CTCs, MoH at national level and state levels, especially the Department of IDSR, who have helped to gather the information presented here. Situation Reports are posted on the WHO website: http://www.who.int/hac/crises/ssd/en/ as well as on the Humanitarian Info webpage: http://southsudan.humanitarianresponse.info/clusters/health.
The MoH/WHO surveillance team welcomes feedback and data provided by individual agencies. Given the fast evolving nature of this epidemic, errors and omissions are inevitable: we will be grateful for any information that helps to rectify these. Send any comments and feedback to: E-mail: [email protected], The Toll free numbers for alerts are: Gemtel: 9999, Vivacell: 0952000098 and Zain: 0912000098.
Contacts For more information please contact:
Dr. Pinyi Nyimol Mawien Director General - Preventive Health Services MoH, Republic of South Sudan Tel: +211955604020
Dr Othwonh Thabo Ag. Director - IDSR MoH, Republic of South Sudan
Tel: +211 0954082015
