Situation Report #98 on Cholera in South Sudan As at 23:59 Hours, 8 December 2016

Transcription

1 Republic of South Sudan Situation Report #9 on Cholera in South Sudan As at 3:9 Hours, December 6 Situation Update Cholera outbreaks have been confirmed in 9 (3%) of states countrywide. The affected states include Imatong, Eastern Lakes, Jubek, Terekeka, Jonglei, Western Bieh, Northern Liech, Southern Liech; and Eastern Nile (Table and Figure.). Suspect cholera cases have been reported in Mayendit, Panyijiar, and Ayod (Table ). Cumulatively 3 (3.6 %) of the samples tested positive for Vibrio Cholerae inaba in the National Public Health Laboratory as of December 6 (Table 3). Jubek state has recorded,6 cholera cases including 7 deaths (CFR.3 %). No new cholera case was reported in Jubek State during week of 6 (Table and Figure.). Active transmission is ongoing in Bentiu PoC where 63 new cases were reported in week of 6 (Annex ). Ongoing transmission in the PoC is suspected to be associated with exposure to unsecured water reservoirs that are used for washing, bathing and swimming. Table : Summary of cholera cases reported in South Sudan as of December 6 Reporting Sites Jubek Juba Jonglei- Duk New admission s WK New discharges WK New deaths WK cases currently admitted facility deaths community deaths deaths cases discharge d cases ,979, Terekeka Eastern Lakes - Awerial Imatong - Pageri Western Bieh Fangak Northern Liech Rubkona Southern Liech - Leer Eastern Nile - Pigi , 3,39 In Southern Liech (Leer and Mayendit), the response is led by UNIDO although implementation of sustained and comprehensive investigation and response activities continues to be constrained by security concerns. In Pigi, Eastern Nile state, transmission has been contained with the last four cases discharged from Kurwai

2 PHCC on November 6. Cholera was confirmed in Pigi after two cases tested positive by culture on November 6. A least 63 cases including 6 deaths ( health facility and one community) (CFR.9%) have been reported since October 6. Health and WASH activities in Pigi are led by NHDF supported by WHO, UNICEF, and MSF-F. Figure.: Cholera incidence (cases per,) and case fatality rate (%) as of December 6 Cholera Fatality Density Map for cases per population and CFR Weeks - 6 World Health Organization Map Date: December, 6 Manyo Central African Republic Legend xx Case fatality rate (CFR) Counties with Cholera alert Cases per, population No case reported River Raga Aweil North Aweil West Wau Tambura Aweil East Nagero Ezo Nzara Abyei Twic Yambio Sudan Wulu Ibba Pariang Abiemnhom Rubkona Guit Mayom.79 Aweil South Gogrial East Koch Aweil Centre Gogrial West Tonj North Leer Mayendit.3 Tonj East Jur River Tonj SouthCueibet Rumbek Centre Mvolo Yei Democratic Republic of Congo Fangak.9 Rumbek NorthPanyijiar Ayod Yirol East Rumbek East Yirol West Duk.7 Twic East 36. Mundri WestMundri East Maridi Juba Lainya Morobo Panyikang Nyirol Uror Bor South Awerial..3 Fashoda Malakal Pigi.9 Kajo-Keji Terekeka Melut Baliet Lafon Torit Magwi 3. Pageri Uganda Renk Akobo Ikotos Maban Longochuk Luakpiny/NasirMaiwut Ulang Pochalla Budi Pibor Kapoeta North Kapoeta South Ethiopia The boundaries and names shown and the designations used on this map do not imply official endorsement or acceptance by the United Nations. Kilometers Kapoeta East Kenya Figure.: New cholera cases admitted by location in week of Puluk Dongchak Kator Juba Rejaf Munuki Northern Bari Eastern Lakes Nimule Terekeka New Fangak Old Fangak 63 Toch Thonyor Yang Bentiu PoC Bentiu Town Jonglei Jubek Imatong Terekeka Western Bieh Southern Liech Northern Liech Piliny In Eastern Lakes state, cholera cases were reported in Mingkaman IDP settlement. The initial cases were confirmed on August 6, after two of four samples tested postive for Vibrio cholerae Inaba. The cumulative cases are 3 cholera cases including 7 confirmed cases and deaths (one facility and three community) (CFR. %). This outbreak has been controlled with only sporadic cases being reported the most recent being admitted on 6 November 6. In Jonglei state, 9 suspected cholera cases including deaths (CFR.7 %) have been reported from Duk County involving mainly the three Islands of Kawer, Long, and Moldova. The index case was reported on 3 rd July 6 from Moldova Island. Of the five samples from Duk Islands that underwent culturing, one sample from Moldova Island, also the most affected, was confirmed as cholera on 9 July 6. The most recent cases

3 reported in Duk originated from Koyom Island on Nov 6. No additional cases have been reported since then. Figure.: Cumulative cholera cases by payam of residence as at December Puluk Nimule 7 Uganda 9 Dongchak 3 Padiat Pageet Gondokoro Juba Town Kator 37 Lokiliri Mangalla Munuki Northern Bari Rejaf Buko Nyarjwa Lwoki Terekeka Old Fangak New Fangak 7 Mareang Paguir Toch Kolanyang Leer Bentiu Town Dhorbor Piliny Bentiu PoC Leer Town Thonyor Yang kurwai fangak Eastern Lakes Imatong Jonglei Jubek Terekeka Western Bieh Northern Liech Southern Liech Eastern Nile Terekeka state has reported cases of cholera including deaths (CFR 36.%) with samples confirmed by the laboratory to be cholera. All the deaths were reported at the onset of the outbreak from Islands on River Nile where access to health services is poor. No additional deaths occurred after the rapid response team was deployed. The most of the recent cases originated from Kuda village, Lwoki payam, Nyori county on September 6. No additional cases have been reported since then. In Nimule, Imatong state, a cumulative of 9 cholera cases including four laboratory confirmed cases and one death (CFR 3.%) were reported from August 6.The afffected locations in Imatong state included Abila, Malakia, and Motoyo. The last cholera case in Nimule was admitted in Nimule hospital on 9 Sept 6 and discharged on Oct 6. No additional cases have been reported since then. Table.: Cholera cases and deaths by state and county as of December 6 State County Population at risk New cases W Week Weeks - Cases per, population No. cases Cases per, population CFR [%] Western Bieh Fangak 39, Northern Liech Rubkona 6, Southern Liech Leer 67, Eastern Lakes Awerial, Imatong Pageri, Jonglei Duk 6, Jubek Juba 7, Terekeka Terekeka 77, Eastern Nile Pigi, ,6, The cholera outbreak in Western Bieh state was confirmed on September 6 after two of four samples tested positive for Vibrio cholerae inaba. The initial cases were reported on August 6 in Old Fangak. The cumulative cases are 6 cholera cases including 3 confirmed cases and deaths ( facility and zero community) (CFR.9%). As of December 6, the affected areas included Old Fangak (7 cases); New Fangak ( cases); Mareang ( case); Paguir ( cases); Toch (3 cases); and Kolanyang ( case) (Figure.). Three cases were reported from Old Fangak in week of 6. In Northern Liech state, 3 cholera cases including confirmed cases and three deaths (CFR.79%) have been reported in Bentiu Town/PoC since 9 September 6. The cholera taskforce, chaired by MoH and constituted by Health and WASH cluster partners is coordinating the response. The new cases in Bentiu are largely reported among children under two years and in individuals that arrived from Leer, Mayendit, Koch, Panyijiar, and Guit after the oral cholera vaccine campaign in Bentiu PoC. Over 9% of cholera cases in Bentiu PoC did not receive oral cholera vaccine (Annex ). Ongoing transmission is suspected to be associated with exposure to unsecured water reservoirs that are used for washing, bathing and swimming. 3

4 In Southern Liech, two cholera cases originating from Leer Town tested positive for Vibrio cholerae Inaba on October 6. Cumulatively, cholera cases have been reported from Leer in Southern Liech state. Since 7 October 6, at least 3 suspect cholera cases including three deaths have been reported by UNIDO response team in Mayendit. The implementation of sustained and comprehensive response activities in Leer and Mayendit has been constrained by security concerns. To improve access to timely rehydration, at least twenty of twenty-three (9%) oral rehydration points (ORPs) have been set up and are submitting case line list data countrywide. Cholera cases have been reported in seven special populations: Bentiu PoC, UN House PoC, Tongping UNMISS transit site, Gorom Refugee camp, Mahad IDPs, Mangatain IDPs, and among IDPs in Gumbo. The Tongping UNMISS transit site reported cholera cases with one confirmed case and no death, while the UN House PoC has recorded 96 cholera cases with 6 confirmed cases and no death. Cumulatively, 3,39 cholera cases including 6 deaths (6 facilities and 3 community) (CFR.%) have been reported in South Sudan involving 9 states since the initial case was reported on June 6 for Jubek state; 3 rd July 6 in Jonglei state; July 6 for Terekeka state, August 6 for Eastern Lakes and Imatong states; August 6 for Fangak in Western Bieh and state; 9 September 6 for Rubkona in Northern Liech state; October 6 for Leer in Southern Liech state; and October 6 for Pigi in Eastern Nile state (Figure. and Table.). As seen from Figure. there was a spike in cholera transmission in weeks 3- that was attributed to transmission in Bentiu PoC where most cases were < years of age and did not receive oral cholera vaccine. Figure : Epidemic curve for cholera cases in South Sudan, from June - December % % Number of cases 6.9% % 3.% 3.3% 3.6% 97.%.9%.%.6%.% 3.6% 3.6%.9%.%.%.%.%.%.%.9%.%.%.% 3.%.% % Epidemiological week of onset Jonglei Jubek Terekeka Imatong Eastern Lakes Western Bieh Northern Liech CFR[%] Southern Liech Eastern Nile % % CFR % Figure 3: Cholera case distribution by gender and age in Jubek State December 6 3 Cholera - age and sex distribution Jubek up to Dec Under Adult

5 Out of the 6 cholera cases in Jubek State, (.%) were female, while (7.6%) were male Figure 3: Cholera case distribution by gender and age in Jonglei State December 6 6 Cholera - age and sex distribution Jonglei up to Dec Under Adult Data on Age missing for cases Out of the 9 cholera cases, in Jonglei State (3. %) were female, while (6.%) were male Figure 3:3 Cholera case distribution by gender and age in Eastern Lake State December Cholera - age and sex distribution Eastern Lakes up to Dec Under Out of the 3 cholera cases, in Eastern Lake State (3%) were female, while (7 %) were male. Figure 3: Cholera case distribution by gender and age in Western Bieh State December 6 6 Cholera - age and sex distribution Western Bieh up to Dec 6 3 Under Adult Blank Out of the 6 cholera cases, in Western Bieh State 7 (6 %) were female, while 9 (3 %) were male.

6 Figure 3: Cholera case distribution by gender and age in Southern Liech State December 6 6 Cholera - age and sex distribution Southern Liech up to Dec Under Out of the cholera cases, in Southern Liech State (33 %) were female, while (67 %) were male. Figure 3:6 Cholera case distribution by gender and age in Northern Liech State December Cholera - age and sex distribution Northern Liech up to Dec Under Out of the 3 cholera cases, in Northern Liech State 7 (.3 %) were female, while 7 (.7 %) were male. Figure 3:7 Cholera case distribution by gender and age in Eastern Nile State December Cholera - age and sex distribution Eastern Nile up to Dec Under Adult Blank Out of the 6 line listed cholera cases, in Eastern Nile State (.6 %) were female, while 3 (9. %) were male. 6

7 Table : Case distribution by gender in South Sudan December 6 State Grand Eastern Lakes 3 Imatong Jonglei 9 Jubek 6 Terekeka 3 9 Western Bieh Northern Liech Southern Liech Eastern Nile 3 6 Grand 339 The probable risk factors fueling transmission include: using untreated water from the River Nile and water tankers; lack of household chlorination of drinking water; eating food from unregulated roadside food vendors or makeshift markets; open defecation/poor latrine use especially following the conflict. Laboratory updates Table 3: Cholera laboratory test results for Juba by December 6 Culture results State New positives in Cumulative Cumulative tested week Positive Negative Eastern Nile Jonglei Jubek Terekeka Eastern Lakes 7 3 Imatong 7 Fangak Wau 6 6 Boma Northern Liech Southern Liech Eastern Nile (Pigi) 7 tested Table : Cholera Alerts Date of Details of the alert notification No alerts 3-Sept- From -7 Nov, the MedAir 6 team responded to 7 suspect cholera cases including deaths in Wiechdeng, Ayod. One case tested positive on cholera RDT. Area Wiechdeng, Ayok county, Southern Bieh state Action MedAir responded to suspect cholera cases in Wiechdeng by setting up a bed CTU. 7

8 - Oct-6 UNIDO reported 3 suspect cholera cases including three deaths 6-Oct-6 In Panyijiar suspect cholera cases including 3 deaths have been reported in Ganyliel; Nyal; Tayar. Of these, cases including three deaths reported by Ganyliel PHCC. The initial case seen on Oct 6 involving a trader from Duk. Cases have also been reported in Nyal PHCC (7 cases in total since 7 Oct 6). 3 Dec 6 Yirol East County Health Director reported three suspect cholera cases including two deaths in Nyluel. Thaker, Tutnyang, & Leah Payams, Mayendit North, Southern Liech state Ganyliel, Tayar, Nyal, Panyijiar, Southern Liech Nyluel, Yirol East UNIDO is the healthcare partner responding to suspect cases in Mayendit. Security concerns have constrained comprehensive and sustained interventions. Facility and community based response is ongoing with cases being managed in Ganyliel PHCC with support from IRC and Nyal PHCC. Laboratory confirmation of cases is still pending. Yirol East RRT to investigate these cases and search for additional cases in this area including sample collection from suspect cases and close contacts to suspect cases. Cholera Response Activities Overall coordination of the cholera response at the national level is coordinated by the National cholera taskforce to review outbreak trends and progress of implementation activities. Security concerns have remained a major impediment to the implementation of sustained and comprehensive cholera investigation and response activities in Leer and Mayendit. Cholera case management is ongoing at the designated cholera treatment facilities in the nine affected states. As cases decline in the affected areas, laboratory surveillance has been strengthened to ensure that all suspect cholera cases undergo rapid diagnostic testing and stool culturing to confirm cholera. WHO has therefore supported the partners operating cholera treatment facilities with ample supplies for sample collection, onsite rapid diagnostic testing, and shipment to the National Public Health Laboratory for culturing. WHO is supporting the cholera investigation and response activities in all the nine affected states and the two states with alert suspect cases. Core to WHO s support to the current cholera response is technical support to the taskforce committees by providing updated situation reports; supporting the investigation and testing of suspect cases; support towards case management activities through trainings on cholera case management protocols; recommending tailored strategies in response to emerging trends; and support for the outbreak evaluation process that is already underway. WHO technical officers are currently deployed in Mingkaman; Bentiu, Bor, Malakal, Imatong, and Juba to support the ongoing response activities. UNICEF continues to support the Cholera response at the community level across all relevant sectors of Health, WASH, and communication through active partnerships with following implementing partners: Health Link South Sudan (HLSS), LiveWell, ACROSS, CAPIAD, THESO, BEDN, IMC, RUWASSA, SMC, NHDF, UNIDO, World Relief, and ARUDA. In Bentiu, the weekly cholera taskforce meetings take place weekly on Wednesdays to coordinate preparedness and response activities. The implementation of the integrated case-centered approach is ongoing with at least,3 doses oral cholera vaccines deployed to augment the response. Ongoing transmission is suspected to be associated with exposure to unsecured water reservoirs that are used for washing, bathing and swimming. Security concerns continue to be the main impediment for a sustained and comprehensive response in Leer and Mayendit. In Panyijiar; at least 7 suspect cases including three deaths have been reported in Ganyliel; Nyal; and Tayar. WHO and UNICEF have supported IRC, UNIDO, and Sign of Hope to respond to the suspect cases. In Fangak, MSF France is running a CTC in Fangak town where cholera cases are being managed. The health and WASH clusters have mobilized additional partners Hold the Child and ACF to support the community

9 interventions including establishment of ORPs, community health education, hygiene promotion and support for personal hygiene and chlorination of water at water collection points. In Pigi; cases are being managed in Kurwai PHCC by Nile Hope with support from WHO, UNICEF, and MSF-F. At least 6 cases including six deaths of cholera have been reported. The cases have been on the decline and by December 6, there were no cholera cases admitted in the treatment center. The last four cases were discharged from Kurwai PHCC on November 6. Planned Activities. The next weekly EPR/cholera taskforce meeting is scheduled for December 6 starting :pm in the WHO Conference Hall.. Continue social mobilization activities, active case surveillance, and street announcements with open van, house to house awareness and distribution of WASH supplies by HHPs in affected and at risk 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: as well as on the Humanitarian Info webpage: 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: outbreak_ss_7@yahoo.com, The Toll free number for Vivacell calls is:. Contacts For more information, please contact Dr. John Rumunu Director General - Preventive Health Services MoH, Republic of South Sudan Tel: Dr. Alice Igale Ag. Director - IDSR MoH, Republic of South Sudan Tel:

10 Annex : Cholera distribution in Bentiu PoC as of December 6 Annex.: Cholera case distribution by time in Bentiu PoC December 6 Epidemic Curve for cholera in Bentiu PoC as of 9 Dec 6 3 /6/6 //6 //6 //6 //6 /6/6 //6 /3/6 //6 /3/6 //6 /7/6 /9/6 //6 /3/6 //6 /7/6 /9/6 //6 /3/6 //6 /7/6 /9/6 No. cases //6 Date of onset Annex.: Cholera age and sex distribution in Bentiu PoC as of December 6 9 Cholera - age and sex distribution Northern Liech up to Dec Under Adult Blank Annex.3: Cholera case distribution by sector in Bentiu PoC as of December Sector Sector Sector 3 Sector Sector (blank) New arrival Referral Camp Area of Residence