Republic of South Sudan

Transcription

1 Republic of South Sudan CHOLERA SITUATION AND RESPONSE UPDATES 8 DECEMBER 217 Epidemic trends One new cholera case reported from Ngauro in Budi during week 48 of 217 (Table 1). Four new cholera cases reported from Juba in week 48, 217 No new case confirmed in week 49 (Table 4). Table 1: Cholera cases by county for weeks 46, 217 to 49, 217 County Date first reported New during reporting period Cases reported Cumulative Number of cases (attack rate per 1,) New during reporting period Community Deaths Cumulative Facility Facility+ Community Juba 18Jun16 4 2, Budi 22Jul Cholera transmission has declined significantly with only sporadic transmission reported in Budi and Juba counties (Table 1 and Figure 1). CFR% Number of cases Fig.1 Cholera cases by county, week 4649, Budi Juba Epidemiological week of onset Cholera transmission has reduced significantly in Juba with four cases reported in week 48 from New Bongo (2 cases), Hai Mayo (1 case), and Hai Malakia (1 case). The cumulative for Juba stands at 2957 cases including 38 cases (CFR 1.29%). The recent transmission upsurge in New Bongo has been contained. 1

2 Number of cases/deaths Fig.2 Cholera Epidemic Curve for Juba County, week 23, 216 to week 49, 217 Alive Died CFR% Epidemiological week of onset 217 8% 6% 4% 2% % CFR% Fig.3 Cholera cases by village in Juba county, week 4648, Number of cases WK 46 WK 47 wk Name of vilage in Juba county Number of cases/deaths Fig.4 Cholera Epidemic Curve for Budi County, week 23, 216 to week 49, Epidemiological 217week of onset Alive Died CFR% 1% 8% 6% 4% 2% % CFR% A cumulative of 856 cases including 83 deaths [CFR 9.7%] have been reported in Budi since week 29, 217 (Table 1 and Figure 4). Overall, males (54.6%) are more affected than females (43.9%) in Budi county. Male children and male young adults are more affected than their 2

3 female counterparts of corresponding age (Figure 5). The outbreak in Budi started on 28 July 217 with the initial transmission occurring among goldminers in Ngauro. 884yrs 774yrs 664yrs 554yrs 444yrs 334yrs 224yrs 114yrs 4yrs Figure 5 Cholera case distribution by age and sex in Budi, June 216 Nov Percentage % Yirol West Yirol East Tonj North Tonj East Terekeka Rubkona Renk Panyijiar Nyirol Mayom Mayendit Malakal Magwi Leer Kapoeta South Kapoeta North Kapoeta East Juba Fashoda Fangak Duk Canal Pigi Budi Bor Ayod Awerial Fig.6 Cholera cases per 1, by county in South Sudan, 216 and cholera cases per 1, population

4 Overall cholera trends Since the start of the current outbreak on 18 June 216, a total of 21,571 cases including 462 deaths (CFR 2.14%) have been reported from 27 counties (Table 2). The most affected counties include Ayod, Tonj East, Yirol East, Fashoda, Kapoeta East, and Kapoeta South (Figure 6). The most affected populations in these locations include: Landing sites/ towns along River Nile; cattle camp dwellers; populations living on islands no social services; and IDPs recently displaced with inadequate access to WASH. Yirol West Yirol East Tonj North Tonj East Terekeka Rubkona Renk Panyijiar Nyirol Mayom Mayendit Malakal Magwi Leer Kapoeta Kapoeta Kapoeta East Juba Fashoda Fangak Duk Canal Pigi Budi Bor Ayod Awerial Fig.7 Cholera cases fatality rate (%) by county in South Sudan, 216 and 217.%.%.% 1.1% 2.9% 2.8% 1.5% 3.1% 3.4% 3.2% 1.%.1% 1.2%.8% 1.5% 1.6%.8% 3.% 2.1% 3.% 1.% 1.1% 2.5% 4.5%.8% 6.2% 8.7% 1.1% 7.% 9.6% 33.3% % % 5% 1% 15% 2% 25% 3% 35% 4% 45% 5% cholera case fatality rate CFR [%] Cholera case fatality rates were highest in counties with poor access to health care especially in populations living in the islands and cattle camps (Figure 7). Overall, a higher proportion of females (51.8%) are affected than males (47.6%). Children and young adults are more affected. Figure 8 shows the age and sex distribution of cases. There are no significant sex differences after adjusting for age (marginally higher number of cases in females). 4

5 884yrs 774yrs 664yrs 554yrs 444yrs 334yrs 224yrs 114yrs 4yrs Fig. 8 Cholera case distribution by age and sex, June 216 Nov Percentage % Fig.9 Cholera Epidemic Curve for South Sudan, week 23, 216 to week 49, % Number of cases/deaths Alive Died CFR% 15% 1% 5% CFR% % 216 Epidemiological week of onset 217 Figure 9 shows the overall cholera epidemic curve for South Sudan. The highest transmission peaks were associated with outbreaks that affected cattle camps in the following counties Awerial, Yirol East, Duk, Bor, Uror, Ayod, Kapoeta East, Kapoeta South, and Kapoeta North. The same locations also reported high CFR due to poor access to health care especially at the onset of the outbreak As seen in Table 2, cholera cases have been confirmed every year since the onset of the South Sudan crisis in 213. The 216/17 outbreak is the longest and largest in magnitude and geographical extent. Due to the protracted crisis, displacements, insecurity, and declining investment in WASH, access to safe drinking water and sanitation facilities has declined significantly. Access to improved sanitation facilities is less than 1% while access to safe drinking water from improved water sources is estimated at 6%. 5

6 TABLE 2 Cholera Outbreaks in South Sudan Summary measure /17 No. cases 6,421 1,818 21,571 No. deaths CFR% 2.6% 2.59% 2.14% No. counties affected Duration (weeks) (8) Ongoing Outbreak start date 24/4/216 18/5/216 18/6/216 Date of last case 13/11/216 24/9/216 Ongoing Attack rate [per 1,] Coordination of cholera response The National cholera task force is coordinating the overall cholera response. The task force meetings convene weekly on Wednesdays from 2 pm in the WHO conference hall in Juba. Cholera response updates The overall response to cholera in South Sudan is coordinated by the national taskforce that is Chaired by MoH with support from WHO, Unicef, and partners (Health and WASH clusters). From 6 th to 7 th December 217, the cholera response review meeting was conducted in Juba Landmark hotel involving cholera control stakeholders. The meeting reviewed the implementation of the response to document what worked well, the challenges, best practices, lessons learnt, and recommendations for improving future response. Based on the review findings, the meeting resolved to develop a revised cholera response strategy that is aligned to the Global cholera roadmap 23. The updated strategy will therefore aim to reduce cholera deaths by 9% by 23. To attain this target, the overall leadership and coordination of cholera prevention and response activities will be enhanced through the formation of a multisectoral cholera control program. The other interventions will entail enhancing case detection and rapid response to prevent widespread outbreaks and prevent avoidable cases and deaths. The third strategy will entail implementing multisectoral interventions including term WASH to prevent recurrent cholera outbreaks in cholera transmission hotspots. The Honourable Minister of Health, Dr. Riek Gai Kok, presided over the closure of the twoday review meeting. In his remarks, he reiterated Government commitment to support the implementation of the revised cholera response strategy. 6

7 Fig.1: Oral cholera vaccine administrative coverage by round and site for Fig. 1 Administrative coverage (%) for OCV by site in Coverage % First Round Second Round Progress of oral cholera vaccine campaigns As part of the ongoing cholera response, cholera vaccines have been deployed to complement cholera response in several highrisk populations and locations. These areas include Leer, Bor PoC, Malakal Town, Bentiu PoC, Mingkaman IDP settlement, Aburoc IDPs, Bentiu/Rubkona Town, Ayod (Pagil, Tar, Jiech, Karmun, Padek, and Kandak), Juba (Don Bosco IDPs and additional highrisk locations), Tonj East and Marial Lou payam, Kapoeta North, Kapoeta South, and Kapoeta North. Out of the 1,44,358 doses secured by WHO in 217, a total of doses have been deployed (see Figure 1). Following an oral cholera vaccine working group meeting conducted on 14 November 217 in Juba; a total of 737,819 doses of oral cholera vaccines have been requested from the GTFCC Global stockpile (Table 3). The vaccines will be used for second round campaigns in areas listed in table 3. The first batch 4, doses arrived in Juba on 27 November 217 while the balance will be delivered on 11 December 217. Table 3 OCV doses requested from the Global Stockpile Sno. County OCV doses Partner Proposed campaign dates 1 Kapoeta South 97, ARC 117 December Kapoeta North 141,52 3 Kapoeta East 97, ARC 117 December Tonj East 164,9 IOM 1117 December Juba 2, MSFE 6 Aburoc 2,797 MSFE 7 Malakal Town 16,62 MSFE Total 737,819 Preparations are underway to implement the second round of oral cholera vaccine campaigns in Kapoeta South, Kapoeta East, and Tonj East as scheduled in table 3. 7

8 Laboratory updates There were no new samples tested in week 49 of 217 (Table 4). A total of 33 Vibrio cholerae isolates have been shipped for genetic sequencing; typing; and antimicrobial sensitivity testing by Institute Pasteur, Paris. Table 4: Cholera laboratory culture test results June 216 November 217 Week 49 Cumulative (216217) County Positive Positive Negative Total tested Abyei 1 1 Akobo 2 2 Awerial Ayod Bor Budi Duk Fangak Fashoda Juba Kapoeta East 1 1 Kodok Lankien Leer Magwi Malakal Mayendit Mayom Panyijiar 1 1 Pibor 5 5 Pigi Renk 2 2 Rubkona Terekeka 2 2 Tonj East Torit 6 6 Uror 2 2 Wau 6 6 Yirol East Yirol West 4 4 Kapoeta South Nyirol Rumbek North 2 2 Total tested ,148 8

9 WASH CLUSTER RESPONSE UPDATES Beneficiaries reached by WASH cluster partners in week 47 9

10 SOCIAL MOBILISATION UPDATES Social Mobilization, Communication and Hygiene Promotion Reporting Format (24 November 1 December, 217) Locations with ongoing outbreak and hot spots (Payam level) Partners present Ongoing Action with number of population reached with Cholera interventions Gaps and recommended action Kapoeta (EEQ) Jonglei (Bor, Twic East, Duk, Pibor and Pochalla) SSRC, ARC, Singaita FM CDNF One Radio talk show done by ARC and SSRC on cholera prevention Signata FM Sanitization of 3567 women at Kapoeta south at the GFD distribution Site on the five step of cholera prevention 231 HH & 652 individuals in Kapoeta town have been reach with cholera prevention messages. 56 megaphones were aired on OCV campaign give key message on service are availability. UNICEF supported partner CDNF continue with community engagement activities which include household visits with critical demonstrations, community meetings, waterpoint and market awareness, school and cattle camps intervention in areas of Bor, Twic East, Duk, Pibor and Pochala counties. Capacity building of 9 community mobilizers on IPC in Jebel Boma of Pibor on 2 th November community mobilizers reached people visiting 1,196 households (6,689 individual) with messages on integrated cholera control, disease prevention and immunization. 1,72 students were oriented on cholera prevention in 7 school sessions. 85 community members have attended 6 community meetings. 653 people were oriented on cholera through 1 market sessions and on water point intervention sessions 783 people reached in 7 water points. Lack of mobility such as motorbikes i.e. Bicycles for supervisors and social mobilizers to facilitate their movement to the field site. 1

11 Locations with ongoing outbreak and hot spots (Payam level) Partners present Ongoing Action with number of population reached with Cholera interventions Gaps and recommended action Religious engagement: Social mobilizers reached people with effective cholera messages in 3 churches during Sunday in the counties Mass media intervention: cholera key messages and radio spots are being broadcasted on Mingkaman1 FM, and Radio Jonglei 95.9FM to reach population remote villages. Jonglei (Old Fangak, Akobo and Pigi Jonglei (Akobo, Nyirol, Uror) FCDI and CHDs Nile Hope and CHDs No updates shared Nile Hope in partnership with UNICEF C4D continue with community engagement activities which include household visits with critical demonstrations, community meetings, waterpoint and market awareness, school and cattle camps intervention in areas of Akobo, Nyirol and Uror. Below are some of the achievements; Door to Door mobilization: This week, 98 Social mobilizers conducted house to house visit and reached 2,43 Households (12,15 peoples) who were sensitized on behavior change on integrated emergency response including Malaria, cholera, diarrheal control and routine immunization on both Counties of Uror, Akobo and Nyirol Cholera awareness at School: A total of 13 schools reached and 2,778 pupils benefited from schoolbased interventions on integrated cholera awareness and routine immunization session carryout by social mobilizes at different counties of Uror, Akobo and Nyirol. Insecurity in Waat area that is affecting the work and movement of staffs Social mobilizes are complaining of low incentives Labour cost for transportation to the working station is becoming expensive 11

12 Locations with ongoing outbreak and hot spots (Payam level) Partners present Ongoing Action with number of population reached with Cholera interventions Gaps and recommended action Community sensitization Meetings: Nile Hope social mobilizers conducted community meetings at different Payam of Akobo, Nyirol and Uror counties, Numbers of 2 meetings were held and 1 peoples including of community leaders which comprise of local chiefs, religious leaders and women and youth leaders. Markets awareness interventions: 11 sessions were held at the market places and 3,129 reached individuals through market sessions including food vendors in Akobo, Uror and Nyirol Intervention at water points: The social mobilizers/home health promoters from carried out 13 Sessions on cholera awareness interventions reaching 5,98 peoples on Cholera and diarrheal disease messages including demonstration on hand washing, water treatment and proper water storage. Public Awareness: Nile Hope Socials mobilizes had conducted 4 public awareness on cholera key messages around the town of Akobo, and Nyirol Counties using megaphones, announcing the key messages for prevention of cholera and diarrheal disease in their residential areas and reached 8,33 peoples. Religious engagement: Social mobilizers reached people with effective cholera messages in 9 churches during Sunday praying services in the counties of Uror, Nyirol and Akobo and reached 9,25 peoples including Children, women, men in different churches 12

13 Locations with ongoing outbreak and hot spots (Payam level) Partners present Ongoing Action with number of population reached with Cholera interventions Gaps and recommended action Rubkona, Mayendit Guit counties 1. Awerial County (Payams: All, Dor, Puluk, Bunangok, Nile Magok, Abuyong) 2. Yirol East (Payams: Adior, Malek, Lekakedu, Yali, Pagarau Tinagau and Nyang) Nile Hope and CHD Nile Hope social mobilizers conducted 3 focus group discussions with 5 individuals benefited from those session. Nile Hope in partnership with UNICEF C4D continue with community engagement activities which include household visits with critical demonstrations, community meetings, waterpoint and market awareness, school and cattle camps intervention in Rubkona. Below are some of the achievements; 36 HH and 6,853 individuals has been reached with hygiene promotion and sanitation messages. 78 people were oriented on cholera through 19 market and water point intervention sessions. A total of 1,16 people from 8 cattle camps has been reached with risk of cholera and prevention strategies Religious engagement: Social mobilizers reached 86 people with effective cholera messages in 5 churches during Sunday in the counties CHADO and UNICEF support communities in eastern lake with continued community interaction sessions such as household visits with critical demonstrations, community meetings, waterpoint and market awareness, school and cattle camps intervention in hot spots areas in Eastern 13

14 Locations with ongoing outbreak and hot spots (Payam level) Partners present Ongoing Action with number of population reached with Cholera interventions Gaps and recommended action Lakes. CHADO had trained 139 social mobilizers to reached people in different community sessions in Eastern Lakes. 3. Yirol West (Payams: Abang, Anuol, Yirol Centre (Town), GengGeng, Geer, Aluak Luak, Mapuordit) 4633 HHs reached and 17,81 Individuals through door to door mobilization for community on social and behavior change intervention on cholera control and diarrhea disease prevention. A total of 77 and 12,763 pupils benefited from schoolbased interventions on cholera awareness session. A total 176 water point sessions reaching a total of 1495 people including water vendors with Cholera and diarrheal disease educative messages including demonstration on water treatment and proper storage. A total 119 market awareness sessions were also conducted reaching 1514 individuals including food vendors. A total 123 community meetings and attended by1,847 people inclusive of community leaders which comprise of local chiefs, religious leaders and women and youth leaders. 14

15 Locations with ongoing outbreak and hot spots (Payam level) Partners present Ongoing Action with number of population reached with Cholera interventions Gaps and recommended action A total 2 churches /parishes in the counties of Eastern reaching population with lifesaving messages on cholera control and prevention. 18 Cattle camps with total of 958 individuals has been reached with cholera prevention and control. Juba Health link, SMoH and CHD During the reporting period: As part of Mass media, a total of 14 FM stations continue with airing of radio spots and talkshows in Juba and Yei. As of 24 November1 st December, 217, 1,12 times radio jingles have been broadcasted reaching over 2 million people across the country. 22, HHs reached and 136,26Individuals through door to door mobilization for community on social and behavior change intervention on cholera control and diarrhea disease prevention. A total 6 community meetings and attended by 237people inclusive of community leaders which comprise of local chiefs, religious leaders and women and youth leaders. 3 street announcements in Juba County Tonj East and Marial Lou THESO, CHD UNICEF Implementing partner, The Health Support Organization (THESO) has been carrying on integrated community engagement activities covering critical health and nutrition lifesaving messaging. The thematic areas include cholera intervention, WASH, immunization, Malaria and best feeding practices. The partner also engaged communities at household level with critical 15

16 Locations with ongoing outbreak and hot spots (Payam level) Partners present Ongoing Action with number of population reached with Cholera interventions Gaps and recommended action demonstrations, community meetings, waterpoint and market awareness, school and cattle camps intervention in cholera hotspots and all other Payams and Bomas of Tonj East and Marial Lou As of this week, 4 community mobilizers conducted household visits and reached 684 households (about 2776 people reached) with cholera messages. A total of 18 schools with 1998 school children were sensitized on cholera prevention and control and important of immunization. 6 market sessions reaching 5 people reached including food vendors conducted, 13 water point sessions reaching 197 people. 16

17 CDNF social mobilizers doing cholera awareness at Market and water points in Bor county CDNF social mobilizers doing house to house cholera awareness in Bor county Contacts Dr. Mathew Tut Director, Emergency Preparedness and Response Ministry of Health, Ministerial Complex Juba, Republic of South Sudan Dr. Joseph F. Wamala Epidemiologist World Health Organization Ministerial Complex Juba, Republic of South Sudan 17