Situation Report #93 on Cholera in South Sudan As at 23:59 Hours, 3 November 2016

Transcription

1 Republic of South Sudan Situation Report #93 on Cholera in South Sudan As at 3:9 Hours, 3 November 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 (Figure.). Suspect cholera cases have been reported in Mayendit and Ayod (Table ). Cumulatively (3.%) of the samples tested positive for Vibrio Cholerae inaba in the National Public Health Laboratory as of 3 November (Table 3). Jubek state has recorded 93 cholera cases including deaths (CFR. %). A total of 9 new cholera cases were reported in Jubek State during week of (Table and Figure.). During the week, Bentiu PoC reported cases, the highest reported when compared to other affected areas. Most of the cases in Bentiu PoC have been reported in children under years 3 (3%) while children under years constitute 3 (%) of the cases (Annex ). Most (%) of the cases in Bentiu PoC have been reported in individuals that did not receive oral cholera vaccine. Most cases have been reported from sectors, 3, and (Annex ). Response in Bentiu is coordinated by a taskforce and the case-centered approach has been adopted to interrupt transmission. Table : Summary of cholera cases reported in South Sudan as of 3 November Reporting Sites New admissions WK New discharges WK New deaths WK Total cases currently admitted Total facility deaths Total community deaths Total deaths Total cases discharged Total cases Jubek Juba Jonglei- Duk 9-3,9, Terekeka Eastern Lakes - Awerial Imatong - Pageri Western Bieh Fangak Northern Liech Rubkona Southern Liech - Leer Eastern Nile - Pigi Total 9 3,,9 The implementation of sustained and comprehensive investigation and response activities in Leer and Mayendit continues to be constrained by security concerns. In Pigi, two cases were confirmed by culture on November. A least 3 cases including deaths ( health facility and one community) (CFR.%) have been reported since October. Current Health and WASH activities in Pigi are led by NHDF supported by WHO, UNICEF, and MSF-F.

2 Figure.: Cholera incidence (cases per,) and case fatality rate (%) as of 3 November Cholera Fatality Density Map for cases per population and CFR Weeks -3, World Health Organization Map Date: November, Manyo Central African Republic Legend xx Case fatality rate (CFR) Counties with Cholera alert Cases per, population No case reported River Raga Wau Tambura Nagero Ezo Yambio Nzara Sudan Fashoda Maban Abyei Pariang Malakal Abiemnhom Baliet Aweil East Panyikang Aweil North Rubkona Fangak Twic Guit Longochuk Mayom Pigi/Korflus Aweil West. Luakpiny/NasirMaiwut Aweil South Gogrial East Koch Nyirol Ulang Aweil Centre Gogrial West Tonj North Ayod MayenditLeer Jur River Tonj East Rumbek NorthPanyijiar Tonj SouthCueibet Rumbek Centre Wulu Ibba Yirol East Rumbek East Mvolo Democratic Republic of Congo Yirol West Duk Mundri WestMundri East Maridi Juba Yei Lainya Twic East Uror Bor South Awerial.9. Terekeka Kajo-Keji Morobo Melut Lafon Torit Magwi 3. Pageri Uganda Renk Akobo Ikotos 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 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 9 cholera cases with confirmed cases and no death. Figure.: New cholera cases admitted by location in week of Puluk Dongchak Kator Juba Rejaf Munuki Northern Bari Eastern Lakes 3 Kator Nimule Terekeka New Fangak Old Fangak Toch Thonyor Yang Bentiu PoC Kalja Piliny Jonglei Jubek Imatong Terekeka Western Bieh Southern Liech Northern Liech On August, cholera was confirmed in Mingkaman IDP settlement after two of four samples tested postive for Vibrio cholerae Inaba. The cumulative cases are 333 cholera cases including confirmed cases

3 and deaths (one facility and three community) (CFR.9 %). On 3 November, there was no new case in Mingkaman. In Jonglei state, suspected cholera cases including deaths (CFR 9.9 %) have been reported from Duk County involving mainly 3 Islands namely Kawer, Long, and Moldova with the date of onset of index case on the 3 rd July. 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. The most recent cases reported in Duk originated from Koyom Island on st Nov. Figure.: Cumulative cholera cases by payam of residence as at 3 November Puluk Nimule Uganda Dongchak 3 Padiat Pageet Gondokoro Juba Town Kator 3 Lokiliri Mangalla Munuki Northern Bari Rejaf Buko Nyarjwa Lwoki Terekeka Old Fangak 3 New Fangak 3 Mareang Paguir Toch Kolanyang Bentiu Town Nhialdu kalja Dhorbor Piliny Bentiu PoC Leer Town Thonyor Yang kurwai fangak Eastern LakesImatong Jonglei Jubek Terekeka Western Bieh Northern Liech Southern Liech Eastern Nile Terekeka has reported cases of cholera including deaths (CFR 3.%) with samples confirmed by the laboratory to be cholera.the most of the recent cases are from Kuda village, Lwoki payam, Nyori county on September. No additional cases have been reported since then. As of 3 November, a cumulative of 9 cholera cases including four laboratory confirmed cases and one death (CFR 3.%) have been reported from Nimule in Imatong state since August.The afffected locations in Imatong state include Abila,Malakia and Motoyo. The last cholera case in Nimule was admitted in Nimule hospital on 9 Sept and discharged on Oct. Table.: Cholera cases and deaths by state and county as of 3 November 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, Southern Liech Leer, -. - Eastern Lakes Awerial, Imatong Pageri, Jonglei Duk, Jubek Juba, Terekeka Terekeka, Eastern Nile Pigi, Total,, The cholera outbreak in Western Bieh state was confirmed on September after two of four samples tested positive for Vibrio cholerae inaba. The initial cases were reported on August in Old Fangak. The cumulative cases are cholera cases including confirmed cases and deaths ( facility and zero community) (CFR.%). As of 3 November, the affected areas include Old Fangak ( cases); New Fangak (3 cases); Mareang ( case); Paguir ( cases); Toch (3 cases); and Kolanyang ( case) (Figure.). 3

4 In Northern Liech state, cholera cases including 9 confirmed cases and no death have been reported in Bentiu Town/PoC since 9 September. 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 % of cholera cases in Bentiu PoC did not receive oral cholera vaccine (Annex ). In Southern Liech, two cholera cases originating from Leer Town tested positive for Vibrio cholerae Inaba on October. Cumulatively, cholera cases have been reported from Leer in Southern Liech state. Since October, 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. Cumulatively,,9 cholera cases including deaths (9 facilities and community) (CFR.%) have been reported in South Sudan involving 9 states since the initial case was reported on June for Jubek state; 3 rd July in Jonglei state; July for Terekeka state, August for Eastern Lakes and Imatong states; August for Fangak in Western Bieh and state; 9 September for Rubkona in Northern Liech state; October for Leer in Southern Liech state; and October for Pigi in Eastern Nile state (Figure. and Table.). As seen from Figure. there was a spike in cholera transmission in week 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 - 3 November 3 3.% % Number of cases.9% 33 3 % 3 3.3% 9 3.% 3.%.%.9% 3 3.%.%.%.3%.%.%.%.%.%.%.%.%.%.% % Epidemiological week of onset Jonglei Jubek Terekeka Imatong Eastern Lakes % % CFR % Western Bieh Northern Liech CFR[%] Southern Liech Eastern Nile Figure 3: Cholera case distribution by gender and age in Jubek State 3 November 3 Cholera - age and sex distribution Jubek up to 3 Nov Under Adult

5 Out of the 93 cholera cases in Jubek State, 3 (.%) were female, while (.%) were male Figure 3: Cholera case distribution by gender and age in Jonglei State 3 November Cholera - age and sex distribution Jonglei up to 3 Nov Under Adult Data on Age missing for cases Out of the cholera cases, in Jonglei State (. %) were female, while (.%) were male Figure 3:3 Cholera case distribution by gender and age in Eastern Lake State 3 November 3 Cholera - age and sex distribution Eastern Lakes up to 3 Nov Under Out of the 333 cholera cases, in Eastern Lake State 3 (.9%) were female, while 9 (. %) were male. Figure 3: Cholera case distribution by gender and age in Western Bieh State 3 November 3 Cholera - age and sex distribution Western Bieh up to 3 Nov 9 3 Under Adult Blank

6 Out of the cholera cases, in Western Bieh State (. %) were female, while (3. %) were male. Figure 3: Cholera case distribution by gender and age in Southern Liech State 3 November 9 3 Cholera - age and sex distribution Southern Liech up to Nov 3 Under Out of the cholera cases, in Southern Liech State (.9 %) were female, while (. %) were male. Figure 3: Cholera case distribution by gender and age in Northern Liech State 3 November Under Cholera - age and sex distribution Northern Liech up to 3 Nov Out of the cholera cases, in Northern Liech State (. %) were female, while (. %) were male. Figure 3: Cholera case distribution by gender and age in Eastern Nile State 3 November 9 3 Cholera - age and sex distribution Eastern Nile up to 3 Nov 3 Under Out of the cholera cases, in Eastern Nile State (. %) were female, while (. %) were male.

7 Table : Case distribution by gender in South Sudan 3 November State Total cases Eastern Lakes Imatong 3 9 Jonglei Jubek 3 93 Terekeka 3 9 Western Bieh Northern Liech 3 Southern Liech Eastern Nile South Sudan 3 9 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 3 November State Culture results Positive Negative Total tested Eastern Nile Jonglei Jubek Terekeka Eastern Lakes 3 39 Imatong Fangak Wau Boma Northern Liech 9 Southern Liech Eastern Nile (Pigi) Total tested 9 3

8 Table : Cholera Alerts Date of Details of the alert notification No alerts 3-Sept- COSV reported suspect cholera cases in Haat Islands, Ayok county, Southern Bieh state - Oct- UNIDO reported 3 suspect cholera cases including three deaths -Oct- IRC reported 3 suspect cholera cases including one death in Ganyliel. Two cases seen at Ganyliel PHCC. Initial case seen on Oct involving a trader from Duk Nov At least 9 AWD cases reported in Nyal PHCC by IRC Area Haat Islands, Ayok county, Southern Bieh state Thaker, Tutnyang, & Leah Payams, Mayendit North, Southern Liech state Ganyliel, Tayar, Southern Liech Nyal, Southern Liech Action Follow up mission to Ayod, Haat Island by MedAir currently is underway. UNIDO is the healthcare partner responding to suspect cases in Mayendit. Security concerns have constrained comprehensive and sustained interventions. Partners meeting involving Mercy corps, IRC, GAA, and ICRC organized on Oct to initiate a coordinated response. WHO supported ICRC to verify and respond to the cases. Verification is ongoing 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 of 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. In Bentiu PoC where the transmission has increased over the last two weeks, the case-centered approach has been deployed to stem transmission. The strategy entails early identification of suspect cases using cholera RDT testing. This is followed by identification of all household contacts aged one year and above and administration of single dose of azithromycin or doxycycline within hours of identifying the source case. In the surrounding households within a -meter radius of the case household, social mobilization, active case finding, WASH, and single dose oral cholera vaccination is administered. Follow up for new cases of acute diarrhoea and new episodes of acute diarrhoea is then performed for the next three weeks. 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. During week, WHO trained Ministry of Health Public Health Officers that will be deployed to support cholera surveillance response activities countrywide. The team will also support the implementation of integrated disease surveillance and response by augmenting the activities of surveillance officers at state, country, and health facility level. This will entail following up on silent health facilities and counties, conducting targeted support supervision and onsite training; and working with the state rapid response teams to report and verify disease outbreak alerts. 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

9 Sudan (HLSS), LiveWell, ACROSS, CAPIAD, THESO, BEDN, IMC, RUWASSA, SMC, NHDF, UNIDO, World Relief, and ARUDA. UNICEF continues to support 3 active Oral Rehydration points across Jubek, Mingkaman, and Duk while standby ORPs in other previously identified high risk areas are in place. In Juba, the following eight ORPs continue to operate: Gurei, Gumbo, Lologo, and Al Sabah Hospital (HLSS), Jebel Yesua (CAPIAD), Mangatain, Mangatain (LIVEWELL), and Gorom PHCC (ACROSS). In Mingkaman, all the ORPs continue to operate (HLSS) while in Nimule, the ORP has already been closed as the outbreak in that area is controlled. In Duk, ORP is being supported by UNICEF through SMC while standby ORPs in Bor are also in place. Meanwhile in the areas of new outbreak or more recent outbreaks (downstream River Nile), new ORPs and CTUs are to be set-up with UNICEF support i.e. Leer, New Fangak, and Pigi through UNIDO and Nile Hope. Support for the ORPs will continue until the end of the month (November). There are also standby ORPs in Wau Shiluk should the outbreak reach that area. While no cases have been reported in the ORPs for the last weeks in Mingkaman, cases have recently been reported in the CTU including death, bringing the cumulative death in Mingkaman to. Appropriate aggressive measures were taken by HLSS by disinfection and provision of water purification commodities and ORS to the affected community. In Rubkona, UNICEF continues to support coordination through the state cholera task force. Adequate supplies have also been prepositioned to support response in case the outbreak escalates. A health staff will be deployed to support the response. Support for the activities in Kuach payam is under way which is the transit point for people coming from Southern Unity. Cumulatively, at least,3 cases have directly benefitted from UNICEF-supported ORPs while almost all cases have benefitted indirectly through supplies (all sectors). WASH UNICEF in collaboration with Health Link, RUWASSA and LIVEWELL reached a total of,33 households (, individuals) with cholera prevention messages and hygiene promotion messages in Jubek, Imatong and Eastern Lakes states. The strategy of passing the message includes house-to-house visits, community meetings and in school sessions. WASH supplies distributed during household visits include Aquatabs 9,3 strips, PUR 3, sachets and washing soap, bars. BEDN with support from UNICEF conducted targeted intervention in Gudele block where case of cholera was reported, about households were reached with cholera prevention messages and given Aquatabs and bars of washing soap. Assorted wash supplies have been delivered to Nile Hope to support cholera interventions in New Fangak and Kurwai/ Pigi, Eastern Nile State where cholera outbreak has recently been confirmed. UNHOUSE: No cholera case reported but UNICEF through THESO continue with the provision of 9, liters of safe drinking water, sewage desludging and waste collection in POC and 3 on a daily basis. UNICEF and THESO have completed the construction of three (3) water tanks with capacity of 9, L capacity, this tanks will be use store water to be used during critical emergency time. Communication UNICEF supported the cholera mass awareness activities during the Gurei Integrated Cholera /OCV targeted Mass Campaign last th th November. The activity targeted beneficiaries in GUEREI blocks,,,, & where an upsurge of cases was noted few days prior to the campaign. So far, mass campaigns have been conducted so far and no cases have been reported from the area. During the UN day celebrations, cholera awareness sessions were also conducted and the following commodities distributed to women and children who participated: 3 buckets, bars of soap, buckets of P&G and strips of Aquatabs. Cumulatively, since the beginning of the outbreak,,3 households and,3, people have been reached with cholera messages and commodities (,9 Soaps,, PUR, 3, ORS, and, Aqua tabs) through UNICEF support across all the Cholera affected areas. As of week of, LiveWell with volunteers in Mangatain, New site, Hai Referendum, Giada, Lologo, and Shirkat where they have visited a cumulative of 3,93 households where they reached,99 people; identified 9 suspect cholera cases and referred six of them; visited schools reaching,9 pupils; conducted 9 community meetings reaching, people; 3 market sessions reaching, market vendors; water point sessions reaching people; public announcements reaching 9, people; distributed 9 IEC materials and banners; distributed, Aquatabs; 3, sachets of PuR;,9 bars of soap; 9,3 sachets of ORS; and,99 cholera booklets. 9

10 As of week of, ACROSS with 3 volunteers in Gorom refugee camp has visited a cumulative of households where they reached,39 people; visited five schools reaching,3 pupils; conducted community meetings reaching, people; three market sessions reaching market vendors; 3 water point sessions reaching 3 people; two public announcements reaching people; distributed 3 IEC materials and banners; distributed, Aquatabs;,3 PuR sachets;,3 bars of soap; and,9 sachets of ORS. As of week of, HLSS with hygiene promoters in Gurei, Lologo, and Gumbo reached a cumulative of,9 households reaching 9,3 females and, males and distributed,33 chlorine tablets;,33 PuR sachets;, soaps; and, sachets of ORS sachets in Jubek. The volunteers have also visited schools reaching, pupils; conducted 3 community meetings reaching 3,9 individuals; market sessions reaching, market vendors; six water point sessions reaching 9 people; and distributed,9 posters and eight banners with messages on cholera prevention and control. In Bentiu, the weekly cholera taskforce meetings take place weekly on Wednesdays to coordinate preparedness and response activities. Activities in progress in Bentiu PoC include the following: Hand washing at main entrance gates to the PoC is ongoing with improved water trucking from IOM. Cholera messages shared with inter-news for dissemination across the PoC. Similar messages shared with all WASH partners. Better use of line listing for follow up and conducting overall WASH audit in the suspected/affected household and entire block has been enhanced. Free residual chlorine (FRC) at water points maintained at.-.mg/l in the PoC. Planned NFI distribution-litres bucket, litres collapsible jerry cans and gms soap for handwashing. School WASH activities ongoing-wash partners working is specific sectors have engaged with the school administration and education partners. Regarding the issue of community using pond water for washing clothes, and taking bath a possible source of infection; the taskforce has agreed to sensitize the community and provide alternative water for washing and bashing; and in the long-term- CCM will fence-off the areas. Possibility of assessing cholera reservoir in the PoC area underway and a ioint PoC visit between the two clusters was agreed is planned. In Thonyor, Southern Liech. Active case finding and management is ongoing Community awareness has been enhanced to interrupt transmission. An ORP has been established at Tothriak with outreaches in Tochtel, Tochthil and Chulung villages. Supplies from WHO and UNICEF were received two days ago support the response in Southern Liech. Security concerns continue to be the main impediment for a sustained and comprehensive response in Leer and Mayendit. In Fangak, MSF France has established a -bed capacity CTC in Fangak town to manage cholera cases. The health and WASH clusters have mobilized additional partners Hold the Child and ACF to support the community interventions including establishment of ORPs, community health education, hygiene promotion and support for personal hygiene and chlorination of water at water collection points. Other interventions In Mingkaman, Cholera Task Force meeting in Mingkaman continues to be conducted twice a week to review trends and progress of interventions. Case management is ongoing at the site II CTU and ORPs. House to house mobilization by home hygiene promoters and Radio messaging are still ongoing in Mingkaman. In Mingkaman, WHO has deployed Technical Officers to support the overall coordination of cholera response activities. HLSS South Sudan is now running the CTC in Mingkaman. Cholera transmission is now contained in Mingkaman IDP settlement.

11 In the whole Country A total of radio channels continue to air cholera messages country-wide (Juba, Yei, Kajo-Keji, Torit, Bor, Bentiu, Mingkaman and Wau) reaching million audiences per day. MTN, a mobile telecommunications carrier is broadcasting key cholera messages to all its subscribers once a day. Planned Activities. The next cholera coordination meeting in will be held in Juba Teaching Hospital on November starting :am in Juba Teaching Hospital.. The next weekly cholera taskforce meeting is scheduled for 9 November starting :pm in the WHO Conference Hall. 3. 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.. Negotiate for security access to allow humanitarian access for partners to implement cholera investigation and response activities in Mayendit, and Leer.. Verification and response mission to Haat Islands in Ayod, by MedAir.. Respond to the new suspect cholera alerts in Nyal and Tayar, Ganyliel. 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_@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: +9 Dr. Thomas Akim Ujjiga Director - IDSR MoH, Republic of South Sudan Tel: +9

12 Annex : Cholera distribution in Bentiu PoC as of 3 November Annex.: Cholera case distribution by time in Bentiu PoC 3 November No. cases Epidemic Curve for cholera in Bentiu PoC as of 3 Nov Date of onset Annex.: Cholera age and sex distribution in Bentiu PoC as of 3 November Under Annex.3: Cholera case distribution by sector in Bentiu PoC as of 3 November 3 Number of cases Sector Sector Sector 3 Sector Sector (blank) Residence