Situation Report #69 on Cholera in South Sudan As at 23:59 Hours, 29 August 2015

Transcription

1 Republic of South Sudan Situation Report #69 on Cholera in South Sudan As at :9 Hours, 9 August Situation Update Today, six new cholera cases have been reported in Juba County. As of 9 August, a total of,6 cholera cases including 46 deaths (CFR.74%) have been reported in South Sudan. In Juba County, a total of 4 including 4 deaths (CFR.9%) from seven Payams (Table ). In Bor, 6 cases including one death (CFR.74%) have been reported from Malou in Makuach Payam and other areas within the County. Table and Figure. Table. Summary of cholera cases reported in Juba and Bor Counties, May - 9 August Reporting Sites New admisions New discharges New deaths Total cases currently admitted LAMA* Total facility deaths Total community deaths Total deaths Total cases discharged Total cases CES Juba County IMC UN House PoC clinic 74 7 Juba Teaching Hospital MedAir Gumbo CTU MedAir Gudele ORP HLSS Nyakuron ORP 4 4 HLSS Kator ORP 7 7 HLSS Gurei ORP 7 7 HLSS Munuki ORP 4 4 HLSS Al Sabah ORP 9 HLSS Lologo ORP 4 MSF Munuki CTC Other sites in Juba 9 9 Jonglei State Bor 6 Bor State Hospital 6 Total *LAMA: LEAVE AGAINST MEDICAL ADVICE; CES- Central Equatoria State Figure : New cholera cases in Juba by residence on 9 August Borom Gumbo Juba Prison Giada Kor William UNMISS-Yei Road Northern Bari Rejaf Juba Kator Munuki Juba During week 4 of (as of August ), in Juba County majority cholera cases originated from Munuki () followed by Northern Bari () Payams.(Figures. and ; Annex ).

2 // // // //4 //7 // /6/ /6/ /6/ /6/ /6/4 /6/7 /6/ /6/ /6/6 /6/9 /7/ /7/ /7/ /7/ /7/4 /7/7 /7/ /7/ /7/6 /7/9 // //4 //7 // // //6 //9 // // // Case Fatality Rate [%] Hai Jalaba Juba Juba Prison Tongping Gudele Gudele Mauna Munuki Nyakuron West Gudele block 9 Mangaten UNMISS-Yei Road Gumbo Gumbo Gurei Hai Referendum New site Jebel Dinka Jebel Josua Borom Lokwilili Gurei East Giada Kor William Lologo Marol Panmaketh Leudiet Hai Fangak Figure.: New cholera cases by residence during week of Juba Munuki Rejaf Northern Bari Kator Makuach Anyidi Juba Bor Cumulatively,,6 cholera cases including 46 deaths (7 facilities and 9 communities) have been reported in Juba and Bor Counties since the initial case was reported on 6 May in Juba. Of the 46 deaths, (4%) occurred in children five while (67.4%) occurred in male. Table : New cholera cases by facility and week in Juba and Bor Counties, May 9 August New cases by epidemiological week of Reporting Facility Grand Total CES Juba County JTH Juba IMC clinic HLSS Nyakuron ORP HLSS Kator ORP 7 MedAir Gudele ORP 4 MedAir Gumbo CTU HLSS Gurei ORP 7 HLSS Munuki ORP 4 HLSS Al Shabah ORP 4 HLSS Lologo ORP 4 4 MSF Munuki CTC Other sites in Juba 9 Jonglei State Bor County Bor State Hospital Grand Total As seen from Figure and., sustained and consistently increasing community transmission was established in Juba from the 6 June [ rd epidemiological week] with two transmission peaks in week 7 and 9. Cholera cases have been declining since July [ th epidemiological week]. Figure : Epidemic curve for cholera cases in Juba and Bor, May 9 August JS: Jonglei State; CES: Central Equatoria State; CFR: Case Fatality Rate JS CES CFR

3 Case Fatality Rate [%] This decline was interrupted in week during which a noticeable rise in cases was registered. This rising trend in Juba during week was driven by community transmission in Gondokoro, Northern Bari, Munuki, and Rejaf Payams (Annex ). In Bor, the initial case occurred on 6 June [6 th epidemiological week] with increasing number of cases from week 6 to week 7 when the highest transmission peak was registered. In the subsequent weeks, successively shorter transmission peaks were registered, a trend that is consistent with declining community transmission (Figures and.). Figure.: Cholera cases in Juba and Bor by week of onset, week - of Week of onset JS CES CFR[%] As of August, the sites reporting the highest cumulative number of cholera cases included Gumbo, New site, Juba PoC, Gudele, Atlabara B, and Munuki with satellite cases distributed in seven Payams in Juba County (Figure.). In Bor County, the majority of the cases originated from Malou, Langbar, Achingdii, Arek, and Hai Salam in Makuach Payam. Figure.: Spot map for cholera cases by residence in Juba from May to 9 August

4 Within Juba County and its most affected Payams of Juba, Northern Bari, Munuki, Rejaf, and Kator, children and young adults aged -4 are the most affected while in Makuach Payam, Bor County, children are the most affected. (Tables. and.; Annex ). Table.: Cholera case distribution by age in Juba County, May - 9 August Cholera case distribution by age in Juba County, week -4, Table.: Cholera case distribution by age in Bor County, May 9 August Cholera case distribution by age in Bor County, week 6-, *There are missing information in sex and age Out of the 7 cholera cases with known sex in Juba, 666 (4.%) were female, while 7(6.7%) were male while in Bor, 79 (%) of the cases were females, while 7 (4%) were males (Table 4). Table 4: Case distribution by sex and age in Juba and Bor Counties, May - 9 August Case distribution by sex n (%) CES - Juba (4) 7 (7) Jonglei state Bor County 6 79 () 7 (4) Grand Total 67 *There are missing information in sex and age The probable risk factors fueling transmission include: residing in a crowded IDP camp with poor sanitation and hygiene; using untreated water from the Water tankers; lack of household chlorination of drinking water; eating food from unregulated roadside food vendors or makeshift markets; open defecation/poor latrine use; and attending/eating food at a funeral. 4

5 Laboratory updates Since the beginning of the outbreak, 9 specimen collected across the country were received at the National Public Health Laboratory (NPHL), of which 4(9.%) were positive for Vibrio Cholera O type including (.%) among < (7.6%) negative, 4 (.%) pending and 4 (.9%) rejected probably due to improper collection and transportation Highlight of the Response As of 9 August additional activities initiated to the already on-going response by cluster or sub working groups are as followed: COMMUNICATION This week over 6 trained social mobilization volunteers from South Sudan Red Cross and the State Ministry of Health Central Equatoria reached 7,96 households (47,496 individuals) in Juba suburbs of MTC, Ghabat, Hai Mayo, Hai Game, Juba Nabari, Nyakuron East & West, Kator East and West, Atlabara A,B,C, Lologo &, Hai Kosti, Gondokoro Islands, Hai Tarawa, New Site, Mauna, Suk Zande, Rock City, Tongping, Jebel Dinka and Gurei with cholera prevention and control messages and distributed 6, sachets of ORS,,6 bars of soap and 7,4 sachets of PUR. To date cumulatively, a total of, households (over 4, individuals) reached in Juba with cholera messages in hot spots and surrounding terrains. PSAs and jingles continue on radio stations in South Sudan with extensive coverage reaching Central Equatoria, Eastern Equatoria, Upper Nile States and Mingkaman IDP camp The social mobilization group this week reached additional, individuals through market sessions, churches and social gatherings with cholera prevention messages in three main Blocks and Payams namely; Juba, Kator, Munuki, Rajaf Payam and some parts of Northern Bari Payam This week in Juba, Central Equatoria Ministries of Health and Education collaborated and conducted cholera video sessions on prevention and control in six primary schools with total attendances of 4,9 Pupils and teachers. In Bor, cumulatively,,67 households (94, Individuals) have been reached with cholera messages in Bor POC, Bor town, Twic east, Duk Island by 6 social mobilization volunteers since the inception of the response This week in Bentui, Community Volunteers reached,7 households (79,6 people) with keys messages on cholera in bentui POC with a target population of 6,76 WASH AFOD an NGO supported by UNICEF trained Home Health Promoters (HHP) in water chain management in Torit Eastern Equatoria State. The HHP distributed 6, water purification tablets to households with in Toirt Health Despite the closing of the CTCs with in Muniki and Gumpo, efforts have been made to increase and strengthen capacity at other CTCs. Juba Teaching Hospital CTC has been equipped and capacity expanded to beds, Torit CTC and ORPs beds and Bor CTC and ORPs 4 beds. Provision of cholera beds in Malakal, Bentui and Pibor is in process With support of WHO the National Public Health Laboratory (NPHL) conducted quality control and assurance of laboratory testing, isolates and clinical specimens were sent to accredited laboratory in Uganda to ensure the efficiency of the NPHL. The six isolates ( positive and negatives) sent to Uganda, yielded the same results as those produced in the NPHL and all isolates were sensitive to tetracycline, ciprofloxacin, intermediate to Ampicilin and chloramphenicol and resistant to Sulfamethoxazol. In an effort to enhance the smooth and efficient functioning of the NPHL WHO donated sanitary supplies and consumables to the Microbiology department.

6 Planned and On-going Activities. The next national cholera taskforce meeting is scheduled for Monday August at : am in the MoH Ministerial Boardroom.. The next cholera coordination meeting in UN House PoC is scheduled for September at : am in the RRP Boardroom. 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 numbers for alerts are: Zain: 99 Contacts For more information please contact: Dr. John Rumunu Director General - Preventive Health Services MoH, Republic of South Sudan Tel: Dr. Thomas Akim Ujjiga Director - IDSR MoH, Republic of South Sudan Tel:

7 Annex: Cholera Data tables and Charts May to 9 August Annex : Cholera epidemic curves by Payam - May to 9 August Cholera Epidemic Curve Juba Payam //6 // // // //4 //6 // // /6/ /6/ /6/ /6/7 /6/9 /6/ /6/ /6/ /6/7 /6/9 /6/ /6/ /6/ /6/7 /6/9 /7/ /7/ /7/ /7/7 Juba /7/9 /7/ /7/ /7/ /7/7 /7/9 /7/ /7/ /7/ /7/7 /7/9 /7/ // //4 //6 // // // //4 //6 // // // //4 //6 // //6 // // // //4 //6 // // /6/ Cholera Epidemic curve Northern Bari Payam /6/ /6/ /6/7 /6/9 /6/ /6/ /6/ /6/7 /6/9 /6/ /6/ /6/ /6/7 /6/9 /7/ /7/ /7/ /7/7 /7/9 /7/ Northern Bari /7/ /7/ /7/7 /7/9 /7/ /7/ /7/ /7/7 /7/9 /7/ // //4 //6 // // // //4 //6 // // // //4 //6 // //6 // // Cholera Epidemic Curve Rejaf Payam // //4 //6 // // /6/ /6/ /6/ /6/7 /6/9 /6/ /6/ /6/ /6/7 /6/9 /6/ /6/ /6/ /6/7 /6/9 /7/ /7/ /7/ /7/7 Rejaf /7/9 /7/ /7/ /7/ /7/7 /7/9 /7/ /7/ /7/ /7/7 /7/9 /7/ // //4 //6 // // // //4 //6 // // // //4 //6 // Cholera Epidemic Curve Munuki Payam //6 // // // //4 //6 // // /6/ /6/ /6/ /6/7 /6/9 /6/ /6/ /6/ /6/7 /6/9 /6/ /6/ /6/ /6/7 /6/9 /7/ /7/ /7/ /7/7 /7/9 Munuki /7/ /7/ /7/ /7/7 /7/9 /7/ /7/ /7/ /7/7 /7/9 /7/ // //4 //6 // // // //4 //6 // // // //4 //6 // 7

8 6// 6/4/ 6/6/ 6// 6// 7// 7/4/ 7/6/ 7// 7// 7// 7/4/ 7/6/ 7// 7// 7// 7/4/ 7/6/ 7// 7// // // // /7/ /9/ // // // /7/ in other villages in Kator in Atlabara B Cholera Epidemic Curve Kator Payam // //6 //4 // // // //6 //4 // // // //6 //4 // /7/ /7/9 /7/7 /7/ /7/ /7/ /7/9 /7/7 /7/ /7/ /7/ /7/9 /7/7 /7/ /7/ /7/ /6/9 /6/7 /6/ /6/ /6/ /6/9 /6/7 /6/ /6/ /6/ /6/9 /6/7 /6/ /6/ /6/ // // //6 //4 // // // //6 Kator Atlabara 6 4 Cholera Epidemic Curve Gondokoro Payam //6 // // // //4 //6 // // /6/ /6/ /6/ /6/7 /6/9 /6/ /6/ /6/ /6/7 /6/9 /6/ /6/ /6/ /6/7 /6/9 /7/ /7/ /7/ /7/7 /7/9 /7/ Gondokoro /7/ /7/ /7/7 /7/9 /7/ /7/ /7/ /7/7 /7/9 /7/ // //4 //6 // // // //4 //6 // // // //4 //6 // //6 // // // //4 //6 // // /6/ /6/ /6/ Cholera Epidemic Curve Lokiliri Payam /6/7 /6/9 /6/ /6/ /6/ /6/7 /6/9 /6/ /6/ /6/ /6/7 /6/9 /7/ /7/ /7/ /7/7 Lokiliri /7/9 /7/ /7/ /7/ /7/7 /7/9 /7/ /7/ /7/ /7/7 /7/9 /7/ // //4 //6 // // // //4 //6 // // // //4 //6 // Cholera Epidemic Curve Makuach Payam, Bor Makuach

9 Annex : Cholera case distribution by age, sex and Payam May to 9 August Cholera case distribution by age in Juba Payam, week 6-, Cholera case distribution by age in Kator Payam, week 6-, Cholera case distribution by age in Munuki Payam, week 6-,

10 Cholera case distribution by age in Northern Bari Payam, week 6-, Cholera case distribution by age in Rejaf Payam, week 6-, Cholera case distribution by age in Makuach Payam, Bor week 6-,