Republic of South Sudan

Transcription

1 Republic of South Sudan CHOLERA SITUATION AND RESPONSE UPDATES 10 NOVEMBER 2017 Epidemic trends Cholera transmission reported in two counties [Juba and Budi] in the last four weeks [42-45, 2017]. Two samples from Bentiu PoC tested negative for cholera by culture (table 2). Table 1: Cholera cases by county for weeks 42, 2017 to 45, 2017 County Date first reported New during reporting period Cases reported Cumulative Number of cases (attack rate per 10,000) New during reporting period Community Deaths Cumulative Facility Facility+ Community Juba 18-Jun , Budi 22-Jul During the last four weeks, cholera cases have been reported from Juba and Budi. The cholera trend in the two counties is on the decline (Table 1). During the same period, four deaths were reported from Budi (2) and Juba (2) (Table 1). CFR% Number of cases Fig. 1 Cholera cases in Juba, Budi, & Fangak from week 42 to 45, 2017 Budi Juba Fangak wk 42 wk 43 wk 44 wk 45 Epidemiological week of onset The Ministry of Health-led and WHO-supported rapid response team just returned from Budi after a response mission that spanned from 28 Oct to 7 November The team visited 6 cholera treatment facilities in Chukudum, Kikilai, Lorema, Kimotong, Vaka, and Ngauro. None of the treatment facilities had cholera cases on admission. Nagishod CTU was not visited due to poor access to the facility. 1

2 A cumulative of 824 cases including 82 deaths [CFR 9.95%] have been reported in Budi since week 29, 2017 (Table 1 and Figure 2). Overall, males (55.5%) are more affected than females (43%) in Budi county. Male children and male young adults are more affected than their female counterparts of corresponding age (Figure 3). The outbreak in Budi started on 28 July 2017 with the initial transmission occurring among gold-miners in Ngauro. Fig. 2 Cholera epidemic curve, Budi county 2017 Number of cases Alive Died CFR% Epidemiological week of onset 120% 100% 80% 60% 40% 20% 0% CFR% Cordaid and the County Health Department are supporting management in Ngauro CTU, Kimotong CTU, Kimotong PHCC, Vaka ORP, Nagishot PHCC, Lorema CTU, and Kakilai PHCC in Budi county <0-4 Fig. 3Cholera case distribution by age and sex, Budi, week Percentage % There are ample cholera case management kits and the cholera treatment facilities are adequately staffed for the current case-loads. In addition to case management, surveillance, and WASH interventions, a cholera vaccine campaign is planned for the second week of 2

3 November In Juba, 69 cases including two deaths (CFR 2.90%) were reported in the last four weeks [week 42-45]. Most of the cases seen in Juba in the last four weeks originated from Rejaf and Northern Bari payams. An oral cholera vaccine campaign has been completed in Juba targeting both highrisk locations and areas with active transmission. Fig.4 Cholera cases per 10,000 by county in South Sudan, 2016 and 2017 Yirol West - 15 Yirol East Tonj North 1 - Tonj East Terekeka 1 - Rubkona Renk 0 - Panyijiar Nyirol - 4 Mayom 0 - Mayendit Malakal 1 - Magwi - 1 Leer - 10 Kapoeta - 87 Kapoeta - 66 Kapoeta East - 88 Juba Fashoda Fangak 8 Duk Canal Pigi 3 11 Budi Bor 4 Ayod Awerial cholera cases per 10,000 population Overall cholera trends Since the start of the current outbreak on 18 June 2016, a total of 21,439 cases including 461 deaths (CFR 2.15%) have been reported from 27 counties. The most affected counties include Ayod, Tonj East, Yirol East, Fashoda, Kapoeta East, and Kapoeta South (Figure 4). 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. 3

4 Yirol West Yirol East Tonj North Tonj East Terekeka Rubkona Raja Panyijiar Nyirol Mayom Mayendit Malakal Magwi Leer Kapoeta Kapoeta Kapoeta East Juba Fashoda Fangak Duk Canal Pigi Budi Bor Ayod Awerial Fig. 5 Cholera cases fatality rate (%) by county in South Sudan, 2016 and 0% % 0% 2% 0% 1% 0% 0% 3% 3% 2% 3% 7% 3% 3% 1% 0% 1% 1% 2% 2% 1% 1% 6% 9% 0% 3% 10% 3% 1% 2% 1% 1% 0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50% cholera case fatality rate - CFR [%] 33% % 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 5). Overall, a higher proportion of females (51.9%) are affected than males (47.5%). Children and young adults are more affected. Figure 6 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) Cholera case distribution by age and sex, June Nov Percentage %

5 Number of cases/deaths Fig.7 Cholera Epidemic Curve for South Sudan, week 23, 2016 to week 45, 2017 Alive Died Epidemiological week of onset % 15% 10% 5% 0% CFR% Figure 7 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 The 2016/17 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 10% while access to safe drinking water from improved water sources is estimated at 60%. TABLE 2 CHOLERA OUTBREAKS IN SOUTH SUDAN Summary measure /17 No. cases 6,421 1,818 21,439 No. deaths CFR% 2.60% 2.59% 2.15% No. counties affected Duration (weeks) (74) Ongoing Outbreak start date 24/04/ /05/ /06/2016 Date of last case 13/11/ /09/2016 Ongoing Attack rate [per 10,000] 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. 5

6 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). The weekly cholera taskforce meetings are ongoing in Juba during which, the cholera situation and the ongoing cholera prevention and response activities in the affected and high-risk areas are reviewed. During week 45, the cholera taskforce meeting was convened in Juba on 8 November 2017 to review the current cholera situation and status of outbreak response activities. The Ministry of Health-led and WHO-supported rapid response team just returned from Budi after a response mission that spanned from 28 Oct to 7 November The team visited 6 cholera treatment facilities in Chukudum, Kikilai, Lorema, Kimotong, Vaka, and Ngauro. None of the treatment facilities had cholera cases on admission. Nagishod CTU was not visited due to poor access to the facility. The team provided on-the-site training of health workers on cholera case management, sample collection, and infection prevention and control. A total of 50 health workers including nurses, community health workers, and clinical officers were trained on cholera case management, sample collection, and infection prevention and control during the mission. Preparations are underway to conduct an oral cholera vaccine campaign in Budi county with support from IOM and CORDAID. The training of trainers for campaign supervisors is slated for 16 Nov 2017 in Chukudum. Then cascade trainings of the vaccinators, preparers, social mobilizers, recorders, and crowd controllers will then follow from 17 Nov The tentative dates for the campaign are 18 th to 22 Nov The campaign targets to reach at least 150,000 individuals aged one year and above with oral cholera vaccines. Table 3: Oral cholera vaccine administrative coverage by round and site for 2017 Coverage % Fig. 8 Administrative coverage (%) for OCV by site in 2017 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 high-risk populations and locations. These areas include Leer, Bor PoC, Malakal Town, Bentiu PoC, Mingkaman IDP settlement, Aburoc IDPs, Bentiu/Rubkona 6

7 Town, Ayod (Pagil, Tar, Jiech, Karmun, Padek, and Kandak), Juba (Don Bosco IDPs and additional high-risk locations), Tonj East and Marial Lou payam, Kapoeta North, Kapoeta South, and Kapoeta North. Out of the 1,440,358 doses secured by WHO in 2017, a total of doses have been deployed (see Table 3). Laboratory updates This week, two samples from Bentiu PoC tested negative for cholera. Overall, at least 1,119 samples have been tested out of which at least 493 (44%) have teste positive for Vibrio Cholerae O1 Inaba by microbiological culturing. This week, on the 10 th of November 2017, 33 Vibrio cholerae isolates were shipped for genetic sequencing; typing; and antimicrobial sensitivity testing by Institute Pasteur, Paris. Table 2: Cholera laboratory culture test results Jun Sept 2017 Week 45 Cumulative ( ) County Positive Positive Negative Total tested Abyei 1 1 Akobo 2 2 Awerial Ayod Bor Budi Duk Fangak Fashoda Juba Kapoeta East Kodok Lankien Leer Magwi Malakal Mayendit Mayom Panyijiar 1 1 Pibor 5 5 Pigi Renk 2 2 Rubkona Terekeka 2 2 Tonj East Torit 5 5 Uror 2 2 Wau 6 6 Yirol East Yirol West 4 4 Kapoeta South Nyirol Total tested ,119 7

8 WASH CLUSTER RESPONSE UPDATES Beneficiaries reached by WASH cluster partners in week 43 8

9 SOCIAL MOBILISATION UPDATES Social Mobilization, Communication and Hygiene Promotion Reporting Format (4-10 November, 2017) Locations with ongoing outbreak and hot spots (Payam level) Partners present Ongoing Action with number of population reached with Cholera interventions Tonj East: Most affected Makuac, Paliang, Paweng Payam, Tonj South and Marial- Lou-Tonj North. (Warrap) THESO and CHDs 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 demonstrations, community meetings, water-point and market awareness, school and cattle camps intervention in cholera hotspots and all other Payams and Bomas of Tonj East, Tonj North, Tonj South, Twic, Abyei and Gogrial. Gaps and recommended action As of this week, 254 community mobilizers conducted household visits and reached 72,932 households (about 229,744 people reached) with cholera and immunization messages. A total of 10 schools with 2891 school children were sensitized on cholera prevention and control and important of immunization. 7 community meetings conducted in which 500 community leaders participated and 4 FGD session was conducted with 8 participants in Tonj North, 15 in Gogrial East and 15 in Tonj East, Tonj South 10 were selected from different groups representing; women group, youth groups, teachers, and religious leaders 9

10 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 4 market sessions were conducted educating 500 people including water vendors and ten (10) round of public announcements have also been conducted in public places reaching an estimate of about 10,000 people. Two (2) cattle camps reached with health education messages and about 300 people were sensitized. 1. Bor County: - Bor Municipality, Anyidi Payam, Makuac Payam, Kolnyang Payam, Baidit Payam and Jalle payam. 2. Twic East: - Lith Payam, Kongor payam, Nyuak payam, Ajuong payam, and PakeerPayam, 3. Duk: - Poktap payam, Dukpayuel payam, Padiet payam and Ayueldit payam 4. Pibor County: Pibor, Lekuangole, Verteth, Gumuruk and Boma 5. Pocalla County: Pochalla, Ojangbai Akoye, Akila, Akwara, Adongo and Burator CDNF UNICEF supported partner CDNF continue with community engagement activities which include household visits with critical demonstrations, community meetings, water-point and market awareness, school and cattle camps intervention in areas of Bor, Duk and Twic East community mobilizers reached people visiting 13,500 households (40,500 individual) with messages students were oriented on cholera prevention in 15 school sessions community members have attended 27 community meetings. - 8,54people were oriented on cholera through market and water point intervention sessions public announcements have reached 15,000 people. - Religious engagement: Social mobilizers reached people with effective cholera messages in over 27 churches during Sunday in the counties 10

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 - Mass media intervention: cholera key messages and radio spots are being broadcasted on Mingkaman100 FM, and Radio Jonglei 95.9FM to reach population remote villages social mobilizers from CDNF received refresher training on basic interpersonal communication skills in Bor and Twic east counties Jonglei (Old Fangak, Akobo and Pigi FCDI and CHDs UNICEF supported partner Fangak Community Development Initiative (FCDI) continue with community engagement activities which include household visits with critical demonstrations, community meetings, water-point and market awareness, school and cattle camps intervention in areas of Fangak, Pigi and Khorflous community mobilizers reached 24,570 people visiting 8190 households. - 4,050 students were oriented on cholera prevention in 9 school sessions community members have attended 15 community meetings people were oriented on cholera through 5 market and water point intervention. - Jonglei (Akobo, Nyirol, Uror) Nile Hope and CHDs Nile Hope in partnership with UNICEF C4D continue with community engagement activities which include household - 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 visits with critical demonstrations, community meetings, water-point 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, 115 Social mobilizers conducted house to house visit and reached 820 Households (4,100 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 4 schools reached and 940 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. - Community sensitization Meetings: Nile Hope social mobilizers conducted community meetings at different Payam of Akobo, Nyirol and Uror counties, Numbers of 3 meetings were held and 770 peoples including of community leaders which comprise of local chiefs, religious leaders and women and youth leaders. - Markets awareness interventions: 8 sessions were held at the market places and 2,780 reached 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 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 11 Sessions on cholera awareness interventions reaching 6,430 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 2 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 4,570 peoples. - Religious engagement: Social mobilizers reached people with effective cholera messages in over 6 churches during Sunday praying services in the counties of Uror, Nyirol and Akobo and reached 3350 peoples including Children, women, men in different churches 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 Rubkona county Nile Hope and CHD Nile Hope in partnership with UNICEF C4D continue with community engagement activities which include household visits with critical demonstrations, community meetings, water-point and market awareness, school and cattle camps intervention in Rubkona. Below are some of the achievements; - 2 health facilities are visited in Bentiu 850 individual benefited from hygiene promotion and sanitation messages. 5 water points are visited in Rubkona town and 267 individuals benefited from hygiene promotion and sanitation messages. 1 school visited in Rubkona and 200 individuals benefited from hygiene promotion and sanitation. 7 health facilities and 8 water point are visited in PoC and 2290 individuals benefited from hygiene promotion and sanitation messages. Therefore, the total number of people benefited from hygiene and sanitation messages 3,607 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 1. Awerial County (Payams: Alel, Dor, Puluk, Bunangok, Nile Magok, Abuyong) CHADO and UNICEF support communities in eastern lake with continued community interaction sessions such as household visits with critical demonstrations, - 2. Yirol East (Payams: Adior, Malek, Lekakedu, Yali, Pagarau Tin-agau and Nyang) community meetings, water-point and market awareness, school and cattle camps intervention in hot spots areas in Eastern Lakes CHADO had trained 83 social mobilizers to reached people in different community sessions in Eastern 3. Yirol West (Payams: Abang, Anuol, Yirol Centre (Town), Geng- Geng, Geer, Aluak Luak, Mapuordit) Lakes HHs reached and 7712Individuals through door to door mobilization for community on social and behavior change intervention on cholera control and diarrhea disease prevention in Eastern Lakes In Awerial, 615 households and 2121 individuals have been reached with cholera messages by 28 trained social mobilizers. A total of 23 and 2163 pupils benefited from schoolbased interventions on cholera awareness session. 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 The mobilizers also conducted 34 water point sessions reaching a total of 345 people including water vendors with Cholera and diarrheal disease educative messages including demonstration on water treatment and proper storage. 28 market awareness sessions were also conducted reaching 234 individuals including food vendors. At the same week, the social mobilizers conducted 25 community meetings and attended by 293 people inclusive of community leaders which comprise of local chiefs, religious leaders and women and youth leaders at different payams of Eastern Lakes Religious leaders engagement with key messages done during religious service days (Friday, Saturday and Sunday). 7 churches /parishes in the counties of Eastern reaching population with lifesaving messages on cholera control and prevention. 16

17 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 CHADO conducted social mobilization outreach activities in 26 Cattle camps with total of 564 individual In Yirol East, 28 trained mobilisers/health promoters reached, 643 households 2861 people) with key messages on cholera prevention and control on the same note, 23 community meetings were conducted with (354 people participated), 19 market sessions with total of 456 individuals reached, 36 schools with total of 5871 pupils, 54 water sessions conducted with total of 456 individuals reached. The Religious leaders were also engaged: During religious services, to reach people with effective cholera messages in the churches /parishes with lifesaving messages on cholera control and prevention. and have reached 10 churches/parishes in the county 17

18 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 In Yirol West, 758 households 2730 people) with key messages on cholera prevention and control by 28 trained mobilisers. 33 community meetings (460 people participated). 24 market session with total of 274 individuals reached. 21 school with total of 2510 pupils reached and 34 water sessions conducted with total of 350 individuals reached. The engagement of religious leaders: During religious services, Social mobilizers reached people with effective cholera messages in over 9 churches /parishes in the counties of Eastern lake reaching population with lifesaving messages on cholera control and prevention. Juba Gurei, Kator, Lologo, Gumbo, Nesitu Health link, SMoH and CHD As part of Mass media, a total of 14 FM stations continue with airing of radio spots and talk-shows in Juba and Yei. As of October, 2017, 1,680 times radio - 18

19 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 jingles have been broadcasted reaching over 2 million people across the country. This week, street announcement of both cholera and immunization messages has been ongoing through Five (5) Public Address Systems (PAs) in five main areas of the City namely; Rejaf, Kator, Juba, Munuki and Nyar-kenyi/Northern Bari. The PAs conducts 5 hours announcements per day (3 hr. morning and 2hrs evening). UNICEF partner Health Link South Sudan continue with social mobilization activities in the catchment areas of the nine (9) ORPs in Juba City and Lokiliri. As of week 45, trained community mobilizers reached a cumulative total of 44,248 households, 141,304 Females, 121,364 Males, 13 Community meetings with 932 people, 10 Schools with 3,514 with cholera messages in cholera hotspots areas that include Gurei, Kator, Lologo, Gumbo, Munuki, Khor William, Nyakuron and Nesitu. There were also 63,687 Aquatabs, 24,626 PuR, 1,048 tabs of soaps, 33,177 ORS given out. Also, this week, 94 IEC materials were distributed at social places including private clinics. 19

20 UNICEF supported partner, CDNF Mobilizers conducting IPC at household level and water point session in Marol and community meeting in Pariak FCDI mobilizers in Fangak engaging with community members at different levels in Fangak 20

21 CHADO Community mobilizers conducting several community engagement activities in Awerial, Yirol East and Yirol West Nile Hope social mobilizers making cholera awareness session at Karam IDP areas, Uror and school intervention in Padoi Village, Diror Payam, Akobo 21

22 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 22