Situation Report #20 on Cholera in South Sudan As at 23:59 Hours, 11 July 2015

Transcription

1 Republic of South Sudan Situation Report # on Cholera in South Sudan As at 3:59 Hours, 11 July 15 Situation Update As of 11 July 15, a total of 86 cholera cases including 34 have been reported in Juba County and in Bor, Jonglei State (Total CFR 3.9%). In Juba County 79 cases including 33 (CFR 4.%) have been reported from 75 villages in eight payams (Table 1). In Bor, the last update is as of 9 July 15, where 7 cases including one death (CFR 1.4%) were reported from Malou (34 cases) and other areas around Bor. The initial cases in Juba were traced back to 18 May 15 in UN House PoC where the first cholera case was confirmed on 1 June 15. Most of the cholera cases in Juba have been reported from New site followed by Gudele, Juba 3 PoC, Gumbo, and Gudele 1 (Figure 4). In Bor, the initial cases were reported from Malou area. Later, cases were reported from mainly from Arek, Block 8, Hai Salam, Achingdi, Langbar and 1 other areas around the city. Table 1. Summary of cholera cases reported in Juba County, 18 May 11 July 15 Reporting Sites New admisions New discharges New Total cases currently admitted LAMA* Total facility Total community Total Total cases discharged Total cases IMC UN House PoC clinic Hai Referendum IDP clinic Juba Teaching Hospital Al Sabah Hospital Morobo clinic Nyakuron PHCC Juba Military Hospital 5 5 Luri Military St. Kizito clinic Mauna Medical clinic Juba Prison MedAir Gumbo CTU Gorom PHCC MedAir Gudele ORP 4 4 Nyakuron ORP Kator ORP 3 3 Total *LAMA: LEAVE AGAINST MEDICAL ADVICE A total of 1 new cholera cases were reported in Juba on 11 July 15. In the last report from Bor 13 new cases were reported on 9 July 15 o Juba Teaching Hospital reported nine new cases while Al Sabbah Hospital, MedAir Gumbo CTU and Nyakuron ORP reported one new case each. 1

2 Figure 1: New cholera cases by residence on 11 July Game Hai Amarat Juba Nabari Lologo Malakia Nyakuron Gudele Gurei Plot 4 Dar es Salam Nyakuron West Gumbo Juba Kator Northern Bari Munuki Rejaf Cumulatively, 79 cholera cases including 33 (1 9 facility and 14 community) have been reported in Juba since the initial case was reported on 6 May 15 (Tables 1 and ). Of the 33, seven (1%) have occurred in children under five years. Table : New cholera cases by facility and week in Juba, 18 May 11 July 15 New cases by epidemiological week of 15 Reporting Facility Grand Total Al Sabah hospital Hai referendum IDP clinic 1 1 JTH IMC UN House PoC clinic Juba Military hospital 5 5 Morobo clinic Nyakuron PHCC 1 1 Luri Military 1 1 St. Kizito clinic Mauna Medical Clinic 1 1 Juba Prison 1 1 MedAir Gumbo CTU Gorom PHCC MedAir Gudele ORP 4 4 Nyakuron ORP 3 5 Kator ORP 3 3 Grand Total As seen from Figure, the initial and isolated cases were reported from UN House PoC starting on 6 May 15. However, following epidemiological investigations on 7 May 15, cases could be traced back to 18 May 15. Cholera was eventually confirmed on 1 June 15 after Vibrio cholerae inaba was isolated from the one of five samples tested in the National Public Health Laboratory. Since 6 June 15, sustained and consistently increasing community transmission was established with increasingly more suspect cases reported outside UN House PoC. There are three discernible transmission peaks with the initial peak of 15 cases occurring on 13 June 15 while the subsequent and higher peaks occurred on June, 6 June, and 8 June with 6, 49, and 54 cases respectively (Figure ). However there has been a gradual overall decline in the number of daily new cases in Juba from 9 June 15.

3 Figure : Epidemic curve for suspect cholera cases in Juba, 18 May 11 July Investigation and confirmation of initial case in UN house PoC Confirmation of initial Alive Date of onset Died 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; and open defecation/poor latrine use. Figure 3: Spot map for suspect cholera cases by residence in Juba, 18 May 11 July 15 As of 11 July 15, the sites reporting the majority of cases in Juba include New site, Gudele, Juba 3 IDP, Gumbo, Gudele 1 and Nyakuron West. Nonetheless, there are satellite cases distributed in eight Payams and 75 villages in Juba County (Figure 3 and 4). 3

4 Figure 4: Cholera cases by residence in Juba, 18 May 11 July Juba Nabari Juba Korobou Hai Jalaba Hai Zendia Makas Sabab Juba Prison Hai Soura Hai Commercial Suk Juba Hai Kosti 16 8 Lologo 5 1 Nyakuron Atlabara Konyokonyo Suk Jebel Nyakuron West 37 3 Gudele Jopa Jebel Kujur 38 Gudele Gudele Hai Tharawa Rock City Hai Jebel Gudele Block Juba Kator Munuki Northern Bari Rejaf Lokiliri Gondokoro Terekeka New site Walawalak Gurei Gorom Hai Referendum Jebel Lado Gurei Plot 4 Gorom Kor William Digala Juba 3 PoC Juba POC 3 Rajef Kodoro Lologi Duguge Lokiliri Gezira Khor Bow Out of the 771 suspect cholera cases with known age from Juba, 11 (13%) were children less than five years of age, while 67 (87%) were individuals five years and above (Figure 5). Figure 5: Suspect case distribution by age in Juba, 18 May 11 July 15 13% <5Yrs 5+Yrs 87% Out of the 771 cholera cases with known gender, 317 (41%) were female, while 45 (59%) were male (Table 3). Table 3: Case distribution by gender and age in Juba, 18 May 11 th July 15 Gender and age N (%) Female 317 (41) <5yrs 4 5+yrs 77 Male 45 (59) <5yrs 59 5+yrs 393 Grand Total 771(1) 4

5 Laboratory updates Table 4: Cholera laboratory test results for Juba, 18 May 11 July 15 Health Facility Number of RDT tests Number of cholera RDT positives Number of stool cultures Number of cholera Culture positives 1 Al Sabah hospital Juba Teaching Hospital Juba 3 PoC clinic Juba Military Hospital Morobo clinic 1 6 Gorom PHCC Total As seen from ttble 4, 65 (77%) of the samples have been RDT positive while 33 (44%) have been confirmed by culture after Vibrio cholerae inaba was isolated by the National Public Health Laboratory. Most of the culture confirmed cases have been reported from Juba 3 PoC and New site (Figure 6). All samples submitted from Kajo Keji (1) and Torit (3) were negative on culture. Figure 6: Number of culture positives by residence in Juba, 18 May 11 July Table 5: Cholera Alerts 3 to 11 July 15 Date of Details of the alert Area Action notification 5-July-15 One case in Warrap, Kuajok State Hospital, 5 July 15, elderly man initially seen in a private facility; profuse diarrhoea and vomiting and severe dehydration; no travel history; positive RDT. Kuajok State Hospital 1-July-15 3-Jun-15 7-Jun-15 6-Jun-15 Four acute watery diarrhoea cases including one death reported from Bele village in Bungu Payam, Juba Kabigiri PHCC in Wonduruba Payam in Juba County admitted four acute watery diarrhoea cases on 3 June 15 Community death following acute watery diarrhoea was reported in Juba Prison Nineteen suspect cholera cases reported in Kajo Keji Civil hospital Bele village, Bungu Payam, Juba Kabigiri PHCC, Wonduruba PHCC - Case being managed in Kuajok State Hospital. Stool specimen sent to Juba. Investigations are ongoing. - Four acute watery diarrhoea cases including one death reported from Bele village - Initial cases in this cluster developed severe diarrhoea at a funeral in Bele village and were rushed to Juba for treatment - One death occurred in the night of 1 July 15 and was buried on July Cluster verified by the county rapid response team - The four cases are admitted in Kabigiri PHCC - Initial case traveled from Juba on 8 June 15 - Four samples collected and shipped to Juba - Case management ongoing Juba Prison - Case verification and supervised burial conducted by the state rapid response team Kajo Keji, CES - A total of 19 acute watery diarrhoea cases have been line listed with eight cases on admission at the hospital - Ten samples shipped to Juba for culture and sensitivity. 5

6 Date of notification 6-Jun-15 5-Jun-15 Details of the alert Area Action Bor State Hospital reported 4 suspect cholera cases including one death from Malou area Two suspect cholera cases reported from Torit State Hospital Bor, Jonglei State - 4 suspect cholera cases including one new death have been reported in Bor - Out of the 4 suspect cholera cases, 1 have been discharged and 14 are still hospitalized in the cholera treatment center setup by MSF in Bor State Hospital - New cases reported from High Machor, 4 km from to the index village of Malou. - Five stool samples shipped to Juba for microbiological culturing. - Supplies including Carry Blair, RDTs, and case management kits dispatched to Bor - Epidemiological investigation undertaken by the state rapid response team - Preparations are underway to deploy the national rapid response team to support the ongoing response led by the state Ministry of Health Torit, EES - Three stool samples collected and received in Juba on 7 June 15 - Refresher training on cholera conducted for the state hospital healthcare workers - Temporary isolation for at least 1 patients set up in Torit state hospital - Since 5 June 15, at least seven alerts of suspect cholera cases have been reported outside Juba. The national and respective state cholera taskforce committees have initiated the recommended follow up actions as described in Table 5. The Bor outbreak has since been confirmed to be due to cholera. The number of cases as of 9 July was 7 with 1 death. Of the five stool samples sent to Juba, 3 were positive for V. cholerae. Planned and On-going Activities 1. The next national cholera taskforce meeting is scheduled for Monday 13 July 15 at 1: am in the Ministry of Health Ministerial Boardroom.. The next cholera coordination meeting in UN House PoC is scheduled for 16 July 15 at 11:3 am in the RRP Boardroom. 3. Testing for residual chlorine at household level by JCC in collaboration with WASH partners 4. Two new CTCs have been established at Gumbo and Suk Melitia. 5. ORPs have been established in selected locations in Juba 6. The second round of the Oral Cholera Vaccination (OCV) campaign in Juba is scheduled to start on 13 July. 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: 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: