Cholera in South Sudan

Transcription

1 Republic of South Sudan Cholera in South Sudan Situation Report # 12 as at 23:59 Hours, 27 May 2014 Background On 29 April 2014, a suspected case of cholera was reported from MSF clinic at UN House/Juba III IDP camp. The previous day he had visited relatives in Gudele where he developed severe diarrhoea. One of the contacts in the household had developed acute watery diarrhea on the 23 April Following field investigations and laboratory confirmation, on 15 May 2014, the Ministry of Health declared an outbreak of cholera in Juba. Since then, several suspected cases have been recorded and laboratory confirmed from different suburbs in Juba. Situation Update The table below summarizes the number of suspected and confirmed cases reported in Juba. Table 1 Summary of cholera cases, 23 April - 27 May 2014 No. Summary of cases JTH CTC Gurei CTC Tongping CTC UN House (Juba III) Other sites* A Total new admisions today B Total new discharges today C Total new deaths today D Total number of cases currently admitted E Leave Against Medical Advice (LAMA) F G H Total facility deaths since the onset of the outbreak Community deaths since the onset of the outbreak Cumulative deaths since the onset of the outbreaks Total J Cumulative cases discharged K Cumulative cases L Number of cases with laboratory confirmation by culture *Includes cases detected in private health facilities and at community level On 27 May 2014, 63 new cases were admitted at the cholera treatment centres (CTC) in Juba and 67 cases discharged leaving 139 patients on admission in the cholera treatment centres (table 1). Cases have been reported from 10 Payams in Juba county with the most affected being Northern Bari 177 (22%). See table 2. 1

2 Table 2 Cholera cases by area of origin in Juba, 23 April - 27 May 2014 Payam Week 17 Week 18 Week 19 Week 20 Week 21 Week 22 Cases by Payam (%) Northern Bari (22) Munuki (21) Rejaf (20) Juba (17) Kator (9) Missing (9) Gondokoro (1) Lirya (0.1) Lokiriri (0.4) Mangala (0.1) Total by epi-week Figure 1 shows the most affected villages that include Gumbo in Rejaf, Gudele I in Munuki, Tongping in Juba, and Gudele II in Northern Bari payam. Figure 1: Cholera cases from the five most affected villages per Payam, 23 April - 27 May 2014 Since the beginning of the outbreak on 23 April 2014, 800 cumulative cholera cases including 27 deaths (16 institutional and 11 community deaths) (CFR 3.4%) have been reported. The majority of the deaths reported in hospital died on arrival, highlighting the need to strengthen community case detection and prompt initiation of treatment with ORS, and immediate referral to the CTCs. 2

3 Figure 2 shows the outbreak trend since its start on 23 April 2013.Two peaks of transmission were registered on 19/05/2014 and 26/05/2014 with the later being higher than the former. Figure 2: Juba cholera epidemic curve, 23 April May 2014 Of the 800 cholera cases reported, majority (456, 57%) are male, and aged years (335, 42%). Figure 3: Distribution of cholera cases by age, Juba, 23 April - 27 May

4 Figure 4: Number of daily admissions at the Juba CTCs, 23 April - 27 May 2014 Assessment of risk factors and possible exposure is ongoing in all locations. The main risk factors for cholera in Juba are suspected to include the following: Drinking of untreated river water which in Juba is primarily supplied by water tankers, Poor latrine use, lack of latrines and open defecation, Eating foods sold on the roadside and at makeshift markets. Poor personal hygiene practices (for example hand washing) and community hygiene. In addition, consumption of water from unsafe sources such as surface water-river and ponds, poor community handling of dead bodies and unsupervised burials are other factors that increase the risk of the Juba community to contracting cholera. Cholera Alerts Table 1 Summary of cholera alerts No Date received Details of the alert Area Needs/Actions taken 1. 26/05/2014 The National MoH, State MoH in collaboration with WHO investigated two community deaths 2. 26/05/2014 Two suspected cholera cases reported to the alert desk 3. 26/05/2014 Two acute watery diarrhea cases were reported by the Gumbo, Rejaf Verification of community deaths undertaken by the team Juba Prisons Central Jemeza Payam, Terekeka Household disinfection done Health education of affected community members Additional suspect cholera cases referred to JTH-CTC Ambulance dispatched to transfer the cases to the JTC-CTC Health education provided to the prison authorities & inmates State MoH has asked the Terekeka County Health Department to conduct verification and submit a report. 4

5 No Date received Details of the alert Area Needs/Actions taken Terekeka County Commissioner Response actions today Case Management Case management services continue at the designated CTCs in Juba Teaching hospital, Gudele, Tongping and Juba III. Following the streamlining of ambulance services and dissemination of the hotlines, the communities are calling in to report suspected cases that require ambulance services. One DDK kit (that treats 100 severe and 400 moderate cholera cases) was donated to JTH CTC; one kit of PPEs to the burial team, and 10 cartons of examination gloves to the OPD in JTH. Surveillance and Laboratory Results of thirteen samples were received: three were positive for vibrio cholerae and are sensitive to tetracycline, while ten were negative. The national public health laboratory conducted test runs in preparation for the microbiological testing that is scheduled to start on 29/05/2014. The national public health laboratory has received two stool samples for testing. The first sample came from the Juba teaching hospital CTC while the second came from Melut in Upper Nile. Testing for the two samples is underway and the results will be available in the next hours. The surveillance team continues to receive and investigate all cholera alerts from the peripheral facilities and community levels. Epidemiological analysis of the outbreak data is ongoing to inform the current response. Social Mobilization UNMISS in collaboration with WHO and UNICEF facilitated a press conference on the cholera response. The press conference saw representation from various national and international media as well as MSF, MoH, UNMISS, WHO and UNICEF. Social mobilizers conducted group activities in public places of Munuki A, B, C and Gudele I & II that reached 15,727 males and 14,386 females. Streets announcements ongoing in Gumbo, Rejaf Payam where more cases are emerging. Collaboration with music shops in the main markets Munuki, Custom, Jebel, Gudele, Juba Town and Konyo konyo to play cholera prevention messages. Social mobilizers in Gumbo are now referring suspected cholera cases seen during house-to-house mobilization. Social Mobilizers continued to conduct house to house visits in areas of Gudele roundabout up to Lou Clinic, Gudele, Jebel Dinka, Rock city up to Mahona. To date 6,663 HHs have been covered. Awareness in Gumbo-IDPs with all IEC materials. Trained IYCF health workers on cholera prevention on hygiene and sanitation practices. 5

6 WASH From the assessment conducted in Melut, Kodok and Kaka the key Cholera propagation factors in both Kodok and Melut are contaminated drinking water as a result of open defecation, drinking untreated water (contaminated) water, and eating unhygienically prepared and/or stored food. 1000m 3 water was chlorinated at the CTCs in Juba, and FRC tested. Garbage collection in CTC and disinfection of contaminated areas continues. Construction of three new latrine stances for cholera patients was completed at Juba Teaching Hospital. A septic tank was installed at JTH for disposing of cholera waste. In Gumbo, WASH assessment was done, four awareness sessions were conducted that reached 290 people. In Ghabat, 196 HH visits conducted, awareness sessions reached 883 people; 2020 PuR sachets distributed to 202 HHs and 40,000 L of treated water were served In MTC, buckets and PuR were distributed to 43 HHs, 6,000 L of treated water were served, 2 Hand washing stations completed today 1 in Munuki (2 tanks) and 1 in Gedele I market (3 tanks).demonstrations on the use of PUR to hygiene promoters who will in turn teach the community in Munuki and Nothern Bari Payams Hand washing facilities were provided in Munuki Market and Gudele I & II Markets Current gaps Increasing case load at JTH CTC. Increasing number of cholera cases from Gumbo, which has no CTC close by and is relatively far from JTH. Community engagement still needs to be strengthened in order to encourage early treatment seeking behaviour. Planned Activities NPA will conduct training on social mobilization for volunteers from the areas of Bungu, Ganji, Wonduruba, Dolo, Rokon and Tijor on 4 June, The Ministry of Health in collaboration with the WHO and Medair are planning to conduct a training for all the clinical staff in the JTH CTC. The trainings are scheduled for 30 May 2014 and 2 June Plans are underway to set up oral rehydration points in the communities to support the early initiation of treatment of suspect cases in the communities. Mapping of operational presence and response capacity of health partners in PoCs across South Sudan. Investigate all alerts of cholera and continue with active case searching. Conduct burial supervision, disinfection of dead bodies and patients households. Conclusion and Recommendation Additional partners continue to join the response. There is a risk of the outbreak spreading to other surrounding counties and villages if community interventions are not rigorously conducted. Plans and budgets for community level interventions have been developed, however their implementation is challenging due to financial constraints. 6

7 From all indications, if community level interventions are implemented, the spread of cholera will be interrupted. The inadequate number of human resources to support case management at the CTC is a challenge that needs to be urgently addressed. Increasing case load at JTH needs to be urgently addressed as the CTC s bed and human resources capacity are being stretched. Acknowledgements The following partners who are supporting the Ministry of Health to conduct the response: Case management: Medair, MSF, UNICEF and WHO Social mobilization: ART, Medair, South Sudan Red Cross, OVCI, UNICEF and WHO Surveillance and Laboratory: WHO WASH: Medair, Norwegian People s Aid, OXFAM, People In Need and UNICEF We are very grateful 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 welcome 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. Please send any comments and feedback to: outbreak_ss_2007@yahoo.com, The Toll free number for alerts are: Gemtel: 9999 and Vivacell: Contacts For more information please contact: Dr. Pinyi Nyimol Mawien Director General - Preventive Health Services MoH, Republic of South Sudan Tel: Dr Othwonh Thabo Ag. Director - IDSR MoH, Republic of South Sudan Tel: