Cholera in South Sudan

Transcription

1 Republic of South Sudan Cholera in South Sudan Situation Report # 14 as at 23:59 Hours, 29 May 2014 Background On 29 April 2014, a suspected case of cholera was reported from the MSF clinic at UN House/Juba III Protection of Civilian (PoC) 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 24 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. A retrospective record review at the emergency medical ward of Juba Teaching Hospital (JTH) revealed seven suspected cholera cases including one death, with the first case admitted at JTH on 23 April Situation Update The table below summarizes the number of suspected and confirmed cases reported in Juba. Table 1 Summary of cholera cases, 23 April - 29 May 2014 Summary of cases JTH Gurei Tongping UN House (Juba III) Gumbo Other sites Total new admisions today Readmissions Total new discharges today Total new deaths today Total number of cases currently admitted Leave Against Medical Advice (LAMA) Total facility deaths since the onset of the outbreak 16 Community deaths since the onset of the outbreak 11 Cumulative deaths since the onset of the outbreaks 27 Cumulative cases discharged Cumulative cases *Includes cases detected in private health facilities and at community level Total On 29 May 2014, 63 new cases were admitted at the cholera treatment centres () in Juba and 69 cases discharged, leaving 130 patients on admission in the. Cases have been reported from nine Payams in Juba county with the most affected being Munuki (302, 31%). See table 2. 1

2 Table 2 Distribution of cholera cases by place of residence in Juba, 23 April - 29 May 2014 Payam Week 20 Week 21 Week 22 Cases by Payam (%) Munuki (31) Rejaf (22) Northern Bari (17) Juba (16) Kator (9) Gondokoro (1) Lokiriri (0.4) Lirya (0.1) Mangala (0.1) Missing (3) Total by epi-week (100) The most affected villages include Gumbo in Rejaf, Gudele I in Munuki, Tongping in Juba, and Gudele II in Northern Bari (figure 1). Figure 1: Cholera cases from the five most affected villages per Payam, 23 April - 29 May 2014 Since the beginning of the outbreak on 23 April 2014, 960 cumulative cholera cases including 27 deaths (16 institutional and 11 community deaths, CFR 2.8%) have been reported. The majority of the deaths reported in hospital died on arrival. Hence the need to strengthen community case detection and prompt initiation of ORS treatment while immediate referral to the nearest is being organized. Figure 2 shows the outbreak trend since it started on 23 April Two peaks of transmission were registered on 19/05/2014 and 26/05/2014 with the latter higher than the former. 2

3 Figure 2: Juba cholera epidemic curve, 23 April May 2014 Of the 892 cholera cases reported, majority (537, 56%) are male, and aged years (380, 40%). Figure 3: Distribution of cholera cases by age, Juba, 23 April - 29 May

4 Figure 4: Number of daily admissions at the Juba s, 23 April - 29 May 2014 The following are some of suspected risk factors for contracting cholera in Juba: Drinking water from unsafe sources such as: untreated river water which in Juba is primarily supplied by water tankers, surface water-river and ponds Poor latrine use, lack of latrines and open defecation, Poor latrine use and open defecation Eating foods sold on the roadside and at makeshift markets. Poor hygiene practices at community level Poor community handling of dead bodies and unsupervised burials. Cholera Alerts Table 3 Summary of cholera alerts No Date received Details of the alert Area Needs/Actions taken 1. 30/05/2014 Two additional suspect cholera cases have been admitted in Yei Civil Hospital. Cumulatively seven suspect cholera cases including one death have been reported. Six suspect cases are currently admitted in Yei Civil Hospital /05/2014 The Central Equatoria MoH surveillance team followed up the AWD cases reported from Mangala two weeks ago Yei, Central Equatoria Mangala, Central Equatoria Taskforce has been re-activated Isolation ward has been designated in Yei Civil hospital PSI contacted to provide water guard Rapid diagnostic test positive for cholera Four samples from Yei arrives in the National Reference Laboratory and will be tested on 31/05/2014 No additional cases reported from the area 24 AWD cases improved on treatment 4

5 No Date received Details of the alert Area Needs/Actions taken 3. 30/05/2014 The Central Equatoria MoH surveillance team followed up on the two AWD cases reported from Terekeka hospital Jemeza, Central Equatoria Samples were collected but tested in the hospital laboratory with no conclusive findings No additional cases have been reported form Jemeza Payam (the area where the two cases originated from). Response actions today Case Management Refresher training was held for the clinical staff of the at JTC to emphasize on adherence to the National cholera control guidelines and infection control protocols. Importance of monitoring and supervision to further improve clinical outcomes and patient management were also emphasized, and clinical staff s duty hours/schedule was adjusted. JTH provided with 400 litres of ringers lactate, IEC materials, two tents, Personal Protective Equipment (PPEs) and 8 ORS modules. In addition, 200 bottles of 1liter of ringer lactate were sent to Yei to support the Civil Hospital in the management of suspected cholera cases. Surveillance and Laboratory Two new suspect cholera cases were admitted in Yei Civil hospital bringing the total number of patients on admission to six. Four samples arrived today in the National Reference Public Health Laboratory in Juba. A follow up visit to affected households in Gumbo was conducted. It was observed that there were no proper sanitary disposal facilities, no proper latrines as most of them had collapsed/open and flooded with rainwater and though to be contaminating the ground water. 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 House to house cholera prevention and control campaigns continued in Gudele, Juba, Lologo, Kator and Rejaf focusing on cholera prevention through hand washing and chlorination demonstrations. In Munuki A, B, C and Gudele I and II people working in public areas were reached with cholera prevention messages and received PuR sachets for water treatment and ORS. Other community mobilization activities conducted included: o Street announcements and distribution of about IEC materials in Gumbo and Gudele. o Mobilization using music, dance and drama in markets and other public areas of Gudele. o Jingles, radio announcements and talk shows focusing on cholera prevention. WASH Partners continued to conduct assessments and WASH interventions in: o Gudele I and II 5

6 o Gumbo, Ghabat & MTC: o Global ACF WASH partners working with urban corporation to support chlorination of water trucks. Protocols for waste management in /ORPs developed. Support to WASH activities in s including infection control activities continues, as well as provision of soap and chlorine for discharged patients. Current gaps Increasing case load at JTH. Increasing number of cholera cases from Gumbo, which is relatively far from JTH. Community engagement still needs to be strengthened in order to encourage early treatment seeking behaviour. Planned Activities Assessments in Gumbo to identify risk factors for cholera at household level. Further investigation of cholera alerts reported in new payams in Juba as well as in areas outside Juba. 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. 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. 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 is a challenge that needs to be urgently addressed. Increasing case load at JTH needs to be urgently addressed as the 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 6

7 We are very grateful to the staff at s, 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: 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: