Cholera in South Sudan

Transcription

1 Republic of South Sudan Cholera in South Sudan Situation Report # 2 as at 23:59 Hours, 4 June 214 Background On 29 April 214, a suspected case of cholera was reported by the MSF clinic in UN House/Juba III Protection of Civilian (PoC) camp. On 28 April, he visited relatives in Gudele II where he spent a night and developed severe watery diarrhoea. One of the contacts in the household had developed acute watery diarrhea on the 24 April 214. The Ministry of Health and WHO team collected stool samples on 14 May 214 from the four household s contact in Gudele II which were all laboratory confirmed. On 15 May 214, the Ministry of Health declared a cholera outbreak in Juba. Since then, several suspected cases have been reported and laboratory confirmed from different suburbs in Juba. A retrospective record review at the emergency medical ward at Juba Teaching Hospital (JTH) revealed seven suspected cholera cases including one death, with the first case admitted at JTH on 23 April 214. Situation Update Table 1 summarizes the number of suspected and confirmed cases reported in South Sudan. Table 1 Summary of cholera cases, 23 April - 4 June 214 Summary of cases JTH Gurei Tongping UN House Gumbo Kajo-Keji Yei Other Total CTC CTC CTC (Juba III) ORP Civil Hosp Hospital sites Total new admisions today 48 Readmissions 1 1 Total new discharges today 46 Total new deaths today Total number of cases currently admitted 76 Leave Against Medical Advice (LAMA) Total facility deaths since 15 1 the onset of the outbreak 16 Community deaths since the onset of the outbreak 13 Cumulative deaths since the onset of the outbreaks 29 Cumulative cases discharged 1119 Cumulative cases ,36 *Includes cases detected in private health facilities and at community level ** An extensive data clean-up exercise is underway to improve analysis and reporting quality. Cases were reported from eleven Payams in Juba County with the most affected being Munuki (34, 26.4%) are summarized in Table 2. 1

2 Tongping Amarat Juba Town Malakia Gabat Giada Kator Lologo Jebel market Konyokonyo Gurei Gudele 2 New Site Jebel Dinka Jebel Check Point Gumbo Sirikat UN House Juba 3 Khor Wolyang Khor Romula Gudele 1 Nyakuron Mauna Mia sava Munuki Number of cases Table 2 Distribution of cholera cases by place of residence in Juba, 23 April 4 June 214 Payam Week 17 Week 18 Week 19 Week 2 Week 21 Week 22 Week 23 Total cases by Payam Northern Bari Munuki Juba Rejaf (2.5) 34 (26.4) 21 (15.6) 277 (21.5) Kator (11.6) Missing (2.4) Gondokoro (1.5) Lirya (.2) Lokiriri (.4) Mangala 1 1 (.8) Total cases by week Figure 1 shows the most affected villages including; Gumbo in Rejaf, Gudele I in Munuki, Tongping in Juba, Giada in Kator, and Gurei in Northern Bari. Figure 1: Cholera cases from 5 most affected villages per Payam, Juba, 23 April - 4 June Juba Kator Nothern Bari Rejaf Munuki Affected Areas Since the onset of the outbreak on 23 April 214, a total of 1,36 cholera cases including 29 deaths (16 institutional and 13 community deaths, CFR 2.2%) have been reported. The majority of deaths reported in hospital died on arrival. Hence the urgent need to strengthen community surveillance activities, prompt initiation of ORS treatment and quick referral to the nearest CTC is being organized. Figure 2 shows the outbreak trend with two peaks of transmission registered on 19/5/214 and 26/5/214. 2

3 Number of cases 21/4/29 23/4/211 25/4/213 27/4/215 29/4/214 1/5/214 3/5/214 5/5/214 7/5/214 9/5/214 11/5/214 13/5/214 15/5/214 17/5/214 19/5/214 21/5/214 23/5/214 25/5/214 27/5/214 29/5/214 31/5/214 2/6/214 4/6/214 Number of cases Figure 2: South Sudan cholera epidemic curve, 23 April June Died Alive Date of onset Of the total 1,283 cholera cases for which age and gender information is available, majority are male (734, 57.2%), and aged 2-34 years (52, 39%). Figure 3: Distribution of cholera cases by age 23 April 4 June M F Age group The following are some of suspected risk factors for contracting cholera in Juba: Drinking water from unsafe sources such as: untreated river water supplied by water tankers, surface water-river and ponds Poor latrine use, lack of latrines 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. 3

4 Cholera Alerts Table 3 Summary of cholera alerts No Date received 1. 5/6/214 One community death and two suspected cholera cases were reported from Lanyi PHCC in Mundri. 2. 4/6/214 Two community deaths of suspected cholera cases were reported at New site. One died on 3 June and his body was taken to Juba Military Hospital and another on 1 June 214 reported to the investigation team. The two deceased were neighbours. 3. 3/6/214 Two suspected cases of cholera were reported from Lanyi primary health care centre. A 17 year old female with a history of travel from Juba on 28 th May. She developed severe watery diarrhea and vomiting on Friday 3 th May and was rushed to Lanyi PHCC. She was treated on fluids and improved. The second person, the mother of the patient also developed watery diarrhea, but improved following management. Response actions today Details of the alert Area Needs/Actions taken Lanyi, Mundri East New site, Juba, Central Equatoria State Lanyi, Mundri East WHO and MoH emergency response team are heading to Lanyi for field investigation and stool sample collection today 6 June 214. A team from the Ministry of Health disinfected the body and household of case that died on 3 June. The first case was investigated/followed up Another investigation will be conducted on 5 June 214 A rapid assessment was made to the facility. Request for Carry Blair has been made Samples to be collected Case Management The case management working group meeting was held on 5 June 214. During the meeting, members were informed that two ORS corners were opened up at Muniki and Nyakuron and the construction of CTC in Gumbo was started. Three ambulances are positioned at Juba Teaching hospital designated to transport/refer patients to the nearest CTC. Surveillance and Laboratory The WHO Emergency Response Team and the County surveillance focal person for Juba County conducted contact tracing and investigation of a suspected cholera case reported from New Side in Juba. Two community deaths were also reported from the area on 4 June 214. The team was informed of another case who was treated at the military hospital and discharged the same day. Plans are underway to dispatch an infection control team to disinfect the households of the deceased and distribute ORS sachets to members of this community. Health education was given to the relatives of the affected and deceased persons. Community based surveillance continued to enable early case identification and ensure prompt referral to the CTCs. The team continued receiving and investigating all cholera alerts from the peripheral facilities and community levels. Epidemiological analysis of the outbreak data continued to inform the current response. 4

5 Social Mobilization and WASH Two hotlines remain operational to support cholera case reporting: 9999 and Sixty (6) State Ministers from 1 states of South Sudan were oriented on cholera prevention in a consultative planning meeting for state ministers organized by the Ministry of Education in partnership with UNICEF. Seventy six, (76) social mobilizers conducted door to door campaigns to disseminate cholera preventive messages. A total of 1,512 households were reached, 1,153 in Rajaf,, 1,24 in Kator and 112 in Gumbo. Demonstrations on proper hand washing, water treatment with PUR and immediate response with Oral Rehydration Solution was done. Sensitization on benefits of seeking medical treatment was also shared with the families visited. Twenty (2) ORT Corners have been established in major health facilities in Juba town to support rehydration of the patients. Distribution of emergency supplies continued in Juba, Rajaf and Kator with total of 6,64 sachets of chlorine, 895 bars of soap, 1, 25 sachets of ORS distributed to households in IDP camps, Don Bosco PHCC, 2-host community, Kator and Rajaf. In response to cholera outbreaks in other parts of the country, a joint team of social mobilizers and WASH visited Kajo Keji County to assessment risk factors, following reported cases in the area. Discussions were held with the County Health Department to agreed on appropriate interventions. WASH Water Hygiene and Sanitation assessment was conducted at Al Sabbah Hospital to set up stabilizing center for children suspected with Cholera. The construction of 42sqm tent was completed and installation of WASH facilities such as; drinking water and waste water storage tanks at the isolation is in process. Forty (4) staffs from Al Sabbah Hospital (Nurses, Clinical Officers, Hygiene promoters and Medical Officers) were trained on: Safety procedures for patients and care givers in the hospital, chlorination of water for drinking, use of chlorine for disinfection and use of pool tester for monitoring of free chlorine residual,etc Twelve (12) drums of 45kg chlorine were provided to Juba City Council for the disinfection of tanker trucked water from various riverside collection points. In total 1 water points currently have a total of 53 chlorinators trained by UNICEF to provide daily disinfection of an estimated 3, tanker trips, or 2, cubic meter of water A total of 13, 28 liters of treated drinking water, hand washing, disinfection and cleaning, 362 bars of laundry soap for CTC staff, and patients admitted and those discharged, and 595 strips of chlorine tablets to be distributed to patients discharged were distributed to Juba Teaching Hospital CTC. Current gaps Strengthen community engagement and monitoring in order to encourage early treatment seeking behavior. Conclusion and Recommendation The numbers of partners joining in the response has slowed down. More partners are therefore required to support the response art various locations outside of Juba. There is a risk of the outbreak spreading to other surrounding states, counties and villages as evidenced by alerts from four states namely; Western Equatoria, Upper Nile, Unity and Jonglei States. Thus a call for rigorous community interventions. Plans and budgets for community level interventions have been developed, however their implementation is challenging due to financial constraints. 5

6 If community level interventions are implemented, the spread of cholera will be interrupted. The inadequate number of human resources to support case management in different parts of South Sudan should the outbreak spread further. 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_27@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: