Republic of South Sudan Cholera in Juba, Central Equatoria State, Republic of South Sudan Situation Report # as at 3:9 Hours, 3 June 1 Situation Update As of 3 June 1, a total of 6 cholera cases including 19 (CFR %) have been reported from 7 villages in seven payams of Juba County (Table 1). The initial cases were traced back to 18 May 1 in UN House PoC, which has reported the majority of the cases followed by site, Mangatain IDP, Gumbo, Kor William, Gudele 1 and Munuki. Table 1. Summary of cholera cases reported in Juba County, 18 May 3 June 1 Reporting Sites admisions discharges currently admitted LAMA* facility community discharged UN House PoC clinic 3 1 1 17 Hai Referendum IDP clinic 1 1 1 Juba Teaching Hospital 16 19 6 1 7 9 8 16 Al Sabah Hospital Morobo clinic 1 1 3 Nyakuron PHCC 1 1 1 Juba Military Hospital Luri Military 1 1 1 St. Kizito clinic Mauna Medical clinic 1 1 1 16 6 1 9 19 111 6 *LAMA: LEAVE AGAINST MEDICAL ADVICE Epidemiological updates Sixteen new cholera cases were reported in Juba on 3 June 1. o All the new cases were reported by Juba Teaching Hospital Cumulatively, 6 cholera cases including 19 (nine faci lity and community) have been reported since the initial case was reported in Juba on 6 May 1 (Tables 1 and ). Table : cholera cases by facility and week in Juba, 18 May 3 June 1 cases by epidemiological week of 1 Reporting Facility 1 3 6 Grand Al Sabah hospital Hai referendum IDP clinic 1 1 JTH 31 11 1 16 Juba 3 IMC clinic 9 Juba Military hospital Morobo clinic 1 3 Nyakuron PHCC 1 1 Luri Military 1 1 St. Kizito clinic Mauna Medical Clinic 1 1 Grand 7 13 1 6 As seen from Figure 1, the initial and isolated cases were reported from UN House PoC starting 6 May 1. However, following epidemiological investigations on 7 May 1, cases could be traced back to 18 May 1. Cholera was eventually confirmed on 1June 1 after Vibrio cholerae inaba was isolated from the one of five samples tested in the National Public Health Laboratory. 1
Since 6 June 1, sustained and consistently increasing community transmission has been established with more suspect cases being reported outside UN House PoC. There are two discernable transmission peaks with the initial peak of 1 cases occurring on 13 June 1 while the subsequent and higher peak of cases occurred on June 1 (Figure 1). Figure 1: Epidemic curve for suspect cholera cases in Juba, 18 May 3 June 1 3 1 Investigation & Confirmation of initial case in UN house Poc Confirmation of initial case in UN house Poc /1/1 /17/1 /19/1 /1/1 /3/1 //1 /7/1 Alive /9/1 /31/1 6//1 6//1 6/6/1 6/8/1 Date of onset 6//1 6/1/1 Died 6/1/1 6/16/1 6/18/1 6//1 6//1 6//1 The majority of suspect cholera cases in Juba have been reported from Juba 3 IDP, site, Mangatain IDP, Gumbo, Kor William, Munuki and Gudele 1 (Figure ). Figure : Spot map for suspect cholera cases by residence in Juba, weeks 1-6 of 1
As of 3 June 1, the sites reporting the majority of cases in Juba include UN House PoC, site, Mangatain IDP, Gumbo, Munuki and Kor William (Figure 3). There are satellite cases distributed in seven payams and 7 villages in Juba County. Intensive interventions in the form of social mobilization and health education on cholera presentation and prevention, improving access to safe drinking water, latrine use and good personal and food hygiene are therefore required to prevent further escalation in Juba and spread to other counties outside Juba. Figure 3: Suspect cholera cases by residence as at 3 June 1 1 3 3 16 13 11 1 6 6 6 1 3 1 3 6 1 1 1 3 1 3 1 1 1 1 1 1 1 1 1 1 1 Hai Jalaba Tongping Hai Amarat Nimilatalata Hai Zendia Hai Kosti Lologo Giada Atlabara Nyakuron West Gudele Jopa Gudele Gurei Gudele 1 Hai Kuwait site Walawalak Gurei Gorom Gumbo Kor Wiliam Digala Lokiliri Juba Juba Nabari Kator Munuki Northern Bari Rejaf Lokiliri Out of the 199 suspect cholera cases with known age, 7 (1%) were children less than five years of age, while 17 (86%) were individuals five years and above (Figure ). Figure : Suspect case distribution by age in Juba, week 1 to of 1 1% 86% <yrs +yrs Out of the 199 cholera cases with known gender, 83 (%) were female, while 116 (8%) were male (Table 3). Table 3: Case distribution by gender and age as at 3 June 1 Gender and age N (%) Female 83 () <yrs +yrs 73 Male 116 (8) <yrs 17 3
Gender and age N (%) +yrs 99 Grand 199 () The probable risk factors identified 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 unsafe food from unregulated roadside food vendors; eating food from unregulated roadside food vendors or makeshift markets; and open defecation/poor latrine use. Laboratory updates Table : Cholera laboratory test results for Juba, 18 May 3 June 1 Health Facility Number of sample collected Number of cholera RDT positives Number of cholera Culture positives 1 Al Saba hospital Juba Teaching Hospital 7 3 Juba 3 PoC clinic 16 9 Juba Military Hospital 3 Morobo clinic 1 69 1 A total of 69 stool samples have been collected from suspect cholera cases in Juba and submitted to the National Public Health Laboratory for testing (test results by facility shown in Table ). The National Public Health Laboratory has confirmed 1 cholera cases following the isolation on Vibrio cholerae inaba. Most of the culture confirmed cases have been reported from Juba 3 PoC and site (Figure ). Figure : Number of culture positives by residence as at June 1 9 8 7 6 3 1 1 1 9 1 1 1 1 Cholera Response Highlights 1. Urgent and lifesaving cholera response activities have been initiated by the national cholera taskforce in response to the increasing number of cases in Juba.. The cholera response strategy is being reviewed and updated to suit the current context and to facilitate mobilization of resources to control the outbreak. 3. The national Epidemic Preparedness and Response committee convened on June 1 to review the current cholera situation and response interventions.. Oral cholera vaccination campaigns are underway in Bentiu PoC and UN House PoCs with Bentiu PoC implementing the second round of vaccination while UN House PoC is implementing its first round of vaccination. The vaccination in the two sites is expected to end on June 1 with a possibility of extending to 6 June 1 to mop up unvaccinated individuals. Urgent needs 1. Partners to support Juba Teaching Hospital cholera treatment center (CTC) and set up oral rehydration points (ORP) in Gumbo, site, Mangatain IDP, Gudele, Nyakuron, Munuki and Kator.. Standby ambulances to support the transfer of cases to designated treatment centers.
3. Stricter monitoring of water tankers by the Riverside and field surveillance to ensure water delivered to households conforms to the minimum free residual chlorine levels.. Urgently train and deploy home hygiene promoters to cholera hotspots for house-to-house sensitization on cholera prevention; active case finding and reporting; initiating oral rehydration treatment for new cases and referral to oral rehydration point or cholera treatment center; and distributing water purification tablets. Planned activities 1. The cholera coordination meeting in UN House PoC is scheduled for June 1 in the RRP boardroom starting 11:3 am.. The national cholera taskforce meeting takes place weekly. 3. Finalizing sub-committee response strategies and plans ready for presentation at the next national cholera taskforce meeting. 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: http://www.who.int/hac/crises/ssd/en/ as well as on the Humanitarian Info webpage: http://southsudan.humanitarianresponse.info/clusters/health. 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: E-mail: outbreak_ss_7@yahoo.com, The Toll free numbers for alerts are: Zain: 9198. Contacts For more information please contact: Dr. John Rumunu Director General - Preventive Health Services MoH, Republic of South Sudan Tel: +119668178 Dr. Thomas Akim Ujjiga Ag. Director - IDSR MoH, Republic of South Sudan Tel: +11916