Cholera in South Sudan Situation Report # 92 As at 23:59 Hours, 08 -14 September 2014

Cholera in South Sudan Situation Report # 92 as at 23:59 Hours, 08 -14 September 2014

Situation Update

As of 14 September 2014, a total of 6,115 cholera cases including 139 deaths (CFR 2.27%) had been reported in South Sudan as summarized in Tables 1 and 2.

Table 1. Summary of cholera cases reported in Juba County, 23 April –14 September 2014 New New New deaths Total cases Total Total admisions discharges Total Total cases Reporting Sites 08-14 Sept currently facility community Total cases 08-14 Sept 08-14 Sept deaths discharged 2014 admitted deaths deaths 2014 2014 JTH CTC 5 2 0 3 16 0 16 1452 1476

Gurei CTC (changed to ORP) Closed 28 July 2 0 2 365 367

Tongping CTC -- 0 0 0 2 1 3 69 72

Jube 3/UN House CTC -- 0 0 0 0 0 0 97 97

Nyakuron West CTC Closed 15 July 0 0 0 18 18

Gumbo CTC Closed 5 July 0 0 0 48 48

Nyakuron ORP Closed 5 July 0 0 0 20 20

Munuki ORP Closed 5 July 0 0 0 8 8

Gumbo ORP Closed 15 July 0 3 3 67 70

Pager PHCU 6 0 0 1 1 5 6 40 47

Other sites 0 0 0 1 15 16 1 17

Total 11 2 0 4 22 24 46 2185 2240 N.B. To prevent double counting of patients, transferred cases from ORPs to CTCs are not counted in the ORPs.

Table 2: Summary of cholera cases reported outside Juba County, 23 April –14 September 2014 New New New Total cases Total Total admisions discharges deaths Total Total cases Total States Reporting Sites currently facility community 08-14 Sept 08-14 Sept 08-14 deaths discharged cases admitted deaths deaths 2014 2014 Sept 2014 Kajo-Keji civil hospital 2 0 0 0 3 4 7 86 93 CES Yei Hospital -- 0 0 0 0 2 2 45 47 WES Lanyi- Mundri East -- 0 0 0 0 0 0 3 3 Jonglei Kolmanyang, Bor -- 0 0 0 0 0 0 1 1 Nimule Hospital 3 0 0 0 0 0 0 104 104 OTC PHCC, Magwi -- 0 0 0 10 0 10 141 151

Magwi PHCC 0 0 0 5 1 0 1 12 18

Pajok PHCC, Magwi -- 0 0 0 0 0 0 1 1

Nyolo CTC, Magwi 0 0 0 0 0 0 0 25 25

Idali PHCU, Lafon -- 0 0 0 5 1 6 90 96 Lwala PHCU, Pachidi -- 0 0 0 0 1 1 1 2 payam, Lafon Longiro PHCU,Lafon -- 0 0 0 1 0 1 15 16 EES Lalanga PHCU, Lafon 0 0 0 0 0 2 2 63 65

Torit Hospital 0 4 0 0 8 9 17 1403 1420 Bur Mutram PHCU, -- 0 0 0 0 1 1 59 60 Bur Payam, Torit Ohiri PHCC, Bur -- 0 0 0 3 0 3 53 56 Payam, Torit Ohila PHCC, Bur -- 0 0 0 0 0 0 24 24 Payam, Torit Imurok PHCU, Imurok -- 0 0 0 2 1 3 10 13 Payam, Torit Hiyala PHCC, Torit -- 0 0 0 0 0 0 86 86 Olere PHCU, Imurok -- 0 0 0 0 0 0 4 4 Payam, Torit

1 New New New Total cases Total Total admisions discharges deaths Total Total cases Total States Reporting Sites currently facility community 08-14 Sept 08-14 Sept 08-14 deaths discharged cases admitted deaths deaths 2014 2014 Sept 2014 Osito PHCU, Bur -- 0 0 0 0 0 0 42 42 payam, Torit Ileu PHCU, Hiyala -- 0 0 0 3 7 10 147 157 payam, Torit Hileu PHCC, Himodonge Payam, -- 0 0 0 0 0 0 6 6 Torit Ofiri PHCU, Kudo -- 0 0 0 0 0 0 5 5 Payam, Torit Kudo PHCC, Kudo -- 0 0 0 1 0 1 54 55 Payam, Torit Moti PHCU, Ifwotu, -- 0 0 2 0 1 1 4 7 Torit Riwoto PHCC, Kapoeta 1 1 0 0 1 0 1 71 72 North SSRCORPs, Nyong -- 0 0 0 0 0 0 70 70 Payam, Torit St. Theresa, Isohe, 0 7 1 2 2 2 4 93 102 Ikotos Ibahure PHCC, ibahure 0 0 2 1 0 1 23 25 Payam, Lopa/Lafon Other sites -- 0 0 0 0 0 0 23 24

Kaka -- 0 0 0 0 0 0 0 1

Wau Shilluk, Malakal -- 0 0 4 15 2 17 885 906 Upper Nile Malakal PoC -- 0 0 0 2 0 2 59 61

Other sites -- 0 0 0 2 0 2 55 57

Total 6 12 1 15 60 33 93 3763 3875 x: facilities that did not report; -- no cases reported for at least two weeks

Figure 1: South Sudan Cholera Epidemic Curve, week 17-37, 2014 1200

1000

800

600

No Cases No 400

200

0 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 Epidemiological week 2014 WES UNS EES CES

Figure 2: Cholera Case Distribution by Age, Sex, & State – week 37 10 9 8 7 4 6 5 4

No. cases No. 3 2 5 3 1 2 2 0 CES EES CES EES <5yrs ≥5YRS

Female Male

2 Figure 3: New Cholera Cases in Juba County during week 37, 2014 3

No. cases cases No. 1 2 2 2

1 1 1 1 1

0 Lologo New Site Karpeto Kelang Jibi/Karpeto Gwadiang Gezira Mia sava Kator Northern Bari Lobonok Gondokoro Munuki

Figure 4: New Cholera Cases in Magwi County during week 37, 2014

1 No. cases No.

1 1 1

0 Motoyo West Motoyo East Malakia West Nimule

Figure 5: New Cholera Cases in Kapoeta North County during week 37, 2014 3

No. cases cases No. 1 2

0 Najie (Naskal)

Table 3. Cholera alerts reported between 25 – 14, September 2014 Date of Details of the alert Area Action notificatio n 24/08/2014 Pager PHCU reported a cluster Lobonok - Verification was conducted by the of nine (9) acute watery Payam, county surveillance team. diarrhoea cases including five Juba, CES - WHO has provided case management (5) community deaths. The supplies and a tent to accommodate cases were reported from two the suspected cases. (2) villages (Karpeto & Pager) - WASH interventions at the community in Lobonok Payam, Juba level are still pending. County. By 14 September - A joint mission of MoH and partners 2014, the cases had risen to visited Lobonok during week 37 to 47, including six (6) deaths (five assess the outbreak and support the community deaths and one response. death in the health facility).

Coordination The MOH and partners have started preparing for the national workshop to develop a comprehensive framework on cholera prevention and response to be implemented in 10-15 potential outbreak counties. This workshop will also take stock of achievements, identify gaps and explore integration of cholera preparedness under the larger umbrella of essential practices at HH level covering safe water treatment, sanitation, nutrition and hand-washing among other issue.

Surveillance and laboratory . Eleven (11) new cholera cases was reported in Juba County in week 37 with the majority (6) being reported from Lobonok (55%), while the rest were reported from Lologo in Kator (2 cases); Gezira in Gondokoro (1 case) and Mia saba in Munuki (1 case). Two cholera cases were reported from Kajo-Keji during week 37. . Cases in Lobonok have reduced following a joint response by MOH with support from Health and WASH partners. Support was provided in the areas of; case management, surveillance, social mobilization and WASH interventions (see details in corresponding sections of this report). . In Eastern Equatoria State, four new cholera cases were reported in week 37 with the majority being reported from Nimule hospital (3 cases) while the rest were reported from Kapoeta North (1 case). . There were no new cholera cases reported from Malakal PoC or Wau Shilluk in week 37. . As seen from figure 1, the cholera trend is on the decline in all the five states where cholera has been confirmed. . Due to the declining cholera trend, it is recommended that all new suspect cholera cases have their samples obtained for laboratory confirmation.

Case management  Management of new cholera cases is ongoing in Juba, Nimule and Kapoeta North where new cases were reported during week 37.  Adequate supplies have been availed to support case management activities in Lobonok where cases are reported to be on the decline.

Social mobilization This week, social mobilization activities were implemented in various parts of the county, through a number of strategies listed below:

. Information, Education and Communication (IEC) materials were provided and displayed in strategic locations in public places in Lobonok. . In Gadiang, Maremo and Kit villages, 15,000 Aqua tablets were distributed to the communities and health facilities during community and door to sensitizations

4 . Community meetings were held with community and religious leaders, including paramount and executive chiefs in Karpeto to seek their support in creating community awareness on Ebola. . In Juba, partners reached 4,718 households. A total of 20,643 were also reached with messages on on hand washing with soap, household water treatment and preparation of oral rehydration salts (ORS) and salt sugar solution (SSS). . In Jonglei, drama and Video sessions were conducted in Bor town as a part of cholera awareness in schools and Child Friendly Spaces. A total of 250 schoolchildren and eight teachers from 12 schools reached on cholera control and prevention. Demonstrations on hand washing using soap and clean water were done. . Messages continue to be broadcast in Radio Jonglei six times a day and in Eastern Equatoria . A total 802 HHs were also reached with cholera prevention messages in Eastern Equatorial State.

WASH . In light of the increase in AWD cases reported in Juba, WASH partners have been mobilized and are responding in Lobonok. Partners continue to enhance water, sanitation and hygiene within the communities in Eastern Equatorial State. . In Central Equatoria State, partners are providing safe drinking water in markets forhand washing, Community mobilization, hygiene promotion, cholera awareness and prevention messages reaching 4,833 households reached in this reporting period; and constructing, Emergency latrine construction and targeted distribution of WASH non-food items (NFI) in Lobonok. . In Upper Nile State, (Malakal PoC and Wau Shilluk), partners have reached 3,172 households in the past one month with the distribution of soap and hygiene kits, one kit per household reaching 407 households. . In Akoka, Panyikang and Banketa, partners plan to start hygiene promotion and cholera awareness campaigns. . In Eastern Equatoria State, partners continue with interventions in Torit, Magwi, Ikwoto, Lopa- lafon, Kapoeta and Budi counties among them: Training of 180 home health promoters, hygiene promotion targeting Cholera hot spots including distribution of soap for hand washing, aqua tabs and PUR for household water treatment reaching 2,400 households in Kapoeta, rehabilitation of water points at Magwi PHC; and water testing in boreholes and rainwater harvesting tanks with 14 boreholes covered in in Magwi.

Gaps and needs Case management, surveillance and laboratory . Submission of updated cholera line lists to the Ministry of Health needs continue . Cholera treatment centres should submit samples from new cases for laboratory testing. This will guide decisions on the end of outbreak declarations in the affected counties.

Social mobilization . There is a huge gap in monitoring and supervision activities and dissemination of cholera messages outside Bor county, and Twic East.

Conclusions and Recommendations Overall, cholera is on the decline countrywide. The following are the key recommendations: . Rollout targeted and comprehensive interventions to the affected villages in Lobonok Payam in Central Equatorial state and to Magwi & Kapoeta North Counties in Eastern Equatoria. . Sustain interventions to the other affected counties in the areas of case management, surveillance and laboratory, social mobilization and WASH. . Evaluate the overall response to the cholera outbreak to document experiences and lessons learnt for improving future response. . Update development plans to ensure that areas at high-risk for cholera are prioritised for social mobilization and sensitization and other evidence based interventions for improving the construction and use of appropriate sanitary facilities and improving access to safe water.

5 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: [email protected], The Toll free numbers for alerts are: Gemtel: 9999, Vivacell: 0952000098 and Zain: 0912000098.

Contacts For more information please contact: Dr. John P. Rumunu Dr Thomas Akim Ujjiga Director General - Preventive Health Ag. Director - IDSR Services MoH, Republic of South Sudan MoH, Republic of South Sudan Tel: +211955150406 Tel: +211955668178