Republic of

CHOLERA RESPONSE UPDATES AS OF 30 June 2017

Overall coordination of the cholera response at the national level is coordinated by the National cholera taskforce that meets weekly on Wednesdays from 2pm in the WHO conference hall in . In addition, the cholera coordination meeting in Juba Teaching hospital convenes on Monday starting 11am and Friday starting 9am in the Postgraduate School.

At the sub-national level, cholera taskforce committees are coordinating the cholera response in locations with active transmission including Yirol East and Yirol West, Bor, Duk, Tonj East, South, Kapoeta North, and Kapoeta East. Other non-affected states have also initiated cholera preparedness meetings in Aweil, , Wau, Yambio, and Rumbek.

Surveillance and case management updates

New cholera alerts

In Torit: Six suspect cholera cases were reported from Orieju, 12km from Torit Town. A verification mission to the affected area on 30 June 2017 could not materialize due to security concerns.

Terekeka: Suspect cholera cases reported in SPLA soldiers deployed in Magri and Mangala, County. Ten suspect cholera cases have been reported since 28 June 2017. Medical officer Liaison person in Juba contacted to verify the reports.

Laboratory test results During the week, 9 cholera sample results were released from the National Public Health Laboratory, with six being positive in Juba (samples collected from JTH), two negative from Juba (JTH), and one negative from Bentiu PoC.

1 Table 1: Cholera laboratory test results by 30 June 2017 State (County) Culture results New positives in week Cumulative Cumulative Negative Total tested 26 Positive Central 0 0 5 5 Jonglei-Duk 0 7 5 12 Jonglei-Bor South 0 6 3 9 Jonglei-Lankien 0 4 3 7 Jubek 6 92 135 227 Terekeka 0 2 0 2 Eastern - Mingkaman 0 44 52 96 Eastern Lakes – Yirol West 0 3 0 3 Eastern Lakes – Yirol East 0 4 6 10 Imatong 0 7 1 8 – Fangak 0 18 42 60 Fangak – 0 1 2 3 Wau 0 0 6 6 Boma 0 0 2 2 Northern Liech – Rubkona 0 32 76 108 Northern Liech – Mayom 0 1 2 3 Southern Liech – Leer 0 2 0 2 Southern Liech - Panyijiar 0 1 0 1 Southern Liech – Mayendit 0 4 6 10 Fashoda – Kodok, Aburoc 0 3 5 8 Central Upper Nile (Pigi) 0 3 5 8 Central Upper Nile (Malakal) 0 1 11 12 Kapoeta (Kapoeta South) 0 4 2 6 Kapoeta (Kapoeta East) 0 4 0 4 Tonj State (Tonj East) 0 3 3 6 Torit 0 0 2 2 Renk (Geiger) 0 1 0 1 Total tested 6 247 374 621

Cholera response updates and field missions A total of 15 cholera treatment facilities have been set up in , with Kapoeta South having 2 CTUs and 1 ORP; Kapoeta East having 3CTUs and 3 ORPs; and Kapoeta North having 1 CTC and 5 ORPs.

During the week, the WHO/MoH team deployed in Kapoeta conducted on the job support and training on cholera case management, cholera RDT testing, and infection control for the health workers in Napotpot CTU, Mogos CTU, Katiko Hospital, and Kapoeta State CTU.

On June 28, 2017 ARC and WHO organized and carried out a training on Community-based case detection and management for seven participants i.e. the 2 Cholera Response Supervisors for Kapoeta South and Kapoeta East; and 5 HHPs Supervisors (1 from Mogos and the others from Kapoeta South).

The surveillance teams deployed in Kapoeta state conducted active search for cholera cases in , Bongo 1 and 2, Nachodokopele, Napwatasigiria, and Monu villages in Kapoeta East.

Following the reports of suspect cholera 60 deaths in Kauto in May and June, a joint of WHO, UNICEF, ARC, RRH, IRW, and CHD visited the area on 26 June 2017. After visiting the villages implicated in the report, the assessment showed there was no evidence to show that these deaths occurred. The team therefore recommended that case management, surveillance, and social mobilization /hygiene promotion are strengthened in the area.

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In order to improve on the quality of care being provided in the response to the cholera outbreak, UNICEF Health Officers from all supported states and RRM team members were trained by WHO team on cholera investigation kits (rapid diagnostic tests, Cary Blair transport media, rectal swabs, stool collection containers, triple packaging for transportation of samples) to enable the laboratory confirmation of cholera at affected sites.

Oral cholera vaccination As part of the ongoing cholera response, cholera vaccines have been deployed in Leer, Bor PoC, Malakal Town, Bentiu PoC, Mingkaman IDP settlement, Aburoc IDPs, and Bentiu/Rubkona Town. All these sites are not reporting cholera cases with the exception of Aburoc where cases have also declined. In 2017, a total of 369,422 doses of the vaccine have been deployed targeting individuals aged one year and above. WHO has secured a total of 544,140 doses of oral cholera vaccines in 2017.

A schedule has been drawn for the next round of OCV vaccinations with a target to reach 1,984,364 individuals aged one year and above that are located in areas with active transmission and potential areas where the current outbreaks are likely to spread. Vaccination micro-plans have been finalized and partial funding secured from HPF funded counties to facilitate the campaigns.

Table 2: Doses of oral cholera vaccines deployed in 2017 by site Target No. No Site populatio Coverage Dates Partners vaccinated n 1 Leer first round 44731 30,772 69% 22/02/2017 MedAir, WHO, UNICEF 2 Malakal Town first round 16500 10,499 64% 18-24Mar2017 MSF-E, WHO, UNICEF 3 Bor PoC first round 2265 1,926 85% 3-4Apr2017 HLSS, WHO, UNICEF 8 Bor PoC 2nd round 2265 1,885 83% 26-29Apr2017 HLSS, WHO, UNICEF 4 Mingkaman 1st round 111,278 65,000 58% 26Apr-5May2017 MedAir, WHO, UNICEF 5 Mingkaman 2nd round 111,278 47,500 43% 12-26May & 10-21Jun MedAir, WHO, UNICEF 6 Ayod Tar first round 19,400 15,649 81% 9-22May MedAir, WHO, UNICEF 7 Ayod Pagil first round 4,850 3,943 81% 9-22May2017 MedAir, WHO, UNICEF 9 Bentiu PoC 1st round 112,924 72,514 64% 5-10May2017 IOM, WHO, Unicef

10 Bentiu PoC 2nd round 112,924 77,603 69% 26-29May2017 IOM, WHO, Unicef 11 First round - Rubkona & Bentiu towns 35204 31,908 91% 20-23 Jun 2017 IOM, WHO, Unicef 12 Aburoj first round 9,989 10,223 102% 20-22May2017 MSF-E, WHO, UNICEF Total doses deployed in 2017 583,608 369,422 63%

3 WASH CLUSTER RESPONSE UPDATES

Note: WASH Cluster partners to send their Cholera response updates by Friday 4pm every week at [email protected] and [email protected]

WASH Cluster Key Cholera Response updates: 30th June 2017

Locations with ongoing WASH Partners present Ongoing Action with number of population reached with Cholera Gaps and recommended action outbreak and hot spots interventions (Payam level)

Tonj East: Most affected - UNICEF Cumulatively: - UNICEF to lead the response and Makuac, Paliang, Paweng, - OXFAM conducting - 26 Hand pump repaired guide the other Cluster partners Wunlit Payam. survey to support the - 159 community sensitization meetings willing to respond. response - Sensitization sessions in 16 schools - OXFAM has send a team to identify UNICEF – WASH Focal - Sensitization sessions in 34 churches gaps and report back point – Josaphat - Sensitization in 24 markets - Sensitization of persons at 26 water points - Training household water treatment and safe storage using PUR and Aquatabs. - 6 local authorities’ advocacy meetings conducted to assign roles and responsibilities - 15 sensitization sessions for persons living among the cattle keeping communities - Sensitization of cattle keepers in 21 sessions

Kapoeta South and North IOM Hygiene promotion activities ongoing at community level with (Kapoeta town, Nakware, cholera messages in the 3 targeted payams in Kapoeta South Namorunyang, Paringa, (Nakwasingira, Napetait and Kapoeta town) and 6 payams in Nachilagur, Machi) Kapoeta North (Najie, Chumakori, Lokwamor, Lomeyen, Paringa and Nakwa). A total of 12,769 individuals (3924 men, 3996 women and 4849 children) have been sensitized on water treatment at household level, hand washing practices, safe water chain, proper disposal of human excreta and proper health seeking behavior for cholera. The team has achieved this through house-to-house visits, school sessions and mass awareness campaigns in market;

4 Locations with ongoing WASH Partners present Ongoing Action with number of population reached with Cholera Gaps and recommended action outbreak and hot spots interventions (Payam level)

IRW Action points - Has been deployed on 25th June 2017 and will intervene in - Ensure the hygiene promotion 4 payams: , Narus, Napotpot and Natinga; is in place asap in all the - Assessment report has been shared with WASH cluster; targeted areas; - Main activities that will be carried out for cholera response - Assessment to be conducted in are: hygiene promotion activities, repairing and drilling Natinga (Mining site) asap; boreholes and NFI distribution; - IRW and RAAH to work closely - Already having a team of 7 hygiene promoters conducting with Rural Water in Kapoeta sensitization in Napotpot and Nadapal; East to get information on - Assessment of boreholes in ongoing to determine the boreholes to be repaired; Kapoeta East (Loyolo, IRW, RAAH number that will be repaired; - UNICEF will provide 2 GPS for Mogos, Natinga, Katodori) - As most of the cholera cases are coming from Natinga Kapoeta East and South – (mining area), assessment will be conducted to determine Coordinate GPS for new the main causes and potential intervention; boreholes and boreholes Rural Action Against Hunger (RAAH) repairs; - Funding has been received for cholera response for two - RAAH to conduct assessment in bomas in Kapoeta East: Lolim and Lopua. The main Lolim and Lopua; activities that will be conducted are hygiene promotion, - UNICEF will support partners repairing boreholes and NFI distributions for the training of hygiene - 1 borehole repaired in Narus (Bakita Primary School); promoters. - Participated in the assessment team for Kauto Northern Jonglei ( - OXFAM - Karam: sickness and fatalities over the last few weeks in Karam, - No report on Uror, Akobo from Nile Wechjal, Karam, Akobo, - Nile Hope lack of health partners on the ground. Unfortunately, poor to Hope. Uror) - Tear Fund ( was no record keeping. The cases are reported to have reduced intervening and reviewing over the last few days which may relate to the fact that the OXFAM/ Nile Hope – the situation to offer WASH Focal Point support) population in Karam has reduced as people are returning home to nearby villages following the end of the food distribution. Wechjal: Potential cholera cases admitted to the PHU. NH has sent samples to Juba for testing so results awaited.

5 Locations with ongoing WASH Partners present Ongoing Action with number of population reached with Cholera Gaps and recommended action outbreak and hot spots interventions (Payam level)

Duk (Jonglei) - CRS - Reached 474HHs (2621individuals (1481 males and 1413 - PAH females) with hygiene messages through house to house hygiene sensitization. - Gaps/Challenges: - Reached 1302 beneficiaries with hygiene messages through - There is need for supply of working CRS – WASH Focal Point mass campaign. gears (Masks, Gumboots, raincoats, - Distributed 2,100 strips of aqua taps to 210 HH aprons and gloves) - Disinfected 114 stances of latrines and 79 infected HH - Lack of disinfection facility (knapsack sprayer) - Cleaned/chlorinated 1964 jerry can during Jerry can cleaning - Recommendation and actions: campaign at water points - CRS has on the process receiving - Distributed 6 latrine slabs to 6HH for household’s latrines some of the abovementioned NFIs promotion. from WASH cluster. This will be - Distributed 275 bars of soap distributed 550 HH for solved by next week handwashing promotion. - Distributer 2209 strips of Aqua taps distributed to 221 HH. - 884 buckets/jerry cans were chlorinated at house to house campaigns. Ayod (Jonglei) - CMD on ground - CMD sent a request of drilling bore holes for erection of hand - UNICEF to clarify on the supply - Medair in NORMANYANG pumps to CRS. CRS will explore possibilities of drilling and will request of CMD. CMD – WASH Focal Point - CRS is supporting in inform back. Kandak with drilling of - Cholera response supported by CMD. new bore holes and rehabilitation. Mingkaman (Lakes) - RUWASSA funding - Repair of hand pumps by RUWASSA and other. - Request for Pool Tester from the support by UNICEF, HELP - Hygiene promotion activities and latrine repairs and core pipeline through Ruwassa. RUWASSA – WASH Focal (supported by German rehabilitation by CRS. Point corporation), CRS - HELP continues with the Hygiene promotion activities. Yirol (Lakes) - HELP - No information on gaps - WASH responses continues. - CCOSS HELP – WASH Focal Point - CAFOD - PAH - HACT - CHADO

6 Locations with ongoing WASH Partners present Ongoing Action with number of population reached with Cholera Gaps and recommended action outbreak and hot spots interventions (Payam level)

- HACO Renk ( Upper Nile) - Medair - 8 cases of cholera so far. 1 confirmed with RDT - First case was on Sat 17th June 2017 SFP – WASH Focal Point - All cases were seen and treated at the Medair clinic in Wonthow, close to the Sudan border. 3 cases originated in Sudan and 5 from a small village in Renk County near Wonthow (Fakur) - No more cases have been seen in the past week - CTU set-up in Wonthow - Emergency WASH response in Fakur village (100 HHs) ongoing – distribution of PuR; construction of shared HH latrines (33); hygiene promotion - Ongoing response in Wonthow camp (115 HHs) – operation of SWAT; construction of shared HH latrines; hygiene promotion

Aburoc ( Upper Nile) - World Vision, Solidarités - WASH response ongoing SFP – WASH Focal Point International, Cord aid Juba - Medair, PAH, NRC, - 40-50 cases were admitted in the CTC during the reporting - Don Bosco, Gumbo, Shirkat, OXFAM, UNICEF, THESO, period. Munuki, checkpoint, Rock city, UN OXFAM – WASH Focal Live Well, NSDO, BEDN - Cholera WASH activities ongoing by the WASH Cluster House, etc. Point (exploring funding Partners. - Report awaited from MOH/ WHO support), GBI (exploring Don Bosco camp (Juba) funding support) - 16 cases seen so far, since beginning of June. Patients were transferred to Juba Teaching Hospital (CTU) by the Catholic Mission - Medair WASH response – construction of 18 shared HH latrines; bucket chlorination at water points; hygiene promotion - MSF-Switzerland is planning to start OCV campaign there next week. Also the local health partner (Interlink) have committed to providing an ORP site in the camp

7 Locations with ongoing WASH Partners present Ongoing Action with number of population reached with Cholera Gaps and recommended action outbreak and hot spots interventions (Payam level)

Terekeka NRC in Gori, Gulubatch, - 18 settlements in 8 islands assessed. - Requested WASH supplies from Gemeiza, Kanyi Awai UNICEF. NRC – WASH Focal Point Korshomba - Information on the targeted numbers with intervention needs to be shared by NRC Pariang/ More information to be - Reported cholera cases in Pariang (65!), with 2 (WHO) - More information to be explored on explores confirmed deaths. the gaps and recommended action

8 SOCIAL MOBILISATION UPDATES

Social Mobilization, Communication and Hygiene Promotion Reporting Format (Date: 25 June-1 July, 2017) Locations with ongoing Partners present Ongoing Action with number of Gaps and recommended action outbreak and hot spots population reached with Cholera (Payam level) interventions Tonj East: Most affected - CCM, THESO, UNICEF, WHO - Cholera social mobilization, hygiene - Increased the awareness in the Makuac, Paliang, Paweng and SMOH promotion and communication is community Payam. (Warrap) ongoing in Tonj East and North where - Lack of transport for social cases are being reported. UNICEF mobilizers supported partner THESO continue with - Inadequate borehole and pit latrine community engagement activities which - Refresher training in Tonj East include household visits with critical demonstrations, community meetings, water-point and market awareness, school and cattle camps intervention. - Due to recent cholera alerts from Tonj South and Tonj North, THESO have increased social mobilizers have from 45- 101. - 1 Formation of 13 Social mobilizers, 6 payam supervisors and 1 County supervisors for Gogrial East - 3 Conduct sensitization meeting including project interdiction with stakeholders of Gogrial East and Tonj North {Warrap Town} chair by Hon Commissioners attend by 83 people, CHDs, Commissioners, chiefs, youth representative, women representative, church leaders, payam administrators, in 5 payam, Luonyakeer, yiik adoor ,Liet nhom, Awutwut

9 Locations with ongoing Partners present Ongoing Action with number of Gaps and recommended action outbreak and hot spots population reached with Cholera (Payam level) interventions - 4 Distribution of posters and banners in Tonj North, Tonj South and Gogrial East County - 5 Conducted quick training for cholera intervention in Tonj South attend by 27 participants - Indicators for outreach activities Kapoeta (EEQ) SSRC, ARC, Singaita FM - 180 trained volunteers from SSRC/ARC - Inaccessibility of some areas conducted household visits and school especially cattle camps which are intervention reaching 658 HHs and 3 deep in the mountains with no road schools with 1560 children with cholera access. awareness. - High expectations of supplies items - 14 community meetings were also from the community conducted - Inaccessibility of some villages and - Singaita FM, a community radio has pastoralists continued broadcasting cholera - Prevalence of hunger in most areas messages (jingles, Talk-shows, of Kapoeta. Interviews, News bulletin) in Toposa, Dindinga and English. - This week, a total of 72 jingles aired 12 per day. Torit, (EES) Health Link, SSRC and Radio - 3 radio Voice of Torit and Radio - stations Emmanuel continue to broadcast cholera messages. A total of 180 jingles aired (10 times a day) from a period of 23 June-1 July, 2017 Jonglei (Duk, Bor and Twic - CDNF, SMoH, CHDs UNICEF supported partner CDNF continue Inadequate WASH supplies (PUR and East with community engagement activities which Aquatabs) include household visits with critical demonstrations, community meetings,

10 Locations with ongoing Partners present Ongoing Action with number of Gaps and recommended action outbreak and hot spots population reached with Cholera (Payam level) interventions water-point and market awareness, school and cattle camps intervention in areas of Bor, Duk and Twic East.

- In Duk 15 trained mobilizers reached 145 households (725 people) through household visits in areas such as HQ, Geer Poktap, Payuel, Padiet, Panyang and Dongchak. - 2 schools with only 84 children were reached by 3 mobilizers - Radio Jonglei continue to broadcast cholera messages. A total of 60 jingles aired from a period of 24 June-1 July, 2017 Akobo, Old Fangak, Nile Hope, FCDI In Northern part of Jonglei, UNICEF - Insecurity which interrupt (Jonglei) supported partner Fangak implementation of activities Community Development Initiative - Lack of road networks which hinder (FCDI) have conducted cholera social movement. mobilization activities in areas of Fangak.

- 91 trained mobilizers reached 841 households, 15 schools with 1269 children, 12 community meetings with attendance of 1879 people.

- The mobilizers also conducted 13 market sessions reaching 915

11 Locations with ongoing Partners present Ongoing Action with number of Gaps and recommended action outbreak and hot spots population reached with Cholera (Payam level) interventions people and 17 water-point sessions which a total of 1018 people at water-points.

- As part of active case search, the mobilizers identified 6 AWD cases and the cases were from the following areas, 1 in Manjang payam in , 1 in Tar village near khorwai in , 3 cases in Kuachdeng , 1 case in Tonga in Fangak County. Payinjiar: Thoanom, UNIDO, Nile Hope, IRC, Mercy - Social Mobilization going on in Payinjiar Gaps: Pachak, Ganyliel Corps County where 2 suspected cholera cases were reported on 24th and 27th June. Two - Additional communication adults 29 and 48 year olds were infected. materials needed. Cholera social mobilization, hygiene - There is lack of enough boreholes promotion and communication is and latrines. ongoing in Ganyliel, Thoanom and - There is need for refresher training Pachak Payams where cases were of hygiene promoters. reported. UNICEF supported IP partner UNIDO with communication materials, Actions needed megaphones and job aids and 20 social - Nile Hope to transport additional, mobilizers are educating communities requested communication and reached population 12639 people in materials to the County. the three payams. - WASH partners to distribute water treatment chemicals to populations.

12 Locations with ongoing Partners present Ongoing Action with number of Gaps and recommended action outbreak and hot spots population reached with Cholera (Payam level) interventions - Nile Hope to come on ground and start refresher training for HPs. - Yirol East and Mingkaman, - CHADO/ CHD - From 13-30 June, 2017, 58 trained - (Lakes) mobilizers from CHADO conducted household visits, community meetings, water-points and market awareness sessions and schools reaching the following; - 2182 households with cholera messages - 56 schools with 16,993 children and teachers with awareness intervention - 102 community meetings with 2,951 people - 93 market sessions reaching 2,308 people and a total of 195 water-point sessions which reached 3,101 people - Radio Mingkaman is also broadcasting cholera messages and cattle camps interventions Yirol West (Lakes) - CHADO, SSRC and CHD - From 13-29 June, 2017, 28 trained - mobilizers from CHADO conducted household visits, community meetings, water-points and market awareness sessions and schools reaching the following; - 1245 households with cholera messages - 7 schools with 1760 children and teachers with awareness intervention - 21 community meetings with 380

13 Locations with ongoing Partners present Ongoing Action with number of Gaps and recommended action outbreak and hot spots population reached with Cholera (Payam level) interventions people, 14 market sessions reaching 234 people and a total of 64 water-point sessions which 772 people - Radio Mingkaman is also broadcasting cholera messages Juba - MoH, SMoH-Jubek, SSRC, As part of mass media, UNICEF, MoH - Economic crisis-Fuel shortage in Cholera was confirmed in Radio Stations, Telecom SMoH and partners continue to engage town sometimes affect Juba by lab culture. Four Companies, THESO-POC radio stations, Public Address systems operation of radio stations and cases were admitted to JTH and drama groups to inform and educate th PAs CTC on 8 June, originating communities on cholera prevention and from Gumbo, Atlabara, control practices in Juba and Yei. - Insecurity in some areas checkpoint and Rock city.

- A total of 14 FM stations continues - Sound with airing of radio spots and talk- impediments/interruption shows in Juba and Yei. As of 24 June-1 (Megaphones for vehicle used July, 2017, 840 times radio jingles for PA in Munuki is not have been broadcasted reaching over efficient/not loud to be heard in 2 million people across the country. the community. Explore more

- For the last one week, street audible speakers and favorable announcement of cholera messages hours such as early in the has been ongoing through Five (5) morning. Public Address Systems (PAs) in five - Areas not accessible due to bad main areas of the City namely; , roads in Munuki Payam Kator, Juba, Munuki and Nyar- kenyi/Northern Bari. The PAs conducts 5 hours’ announcements

14 Locations with ongoing Partners present Ongoing Action with number of Gaps and recommended action outbreak and hot spots population reached with Cholera (Payam level) interventions per day (3 hr morning and 2hrs evening) and will be ongoing for a period of 60 days.

- THESO is also conducting hygiene promotion and megaphone announcements in Juba POC - SMoH-Jubek with support from UNICEF oriented 16 drama groups and traditional dancers who will intensify awareness in markets and other public places through roadshows (drama performances and traditional dances) - Ministry of Health, WHO and UNICEF in collaboration with Vivacell Telecom Company have re-activated Cholera hotline (1144) which currently respond to all calls as well as educating callers on cholera response and preventive measures. For the last two weeks, 88 calls with which 11 AWD cases were reported and referred from treatment. The 11

15 Locations with ongoing Partners present Ongoing Action with number of Gaps and recommended action outbreak and hot spots population reached with Cholera (Payam level) interventions alerts were on 24, 25, 26 June and from the following areas namely; Gudele 1, Shirkat, Don Bosco, Munuki and Lologo 1,

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