Acute Watery Diarrhoea in Southern Sudan Date of Reporting
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Acute Watery Diarrhoea in Southern Sudan Date of Reporting: 27 March 2006 Overview As of 26 March 2006, the cumulative number of cases reported, so far, from acute watery diarrhoea in Juba is 4,648 and the cumulative number of deaths reported, so far from Juba, is 90 (case fatality rate: 1.94%). In Yei, the cumulative number of cases, reported from acute watery diarrhoea, now stands at 1,819 (through 23-03-06) and the cumulative number of deaths stand at 54 (case fatality rate: 2.97%). In other areas reported cumulative cases total 2,927 cases with 104 deaths (case fatality rate: 3.55%). During last 48 hours, a total of 29 cases and 2 deaths from acute watery diarrhoea were reported from Juba. Overall, between 28 January to date, a total of 9,394 cases and 248 deaths with an overall case fatality rate of 2.64% was reported from this outbreak of acute watery diarrhoea in Southern Sudan. Table-1: Total number of reported cases and deaths from Acute Watery Diarrhoea, South Sudan 28 January – 26 March 2006 Town Date the Number Number Case- Cumulative Cumulative Overall first of cases of fatality number of number of case- “ index” reported deaths rate in cases deaths fatality case was in last reported last 24 reported till reported till rate reported 24 in last hours date date hours 24 hours Yei (up 28/01/06 NA NA - 1,819 54 2.97% to 23/03) Juba 06/02/06 16 2 12.5% 4,648 90 1.94% Other* 11/02/06 NA NA NA 2,927 104 3.55% TOTAL 9,394 248 2.64% NA: not available * Not all areas have reported through 26-03-06. See text The outbreak has now been reported in 7 of the 10 states in Southern Sudan and new locations continue to appear almost daily. As not all areas report on the same day please see table of other locations to determine the exact reporting date for individual locations. In Kajo-Kegi, Pibor Area (Pibor; Lekongole; Gumruk), Bor, Terekeka and Malakal stool specimens have tested positive for Vibrio cholerae Inaba (tests done at AMREF in Kenya). In Mongella no cases have been reported since 28-02 and laboratory specimens sent at that time were negative for Vibrio cholerae. In Torit the outbreak also seems to have peaked and the number of daily cases is now declining. In Lohutok, an area northeast of Torit where initial reports were of >700 cases and 40 deaths, MedAir has established a CTC and in the 14 days on ground have reported treating 344 cases with 2 deaths. Laboratory specimens are pending from this location. Overall, the situation in Yei is stable and improving daily with the last report received as of 23 March indicating the outbreak has been contained and only sporadic cases are appearing in town. The outbreak in Yei was declared officially over by the Undersecretary of Health of the GoSS, Dr. Majok Yak on 14-03- 06. However from 18 to 23 March 25 new cases were reported, 22 more than the previous week. The official number of total cases and deaths is 1,819 with 54 deaths for a 2.97% CFR as of 23-03-06. Of concern is the waning of intensity of watsan interventions and the general insecurity in the outlaying areas and roads (LRA) with the emergence of new cases especially in the peripheral villages. The situation in Juba is improving as the number of cases has consistently decreased daily over the past three weeks. However the situation will continue to be followed closely as the full rainy season has not yet arrived. Of concern is the waning of intensity of watsan interventions with no chlorination being currently done. On March 21 eleven samples of water taken from different settings have shown four of them polluted. The reports of increasing locations in the states (EES & Jonglei State) neighboring Juba (CES) with increasing numbers of cases and deaths of laboratory confirmed (Vibrio cholerae Inaba) acute watery diarrhoea continues to pose a serious challenge to the ongoing response efforts. The spread by road from Juba to the east (in Torit area) continues at present to be significant focus area with cases in Torit town itself and to the villages to the northeast of Torit town totally now over 1300. In addition on 17-03- 06 reports were received that indicate there are cases appearing in Ikotos which is on the road heading 1 south to the border with Uganda. This location continues to report more cases and supplies are urgently needed. In Malakal in Upper Nile State after the importation of the index case on a barge from Bor (01-Mar) the number of cases of AWD reported continues to increase daily and as of 25-03-06 has reached 573 cases with 11 deaths (CFR= 1.92%). Nearby locations outside of Malakal town which have reported cases are also increasing and include the towns of Nyilwak, Dolieb Hill, Wilnyang, Atar, Nasir and Melut. In Unity State suspicious cases in Leer are under investigation. Situation in Juba town The reported cases of acute watery diarrhoea, in Juba, progressively increased after the first index case was reported on 6 February 2006 (Figure-2). After 23 February 2006 (about 2.5 weeks after the onset of the outbreak), the number of cases reported daily started to decline in spite of the improvement in the daily reporting system and number of surveillance sites. This trend in declining cases has continued to the current week when the rate of decline has slowed and remains below 20 new cases / day for the last two days. After a few high spikes at the very beginning of this outbreak, the daily case fatality rate of AWD in Juba gradually declined to below 2% however slight daily fluctuation continues to occur. Investigations have been carried out on days when the case fatality rate is high and on most days it appears that the death cases involve persons arriving at the treatment facility in late stage of disease or persons that have died in the community. The overall case fatality rate from AWD in Juba now remains below 2%. Stool specimens obtained in Juba from Lologo camp on 03-03-06 continued to be positive (3 of 5 specimens obtained) for Vibrio cholerae Inaba with the same sensitivity pattern as the original isolates, i.e. sensitive to tetracycline and resistant to chloramphenicol, nalidixic acid, cotrimoxazole and erythromycin. The rapid test (SMART) is being utilized on patients now presenting with non-classical cholera symptoms and a high percentage, 66.6% (6/9), are still positive for cholera. In Figure 1 the number of cases in Juba per week is graphed and in figure 2 the number of cases, deaths and CFR is plotted per day. Figure 1: AWD by Week Juba - Southern Sudan 2500 2000 1500 Cases 1000 500 0 1 (4-10 2 (11-17 3 (18-24 4 (25 5 (4-10 6 (11-17 7 (18-24 Feb) Feb) Feb) Feb-3 Mar) Mar) Mar) Mar) 2 Figure-2: Reported cases and deaths from acute watery diarrhoea, Juba town, 06 February - 26 March 2006 450 60 400 Cases (n = 4648) CFR Deaths (n = 90) 50 350 300 40 250 30 200 No of cases 150 20 deaths of No 100 10 50 0 0 4 7 6 3 6 9 8 10 13 1 19 22 25 28 12 15 1 21 24 Reports of Acute Watery Diarrhoea from other locations Notes: 1) In addition to Yei and Juba positive stool specimens have been obtained at Kajo-Kegi, Terekeka, Bor, Pibor and Malakal but at other locations the pathogen is not laboratory confirmed 2) Numbers of cases and deaths at locations are added to the cumulative statistics if cases have been laboratory or clinically confirmed. • Jebel Lado Area (CES): Jebel Lado area is located approximately 15 miles to the northwest of Juba town and is divided into 2 villages each reporting cases of AWD. In total since the first suspected case appeared on 15-02 there have been 37 cases with 11 deaths (these cases have not been added to Juba statistics). There is only one CHW for both villages and persons are using home-made ORS for treatment. A team from SMoH-CES was mobilized and travelled to the location from 03-06 March 2006. At the time of the visit there were no “new cases” seen and confirmation that suspected cases were AWD was not possible and review of records indicated perhaps the cases and deaths were more likely to be malaria. • Lui (West Equatoria State): On 27-02-06 Samaritans Purse, an NGO partner supporting the Lui hospital reported 2 cases of AWD. No deaths occurred and no further cases have been reported as of 23-03. • Bor (Jonglei State): 11 cases of Acute Watery Diarrhea from 16-02 to 22-02 with 1 death – stool specimens sent 23-02-06 (AMREF-Nbo) are positive for Vibrio cholerae. MSF-B team has agreed with authorities that MSF-B will upgrade hospital services in Bor while Johanniter will attend to the PHC services. A report received from UNMIS on 07-03 indicated that from 16-02 to 28-02 there were a total of 31 cases of AWD in Bor with 1 death. A report received on 09-03 indicated the case load had increased to 72 with 12 new admissions in the preceding 24 hrs. MSF-B opened the CTC in Bor on 07-03-06 and are now providing accurate data.