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Cholera in South Sudan Situation Report # 17 As at 23:59 Hours, 01 June 2014

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Cholera in South Sudan Situation Report # 17 As at 23:59 Hours, 01 June 2014 Republic of South Sudan Cholera in South Sudan Situation Report # 17 as at 23:59 Hours, 01 June 2014 Background On 29 April 2014, a suspected case of cholera was reported from the MSF clinic at UN House/Juba III Protection of Civilian (PoC) camp. On 28 April 2014, he visited relatives in Gudele II where he developed severe diarrhea and vomiting. One of the contacts in the household had developed acute watery diarrhea on the 24 April 2014. Stool samples collected from his four household contacts were all laboratory confirmed. On 15 May 2014, the Ministry of Health declared an outbreak of cholera in Juba. Since then, several suspected cases have been recorded and laboratory confirmed from different suburbs in Juba. A retrospective record review at the emergency medical ward of Juba Teaching Hospital (JTH) revealed seven suspected cholera cases including one death, with the first case admitted on 23 April 2014. Situation Update The table below summarizes the number of suspected and confirmed cases reported in Juba. Table 1 Summary of cholera cases, 23 April - 01 June 2014 Summary of cases JTH Gurei Tongping UN Gumbo Kajo- Other Total CTC CTC CTC House ORP Keji Civil sites (Juba III) Hosp Total new admisions today 28 3 0 1 4 0 0 36 Readmissions 3 0 0 0 0 0 0 3 Total new discharges today 23 11 0 0 0 0 0 34 Total new deaths today 0 0 0 0 0 0 0 0 Total number of cases currently 82 10 0 0 4 0 0 96 admitted Leave Against Medical Advice 0 0 0 0 0 0 0 0 (LAMA) Total facility deaths since the 15 0 0 0 0 0 1 16 onset of the outbreak Community deaths since the 0 0 0 0 3 0 8 11 onset of the outbreak Cumulative deaths since the onset 15 0 0 0 3 0 9 27 of the outbreaks Cumulative cases discharged 771 138 4 11 12 1 1 938 Cumulative cases 925 148 4 14 16 1 16 1,124 *Includes cases detected in private health facilities and at community level . On 01 June 2014, 36 new cases were admitted at the cholera treatment centers (CTC) in Juba and 34 cases discharged, leaving 96 patients on admission. Cases have been reported from nine Payams in Juba county with the most affected being Munuki (354, 32%). See Table 2. 1 Table 2 Distribution of cholera cases by place of residence in Juba, 23 April – 01 June 2014 Payam Week 20 Week 21 Week 22 Cases by Payam n=1,123 (%) Northern Bari 63 71 39 175 (16) Munuki 77 122 155 354 (32) Juba 26 97 45 168 (15) Rejaf 19 73 156 250 (22) Kator 14 43 66 124 (11) Missing 4 23 5 33 (3) Gondokoro 3 2 7 12 (1) Lirya 1 0 1 2 (0.2) Lokiriri 2 1 1 4 (0.4) Mangala 0 0 1 1 (0.1) Total by epi week 209 432 476 1,123 . Figure 1 shows the most affected villages include Gumbo in Rejaf, Gudele I in Munuki, Tongping in Juba, and Gudele II in Northern Bari. Figure 1: Cholera cases from the five most affected villages per Payam in Juba, 23 April - 01 June 2014 200 189 180 160 140 120 109 100 76 80 60 48 43 34 32 40 27 29 29 19 20 22 Number of cases Number 14 14 17 10 10 11 10 13 12 12 20 7 6 0 Gurei Gurei Gurei Kator Mobil Gabat Giada Sirikat Mauna Lologo Lologo Gumbo Amarat Munuki Atlabara Gudele Gudele 1 Gudele 2 New Site New Tongping Hai Game Hai Nyakuron Juba Town Jebel market Jebel Walang Walang Jebel Check JebelPoint Juba Kator Rejaf Munuki Northern Bari Affected areas . Since the beginning of the outbreak on 23 April 2014, 1,124 cumulative cholera cases including 27 deaths (16 institutional and 11 community deaths, CFR 2.4%) have been reported. The majority of the deaths reported in hospital died on arrival. Hence the need to strengthen community case detection and prompt initiation of ORS treatment while immediate referral to the nearest CTC is being organized. Figure 2 shows the outbreak trend since it started on 23 April 2013. Three peaks of transmission were registered on 19/05/2014, 26/05/2014 and 28/05/2014 with 26/05/2014, higher than other two. 2 Figure 2: Cholera epidemic curve, 23 April 2014 - 31 May 2014 140 Died 120 Alive 100 80 60 113 100 86 87 40 73 72 66 Number of cases Number 59 47 52 48 20 39 44 44 43 27 25 20 13 12 0 2 1 1 1 1 1 3 21/04/2009 22/04/2010 23/04/2011 24/04/2012 25/04/2013 26/04/2014 27/04/2015 28/04/2014 29/04/2014 30/04/2014 01/05/2014 02/05/2014 03/05/2014 04/05/2014 05/05/2014 06/05/2014 07/05/2014 08/05/2014 09/05/2014 10/05/2014 11/05/2014 12/05/2014 13/05/2014 14/05/2014 15/05/2014 16/05/2014 17/05/2014 18/05/2014 19/05/2014 20/05/2014 21/05/2014 22/05/2014 23/05/2014 24/05/2014 25/05/2014 26/05/2014 27/05/2014 28/05/2014 29/05/2014 30/05/2014 31/05/2014 01/06/2014 17 18 19 20 21 22 Date of onset . Of the 1,124 cholera cases reported, the majority (631, 56%) are male, and aged 20-34 years (445, 40%). Figure 3: Distribution of cholera cases by age 23 April - 31 May 2014 200 180 M 160 F 140 120 111 100 82 73 77 80 47 41 60 51 28 40 21 38 63 70 Number of cases Number 52 20 49 48 42 26 15 12 27 32 30 19 14 9 17 0 11 4 Age group Note: This is based on age and sex information entered in the line list. The following are some of suspected risk factors for contracting cholera in Juba: . Drinking water from unsafe sources such as: untreated river water which in Juba is primarily supplied by water tankers, surface water-river and ponds . Poor latrine use, lack of latrines and open defecation, 3 . Poor latrine use 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. Cholera Alerts Table 3 Summary of cholera alerts No Date Details of the alert Area Needs/Actions taken received 1. 01/06/2014 One suspected case of Block 25, An investigation was conducted by cholera was reported from Kuajok, SMoH/WHO Kuajok, Warrap. A two and Kuac North Surveillance level increased in the state a half year male from payam, State cholera taskforce reactivated reported suffering from Gogrial Diarrhoea disease kits provided to Kuajok Acute Watery Diarrhea died West hospital at New Side Private Clinic. County, Discussions ongoing about the set up of a The child had travelled with Warrap CTC three other children and two State ladies from Gudele in Juba. One of the other children had developed diarrhoea, and was reported to have recovered. 2. 30/05/2014 One suspected case of Kajo keji, Case management ongoing cholera is admitted in Kajo Central Investigation and contact tracing conducted Keji hospital. She travelled Equatoria Samples collected from contacts from Juba on 22 May and Health education conducted in affected developed symptoms of household and on local radio cholera when she arrived in Kajo Keji. Admitted at Kajo keji civil hospital. 3. 30/05/2014 Two additional suspect Yei, Central Taskforce has been re-activated cholera cases have been Equatoria Isolation ward has been designated in Yei admitted in Yei Civil Civil hospital Hospital. Cumulatively PSI contacted to provide water guard seven suspect cholera Rapid diagnostic test positive for cholera cases including one death Four samples from Yei arrives in the have been reported. National Reference Laboratory and will be Six suspect cases are tested on 31/05/2014 currently admitted in Yei Civil Hospital. 4. 30/05/2014 The Central Equatoria MoH Mangala, No additional cases reported from the area surveillance team followed up Central 24 AWD cases improved on treatment the AWD cases reported from Equatoria Mangala two weeks ago 5. 30/05/2014 The Central Equatoria MoH Jemeza, Samples were collected but tested in the surveillance team followed up Central hospital laboratory with no conclusive on the two AWD cases Equatoria findings reported from Terekeka No additional cases have been reported hospital form Jemeza Payam (the area where the two cases originated from). Response actions today Case Management . The team has continued to conduct burial supervision, dead body management and disinfection of deceased households. Three ambulances have been positioned at Juba Teaching hospital designated to transport/refer patients to the nearest cholera treatment centres (CTCs). 4 Surveillance and Laboratory . Community based surveillance and cholera awareness campaigns activities have been intensified to enable case identification and ensure prompt referral to the CTCs. The surveillance team continues to receive and investigate all cholera alerts from the peripheral facilities and community levels. Epidemiological analysis of the outbreak data is ongoing to inform the current response. Social Mobilization and WASH . Ninety five (95) social mobilizers visited 1,154 households in Gudele and 1,554 others in Lologo Kasira. A social mobilizer covers an average of 16 households per day in 8 hours.
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