Cholera in South Sudan Situation Report # 96 As at 23:59 Hours, 6 to 12 October 2014

Cholera in South Sudan Situation Report # 96 as at 23:59 Hours, 6 to 12 October 2014

Situation Update

As of 12 October 2014, a total of 6,141 cholera cases including 139 deaths (CFR 2.26%) had beenTable reported1. Summary in of South cholera Sudan cases asreported summarized in Juba in County Tables, 23 1 April and –2.12 October 2014 New New New deaths Total cases Total Total admisions discharges Total Total cases Reporting Sites 6 to 12 Oct currently facility community Total cases 6 to 12 Oct 6 to 12 Oct deaths discharged 2014 admitted deaths deaths 2014 2014 JTH CTC 2 2 0 0 16 0 16 1468 1484

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

Tongping CTC 0 2 1 3 69 72 Closed August Jube 3/UN House CTC Closed August 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 0 0 0 0 1 5 6 42 48

Other sites 0 0 0 1 15 16 1 17

Total 2 2 0 0 22 24 46 2203 2249 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 – 12 October 2014 New New New Total cases Total Total admisions discharges deaths Total Total cases Total States Reporting Sites currently facility community 6 to 12 Oct 6 to 12 Oct 6 to 12 deaths discharged cases admitted deaths deaths 2014 2014 Oct 2014 Kajo-Keji civil hospital 0 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 0 0 0 0 0 0 0 106 106

OTC PHCC, Magwi -- 0 0 0 10 0 10 141 151

Magwi PHCC 0 0 0 0 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

Lalanga PHCU, Lafon 0 0 0 0 0 2 2 63 65 EES Torit Hospital 0 0 0 0 8 9 17 1407 1424 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 Osito PHCU, Bur -- 0 0 0 0 0 0 42 42 payam, Torit

1 New New New Total cases Total Total admisions discharges deaths Total Total cases Total States Reporting Sites currently facility community 6 to 12 Oct 6 to 12 Oct 6 to 12 deaths discharged cases admitted deaths deaths 2014 2014 Oct 2014 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 0 0 1 1 4 7 Torit Riwoto PHCC, Kapoeta 0 0 0 0 1 0 1 82 83 North SSRCORPs, Nyong -- 0 0 0 0 0 0 70 70 Payam, Torit St. Theresa, Isohe, 0 0 0 0 2 2 4 93 102 Ikotos Ibahure PHCC, ibahure 0 0 0 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 0 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 0 0 0 0 60 33 93 3780 3892 x: Facilities not reporting; -- no cases reported for at least two weeks

Figure 1: South Sudan Cholera Epidemic Curve, week 17-41, 2014

1200

1000

800

No No Cases 600

400

200

0 Epidemiological week 2014 15 17 19 21 23 25 27 29 31 33 35 37 39 41

Figure 2: Cholera Case DistributioWESn by Age, Sex, UNS& State – week 17EES-41, 2014 CES

2500

2000 964 1041 1500 Male Female

1000 375 1031 876 294 240 214 500 186 318 207 274 3 10 1

0 <5yrs ≥5yrs (blank) <5yrs ≥5yrs (blank) <5yrs ≥5yrs ≥5yrs CES EES UNS WES

2 Surveillance and laboratory  During week 41, only two new cholera cases were reported from Lologo and Kator villages in Kator Payam, Juba County. There were no new cases reported from Torit, Magwi, and Kapoeta North Counties in Eastern Equatoria.  As seen from Figure 1, the cholera trend is on the decline in all the five states where cholera has been confirmed.  No new culture positive cases reported during week 41.  Overall, 187 (43.4%) of the samples tested have been positive for cholera by culture.  Due to the declining cholera trend, it is recommended that all new suspect cholera cases have samples obtained for laboratory confirmation.

Case management  The two cases were treated at Juba Teaching Hospital cholera treatment centre and they both improved on treatment and were discharged by 12 October 2014.  Adequate supplies have been availed to support case management activities in the cholera treatment centres where the cases are being treated.

WASH WASH efforts and responses are ongoing in Central and Eastern Equatoria states where some AWD cases are still being reported in some areas.

Central Equatoria State

In Lobonok Payam:

 Partners conducted awareness campaigns at three churches, namely, St. Matthew, St. Mary and St. Francis as well as 256 pupils at Yapa Secondary School in Kapota.  Targeted distribution of hygiene kits at Kapota center continues.  An emergency pit latrine was constructed at Pager Health center.

Eastern Equatoria State

In Torit County:  House to house hygiene promotion is still on-going to raise community awareness on water handling and hand- washing at critical times.  Hygiene promotion through a weekly radio talk show continues to reinforce the house to house hygiene promotion.  Safe water supply through the water treatment units and repair of hand pumps is ongoing.

In Lopa-Lafon County.

 A team has been deployed to strengthen and continue cholera awareness and community mobilization activities to reduce the risk of new case in the county, which was severely affected.

In North Kapoeta County

 A security assessment is in progress with partners planning to send a WASH team for an initial assessment and response in mid-October.

Gaps and needs Case management, surveillance and laboratory • Submission of updated cholera line lists to the Ministry of Health needs to be strengthened • 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.

Conclusions and Recommendations Overall, cholera is on the decline countrywide. The following are the key recommendations: • Samples should be collected from all new suspect cases and submitted to the National Public Health Reference Laboratory for testing. This will allow the taskforce to determine if cholera has been controlled in the affected areas. • Sustain interventions to for cholera prevention and control in all the affected counties. • Evaluate the overall response to the cholera outbreak so as 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 risk communications and other evidence based interventions for improving the construction and use of appropriate sanitary facilities and improving access to safe water.

Please note that the Cholera Situation Report is being discontinued. This is the last report. Subsequent updates will appear in the Ministry of Health weekly disease surveillance bulletins.

3 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/no 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 Services Ag. Director - IDSR MoH, Republic of South Sudan MoH, Republic of South Sudan Tel: +211955668178 Tel: +211955150406