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Situation Report #119 on Cholera in South Sudan As at 23:59 Hours, 5 May 2017

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Situation Report #119 on Cholera in South Sudan As at 23:59 Hours, 5 May 2017 Reporting period: week 18 (1st -7th May 2017) Republic of South Sudan Situation Report #119 on Cholera in South Sudan As at 23:59 Hours, 5 May 2017 Epidemic trends Cholera confirmed in Kapoeta South after four of six samples tested positive for Vibrio cholerae on 5 May 2017 Table 3. Table 1 summarizes reported cases (confirmed or suspected), admissions and deaths during the current reporting period, and cumulatively, by affected county and state. Currently, 9 (47%) out of 19 counties ever affected (since June 2016) have reported cholera cases in the past 4 reporting periods (weeKs) and are considered to have active transmission Table 1. Table 1: Counties with active transmission (cholera cases in the last four weeks) as at 5 May 2017 Cases reported Inpatient admissions Deaths Cumulative Cumulative to date County or Date first New to date New New State during during Cumulative during site reported (attacK rate reporting reporting to date reporting Facility per 10,000) period period period Community Facility (CFR%)† Jonglei DuK 05-Jul-16 45 40 45 466 0 32 4 0.9 Fashoda Kodok 04-Apr-17 0 5.1 0 30 0 1 3 10.3 FANGAK 10-Aug-17 0 20.5 0 356 0 0 5 1.4 Fangak Ayod 30-Mar-17 2 11.6 2 308 0 38 0 0.0 Awerial 15-Aug-16 33 94.2 33 1126 0 11 2 0.2 Eastern Yirol East 05-Feb-17 117 69 117 917 3 40 16 1.8 Lakes Yirol West 12-Apr-17 12 3.5 12 96 0 0 0 0.0 Central Pigi- canal 10-Oct-16 0 12.2 0 202 0 0 5 2.5 Upper Nile Kapoeta Kapoeta 23-Apr-17 25 2.4 25 28 0 0 0 0.0 South Totals (South Sudan) 234 234 3529 3 122 35 1.0 † Case-fatality ratio (deaths among all cases discharged dead or alive from health facilities). Laboratory testing and confirmation During the reporting period, five samples from Kapoeta South (4) and KodoK (1) tested positive for Vibrio cholerae. A total of 19 counties in 11 (33%) of 32+1 states countrywide have confirmed cholera outbreaks since June 2016 Table 1.1; Figure 1.0. Cumulatively, 226 (38.8%) samples have tested positive for Vibrio Cholerae inaba in the National Public Health Laboratory as of 5 May 2017 Table 3. Table 1.1: Summary of cholera cases reported in South Sudan as of 5 May 2017 County ed 18 WK 18 WK 18 WK deaths deaths discharged Total cases cases Total cases Total cases Total Total facility facility Total Total deaths Total New discharges discharges New New deaths WK deaths New New admissions admissions New Total community community Total currently admitt currently Juba - - - 8 19 27 2,018 2,045 DuK 45 81 1 - 5 32 37 429 466 Bor - - - - 1 4 5 82 87 Terekeka - - - - - 9 9 13 22 1 Reporting period: week 18 (1st -7th May 2017) County ed 18 WK 18 WK 18 WK deaths deaths discharged Total cases cases Total cases Total cases Total Total facility facility Total Total deaths Total New discharges discharges New New deaths WK deaths New New admissions admissions New Total community community Total currently admitt currently Awerial 33 56 - 21 2 11 13 1,092 1,126 Yirol East 117 161 6 5 16 40 56 856 917 Yirol West 12 19 - 6 - - - 90 96 Pageri - - - - - 1 1 28 29 Ayod 2 14 - - - 38 38 270 308 Fangak - - - - 5 - 5 351 356 RubKona - - - - 7 2 9 1,167 1,176 Mayom - - - - - 4 4 3 7 Leer - - - - 3 - 3 91 94 Panyijiar - - - - 21 4 25 476 501 Mayendit - - - - - 5 5 221 226 Pigi - - - 5 5 197 202 KodoK - - - 3 1 4 26 30 MalaKal - - - 0 - 19 19 Kapoeta South 25 14 14 0 - 14 28 Total 234 345 7 46 76 170 246 7,443 7,735 Highlights in week 18 of 2017: 1. Cholera confirmed in Kapoeta South after four of six samples tested positive for Vibrio cholerae on 5 May 2017 Table 3. 2. During the reporting period, five samples from Kapoeta South (4) and KodoK (1) tested positive for Vibrio cholerae Table 3. 3. Active transmission reported in at least nine counties where cases have been reported in the last four weeks Table 1. 4. The first round of oral cholera vaccination in Bentiu PoC started on 5 May 2017 while the first round of the vaccination campaign in MingKaman ends on 6 May 2017 Table 5 and Table 6. Figure 1.0: Cholera incidence (cases per 10,000) anD case fatality rate (%) as of 22 April 2017 Cholera Fatality Density Map by CFR, World Health Week 24 to Week 18, 2017 Organization Manyo Renk Melut 13.33 Fashoda Maban Abyei Pariang Malakal Panyikang Abiemnhom0.77 Baliet Aweil North 0 Rubkona 1.4 Aweil East Guit Longochuk Twic Mayom Fangak Canal/Pigi Aweil West 57.14 2.48 Luakpiny/Nasir Aweil South Maiwut Raga Gogrial WestGogrial East Koch Nyirol Ulang Aweil Centre Ayod Tonj North 2.28 16.1 Leer Mayendit 3.19 Tonj East 4.99 Akobo Jur River Uror Rumbek NorthPanyijiar Duk Wau 9.35 Pochalla Tonj SouthCueibetRumbek Centre 7.04 Twic East Yirol East Legend Rumbek East 5.75 Nagero 0 Bor South Yirol West 1.2 Pibor Cases /10,000 Population Wulu Awerial Tambura No Case Mvolo 36.36 0.1 - 15 Terekeka 16 - 30 Mundri WestMundri East Lafon Kapoeta North 31 - 45 Ezo Ibba Maridi Kapoeta East Yambio 46 - 60 Nzara 1.32Juba > 60 Kapoeta South Torit Budi River Nile Yei Lainya 3.45 Ikotos Kajo-Keji Magwi Morobo Case Fatality Rate ( CFR ) ± Counties with Cholera Alerts 0 90 180 KM The boundaries and names shown and the designations used on this map do not imply official endorsement or acceptance by the United Nations. Creation date: 04 May 2017 Source: WHO 2 Reporting period: week 18 (1st -7th May 2017) As seen from Figure 1, while cholera outbreaks have been confirmed in 19 counties. The most affected counties are located along River Nile. This suggests – vehicle borne transmission from contaminated water in affected counties. Figure 1.1: New cholera cases aDmitteD by location in week 16 anD 17 of 2017 200 168 week 17 week 18 117 100 80 70 45 Number of Cases 32 33 31 25 18 22 12 2 3 0 Awerial Yirol East Yirol West Duk Pigi- canal FANGAK Ayod Kapoeta South Eastern Lakes Jonglei Central Upper Fangak Kapoeta Nile During the reporting period, a total of 234 cholera cases were reported from Awerial (33), Yirol East (117), Yirol West (12), DuK (45), Kapoeta South (25), and Ayod (2) Figure 1.1. Most of the cases in Yirol East originated from Yali Payam and were seen at ThonabitKoK ORP. In DuK, most of the cases reported in the weeK originated from PoKtap. Table 1.2: Cholera cases anD deaths by state and county as of 5 May 2017 State County Population WeeK 18 WeeKs 24, 2016 to 18 of 2017 at risK New cases Cases per No. Cases per CFR [%] W18 10,000 cases 10,000 population population Fangak Fangak 168,947 0 - 356 21.1 1.4 Fangak Ayod 204,215 2 0.10 308 15.1 13.6 Northern Liech RubKona 126,976 0 - 1176 92.6 0.77 Northern Liech Mayom 191,758 0 - 7 0.4 57.14 Southern Liech Leer 95,731 0 - 94 9.8 3.19 Southern Liech Panyijiar 78,020 0 - 501 64.2 4.99 Southern Liech Mayendit 97,127 0 - 226 23.3 2.28 Eastern LaKes Awerial 114,837 33 2.87 1126 98.1 1.15 Eastern LaKes Yirol East 104,694 117 11.18 917 87.6 6.11 Eastern LaKes Yirol West 155,934 12 0.77 96 6.2 0 Imatong Pageri 215,130 0 - 29 1.3 3.45 Jonglei Bor South 331,611 0 - 87 2.6 5.75 Jonglei DuK 96,259 45 4.67 466 48.4 7.94 JubeK Juba 579,778 0 - 2,045 35.3 1.32 Terekeka Terekeka 209,902 0 - 22 1.0 36.36 Central Upper Nile Pigi 150,800 0 - 202 13.4 2.48 Fashoda KodoK 59,074 0 - 30 5.1 13.33 Central Upper Nile MalaKal 214,679 0 - 19 0.9 0 Kapoeta Kapoeta South 116,695 25 2.14 28 2.4 0 Total 3,312,167 234 0.71 7,735 23.4 3.23 † Case-fatality ratio (deaths among all cases discharged dead or alive from health facilities). Cumulatively, 7,735 cholera cases including 246 deaths (76 facilities and 170 community) (CFR 3.23%) have been reported in South Sudan involving 19 counties in 11 states since the initial case was reported on 18 June 2016 for Jubek state; 3rd July 2016 for DuK in Jonglei state; 14 July 2016 for TereKeKa state, 15 August 2016 for MingKaman in Eastern LaKes and Pageri in Imatong states; 10 August 2016 for Fangak in Western bieh state; 29 September 2016 for RubKona in Northern Liech state; 11 October 2016 for Leer; 22 October 2016 for Panyijiar in Southern Liech state; 10 October 2016 for Pigi in Central Upper Nile state; 7 October 2016 for Mayendit in 3 Reporting period: week 18 (1st -7th May 2017) Southern Liech state; 30 January 2017 for bor South in Jonglei state; 3 February 2017 for Yirol East in Eastern Lakes state; 22 February 2017 for Malakal, in Central Upper Nile state; and 8 April 2017 for Ayod; 4 April for KodoK; and 23 April for Kapoeta South (Figure 2.1 and Table 1.1).
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