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SITREP#95 17Nov 2016Final Republic of South Sudan Situation Report #95 on Cholera in South Sudan As at 23:59 Hours, 17 November 2016 Situation Update Cholera outbreaks have been confirmed in 9 (32%) of 28 states countrywide. The affected states include Imatong, Eastern Lakes, Jubek, Terekeka, Jonglei, Western Bieh, Northern Liech, Southern Liech; and Eastern Nile (Table 1 and Figure 1.0). Suspect cholera cases have been reported in Mayendit, Panyijiar, and Ayod (Table 4). Cumulatively 128 (36 %) of the samples tested positive for Vibrio Cholerae inaba in the National Public Health Laboratory as of 17 November 2016 (13 confirmed in week 46) (Table 3). Jubek state has recorded 1990 cholera cases including 14 deaths (CFR 0.71 %). A total of 4 new cholera cases were reported in Jubek State during week 46 of 2016 (Table 1 and Figure 1.1). During the week, Bentiu PoC reported 24 cases, the highest when compared to other outbreak areas. Most of the cases in Bentiu PoC have been reported in children under 2 years 143 (55%) while children under 10 years constitute 196 (75%) of the cases (Annex 1). Most 260 (94%) of the cases in Bentiu PoC have been reported in individuals that did not receive oral cholera vaccine. Most cases have been reported from sectors 2, 3, and 5 (Annex 1). Response in Bentiu is coordinated by a taskforce and the case-centered approach has been adopted to interrupt transmission. Table 1: Summary of cholera cases reported in South Sudan as of 17 November 2016 New New New Total cases Total Total Reporting Total Total cases admissions discharges deaths WK currently facility community Total cases Sites deaths discharged WK 46 WK 46 46 admitted deaths deaths Jubek – 4 6 - 2 8 6 14 1,974 1,990 Juba Jonglei- - - - - 5 3 8 84 92 Duk Terekeka - - - - - 8 8 14 22 Eastern Lakes - - 2 - 1 1 3 4 335 340 Awerial Imatong - - - - - - 1 1 28 29 Pageri Western Bieh - 1 5 - 1 4 - 4 242 247 Fangak Northern Liech - 24 164 - 12 - - - 259 271 Rubkona Southern Liech - - - - - - - - 28 28 Leer Eastern 5 126 Nile - Pigi 5 121 Total 29 177 - 16 23 21 44 3,085 3,145 While the current response in Leer and Mayendit is led by UNIDO with support from WHO and UNICEF, implementation of sustained and comprehensive investigation and response activities continues to be constrained by security concerns. In Pigi, two cases were confirmed by culture on 2 November 2016. A least 1 156 cases including 6 deaths (5 health facility and one community) (CFR 3.85%) have been reported since 10 October 2016. Current Health and WASH activities in Pigi are led by NHDF supported by WHO, UNICEF, and MSF-F. Only sporadic transmission is currently reported in Pigi. Figure 1.0: Cholera incidence (cases per 10,000) and case fatality rate (%) as of 17 November 2016 World Health Organization Cholera Fatality Density Map for cases per population and CFR Weeks 24-46, 2016 Map Date: 16 November, 2016 Manyo Renk The boundaries and names shown and the designations used on this map do not imply ofcial endorsement or acceptance by the United Nations. Sudan 0 50 100 200 Melut Kilometers Fashoda Maban Abyei Pariang Malakal Abiemnhom Baliet Aweil East Panyikang Aweil North Rubkona Fangak Guit Longochuk Twic Mayom Pigi Aweil West 3.97 1.62 Luakpiny/NasirMaiwut Aweil South Raga Gogrial East Koch Nyirol Ulang Aweil Centre Gogrial West Tonj North Ayod Leer Mayendit Ethiopia Tonj East Duk Uror Akobo Jur River Rumbek NorthPanyijiar 8.7 Wau Twic East Pochalla Central African Republic Tonj SouthCueibetRumbek Centre Yirol East Rumbek East Nagero Bor South Yirol West Awerial Pibor Wulu Tambura 1.18 Mvolo Legend Terekeka xx Case fatality rate (CFR) 36.4 Counties with Cholera alert Mundri WestMundri East Lafon Kapoeta North Cases per 10,000 population Ezo Ibba Maridi Kapoeta East Juba 40.1 - 50 Yambio Nzara 0.7 20.1 - 40 Kapoeta South 10.1 - 20 Torit Budi Yei Lainya 5.1 - 10 Magwi Ikotos 0.1 - 5 Kajo-Keji 3.45 Kenya No case reported Morobo Pageri River Democratic Republic of Congo Uganda To improve access to timely rehydration, at least twenty of twenty-three (90%) oral rehydration points (ORPs) have been set up and are submitting case line list data countrywide. Cholera cases have been reported in seven special populations: Bentiu PoC, UN House PoC, Tongping UNMISS transit site, Gorom Refugee camp, Mahad IDPs, Mangatain IDPs, and among IDPs in Gumbo. The Tongping UNMISS transit site reported 50 cholera cases with one confirmed case and no death, while the UN House PoC has recorded 96 cholera cases with 6 confirmed cases and no death. Figure 1.1: New cholera cases admitted by location in week 45 of 2016 30 24 25 20 15 10 Number of Cases 5 2 0 0 1 0 1 0 0 0 0 1 0 0 0 0 0 0 Puluk Dongchak Kator Juba Rejaf Munuki Northern Nimule Terekeka New Old Fangak Toch Thonyor Yang Bentiu PoC Bentiu Piliny Bari Fangak Town Eastern Jonglei Jubek Imatong Terekeka Western Bieh Southern Liech Northern Liech Lakes 2 On 24 August 2016, cholera was confirmed in Mingkaman IDP settlement after two of four samples tested postive for Vibrio cholerae Inaba. The cumulative cases are 340 cholera cases including 17 confirmed cases and 4 deaths (one facility and three community) (CFR 1.18 %). In Jonglei state, 92 suspected cholera cases including 8 deaths (CFR 8.7 %) have been reported from Duk County involving mainly 3 Islands namely Kawer, Long, and Moldova with the date of onset of index case on the 3rd July 2016. Of the five samples from Duk Islands that underwent culturing, one sample from Moldova Island, also the most affected, was confirmed as cholera on 29 July 2016. The most recent cases reported in Duk originated from Koyom Island on 10 Nov 2016. Figure 1.2: Cumulative cholera cases by payam of residence as at 17 November 2016 700 604 600 500 469 400 340 355 314 300 Number of Cases 262 206 199 200 125 90 100 39 22 37 7 1 1 3 2 4 2 1 15 1 1 5 1 1 7 1 1 2 15 11 1 0 Yang Toch Buko Rejaf Piliny Kator Puluk Lwoki Leer Padiat Paguir Lokiliri fangak kurwai Pageet Nimule Munuki Uganda Nyarjwa Thonyor Dhorbor Mareang Terekeka Mangalla Dongchak Kolanyang Juba Town Leer Town Gondokoro Bentiu PoC Old Fangak Bentiu Town New Fangak Northern Bari Eastern LakesImatong Jonglei Jubek Terekeka Western Bieh Northern Liech Southern Liech Eastern Nile Terekeka has reported 22 cases of cholera including 8 deaths (CFR 36.4%) with 2 samples confirmed by the laboratory to be cholera.The most of the recent cases are from Kuda village, Lwoki payam, Nyori county on 22 September 2016. No additional cases have been reported since then. As of 17 November 2016, a cumulative of 29 cholera cases including four laboratory confirmed cases and one death (CFR 3.45%) have been reported from Nimule in Imatong state since 15 August 2016.The afffected locations in Imatong state include Abila,Malakia and Motoyo. The last cholera case in Nimule was admitted in Nimule hospital on 29 Sept 2016 and discharged on 2 Oct 2016. Table 1.1: Cholera cases and deaths by state and county as of 17 November 2016 Week 46 Weeks 24-46 Cases per Cases per Population New cases 10,000 10,000 State County at risk W46 population No. cases population CFR [%] Western Bieh Fangak 139,509 1 0.07 247 17.7 1.62 Northern Liech Rubkona 126,976 24 1.89 271 21.3 - Southern Liech Leer 67,167 0 - 28 4.2 - Eastern Lakes Awerial 114,837 0 - 340 29.6 1.18 Imatong Pageri 215,130 0 - 29 1.3 3.45 Jonglei Duk 26,180 0 - 92 35.1 8.7 Jubek Juba 471,762 4 0.08 1990 42.2 0.7 Terekeka Terekeka 177,849 0 - 22 1.2 36.4 Eastern Nile Pigi 125,496 0 - 126 10.0 3.97 Total 1,464,906 29 0.20 3145 21.5 1.4 The cholera outbreak in Western Bieh state was confirmed on 22 September 2016 after two of four samples tested positive for Vibrio cholerae inaba. The initial cases were reported on 10 August 2016 in Old Fangak. The cumulative cases are 247 cholera cases including 13 confirmed cases and 4 deaths (4 facility and zero community) (CFR 1.65%). As of 17 November 2016, the affected areas include Old Fangak (199 cases); New Fangak (39 cases); Mareang (1 case); Paguir (1 cases); Toch (3 cases); and Kolanyang (1 case) (Figure 1.2). 3 In Northern Liech state, 271 cholera cases including 11 confirmed cases and no death have been reported in Bentiu Town/PoC since 29 September 2016. The cholera taskforce, chaired by MoH and constituted by Health and WASH cluster partners is coordinating the response. The new cases in Bentiu are largely reported among children under two years and in individuals that arrived from Leer, Mayendit, Koch, Panyijiar, and Guit after the 2015 oral cholera vaccine campaign in Bentiu PoC. Over 90% of cholera cases in Bentiu PoC did not receive oral cholera vaccine (Annex 1). In Southern Liech, two cholera cases originating from Leer Town tested positive for Vibrio cholerae Inaba on 11 October 2016. Cumulatively, 28 cholera cases have been reported from Leer in Southern Liech state. Since 7 October 2016, at least 35 suspect cholera cases including three deaths have been reported by UNIDO response team in Mayendit.
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