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. The implementation of sustained and comprehensive response activities in Leer and Mayendit has been constrained by security concerns.

Cumulatively, 3,145 cholera cases including 44 deaths (29 facilities and 15 community) (CFR 1.40%) have been reported in South Sudan involving 9 states since the initial case was reported on 18 June 2016 for Jubek state; 3rd July 2016 in Jonglei state; 14 July 2016 for Terekeka state, 15 August 2016 for Eastern Lakes and Imatong states; 10 August 2016 for Fangak in Western Bieh and state; 29 September 2016 for Rubkona in Northern Liech state; October 2016 for Leer in Southern Liech state; and 10 October 2016 for Pigi in Eastern Nile state (Figure 2.1 and Table 1.1).

As seen from Figure 2.1 there was a spike in cholera transmission in week 43, 44, and 45 that was attributed to transmission in Bentiu PoC where most cases were <2 years of age and did not receive oral cholera vaccine.

Figure 2:1 Epidemic curve for cholera cases in South Sudan, from 18 June - 17 November 2016

350

21.1% 300 20%

250 16.9% 15% 200 315

313 CFR % 150 10% Number of cases 216 100 180 184 186 165 5% 50 35 3101.3% 97 3.6% 1 1.5% 1.4% 1.434% 1.6% 31 28 0.9% 1.0% 0.228% 22 12 0.189% 12 0 0.10%0 .0%0 .04% 0.3%0 .4% 0.0% 0.4% 0.0%0 .0% 0.0%0 .04% 0% 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 Epidemiological week of onset Jonglei Jubek Terekeka Imatong Eastern Lakes

Western Bieh Northern Liech Southern Liech Eastern Nile CFR[%]

Figure 3:1 Cholera case distribution by gender and age in Jubek State 17 November 2016 300 Cholera - age and sex distribution Jubek up to 17 Nov 2016

250

200 159 154 135 118 150 138

74

Number of Cases 100 92 57 59 48 50 108 100 106 102 80 80 39 58 63 21 46 34 16 21 17 10 13 7 0 10 4 8 5 3 Under 2 3-5 6-10 11-15 16-20 21-25 26-30 31-35 36-40 41-45 46-50 51-55 56-60 61-65 66-70 70+ Adult

Female Male

4

Out of the 1990 cholera cases in Jubek State, 845 (42.5%) were female, while 1145 (57.5%) were male

Figure 3:2 Cholera case distribution by gender and age in Jonglei State 17 November 2016

18 Cholera - age and sex distribution Jonglei up to 17 Nov 2016 16

14

12

10

8 10 1

Number of Cases 6 12 2 4 8 1 2 2 2 7 5 7 3 4 2 4 7 2 1 1 3 3 1 1 0 Under 2 3-5 6-10 11-15 16-20 21-25 26-30 31-35 36-40 41-45 46-50 51-55 56-60 61-65 66-70 70+ Adult

Female Male

Data on Age missing for 11 cases

Out of the 92 cholera cases, in Jonglei State 40 (43.5 %) were female, while 52 (56.5%) were male

Figure 3:3 Cholera case distribution by gender and age in Eastern Lake State 17 November 2016 80 Cholera - age and sex distribution Eastern Lakes up to 17 Nov 70 60 2016 50 40 39 30 50 15 Number of Cases 20 26 9 12 15 7 10 11 1 4 5 6 16 23 30 14 20 15 8 14 3 3 0 Under 2 3-5 6-10 11-15 16-20 21-25 26-30 31-35 36-40 41-45 46-50 51-55 56-60

Female Male

Out of the 340 cholera cases, in Eastern Lake State 145 (42.6%) were female, while 195 (57.4 %) were male.

Figure 3:4 Cholera case distribution by gender and age in Western Bieh State 17 November 2016 60 Cholera - age and sex distribution Western Bieh up to 17 Nov 2016 50

40 27 30 8 10 4 5 20 Number of Cases 8 22 24 22 4 23 4 10 20 8 10 11 2 9 0 1 1 0 4 4 1 2 4 1 2 20 1 Under 3-5 6-10 11-15 16-20 21-25 26-30 31-35 36-40 41-45 46-50 51-55 56-60 61-65 66-70 70+ Adult Blank 2

Female Male

Out of the 247 cholera cases, in Western Bieh State 162 (65.6 %) were female, while 85 (34.4 %) were male.

5 Figure 3:5 Cholera case distribution by gender and age in Southern Liech State 17 November 2016

10 Cholera - age and sex distribution Southern Liech up to 17 Nov 8 0 2016 6

4 0 0 Number of Cases 2 8 0 1 6 0 01 02 3 2 01 0 0 01 01 01 0 01 0 Under 2 3-5 6-10 11-15 16-20 21-25 26-30 31-35 36-40 41-45 46-50 51-55 56-60 61-65 66-70 70+

Female Male

Out of the 28 cholera cases, in Southern Liech State 12 (42.9 %) were female, while 16 (57.1 %) were male.

Figure 3:6 Cholera case distribution by gender and age in Northern Liech State 17 November 2016

180 Cholera - age and sex distribution Northern Liech up to 17 150 120 Nov 2016 90 68 60 Number of Cases 30 9 23 0 75 13 10 49 62 9 51 7 32 12 30 10 42 10 1 0 0 Under 3-5 6-10 11-15 16-20 21-25 26-30 31-35 36-40 41-45 46-50 51-55 56-60 61-65 66-70 70+ 2

Female Male

Out of the 271 cholera cases, in Northern Liech State 145 (53.5 %) were female, while 126 (46.5 %) were male.

Figure 3:7 Cholera case distribution by gender and age in Eastern Nile State 17 November 2016

10 Cholera - age and sex distribution Eastern Nile up to 17 Nov 2016 8 0 6

4 0 0 Number of Cases 2 8 0 1 6 0 01 02 3 2 01 0 0 01 01 01 0 01 0 Under 2 3-5 6-10 11-15 16-20 21-25 26-30 31-35 36-40 41-45 46-50 51-55 56-60 61-65 66-70 70+

Female Male

Out of the 126 line listed cholera cases, in Eastern Nile State 66 (52.4 %) were female, while 60 (47.6 %) were male.

6 Table 2: Case distribution by gender in South Sudan 17 November 2016 State Female Male Grand Total Eastern Lakes 145 195 340 Imatong 13 16 29 Jonglei 40 52 92 Jubek 845 1,145 1,990 Terekeka 13 9 22 Western Bieh 162 85 247 Northern Liech 145 126 271 Southern Liech 12 16 28 Eastern Nile 66 60 126 Grand Total 1,441 1,704 3,145

The probable risk factors fueling transmission include: using untreated water from the River Nile and water tankers; lack of household chlorination of drinking water; eating food from unregulated roadside food vendors or makeshift markets; open defecation/poor latrine use especially following the conflict.

Laboratory updates

Table 3: Cholera laboratory test results for Juba by 17 November 2016

Culture results State New positives in Cumulative Cumulative Total tested week 46 Positive Negative Eastern Nile 0 0 5 5 Jonglei 0 1 4 5 Jubek 3 73 125 198 Terekeka 0 2 0 2 Eastern Lakes 1 17 28 45 Imatong 0 7 1 8 Fangak 8 13 26 39 Wau 0 0 6 6 Boma 0 0 2 2 Northern Liech 1 11 26 37 Southern Liech 0 2 0 2 Eastern Nile (Pigi) 0 2 5 7 Total tested 13 128 228 356

Table 4: Cholera Alerts – Date of Details of the alert Area Action notification No alerts 13-Sept- COSV reported suspect cholera Haat Islands, Follow up mission to Ayod, Haat Island 2016 cases in Haat Islands, Ayok Ayok county, by MedAir currently is underway. county, Southern Bieh state Southern Bieh state

7 8- Oct-2016 UNIDO reported 33 suspect Thaker, Tutnyang, UNIDO is the healthcare partner cholera cases including three & Leah Payams, responding to suspect cases in deaths Mayendit North, Mayendit. Security concerns have Southern Liech constrained comprehensive and state sustained interventions. 26-Oct-16 In Panyijiar 42 suspect cholera Ganyliel, Tayar, Partners meeting involving Mercy corps, cases including 3 deaths have Nyal, Panyijiar, IRC, GAA, and IRC organized on 26 Oct been reported in Ganyliel; Nyal; Southern Liech 2016 to initiate a coordinated response. Tayar. Of these, 21 cases including three reported by WHO supported IRC and Sign of Hope Ganyliel PHCC. The initial case to respond to the suspect cases. seen on 22 Oct 2016 involving a Laboratory confirmation is still pending. trader from Duk. Cases have Supplies have been provided to UNIDO also been reported in Nyal and IRC to facilitate confirmation, case PHCC (21 cases in total since management and cholera prevention in 27 Oct 2016). the communities.

Cholera Response Activities

Overall coordination of the cholera response at the national level is coordinated by the National cholera taskforce to review outbreak trends and progress of implementation activities. Security concerns have remained a major impediment to the implementation of sustained and comprehensive cholera investigation and response activities in Leer and Mayendit.

Cholera case management is ongoing at the designated cholera treatment facilities in the nine affected states. As cases decline in the affected areas, laboratory surveillance has been strengthened to ensure that all suspect cholera cases undergo rapid diagnostic testing and stool culturing to confirm cholera. WHO has therefore supported the partners operating cholera treatment facilities with ample supplies for sample collection, onsite rapid diagnostic testing, and shipment to the National Public Health Laboratory for culturing. In Bentiu PoC where the transmission has increased over the last four weeks, the case-centered approach has been deployed to stem transmission. Arrangements are underway to avail at least 2,800 doses of oral cholera vaccines to augment the case-centered approach in Bentiu PoC.

WHO is supporting the cholera investigation and response activities in all the nine affected states and the two states with alert suspect cases. Core to WHO’s support to the current cholera response is technical support to the taskforce committees by providing updated situation reports; supporting the investigation and testing of suspect cases; support towards case management activities through trainings on cholera case management protocols; recommending tailored strategies in response to emerging trends; and support for the outbreak evaluation process that is already underway. WHO technical officers are currently deployed in Mingkaman; Bentiu, Bor, Malakal, Imatong, and Juba to support the ongoing response activities.

UNICEF continues to support the Cholera response at the community level across all relevant sectors of Health, WASH, and communication through active partnerships with following implementing partners: Health Link South Sudan (HLSS), LiveWell, ACROSS, CAPIAD, THESO, BEDN, IMC, RUWASSA, SMC, NHDF, UNIDO, World Relief, and ARUDA. UNICEF continues is supporting 20 active Oral Rehydration points (including 2 CTUs), in Jubek, Mingkaman, Duk, Leer, and Pigi. Two more ORPs are to be set-up by Nile Hope in Kurwai, Pigi. All in all, more than 1,500 cholera patients have benefitted directly from UNICEF support while almost all patients have benefitted from supplies across all relevant sectors (Health, WASH, and communication).

As of week 46 of 2016, ACROSS with 34 volunteers in Gorom refugee camp has visited a cumulative of 6,175 households where they reached 13,593 people; visited five schools reaching 1,263 pupils; conducted 25 community meetings reaching 2,480 people; three market sessions reaching 61 market vendors; 39 water point sessions reaching 596 people; two public announcements reaching 81 people; distributed 2129 IEC materials and 88 banners; distributed 12,176 Aquatabs; 1,536 PuR sachets; 5,762 bars of soap; and 5,749 sachets of ORS.

As of week 46 of 2016, HLSS with 16 hygiene promoters in Gurei, Lologo, and Gumbo reached a cumulative of 60,130 households reaching 199,771 females and 185,262 males and distributed 84,233 chlorine tablets;

8 26,454 PuR sachets; 58,574 soaps; and 58,721 sachets of ORS sachets in Jubek. The volunteers have also visited 16 schools reaching 7,028 pupils; conducted 42 community meetings reaching 3,835 individuals; five market sessions reaching 1,687 market vendors; eight water point sessions reaching 120 people; and distributed 1,909 posters and 18 banners with messages on cholera prevention and control.

In Bentiu, the weekly cholera taskforce meetings take place weekly on Wednesdays to coordinate preparedness and response activities. The implementation of the integrated case-centered approach is ongoing with plans to deploy at least 2,800 doses oral cholera vaccines to augment the response.

Security concerns continue to be the main impediment for a sustained and comprehensive response in Leer and Mayendit. In Panyijiar; at least 42 suspect cases including three deaths have been reported in Ganyliel; Nyal; and Tayar. WHO and UNICEF have supported IRC, UNIDO, and Sign of Hope to respond to the suspect cases.

In Fangak, MSF France is running a CTC in Fangak town where cholera cases are being managed. The health and WASH clusters have mobilized additional partners – Hold the Child and ACF to support the community interventions including establishment of ORPs, community health education, hygiene promotion and support for personal hygiene and chlorination of water at water collection points.

In Pigi; cases are being managed in Kurwai PHCC by Nile Hope with support from WHO, UNICEF, and MSF-F. At least 156 cases including six deaths of cholera have been reported. The cases have been on the decline and by 17 November 2016, there were no cholera cases admitted in the treatment center.

A total of 17 radio channels continue to air cholera messages country-wide (Juba, Yei, Kajo-Keji, Torit, Bor, Bentiu, Mingkaman and Wau) reaching 2 million audiences per day. MTN, a mobile telecommunications carrier is broadcasting key cholera messages to all its subscribers once a day.

Planned Activities 1. The next cholera coordination meeting in will be held in Juba Teaching Hospital on 21 November 2016 starting 11:00am in Juba Teaching Hospital. 2. The next weekly cholera taskforce meeting is scheduled for 23 November 2016 starting 2:00pm in the WHO Conference Hall. 3. Continue social mobilization activities, active case surveillance, and street announcements with open van, house to house awareness and distribution of WASH supplies by HHPs in affected and at risk areas. 4. Negotiate for security access to allow humanitarian access for partners to implement cholera investigation and response activities in Mayendit, and Leer. 5. Consolidate the implementation of the integrated case-centered approach in emerging cholera transmission hotspots in Northern Liech.

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/ 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 number for Vivacell calls is: 1144.

Contacts For more information, please contact

Dr. John Rumunu Dr. Thomas Akim Ujjiga Director General - Preventive Health Services Director - IDSR MoH, Republic of South Sudan MoH, Republic of South Sudan Tel: +211955668178 Tel: +211955150406

9 Annex 1: Cholera distribution in Bentiu PoC as of 17 November 2016

Annex 1.1: Cholera case distribution by time in Bentiu PoC 17 November 2016

Epidemic Curve for cholera in Bentiu PoC as of 17 Nov 2016

30 25 20 15 10 No. cases 5 0

Date of onset

Annex 1.2: Cholera age and sex distribution in Bentiu PoC as of 17 November 2016

180 Cholera - age and sex distribution Northern Liech up to 17 Nov 2016 150

120

90 68

60 Number of Cases 30 8 22 0 6 75 13 10 48 51 9 41 7 32 12 20 10 40 1 1 0 2 0 Under 3-5 6-10 11-15 16-20 21-25 26-30 31-35 36-40 41-45 46-50 51-55 56-60 61-65 66-70 70+ Adult Blank 2 Female Male

Annex 1.3: Cholera case distribution by sector in Bentiu PoC as of 17 November 2016 Cholera cases by sector in Bentiu PoC as of 15 Nov 2016

80

70

60

50

40 72 30 58

Number of cases 51 20 38 40

10

0 Sector 1 Sector 2 Sector 3 Sector 4 Sector 5

10