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SITREP#97 1Dec 2016Final Republic of South Sudan Situation Report #97 on Cholera in South Sudan As at 23:59 Hours, 1 December 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 (34.7 %) of the samples tested positive for Vibrio Cholerae inaba in the National Public Health Laboratory as of 1 December 2016 (Table 3). Jubek state has recorded 2,006 cholera cases including 27 deaths (CFR 1.35 %). No new cholera case was reported in Jubek State during week 48 of 2016 (Table 1 and Figure 1.1). Active transmission is ongoing in Bentiu PoC where 13 new cases were reported in week 48 of 2016 (AnneX 1). Table 1: Summary of cholera cases reported in South Sudan as of 1 December 2016 New New New Total cases Total Total Reporting Total Total cases admissions discharges WK deaths WK currently facility community Total cases Sites deaths discharged WK 48 48 48 admitted deaths deaths Jubek – Juba - - - - 8 19 27 1,979 2,006 Jonglei-Duk - - - - 5 3 8 84 92 Terekeka - - - - - 8 8 14 22 Eastern Lakes - - - - 2 1 3 4 345 351 Awerial Imatong - - - - - - 1 1 28 29 Pageri Western Bieh - 3 1 - 2 4 - 4 260 266 Fangak Northern Liech 13 27 - 19 - - - 312 331 - Rubkona Southern Liech - - - - 1 - 1 41 42 - Leer Eastern Nile - 5 168 Pigi 5 163 Total 16 28 - 23 24 34 58 3,226 3,307 In Southern Liech (Leer and Mayendit), the response is led by UNIDO although implementation of sustained and comprehensive investigation and response activities continues to be constrained by security concerns. In Pigi, Eastern Nile state, transmission has been contained with the last four cases discharged from Kurwai PHCC on 15 November 2016. Cholera was confirmed in Pigi after two cases tested positive by culture on 2 November 2016. A least 163 cases including 6 deaths (5 health facility and one community) (CFR 2.98%) 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. 1 Figure 1.0: Cholera incidence (cases per 10,000) and case fatality rate (%) as of 1 December 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 Figure 1.1: New cholera cases admitted by location in weeK 48 of 2016 15 13 10 5 3 Number of Cases 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Puluk Dongchak Kator Juba Rejaf Munuki Northern Nimule Terekeka New Fangak Old Fangak Toch Thonyor Yang Bentiu PoC Bentiu Town Piliny Bari Eastern Jonglei Jubek Imatong Terekeka Western Bieh Southern Liech Northern Liech Lakes In Eastern Lakes state, cholera cases were reported in Mingkaman IDP settlement. The initial cases were confirmed on 24 August 2016, after two of four samples tested postive for Vibrio cholerae Inaba. The cumulative cases are 351 cholera cases including 17 confirmed cases and 4 deaths (one facility and three community) (CFR 1.14 %). This outbreak has been controlled with only sporadic cases being reported – the most recent being admitted on 26 November 2016. In Jonglei state, 92 suspected cholera cases including 8 deaths (CFR 8.7 %) have been reported from Duk County involving mainly the three Islands of Kawer, Long, and Moldova. The indeX case was reported on 3rd July 2016 from Moldova Island. 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. No additional cases have been reported since then. 2 Figure 1.2: Cumulative cholera cases by payam of residence as at 1 December 2016 700 606 600 500 470 400 351 358 320 322 300 Number of Cases 210 215 200 167 90 100 42 22 37 25 7 1 1 3 2 4 2 1 15 1 1 5 1 1 7 1 1 2 15 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 state has reported 22 cases of cholera including 8 deaths (CFR 36.4%) with 2 samples confirmed by the laboratory to be cholera. All the deaths were reported at the onset of the outbreak from Islands on River Nile where access to health services is poor. No additional deaths occurred after the rapid response team was deployed. The most of the recent cases originated from Kuda village, Lwoki payam, Nyori county on 22 September 2016. No additional cases have been reported since then. In Nimule, Imatong state, a cumulative of 29 cholera cases including four laboratory confirmed cases and one death (CFR 3.45%) were reported from 15 August 2016.The afffected locations in Imatong state included 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. No additional cases have been reported since then. Table 1.1: Cholera cases and deaths by state and county as of 1 December 2016 Week 48 Weeks 24-48 Cases per Cases per Population New cases 10,000 10,000 State County at risk W48 population No. cases population CFR [%] Western Bieh Fangak 139,509 3 0.22 266 19.1 1.5 Northern Liech Rubkona 126,976 13 1.02 331 26.1 - Southern Liech Leer 67,167 0 - 42 6.3 2.38 Eastern Lakes Awerial 114,837 0 - 351 30.6 1.14 Imatong Pageri 215,130 0 - 29 1.3 3.45 Jonglei Duk 26,180 0 - 92 35.1 8.7 Jubek Juba 471,762 0 - 2006 42.5 1.35 Terekeka Terekeka 177,849 0 - 22 1.2 36.4 Eastern Nile Pigi 125,496 0 - 168 13.4 2.98 Total 1,464,906 16 0.11 3307 22.6 1.75 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 266 cholera cases including 13 confirmed cases and 4 deaths (4 facility and zero community) (CFR 1.50%). As of 1 December 2016, the affected areas included Old Fangak (215 cases); New Fangak (42 cases); Mareang (1 case); Paguir (1 cases); Toch (3 cases); and Kolanyang (1 case) (Figure 1.2). Three cases were reported from Old Fangak in week 48 of 2016. In Northern Liech state, 331 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, 42 cholera cases have been reported from Leer in Southern Liech state. Since 7 3 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. 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.
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