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SITREP#115 7Apr2017final Republic of South Sudan Situation Report #115 on Cholera in South Sudan As at 23:59 Hours, 7 April 2017 Situation Update A total of 14 counties in 9 (28%) of 32 states countrywide have confirmed cholera outbreaks (Table 1; Figure 1.0). Suspect cholera cases are being investigated in Padiet, Dorok, Mamour, Dongchak, and Amiel in Duk; Kalagany and Paroj in Kodok; and Jachor, Nyawit, Pagil, Gorwai, and Pajiek in Ayod (Table 4). During week 14 of 2017, two samples from Malakal tested negative for Vibrio cholerae (Table 3). Cumulatively, 207 (38%) samples have tested positive for Vibrio Cholerae inaba in the National Public Health Laboratory as of 7 April 2017 (Table 3). Table 1: Summary of cholera cases reported in South Sudan as of 7 April 2017 New New Total cases Total admissio New deaths Total facility Total cases Reporting Sites discharges WK currently community Total deaths Total cases ns WK WK 14 deaths discharged 14 admitted deaths 14 Jubek – Juba - - - 8 19 27 2,018 2,045 Jonglei-Duk - - - - 3 5 8 92 100 Jonglei-Bor - - - - 1 4 5 82 87 Terekeka - - - - - 8 8 14 22 Eastern Lakes - 24 33 - 25 2 10 12 713 750 Awerial Eastern Lakes - 12 - - 5 12 23 35 453 493 Yirol East Imatong - Pageri - - - - - 1 1 28 29 Western Bieh - - - - - 4 - 4 266 270 Fangak Northern Liech - - - - - 7 2 9 1,167 1,176 Rubkona Southern Liech - - - - - 3 - 3 91 94 Leer Southern Liech - - - - - 20 4 24 477 501 Panyijiar Southern Liech - - - - - - 5 5 221 226 Mayendit Central Upper - - - 5 183 Nile - Pigi 5 178 Central Upper - - - - 19 Nile - Malakal 0 19 Total 36 33 - 30 65 81 146 5,819 5,995 Highlights in week 14 of 2017: 1. In week 14, cholera cases were reported from Yirol East 12 cases (Guthom (5), Shambe (3) Other sites (4) and Mingkaman IDP settlement 24 cases (14 [58%] from sites 0, 1, & 2) Table 1. 2. Suspect cholera cases are being verified/investigated in Padiet, Dorok, Mamour, Dongchak, and Amiel in Duk; Kalagany and Paroj in Kodok; and Jachor, Nyawit, Pagil, Gorwai, and Pajiek in Ayod (Table 4). 3. The counties with active cholera transmission include Yirol East, and Awerial (Figure 1). 4. Results from the first round OCV campaign conducted in Bor PoC from 3rd to 4th April 2017 show that 1,926 (85%) individuals aged one year and above were immunized. 1 Figure 1.0: Cholera incidence (cases per 10,000) and case fatality rate (%) as of 7 April 2017 Cholera Fatality Density Map by CFR, World Health Week 24 to Week 12, 2017 Organization Manyo Renk Melut Fashoda Maban Abyei Pariang Malakal Panyikang Abiemnhom0.77 Baliet Aweil North 0 Rubkona 1.48 Aweil East Guit Longochuk Twic Mayom Fangak Canal/Pigi Aweil West 2.76 Luakpiny/Nasir Aweil South Maiwut Raga Gogrial WestGogrial East Koch Nyirol Ulang Aweil Centre 3.19 Ayod Tonj North 2.28 MayenditLeer Tonj East 4.79 Akobo Jur River Uror Rumbek NorthPanyijiar 8 Duk Wau Pochalla Tonj SouthCueibetRumbek Centre 8.02 Twic East Yirol East Rumbek East 5.75 Case Fatality Rate ( CFR ) Nagero Bor South Yirol West 1.64 Pibor Wulu Awerial Tambura Continues with Cholera Alert Mvolo 36.36 Terekeka River_Nile Mundri WestMundri East Lafon Kapoeta North Cases /10,000 Population Ezo Ibba Maridi Kapoeta East Yambio No Case Nzara Juba 1.32 Kapoeta South 0.1 - 15 Torit Budi Yei Lainya 16 - 30 3.45 Ikotos Kajo-Keji Magwi 31 - 45 Morobo 46 - 60 > 60 ± 0 90 180 KM Data_source: HF_data_by-WHO_states_hubs/ Data_as_of_Jan_2017 Monday, March 27, 2017 As seen from Figure 1, while cholera outbreaks have been confirmed in 14 counties, active transmission is currently ongoing in Yirol East and Awerial counties. Suspect cholera cases are being investigated in Duk, Ayod, and Kodok counties. Figure 1.1: New cholera cases admitted by location in week 13 and 14 of 2017 120 111 100 week 13 week 14 80 70 60 40 36 40 Number of Cases 24 20 12 1 0 Awerial Yirol East Pigi- canal Eastern Lakes Central Upper Nile Total by week 2 Figure 1.2: Cumulative cholera cases by state and county of residence as at 7 April 2017 7000 5995 6000 5000 4000 3000 Number of Cases 2045 2000 1176 750 1000 501 493 270 226 22 94 87 100 29 183 19 0 FANGAK Terekeka Leer MayenditPanyijiar Rubkona Juba Bor South Duk Pageri Awerial Yirol EastPigi- canal Malakal Western Terekeka Southern Liech Northern Jubek Jonglei Imatong Eastern Lakes Central Upper Nile Grand Bieh Liech Total Table 1.1: Cholera cases and deaths by state and county as of 7 April 2017 Week 14 Weeks 24, 2016 to 14 of 2017 Population New cases Cases per 10,000 Cases per 10,000 State County at risk W14 population No. cases population CFR [%] Western Bieh Fangak 168,947 0 - 270 16.0 1.48 Northern Liech Rubkona 126,976 0 - 1176 92.6 0.77 Southern Liech Leer 95,731 0 - 94 9.8 3.19 Southern Liech Panyijiar 78,020 0 - 501 64.2 4.79 Southern Liech Mayendit 97,127 0 - 226 23.3 2.28 Eastern Lakes Awerial 114,837 24 2.09 671 65.3 1.60 Eastern Lakes Yirol East 104,694 12 1.15 438 47.1 7.10 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 0 - 100 10.4 8 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 - 181 12.0 2.76 Central Upper Nile Malakal 214,679 0 - 16 0.7 0 Total 2,584,491 36 0.14 5,995 23.2 2.44 Cumulatively, 5,995 cholera cases including 146 deaths (65 facilities and 81 community) (CFR 2.44%) have been reported in South Sudan involving 14 counties in 9 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 Southern Liech 3 state; 30 January 2017 for Bor South in Jonglei state; 3 February 2017 for Yirol East in Eastern Lakes state; and 22 February 2017 for Malakal, in Central Upper Nile state (Figure 2.1 and Table 1.1). Figure 2:1 Epidemic curve for cholera cases in South Sudan, from 18 June - 7 April 2017 350 25 300 21.05 20 250 16.92 15 200 Number of cases CFR [%] 150 10 100 6.67 6.91 5.75 5.11 4.84 5 4.48 4.12 50 3.33 3.33 3.49 2.75 2.86 2.26 2.42 2.24 2.30 2.05 1.85 2.00 1.76 1.42 1.55 1.35 1.27 1.47 0.86 0.76 0.75 0.82 0.79 0.90 0.62 0.42 0.63 0.57 0.60 0 - - - - - 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 47 48 49 50 51 52 1 2 3 4 5 6 7 8 9 10 11 12 13 14 Epidemiological week of onset 2016 2017 Jonglei Jubek Terekeka Imatong Eastern Lakes Western Bieh Northern Liech Southern Liech Central Upper Nile CFR[%] Figure 3:1 Cholera case distribution by gender and county 7 April 2017 Cholera case gender distributionby IDP site wk 27 of 2016 to week 14 of 2107 100% 90% 35 37 80% 44 42 41 48 49 52 50 50 49 57 57 55 70% 74 60% 50% e itiuin % Sex distribution 40% 65 63 30% 56 58 59 52 51 48 50 50 51 43 43 45 20% 26 10% 0% Awerial Bor South Duk FANGAK Juba Leer Mayendit Pageri Panyijiar Pigi- canal Rubkona Terekeka Yirol East Malakal Overall Female Male Overall, males and females are almost evenly Figure 3.1. The gender distribution of cholera cases by county is shown in Figure 3.1. 4 Figure 3:2 Cholera case distribution age in South Sudan 7 April 2017 CholerA cAse Age distribution by wk 27 of 2016 to week 14 of 2017 25.0 22.8 20.0 15.6 15.0 10.8 10.0 8.4 7.6 7.7 g itiuin % Age distribution 7.2 5.6 5.0 3.9 2.9 1.8 1.4 1.8 1.7 0.8 - 9yrs +yrs - 14yrs 24yrs <5yrs 19yrs 29yrs 34yrs 39yrs 44yrs 49yrs 54yrs 59yrs 64yrs 69yrs - - - - - - - - - - - - 5 70 10 20 15 25 30 35 40 45 50 55 60 65 Children under 19 years constitute nearly 60% of the total cholera cases Figure 3.2. The age distribution of cholera cases by county is shown in Figure 3.3. Figure 3:3 Cholera case distribution by age and county in South Sudan 7 April 2017 Cholera case age distributionby IDP site wk 27 of 2016 to week 14 of 2107 100% 90% 80% 70% 60% 50% 40% g itiuin % Age distribution 30% 20% 10% 0% Awerial Bor South Duk FANGAK Juba Leer Mayendit Pageri Panyijiar Pigi- canal Rubkona Terekeka Yirol East Malakal 0-5yrs 5-9yrs 10-14 yrs 15-19 yrs 20-24 yrs 25-29 yrs 30-34 yrs 35-39 yrs 40-44 yrs 45-49 yrs 50-54 yrs 55-59 yrs 60-64yrs 65-69 yrs 70+yrs Probable risk factors 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.
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