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Cholera Situation Analysis and Hotspot Mapping in South Sudan

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GTFCC Meeting for the Working Groups on CHOLERA SITUATION ANALYSIS Surveillance AND HOTSPOT MAPPING IN (Epidemiology and Laboratory) (15th to 17th SOUTH SUDAN March 2019) BACKGROUN D 1. South Sudan borders Uganda, Kenya, Ethiopia, Sudan, DR Congo, & CAR 2. Got independence in 2011 3. Protracted Grade 3 crisis since 2013 (situation improving since Sept 2018) 4. Severe food insecurity – 7.1million (63% of population) – 45,000 faced with famine 5. 1.87 million IDPs & 2.27million refugees to neighboring countries 1. Multisectoral taskforce in place chaired by MoH with the other sectors (Water & COORDINATION OF Humanitarian Affairs) and partners (Health + WASH) CHOLERA CONTROL clusters as members 2. Draft National Cholera Control Plan pending WASH assessment & stakeholder review/costing 3. Implemented preventive OCV campaigns since 2017 (2.9 million doses approved 27/Mar/2019) 4. Sub-optimal involvement of other sectors and WASH in OCV preventive campaigns CHOLERA IN SOUTH 1. South Sudan endemic for SUDANcholera 2. Since the 2013 crisis onset – cholera outbreaks – 2014 - 2017 3. Between 2014-2017 at least 28,676 cases & 644 deaths reported 4. All outbreaks started in Juba 5. Cases reported along River Nile, cattle camps, IDPs, islands, & Commercial hubs 1600 Cholera cases in South Sudan, 2014 s e s a 1200 Cholera cases in South Sudan, 2014 s c e f s a o 2014 c f r 800 o 2014 e 1000 r e b b m 400 m CHOLERA IN u u N N 0 0 1 3 5 7 9 111315171921232527293133353739414345474951 1 3 5 7 9 111315171921232527293133353739414345474951 Week of onset Week of onset 1900 Cholera cases in South Sudan, 2015 s e s SOUTH a c 1600 Cholera cases in South Sudan, 2015 f o s r 900 e e 2015 b s m a 1200 u c N f o -100 r 800 1 3 5 7 9 111315171921232527293133353739414345474951 SUDAN e 2015 Week of onset b m 400 u Cholera cases in South Sudan, 2016 s N e 1600 s a 0 c f 1200 1. From 2014 to 2017 o 2016 r 1 3 5 7 9 111315171921232527293133353739414345474951 e 800 Week of onset b m u 400 N 1. Case amplitude highest in 0 Cholera cases in South Sudan, 2016 1 3 5 7 9 111315171921232527293133353739414345474951 s Week of onset e 1600 s 2014 & 2017 (1000-1500 a c Cholera cases in South Sudan, 2017 s f 1200 e 1600 o s 2016 a r c 2017 f e 800 1200 cases/week) o b r e 800 m b u 400 m u 400 N N 2. Longest duration in 0 0 1 3 5 7 9 111315171921232527293133353739414345474951 1 3 5 7 9 111315171921232527293133353739414345474951 Week of onset Week of onset 2016/17 (77 weeks) Cholera cases in South Sudan 2018 s e 1600 s a c f 1200 o r 3. Geog. spread highest in e 800 2018 b m u 400 N 2017 (23 counties) 0 1 3 5 7 9 111315171921232527293133353739414345474951 Week of onset Cholera cases in South Sudan April 2019 2. No cholera cases confirmed in s e 1600 s a c f 1200 o 2018 r e 800 b m 2019 u 400 N 3. No cholera cases confirmed 0 1 3 5 7 9 111315171921232527293133353739414345474951 by April 2019 Week of onset Cholera hotspot South Sudan experience mapping Cholera Hotspot definition • A cholera hotspot is defined as a geographically limited area (e.g. city, administrative level 2 or health district catchment area) where environmental, cultural and socioeconomic conditions facilitate disease transmission and where cholera persists or re-appears regularly. Hotspots play a central role in the spread of disease to other areas. (Source – Cholera surveillance definitions – GTFCC) Cholera Hotspot • Use recent cholera data - at least last 5 years mapping - • Mapping cholera hotspots by district level GTFCC guidance – Incidence and mortality by hotspot • Description of contextual factors that favor cholera transmission in the hotspots • Review local capacities for implementing control interventions (incl. finances, surveillance, patient care, WASH, ability to conduct OCV campaigns) • Cholera line list data used South – Annual cholera attack rates by county Sudan – Annual cholera CFR Hotspot by county Microsoft Excel Worksheet mapping – – Assessment of high- risk groups in hotspot data used areas –Context and capacities assessed Cases/10,000 (2014) Cases/10,000 (2015) Cases/10,000 (2016) Cases/10,000 (2017) Renk Mayom Tonj North Nyirol Yirol West Tonj East Fashoda Yirol East Cholera Ayod Terekeka Manyo Hotspot - Mundri East Panyikang Yei analysis Magwi Lopa/Lafon Ikotos Torit output Fangak Mayendit Duk Canal Pigi Awerial Panyijiar Rubkona Bor Budi Kapoeta East Kapoeta South Kapoeta North Kajo keji Malakal Juba - 50 100 150 200 0 50 100 150 200 0 50 100 150 200 0 50 100 150 200 Estimated Annual Incidence Rate per 10,000 population by county and year CFR (%) 2014 CFR (%) 2015 CFR (%) 2016 CFR (%) 2017 Yirol West Yirol East Tonj North Tonj East Terekeka Rubkona Renk Panyijiar Nyirol Mayom Mayendit Magwi Leer Kapoeta East Cholera Fashoda Fangak Duk Canal Pigi Hotspot - Bor Ayod Awerial analysis Mundri East Manyo Budi Kapoeta South Bor output Juba 3 PoC Kapoeta North Torit Malakal Juba South Sudan Magwi Tongping PoC Yei River Lopa-Lafon Kajo-Keji Ikotos 0 20 40 0 20 40 0 20 40 0 20 40 60 Estimated CFR by county and year. Dashed vertical line represents 1% CFR cases In recent years cholera outbreaks have been reported in: 1. Major commercial hubs 2. Communities along major rivers – River Nile 3. Cattle camp populations 4. Internally displaced populations (IDPs) 5. Populations on islands with no social amenities CHOLERA HOTSPOT MAPS SOUTH SUDAN CHOLERA HOTSPOT MAP - UNICEF STUDY 14 Type 1 (2) Type 2 (8) Type 3 (2) Type 4 (2) High Medium High Medium recurrence recurrence recurrence recurrence Long Long Short Short duration duration duration duration • List • List • List • County • County • County . Juba . Ikotos . Duk . Budi . Magwi . Kapoeta . Malakal . Kapoeta North South . Lafon . Torit . Fangak . Panyijiar . Rubkona . Tonj East Same datasets used hence the overlap in hotspot areas identified and targeted for the ongoing preventive OCV campaigns OCV CAMPAIGNS IN HOTSPOT AREAS Two rounds (2017_18) OCV doses received in South Sudan, 2014-2018 2,500,000 First round (pending second) – 2017_18 Hotspot – OCV pending 2,000,000 d e v i e 1,500,000 c 1,371,430 e r s e Shanchol™ Euvichol ® s o d 1,000,000 V C O 500,000 737,870 448,945 417,060 252,070 - 72,450 113,800 2014 2015 2016 2017 2018 Year received Year Euvichol ® Shanchol™ Total doses 2014 252,070 252,070 1. 3.4 million OCV doses deployed in South 2015 417,060 417,060 2016 72,450 72,450 Sudan from 2014 - 2018 2017 737,870 1,371,430 2,109,300 2. No new confirmed cholera cases in 2018 113,800 448,945 562,745 Total doses 851,670 2,561,955 3,413,625 South Sudan since 18 December 2017 CHOLERA CONTROL CHALLENGES IN SOUTH SUDAN 1. Weak social services sector – Health & Water 2. Development funding still low & hence no progress on implementing long term WASH interventions for cholera prevention 3. Inadequate integration of WASH in OCV campaigns 4. Sub-optimal involvement of other sectors 5. Access constraints - security, rainy season NEXT STEPS • Conduct an assessment of WASH needs that will be used to update the situation analysis and tailored WASH interventions in the NCCP • Review, update, validate, cost & launch the National Cholera Control Plan for South Sudan that is aligned to the Global Roadmap for cholera elimination by 2030 AKNOWLEDGEMENTS South Sudan Ministry of Health Pool Fund Health USAID/IOM Rapid Response UNOCHA – South Sudan Fund UNICEF GAVI Health Cluster partners GTFCC – Global Taskforce on Cholera Control WHO Thank you.
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