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SITREP#108 17Feb 2017Final Republic of South Sudan Situation Report #108 on Cholera in South Sudan As at 23:59 Hours, 17 February 2017 Situation Update A total of 12 counties in 9 (28%) of 32 states countrywide have confirmed cholera outbreaks (Table 1; Figure 1.0). The most recent cases were confirmed in Mingkaman, Eastern Lakes state on 13 February 2017. Suspect cholera cases are being investigated and responded to in Adior, Shambe, and Langmatot in Yirol East county; Panyagor in Twic East county; and Moldova in Duk county (Table 4). During week 7 of 2017, a total of 8 samples from Mingkaman in Eastern Lakes tested positive for cholera (Table 3). Cumulatively, 179 (37.8 %) samples have tested positive for Vibrio Cholerae inaba in the National Public Health Laboratory as of 17 February 2017 (Table 3). Table 1: Summary of cholera cases reported in South Sudan as of 17 February 2017 New New New Total cases Total Total Total Total cases Reporting Sites admissions discharges deaths WK currently facility community Total cases deaths discharged WK 7 WK 7 7 admitted deaths deaths Jubek – Juba - - - - 8 19 27 2,018 2,045 Jonglei-Duk - - - - 3 5 8 92 100 Jonglei-Bor 23 15 - 7 1 3 4 45 56 Terekeka - - - - - 8 8 14 22 Eastern Lakes - 32 42 - 14 2 8 10 450 474 Awerial Imatong - Pageri - - - - - 1 1 28 29 Western Bieh - - - - - 4 - 4 266 270 Fangak Northern Liech - - - - - 7 2 9 1,145 1,154 Rubkona Southern Liech - - - - - 3 - 3 91 94 Leer Southern Liech - - - - - 17 4 21 435 456 Panyijiar Southern Liech - 1 1 - - - 5 5 204 209 Mayendit Central Upper 5 176 Nile - Pigi 1 1 5 171 Total 57 59 - 21 50 55 105 4,959 5,085 Highlights in week 7 of 2017: 1. Eight cholera cases confirmed in Mingkaman where 32 new cases reported in the week Table 3. 2. An integrated response has been rolled out in Yirol East, Twic East, and Duk including the hard-to-reach populations on the Islands Table 4. 3. A total of 57 new cholera cases reported from Awerial, Bor South, Mayendit, and Pigi in week 7 Table 1. 1 In Northern Liech state, at least 1,154 cholera cases including 31 confirmed cases and nine deaths (CFR 0.78%) were 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. Ongoing transmission is associated with exposure to water from an unsecured water reservoir; continued arrival of new people in the PoC thus straining existing WASH amenities; continued new arrivals from cholera affected areas; and the fact that its more than two years since the last oral cholera vaccine campaigns. Bentiu PoC now has the highest cumulative incidence for cholera Table 1.1. Cholera risk assessment and vaccination microplanning have been finalized to facilitate complementary vaccination using oral cholera vaccines in Bentiu PoC. In Southern Liech, two cholera cases originating from Leer Town tested positive for Vibrio cholerae Inaba on 11 October 2016. One additional case from Ganyliel in Panyijiar tested positive for cholera on 3 January 2017; and on 31 January, two samples from Madol in Mayendit tested positive for cholera by culturing. Cumulatively, 94 cholera cases including three deaths have been line listed from Leer and at least 456 cases including 21 deaths from Panyijiar in Southern Liech state. The initial case in Panyijiar was seen on 22 October 2016 involving a trader from Duk. Facility and community based response is ongoing with most cases being managed in facilities like Duong PHCC, Ganyliel PHCC, and Nyal PHCC with support from IRC, and UNIDO. Since 7 October 2016, at least 209 cholera cases including five deaths were reported by UNIDO and MedAir response teams in Mayendit. The MedAir CTU in Madol 1 has seen at least 89 cases aged 2 years and above since 7 January 2017. Cholera risk assessment and microplanning have been finalized to facilitate complementary vaccination using oral cholera vaccines in Panyijiar and Mayendit. Figure 1.0: Cholera incidence (cases per 10,000) and case fatality rate (%) as of 17 February 2017 World Health Organization Cholera Fatality Density Map for cases per population and CFR Weeks 24, 2016 to 6 of 2017 Map Date: 11 February, 2017 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 0.70 2.92 1.48 Luakpiny/NasirMaiwut Aweil South Raga Gogrial East Koch Nyirol Ulang Aweil Centre Gogrial West Leer Tonj NorthMayendit Ayod 4.08 1.99 Ethiopia Tonj East Duk Panyijiar Uror Akobo Jur River Rumbek North 8.7 4.29 Wau Twic East Pochalla Central African Republic Tonj SouthCueibetRumbek Centre Yirol East Rumbek East Bor South Nagero Yirol West Awerial 17.39 Pibor Wulu Tambura 1.24 Mvolo Legend Terekeka xx Case fatality rate (CFR) 36.36 Counties with Cholera alert Mundri WestMundri East Lafon Kapoeta North Cases per 10,000 population Ezo Ibba Maridi Kapoeta East Juba > 60 Yambio Nzara 1.32 46 - 60 Kapoeta South 31 - 45 Torit Budi Yei Lainya 16 - 30 Magwi Ikotos 0.1 - 15 Kajo-Keji 3.45 Kenya No case reported Morobo Pageri River Democratic Republic of Congo Uganda 2 Figure 1.1: New cholera cases admitted by location in week 6 and 7 of 2017 60 56 50 40 32 week 6 week 7 30 23 20 17 13 13 Number of Cases 10 3 4 2 1 1 0 Awerial Duk Bor South Rubkona Panyijiar Mayendit Pigi- canal Eastern Lakes Jonglei Northern Liech Southern Liech Central Upper Nile In Eastern Lakes state, cholera cases were reported in Mingkaman IDP settlement and response for the suspect cases in Yirol East is ongoing. The initial cases in Mingkaman were confirmed on 24 August 2016, after two of four samples tested postive for Vibrio cholerae Inaba. The cumulative cases in Mingkaman are 474 cholera cases including 27 confirmed cases and 10 deaths (two facility and eight community) (CFR 2.11 %). However; after a lull of two weeks with only sporadic transmission since 16 December 2016, new cases were reported from 26 January 2017 with a total of 121 new cases including five deaths being reported since the beginning of 2017 (Fig 2.1). The new cases have been reported from informal settlemements in Mingkaman with inadequate no access to safe water and sanitation facilites. Current response is led by the CHD with support from CUAMM and HLSS. A MoH/WHO rapid response team was dispatched on 8 February 2017 with supplies to augment the response in Mingkaman. In Shambe, Yirol East, at least 187 suspect cholera cases including 16 deaths in reported since 1 Feb. 2017 Table 4. Initial response in Yirol East is led by the state MoH, the CHD, and CUAMM supported by WHO, UNICEF, Health and WASH cluster partners – IOM, MSF-B. In Jonglei state, 100 cholera cases including 8 deaths (CFR 8 %) were 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. Eight of the recent cholera cases in Bor hospital originated from Duk. A rapid response team dispatched with supplies to Duk on 19 Feb. 17. Figure 1.2: Cumulative cholera cases by state and county of residence as at 17 February 2017 2500 2045 2000 1500 1151 1000 Number of Cases 456 474 500 269 209 176 94 100 1 22 3 56 29 0 FANGAK Leer Terekeka Leer Mayendit Panyijiar Leer Rubkona Juba Bor South Duk PaGeri Awerial PiGi- canal Western Bieh Terekeka Southern Liech Northern Liech Jubek JonGlei ImatonG Eastern Lakes Central Upper N ile 3 In Bor South, the initial suspect cholera cases were reported on 30 January 2017 by Jalle Pagam PHCC. The initial cluster involved eight suspect cholera cases including four deaths (two community deaths) – all from Kuei Islands. An initial verification and response mission was undertaken by Health and WASH partners on 31 Jan. 2017. The MoH-led and WHO-supported rapid response is currently working with the taskforce in Bor to support alert verification and response. Cholera was eventually confirmed after four samples tested positive for Vibrio cholerae on 9 Feb. 17. A total of 56 cholera cases including four confirmed cases and four deaths (CFR 7.14%) have been reported in Bor South County. Table 1.1: Cholera cases and deaths by state and county as of 17 February 2017 Week 7 Weeks 24, 2016 to 7 of 2017 New Cases per Population cases 10,000 No. Cases per 10,000 State County at risk W7 population cases population CFR [%] Western Bieh Fangak 139,509 0 - 270 19.4 1.48 Northern Liech Rubkona 126,976 0 - 1154 90.9 0.78 Southern Liech Leer 67,167 0 - 94 14.0 3.19 Southern Liech Panyijiar 64,254 0 - 456 71.0 4.61 Southern Liech Mayendit 68,131 1 0.15 209 30.7 2.39 Eastern Lakes AweriaL 114,837 32 2.79 474 41.3 2.11 Imatong Pageri 215,130 0 - 29 1.3 3.45 JongLei Bor South 331,611 23 0.69 56 1.7 7.14 JongLei Duk 26,180 0 - 100 38.2 8 Jubek Juba 471,762 0 - 2,045 43.3 1.32 Terekeka Terekeka 177,849 0 - 22 1.2 36.36 CentraL Upper NiLe Pigi 125,496 1 0.08 176 14.0 2.84 Total 1,928,902 57 0.30 5,085 26.4 2.06 Cumulatively, 5,085 cholera cases including 105 deaths (50 facilities and 55 community) (CFR 2.06%) 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; 11 October 2016 for Leer and 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 state; 30 January 2017 for Bor South in Jonglei state (Figure 2.1 and Table 1.1).
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