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Republic of South Sudan Republic of South Sudan CHOLERA RESPONSE UPDATES AS OF 12-August-2017 Coordination of cholera response Overall coordination of the cholera response at the national level is coordinated by the National cholera taskforce that meets weekly on Wednesdays from 2pm in the WHO conference hall in Juba. In addition, the cholera coordination meeting in Juba Teaching hospital convenes on Monday starting 11am and Friday starting 9am in the Postgraduate School. At the sub-national level, cholera taskforce committees are coordinating the cholera response in Yirol East and Yirol West, Nyirol, Uror, Tonj East, Kapoeta South, Kapoeta North, and Kapoeta East. Other non-affected states have also initiated cholera preparedness meetings in Aweil, Torit, Wau, Yambio, and Rumbek. Across the border in Sudan, the week 27, 2017 joint situation report by the Federal Ministry of Health and WHO showed that 15 out of the 18 states have been affected by acute watery diarrhoea with active transmission reported in Kassala, Blue Nile, River Nile, Gezira, Senar, Khartoum, Gedarif, Northern, White Nile, South Kordofan, North Kordofan, West Kordofan, North Darfur and East Darfur. All the states bordering South Sudan are affected. This therefore calls for enhanced preparedness in Renk, Western Bank of the Nile, Pariang, Abiemnhom, Abyei, Aweil East, Aweil North, and Raja counties. To enhance cross-border surveillance and response, cross-border meetings are planned starting with the South Sudan, Uganda, and Kenya meeting that is planned for next month in Nimule. Surveillance and case management updates New cholera alerts Berteth County (formerly Pibor): In Maruwa (Boma Payam), 17 people reported dead of suspected cholera between 7th and 9th August, 2017. WHO is working with the field teams and also in collaboration with MSF to conduct an assessment of the situation in the area. Raja County: In Katta, several people reported of severe dehydration and vomiting in the past week. An assessment team from Raja Project and ALIMA deployed to conduct investigation failed to reach the area because of insecurity on the road leading to Katta. The CHD and health partners in the area are planning for another deployment to the area. Akobo West County: In Wechjal and Boung, eight (8) suspect cholera cases were reported between 5th and 10th August. Nile Hope with support from WHO is conducting investigation and assessment of the situation. General cholera trends There is a general declining trends in cholera cases in the country over the past three weeks. The number of counties with active transmission remains at 10 namely; Kapoeta South, Kapoeta East, Kapoeta North, Tonj East, Yirol East, Yirol East, Nyirol, Ayod, Duk and Juba. However, Kapoeta South reported an increase in cases over the week with Kapoeta town reporting more cases. Similar declining trend is being reported in the Tonj East with transmission reported to have plummeted in Paweng and Makuach. However, a new hotspot has emerged in Marial lou, in Tonj North where suspect cholera cases have been reported. A cholera treatment unit has been established to manage cases. Low level transmission continues to be reported in Yirol East and Yirol West; in Uror (Pieri), and Nyirol (Lankien). In Juba, transmission in Don Bosco IDP camp is controlled following the first round of oral cholera vaccination from 3rd to 6th July 2017. Sporadic transmission continues from widespread areas including Gondokoro, Shirkat, Lologo, Gudele 2, Rock City, Kor William, and Nyakuron. Cholera response updates and field missions At least 50 cholera treatment facilities including cholera treatment centers and units; and oral rehydration points are currently operational in the areas with active cholera transmission. In Juba, HLSS has been supported by Unicef to establish 9 ORP sites in Al Sabbah hospital; Gurei; Kator; Lologo; Gumbo; Don Bosco, Kor Woliang, Nesitu, and Nyakuron. In Tonj East, there are currently seven (7) cholera treatment facilities (4-CTUs and 3-ORPs) The four CTUs are located in Makuac, Mapara, Paweng and Paliang payams while the ORPs are in Ager bac, Aliet and Aper num. Four more ORPs are proposed to be sited at Marial Lou where cholera has been confirmed, Wunbol, Gol guk and Pagour. One more CTU has been established in response to the case upsurge in Marial Lou. A total of 15 cholera treatment facilities have been set up in Kapoeta state, with Kapoeta South having 1CTC, 1CTU, and 1 ORP; Kapoeta East having 3CTUs and 3 ORPs; and Kapoeta North having 1 CTC and 5 ORPs. With support from UNICEF, a total of 16 cholera beds were delivered to Kapoeta State Hospital CTC (10 beds); Napotpot (3beds); and Narus (3beds). Due to the shortage of cholera kits, UNICEF is planning to deliver case management and WASH kits to support the cholera response activities in Kapoeta state. Tab.1: Cholera treatment facilities in highly active transmission counties Cholera treatment facilities by type Total State County CTC CTU ORP Kapoeta North 1 0 5 6 Kapoeta Kapoeta South 1 1 1 3 Kapoeta East 0 3 3 6 Tonj Tonj East 0 5 3 8 Jubek Juba 1 0 9 10 Total 3 9 21 33 Oral cholera vaccination Vaccination campaign in the four priority counties including Kapoeta North, Kapoeta South, Kapoeta East and Tonj East is now in a mop up stage. The vaccination campaign started on the 29th July, 2017 to the 4th August, 2017 in the Kapoeta state while in Tonj East the campaign started on the 5th August, 2017 and ended on the 12th August, 2017. A total of 500, 010 doses were deployed to cover a target of 500,000 people across the four counties. This brings the total OCV doses secured from ICG/GTFCC since the beginning of 2017 to 1,544,150. A total of 611,564 doses have been deployed during the first round and 161,321 doses deployed during the second round. Cholera cases have significantly reduced in areas, especially in sites where the OCV campaign have been conducted so far in 2017. Since the beginning of 2017, cholera vaccines have been deployed in Leer, Bor PoC, Malakal Town, Bentiu PoC, Mingkaman IDP settlement, Aburoc IDPs, Bentiu/Rubkona Town, Ayod (Pagil, Tar, Jiech, Karmun, Padek, and Kandak), Juba (Don Bosco IDPs), Kapoeta North, Kapoeta South, Kapoeta East and Tonj East and surrounding payams.( Ref. Tab.2) The next phase of the campaign will target the remaining four prioritized counties including Juba, Akobo/Uror, Lankien and Panyijiar with a target population of 395,940. An additional two million doses of oral cholera vaccines are required to mitigate the risk of cholera in high risk areas and to interrupt transmission in the areas with ongoing transmission. W.H.O is in the final stages of securing these additional doses to complement the ongoing cholera response. Table 2: Doses of Oral Cholera Vaccines deployed in 2017 by site Target First round Second round No Site pop. # vacc. %cov. # vacc. %cov. Drop Vacc. Dates Partner out 1 Leer 44,731 30,772 69 - - - 22-Feb-17 MedAir, WHO,UNICEF 2 Malakal Town 16,500 10,499 64 - - - 18-22 May MSF-E, WHO,UNICEF 3 Bor PoC 2,265 1,926 85 1,885 83 - 3-4 Apr/ HLSS, 26-29 Apr WHO,UNICEF 4 Mingkaman 111,278 68,512 62 42,296 38 - 12-26 May MedAir, 10-21 Jun WHO,UNICEF 5 Ayod Tar 19,400 15,649 81 - - - 9-22 May MedAir, WHO,UNICEF 6 Ayod Pagil 4,850 3,943 81 - - - 9-22 May MedAir, WHO,UNICEF 7 Bentiu PoC 112,924 72,514 64 77,603 69 - 5-10 May IOM, WHO, UNICEF 8 Rabkona &Bentiu 35,204 31,908 91 38,387 109 - 20-23 Jun IOM, WHO, town UNICEF 9 Aburoj IDPs 11,640 10,723 92 - - 20-22 May MSF-E, WHO,UNICEF Ayod (Jiech, 10 Karmun,Padek 15,000 11,140 74 - - - 22-25 Jun IOM, CMD, &Kandak) WHO, UNICEF MSF-H, 11 Juba Don Bosco IDPs 5,940 3,909 66 1150 19 - 3-6 Jul; 24- WHO,UNICEF 27 Jul WHO, 12 Tonj East 189,058 160,862 85 - - - 6-12 Aug UNICEF, IOM,CCM, THESO 13 Kapoeta North 141,520 44,438 31 - - - 29 Jul-4-Aug WHO, UNICEF, SCI 14 Kapoeta South 97,000 78,469 81 29 Jul-4-Aug WHO,UNICEF, ARC 15 Kapoeta East 97,000 66,300 68 29 Jul-4-Aug WHO, UNICEF, SCI Total doses deployed 2017 904,310 611,564 68 161,321 42 Fig.1: First Round OCV Vaccination Coverage in Four priority counties, 2017 Target Coverage % Coverage 1,000,000 90.0 85.1 350,069 900,000 80.9 80.0 800,000 70.0 68.4 66.7 700,000 60.0 600,000 50.0 500,000 40.0 Target/Coverage 400,000 160,862 % Coverage 31.4 30.0 300,000 44438 66,300 524,578 200,000 78,469 20.0 100,000 189,058 10.0 141,520 97,000 97,000 0 0.0 Kap-N Kap-S Kap-E Tonj-E Total Counties A total of 350,069 out of a target of 524,578 across the four counties were vaccinated, representing 67% of the target population vaccinated. Kapoeta South and Tonj East recorded slightly above 80%, that is, 80.9% and 84.7% respectively. Coverage for Kapoeta North was very low at just 31.4%. Partners will have to remobilize and also re-strategize and conduct a vigorous mop-up in the area. Similarly, Kapoeta East may have to also conduct mop-up exercise before the second round is rolled out. Kap= Kapoeta North, South, East and Tonj East Laboratory updates A total 662 samples of cholera have been tested of which 41.8% (277) have been confirmed positive for Vibrio cholerae.
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