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Republic of South Sudan Republic of South Sudan Situation Report #111 on Cholera in South Sudan As at 23:59 Hours, 10 March 2017 Situation Update A total of 14 counties in 9 (28%) of 32 states countrywide have confirmed cholera outbreaks (Table 1; Figure 1.0). During week 10 of 2017, a total of 13 samples from Bentiu PoC all tested negative for cholera (Table 3). Cumulatively, 187 (36.5 %) samples have tested positive for Vibrio Cholerae inaba in the National Public Health Laboratory as of 10 March 2017 (Table 3). Table 1: Summary of cholera cases reported in South Sudan as of 10 March 2017 New New Total cases Total New deaths Total facility Total cases Reporting Sites admissio discharges WK currently community Total deaths Total cases WK 10 deaths discharged ns WK 10 10 admitted deaths Jubek – Juba - - - - 8 19 27 2,018 2,045 Jonglei-Duk - - - - 3 5 8 92 100 Jonglei-Bor - - - 3 1 3 4 67 74 Terekeka - - - - - 8 8 14 22 Eastern Lakes - - - - 13 2 8 10 512 535 Awerial Eastern Lakes - 13 - - 10 10 21 31 301 342 Yirol East Imatong - Pageri - - - - - 1 1 28 29 Western Bieh - - - - - 4 - 4 266 270 Fangak Northern Liech - - - - - 7 2 9 1,150 1,159 Rubkona Southern Liech - - - - - 3 - 3 91 94 Leer Southern Liech - - - - - 18 4 22 466 488 Panyijiar Southern Liech - - - - - - 5 5 214 219 Mayendit Central Upper - - - 5 181 Nile - Pigi 5 176 Central Upper 2 - 12 - 16 Nile - Malakal 0 4 Total 15 - - 38 61 76 137 5,399 5,574 Highlights in week 10 of 2017: 1. A total of 15 new cholera cases reported from Yirol East (13 cases) and Malakal Town (2 cases) in week 10 of 2017 Table 3. 2. The cumulative cases in Malakal Town have risen to 16. The national cholera taskforce has approved emergency oral cholera vaccination for Malakal Town using a two-dose strategy. The target population for Malakal Town is estimated at 16,500 persons aged one year and above. MSF-E will lead the campaign in Malakal Town. 3. A total of 15 cases reported in week 10 compared to 75 cases in week 9 of 2017 Figure 1.1. 4. A stakeholder meeting was conducted in Juba from 8-9 March 2017 to develop a plan on rational use of oral cholera vaccines alongside other tools like WASH and social mobilization. The Meeting was organized by the 1 Ministry of Health and supported by WHO and the Global Taskforce for Cholera control with participants drawn from the National Cholera taskforce, Health and WASH clusters, and the Ministry of Water. 5. During the week, the International Coordinating Group (ICG) for oral cholera vaccines approved at total of 475,020 doses of oral cholera vaccines that will be used to conduct two-dose campaigns in Bentiu PoC, Mingkaman IDP settlement, and Bor PoC. The vaccines are expected to arrive in Juba on 15 March 2017. Figure 1.0: Cholera incidence (cases per 10,000) and case fatality rate (%) as of 10 March 2017 Figure 1.1: New cholera cases admitted by location in week 9 and 10 of 2017 60 52 week 9 week 10 40 20 13 Number of Cases 10 6 7 1 2 0 Awerial Yirol East Bor South Rubkona Malakal Eastern Lakes Jonglei Northern Liech Central Upper Nile The transmission in Mingkaman, Bor, Northern and Southern Liech has declined significantly Figure 2.1. 2 Figure 1.2: Cumulative cholera cases by state and county of residence as at 10 March 2017 6000 5574 5000 4000 3000 2045 Number of Cases 2000 1159 1000 488 535 342 270 219 181 22 94 74 100 29 16 0 FANGAK Terekeka Leer MayenditPanyijiar Rubkona Juba Bor South Duk Pageri Awerial Yirol EastPigi- canalMalakal 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 10 March 2017 Week 10 Weeks 24, 2016 to 10 of 2017 New cases Cases per Population W10 10,000 No. Cases per 10,000 State County at risk population cases population CFR [%] Western Bieh Fangak 168,947 0 - 270 16.0 1.48 Northern Liech Rubkona 126,976 0 - 1159 91.3 0.78 Southern Liech Leer 95,731 0 - 94 9.8 3.19 Southern Liech Panyijiar 78,020 0 - 488 62.5 4.51 Southern Liech Mayendit 97,127 0 - 219 22.5 2.28 Eastern Lakes AweriaL 114,837 0 - 535 46.6 1.87 Eastern Lakes YiroL East 104,694 13 1.24 342 32.7 9.06 Imatong Pageri 215,130 0 - 29 1.3 3.45 JongLei Bor South 331,611 0 - 74 2.2 5.41 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 2 0.09 16 0.7 0 Total 2,584,491 15 0.06 5,574 21.6 2.46 Cumulatively, 5,574 cholera cases including 137 deaths (61 facilities and 76 community) (CFR 2.46%) 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 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). 3 Figure 2:1 Epidemic curve for cholera cases in South Sudan, from 18 June - 10 March 2017 350 25 300 21.05 20 250 16.92 15 200 CFR [%] Number of cases 150 10 100 6.67 6.91 6.58 5.95 5.11 5 4.48 50 3.33 3.33 3.49 2.75 2.42 2.30 2.05 1.85 2.26 2.00 1.76 2.24 1.42 1.55 1.35 1.27 0.62 0.86 0.42 0.76 0.75 0.82 0.63 0.57 0.79 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 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 10 March 2017 Cholera case gender distributionby IDP site wk 27 of 2016 to week 10 of 2107 100% 90% 35 37 41 80% 44 42 50 48 50 53 50 54 57 57 55 70% 60% 81 50% e itiuin % Sex distribution 40% 65 63 59 30% 56 58 50 52 50 47 50 46 43 43 45 20% 10% 19 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 have been affected 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 10 March 2017 CholerA cAse Age distributionby IDP site wk 27 of 2016 to week 10 of 2017 25 22.8 20 15.6 15 11.0 10 8.5 7.7 7.6 g itiuin % Age distribution 7.1 5.5 5 3.9 2.9 1.8 1.4 1.7 1.7 0.7 0 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 10 March 2017 Cholera case age distributionby IDP site wk 27 of 2016 to week 10 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. Other factors 1. Due to the protracted nature of the crisis since 2013, there has been destruction of infrastructure and limited investments to improve social services to the general population as such, living conditions have deteriorated with declining access to safe water and sanitation amenities.
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