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SITREP#107 10Feb 2017Final Republic of South Sudan Situation Report #107 on Cholera in South Sudan As at 23:59 Hours, 10 February 2017 Situation Update A total of 12 counties in (28%) of 32 states countrywide have confirmed cholera outbreaks (Table 1; Figure 1.0). The most recent cases were confirmed in Bor South, Jonglei state on 9 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 6 of 2017, a total of 12 samples from Bor South, Fangak, and Bentiu PoC tested positive for cholera (Table 3). Cumulatively, 171 (37.3 %) samples have tested positive for Vibrio Cholerae inaba in the National Public Health Laboratory as of 10 February 2017 (Table 3). Table 1: Summary of cholera cases reported in South Sudan as of 10 February 2017 New New Total cases Total New deaths Total facility Total cases Reporting Sites admissions discharges currently community Total deaths Total cases WK 6 deaths discharged WK 6 WK 6 admitted deaths Jubek – Juba - - - - 8 19 27 2,018 2,045 Jonglei-Duk - - - - 3 5 8 84 92 Jonglei-Bor 7 4 - 10 1 3 4 9 23 Terekeka - - - - - 8 8 14 22 Eastern Lakes - 20 20 - 16 2 3 5 382 403 Awerial Imatong - Pageri - - - - - 1 1 28 29 Western Bieh - - - - - 4 - 4 266 270 Fangak Northern Liech - 3 3 - 5 7 2 9 1,128 1,142 Rubkona Southern Liech - - - - - 3 - 3 91 94 Leer Southern Liech - - - - - 15 4 19 424 443 Panyijiar Southern Liech - 6 6 - - - 4 4 197 201 Mayendit Central Upper 5 171 Nile - Pigi 5 166 Total 36 33 - 31 48 49 97 4,807 4,935 Highlights in week 6 of 2017: 1. A new cholera outbreak confirmed in Bor South thus raising the affected counties to 12 Table 1. 2. Investigations and response ongoing into the suspect cholera cases in Adior, Shambe, and Langmatot in Yirol East. Alerts also reported from Twic East and Duk in Jonglei Table 4. 3. A total of 12 cases confirmed from Bor South (4); Fangak (3); and Northern Liech (5) Table 3. 4. A total of 36 new cholera cases were reported from Bor South, Awerial, Rubkona, and Mayendit in week 6 of 2016 Table 1. 1 In Jubek, the resurgence of cases in UN House PoC where at least 43 cases including at least 10 confirmed cases have been reported since week 52 of 2016 is now contained following a multisectoral integrated response. Cholera risk assessment is underway to facilitate complementary vaccination using oral cholera vaccines. In Northern Liech state, at least 1,142 cholera cases including 31 confirmed cases and nine deaths (CFR 0.70%) 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 is underway to facilitate complementary vaccination using oral cholera vaccines. 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 443 cases including 19 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 201 suspect cholera cases including three deaths were reported by UNIDO and MedAir response teams in Mayendit. The MedAir CTU in Madol 1 has seen at least 81 cases aged 2 years and above since 7 January 2017. Cholera risk assessments are underway in Panyijiar and Mayendit to facilitate complementary vaccination of high-risk populations using oral cholera vaccines. Figure 1.0: Cholera incidence (cases per 10,000) and case fatality rate (%) as of 10 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 of 2017 30 20 20 Number of Cases 10 7 6 3 0 Awerial Bor South Rubkona Mayendit Eastern Lakes Jonglei Northern Liech Southern Liech In Eastern Lakes state, cholera cases were reported in Mingkaman IDP settlement. The initial cases were confirmed on 24 August 2016, after two of four samples tested postive for Vibrio cholerae Inaba. The cumulative cases are 403 cholera cases including 19 confirmed cases and 5 deaths (one facility and four community) (CFR 1.24 %). However; after a lull of two weeks with only sporadic transmission since 16 December 2016, new cases were reported from 1 January 2017 with a total of 53 new cases including at least one death 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 113 suspect cholera cases including 6 deaths in reported since 1 Feb. 2017 Table 4. Initial response in Yirol East is led by CUAMM and a MoH-WHO supported rapid response team. In Jonglei state, 92 suspected cholera cases including 8 deaths (CFR 8.7 %) 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. The most recent cases reported in Duk originated from Koyom Island on 10 Nov 2016. Figure 1.2: Cumulative cholera cases by payam of residence as at 10 February 2017 1200 1133 1000 800 645 600 Number of Cases 470 402 358 400 320 219 210 170 200 127 76 71 95 90 42 41 33 27 36 36 49 37 5 1 1 1 1 15 2 1 4 1 15 7 4 6 1 1 2 5 5 17 2 3 1 15 5 17 6 1 2 4 3 1 10 13 1 1 7 2 3 1 2 12 5 3 1 1 7 22 1 1 0 Kol Yai Gap Tiap NFG OFG Jalle Leer Nyal Leah Bhor Yang Rejaf Nyal Kuok Buko Jiech Kator Pariel TOCH katith Piliny Puluk Adok Lwoki Akuak Padiat fangak Thaker Anyidi Lokiliri kurwai NiMule Khaigai Maluak Pachak mayoM Dablual Uganda PAGUIR Munuki Nyarjwa Malkuer Thonyor Dhorbor Dhoryiel Madol 2 Madol 1 Terekeka Ganyliel Rubchay Pabuong Abuyung Mangalla Tutnyang Payinjiar Kolnyang Bor Town Dongchak mayiandit MAREANG Juba Town Pachienjok Gondokoro ThoarnhuM Bentiu PoC Bentiu Town KOLANYANG Northern Bari Matjang island Dhuorguol Deng Western Bieh Terekeka Southern Liech Northern Liech Jubek Jonglei Imatong Eastern Central Lakes Upper Nile However, on 30 January 2017, new suspect cholera cases were reported by Jalle Pagam PHCC in Bor South county where at least eight suspect cholera cases including four deaths (two community deaths) – were reported all from Kwei Islands. An initial verification and response mission was undertaken by Health and WASH partners on 31 January 2017. The MoH-led and WHO-supported rapid response is currently working 3 with the taskforce in Bor to support alert verification and response. A total of 23 cholera cases including four confirmed cases and four deaths (CFR 17.4%) have been reported in Bor South County. Terekeka state has reported 22 cases of cholera including 8 deaths (CFR 36.4%) with 2 samples confirmed by the laboratory to be cholera.
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