Republic of South Sudan Cholera in Juba, Central Equatoria State, Republic of South Sudan Situation Report # 4 as at 23:59 Hours, 25 June 2015 Situation Update As of 25 June 2015, a total of 268 cholera cases including 20 deaths (CFR 7.5%) have been reported from 55 villages in eight payams of Juba County (Table 1). The initial cases were traced back to 18 May 2015 in UN House PoC, which has reported the majority of the cases followed by New site, Gumbo, Kor William, Mangatain, Gudele 1 and Munuki. Table 1. Summary of cholera cases reported in Juba County, 18 May – 25 June 2015 Reporting Sites New New New Total cases LAMA* Total Total Total Total cases Total cases admisions discharges deaths currently facility community deaths discharged admitted deaths deaths UN House PoC clinic 1 0 0 6 0 0 1 1 18 27 Hai Referendum IDP clinic 0 0 0 0 0 0 1 1 0 1 Juba Teaching Hospital 24 14 1 62 28 8 2 10 121 222 Al Sabah Hospital 0 0 0 0 0 2 0 2 2 4 Morobo 2 clinic 0 0 0 0 0 0 1 1 3 4 Nyakuron PHCC 0 0 0 0 0 0 1 1 0 1 Juba Military Hospital 0 0 0 0 0 0 0 0 5 5 Luri Military 0 0 0 0 0 0 1 1 0 1 St. Kizito clinic 0 0 0 0 0 0 2 2 0 2 Mauna Medical clinic 0 0 0 0 0 0 1 1 0 1 Total 25 14 1 68 28 10 10 20 149 268 *LAMA: LEAVE AGAINST MEDICAL ADVICE Epidemiological updates A total of 25 new cholera cases and one new death were reported in Juba on 25 June 2015. o Juba Teaching Hospital reported 24 new cases and one new death o UN House PoC clinic reported one new case o Most of the new cases were reported from Gudele 2, Tongping, Lologo, Gudele 1 and Kor William (Figure 1) o Gondokoro becomes the eighth payam in Juba to report cholera cases o Five new villages including Juba Prison, Hai Seminar, Lemon Gabah, Jezira, Juba Nabari and Hai Tharawa reported cholera cases for the first time thus raising the number of affected villages in Juba to 55. Figure 1: New cholera cases by residence on 25 June 2015 5 s e 4 s a c f 3 o r e 2 4 b 3 m 1 2 2 2 u 1 1 1 1 1 1 1 1 1 1 1 1 N 0 i t a o 1 2 h 3 r r g a e n o m m a r n g a a t a i i n b e e C o b a i u b i z l l o i b n b s s a u l l o i a d i e e e p i a t m J a r J o P n g G d d a u m w G L N P e W n g u u 3 e e r G n a r a o n S G G e a N o b T o a b f i b u e a K u m u J M J R J H e i L a H Juba Kator Munuki Northern Bari Rejaf Gondokoro 1 Cumulatively, 268 cholera cases including 20 deaths (10 facility and 10 community) have been reported since the initial case was reported in Juba on 26 May 2015 (Tables 1 and 2). Table 2: New cholera cases by facility and week in Juba, 18 May – 25 June 2015 New cases by epidemiological week of 2015 Reporting Facility 21 22 23 24 25 26 Grand Total Al Sabah hospital 4 4 Hai referendum IDP clinic 1 1 JTH 2 2 32 119 67 222 Juba 3 IMC clinic 4 4 9 5 5 27 Juba Military hospital 5 5 Morobo 2 clinic 1 3 4 Nyakuron PHCC 1 1 Luri Military 1 1 St. Kizito clinic 2 2 Mauna Medical Clinic 1 1 Grand Total 4 2 7 56 127 72 268 As seen from Figure 2, the initial and isolated cases were reported from UN House PoC starting on 26 May 2015. However, following epidemiological investigations on 27 May 2015, cases could be traced back to 18 May 2015. Cholera was eventually confirmed on 1 June 2015 after Vibrio cholerae inaba was isolated from the one of five samples tested in the National Public Health Laboratory. Since 6 June 2015, sustained and consistently increasing community transmission has been established with increasingly more suspect cases reported outside UN House PoC. There are three discernable transmission peaks with the initial peak of 15 cases occurring on 13 June 2015 while the subsequent and higher peaks occurred on 20 June and 24 June with 26 and 38 cases respectively (Figure 1). Figure 2: Epidemic curve for suspect cholera cases in Juba, 18 May – 25 June 2015 40 Investigation adn Confirmation 35 of initial case in UN house PoC 30 Confirmation of initial case in UN house Poc 25 20 Number Number of cases 15 10 5 0 6/2/15 6/4/15 6/6/15 6/8/15 5/15/15 5/17/15 5/19/15 5/21/15 5/23/15 5/25/15 5/27/15 5/29/15 5/31/15 6/10/15 6/12/15 6/14/15 6/16/15 6/18/15 6/20/15 6/22/15 6/24/15 6/26/15 Date of onset Alive Died The majority of suspect cholera cases in Juba have been reported from Juba 3 IDP, New site, Gumbo, Kor William, Mangatain, Gudele 1 and Munuki (Figure 3). 2 while 223 (86 while 223 260 the of Out Figure Juba. outside counties other to spread and in Juba escalation further prevent to required therefore educ health and prevention mobilization social of form the in interventions Intensive p Gumbo 25 of As 3 Figure ayams Number of cases 1 1 2 2 3 G 0 5 0 5 0 5 0 , 4 :mapsuspect for cases Spot cholera b o and 55 and Kor William : n d June 2015, the sites reporting the majority the reporting sites the 2015, June C 1 o , improving access to safe to access improving , k Jezira holera cases by residence by cases holera o 2 r o %) were individuals five years and above ( above andyears five individuals were %) Hai Jalaba Juba 7 7 suspect Tongping County. Juba in villages Korobou 1 3 Hai Amarat 1 Gudele , Mangatain, J 3 u b Gabat a Nimra Talata 1 cholera Buluk 2 Hai Zendia 1 Game 2 1 J u Makas Sabab b 1 a cases with known age, 37 (14 37 age, known with cases Juba Prison N 3 a Juba Nabari b 2 a r Hai Kos i Kator 7 9 Lologo use latrine water, drinking K in Juba, in 1 a t Malakia o 7 r Giada Munuki and Suk Sita 1 y in Juba, residence Atlabara 4 Konyokonyo 2 5 Nyakuron West May 18 1 Munuki 3 Gudele 7 5 ( of cases of F Mauna F 3 igure 5 igure 4 igure Jopa – 2 Luri 25 M 2 u Jebel Kujur 4 n u Gurei 2015 June k 4 %) were %) ). i Nyakuron di cases satellite are There ). 1 in Juba include UN House PoC, New s New PoC, House UN include Juba in 18 18 May Gudele 1 3 and Dar es Salam 3 Hai Kuwait 1 1 Hai Tharawa food and personal good 1 – children less t less children Mia sava 1 25 Hai Seminar ation 2 7 New site June2015 Suk Zande 1 1 N Walawalak and presentation cholera on o 2 r t Bilpam 1 h 4 e r Mangatain IDP n 2 B Gorom 1 a 3 han five years of age, of years five han r i Gudele 2 Hai Referendum 4 Lemon Gabah 1 1 Juba Nabari eight in stributed 2 Juba 3 IDP 8 2 Gumbo 0 1 hygiene are hygiene R suk Jebel 1 e 5 j a Kor Wiliam f Checkpoint 1 Digala 1 1 L o Mijiki k 1 ite, i l i Lokiliri r i 3 Figure 5: Suspect case distribution by age in Juba, 18 May – 25 June 2015 14% <5yrs 5+yrs 86% Out of the 260 cholera cases with known gender, 109 (42%) were female, while 151 (58%) were male (Table 3). Table 3: Case distribution by gender and age in Juba, 18 May – 25 June 2015 Gender and age N (%) Female 109 (42) <5yrs 12 5+yrs 97 Male 151 (58) <5yrs 25 5+yrs 126 Grand Total 260 (100) The probable risk factors identified include: residing in a crowded IDP camp with poor sanitation and hygiene; using untreated water from the Water tankers; lack of household chlorination of drinking water; eating food from unregulated roadside food vendors or makeshift markets; and open defecation/poor latrine use. Laboratory updates Table 4: Cholera laboratory test results for Juba, 18 May – 25 June 2015 Health Facility Number of sample Number of cholera Number of cholera collected RDT positives Culture positives 1 Al Saba hospital 2 0 2 2 Juba Teaching Hospital 40 27 7 3 Juba 3 PoC clinic 22 20 9 4 Juba Military Hospital 3 2 2 5 Morobo 2 clinic 2 2 1 Total 69 51 21 A total of 69 stool samples have been collected from suspect cholera cases in Juba and submitted to the National Public Health Laboratory for testing (test results by facility shown in Table 4).