Republic of South Sudan Cholera in South Sudan Situation Report # 95 as at 23:59 Hours, 29 September to 5 October 2014 Situation Update As of 5 October 2014, a total of 6,139 cholera cases including 139 deaths (CFR 2%) had been reportedTable 1. Summary in South of Suda choleran as cases summarizedreported in in Juba Tables County 1 and, 23 2.April – 5 October 2014 New New New deaths Total cases Total Total admisions discharges Total Total cases Reporting Sites 29 Sept to currently facility community Total cases 29 Sept to 29 Sept to deaths discharged 5 Oct 2014 admitted deaths deaths 5 Oct 2014 5 Oct 2014 JTH CTC 0 0 0 0 16 0 16 1466 1482 Gurei CTC (changed to ORP) Closed 28 July 2 0 2 365 367 Tongping CTC 0 2 1 3 69 72 Closed August Jube 3/UN House CTC Closed August 0 0 0 0 97 97 Nyakuron West CTC Closed 15 July 0 0 0 18 18 Gumbo CTC Closed 5 July 0 0 0 48 48 Nyakuron ORP Closed 5 July 0 0 0 20 20 Munuki ORP Closed 5 July 0 0 0 8 8 Gumbo ORP Closed 15 July 0 3 3 67 70 Pager PHCU 0 0 0 0 1 5 6 42 48 Other sites 0 0 0 1 15 16 1 17 Total 0 0 0 0 22 24 46 2201 2247 N.B. To prevent double counting of patients, transferred cases from ORPs to CTCs are not counted in the ORPs. Table 2: Summary of cholera cases reported outside Juba County, 23 April – 5 October 2014 New New New Total cases Total Total admisions discharges deaths Total Total cases Total States Reporting Sites currently facility community 29 Sept to 29 Sept to 29 Sep to deaths discharged cases admitted deaths deaths 5 Oct 2014 5 Oct 2014 5 Oct 14 Kajo-Keji civil hospital 0 0 0 0 3 4 7 86 93 CES Yei Hospital -- 0 0 0 0 2 2 45 47 WES Lanyi- Mundri East -- 0 0 0 0 0 0 3 3 Jonglei Kolmanyang, Bor -- 0 0 0 0 0 0 1 1 Nimule Hospital 0 0 0 0 0 0 0 106 106 OTC PHCC, Magwi -- 0 0 0 10 0 10 141 151 Magwi PHCC 0 0 0 0 1 0 1 12 18 Pajok PHCC, Magwi -- 0 0 0 0 0 0 1 1 Nyolo CTC, Magwi 0 0 0 0 0 0 0 25 25 Idali PHCU, Lafon -- 0 0 0 5 1 6 90 96 Lwala PHCU, Pachidi -- 0 0 0 0 1 1 1 2 payam, Lafon Longiro PHCU,Lafon -- 0 0 0 1 0 1 15 16 Lalanga PHCU, Lafon 0 0 0 0 0 2 2 63 65 EES Torit Hospital 0 0 0 0 8 9 17 1407 1424 Bur Mutram PHCU, -- 0 0 0 0 1 1 59 60 Bur Payam, Torit Ohiri PHCC, Bur -- 0 0 0 3 0 3 53 56 Payam, Torit Ohila PHCC, Bur -- 0 0 0 0 0 0 24 24 Payam, Torit Imurok PHCU, Imurok -- 0 0 0 2 1 3 10 13 Payam, Torit Hiyala PHCC, Torit -- 0 0 0 0 0 0 86 86 Olere PHCU, Imurok -- 0 0 0 0 0 0 4 4 Payam, Torit Osito PHCU, Bur -- 0 0 0 0 0 0 42 42 payam, Torit 1 New New New Total cases Total Total admisions discharges deaths Total Total cases Total States Reporting Sites currently facility community 29 Sept to 29 Sept to 29 Sep to deaths discharged cases admitted deaths deaths 5 Oct 2014 5 Oct 2014 5 Oct 14 Ileu PHCU, Hiyala -- 0 0 0 3 7 10 147 157 payam, Torit Hileu PHCC, Himodonge Payam, -- 0 0 0 0 0 0 6 6 Torit Ofiri PHCU, Kudo -- 0 0 0 0 0 0 5 5 Payam, Torit Kudo PHCC, Kudo -- 0 0 0 1 0 1 54 55 Payam, Torit Moti PHCU, Ifwotu, -- 0 0 0 0 1 1 4 7 Torit Riwoto PHCC, Kapoeta 1 3 0 0 1 0 1 82 83 North SSRCORPs, Nyong -- 0 0 0 0 0 0 70 70 Payam, Torit St. Theresa, Isohe, 0 0 0 0 2 2 4 93 102 Ikotos Ibahure PHCC, ibahure 0 0 0 1 0 1 23 25 Payam, Lopa/Lafon Other sites -- 0 0 0 0 0 0 23 24 Kaka -- 0 0 0 0 0 0 0 1 Wau Shilluk, Malakal -- 0 0 0 15 2 17 885 906 Upper Nile Malakal PoC -- 0 0 0 2 0 2 59 61 Other sites -- 0 0 0 2 0 2 55 57 Total 1 3 0 0 60 33 93 3780 3892 x: Facilities not reporting; -- no cases reported for at least two weeks Figure 1: South Sudan Cholera Epidemic Curve, week 17- 40, 2014 1200 1000 800 600 Number Number of Cases 400 200 0 15 17 19 21 23 Epidemiological25 27 29 week 201431 33 35 37 39 WES UNS EES CES Figure 2: Cholera Case Distribution by Age, Sex and State – week 40 4.5 4 3.5 3 2 2.5 2 2 1.5 1 Number Number of cases 1 2 0.5 1 1 0 0 CES EES CES EES <5yrs ≥5YRS Female Male 2 Figure 3: New Cholera Cases in Juba County during week 40, 2014 3 2 1 1 1 1 Number Number of cases Lologo Munuki Sirikat 0 Kator Munuki Rejaf Figure 4: New Cholera Cases in Kapoeta North County during week 40, 2014 3 2 4 1 Numbber Numbber of cases 1 0 Naskal Natir Najie (Naskal) Lomeyen Surveillance and laboratory Sporadic cholera cases continue to be reported in Eastern Equatoria state. During week 40, Riwoto PHCC reported only one new case from Naskal village, Najie Payam in Kapoeta North County, Eastern Equatoria State. There were no new cholera cases reported from the rest of the counties in week 40. As seen from Figure 1, the cholera trend is on the decline in all the five states where cholera has been confirmed. No new culture positive cases reported during week 40. Overall, 187 (43.4%) of the samples tested have been positive for cholera by culture. Due to the declining cholera trend, it is recommended that all new suspect cholera cases have samples obtained for laboratory confirmation. Case management Management of new cholera cases is ongoing in Riwoto PHCC in Kapoeta North where only one new case was reported during week 40. Adequate supplies have been availed to support case management activities in the cholera treatment centres where the cases are being treated. Social mobilization Social Mobilization efforts and response efforts are ongoing in the states of Central and Eastern Equatoria, Jonglei and Upper Nile where cases of Acute Watery Diarrhea (AWD) and cholera are still being reported in some areas. At national level, UNICEF, the Ministry of Health and WHO are working on the National Cholera Communication and Social Mobilization framework. 3 To date 175,863 households and 212 schools have been reached with cholera prevention and control messages. Community skills in the areas of safe drinking water and rehydration through oral rehydration salts (ORS) and sugar salt solution (SSS) are being improved with the help 1,254 social mobilizers. In Central Equatoria State, a meeting with six chiefs from three bomas in Kelang Paya and Gadiang was conducted and they were sensitized on the role they can play in cholera prevention. In Eastern Equatoria State, Caritas-Switzerland is implementing house-to-house community mobilization activities and promoting cholera prevention and control practices in Lafayo village, Ikwoto County. Talk shows on cholera every Tuesday and Friday are being aired on the state-owned radio station 97.5 FM. In Jonglei State, a video play on cholera awareness was performed at Pariak - 40 kms south of Bor. Cholera prevention messages are being disseminated regularly in churches and through meetings with community leaders. Radio Jonglei FM 95.9 continues to broadcast cholera control radio spot messages six times a day after every program. The messages reach listeners within Bor County. WASH WASH efforts and responses are ongoing in Central and Eastern Equatoria states where some AWD and cholera cases are still being reported in some areas. Partners are evaluating the security situation in Kapoeta North County to mobilize a WASH team following the new cases reported in Riwoto. Central Equatoria State: Interventions by WASH partners in Lobonok County are on-going and include: Targeted distribution of hygiene kits composed of filter cloth, soap, bucket, PuR and Aquatabs. Cholera awareness campaigns are ongoing in all the villages. Provision of community support for latrine construction. Monitoring of water quality in the community and at health facilities. Eastern Equatoria State: In Torit County, house to house hygiene promotion still on-going to raise awareness among the community in terms of water handling and hand-washing at the critical times. Hygiene promotion through a weekly radio talk show is ongoing to reinforce house to house hygiene promotion. Safe water supply through the water treatment units and repair of hand pumps is ongoing. In Magwi County, 15 hand pumps have been repaired in communities that recorded high cases of cholera (two in Obbo , four in Nyolo , two Magwi and seven in Nimule). Ten water committees comprised of 10 members with 50% representation of women have been reconstituted. Rehabilitated the Magwi PHCC with all worn out taps replaced, drainage channel reopened and new soak pit to the reservoirs were dug to drain off waste water. Basic protective gear (gumboots, hand brushes, detergents, and receivers, steel wool, and 20 liters buckets) were provided and the tanks were cleaned for the first time since their construction in 2009.