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Republic of South Sudan
Situation Report #16 on Cholera in South Sudan
As at 23:59 Hours, 7 July 2015
Situation Update As of 7 July 2015, a total of 769 cholera cases
including 34 deaths have been reported in Juba County in Central
Equatoria and in Bor in Jonglei State. In Juba County 710 cases
including 33 deaths (CFR 4.6%) have been reported from 75 villages
in eight Payams. (Table 1). In Bor 59 cases including 1 death (CFR
1.7%) were reported from Malou (29 cases) and 16 cases from other
areas around Bor The initial cases in Juba were traced back to 18
May 2015 in UN House PoC where the first cholera case was confirmed
on 1 June 2015. Most of the cholera cases in Juba have been
reported from New site followed by Gudele 2, Juba 3 PoC, Gumbo, and
Gudele 1 (Figure 4).
Table 1. Summary of cholera cases reported in Juba County, 18
May – 7
th July 2015
Reporting Sites New admisions
New discharges
New deaths
Total cases currently admitted
LAMA* Total facility deaths
Total community
deaths
Total deaths
Total cases discharged
Total cases
IMC UN House PoC clinic 0 0 0 3 0 0 1 1 35 42
Hai Referendum IDP clinic 0 0 0 0 0 0 1 1 0 1
Juba Teaching Hospital 23 20 0 122 89 17 5 22 357 613
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
Juba Prison 0 0 0 0 0 0 1 1 0 1
MedAir Gumbo ORP 3 0 0 2 0 0 0 0 17 19
Gorom PHCC 0 0 0 1 0 0 0 0 6 7
Gudele ORP 1 1 0 0 0 0 0 0 2 2
Nyakuron ORP 1 0 0 0 0 0 0 0 4 4
Kator ORP 0 0 0 0 0 0 0 0 3 3
Total 28 21 0 128 89 19 14 33 434 710
*LAMA: LEAVE AGAINST MEDICAL ADVICE
A total of 28 new cholera cases were reported in Juba on 7 July
2015. In Bor 6 new cases were reported on 6 July and 2 cases on 7
July 2015
o Juba Teaching Hospital reported 23 new cases while Gumbo ORP
reported 3 new cases and Gudele and Nyakuron ORPs reported 1 new
case each.
o Most new cases on 7 July 2015 in Juba originated from Gumbo,
Gurei, Rock City, Munuki and Giada (Figure 1).
o Two new cases were reported by Gudele and Nyakuron ORPs .
Figure 1: New cholera cases in Juba County by residence on
7th
July 2015
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Cumulatively, 710 cholera cases including 33 deaths (19
facilities and 14 communities) have been reported since the initial
case was reported in Juba on 26 May 2015 (Tables 1 and 2). Of the
33deaths, 7 (21%) have occurred in children under five years. The
age-specific CFR among children under five years of age is 9.5%,
which is higher when compared to the age-specific CFR of 5.5% among
cases aged five years and above.
Table 2: New cholera cases by facility and week in Juba, 18 May
– 7
th July 2015
Reporting Facility
New cases by epidemiological week of 2015
Grand Total 21 22 23 24 25 26 27 28
Al Sabah hospital 0 0 0 4 0 0 0 0 4
Hai referendum IDP clinic 0 0 0 1 0 0 0 0 1
JTH 0 2 2 32 119 212 208 38 613
IMC UN House PoC clinic 4 0 4 9 6 13 6 0 42
Juba Military hospital 0 0 0 5 0 0 0 0 5
Morobo 2 clinic 0 0 1 3 0 0 0 0 4
Nyakuron PHCC 0 0 0 1 0 0 0 0 1
Luri Military 0 0 0 1 0 0 0 0 1
St. Kizito clinic 0 0 0 0 2 0 0 0 2
Mauna Medical Clinic 0 0 0 0 1 0 0 0 1
Juba Prison 0 0 0 0 0 1 0 0 1
MedAir Gumbo ORP 0 0 0 0 0 9 10 0 19
Gorom PHCC 0 0 0 0 3 3 1 0 7
GUDELE ORP 0 0 0 0 0 0 0 2 2
NYAKURON ORP 0 0 0 0 0 0 2 2 4
KATOR ORP 0 0 0 0 0 0 0 3 3
Grand Total 4 2 7 56 131 238 227 45 710
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 discernible transmission peaks with the initial
peak of 15 cases occurring on 13 June 2015 while the subsequent and
higher peaks occurred on 20 June, 26 June, and 28 June with 26, 49,
and 54 cases respectively (Figure 2). Figure 2: Epidemic curve for
suspect cholera cases in Juba, 18 May – 7
th July 2015
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The probable risk factors fueling transmission 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. Figure 3: Spot map for suspect cholera
cases by residence in Juba, 18 May – 7 July 2015
As of 7 July 2015, the sites reporting the majority of cases in
Juba include New site, Gudele 2, Juba 3 IDP, Gumbo, and Gudele 1.
Nonetheless, there are satellite cases distributed in eight Payams
and 75 villages in Juba County (Figure 3 and 4).
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Confirmation of initial case in UN house Poc
Investigation and confirmation of initial case in UN house
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Figure 4: Cholera cases by residence in Juba, 18 May – 7th
July 2015
Out of the 692 suspect cholera cases with known age, 88 (13%)
were children less than five years of age, while 604 (87%) were
individuals five years and above (Figure 5).
Figure 5: Suspect case distribution by age in Juba, 18 May –
7
th July 2015
Out of the 692 cholera cases with known gender, 206 (40%) were
female, while 306 (60%) were male (Table 3). Table 3: Case
distribution by gender and age in Juba, 18 May – 7
th July 2015
Gender and age N (%)
Female 279 (40)
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Laboratory updates Table 4: Cholera laboratory test results for
Juba, 18 May – 30
th June 2015
Health Facility Number of RDT tests
Number of cholera RDT positives
Number of stool cultures
Number of cholera Culture positives
1 Al Sabah hospital 2 0 2 2
2 Juba Teaching Hospital 46 33 44 17
3 Juba 3 PoC clinic 29 26 22 11
4 Juba Military Hospital 3 2 3 2
5 Morobo 2 clinic 2 2 2 1
6 Gorom PHCC 2 2 2 0
Total 84 65 75 33
As seen from table 4, 65 (77%) of the samples have been RDT
positive while 33 (44%) have been confirmed by culture after Vibrio
cholerae inaba was isolated by the National Public Health
Laboratory. Most of the culture confirmed cases have been reported
from Juba 3 PoC and New site (Figure 6). The last laboratory
results for cases in Juba County were reported on 30
th June 2015.
Figure 6: Number of culture positives by residence in Juba, 18
May – 30 June 2015
Table 5: Cholera Alerts – 23 to 6
th July 2015
Date of notification
Details of the alert Area Action
5-July-15 1 case in Warrap, Kuajok State Hospital, 5 July 2015,
elderly man initially seen in a private facility; profuse diarrhea
&vomiting and severe dehydration; no travel history; positive
RDT;
Case being managed in Kuajok State Hospital. Stool specimen sent
to Juba. Investigations on-going
1-July-15 Four acute watery diarrhoea cases including one death
reported from Bele village in Bungu Payam, Juba
Bele village, Bungu Payam, Juba
- Four acute watery diarrhoea cases including one death reported
from Bele village
- Initial cases in this cluster developed severe diarrhoea at a
funeral in Bele village and were rushed to Juba for treatment
- One death occurred in the night of 1 July 2015 and was buried
on 2 July 2015.
- Cluster verified by the county rapid response team -
30-Jun-15 Kabigiri PHCC in Wonduruba Payam in Juba County
admitted four acute watery diarrhoea cases on 30 June 2015
Kabigiri PHCC, Wonduruba PHCC
- The four cases are admitted in Kabigiri PHCC - Initial case
traveled from Juba on 28 June 2015 - Four samples collected and
shipped to Juba - Case management ongoing
27-Jun-15 Community death following acute watery diarrhoea was
reported in Juba Prison
Juba Prison - Case verification and supervised burial conducted
by the state rapid response team
26-Jun-15 Nineteen suspect cholera cases reported in Kajo Keji
ivil hospital
Kajo Keji, CES
- A total of 19 acute watery diarrhoea cases have been line
listed with eight cases on admission at the hospital
- Ten samples shipped to Juba for culture and sensitivity.
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Date of notification
Details of the alert Area Action
5-July-15 1 case in Warrap, Kuajok State Hospital, 5 July 2015,
elderly man initially seen in a private facility; profuse diarrhea
&vomiting and severe dehydration; no travel history; positive
RDT;
Case being managed in Kuajok State Hospital. Stool specimen sent
to Juba. Investigations on-going
26-Jun-15 Bor State Hospital reported 24 suspect cholera cases
including one death from Malou area
Bor, Jonglei state
- 24 suspect cholera cases including one new death have been
reported in Bor
- Out of the 24 suspect cholera cases, 10 have been discharged
and 14 are still hospitalized in the cholera treatment center setup
by MSF in Bor State Hospital
- New cases reported from High Machor, 4 km from to the index
village of Malou.
- Five stool samples shipped to Juba for microbiological
culturing.
- Supplies including Carry Blair, RDTs, and case management kits
dispatched to Bor
- Epidemiological investigation undertaken by the state rapid
response team
- Preparations are underway to deploy the national rapid
response team to support the ongoing response led by the state
Ministry of Health
25-Jun-15 Two suspect cholera cases reported from Torit State
Hospital
Torit, EES - Three stool samples collected and received in Juba
on 27 June 2015
- Refresher training on cholera conducted for the state hospital
healthcare workers
- Temporary isolation for at least 10 patients set up in Torit
state hospital
- Since 25 June 2015, at least six alerts of suspect cholera
cases have been reported outside Juba. The national and respective
state cholera taskforce committees have initiated the recommended
follow up actions as described in Table 5. The Bor outbreak has
since been confirmed to be due to cholera. The number of cases as
of 7 July was 59 with 1 death. Of the five stool samples sent to
Juba, 3 were positive for V. cholerae.
Highlight of the Response As of 7
th July additional activities initiated to the already on-going
response by cluster or sub working groups
are as followed:
COMMUNICATION
Communication and social mobilization working group trained
additional 52 representatives from City Council and 50 NGO partners
from WASH, Health, CP and Nutrition cluster to enhance their
capacity in communication and social mobilization for cholera
response on 6-7 July thus bringing the total number of people
trained so far to 222.
Three out of four Mobile phones operators (Vivacell, Zain &
Gentel) with in South Sudan have consented and began sending out
bulk short messaging services (SMS) on preventive cholera messages
to their respective subscribers.
In Bor, Jonglei the social mobilization group provided over 2500
posters and banners to the State Ministry of Health and NGOs
partners for dissemination and displaying within the affected areas
of Bor town.
Additional 26 volunteers have been deployed in Malou town in
Jonglei to carry out house to house awareness and sensitization
Radio jingles and PSAs continue on 19 radio stations thrice a
day
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WASH With the support of the cluster an assessment was conducted
for the establishment of additional ORP
sites at Mangaten The cluster also assessed WASH NFI needs for 5
ORT sites – Gurei, St. Kizito, Mangaten, El
Sabbah, JTH CTC- and delivered supplies on 7 July In Bor Water
quality assessment is ongoing in Maluo for 4 boreholes and 7 HHs.
The results to be
shared in the next task force meeting
Health Cluster In Jonglei , the cluster set up 2 tents for
cholera case management - 1 at Bor Hospital CTC and 1 at
the PoC With support of UNICEF the cluster provided 2 DD kits
and 10 cartons of ORS to Jonglei SMoH
Planned activities 1. The next national cholera taskforce
meeting is scheduled for Monday 13 July 2015 at 10:00 am in the
Ministry of Health Ministerial Boardroom. 2. The next cholera
coordination meeting in UN House PoC is scheduled for 9 July 2015
at 11:30 am in the
RRP Boardroom. 3. The next meeting combined meeting for Hygiene
promoters and communication working group will take
place on 15 July at 2:30 pm at UNICEF 4. The national rapid
response team (RRT) will be deployed to Bor week of 6 to 10 July
2015 to support the
ongoing response led by the State Ministry of Health. 5. Testing
for residual chlorine at household level by JCC in collaboration
with WASH partners 6. Hygiene promotion and WASH assessment in Juba
by WASH partners, 6 July 2015 7. Two new CTCs being established at
Gumbo and Suk Melitia 8. ORPs being established in selected
locations in Juba
Many thanks to the staff at CTCs, MoH at national level and
state levels, especially the Department of IDSR, who have helped to
gather the information presented here. Situation Reports are posted
on the WHO website: http://www.who.int/hac/crises/ssd/en/ as well
as on the Humanitarian Info webpage:
http://southsudan.humanitarianresponse.info/clusters/health.
The MoH/WHO surveillance team welcomes feedback and data
provided by individual agencies. Given the fast evolving nature of
this epidemic, errors and omissions are inevitable: we will be
grateful for any information that helps to rectify these. Send any
comments and feedback to: E-mail: [email protected], The
Toll free numbers for alerts are: Zain: 0912000098.
Contacts For more information please contact:
Dr. John Rumunu Director General - Preventive Health Services
MoH, Republic of South Sudan Tel: +211955668178
Dr. Thomas Akim Ujjiga Director - IDSR MoH, Republic of South
Sudan Tel: +211955150406
http://www.who.int/hac/crises/ssd/en/http://southsudan.humanitarianresponse.info/clusters/health
