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Republic of South Sudan
Situation Report #72 on Cholera in South Sudan
As at 23:59 Hours, 1 September 2015
Situation Update Two new cholera cases have been reported in Juba County today. As of 1
st September 2015, a total of 1,698
cholera cases including 46 deaths (CFR 2.71%) have been reported in South Sudan. In Juba County, a total of 1562 including 45 deaths (CFR 2.88%) from seven Payams (Table 1). In Bor, 130 cases including one death (CFR 0.77%) have been reported from Malou in Makuach Payam and other areas within the County. Table 1 and Figure 1. . Table 1. Summary of cholera cases reported in Juba and Bor Counties, 18 May – 1 September, 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
CES – Juba County 2 5 0 11 215 26 19 45 1290 1562 IMC UN House PoC clinic 0 0 0 0 0 0 1 1 75 76
Juba Teaching Hospital 1 4 0 11 211 22 8 30 859 1112
MedAir Gumbo CTU 0 0 0 0 0 1 0 1 97 98
MedAir Gudele ORP 0 0 0 0 0 0 0 0 8 8
HLSS Nyakuron ORP 0 0 0 0 0 0 0 0 40 40
HLSS Kator ORP 0 0 0 0 0 0 0 0 7 7
HLSS Gurei ORP 1 1 0 0 0 0 0 0 79 79
HLSS Munuki ORP 0 0 0 0 0 0 0 0 4 4
HLSS Al Sabah ORP 0 0 0 0 0 1 0 1 20 21
HLSS Lologo ORP 0 0 0 0 0 0 1 1 13 14
MSF Munuki CTC 0 0 0 0 4 0 0 0 70 74
Other sites in Juba 0 0 0 0 0 2 9 11 18 29
Jonglei State – Bor 0 0 0 0 3 1 0 1 132 136
Bor State Hospital 0 0 0 0 3 1 0 1 132 136
Total 2 5 0 11 218 27 19 46 1422 1698 *LAMA: LEAVE AGAINST MEDICAL ADVICE; CES- Central Equatoria State
Figure 1: New cholera cases in Juba by residence on 1 September, 2015
During week 36 of 2015 (week of 31
st Aug- 06 Sept 2015), cholera cases originated from Munuki (3), Kator
(2), Northern Bari (1) Payams. (Figures 1.1 and 3; Annex 1).
1 1
0
1
2
Kor William Gudele Block 1
Kator Northern Bari
Juba
Nu
mb
er
of
case
s
2
Figure 1.1: New cholera cases by residence during week 36 of 2015
Cumulatively, 1,698 cholera cases including 46 deaths (27 facilities and 19 communities) have been reported in Juba and Bor Counties since the initial case was reported on 26 May 2015 in Juba. Of the 46 deaths, 11 (24%) occurred in children under five years while 31 (67.4%) occurred in male. Table 2: New cholera cases by facility and week in Juba and Bor Counties, 18 May – 1 September, 2015
Reporting Facility
New cases by epidemiological week of 2015
Grand Total 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36
CES – Juba County 4 2 7 56 130 229 235 160 237 149 100 77 86 45 39 6 1562
JTH 0 2 2 32 119 208 207 115 146 92 52 44 44 19 25 4 1112
Juba 3 IMC clinic 4 0 4 9 6 13 10 10 11 5 2 0 1 0 1 0 76
HLSS Nyakuron ORP 0 0 0 0 0 0 2 3 11 2 9 3 7 1 2 0 40
HLSS Kator ORP 0 0 0 0 0 0 0 3 1 2 1 0 0 1 0 0 7
MedAir Gudele ORP 0 0 0 0 0 0 0 4 3 1 0 0 0 0 0 0 8
MedAir Gumbo CTU 0 0 0 0 0 5 15 20 25 10 8 9 4 3 0 98
HLSS Gurei ORP 0 0 0 0 0 0 0 1 11 10 15 10 13 13 5 1 79
HLSS Munuki ORP 0 0 0 0 0 0 0 1 0 2 0 0 0 0 1 0 4
HLSS Al Shabah ORP 0 0 0 0 0 0 0 0 4 3 5 3 5 0 1 21
HLSS Lologo ORP 0 0 0 0 0 0 0 0 2 4 2 1 2 2 1 0 14
MSF Munuki CTC 0 0 0 0 0 0 0 0 23 18 7 7 9 6 4 0 74
Other sites in Juba 0 0 1 15 5 3 1 3 0 0 0 0 1 0 0 0 29
Jonglei State – Bor County 0 0 0 0 0 5 46 33 21 8 9 4 4 2 4 0 136
Bor State Hospital 0 0 0 0 0 5 46 33 21 8 9 4 4 2 4 0 136
Grand Total 4 2 7 56 130 234 281 193 258 157 109 81 90 47 43 6 1698
As seen from Figure 2 and 2.1, sustained and consistently increasing community transmission was established in Juba from the 6 June 2015 [23
rd epidemiological week] with two transmission peaks in week 27
and 29. Cholera cases have been declining since 20 July 2015 [30th epidemiological week].
Figure 2: Epidemic curve for cholera cases in Juba and Bor, 18 May – 1 September 2015
JS: Jonglei State; CES: Central Equatoria State; CFR: Case Fatality Rate
1 1 1 1 1 1
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1
2
Giada Kor William Gudele Block 1 Mia Sava Mauna Jebel Market
Kator Northern Bari Munuki
Juba
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mb
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s
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01020304050607080
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20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36
Ca
se F
ata
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Ra
te [
%]
Nu
mb
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of
case
s
JS CES CFR
3
This decline was interrupted in week 33 during which a noticeable rise in cases was registered. This rising trend in Juba during week 33 was driven by community transmission in Gondokoro, Northern Bari, Munuki, and Rejaf Payams (Annex 1). In Bor, the initial case occurred on 26 June 2015 [26
th epidemiological week] with increasing number of cases
from week 26 to week 27 when the highest transmission peak was registered. In the subsequent weeks, successively shorter transmission peaks were registered, a trend that is consistent with declining community transmission (Figures 2 and 2.1). Figure 2.1: Cholera cases in Juba and Bor by week of onset, week 21-36 of 2015
As of 1st September 2015, the sites reporting the highest cumulative number of cholera cases included
Gumbo, New site, Juba 3 PoC, Gudele 2, Atlabara B, and Munuki with satellite cases distributed in seven Payams in Juba County (Figure 3.1). In Bor County, the majority of the cases originated from Malou, Langbar, Achingdii, Arek, and Hai Salam in Makuach Payam. Figure 3.1: Spot map for cholera cases by residence in Juba from 18 May 2015 to 1
st September 2015
4 2 7 56
130
229
235
160
237
149
100
77 86
45 39
6 - -
14.3
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3.8
1.4 1.6 1.6 1.9
- 1.2
2.2
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se F
ata
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te [
%]
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mb
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of
case
s
Week of onset JS CES CFR[%]
4
Within Juba County and its most affected Payams of Juba, Northern Bari, Munuki, Rejaf, and Kator, children under 10 years and young adults aged 20-34 years are the most affected while in Makuach Payam, Bor County, children under 10 years are the most affected. (Tables 3.1 and 3.2; Annex 2). Table 3.1: Cholera case distribution by age in Juba County, 18 May - 1 September 2015
Table 3.2: Cholera case distribution by age in Bor County, 18 May – 1 September 2015
*There are missing information in sex and age
Out of the 1598 cholera cases with known sex in Juba, 670 (43%) were female, while 886 (57%) were male while in Bor, 75 (58%) of the cases were females, while 55 (42%) were males (Table 4). Table 4: Case distribution by sex and age in Juba and Bor Counties, 18 May - 36 August 2015
Case distribution by sex n (%)
CES - Juba 1556
Female 670 (43)
Male 886 (57)
Jonglei state – Bor County 136
Female 79 (58)
Male 57 (42)
Grand Total 1692 *There are missing information in sex and age
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;
96 76
46 57 88 97
55 46 31 22 17 12 11 8 7
132
101
47 50
98
138
96
79
49
25 17
8 14 13 10 0
50
100
150
200
250
Nu
mb
er
of
case
s
Cholera case distribution by age in Juba County, week 21-34, 2015
Male
Female
42
8 5 1 1 2 10
2 3 1 3 1
37
7 3
1 1
1
3 1 2 1 0
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underfives
5-9years
10-14years
15-19years
20-24years
25-29years
30-34years
35-39years
40-44years
45-49years
50-54years
55-59years
65-69years
Nu
mb
er
of
case
s
Cholera case distribution by age in Bor County, week 26-36, 2015
Male
Female
5
eating food from unregulated roadside food vendors or makeshift markets; open defecation/poor latrine use; and attending/eating food at a funeral.
Laboratory updates Since the beginning of the outbreak, 139 specimen collected across the country were received at the National Public Health Laboratory (NPHL), of which
41(29.5%) were positive for Vibrio Cholera O1 type including 3 (2.2%) among <5 years
80 (57.6%) negative,
14 (10.1%) pending and
4 (2.9%) rejected probably due to improper collection and transportation
Planned and On-going Activities 1. The next national cholera taskforce meeting is scheduled for Monday 07 September 2015 at 10:00 am in
the MoH Ministerial Boardroom. 2. The next cholera coordination meeting in UN House PoC is scheduled for 3 September 2015 at 11:30 am
in the RRP Boardroom.
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
6
Annex: Cholera Data tables and Charts – 18 May 2015 to 1 September 2015 Annex 1: Cholera epidemic curves by Payam - 18 May to 1 September 2015
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Cholera Epidemic Curve Juba Payam 2015
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Cholera Epidemic curve Northern Bari Payam 2015
Northern Bari
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Cholera Epidemic Curve Rejaf Payam 2015
Rejaf
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Cholera Epidemic Curve Munuki Payam 2015
Munuki
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B
Nu
mb
er o
f ca
ses
in o
ther
v
illa
ges
in K
ato
r
Cholera Epidemic Curve Kator Payam 2015
Kator Atlabara
0
5
10
15
20
25
20
15
/05
/16
20
15
/05
/18
20
15
/05
/20
20
15
/05
/22
20
15
/05
/24
20
15
/05
/26
20
15
/05
/28
20
15
/05
/30
20
15
/06
/01
20
15
/06
/03
20
15
/06
/05
20
15
/06
/07
20
15
/06
/09
20
15
/06
/11
20
15
/06
/13
20
15
/06
/15
20
15
/06
/17
20
15
/06
/19
20
15
/06
/21
20
15
/06
/23
20
15
/06
/25
20
15
/06
/27
20
15
/06
/29
20
15
/07
/01
20
15
/07
/03
20
15
/07
/05
20
15
/07
/07
20
15
/07
/09
20
15
/07
/11
20
15
/07
/13
20
15
/07
/15
20
15
/07
/17
20
15
/07
/19
20
15
/07
/21
20
15
/07
/23
20
15
/07
/25
20
15
/07
/27
20
15
/07
/29
20
15
/07
/31
20
15
/08
/02
20
15
/08
/04
20
15
/08
/06
20
15
/08
/08
20
15
/08
/10
20
15
/08
/12
20
15
/08
/14
20
15
/08
/16
20
15
/08
/18
20
15
/08
/20
20
15
/08
/22
20
15
/08
/24
20
15
/08
/26
20
15
/08
/28
20
15
/08
/30
20
15
/09
/01
Nu
mb
er o
f ca
ses
Cholera Epidemic Curve Gondokoro Payam 2015
Gondokoro
0
5
10
15
20
25
20
15
/05
/16
20
15
/05
/18
20
15
/05
/20
20
15
/05
/22
20
15
/05
/24
20
15
/05
/26
20
15
/05
/28
20
15
/05
/30
20
15
/06
/01
20
15
/06
/03
20
15
/06
/05
20
15
/06
/07
20
15
/06
/09
20
15
/06
/11
20
15
/06
/13
20
15
/06
/15
20
15
/06
/17
20
15
/06
/19
20
15
/06
/21
20
15
/06
/23
20
15
/06
/25
20
15
/06
/27
20
15
/06
/29
20
15
/07
/01
20
15
/07
/03
20
15
/07
/05
20
15
/07
/07
20
15
/07
/09
20
15
/07
/11
20
15
/07
/13
20
15
/07
/15
20
15
/07
/17
20
15
/07
/19
20
15
/07
/21
20
15
/07
/23
20
15
/07
/25
20
15
/07
/27
20
15
/07
/29
20
15
/07
/31
20
15
/08
/02
20
15
/08
/04
20
15
/08
/06
20
15
/08
/08
20
15
/08
/10
20
15
/08
/12
20
15
/08
/14
20
15
/08
/16
20
15
/08
/18
20
15
/08
/20
20
15
/08
/22
20
15
/08
/24
20
15
/08
/26
20
15
/08
/28
20
15
/08
/30
20
15
/09
/01
Nu
mb
er o
f ca
ses
Cholera Epidemic Curve Lokiliri Payam 2015
Lokiliri
0
5
10
15
20
25
6/2
2/1
5
6/2
4/1
5
6/2
6/1
5
6/2
8/1
5
6/3
0/1
5
7/2
/15
7/4
/15
7/6
/15
7/8
/15
7/1
0/1
5
7/1
2/1
5
7/1
4/1
5
7/1
6/1
5
7/1
8/1
5
7/2
0/1
5
7/2
2/1
5
7/2
4/1
5
7/2
6/1
5
7/2
8/1
5
7/3
0/1
5
8/1
/15
8/3
/15
8/5
/15
8/7
/15
8/9
/15
8/1
1/1
5
8/1
3/1
5
8/1
5/1
5
8/1
7/1
5
Nu
mb
er
of
case
s
Cholera Epidemic Curve Makuach Payam, Bor 2015
Makuach
8
Annex 2: Cholera case distribution by age, sex and Payam – 18 May to 1 September 2015
6 5 3
6 8 8
5 3
1 2 2 2 1 1
11
3 4
7
12
23
12 12
8 3 3
1 1 0
5
10
15
20
25
30
35
underfives
5-9years
10-14years
15-19years
20-24years
25-29years
30-34years
35-39years
40-44years
45-49years
50-54years
55-59years
60-64years
65-69years
70+years
Nu
mb
er
of
case
s
Cholera case distribution by age in Juba Payam, week 26-36, 2015
Male
Female
20
11 5
11
23
14 8
12
4 5 5 2 2 2
20
17
8
11
20 34
17
19
13 4
5 2
2 4 1 0
10
20
30
40
50
60
underfives
5-9years
10-14years
15-19years
20-24years
25-29years
30-34years
35-39years
40-44years
45-49years
50-54years
55-59years
60-64years
65-69years
70+years
Nu
mb
er
of
case
s
Cholera case distribution by age in Kator Payam, week 26-36, 2015
Male
Female
17 15 20
17
29 28
14 8 8
5 10
1 3 1
22
12
11 17
28 32
27
15 8
5 1
4 2 4 4
0
10
20
30
40
50
60
70
underfives
5-9years
10-14years
15-19years
20-24years
25-29years
30-34years
35-39years
40-44years
45-49years
50-54years
55-59years
60-64years
65-69years
70+years
Nu
mb
er
of
case
s
Cholera case distribution by age in Munuki Payam, week 26-36, 2015
Male
Female
9
25 19
8 14 13
22
9 14 12
5 2 2 3 3 2
42
26
15 11
23
26
25 18 14
6 5 4 1
0
10
20
30
40
50
60
70
80
underfives
5-9years
10-14years
15-19years
20-24years
25-29years
30-34years
35-39years
40-44years
45-49years
50-54years
55-59years
60-64years
65-69years
70+years
Nu
mb
er
of
case
s Cholera case distribution by age, Northern Bari Payam, week 26-36, 2015
Male
Female
27 24
10 7
15
25
17
9 5 5 3 2 3 1 1
37 42
9
4
10
18
14
13
6 5 3
1 5
4 0
10
20
30
40
50
60
70
underfives
5-9years
10-14years
15-19years
20-24years
25-29years
30-34years
35-39years
40-44years
45-49years
50-54years
55-59years
60-64years
65-69years
70+years
Nu
mb
er
of
case
s
Cholera case distribution by age in Rejaf Payam, week 26-36, 2015
Male
Female
30
8 3 1 1 1
5 2 3 1 2 1
27
5
2 1
1 1 0
10
20
30
40
50
60
70
underfives
5-9 years 10-14years
15-19years
20-24years
25-29years
30-34years
35-39years
40-44years
45-49years
50-54years
55-59years
Nu
mb
er
of
case
s
Cholera case distribution by age, Makuach Payam, Bor week 26-36, 2015
Male
Female
