South Sudan: Cholera Outbreak - Jul 2016Ongoing
South Sudan’s Minister of Health advised partners to treat the recent rise in suspected cholera cases as a cholera outbreak, and respond accordingly. UNICEF’s Cholera Task Force is fully operational, and measures are being taken to enhance water, sanitation, and hygiene – over 100,000 liters of sewage were collected from UN House POC on 18 July. (UNICEF, 18 Jul 2016)
As of 17 November, communities along the River Nile are worst affected and account for 91 per cent of reported cholera cases. A total of 2,874 cases and all 44 deaths from the outbreak have been reported from eight counties straddling the River Nile: Awerial, Duk, Fangak, Juba, Leer, Pageri, Pigi and Terekeka. Rubkona is the only county affected by the outbreak that is not along the Nile. Juba has the highest number of cases (1,990 - 63 per cent of the total), while Terekeka has the highest case fatality rate. (OCHA, 21 Nov 2016)
As of 5 May 2017, cholera outbreaks have been confirmed in 19 counties in South Sudan. The most affected counties are located along the River Nile. This suggests vehicle-borne transmission from contaminated water in affected counties. Cumulatively, 7,735 cholera cases, including 246 deaths (76 facilities and 170 community) (CFR 3.23%), have been reported in South Sudan since the initial case was reported on 18 June 2016. Nine out of 19 counties ever affected since June 2016 are considered to have active transmission, having reported cholera cases in the past four weeks. (WHO, Govt. South Sudan, 5 May 2017)
Cholera transmission has continued to decline countrywide. In the last four weeks [weeks 37- 40] , cholera cases dropped from at least 40 cases in week 37 of 2017 to at least 15 cases in week 40 of 2017. Three counties [Juba, Budi, and Fangak] have registered cholera transmission in the last four weeks [ 37-40]. A total of 135 cases have been reported from the three counties in the last four weeks [37-40]. Most of the cases have been reported from Juba [112 cases] while Budi and Fangak reported 16 cases and 7 cases respectively. (WHO, 6 Oct 2017)
As part of the ongoing cholera response, health partners have deployed cholera vaccines to complement traditional prevention strategies in several high-risk populations and locations. This is the latest step in ongoing efforts to end South Sudan’s longest and deadliest cholera outbreak (OCHA, 18 Jan 2018.)
Maps & Infographics
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6 of the 21 countries in Eastern and Southern Africa have over 20% of their population using an unimproved water source and they include; Ethiopia, Somalia, Tanzania, Zambia, Mozambique and Madagascar. Of these countries, Somalia has recorded the highest number of cholera cases and deaths. Countries which have 11 to 20% of their population using unimproved water sources include; South Sudan, Uganda, Rwanda, Burundi, Eritrea, Angola, Zimbabwe and Lesotho. 5 of these countries (South Sudan, Rwanda, Burundi, Angola and Zimbabwe) have reported outbreaks in 2017.
3 of the 21 countries in Eastern and Southern Africa have over 50% of their population using unimproved sanitation facilities and they include; Tanzania, Ethiopia and Uganda. Cumulatively, Tanzania has reported 2697 cases since the beginning of 2017. Countries which have 25 to 50% of their population using unimproved sanitation facilities include: Somalia, Kenya, Burundi, Malawi, Mozambique, Zambia and Madagascar. Cumulatively, these countries have reported 83, 346 cases in 2017, and majority of these cases emerging from Somalia.
More than 102,814 cholera / AWD cases and 1551 deaths (Case Fatality Rate: 1.5%) have been reported in 11 of 21 countries of Eastern and Southern Africa Region (ESAR) since the beginning of 2017. These countries include; Angola, Burundi, Kenya, Malawi, Mozambique, Rwanda, Somalia, South Sudan, Tanzania, Zambia and Zimbabwe. Somalia accounts for 76.6% of the total cases reported in 2017, followed by South Sudan at 15.9%.
Completeness for IDSR reporting at county level was 64%. Completeness for EWARS reporting from IDP sites was 74%.
A total of 18 alerts were reported, of which 6% have been verified. 0 alerts were risk assessed and 0 required a response.
A total of 37 new cases including one death (CFR 2.70%) were reported in week 40. The cumulative since the start of the current outbreak on 18 June 2016 is 21,097 cases including 418 deaths (CFR 1.98%).
The Global Early Warning – Early Action (EWEA) report on food security and agriculture is developed by the Food and Agriculture Organization of the United Nations (FAO).
The report is part of FAO’s EWEA system, which aims to translate forecasts and early warnings into anticipatory action.
Update on global programmes
In September, Northern Bahr el Ghazal and Jonglei states experienced flooding as a result of heavy rains. UNICEF together with partners responded to over 20,000 households affected by the flooding in Northern Bahr el Ghazal with provision of supplies, including household water treatment products and water containers. However, the WASH sector continues to face a significant funding gap (54 per cent).
September 30, 2017 (JUBA) - South Sudan’s Ministry of Health and partners have launched a mass cholera vaccination campaign targeting up to 200,000 people.
Ante Wind, deputy medical coordinator of medical charity, Medicines Sans Frontiers (MSF), said the latest vaccination drive seeks to curb outbreaks and enhance protection of people against the deadly diarrheal disease that has killed over 320 people since the outbreak was reported in June 2016.
HIGHLIGHTS HEALTH SECTOR
So far, the Health Cluster funding for HRP 2017 remains at 18%. With the continued armed conflict and resultant displacement and diseases, the needs are increasing while the health response is limited. Impaired access to populations in need continue to increase the cost of operations. As the heavy rains continue and security remains unpredictable, the humanitarian health situation can only get worse during the remaining part of the year.
New cholera alerts
New Fangak: A new cholera alert involving at least eight suspect cholera cases with no deaths was reported by MSF-France on 26 September 2017. The MSF clinic in New Fangak has treated and discharged eight suspect cholera cases since 26 Sept 2017. The verification of additional suspect cases in Phom, Nyalual, and Wangrietha is underway. Samples have been obtained for laboratory testing.
General cholera trends
This weekly bulletin focuses on selected acute public health emergencies occurring in the WHO African Region. The WHO Health Emergencies Programme is currently monitoring 49 events in the region. This week, one new event has been reported: measles in Liberia. This week’s edition also covers key ongoing events, including:
- Plague in Madagascar
- Malaria in Cabo Verde
- Cholera in Tanzania
- Cholera in Chad
- Humanitarian crisis in Cameroon
Humanitarian crisis in South Sudan
The 2017 Sudan Humanitarian Response Plan (HRP) partners are requesting US$804 million to assist 4 million people in need across the country. As of 24 September 2017, HRP 2017 partners received $304 million – representing only 38% of the total amount. This low funding is set to have an immediate and dire impact on the lives and well-being of thousands of people humanitarian partners are serving in Sudan.
25 September 2017, Juba – The Ministry of Health, Republic of South Sudan in collaboration with the World Health Organization (WHO), other government ministries/agencies and partners including FAO, UNICEF and IOM completed the self-assessment of the implementation of International Health Regulations (2005) and Global Health Security Agenda(GHSA). The Self-assessment is in preparation for the Joint External Evaluation (JEE) of the International Health Regulations (2005) a key component of the IHR monitoring framework.
26 September 2017, Juba – WHO’s emergency medical mobile teams are providing lifesaving health services to alleviate the myriad of public health challenges faced in famine-affected and hard-to-reach areas of South Sudan.
The team includes one doctor, nurse, nutritionist and community health worker. They support partners in remote locations with case management of patients, vaccinations, setting up of cholera treatment centers and units in areas reporting outbreaks, and help partners to set up mobile clinics.