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.)
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In June 2017, an outbreak of Cholera was confirmed in Tonj East County (UNICEF, 2017). Latest update as of 21st August 2017 indicates cumulative case numbers of 1,431 with 44 deaths (Tonj SMOH, 2017). The outbreak is concentrated in Tonj East but has also been reported in neighboring Counties of Tonj North and Tonj South. 1 CTC, 4 CTUs and 2 ORPs were set up for case management by CHD and CCM teams.
The ECDC Communicable Disease Threats Report (CDTR) is a weekly bulletin for epidemiologists and health professionals on active public health threats. This issue covers the period 10-16 September 2017 and includes updates on cholera, measles, rubella, Legionnaires' disease, West Nile virus, malaria, chikungunya, and typhoid fever.
This weekly bulletin focuses on selected acute public health emergencies occurring in the WHO African Region. The WHO Health Emergencies Programme is currently monitoring 48 events in the region. This week’s edition covers key new and ongoing events, including:
• Plague in Madagascar
• Undiagnosed acute jaundice syndrome in Ethiopia
• Humanitarian crisis in Nigeria
• Humanitarian crisis in Ethiopia
• Humanitarian crisis in South Sudan
• Hepatitis E in Chad
• Malaria in Burundi
In August, the number of South Sudanese seeking refuge in neighboring countries reached the 2 million mark, the highest number of refugees since South Sudan gained independence in 2011. Of those, 1 million are in Uganda. In August, thousands fled fighting in Yei, Kajo-keji, Kapoeta North, Mundri West, Morobo and Maridi counties. More people also fled to Ethiopia and Sudan following clashes in Aburoc and Pagak in Upper Nile during the month.
This weekly bulletin focuses on selected acute public health emergencies occurring in the WHO African Region. The WHO Health Emergencies Programme is currently monitoring 45 events in the region. This week’s edition also covers key ongoing events, including:
• Cholera in Borno State, Nigeria
• Necrotising cellulitis/fasciitis in São Tomé and Príncipe
• Humanitarian crisis in the Central Africa Republic
• Cholera in the United Republic of Tanzania
• Cholera in Chad
• Dengue fever in Côte d’Ivoire.
Increased influx of new arrivals to South Darfur continues in August.
Acute watery diarrhea outbreaks in White Nile and East Darfur refugee camps have been contained.
Biometric registration in El Meiram, West Kordofan completed, with registration now underway in Kharasana.
5,846 Total new arrivals in August 2017
182,100 Total new arrivals in 2017 so far
459,811 South Sudanese refugees who have fled to Sudan since December 2013.
• United Nations Secretary General appoints Alain Noudéhou as Humanitarian Coordinator for South Sudan.
• A mid-year review of the 2017 Humanitarian Response Plan (HRP) finds increasing humanitarian needs in South Sudan.
• Humanitarian coordinator a.i. calls for immediate end to attacks on civilians and aid workers in South Sudan.
• South Sudan's cholera outbreak, known for being the longest and deadliest in the nation's history, is now declining.
Coordination of cholera response
The National cholera task force is coordinating the overall cholera response. The task force meetings convene weekly on Wednesdays from 2 pm in the WHO conference hall in Juba. Also, the cholera coordination meeting in Juba Teaching hospital holds on Monday starting 11 am in the Postgraduate School.
Surveillance and case management updates
So far this year, at least 140 million people across 37 countries have been left in need of humanitarian aid. But most of them will not get it
WHO IN SOUTH SUDAN
The World Health Organization provides leadership on critical health issues and technical support to the Ministry of Health of South Sudan and partners to achieve the overarching goal of promoting and protecting the health status of the people of South Sudan, as outlined in the 12th General Program of Work (GPW).
There is a general declining trend in cholera cases in the country over the past three weeks. Although the cholera outbreak has affected a total of 23 counties (nearly 30 per cent of the total number of counties in South Sudan) across the ten states to date; currently, only ten counties are reporting active transmission.
Highlights W35 2017
Completeness for IDSR reporting at county level was 68%. Completeness for EWARS reporting from IDP sites was 81% .
A total of 23 alerts were reported, of which 39% have been verified. 1 alert was risk assessed and 0 required a response.
A total of 0 new cholera cases and 0 deaths (CFR 0.0% ) were reported. The cumulative total since the start of the current outbreak on 18 June 2016 is 19,862 cases and 355 deaths (CFR 1.8%)*.
UN records more than 130 humanitarian access incidents in July, a 30 percent increase from June
WFP reaches 4.2 million beneficiaries to date in 2017, exceeds 2016 total
South Sudanese refugees surpass 1 million in Uganda, exceed projections in Sudan
In July, relief organizations recorded the highest number of monthly humanitarian access incidents in South Sudan since 2016, underscoring the arduous operating environment.
Coordination of cholera respons
The National cholera task force is coordinating the overall cholera response. The task force meetings convene weekly on Wednesdays from 2 pm in the WHO conference hall in Juba. Also, the cholera coordination meeting in Juba Teaching hospital holds on Monday starting 11 am i n the Postgraduate School.
Surveillance and case management updates
HIGHLIGHTS HEALTH SECTOR
Malaria, ARI, TB, HIV/AIDS, and measles continue to be major causes of morbidity and mortality in IDP locations and surrounding host communities. In the general population medical complications from malnutrition, severe pneumonia, severe malaria and perinatal complications remain the most common causes of death in children under 5 years
• Malnutrition rates remain high as South Sudan approaches the end of the lean season, with the number of people targeted for humanitarian assistance in 2017 having increased from 5.8 million to 6.2 million as per the mid-year review of the Humanitarian Response Plan (HRP). UNICEF dispatched US$ 2.3 million worth of nutrition supplies in August to address the current critical situation.
More than 100,780 cholera / AWD cases and 1496 deaths (CFR: 1.5%) have been reported in 12 of 21 countries of Eastern and Southern Africa Region (ESAR) since the beginning of 2017. These countries include: Somalia, Kenya, South Sudan, Tanzania, Burundi, Malawi, Zimbabwe, Mozambique, Angola, Uganda, Zambia and Rwanda. Somalia accounts for 76.6% of the total cases reported in the outbreak in 2017, followed by South Sudan at 15.7%.
Children living in fragile situations are four times more likely to lack access to basic drinking water
NEW YORK/STOCKHOLM, 29 August 2017 – More than 180 million people do not have access to basic drinking water in countries affected by conflict, violence and instability* around the world, UNICEF warned today, as World Water Week gets under way.