Sudan: Cholera Outbreak - Sep 2023

On 26 September, the Federal Ministry of Health officially declared a cholera outbreak in the state of Gedaref. Suspected cholera cases have also been registered in Khartoum and South Kordofan states but the limited access and inability to send samples to laboratories prevent the authorities from confirming the outbreak in these states. (ECHO, 29 Sep 2023)

Health partners report that between 15 April and 15 September, the Federal Ministry of Health (FMoH) identified over 4,000 measles cases and 107 associated deaths, most from White Nile and Aj Jazirah states. (OCHA, 28 Sep 2023)

Sudan has declared a cholera outbreak in Gedaref State, where 264 suspected cholera cases, 4 confirmed cases and 16 associated deaths had been reported by 25 September 2023. Investigations are ongoing to determine whether cholera has also spread to Khartoum and South Kordofan states, where increased cases of acute watery diarrhoea have been reported. (WHO, 29 Sep 2023)

According to the World Health Organization (WHO), 1,457 suspected cholera cases and 64 associated deaths have been reported from four states as of 17 October 2023. The outbreak comes at a time that Sudan’s health care system is stretched to the limit: about 70 per cent of hospitals in conflict-affected states are non-functional and facilities in non-conflictaffected states are overwhelmed by the influx of displaced people. (OCHA, 17 Oct 2023)

As of 22 October, there were 1,618 suspected cases of cholera, including 67 associated deaths, in 22 localities of four states, according to the Federal Ministry of Health (FMoH). This includes 763 suspected cases and 32 associated deaths in Gedaref, 346 suspected cases and 8 deaths in South Kordofan, 256 suspected cases and 6 deaths in Aj Jazirah, and 244 suspected cases and 21 deaths in Khartoum. (OCHA, 26 Oct 2023)

As of 9 November 2023, at least 2,525 suspected cases of acute watery diarrhoea (AWD)/cholera, including 78 associated deaths (case fatality rate of 3.1 per cent), were reported from 27 localities of six states, according to the Federal Ministry of Health (FMoH) and the World Health Organization (WHO). Most of the suspected cases tested positive with rapid diagnostic tests (RDTs) and the causative organism (V. cholerae) has been isolated from 33 cases in four states. There are 1,243 suspected cases of cholera, including 22 laboratory confirmed cases and 36 associated deaths, in Gedaref; 501 suspected cases, including 7 laboratory confirmed cases and 10 associated deaths, in Aj Jazirah; 403 suspected cases, including 1 laboratory confirmed case and 24 associated deaths, in Khartoum; 346 suspected cases and eight associated deaths in South Kordofan; 23 suspected cases, including 3 laboratory confirmed cases, in Kassala; and nine suspected cases in Sennar. Based on the epidemiological situation in the affected states, a risk assessment was conducted to identify high-risk localities and target groups for vaccination against cholera. More than 3.1 million people are estimated to be at risk of AWD and cholera in eight states in 13 localities between July and December 2023 as per cholera hotspot mapping exercise conducted by the FMoH with technical support of WHO. (OCHA, 14 Nov 2023)

On 6-10 November, DG ECHO performed a mission to Gedaref, a locality affected by the cholera outbreak declared in Sudan on 26 September. As of 9 November, at least 2,525 suspected cases, including 78 associated deaths, have been reported in seven states. Over 3.1 million people are estimated to be at risk of acute watery diarrhoea and cholera. Following the declaration of the outbreak, WHO, UNICEF and partners activated an Inter-agency Multi-cluster Cholera Action Plan. The International Coordination Group on Vaccine Provision approved the Federal Ministry of Health’s request for more than 2.9 million doses of oral cholera vaccines for reactive vaccination campaigns. Vaccines are expected to arrive on 20 November, and vaccination is expected to start by the end of November. DG ECHO partners are responding to the outbreak and scaling up their operations by supporting the detection and treatment of cases. Surveillance is ongoing in affected and high-risk areas to identify and address risk factors. ECHO, 15 Nov 2023

The number of suspected cases of acute watery diarrhoea/cholera continues to increase with cases now reported across eight states. Overall, 3,591 suspected cases (including 115 associated deaths and a case fatality rate (CFR) of 3.2 per cent), have been reported as of 20 November, according to the Federal Ministry of Health (FMoH) and WHO Outbreaks Dashboard. This includes 1,571 suspected cases of cholera and 44 associated deaths in Gedaref; 951 cases and 20 deaths in Aj Jazirah; 424 cases and 26 deaths in Khartoum; 346 cases and eight deaths in South Kordofan; 44 cases and three deaths in Kassala; 113 cases and five deaths in Red Sea; 30 cases and one death in Sennar; and 112 cases and eight deaths in White Nile. OCHA, 23 Nov 2023

The number of suspected cholera cases has more than doubled over the past month and reached 5,414 cases, including 170 associated deaths as of 3 December, according to the Federal Ministry of Health (FMoH) and WHO Sudan Outbreaks Dashboard. There are 1,824 suspected cases of cholera and 48 associated deaths in Gedaref; 1,397 suspected cases and 23 associated deaths in Aj Jazirah; 794 suspected cases and 37 associated deaths in Red Sea; 463 suspected cases and 26 associated deaths in Khartoum; 453 suspected cases and 22 associated deaths in White Nile; 346 suspected cases and eight associated deaths in South Kordofan; 72 suspected cases and three associated deaths in Sennar; 63 suspected cases and three associated deaths in Kassala; and two suspected case in Blue Nile. The oral cholera vaccine (OCV) campaign that started last week covers about 2.2 million people. The OCV campaign in Gedaref State targeted over 1.57 million people in six localities, of whom 97 per cent were reached. The OCV vaccination campaign in Aj Jazirah State targeted about 693,000 people in one locality, of whom 99 per cent were vaccinated. OCHA, 7 Dec 2023

At least 8,267 suspected cases of cholera, including 224 associated deaths (case fatality rate of 2.7 per cent), were reported as of 23 December from 46 localities of nine states, according to the Federal Ministry of Health (FMoH) and the World Health Organization (WHO) Sudan Outbreaks Dashboard. This is an increase of about 104 per cent compared to the number of cases reported on 23 November 2023. OCHA, 24 Dec 2023

A new cholera outbreak in Kassala and other states was officially declared on 12 August 2024, and the cumulative number of cases and deaths has reached nearly 2700 and 120, as of the end of August 2024.103 The previous cholera outbreak started in June 2023 and was officially declared in September 2023. As of 12 July 2024, a total of 11 241 cases had been reported from 12 states. The weekly reported cases peaked in epidemiological week 49 at the end of last year, with over 1468 cases from 2 to 8 December 2023, followed by a declining trend. A total of 323 deaths had been reported from 11 states, for a CFR of 2.8%. The previous outbreak had unofficially ended before the present one began (more than two incubation periods without a case). Health Cluster, WHO, 1 Sep 2024

As of 19 November, WHO reported more than a thousand deaths and a total of 37,514 cholera cases in the country. The case fatality rate is 2.7%. The escalation of the conflict between the Sudanese Armed Forces (SAF) and the Rapid Support Forces (RSF) has limited the population's access to health services due to its impact on staff, medical supplies and fuel in health centres. 70-80% of health facilities in areas worst affected by the conflict are not functioning. In response to the increased cholera cases, DG ECHO funded humanitarian partners to preposition supplies and scale up their WASH and health responses, repair water supply lines, distribute hygiene kits, launch cholera sensitization and hygiene promotion campaigns, dispatch emergency medical teams and set up cholera treatment centres. (ECHO, 22 Nov 2024)