Republic of South Sudan · Duk Fangak Fashoda Juba Kapoeta ... Communication and Hygiene Promotion...
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1 Republic of South Sudan CHOLERA SITUATION AND RESPONSE UPDATES 3 NOVEMBER 2017 Epidemic trends § Cholera transmission reported in three counties [Juba, Budi, and Kapoeta East] in the last four weeks [41-44, 2017]. § No new confirmed case in the week though samples were delivered from Budi during the week and testing is underway (table 2). § No new suspect cholera cases reported from Wangkei, Mayom. Table 1: Cholera cases by county for weeks 41, 2017 to 44, 2017 County Date first reported Cases reported Deaths New during reporting period Cumulative New during reporting period Cumulative Number of cases (attack rate per 10,000) Community Facility Facility+ Community CFR% Kapoeta East 24-Apr-17 2 2,107 88 0 16 10 1.23 Juba 18-Jun-16 97 2,844 49 2 27 10 1.30 Budi 22-Jul-17 62 824 48 2 45 37 9.95 § During the last four weeks, Juba and Budi have reported the highest number of cholera cases (Table 1). During the same period, four deaths were reported from Budi (2) and Juba (2) (Table 1). § A cumulative of 824 cases including 82 deaths [CFR 9.95%] have been reported in Budi since week 29, 2017 (Table 1 and Figure 2). Overall, males (55.5%) are more affected than females 25 21 13 3 37 25 27 8 0 10 20 30 40 wk 41 wk 42 wk 43 wk 44 Number of cases Epidemiological week of onset Fig. 1|Cholera cases in Juba, Budi, & Fangak from week 41 to 44, 2017 Budi Juba Fangak
Transcript of Republic of South Sudan · Duk Fangak Fashoda Juba Kapoeta ... Communication and Hygiene Promotion...
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Republic of South Sudan
CHOLERASITUATIONANDRESPONSEUPDATES
3NOVEMBER2017
Epidemictrends
§ Choleratransmissionreportedinthreecounties[Juba,Budi,andKapoetaEast]inthelastfourweeks[41-44,2017].
§ NonewconfirmedcaseintheweekthoughsamplesweredeliveredfromBudiduringtheweekandtestingisunderway(table2).
§ NonewsuspectcholeracasesreportedfromWangkei,Mayom.
Table 1: Cholera cases by county for weeks 41, 2017 to 44, 2017
County Datefirstreported
Casesreported Deaths
Newduring
reportingperiod
CumulativeNewduringreportingperiod
Cumulative
Numberofcases
(attackrateper10,000) Community Facility
Facility+Community
CFR%KapoetaEast 24-Apr-17 2 2,107 88 0 16 10 1.23
Juba 18-Jun-16 97 2,844 49 2 27 10 1.30Budi 22-Jul-17 62 824 48 2 45 37 9.95
§ Duringthe last fourweeks, JubaandBudihavereportedthehighestnumberofcholeracases(Table1).Duringthesameperiod,fourdeathswerereportedfromBudi(2)andJuba(2)(Table1).
§ Acumulativeof824casesincluding82deaths[CFR9.95%]havebeenreportedinBudisinceweek29,2017(Table1andFigure2).Overall,males(55.5%)aremoreaffectedthanfemales
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Fig.1|CholeracasesinJuba,Budi,&Fangakfromweek41to44,2017
Budi Juba Fangak
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(43%)inBudicounty.Malechildrenandmaleyoungadultsaremoreaffectedthantheirfemalecounterpartsofcorrespondingage(Figure3).
§ TheoutbreakinBudistartedon28July2017withtheinitialtransmissionoccurringamonggold-minersinNgauro.
Cordaid and the County Health Department are supporting management in Ngauro CTU,KimotongCTU,KimotongPHCC,VakaORP,NagishotPHCC,andKakilaiPHCCinBudicounty.
There are ample cholera case management kits and the cholera treatment facilities areadequatelystaffedforthecurrentcase-loads.Inadditiontocasemanagement,surveillance,and WASH interventions, a cholera vaccine campaign is planned for the second week ofNovember2017.InJuba,97casesincludingtwodeaths(CFR2.06%)werereportedinthelastfourweeks[week
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Fig.2|Choleraepidemiccurve,Budicounty2017
Alive Died CFR%
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Fig.3Choleracasedistributionbyageandsex,Budi,week26- 442017
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41-44].MostofthecasesseeninJubainthelastfourweeksoriginatedfromRejafandNorthernBaripayams.AnoralcholeravaccinecampaignhasbeencompletedinJubatargetingbothhigh-risklocationsandareaswithactivetransmission.
Overallcholeratrends
§ Sincethestartofthecurrentoutbreakon18June2016,atotalof21,426casesincluding441deaths(CFR2.06%)havebeenreportedfrom26counties.ThemostaffectedcountiesincludeAyod,TonjEast,YirolEast,Fashoda,KapoetaEast,andKapoetaSouth(Figure4).
§ Themostaffectedpopulationsintheselocationsinclude:Landingsites/townsalongRiverNile;cattlecampdwellers;populationslivingonislands-nosocialservices;andIDPs-recentlydisplacedwithinadequateaccesstoWASH.
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Kapoeta…Kapoeta…
LeerMagwiMalakal
MayenditMayomNyirol
PanyijiarRenk
RubkonaTerekekaTonjEast
TonjNorthYirolEastYirolWest
choleracasesper10,000population
Fig.4|Choleracasesper10,000bycountyinSouthSudan,2016and2017
2017 2016
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Choleracasefatalityrateswerehighestincountieswithpooraccesstohealthcareespeciallyinpopulationslivingintheislandsandcattlecamps(Figure5).Overall,ahigherproportionoffemales(51.9%)areaffectedthanmales(47.5%).Childrenandyoungadultsaremoreaffected.Figure6showstheageandsexdistributionofcases.Therearenosignificantsexdifferencesafteradjustingforage(marginallyhighernumberofcasesinfemales).
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0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50% AwerialAyodBorBudi
CanalPigiDuk
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Kapoeta…Kapoeta…
LeerMagwiMalakal
MayenditMayomNyirol
PanyijiarRaja
RubkonaTerekekaTonjEast
TonjNorthYirolEastYirolWest
choleracasefatalityrate- CFR[%]
Fig.5|Choleracasesfatalityrate(%)bycountyinSouthSudan,2016and
2017
2017 2016
11.107.50
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Choleracasedistributionbyageandsex,June2016- Oct2017
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Figure7showstheoverallcholeraepidemiccurveforSouthSudan.Thehighesttransmissionpeakswereassociatedwithoutbreaksthataffectedcattlecampsinthefollowingcounties–Awerial,YirolEast,Duk,Bor,Uror,Ayod,KapoetaEast,KapoetaSouth,andKapoetaNorth.ThesamelocationsalsoreportedhighCFRduetopooraccesstohealthcareespeciallyattheonsetoftheoutbreakAsseeninTable2,choleracaseshavebeenconfirmedeveryyearsincetheonsetoftheSouthSudan crisis in 2013. The 2016/17 outbreak is the longest and largest in magnitude andgeographical extent. Due to the protracted crisis, displacements, insecurity, and declininginvestment in WASH, access to safe drinking water and sanitation facilities has declinedsignificantly. Access to improved sanitation facilities is less than 10% while access to safedrinkingwaterfromimprovedwatersourcesisestimatedat60%.
TABLE2|CHOLERAOUTBREAKSINSOUTHSUDAN2014-2017
Summarymeasure 2014 2015 2016/17
No.cases 6,421 1,818 21,426
No.deaths 167 47 441CFR% 2.60% 2.59% 2.06%
No.countiesaffected 16 3 26
Duration(weeks) 29 19 (73)Ongoing
Outbreakstartdate 24/04/2016 18/05/2016 18/06/2016
Dateoflastcase 13/11/2016 24/09/2016 Ongoing
Attackrate[per10,000] 27 17 46.1
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Fig.7|CholeraEpidemicCurveforSouthSudan,week23,2016toweek44,2017
Alive Died CFR%
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Coordinationofcholeraresponse
TheNational cholera task force is coordinating theoverall cholera response.The task forcemeetingsconveneweeklyonWednesdaysfrom2pmintheWHOconferencehallinJuba.
Choleraresponseupdates
TheoverallresponsetocholerainSouthSudaniscoordinatedbythenationaltaskforcethatisChairedbyMoHwithsupportfromWHO,Unicef,andpartners(HealthandWASHclusters).TheweeklycholerataskforcemeetingsareongoinginJubaduringwhich,thecholerasituationandtheongoingcholerapreventionandresponseactivitiesintheaffectedandhigh-riskareasarereviewed.Duringweek44,thecholerataskforcemeetingwasconvenedinJubaon1November2017toreviewthecurrentcholerasituationandstatusofoutbreakresponseactivities.WithsupportfromWHO,aMinistryofHealthrapidresponseteamhasbeendeployedfromJubatosupportthecholeraresponseeffortsinBudicounty.
Table3:Oralcholeravaccineadministrativecoveragebyroundandsitefor2017
Progressoforalcholeravaccinecampaigns
Aspartoftheongoingcholeraresponse,choleravaccineshavebeendeployedtocomplementcholeraresponseinseveralhigh-riskpopulationsandlocations.TheseareasincludeLeer,BorPoC,Malakal Town, Bentiu PoC,Mingkaman IDP settlement, Aburoc IDPs, Bentiu/RubkonaTown,Ayod(Pagil,Tar,Jiech,Karmun,Padek,andKandak),Juba(DonBoscoIDPsandadditionalhigh-risk locations), Tonj East and Marial Lou payam, Kapoeta North, Kapoeta South, andKapoetaNorth.Outofthe1,440,358dosessecuredbyWHOin2017,atotalof1123023doseshavebeendeployed(seeTable3).Table2:CholeralaboratoryculturetestresultsJun2016-Sept2017
Week44 Cumulative(2016-2017)
County Positive Positive Negative Totaltested
Abyei 1 1Akobo 2 2Awerial 55 63 118
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Fig.8|Administrativecoverage(%)forOCVbysitein2017
FirstRound SecondRound
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Week44 Cumulative(2016-2017)
County Positive Positive Negative Totaltested
Ayod 2 6 8Bor 4 4 8Budi 2 1 3Duk 11 6 17Fangak 31 50 81Fashoda 7 14 21Juba 0 265 288 553KapoetaEast 0 10 10Kodok 1 2 3Lankien 3 1 4Leer 9 13 22Magwi 7 1 8Malakal 2 21 23Mayendit 4 6 10Mayom 4 7 11Panyijiar 1 1Pibor 5 5Pigi 2 4 6Renk 2 2Rubkona 30 91 121Terekeka 2 2TonjEast 8 8 16Torit 5 5Uror 2 2Wau 6 6YirolEast 10 12 23YirolWest 4 4KapoetaSouth 12 12 24Nyirol 3 1 4Totaltested 0 493 630 1,117
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WASHCLUSTERRESPONSEUPDATES
Beneficiaries reached by WASH cluster partners in week 43
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SOCIALMOBILISATIONUPDATES Social Mobilization, Communication and Hygiene Promotion Reporting Format (22 October-2 November, 2017)
Locations with ongoing outbreak and hot spots (Payam level)
Partners present Ongoing Action with number of population reached with Cholera interventions
Gaps and recommended action
Bor,TwicEast,DukandPibor
CDNF UNICEFsupportedpartnerCDNFcontinuewithcommunityengagementactivitieswhichincludehouseholdvisitswithcriticaldemonstrations,communitymeetings,water-pointandmarketawareness,schoolandcattlecampsinterventioninareasofBor,DukandTwicEast.
• IncountiesofBor,TwicEastandDuk,from20thOct-
2 November, 2017, CDNF conducted socialmobilization activities and reached the total 2,642HHs (14,041 Individuals) through 70 trainedvolunteerssocialmobilizers/homehealthpromoters)educatingcommunityonsocialandbehaviorchangeinterventiononintegratedcholeracontroldiarrhealdiseasepreventionandimmunization.
• Atotalof21schoolsand4,982pupilsbenefitedfromschool-based interventions on integrated choleraawareness and immunization session carryout bysocialmobilizersatdifferentschools,Bor,TwiceastandDukcounties.
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Locations with ongoing outbreak and hot spots (Payam level)
Partners present Ongoing Action with number of population reached with Cholera interventions
Gaps and recommended action
• In this period, the social mobilizers conductedcommunitymeetingsatdifferentpayamofBor,Twiceast andDuk counties, number ofmeetingwas 17and 1516 people inclusive of community leaderswhichcompriseoflocalchiefs,religiousleadersandwomenandyouthleaders.
• Socialmobilizersmarketsessionreached17and858individuals through market sessions including foodvendorsinthementionedcountiesofJonglei
• Massmediaintervention:cholerakeymessagesandradiospotsarebeingbroadcastedonMingkaman100FM,andRadioJonglei95.9FM,6timesdailyinDinka,English and Arabic reaching population in remotelocationsandvillageslifesavingmessagesoncholerapreventionandcontrol
• Religious engagement: Social mobilizers reachedpeople with effective cholera messages in over 7churchesduringSundayinthecountiesofBor,Twiceast,andDuk2017.
• On the 20th Oct-2nd November, 2017, the StateMinistry of Health, UNICEF, WHO, CDNF, UNAgencies, OXFAM, and all International NGOs andNational NGOs,Women Groups, Youth, and publiccommemorated theGlobalHandwashing day at St.
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Locations with ongoing outbreak and hot spots (Payam level)
Partners present Ongoing Action with number of population reached with Cholera interventions
Gaps and recommended action
AndrewCathedralBor.Thefunctionwasattendedbymorethan4,500peopleandlocalartistswereinvitedfor entertainment known as Anyidi boy, Akol Dau,Nyanpalew,etc.
Boma State, In Payam of Pibor county of Lekuangole,Verteth and Gumuruk, and Pochalla county of Akoye,Akila,AdongoandBuratorfrom20thOct–2ndNov2017,CDNF conducted social mobilization activities andreached the total 1,161 HHs and 8,106 Individualsthrough 23 trained volunteers social mobilizers/homehealth promoters) educating community on social andbehavior change intervention on integrated choleracontroldiarrhealdiseasepreventionandimmunizationA total of 20 schools and 2,662 pupils benefited fromschool-based interventions on integrated choleraawarenessand immunizationsessioncarryoutbysocialmobilizers at different schools, Pibor, Lekuangole,VertethandGumuruk,Payams.In this period, the social mobilizers also conductedcommunity meetings at different payams of Pibor,Lekuangole,VertethandGumuruk,numberofmeeting
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Locations with ongoing outbreak and hot spots (Payam level)
Partners present Ongoing Action with number of population reached with Cholera interventions
Gaps and recommended action
was13and1,140peopleinclusiveofcommunityleaderswhich comprise of local chiefs, religious leaders andwomenandyouthleaders.Socialmobilizersmarket session reached13and2,235individuals through market sessions including foodvendorsinthementionedcountiesofBoma.In hard to reach villages of Pibor, Lekuangole, VertethandGumuruk, Payams the socialmobilizers conducted16water point sessions reached total of1,157peopleincluding water vendors with Cholera and diarrhealdiseaseeducativemessages.
Jonglei(OldFangak,AkoboandPigi
FCDIandCHD UNICEFsupportedpartnerFangakCommunityDevelopmentInitiative(FCDI)continuewithcommunityengagementactivitieswhichincludehouseholdvisitswithcriticaldemonstrations,communitymeetings,water-pointandmarketawareness,schoolandcattlecampsinterventioninareasofFangak,PigiandKhorflous.• InWeek43,91socialmobilizersconducted52markets
awarenesssessionsandreached2125peopleincludingfoodvendorswithcholeramessages.
• Theyconducted41waterpointssessionandreach1423watervendorswithmessagesonwatertreatmentandsafewaterstoragetoavoidcholeradiseasesathouseholdlevels.
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Locations with ongoing outbreak and hot spots (Payam level)
Partners present Ongoing Action with number of population reached with Cholera interventions
Gaps and recommended action
• Themobilizersalsocarriedoutpublicannouncementsinchurches,mosques,cattlecampsandhealthfacilitiesreachingover10,123people.
• Alsoaspartofintegratedresponse,mobilizerscarried
outsensitizationofcaregiversandparentsof0-5onimportanceofimmunizationandexclusivebreastfeeding.Thus,atotalof40,104Individualand11,021HH,reachedwithlifesavingmessagesatcounties,PayamsandBomas.Generally,mostofthefamiliesarecurrentlyreceivingPOLIO,MEASELESandCHOLERAsensitization.
• Thesocialmobilizersconducted44sessionsofawareness
inschoolsandreached6,721pupilswithcholeramessagesinschools.
• Sofar,FCDI,socialmobilizershadincreaseareasof
operationfromthepreviousrestrictedlocationinIO-Controlvillages.Themobilizersconducted50communitymeetingsand399localleaderswithROUNTINEVACCINATION,IMMUNIZATION,POLIO,MEASELSANDCHOLERAcontrolandpreventablemessagesinthecommunity. Additionally,sincelast7weeks,wehadsofarreached188breastfeedingmothers,withroutineimmunizationcampaignmessagesandcholeraawareness.
Findsomeofouractionpictureattachedbelowaswewaittoreceivemorefromthefield.
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Locations with ongoing outbreak and hot spots (Payam level)
Partners present Ongoing Action with number of population reached with Cholera interventions
Gaps and recommended action
CurrentlyFCDIandotherimplementingpartnersarereceivingincomingIDPsfromMalakalinthefollowingareaskhorwai,khorflus,Tonga,AtarPigiandFangakCounty.
JubaGurei,Kator,Lologo,Gumbo,Nesitu
Healthlink,SMoHandCHD
AspartofMassmedia,atotalof14FMstationscontinuewithairingofradiospotsandtalk-showsinJubaandYei.Asof21-28October,2017,980timesradiojingleshavebeenbroadcastedreachingover2millionpeopleacrossthecountry.IncommemorationofUNDay,24thOctober,2017whichwas celebrated in Nyakuron Cultural Centre, intensivepublicawarenesscholeraandPolioNIDswascarriedoutby roadshow which comprised of traditionalperformances, drama, critical demonstration anddistribution of water treatment chemicals (PUR andAquatabs).Thisweek,streetannouncementofbothcholeraandimmunizationmessageshasbeenongoingthroughFive(5)PublicAddressSystems(PAs)infivemainareasoftheCitynamely;Rejaf,Kator,Juba,MunukiandNyar-kenyi/NorthernBari.ThePAsconducts5hours’announcementsperday(3hr.morningand2hrsevening).
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Locations with ongoing outbreak and hot spots (Payam level)
Partners present Ongoing Action with number of population reached with Cholera interventions
Gaps and recommended action
UNICEFpartnerHealthLinkSouthSudancontinuewithsocialmobilizationactivitiesinthecatchmentareasofthenine(9)ORPsinJubaCityandLokiliri.Thisweek,45trainedcommunitymobilizersconductedhouse-to-housefollow-upvisitscovering3,908households(22,815people)withcholeramessagesincholerahotspotsareasthatincludeGurei,Kator,Lologo,Gumbo,Munuki,KhorWilliam,NyakuronandNesitu.ThehouseholdshavealsobeenreachedwithWASHandHealthsupplies.Atotalof440sachetsofORS,4,614sachetsofPURand4,130chlorinetabs).TheMobilizersalsocarriedoutawarenessin1schoolreachingatotalof622schoolchildrenincludingteachers
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UNICEF supported partner, CDNF Mobilizers carrying out cholera intervention in Bor (Panpandiar and Malou) and Pochalla (Terlul)
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FCDImobilizersinFangakengagingwithcommunitymembersatdifferentlevelsinFangak
ContactsDr. Mathew Tut� Director, Emergency Preparedness and Response Ministry of Health, Ministerial Complex�Juba, Republic of South Sudan��Email: [email protected]
Dr. Joseph F. Wamala Epidemiologist��World Health Organization Ministerial Complex Juba, Republic of South Sudan Email: [email protected]
