1

Republic of South Sudan

Situation Report #8 on Cholera in South Sudan

As at 23:59 Hours, 23 July 2016

Situation Update A Cholera outbreak has been confirmed in Juba after 10 (77%) of the samples tested positive for Vibrio Cholera Inaba in the National Public Health Laboratory. The IHR focal person has been informed to contact relevant partners. Jubek state as of 23

rd July 2016, recorded a total of 199 cholera cases including 3 deaths

(CFR 1.71%) have been reported in Juba county. Juba Teaching Hospital has been designated as a CTC, with a total of 24 new cholera cases reported in Juba on 23

rd July 2016 (Table 1 and Figure 1). The most

affected locations in Juba include Gorom, Khor William, and Giada, Tiger area (Fig. 1.1 and 1.2). In Jonglei state, 32 suspected cholera cases with 4 deaths (CFR 12.5%) have been reported from Duk County involving 5 settlements namely Atuek, Atul, Koyom, Moldova and Watkuac with the date of onset of index case on the 3

rd July 2016.

A 3rd

state, Terekeka has reported 10 suspected cases of cholera with 4 death (CFR=40%) and samples taken for laboratory confirmation. Table 1. Summary of cholera cases reported in Juba as of 23 July 2016

Figure 1.1: Cholera cases by residence Jubek State from 13 to 23 July 2016

Reporting SitesNew

admissions

New

discharges New deaths

Total cases

currently

admitted

Total facility

deaths

Total

community

deaths

Total deathsTotal cases

dischargedTotal cases

Jubek – Juba

County 24 65 0 47 2 1 3 149 199

Jonglei-Duk

County0 0 0 0 3 1 4 28 32

Terekeka 0 0 0 0 0 4 0 6 10

Total24 65 0 47 5 6 7 183 241

0

10

20

30

40

50

60

70

Am

arat

J.O

ne

Jub

a N

a B

ari

Atl

abar

a

Gia

da

Kal

ibal

a

Kat

or

We

st

Ko

nyo

kon

yo

Lolo

go

Bilp

am

Gu

de

le

Gu

de

le

Hai

Se

min

ary

Jeb

el

Mau

na

Mia

Sab

a

Mu

nu

ki

Mu

nu

ki

New

site

Gu

rei

Jeb

el L

adu

Kab

u

Ch

eck

po

int

Go

rom

Jen

der

u

Kh

or

Wili

am

Ro

ck C

ity

Shir

ikat

Suk

Jeb

el

Juba Kator Munuki NorthernBari

Rejaf

2 2

17

2

25

1 1 1 8

1 5

1 1 1 3 3 6 1 2 2 1 1

7

65

1

31

1 5 2 N

um

be

r o

f C

ase

s

2

Figure 1.2: New Cholera cases admitted by location Jubek State (23 July 2016)

Figure 1.3: Cumulative suspected cholera cases by residence Jonglei State as of 23 July 2016

Cumulatively, 231 cholera cases including 7 deaths (5 facilities and 2 community) have been reported in South Sudan involving 2 states since the initial case was reported on the 3

rd July in Jonglei state and 13

th July

2016, for Jubek state. As seen from Figure 2 increasing community transmission was established in Juba from the 12th July 2016 Figure 2:1 Epidemic curve for cholera cases in Jubek State, from 12 to 23 July 2016

1 3 1

18 13 14

46

23

38

16 11

15

05

101520253035404550

Nu

mb

er

of

Cas

es

Date of Onset

3

Figure 2:2 Epidemic curve for suspected cholera cases in Jonglei State

Figure 3:1 Suspected Cholera case distribution by age in Jubek State as of 23 July 2016

Out of the 199 suspected cholera cases in Jubek State, 42(21%) were female, while 157(79%) were male Figure 3:2 Suspected Cholera case distribution by age in Jonglei State as of 23 July 2016

Out of the 32 suspected cholera cases, in Jonglei State 11(34%) were female, while 21(66%) were male

4

Table 2: Case distribution by gender and age in Juba as of 23 July 2016

South Sudan

241 Jubek State 199 Jonglei State

32 Terekeka State

10

Female 60(25%) Female 42(21%) Female 11(34%) Female 7(70%)

Male 181(75%) Male 157(79%) Male 21(66%) Male 3(30%)

The probable risk factors fueling transmission include: using untreated water from the River Nile and water tankers; lack of household chlorination of drinking water; eating food from unregulated roadside food vendors or makeshift markets; open defecation/poor latrine use;, especially following the conflict.

Laboratory updates Table 3: Cholera laboratory test results for Juba as of 23 July 2016

State Health Facility Number of RDT tests

Number of cholera RDT positives

Number of stool cultures

Number of cholera Culture positives

Results

Jubek State

Juba Teaching Hospital

15 13 13 10 Vibrio Cholera Serotype Inaba

Jonglei State

Koyom Health Facility

2 2 4 Awaiting lab result

Terekeka Terekeka HF 1 1 1 Awaiting lab result

Response Activities 1. The daily cholera coordination meeting was conducted at Juba Teaching Hospital Cholera Treatment

Center (JTH CTC) to review trends and support the team to improve the quality of care. 2. Ongoing field activity using the integrated approach (surveillance, hygiene, wash and health education) in

areas with high number of cases. 3. Mapping of GIS location of cases to guide plans of action. 4. Social Mobilization and Communication and media airing of cholera prevention jingles on mobile devices

and radio and distribution of IEC Materials. 5. Monitoring of cholera dedicated line for rumors and other activities. Planned Activities • Conduct reactive oral cholera vaccination in Gorom and Giada on 25 July 2017. • Following the confirmation of cholera in Juba, the national cholera preparedness is being updated and

costed to inform the current response. • Weekly technical meeting by working group. • Continue GIS mapping of the locations of cases.

• Train rapid response teams in priority counties. • Follow up on results of pending samples in the laboratory

LibertyC

lock

Kubri

Abuba

Bilp

amR

oad

2 Gom

bura

Stre

et

Yei

Road

Kony

oko n

y oRo

ad

Unity

Avenu

e

Airport

DriveK

ony o k onyoR

oa d

AirportRoad

Gud

ele-

Mia

Saba

Roa

d

AirportDrive

Un ity

Ave nue

Konyokonyo

Road

Custo

ms

Roa

d

Yei Road

Bil p

amR

oad

Unity Road

UnityRoad

Yei

Ro a

d

Bilp

amR

oad

Yei Road

Juba-Mundri

Jebe

lRo

ad

Juba-Mundri

Jub

a -Mangalla

Airport Road

Gud

ele-

Mia

Saba

Road

MinistriesRoad

Airport R

oad

Torit-Juba

Bilpam

Road

Bilpam

Road

Juba-Lainya

Gudele RoadGudele Road

UNMISSUN House

UNMISSTongping

5

Hai Giada25

HaiAmarat

4

Hai Atlabara 'A'2

HaiGurei

3

HaiGumbo

5

Hai KatorWest

1

HaiMalakia

1

HaiMauna

3

HaiMunuki

7 Hai Juba Na Bari(Thong Ping)

11

JebelKujur

7

Hai KonyoKonyo

1

Kworjit3

RockCity

2

MiaSaba

3

HaiGudule 1

6

Lologo8

HaiJebel

3

KhorWilliam

30

JebelMarket

UnivStaff Q.

HaiNyakuron

HaiAtlabara

'B'

HaiAtlabara

'C'

HaiCinema

HaiComercial

HaiDar-el-Salam

HaiGonya

HaiJalaba

HaiNyakuron

West

HaiJerusalem

Hai JubaDay

HaiKosti

HaiKuweit

HaiMalakal

HaiMalakal

Cemetary

HaiMouna

HaiMudria

Hai MunukiBlock 'A'

Hai MunukiBlock 'B'

Hai MunukiBlock 'C'

HaiMuozifin

Hai NeemHai

Negli

Hai NimraTalata

HaiSoura

HaiSuk

Hager

HaiTarawa

HaiTemeregia

Hai Juba NaBari (Thong

Ping)

Juba AirportPremises

JubaTown

UnivCampus

Kworjik

KworjikSwamps

Luwe

MTC

MalakiaMarket

Hai Nakasongola(The ministries)

Nyaing

Prison Q.RockCity

HaiBulukHai

ZendiaHaiNyakama

HaiGudule 2

Wastewatersite

Mangaten

UnHouse

Kondokorisland

HaiJebel

HaiKator

0 31.5 Kilometers

±

- 64 cases reported from Gorom area of Rejaf are not shown on the map

- No location data available for 3 cases

Juba Town Cholera Outbreak and Response23 July 2016 Health Cluster

Data Source: Ministry of Health, Health Cluster, Open Street Map (OSM) and REACH

The names and boundaries on the maps in this document do not imply official endorse-ment or acceptance by the Government of South Sudan or IOM. This document is for planning purposes only. IOM cannot guarantee that this document is error free and therefore will accept no liability for consequential and indirect damages arising from the use of this product.

Map Created by:

Reported Cases

Oral rehydration points (ORP)

MOH/MSF - JTH (CTC)

Map Key

Sentinel site

Sentinel site + ORP

0

50

100

150

200

250

23-Jul-1622-Jul-1621-Jul-1620-Jul-1619-Jul-1618-Jul-1617-Jul-1616-Jul-1615-Jul-1614-Jul-1613-Jul-1612-Jul-16

Onset trend of suspected cases at CTC of the Juba Teaching Hospital (JTH)

Total Cholera cases

Onset of cases

199 Cholera Cases