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Republic of South Sudan

Cholera in Juba, Central Equatoria State,


Republic of South Sudan
Situation Report # 2 as at 23:59 Hours, 23 June 2015
Situation Update
As of 23 June 2015, a total of 206 cholera cases including 19 deaths (CFR 10%) have been reported from 47
villages in seven payams of Juba County (Table 1).
The initial cases were traced back to 18 May 2015 in UN House PoC, which has reported the majority of the
cases followed by New site, Mangatain IDP, Gumbo, Kor William, Gudele 1 and Munuki.
Table 1. Summary of cholera cases reported in Juba County, 18 May 23 June 2015
Reporting Sites

New
admisions

New
discharges

New
deaths

Total cases
currently
admitted

LAMA*

Total
facility
deaths

Total
community
deaths

Total
deaths

Total cases
discharged

Total cases

UN House PoC clinic

17

22

Hai Referendum IDP clinic

Juba Teaching Hospital

16

19

60

12

84

165

Al Sabah Hospital

Morobo 2 clinic

Nyakuron PHCC

Juba Military Hospital

Luri Military

St. Kizito clinic

Mauna Medical clinic

Total

16

22

62

12

10

19

111

206

*LAMA: LEAVE AGAINST MEDICAL ADVICE

Epidemiological updates
Sixteen new cholera cases were reported in Juba on 23 June 2015.
o All the new cases were reported by Juba Teaching Hospital
Cumulatively, 206 cholera cases including 19 deaths (nine facility and 10 community) have been reported
since the initial case was reported in Juba on 26 May 2015 (Tables 1 and 2).
Table 2: New cholera cases by facility and week in Juba, 18 May 23 June 2015
Reporting Facility
Al Sabah hospital
Hai referendum IDP clinic
JTH
Juba 3 IMC clinic
Juba Military hospital
Morobo 2 clinic
Nyakuron PHCC
Luri Military
St. Kizito clinic
Mauna Medical Clinic
Grand Total

New cases by epidemiological week of 2015


22
23
24
25
26
4
1
2
2
31
115
15
4
4
9
5
5
1
3
1
1
2
1
4
2
7
55
123
15

21

Grand Total
4
1
165
22
5
4
1
1
2
1
206

As seen from Figure 1, the initial and isolated cases were reported from UN House PoC starting 26 May 2015.
However, following epidemiological investigations on 27 May 2015, cases could be traced back to 18 May
2015. Cholera was eventually confirmed on 1June 2015 after Vibrio cholerae inaba was isolated from the one
of five samples tested in the National Public Health Laboratory.
1

Since 6 June 2015, sustained and consistently increasing community transmission has been established with
more suspect cases being reported outside UN House PoC. There are two discernable transmission peaks
with the initial peak of 15 cases occurring on 13 June 2015 while the subsequent and higher peak of 25 cases
occurred on 20 June 2015 (Figure 1).
Figure 1: Epidemic curve for suspect cholera cases in Juba, 18 May 23 June 2015

25
20

Investigation & Confirmation of


initial case in UN house Poc
Confirmation of initial
case in UN house Poc

15
10

Date of onset

6/24/15

6/22/15

6/20/15

6/18/15

6/16/15

Died

6/14/15

6/12/15

6/10/15

6/8/15

6/6/15

6/4/15

6/2/15

5/31/15

Alive

5/29/15

5/27/15

5/25/15

5/23/15

5/21/15

5/19/15

5/17/15

5
5/15/15

Number of cases

30

The majority of suspect cholera cases in Juba have been reported from Juba 3 IDP, New site, Mangatain IDP,
Gumbo, Kor William, Munuki and Gudele 1 (Figure 2).
Figure 2: Spot map for suspect cholera cases by residence in Juba, weeks 21- 26 of 2015

As of 23 June 2015, the sites reporting the majority of cases in Juba include UN House PoC, New site,
Mangatain IDP, Gumbo, Munuki and Kor William (Figure 3). There are satellite cases distributed in seven
payams and 47 villages in Juba County.
Intensive interventions in the form of social mobilization and health education on cholera presentation and
prevention, improving access to safe drinking water, latrine use and good personal and food hygiene are
therefore required to prevent further escalation in Juba and spread to other counties outside Juba.
Figure 3: Suspect cholera cases by residence as at 23 June 2015

20
23

Juba

Juba Nabari

Kator

Munuki

12

Northern Bari

1 1 1 1

Rejaf

Digala

Lokiliri

Gorom

New site

Kor Wiliam

1 1 2 1

Gurei

2 1 1

Walawalak

2 1 3

16

13

Hai Kuwait

Gurei

4 4 3

Gudele 2

Atlabara

Giada

Jopa

Gudele

23

10

Nyakuron West

Lologo

3 2
3 2
1 2 1

Hai Kosti

6 5

Hai Zendia

Nimilatalata

Hai Amarat

Tongping

11

Gudele 1

10

Gumbo

15

Hai Jalaba

Number of cases

25

Lokiliri

Out of the 199 suspect cholera cases with known age, 27 (14%) were children less than five years of age,
while 172 (86%) were individuals five years and above (Figure 4).
Figure 4: Suspect case distribution by age in Juba, week 21 to 25 of 2015

14%
<5yrs
5+yrs

86%

Out of the 199 cholera cases with known gender, 83 (42%) were female, while 116 (58%) were male (Table
3).
Table 3: Case distribution by gender and age as at 23 June 2015

Gender and age


Female
<5yrs
5+yrs
Male
<5yrs

N (%)
83 (42)
10
73
116 (58)
17
3

Gender and age


5+yrs
Grand Total

N (%)
99
199 (100)

The probable risk factors identified include: residing in a crowded IDP camp with poor sanitation and hygiene;
using untreated water from the Water tankers; lack of household chlorination of drinking water; eating unsafe
food from unregulated roadside food vendors; eating food from unregulated roadside food vendors or
makeshift markets; and open defecation/poor latrine use.

Laboratory updates
Table 4: Cholera laboratory test results for Juba, 18 May 23 June 2015
Health Facility
1
2
3
4
5

Number of sample
collected
2
40
22
3
2
69

Al Saba hospital
Juba Teaching Hospital
Juba 3 PoC clinic
Juba Military Hospital
Morobo 2 clinic
Total

Number of cholera
RDT positives
0
24
16
2
2
44

Number of cholera
Culture positives
2
7
9
2
1
21

A total of 69 stool samples have been collected from suspect cholera cases in Juba and submitted to the
National Public Health Laboratory for testing (test results by facility shown in Table 4).
The National Public Health Laboratory has confirmed 21 cholera cases following the isolation on Vibrio
cholerae inaba. Most of the culture confirmed cases have been reported from Juba 3 PoC and New site
(Figure 5).

Number of cases

Figure 5: Number of culture positives by residence as at 22 June 2015


10
9
8
7
6
5
4
3
2
1
0

9
4
1

Cholera Response Highlights


1. Urgent and lifesaving cholera response activities have been initiated by the national cholera taskforce in
response to the increasing number of cases in Juba.
2. The cholera response strategy is being reviewed and updated to suit the current context and to facilitate
mobilization of resources to control the outbreak.
3. The national Epidemic Preparedness and Response committee convened on 24 June 2015 to review the
current cholera situation and response interventions.
4. Oral cholera vaccination campaigns are underway in Bentiu PoC and UN House PoCs with Bentiu PoC
implementing the second round of vaccination while UN House PoC is implementing its first round of
vaccination. The vaccination in the two sites is expected to end on 25 June 2015 with a possibility of
extending to 26 June 2015 to mop up unvaccinated individuals.

Urgent needs
1. Partners to support Juba Teaching Hospital cholera treatment center (CTC) and set up oral rehydration
points (ORP) in Gumbo, New site, Mangatain IDP, Gudele, Nyakuron, Munuki and Kator.
2. Standby ambulances to support the transfer of cases to designated treatment centers.
4

3. Stricter monitoring of water tankers by the Riverside and field surveillance to ensure water delivered to
households conforms to the minimum free residual chlorine levels.
4. Urgently train and deploy home hygiene promoters to cholera hotspots for house-to-house sensitization
on cholera prevention; active case finding and reporting; initiating oral rehydration treatment for new
cases and referral to oral rehydration point or cholera treatment center; and distributing water purification
tablets.

Planned activities
1. The cholera coordination meeting in UN House PoC is scheduled for 25 June 2015 in the RRP boardroom
starting 11:30 am.
2. The national cholera taskforce meeting takes place weekly.
3. Finalizing sub-committee response strategies and plans ready for presentation at the next national
cholera taskforce meeting.

Many thanks to the staff at CTCs, MoH at national level and state levels, especially the Department of IDSR, who have
helped to gather the information presented here.
Situation Reports are posted on the WHO website:
http://www.who.int/hac/crises/ssd/en/
as
well
as
on
the
Humanitarian
Info
webpage:
http://southsudan.humanitarianresponse.info/clusters/health.
The MoH/WHO surveillance team welcomes feedback and data provided by individual agencies. Given the fast evolving
nature of this epidemic, errors and omissions are inevitable: we will be grateful for any information that helps to rectify
these. Send any comments and feedback to: E-mail: outbreak_ss_2007@yahoo.com, The Toll free numbers for alerts
are: Zain: 0912000098.

Contacts
For more information please contact:
Dr. John Rumunu
Director General - Preventive Health Services
MoH, Republic of South Sudan
Tel: +211955668178

Dr. Thomas Akim Ujjiga


Ag. Director - IDSR
MoH, Republic of South Sudan
Tel: +211955150406

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