Professional Documents
Culture Documents
New
admisions
New
discharges
New
deaths
Total cases
currently
admitted
LAMA*
Total
facility
deaths
Total
community
deaths
Total
deaths
Total cases
discharged
Total cases
17
22
16
19
60
12
84
165
Al Sabah Hospital
Morobo 2 clinic
Nyakuron PHCC
Luri Military
Total
16
22
62
12
10
19
111
206
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
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
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
N (%)
83 (42)
10
73
116 (58)
17
3
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
9
4
1
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