Republic of South Sudan
Cholera in Juba, Central Equatoria State, Republic of South Sudan Situation Report # 10 as at 23:59 Hours, 1 July 2015 Situation Update As of 1 July 2015, a total of 523 cholera cases including 29 deaths (CFR 5.5%) have been reported from 75 villages in eight payams of Juba County (Table 1). The initial cases were traced back to 18 May 2015 in UN House PoC where the first cholera case was confirmed on 1 June 2015. Most of the cholera cases in Juba have been reported from New site followed by Gudele 2, Juba 3 PoC, Gumbo and Gudele 1 (Figure 4). Table 1. Summary of cholera cases reported in Juba County, 18 May – 1st July 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
IMC UN House PoC clinic
1
1
0
3
0
0
1
1
32
38
Hai Referendum IDP clinic
0
0
0
0
0
0
1
1
0
1
Juba Teaching Hospital
31
54
0
75
85
14
4
18
250
455
Al Sabah Hospital
0
0
0
0
0
2
0
2
2
4
Morobo 2 clinic
0
0
0
0
0
0
1
1
3
4
Nyakuron PHCC
0
0
0
0
0
0
1
1
0
1
Juba Military Hospital
0
0
0
0
0
0
0
0
5
5
Luri Military
0
0
0
0
0
0
1
1
0
1
St. Kizito clinic
0
0
0
0
0
0
2
2
0
2
Mauna Medical clinic
0
0
0
0
0
0
1
1
0
1
Juba Prison
0
0
0
0
0
0
1
1
0
1
MedAir Gumbo ORP
0
0
0
0
0
0
0
0
8
8
Gorom PHCC
0
2
0
0
0
0
0
0
2
2
Total
32
57
0
78
85
16
13
29
302
523
*LAMA: LEAVE AGAINST MEDICAL ADVICE
A total of 32 new cholera cases were reported in Juba on 1 July 2015. o Juba Teaching Hospital reported 31 new cases, while UN House PoC clinic reported one case. o Most new cases reported on 1 July 2015 originated from Gudele 2 and Gudele 1 (Figure 1). o Two new villages, Lupepe and Suk Juba reported cholera cases for the first time. Figure 1: New cholera cases by residence on 1st July 2015 7
7
6 5
5
Juba
Kator
Munuki
1
New site
Northern Bari
1
Juba POC 3
1
Walawalak
1
Gurei
1
Gudele
1
Gudele 2
2
1
Rock City
1
Nyakuron West
1
Mia Sava
1
Mauna
1
Hai Kuwait
1
Gudele 1
1
Gudele
1
Suk Jebel
1
Lologo 2
0
2 1
Atlabara A
1
Lupepe
2
Hai Jebel
3
Gudele Bk7
4
Suk Juba
Number of cases
8
Rejaf
1
Cumulatively, 523 cholera cases including 29 deaths (16 facility and 13 community) have been reported since the initial case was reported in Juba on 26 May 2015 (Tables 1 and 2). Of the 29 deaths, 6 (21%) have occurred in children under five years. The age-specific CFR among children under five years of age is 9.5%, which is higher when compared to the age-specific CFR of 5.5% among cases aged five years and above. Table 2: New cholera cases by facility and week in Juba, 18 May – 1st July 2015 Reporting Facility Al Sabah hospital Hai referendum IDP clinic JTH IMC UN House PoC clinic Juba Military hospital Morobo 2 clinic Nyakuron PHCC Luri Military St. Kizito clinic Mauna Medical Clinic Juba Prison MedAir Gumbo ORP Gorom PHCC Grand Total
21 0 0 0 4 0 0 0 0 0 0 0 0 0 4
New cases by epidemiological week of 2015 22 23 24 25 26 0 0 4 0 0 0 0 1 0 0 2 2 32 119 212 0 4 9 5 13 0 0 5 0 0 0 1 3 0 0 0 0 1 0 0 0 0 1 0 0 0 0 0 2 0 0 0 0 1 0 0 0 0 0 1 0 0 0 0 5 0 0 0 0 2 2 7 56 127 233
27 0 0 88 3 0 0 0 0 0 0 0 3 0 94
Grand Total 4 1 455 38 5 4 1 1 2 1 1 8 2 523
As seen from Figure 2, the initial and isolated cases were reported from UN House PoC starting on 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 1 June 2015 after Vibrio cholerae inaba was isolated from the one of five samples tested in the National Public Health Laboratory. Since 6 June 2015, sustained and consistently increasing community transmission has been established with increasingly more suspect cases reported outside UN House PoC. There are three discernable transmission peaks with the initial peak of 15 cases occurring on 13 June 2015 while the subsequent and higher peaks occurred on 20 June, 26 June and 28 June with 26, 49 and 54 cases respectively (Figure 1). Figure 2: Epidemic curve for suspect cholera cases in Juba, 18 May – 1st July 2015
Number of cases
60 50 40
Investigation and confirmation of initial case in UN house PoC Confirmation of initial case in UN house Poc
30 20 10
0 Alive
Date of onset
Died
The probable risk factors fueling transmission 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 food from unregulated roadside food vendors or makeshift markets; and open defecation/poor latrine use.
2
Figure 3: Spot map for suspect cholera cases by residence in Juba, 18 May – 30 June 2015
As of 1 July 2015, the sites reporting the majority of cases in Juba include New site, Gudele 2, Juba 3 IDP, Gumbo and Gudele 1. Nonetheless, there are satellite cases distributed in eight payams and 75 villages in Juba County (Figure 3 and 4). Figure 4: Cholera cases by residence in Juba, 18 May – 1 July 2015 60
Number of cases
50 40 30 51 43
20 28
10 1
1 3 2
5
11 4 3 2 3 1 2 1 2 1 1 1 1 2
20
14
11 1
7
1
4 2
6
12 1
17
16
11 3 2 3
8
4
4 2 1 3 1 3 1
9 1 2 2
8
5
4 2 2 1
1
2 3 2
1 2 1 1
Juba Nabari Hai Amarat Juba Tongping Korobou Gabat Hai Jalaba Buluk Hai Zendia Nimra Talata Makas Sabab Game Juba Prison Airport Hai Soura Hai Malakal Hai Commercial Joborona Suk Juba Lupepe Hai Kos Kator Lologo Malakia Giada Atlabara Suk Sita Konyokonyo Atlabara A Suk Jebel Bongoroke Nyakuron West Munuki Gudele Mauna Jopa Luri Jebel Kujur Nyakuron Gudele 1 Dar es Salam Gudele Hai Kuwait Hai Tharawa Mia Sava Rock City Hai Seminary Hai Jebel Juba Nabari New site Suk Zande Walawalak Bilpam Gurei Mangatain IDP Gorom Gudele 2 Hai Referendum Lemon Gabah Jebel Lado Kabo Gumbo Mijiki Kor William Checkpoint Digala Kor Romula Juba 3 PoC Jebel Yesua Lokiliri Nesitu Jezira
0
21 9 7
39
38
32
Juba
Kator
Munuki
Northern Bari
Rejaf
Lokiliri Gondokoro
Out of the 512 suspect cholera cases with known age, 68 (13%) were children less than five years of age, while 444 (87%) were individuals five years and above (Figure 5).
3
Figure 5: Suspect case distribution by age in Juba, 18 May – 1 July 2015
13%
