09 June 2014, Juba – On 15 May 2014, the Ministry of Health declared an outbreak of cholera in Juba, South Sudan. Since then, many cases have been reported in Juba and areas outside of Juba. With increased surveillance in all states in South Sudan, many alerts are being received by the Ministry of Health, investigated and verified; by 07 June 2014, MoH and WHO had received 25 alerts. As of 7 June 2014, a total of 1,459 cholera cases including 31 deaths (17 institutional and 14 community deaths, CFR 2.12%) had been recorded since the first suspected case was reported on 23 April 2014.
Confirmed cases have been reported in Juba including inside Tongping and UN House Juba III IDP camps, Kajo Keji, Yei and Kaka. A total of four cases have been confirmed in Tongping and three in UN House Juba III. Outside the camps, cases have been reported from eleven Payams namely; Gumbo in Rejaf, Gudele I in Munuki, Tongping in Juba, Giada in Kator, and Gurei in Northern Bari with the most affected areas being Munuki (26.9%).
Evidence of the cases reported shows that more cases have been reported outside the camps as compared to inside the PoC areas, this could partly be explained by the oral cholera vaccination campaigns that took place in the camps and have offered protection to the community coupled with improved water supplies in the camps which is treated. A total of 13,443 IDPs and in Tongping and 6,205 in UN House Juba III have received two doses of the oral cholera vaccine.
Over the past few weeks, we are seeing a reduction in the number of cases seeking care at the CTCs. Although this reduction is being recorded at Juba Teaching Hospital and other CTCs namely; Gurei, Tongping and UN House Juba III, many areas outside of Juba continue to report alerts. It is therefore too early to conclude that the outbreak has been contained.
Together with health partners, the Ministry of Health initiated a cholera response to interrupt the spread of cholera as well as to manage current cases. National and state taskforces have been reactivated to coordinate the response. The response is being conducted as follows:
Case management: cholera treatment centres/units (CTCs/CTUs) have been set up to treat people; points at community where people can receive oral rehydration solution to prevent dehydration (Oral Rehydration Points), disinfection of patients’ households and bodies, and funeral supervision;
Surveillance: all rumours and reports are being investigated, data from cholera treatment centres (CTCs) analysed including information on affected areas and risk factors-used to inform the response;
Water, Hygiene and Sanitation (WASH): chlorination of trucked water, provision of chlorine tablets and PuR sachets to treat water at household level; provision of soap for hand washing as well as hand washing stations; disposal of waste, waste management in common areas e.g. markets;
Social mobilization: messages through the media-infomercials on 5 steps for cholera prevention, posters/flyers on cholera prevention and control, community mobilization using public address systems, video shows, house to house visits, meetings with politicians, religious and community leaders, announcements at mosques and churches and radio talk shows.
Although every effort is being made to reach all communities with the cholera prevention message, there are still a lot of risk factors for cholera in and outside Juba. Many people continue to drink unboiled /untreated water, some directly from the river, and consume unhygienically prepared food. Many communities continue to practise open defection, very few have and properly use pit latrines. Few people consistently wash their hands with soap/ash at the critical times-before and after handling and eating food, after using the toilet, handling babies’ faeces.
The operation costs for this response are high, thus a need for more resources to continue supporting the ongoing activities at the community level including community surveillance and CTCs. With more resources we shall have a wider community reach.
The Ministry of Health would like to urge all communities to be on high alerts, remain vigilant and report any suspected case of acute watery diarrhoea and seek immediate and early treatment. Two hotline numbers remain operational: 9999 for Gemtel and 0952000098 for Viva cell for reporting cholera cases and ambulances are available to respond to emergencies.