Background and Context
• While cholera cases have decreased in and around Juba, new cases have been reported in Mingkamen. The situation in Mingkamen IDP site is of concern given crowded areas and lack of sanitation facilities.
• UNICEF has scaled up preparedness and response activities and is using a twofold approach to contain the disease in the areas of active transmission and control spread, while simultaneously preventing the occurrence of outbreaks in other areas at high risk.
• Unimpeded humanitarian access is needed to enable UNICEF and partners to respond to cholera outbreaks and prevent further spread of the disease.
Current Epidemiology
Cholera remains endemic in South Sudan as evidenced by recurrent outbreaks during the main rainy seasons. Factors that promote recurrence of these outbreaks are poor sanitary conditions and sub-optimal hygiene practices. While the annual caseload of cholera in South Sudan has progressively decreased in the past several years, Case Fatality Rates have consistently been above the threshold of 1%. Above-threshold case fatality rates are due to health service access challenges, including inability to access health services in a timely manner, and poor case management at the health service delivery points.
As of 26 August, the total number of cholera cases that have been officially reported was 1,484 with 25 deaths. The overall CFR has decreased from 7.4% to 1.7%. CFR in Juba has in fact been below the threshold of 1% since 10 August. This trend reflects considerable improvement in community awareness that leads to timely access to health services and better case management. A gradual decline in the community transmission is also apparent with the progressive decrease in the number of cases reported daily in Juba, Duk, and Terekeka.
Despite the apparent stabilisation of transmission in the initially affected locations, the outbreak appears to be spreading beyond the cholera hotspots to areas that were not initially targeted by preparedness activities, with a number of cases reported in Mingkamen and alerts in Kajo-Keji and Nimule. The situation in Mingkamen IDP site is particularly concerning. Thirty-one cases and two deaths have been reported between 14-28 August, with a CFR of 6.5%. Given the high population density, it is estimated that, should an outbreak occur, the anticipated total cholera cases would be around 5,7501 , of which 1,150 would present severe symptoms needing in-patient care.