Sudan: Cholera outbreak Flash Update No. 4, As of 4 December 2023

HIGHLIGHTS

• Sudan declared a cholera outbreak in Gedaref on 26 September. At least 5,178 suspected cholera cases, including 161 associated deaths, have been reported.

• Cholera has spread to 46 localities in Aj Jazirah, Blue Nile, Gedaref, Kassala, Khartoum, Red Sea, Sennar, South Kordofan, and White Nile states as of 28 November.

• Humanitarian agencies are scaling up the response to the outbreak, supporting the detection and treatment of cases. They are also addressing water, sanitation and hygiene issues, conducting water quality monitoring and chlorination, and risk communication and community engagement.

• Surveillance is ongoing in affected and high-risk areas to identify and address risk factors.

• Oral cholera vaccination campaigns have been organized in Gedaref and Aj Jazirah states reaching 98 per cent of the targeted 2.2 million people.

SITUATION OVERVIEW

As of 2 December 2023, at least 5,178 suspected cases of cholera, including 161 associated deaths (case fatality rate of 3.1 per cent), were reported from 46 localities of nine states, according to the Federal Ministry of Health (FMoH) and the World Health Organization (WHO) Sudan Outbreaks Dashboard. To date, there are 1,808 suspected cases of cholera and 48 associated deaths in Gedaref; 1,345 suspected cases and 23 associated deaths in Aj Jazirah; 684 suspected cases and 28 associated deaths in Red Sea; 463 suspected cases and 26 associated deaths in Khartoum; 346 suspected cases and eight associated deaths in South Kordofan; 399 suspected cases and 22 associated deaths in White Nile; 69 suspected cases and three associated deaths in Sennar; 63 suspected cases and three associated deaths in Kassala; and one suspected case in Blue Nile.

Oral Cholera Vaccine (OCV) Vaccination Campaign

The Oral Cholera Vaccine (OCV) stock is managed globally by the International Coordination Group (ICG). Currently, the global stockpile is critically low. Despite this, Sudan received approval for around 2.9 million OCV doses for Gedaref, Aj Jazirah and Khartoum states, which is 35 per cent of the global stockpile, of which 2.2 million doses have already been used in campaigns in Gedaref and Aj Jazirah. WHO and UNICEF coordinated with the authorities to manage the preparation and implementation of the campaign. Vaccine doses for Khartoum are expected to arrive in early December for the planned vaccination campaign in the same month. 

RESPONSE

Following the declaration of a cholera outbreak in September in Sudan, the World Health Organization (WHO), the UN Children’s Agency (UNICEF) and partners activated an Inter-agency Multi-cluster Cholera Action Plan and established national and state public health emergency operation centres (EOC) with the Federal and State Ministries of Health. The outbreak response is organized by pillars of coordination, disease surveillance, laboratory, case management, water, sanitation and hygiene (WASH) supplies, risk communication and community engagement (RCCE), and OCV.

In terms of the main cholera control measures, partners are focusing on support for the Public Health Emergency Operation Centres (PHEOC) and Cholera Taskforce PHEOC at all levels to analyze and provide daily situation reports to inform the response planning; support the Community-based Surveillance (CBS) system for early detection and confirmation of cases; ensuring access to water, sanitation and hygiene (WASH) facilities in each oral rehydration therapy (ORT) corner.

Humanitarian organizations are participating in the Cholera Taskforce and supporting the PHEOCs at all levels to analyse and provide daily situation reports to inform the response planning; support the community-based Surveillance (CBS) system for early detection and confirmation of cases; ensure access to WASH facilities; support management of cholera cases in cholera treatment centres and units; and build the capacity of health care workers for disease surveillance, case management and infection prevention and control at health facilities.

UNICEF provided technical support, including logistics and delivery to states, and supported the implementation of OCV awareness-raising campaigns and improving the cold chain for proper vaccine management for the immunization programme of Sudan. This includes the procurement of 10 cold rooms for six states; 10 ice pack freezers; 40 ice-lined refrigerates (400 litres); 600 cold boxes and 2,000 vaccine carriers to replenish those destroyed during the conflict; and 280 units of 30-day electronic temperature logger.

All States: 5,178 suspected cases and 161 associated deaths, with a case fatality rate (CFR) of 3.1 per cent.

Coordination: WHO and UNICEF are actively supporting cholera task force meetings jointly with the water, sanitation and hygiene (WASH) Cluster. In addition, joint monitoring is ongoing, including health, nutrition, social and behaviour change (SBC), and WASH cluster participation.

Health: WHO is supporting cholera treatment centres (CTCs) through the provision of supplies, covering operational costs and staff incentives, and supports State Ministries of Health (SMoH) and health partners with the provision of cholera kits that contain medicines, supplies and equipment for cholera treatment. WHO also trains health workers in surveillance, case management of cholera and infection prevention and control; and has trained and helped deploy rapid response teams to affected and at-risk localities. The Early Warning, Alert and Response System launched through WHO support is contributing to real-time data collection and reporting for enhanced disease surveillance. WHO teams are also on the ground conducting water quality monitoring and distribution of chlorine tablets in communities.

UNICEF is supporting CTS and ORT corners with supplies and direct incentive payments; capacity-building for service providers; and support to the Cholera Outbreak Coordination Forums in Gedaref, Aj Jazirah, White Nile, Kassala, Red Sea, Sennar, Blue Nile, and Khartoum states. Supplies are released to affected states through the respective SMoHs and NGO partners.

WASH: The provision of safe drinking water, water chlorination and water quality monitoring, and hygiene promotion/cleaning campaigns are ongoing in Gedaref, Aj Jazirah, White Nile, Kassala, Red Sea, Sennar, and Blue Nile states, as well as providing supplies to Khartoum.

Challenges:

• Limited water quality treatment and monitoring due to inadequate staffing at respective SMoHs.

• Limited supplies and monitoring support for water chlorination.

• Limited resources to support the scale-up of WASH services.

• Improper waste management due to the lack of engagement of locality administration units.

• Access issues, especially for the OCV vaccination in Khartoum and awareness campaigns on cholera outbreak prevention, hygiene practice messages and vaccination against cholera.

Gedaref State: 1,808 suspected cholera cases and 48 associated deaths, with a CFR of 2.7 per cent.

• The OCV vaccination campaign in Gedaref State targeted over 1.57 million people in 6 localities, of whom 97 per cent were reached.

• The Rapid Response Mechanism Partners (RRM) — the Danish Refugee Council (DRC), Norwegian Refugee Council (NRC) and Save the Children (SC) — funded by the European Union (EU) have provided more than 13,300 people with cholera response assistance in the state. This includes:

  • Distribution of 5,000 bars of soap.

  • Distribution of hygiene kits for more than 7,300 people.

  • Awareness session on cholera prevention and best hygiene practices in coordination with the SMoH.

  • Provision and transportation of 180 kg of chlorine to the SMoH to support mass chlorination activities.

  • Establishment of one CTC with a 30-bed capacity, and providing furniture, medical equipment, training of health care providers, printing case management protocols, supplies, incentives for health care workers, WASH facilities, and infection prevention and control system.

• A mobile medical team from the International Organization for Migration (IOM) continues to support cholera response efforts with the initial phase of management of four suspected cholera cases, which were transferred to the Gedaref CTC.

• IOM has supported the launch of the SMoH cholera vaccination campaign with logistical support and health awareness raising.

Aj Jazirah State: 1,345 suspected cholera cases and 23 associated deaths, with a CFR of 1.7 per cent.

Response:

• The OCV vaccination campaign in Aj Jazirah State targeted about 693,000 people in one locality, of whom 99 per cent were vaccinated.

• UNICEF is supporting the establishment of 28 ORT corners in cholera outbreak sites in the state with the SMoH, health partners and the international NGO Médecins Sans Frontières (MSF).

• In Wad Madani, RRM partners rehabilitated the water source and its connection to a CTC; supported SMoH health workers who are doing water quality testing with incentives; and handed over 180 kg of chlorine to support the mass chlorination of water points.

Khartoum State: 463 suspected cholera cases and 26 associated deaths, with a CFR of 5.6 per cent.

Response:

• WHO and UNICEF are delivering AWD/cholera kits, primary health care (PHC) medicines and supplies to Khartoum through convoys arranged by OCHA and through the SMoH to main hospitals (Alnaw, Alban Jadid, Bashaer, Albuluk Paediatric, Omdurman, Jebel Awlia, Aj Jazirah Island, and Sororab), as well as to South Sudanese refugee camps in Jebel Awlia locality. The medicines and supplies released are enough to treat 600 cholera patients and to cover 100,000 mothers and children at PHC level. Awareness campaigns on cholera outbreak prevention and hygiene practice messages were carried out in Omdurman and Karrari reaching 1,000 people.

• Awareness campaigns, house-to-house visits and the training of volunteers are ongoing in Karrari and Um Bada localities.

White Nile State: 399 suspected cholera cases and 22 associated deaths, with a CFR of 5.5 per cent.

Response:

• NRC in coordination with the SMoH is developing a cholera response plan following a cholera alert in Ad Diwaim locality.

• IOM has distributed 1,000 hygiene kits as part of hygiene promotion activities in Ad Diwaim locality.

• IOM is supporting a mobile medical clinic, with health education and hygiene promotion activities at the clinic site and in Aj Jabalain locality, targeting about 600 people (331 families)

Red Sea State: 684 suspected cholera cases and 28 associated deaths, with a CFR of 4.1 per cent.

South Kordofan State: 346 suspected cholera cases and 8 associated deaths, with a CFR of 2.3 per cent.

Sennar State: 69 suspected cholera cases and 3 associated deaths, with a CFR of 4.3 per cent.

Kassala State: 63 suspected cholera cases and 3 associated deaths, with a CFR of 4.8 per cent.

Blue Nile State: 1 suspected cholera case.