Sudan

Situation Report
Feature

The early and timely response to the cholera outbreak saves lives and resources

On 2 September 2019, Blue Nile State Ministry of Health (SMoH) reported five suspected cholera cases from El Roseires hospital. The index case was reported from the Ganees Al Shareg area of El Roseires locality with the date of onset of symptoms being 28 August 2019. On 8 September, the Federal Ministry of Health (FMoH) declared a cholera outbreak in Blue Nile after receiving positive laboratory results confirming the presence of Vibreo Cholerae in four out of six samples collected from the affected state. The previous cholera outbreak 2016 -2018 started primarily in Kassala and Blue Nile states and eventually spreading to all 18 states across Sudan.

The response started as early as 2 September and on 11 September WHO/FMOH conducted the first joint health and WASH cluster meeting on cholera response in Blue Nile.

As of 17 December 2019, 346 suspected cholera cases (including 11 deaths) were reported from Blue Nile, Sennar, Al Gezira and Khartoum states, according to FMoH. The case fatality rate (CFR) is 3.2 per cent.

According to WHO, there are two scenarios or patterns that can play out in any cholera outbreak. One is characterized by delayed outbreak detection, laboratory confirmation and response. In this scenario/pattern, there is little room for control of the outbreak as by the time response starts the outbreak (and the number of new cases per day) is already in the downward trend.

Another scenario/pattern features early detection, lab confirmation and response. This scenario has a much larger opportunity to prevent new cholera cases, avert deaths and saves time and resources to be spent on response.

During the second half of September, WHO experts visiting Sudan had estimated that without proper and timely interventions there could be between 5,000 and 13,200 cholera cases within six months (between September 2019 and February 2020). The projections were created based on the pattern of previous cholera/AWD outbreaks from 2016-2018, which can be characterized as the “delayed outbreak detection and response” case.

The information available and latest figures indicate that the prompt response and mitigation measures by all health sector partners led by FMoH have resulted in a much lower total caseload and spread control, compared to the previous 2016-2018 outbreak when about 37,000 cases were reported and should be considered as a successful early detection and response case. Half-way through this period forecast period, the reported number of cholera cases is way below the projected scenario that the WHO expert team developed.

This is attributed to the early detection, reporting and early response and mitigation measures taken at the right time. Thousands of potential cholera cases were prevented, deaths were averted, and time and resources were saved.

This was mainly due to the following concrete actions and their implementation:

  • A 3-month (October-December 2019) US$20.3 million cholera readiness and response plan was developed.

  • Early detection and announcement of the outbreak.

  • Early mobilization of health partners and providing surge capacity to affected areas.

  • Activation of the emergency operation centers (EOC) in affected states.

  • Effective information sharing and reporting by the State Ministries of Health (SMoH) and FMoH.

  • Early activation and support of cholera treatment centers and isolation wards with provision of cholera treatment kits.

  • The first round of the oral cholera vaccination (OCV) campaign in eight high-risk localities in Blue Nile and Sennar states.

  • This was complemented by aggressive WASH interventions, including water chlorination, sanitation and health and hygiene awareness campaigns.

  • In 2019, the Sudan Humanitarian Fund (SHF) allocated $11 million to floods and cholera outbreak response, with most of the relevant projects combined to respond to cholera cases.

The data on cholera cases shows that the cholera outbreak has been on a downward trend and since early November, 14 new cholera cases were reported, with 0 new cases reported during some weeks.

Way forward and recommendations:

The outbreaks of water-borne diseases, like cholera and AWD, usually follow the rainy season and the subsequent floods. Both 2016-2018 and 2019 outbreaks started after the rainy season and floods and the weekly number of cases for both peaked during the week 38 suggesting a convergence of various factors - rains, floods and contamination of water sources – during that particular time.

Looking ahead to 2020, the government and health partners can save lives, avert hundreds of cholera cases and save time and resources by acting early:

  • Updating rainy season and floods response plans.

  • Pre-positioning of essential medicine and supplies and kits.

  • Ensuring the readiness of disease surveillance, availability of trained rapid response teams (RRTs), and sufficient laboratory capacity in states and at federal level for early confirmation of an outbreak.

  • WASH interventions to minimize contamination and mitigate the cases.

  • Allocate sufficient funds early to ensure the best return on investment.

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