South Sudan has suffered from perennial cholera outbreaks with devastating effects on the health, wellbeing, and socio-economic status of the people. Since the 2013 crisis, cholera cases have been reported every year between 2014-2017 (at least 28,676 cases including 644 deaths) in major urban centres such as Juba, in internally displaced populations and cattle camps, flood affected locations, and other locations with inadequate access to safe water, sanitation and hygiene (WASH) [1]. A cholera outbreak was declared by the government on 7 May 2022 in Rubkona country and as part of the ongoing response and preventive measures, two rounds of pre-emptive Oral Cholera Vaccination (OCV) campaigns were implemented [2]. WHO South Sudan financially supported the procurement of vaccines and provided technical assistance to vaccination teams in the county and strategic guidance at national level. As of week 42, (17-23 October) of 2022, zero new cases were reported from Rubkona county and zero cases in admission in cholera treatment units. 

How did South Sudan, with the support of the WHO Secretariat, achieve this?

Cholera is an acute diarrhoeal infection caused by ingestion of food or water contaminated with the bacterium Vibrio cholerae. It remains a global threat to public health and an indicator of inequity and lack of social development. A multifaceted approach is key to control cholera, and to reduce deaths. When used along with improved access to safe water, sanitation and hygiene, two-doses of oral cholera vaccine are very effective for cholera prevention, giving protection to those at risk. Currently there are three three WHO pre-qualified oral cholera vaccines (OCV : Dukoral®, Shanchol™, and Euvichol-Plus®. All three vaccines require two doses for full protection.

Since 2017, WHO South Sudan has supported the national authorities and partners to set up and implement WHO’s Early Warning, Alert and Response System (EWARS) to improve disease outbreak detection in emergency settings, such as in countries in conflict or following a natural disaster. The EWARS was rolled out to all the 80 counties of South Sudan with the second phase of the rollout further decentralizing data collection and alert management down to the health facility level from 2019 to early 2020 to improve disease outbreak detection in emergency settings. WHO supported this through the EWARS server, capacity building, development of guidelines and directives, procurement of ICT equipment and technical support for the routine functioning of the system.

In anticipation of a cholera outbreak due to the unprecedented floods in 2021 in Rubkona county with persistent flood waters which are often used for bathing and playing, and following the government declaration, over 1.6 million doses of OCV were received in South Sudan.  As of 31 December 2022, over 1.5 million OCV doses have been administered in the areas of Awerial, Leer, Yirol East, Rubkona, Malakal and Juba to build herd immunity against cholera. WHO South Sudan secured and deployed oral cholera vaccines in collaboration with government and partners, through supporting the national emergency preparedness and response department of the Ministry of Health and providing overall strategic, financial, and technical support for prevention and control of infectious diseases. WHO South Sudan also provided technical support on surveillance measures and investigation through support on reporting, collation, analysis, and dissemination of cholera situation reports and provided technical guidance on WASH measures in health facilities. Furthermore, in keeping with the holistic approach to the response, technical assistance was provided for water quality testing and treatment, and waste management, community engagement and risk communication, and case management and infection prevention and control. Rapid response teams were also deployed to support state and county level investigation and response activities. This included the development and distribution of cholera control guidelines, reporting and monitoring tools as well as the provision of cholera case investigation and treatment kits.