WEEKLY BULLETIN ON OUTBREAKS
AND OTHER EMERGENCIES
Week 11: 10 - 16 March 2025
Data as reported by: 17:00; 16 March 2025
...
South Sudan
Cholera
40 231 Cases
694 Deaths
1.7% CFR
EVENT DESCRIPTION
The cholera outbreak first reported in South Sudan
in epidemiological week 39, 2024 (week starting 23
September 2024) continues to unfold. In week 10 (week
starting 10 March 2025), a total of 922 new cases with
nine (9) deaths were reported across nine states and
two administrative areas. The majority of new cases were
recorded in Unity State (n=268), Northern Bahr el Ghazal
(n=227), and Jonglei (n=112), which together accounted
for 65.8% of the new cases. New deaths were reported
from Unity (n=2), Jonglei (n=2), Eastern Equatoria (n=2),
Central Equatoria (n=1), Lakes (n=1), and Warrap (n=1)
states. Due to delays in data transmission and collation,
the actual number of cases and deaths in the last two
weeks (weeks 10 and 11) is likely higher than currently
reported.
As of 16 March 2025, South Sudan has reported a
cumulative total of 40 231 cholera cases with 694
deaths (CFR 1.7%) from nine (9) states and two (2)
administrative areas. The majority of cases have been
recorded in Unity (n=17 372), Northern Bahr el Ghazal
(n=6 751), Jonglei (n=5 475), Central Equatoria (n=5
009), and Upper Nile (n=3 949) states, accounting for
95.8% of the tottal caseload. Females represent 50.6%
(n=20 361) of all reported cases. Among 40 156 cases
with known age, children under five years constituted
28.0% (n=11 231). The highest case fatality ratio (CFR
4.4%) is observed among individuals aged 50 years and
above, who account for 8.5% (n=3 418) of cases.
After a steady rise from the onset, the outbreak peaked
in epidemiological week 51 (week starting 16 December
2024), when 5 162 cases with 101 deaths were reported.
This was followed by a gradual decline until week 06
(week starting 3 February 2025), when 1 589 cases with
22 deaths were recorded. However, case numbers have
risen again in the recent three weeks. Most cases are
from host community (69%) while Internally-displaced
populations (IDPs) and refugees represent 12.2% and
6.4% of the total cases respectively. The weekly case
fatality ratio has also increased consistently over the past
six weeks, reaching 2.1% as of week 10 (week starting 3
March 2025).
South Sudan has conducted multiple targeted oral
cholera vaccination (OCV) campaigns across four (4)
high-burden states, targeting 4 038 037 people. The
campaign achieved a 92.3% coverage, with 3 726 378
individuals vaccinated.
PUBLIC HEALTH ACTIONS
A multisectoral platform under the Ministry of Health
of South Sudan, with support from WHO and health
partners, continues to coordinate the national cholera
response efforts. At the state level, task forces have been
activated to respond to the outbreak.
Cross-border coordination mechanisms with
neighbouring countries, particularly Ethiopia and Sudan,
have been established for information sharing and
coordinating cholera outbreak response efforts among
refugees and host communities in bordering areas.
Since October 2024, WHO has supplied over 53 tons of
medical supplies to cholera-affected areas, including
cholera treatment kits, rapid diagnostic tests (RDTs),
Cary Blair transport media, and triple packaging.
Surveillance activities continue across the country.
Rapid response teams have been deployed to support
outbreak investigations and enhance active surveillance
for cholera in the affected states. Surveillance for cholera
is ongoing at points of entry and transit sites, particularly
among refugees fleeing crises in neighbouring countries
and internally displaced populations.
Routine specimen collection and testing using rapid
diagnostic tests (RDTs) are ongoing. Sample collection
kits have been prepositioned in the affected states and
administrative areas.
Several health partners, including Médecins Sans
Frontières (MSF), International Medical Corps (IMC),
International Organization for Migration (IOM), and
others, are supporting the clinical management of
cholera cases at Cholera Treatment Units (CTUs) and
Cholera Treatment Centres (CTCs) in affected areas.
Oral Rehydration Points (ORPs) have been established
in some hard-to-reach areas to stabilize patients before
referral.
Humanitarian and development partners, including
MSF, Kapoeta Aid for South Sudan (KASS), Medair,
International Committee of the Red Cross (ICRC), IOM,
IMC, World Vision International (WVI), African Relief and
Development Fund (ARDF), and the International Rescue
Committee (IRC), have set up CTUs, CTCs, and ORPs
across states reporting cholera cases. These facilities are
equipped with cholera treatment supplies, and capacitybuilding
efforts are ongoing to improve case management.
Additionally, Case Area Targeted Interventions (CATI) are
being supported by implementing partners.
WASH partners are providing safe water to affected
populations, including those in IDP camps and transit
centres, while supporting water quality testing in health
facilities and communities reporting cholera cases. Water
purification tablets are being distributed.
Hygiene promotion messages and handwashing facilities have also been established in key locations.
An oral cholera vaccination (OCV) campaign was launched on 7 December 2024, targeting over 4 million people across four
(4) high-burden states and achieving 92.3% coverage. The campaign took place at different times in various states across
the country. Vaccination efforts varied by location, with Renk reaching 97% of its target, while other areas, such as Juba and
Rubkona, had lower coverage.
SITUATION INTERPRETATION
The cholera outbreak in South Sudan, first declared in September 2024, has been exacerbated by several factors,
including inadequate access to water, sanitation, and hygiene (WASH) services, and significant population
displacement. The outbreak remains heavily concentrated in a few states, particularly Unity, Northern Bahr el Ghazal,
and Jonglei. The influx of refugees and returnees has intensified the strain on South Sudan’s already fragile healthcare
infrastructure, which is hampered by limited facilities and resources due to years of conflict. While significant efforts,
including vaccination campaigns have been implemented, more targeted interventions, especially in high-risk areas,
are needed to prevent further spread and reduce mortality. Addressing the outbreak necessitates bolstering the health
system’s capacity, improving access to WASH services, and ensuring robust surveillance and response mechanisms
to effectively manage and contain the spread of cholera. The upcoming rainy season is likely to escalate the cholera
outbreak situation if adequate response, preparedness, and readiness measures are not put in place.
https://www.afro.who.int/health-topics/disease-outbreaks/outbreaks-and-other-emergencies-updates
