Abdinasir Abubakar1, Andrew S. Azman2*, John Rumunu3 , Iza Ciglenecki4 , Trina Helderman5 , Haley West6 , Justin Lessler2 , David A. Sack2 , Stephen Martin7 , William Perea7 , Dominique Legros7 , Francisco J. Luquero2,8
In December 2013, violence erupted in South Sudan’s capital, Juba, and quickly spread throughout the country. The crisis exacerbated an already dire humanitarian situation in the youngest and one of the poorest countries in the world, where 40% of the population had access to basic health services, 70% to an improved water supply, and only 13% to adequate sanitation facilities [1,2]. Continued fighting and the threat of escalating violence resulted in displacement of more than one in five people throughout the country, many of them residing in Protection of Civilian (PoC) sites inside United Nations Mission bases and spontaneous settlements of internally displaced persons (IDPs).
The Decision to Use Oral Cholera Vaccine (OCV)
The appalling conditions of the PoC and IDP camps throughout the country led to early discussions between the South Sudan Ministry of Health (MoH), the World Health Organization (WHO), and other partners about the possibility of a cholera outbreak exploding within the camps. Based on the perceived success of a preventative cholera vaccination campaign in Maban County, South Sudan, the previous year , the MoH and partners agreed that oral cholera vaccination should be part of an emergency preventative health package and commissioned a rapid risk assessment. The assessment, conducted by the MoH and WHO in January 2014, confirmed that the poor water and sanitation conditions, poor hygiene behaviors, low nutritional status of IDPs, overcrowded camps, and high acute watery diarrhea rates all pointed to an increased likelihood of a cholera epidemic with significant morbidity and mortality if cholera were to be introduced to the camps.