South Sudan’s Year-Long Battle Against Cholera: Progress and Lessons Learned

Op-Ed By Dr Humphrey Karamagi, WHO Representative for South Sudan

South Sudan is combating its largest and longest cholera outbreak since independence in 2011. The outbreak, which began in September 2024 has been sustained for now one year, testing the country’s experiences, defining new frontiers to interrupt transmission and providing new lessons for future similar outbreaks.

After 12 months of sustained Cholera transmission, the outbreak is slowing but has caused nearly 100 000 suspected cases and slightly over 1 500 deaths across 55 counties in 9 States and 3 Administrative Areas. The country’s multi-sectoral response -featuring surveillance, deployment of rapid response teams, medical supply prepositioning, case management, Infection Prevention and control, Water/Sanitation/Hygiene promotion, reactive vaccination campaigns using oral cholera vaccines, and response coordination-has helped mitigate the risks to communities and saved hundreds of lives.The weekly number of new Cholera cases has drastically reduced from an average of 1000 cases at the peak of the outbreak in December 2024 to a record lowest of 114 in the last week of September 2025.The number of infected Counties declined from 55 to 7 in the same reporting period. And there was no newly infected county since June 2025.

South Sudan’s Cholera response Journey

South Sudan’s cholera outbreak was confirmed on 27 September 2024. A national Cholera outbreak was declared on 28 October. The response efforts to this day have focused on a) coordination of response actors using the Incident Management System; b) Strengthening surveillance for acute watery diarrhea (AWD), c) Laboratory diagnostics support for aetiological agents of AWD, d) Case management of acute watery diarrhea, especially severe dehydration, e) Risk communication and community engagement, f) Infection Prevention and Control, g) Water/Sanitation/Hygiene promotion, h) vaccination using Oral Cholera vaccines, and i) Logistics.

Notably, the cholera outbreak spread so fast, reaching slightly over 27 000 cases and 472 deaths in 40 counties within the first 4 months of confirmation. The increased hostilities in Sudan, where the outbreak originated, facilitated the multiple importations into several areas of South Sudan. But even most importantly, the outbreak affected high-density areas hosting returnees/refugees’ settlements. The cholera outbreak was therefore an emergency complicating another.

even though slightly over 67 000 additional cholera cases were reported in the last 8 months, the geographical spread has been much slower with only 15 new counties reporting cases. At this one-year milestone, we should celebrate:

1. the fact that only seven of the 55 affected counties are still reporting cases, which implies that we have interrupted transmission in 48 counties
2. More than 90 000 people successfully treated and discharged from the multiple case management centres that were set up.
3. The health workers (doctors, clinical officers, nurses, and all support staff) that continue to man our cholera treatment centres/units across the country
4. The Public Health Laboratory network that tested over 32 000 samples and confirmed 12 643 as cholera using both Rapid Diagnostic Tests and Bacterial culture.The laboratory testing of selected cases continues to provide valuable information on causative agents of the outbreak and the antibiotics sensitivity patterns that guided the treatment choices.
5. the targeted responses mounted in the flooding season, when the outbreak was projected to spiral out of control, was successful in averting the increases in cases and deaths.

“`html

South Sudan Cholera Outbreak Response: Update and Lessons Learned

As of October 28, 2025, South Sudan is nearing the end of a significant cholera outbreak that began in June 2023. This update details the response efforts led by the World Health organization (WHO) in collaboration with the government of South Sudan and other partners, along with key lessons learned for future preparedness.

Epidemiological Overview

To date,a cumulative total of 24,798 cases and 439 deaths have been reported across the country,representing a Case Fatality Rate (CFR) of 1.8%. The outbreak has affected 10 of South Sudan’s 78 counties. While the trend shows a decline in new cases over the past several weeks, localized outbreaks continue to occur, particularly in areas with limited access to safe water and sanitation.

WHO’s Response activities

1. Surveillance and Laboratory Support: WHO has strengthened national surveillance systems, providing technical support for early detection and confirmation of cases. This includes training healthcare workers in case definition, reporting, and sample collection.Laboratory capacity has been enhanced thru the provision of reagents and equipment, ensuring timely diagnosis.

2. case Management: WHO has supported the establishment and operation of cholera Treatment Centers (CTCs) and Cholera Treatment Units (CTUs) across affected counties. Essential supplies,including intravenous fluids,antibiotics,and oral rehydration salts (ORS),have been provided to ensure adequate care for patients. WHO has also trained healthcare workers in the clinical management of cholera.

3. Water, Sanitation, and Hygiene (WASH): Recognizing the critical link between WASH and cholera transmission, WHO has collaborated with WASH partners to improve access to safe water, promote sanitation practices, and distribute hygiene kits to affected communities.

4. Risk Communication and Community Engagement (RCCE): WHO has implemented targeted RCCE campaigns to raise awareness about cholera prevention and control measures. These campaigns utilize various channels, including radio broadcasts, community meetings, and social media, to reach diverse populations.

5. Vaccination: Oral Cholera Vaccine (OCV) campaigns have been a cornerstone of the response. A total of 2.2 million doses were obtained for 48 counties (worth 10 million OCV doses). In turn, OCV deployment has been completed in 46 counties (with 2 on hold due to security related constraints) reaching 8,628,298 (84.7% of the targeted population).

6. Provided short-term (3 months) predictive analytics for Cholera outbreak trajectory to inform response planning and pre-positioning of surveillance and case management supplies

7. In order to attain resilience and lasting Cholera Control, WHO is facilitating the identification of Priority Areas for Multi-sectoral Interventions (PAMIs). Technical guidance, training and provision of operations support to the entire process will be guided by the WCO, with assistance from the African Regional Office Emergencies Program.

In the tail end of the cholera outbreak, WHO re-commits to a) care and treatment of more than 71 people that are currently admitted in multiple cholera treatment centres/units in 7 counties; b) Provide care and treatment products for an additional 10,000 cases predicted for the 3-4 months ending December 2025; c) Engage the communities on context appropriate technologies for mitigating the risk of cholera infections; d) Providing education and communication materials needed to create a behavioral practices needed to interrupt Cholera transmission and e) Mobilise the resources (human, financial and materials) needed to see