Cholera outbreak--southern Sudan, 2007.

Vibrio cholerae causes cholera, an acute infectious diarrheal disease that can result in death without appropriate therapy, depending on the severity of the disease. War, poverty, inadequate sanitation, and large numbers of refugees and internally displaced persons (IDPs) are major precursors to cholera outbreaks. In 2005, Southern Sudan ended its 22-year civil war with North Sudan; as a result, IDPs and refugees are returning to the south. During April--June 2007, investigators from the Southern Sudan Field Epidemiology and Laboratory Training Program (SS-FELTP) and CDC investigated a cholera outbreak in the town of Juba, Southern Sudan. This report summarizes the results of that investigation, which found that 3,157 persons were diagnosed with suspected cholera during January--June 2007, with 74 deaths resulting from the disease. An environmental investigation revealed suboptimal hygiene practices and a lack of water and sanitation infrastructure in Juba. A case-control study indicated that persons less likely to have cholera were more likely to have consumed hot meals containing meat during the outbreak. Contaminated food or water were not identified as possible sources of the cholera outbreak in Juba. However, this might be attributed to limitations of the study, including small sample size. Cholera can reach epidemic proportions if adequate control measures are not implemented early. Mass media campaigns are important for current and new residents in Juba to understand the importance of proper food handling, clean water, and optimal hygiene practices to prevent the spread of cholera.