South Sudan

Ministry of HealthRepublic of South Sudan

Printed: 05:27 Sunday, 29 October 2017 UTC

Integrated Disease Surveillance andResponse (IDSR)

Epidemiological Update W42 2017 (Oct 16-Oct 22)

Surveillance

Slide 1 Table 1 IDSR surveillance performance indicators by county (W42)

Table 2 Summary of key IDSR surveillance indicators

Table 3 IDSR report submissions (W42)

Slide 2 Figure 1 Trend in IDSR completeness over time

Slide 3 Map 1a Map of IDSR completeness by county (W42)

Map 1b Map of IDSR timeliness by county (2017)

Slide 4 Table 4 EWARS surveillance performance indicators by partner(W42)

Table 5 Summary of key EWARS surveillance indicators

Table 6 EWARS report submissions (W42)

Alert

Slide 5 Table 7 Alert performance indicators by Hub (W42)

Table 8 Summary of key alert indicators

Slide 6 Table 9 Alert performance indicators by event (W42)

Table 10 Event risk assessment

Slide 7 Map 2a - 2f Maps of key disease alerts by county (W42)

Response

Cholera

Slide 8 Table 11 Summary of key cholera response indicators

Slide 9 Figure 2 Cholera epidemic curve (National)

Slide 10 Map 3a - 3d Maps of distribution of cholera cases (Jul 2016 -present)

Slide 11 Figure 3a - 3k Cholera epidemic curves by county

Slide 12 Table 12 Summary of response indicators by Hub

Slide 13 Figure 4a Cholera cases by sex (2017)

Figure 4b Cholera cases by age (2017)

Figure 4c Cholera cases by patient outcome (2017)

Sources of data

1. Weekly IDSR Reporting Form

2. Weekly EWARS Reporting Form

3. Daily cholera line list

4. Event based surveillance form

Contents

W42 2017 (Oct 16-Oct 22)

Highlights W42 2017

Surveillance

Completeness for IDSR reporting at county level was 71% . Completeness for

EWARS reporting from IDP sites was 79% .

Alert

A total of 13 alerts were reported, of which 54% have been verified. 0 alerts were

risk assessed and 0 required a response.

Response

A total of 27 new cholera cases and 0 deaths (CFR 0.0% ) were reported.

The cumulative total since the start of the current outbreak on 18 June 2016 is

21,268 cases and 436 deaths (CFR 2.0% )*.

* Note: The cholera data may be subject to adjustments as linelist data continues to received and entered from the field.

W42 2017 (Oct 16-Oct 22)

Hub Reporting Performance

# counties # reportsreceived

Completeness Timeliness

South Sudan 80 57 71% 71%

Table 1 | IDSR surveillance performance indicators by county (W42 2017) Table 2 | Summary of key IDSR surveillance indicators

W42 Cumulative (2017)

80 - Number of counties

71% 71% Completeness

71% 64% Timeliness

Table 3 | IDSR report submissions

W42 Cumulative (2017)

57 2,512 total submissions

22 534 submissions by mobile

35 932 submissions by web

Surveillance | IDSR surveillance indicators

1 W42 2017 (Oct 16-Oct 22)

Aweil 5 5 100% 100%

Bentiu 9 9 100% 100%

Bor 11 6 55% 55%

Juba 6 5 83% 83%

Kwajok 7 7 100% 100%

Malakal 13 0 0% 0%

Rumbek 8 8 100% 100%

Torit 8 5 63% 63%

Wau 3 2 67% 67%

Yambio 10 10 100% 100%

Figure 1 | Trend in IDSR completeness over time

Completeness

Surveillance | Trend in IDSR completeness

2 W42 2017 (Oct 16-Oct 22)

Perc

ent

W44 2016 W48 2016 W52 2016 W05 2017 W09 2017 W13 2017 W18 2017 W22 2017 W26 2017 W31 2017 W35 2017 W39 2017

0%

20%

40%

60%

80%

100%

Map 1a | Map of IDSR completeness by county (W42 2017)

Completeness

0 25% 50% 75% 100%

Map 1b | Map of IDSR completeness by county (2017)

Completeness

0 25% 50% 75% 100%

Surveillance | Maps of IDSR completeness by county

3 W42 2017 (Oct 16-Oct 22)

Manyo

Rumbek North Uror

Tambura

Rumbek Centre Twic East

Aweil West

Wulu

Ulang

Magwi

BudiYei

Aweil NorthGuitMayom

Abiemnhom

Tonj North

ToritLainya

Tonj East

Bor

Mundri East

Cueibet

Rumbek EastYirol East

Nyirol

Juba

Ibba

Awerial

Pochalla

Koch

Pariang

Yambio

Baliet

DukAkobo

Jur River

Tonj South

Terekeka

Kajo Keji

MaridiKapoeta North

Renk

Ikotos

Kapoeta East

Kapoeta South

Lopa Lafon

Panyikang

Morobo

Twic

Raja

Canal Pigi

Wau

Mvolo

Nagero

Maiwut

Pibor

Gogrial East

Nzara

Abyei

Ezo

Aweil East

Gogrial WestAweil SouthAweil Centre

FangakLongechuk

Yirol West

Maban

Melut

Luakpiny Nasir

Leer

Fashoda

Panyijiar

Mayendit

Malakal

Rubkona

Ayod

Mundri West

Manyo

Rumbek North Uror

Tambura

Rumbek Centre Twic East

Aweil West

Wulu

Ulang

Magwi

BudiYei

Aweil NorthGuitMayom

Abiemnhom

Tonj North

ToritLainya

Tonj East

Bor

Mundri East

Cueibet

Rumbek EastYirol East

Nyirol

Juba

Ibba

Awerial

Pochalla

Koch

Pariang

Yambio

Baliet

DukAkobo

Jur River

Tonj South

Terekeka

Kajo Keji

MaridiKapoeta North

Renk

Ikotos

Kapoeta East

Kapoeta South

Lopa Lafon

Panyikang

Morobo

Twic

Raja

Canal Pigi

Wau

Mvolo

Nagero

Maiwut

Pibor

Gogrial East

Nzara

Abyei

Ezo

Aweil East

Gogrial WestAweil SouthAweil Centre

FangakLongechuk

Yirol West

Maban

Melut

Luakpiny Nasir

Leer

Fashoda

Panyijiar

Mayendit

Malakal

Rubkona

Ayod

Mundri West

Partner Performance Reporting

# sites # reportsreceived

Completeness Timeliness

CMD 2 2 100% 100%

GOAL 2 2 100% 100%

HLSS 1 0 0% 0%

IMA 2 2 100% 100%

IMC 8 7 88% 88%

IOM 7 7 100% 100%

IRC 1 1 100% 100%

Medair 2 2 100% 100%

MSF-E 2 2 100% 100%

MSF-H 4 3 75% 75%

SMC 3 3 100% 100%

UNIDO 1 1 100% 100%

UNKEA 2 2 100% 100%

World Relief 1 1 100% 100%

Total 47 37 79% 79%

Table 4 | EWARS surveillance performance indicators by partner (W42 2017) Table 5 | Summary of key EWARS surveillance indicators

W42 Cumulative (2017)

47 - Number of EWARS reporting sites

79% 66% Completeness

79% 62% Timeliness

Table 6 | EWARS report submissions

W42 Cumulative (2017)

37 1,369 total submissions

1 75 submissions by mobile

36 1294 submissions by web

Surveillance | EWARS surveillance indicators

4 W42 2017 (Oct 16-Oct 22)

Hub W42 Cumulative (2017)

# alerts % verif. # alerts % verif.

South Sudan 13 54% 644 39%

Table 7 | Alert performance indicators by Hub Table 8 Summary of key alert indicators

W42 Cumulative (2017)

13 644 Total alerts raised

54% 39% % verified

0% 27% % auto-discarded

0% 6% % risk assessed

0% 2% % requiring a response

Alert | Alert performance indicators

5 W42 2017 (Oct 16-Oct 22)

Aweil 2 50% 9 33%

Bentiu 3 100% 79 44%

Bor 2 50% 123 43%

Juba 0 0% 67 12%

Kwajok 1 0% 34 35%

Malakal 1 100% 57 49%

Rumbek 1 100% 99 43%

Torit 0 0% 64 63%

Wau 0 0% 62 15%

Yambio 3 0% 50 34%

Event W42 Cumulative (2017)

# alerts % verif. # alerts % verif.

Indicator-based surveillance

Malaria 0 0% 62 31%

AWD 3 0% 58 33%

Bloody Diarr. 4 75% 106 41%

Measles 3 67% 51 33%

Meningitis 0 0% 0 0%

Cholera 1 100% 138 30%

Yellow Fever 0 0% 10 80%

Guinea Worm 2 50% 78 44%

AFP 0 0% 27 67%

VHF 0 0% 14 100%

Neo. tetanus 0 0% 6 100%

Event-based surveillance

EBS total 0 0% 25 96%

Table 9 | Alert performance indicators by event Table 10 | Event risk assessment

W42 Cumulative (2017)

0 10 Low risk

1 1 Medium risk

0 8 High risk

0 14 Very high risk

Alert | Event risk assessment

6 W42 2017 (Oct 16-Oct 22)

Map 2a | Malaria (W42 2017)

Number of alerts

0 1 10

Map 2d | Cholera (W42 2017)

Number of alerts

0 1 10

Map 2b | Bloody diarrhoea (W42 2017)

Number of alerts

0 1 10

Map 2e | Guinea Worm (W42 2017)

Number of alerts

0 1 10

Map 2c | Measles (W42 2017)

Number of alerts

0 1 10

Map 2f | Event-based surveillance (W42 2017)

Number of alerts

0 1 10

Alert | Maps of key disease alerts by county

7 W42 2017 (Oct 16-Oct 22)

Mayom

Bor

Pariang

Ezo

Melut

Tonj East

Yirol West

Aweil North

Aweil Centre

Panyijiar

Event W42 Cumulative (2017)

# alerts % verif. # alerts % verif.

Indicator-based surveillance

Malaria 0 0% 62 31%

AWD 3 0% 58 33%

Bloody Diarr. 4 75% 106 41%

Measles 3 67% 51 33%

Meningitis 0 0% 0 0%

Cholera 1 100% 138 30%

Yellow Fever 0 0% 10 80%

Guinea Worm 2 50% 78 44%

AFP 0 0% 27 67%

VHF 0 0% 14 100%

Neo. tetanus 0 0% 6 100%

Event-based surveillance

EBS total 0 0% 25 96%

Table 9 | Alert performance indicators by event Table 10 | Event risk assessment

W42 Cumulative (2017)

0 10 Low risk

1 1 Medium risk

0 8 High risk

0 14 Very high risk

Alert | Event risk assessment

6 W42 2017 (Oct 16-Oct 22)

Marburg Alert

• The Government of Uganda declared a Marburg outbreak on 19 Oct 2017 after aMarburg case was confirmed in Kween district, Eastern Uganda

• Cumulative cases are 6 (2 confirmed; 1 probable; 3 suspected) with one suspect caseon admission and 30 contacts under surveillance.

• The following actions have been undertaken to enhance Marburg preparedness inSouth Sudan:

• Review of country VHF preparedness during the weekly EP&R meetings• Review and update of the VHF contingency plan• Updating and disseminating of the Marburg/Ebola case definition to enhanceawareness

• Key messages on Marburg virus disease presentation, prevention, and controlhave been drafted for dissemination

• Prepositioning of PPE and VHF kits in high-risk counties• Plans are underway to conduct a refresher training of the national RRT on VHF

Response| Confirmed epidemics

Summaryofnewandongoingconfirmedepidemics

Aetiologicagent

Location(county)

Datefirstreported

Newcasessincelastbulletin

Cumulativecasestodate(attackrate%)

InterventionsCase

management Vaccination Healthpromotion WASH

Newepidemics:Measles Panyijiar 2/07/2016 30 115 (0.14) Yes No Yes N/A

Ongoingepidemics:Cholera 26 counties 18/06/2016 225 21,268(0.46) Yes Yes Yes Yes

Newepidemic-measlesPanyijiar• NewmeaslesoutbreakconfirmedinPanyijiarafter5samplestestedpositiveformeaslesIgMon23Oct.

17• Atleast115casesincluding3deaths(CFR2.6%)havebeenreportedsinceearlyJuly2017.• Mostcases88(77%)arebelowfiveyearsofage.• ThepayamsreportingmostcasesincludeNyal39(33.9%);Kol26(22.6%);andKatieth26(22.6%)• ThecasesinKatiethandNyalhavebeeninvolvedinIDPs• Noneoftheaffectedcaseshavereceivedmeaslesvaccine• Panyijiarisoneofthecountieswherethemeaslesfollowupcampaignispending• CasesarebeingmanagedinGanylielPHCCandNyalPHCCwithIRCandUNIDOastheimplementing

partners• 300communityhealthworkershavebeentrainedtoidentifyandrefercasesfromthecommunity• Areactivevaccinationmicro-planhasbeendrafted

Response| Confirmed epidemics

Newepidemic- Epidemicdescription- MeaslesinPanyijiarcounty

0

5

10

15

20

23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43

Num

bero

fcases/deaths

Epidemiologicalweekofrashonset

MeaslesEpidemiccurve,Panyijiarcounty,weeks26to43,2017

Alive

Age(years) Female(n) Male(n)Totalcases PercentageCum.%

<1yr 14 14 28 24.3% 24.3% 1-4yrs 34 27 61 53.0% 77.4% 5-14yrs 10 7 17 14.8% 92.2%

15+yrs 7 2 9 7.8% 100.0%

Totalcases 65 50 115 100.0%

0.9% 4.3%

0.9% 4.3%

0.9%

18.3% 22.6%

7.0%

0.9%

33.9%

0.9% 2.6% 0.9% 0.9% 0% 5%

10% 15% 20% 25% 30% 35% 40%

Casepropo

rtion

MeaslescasedistributionbyPayam,Panyijiarcounty,wk26- wk43,2017

W24 2016 - W42 2017 Rapid Diagnostic Test Cholera Treatment Centre

Case fatality is likely to be under-estimated, due to under reporting of deaths that occur in the community and are not reported to health centres

W42

% n

27

19% 5

20% 1

81% 22

0.0% 0

0% 0

Cumul.

% n Indicator

21,268 1. Total number of cases reported

12% 2,471 2. % tested with cholera RDT

71% 1,753 3. % tested with cholera RDT that were positive

57% 12,028 4. % admitted to CTC

2.0% 436 5. Case Fatality Rate (CFR)

49% 214 6. % deaths in community

Response | Cholera response indicators

Table 11 | Summary of key cholera response indicators

8 W42 2017 (Oct 16-Oct 22)

1

2

3

4

1 2 3

4

Figure 2 Cholera epidemic curve (W24 2016 - W42 2017)

Cases Deaths

Response | Cholera epidemic curve

9 W42 2017 (Oct 16-Oct 22)

Num

ber

W26 2

016

W31 2

016

W35 2

016

W39 2

016

W44 2

016

W48 2

016

W52 2

016

W05 2

017

W09 2

017

W13 2

017

W18 2

017

W22 2

017

W26 2

017

W31 2

017

W35 2

017

W39 2

017

0

200

400

600

800

1000

1200

1400

1600

1800

2000

Map 3a | Distribution of cholera cases (Jul 2016 - Sep 2016)

Map 3c | Distribution of cholera cases (Jul 2016 - Mar 2017)

Map 3b | Distribution of cholera cases (Jul 2016 - Dec 2016)

Map 3d | Distribution of cholera cases (Jul 2016 - present)

Number of cholera cases

0 1 10 50 100

Response | Maps of cholera distribution over time by county

10 W42 2017 (Oct 16-Oct 22)

Bor

Juba

Awerial

BorYirol East

Juba

Awerial

Duk

Canal PigiFangak

Panyijiar

Mayendit

Rubkona

Bor

Juba

Awerial

Canal PigiFangak

Panyijiar

Rubkona

Budi

Tonj East

BorYirol East

Juba

Awerial

Duk

Kapoeta NorthKapoeta East

Kapoeta South

Canal PigiFangak

Yirol West

Fashoda

Panyijiar

Mayendit

Rubkona

Ayod

Case Fatality Rate % admitted to cholera treatment centre (CTC) % deaths that occurred in the commmunity

County W42

Cases Deaths CFR % adm. % comm.deaths

County Cumulative (W24 2016 - W42 2017)

Cases Deaths CFR % adm. % comm.deaths

Response | Cholera response indicators by county

Table 12 | Summary of key cholera response indicators in counties with active transmission

12 W42 2017 (Oct 16-Oct 22)

1 23

Awerial 0 0 0.0% 0% 0%

Ayod 0 0 0.0% 0% 0%

Canal Pigi 0 0 0.0% 0% 0%

Duk 0 0 0.0% 0% 0%

Fashoda 0 0 0.0% 0% 0%

Juba 27 0 0.0% 81% 0%

KapoetaEast

0 0 0.0% 0% 0%

KapoetaNorth

0 0 0.0% 0% 0%

KapoetaSouth

0 0 0.0% 0% 0%

Nyirol 0 0 0.0% 0% 0%

Panyijiar 0 0 0.0% 0% 0%

Tonj East 0 0 0.0% 0% 0%

Uror 0 0 0.0% 0% 0%

Yirol East 0 0 0.0% 0% 0%

Yirol West 0 0 0.0% 0% 0%

1 23

Awerial 1,199 13 1.1% 57% 85%

Ayod 3,856 39 1.0% 8% 97%

Canal Pigi 206 5 2.4% 86% 0%

Duk 547 36 6.6% 94% 89%

Fashoda 771 12 1.6% 73% 8%

Juba 2,808 35 1.2% 85% 66%

KapoetaEast

2,105 26 1.2% 43% 62%

KapoetaNorth

993 1 0.1% 96% 0%

KapoetaSouth

1,017 10 1.0% 88% 60%

Nyirol 72 2 2.8% 93% 0%

Panyijiar 612 30 4.9% 73% 10%

Tonj East 2,462 43 1.7% 60% 56%

Uror 0 0 0.0% 0% 0%

Yirol East 1,502 67 4.5% 96% 0%

Yirol West 238 0 0.0% 96% 0%

1 2 3

Figure 4a Cholera cases by sex (2017)

Male ( 47% ; n = 7,899 )

Female ( 53% ; n = 8,922)

Figure 4b Cholera cases by age (2017)

< 5 ( 21% ; n = 3,586 )

5-14 ( 25% ; n = 4,278 )

15-44 ( 42% ; n = 7,071 )

> 45 ( 12% ; n = 1,957 )

Figure 4c Cholera cases by outcome (2017)

Discharged ( 69.8% ; n = 11,927 )

Defaulted ( 0.4% ; n = 68 )

Died ( 2.1% ; n = 355 )

Admitted ( 6.4% ; n = 1,089 )

Response | Cholera cases by sex, age and outcome

13 W42 2017 (Oct 16-Oct 22)

For more help and support,

please contact:

Dr. Pinyi Nyimol Mawien

Director General Preventive Health Services

Ministry of Health

Republic of South Sudan

Telephone: +211 955 604 020

Dr. Mathew Tut Moses

Director Emergency Preparedness and Response (EPR)

Ministry of Health

Republic of South Sudan

Telephone: +211 955 295 257Notes

WHO and the Ministry of Health gratefully acknowledge health cluster and health pooled fund (HPF)

partners who have reported the data used in this bulletin. We would also like to thank ECHO and

USAID for providing financial support.

The data has been collected with support from the EWARS project. This is an initiative to strengthen

early warning, alert and response in emergencies. It includes an online, desktop and mobile

application that can be rapidly configured and deployed in the field. It is designed with frontline users

in mind, and built to work in difficult and remote operating environments. This bulletin has been

automatically published from the EWARS application.

More information can be found at http://ewars-project.org

Ministry of Health

Republic of South

Sudan