weekly epidemiological bulletin republic of south sudan · maridi nyiro l p aring yambio er ka...

Public Health Priorities

Highlights

Early Warning, Alert and Response

• Completeness for weekly reporting was 57% IDSR sites and 83% forthe IDP sites.

• Malaria remains the leading cause of morbidity in nonconflict areaswhile ARI is the leading cause of morbidity in the IDPs.

• A total of 46 suspect measles cases were reported from Mayom,Yambio, Juba, Gogrial East, Gogrial West, Tonj North, Aweil Center,Torit, and Wau.

• Active cholera transmission is ongoing in the counties of Yirol East,Awerial, Panyijiar, and Bor

• A total of 14 HEV cases reported from Bentiu POC in week 11.

System performance

Special focus on cholera• Cumulatively, 5,856 cholera cases including 144 deaths (65 facilities

and 79 community) (CFR 2.46%) have been reported in South Sudan(Figs 19.2&19.3; Table 4.2)

• The counties with active cholera transmission include YirolEast, Awerial, Panyijiar, and Bor (Figs 19.2&19.3; Table 4.2).

• Suspect cholera cases are being verified/investigated inPadiet, Duk; Juaibor and Keew in Old Fangak; and Jachor,Nyawit, Pagil, Gorwai, and Pajiek in Ayod (Figs 19.2&19.3;Table 4.2).

Completeness for weekly reporting was 57% for the routinesurveillance(IDSR sites) and 84% for the EWARS (IDP sites)(Table 1).

This week, 17 counties attained 100% completeness inreporting. A total of 30 (38%) counties attained the targetcompleteness of at least 80% (Figures 1c) in week 11compared to 23 and 29 in Weeks 10 and 9 respectively.

Timeliness for weekly reporting stands at 36% for the routinereporting sites and 84% for the IDP sites (Table 1).

Table 1 | Surveillance performance in South Sudan as of W11 2017

Republic of South SudanW11| 13th –19th March 2017

Weekly Epidemiological BulletinIntegrated Disease Surveillance and Response (IDSR)

!

!

Active responses

CholeraMeaslesKala azar Hepatitis E virus Guinea worm

SystemTotal

Facilities

Timelines Completeness Timeliness Completeness

inweek 11of2017 Cumulativefor2017

IDSR 1127 405(36%) 648(57%) 394(30%) 552(42%)

EWARN 47 39(83%) 39(83%) 35(72%) 37(76%)

Figure 1c -d | IDSR Completeness by county in W11 and Weeks 1-11 2017

Event based surveillance W11 of 2017

Active alerts:

AFP

Event based surveillance data were received from three Hubs of CentralEquatoria, Eastern Equatoria, and Upper Nile. Nine events werereported involving two AFP cases (Kapoeta east and Malakal Poc) andseven measles cases (Torit-2, Juba-5). Investigations were initiated within48 hours and samples sent for laboratory testing.

0% 13%

27%

8% 1%

51%

Figure1b|ProportionalmorbidityinIDPsW112017

Measles

Malaria

ARI

AWD

ABD

Other

Sudan

Ethiopia

KenyaDemocratic Republic of

CongoUganda

Central African Republic

Jonglei

Upper Nile

Lakes

Unity

Warrap

Western Equatoria Eastern

Equatoria

Western Bahr el Ghazal

Central Equatoria

Northern Bahr el Ghazal

Raga

Pibor

Wau

Juba

Lafon

Uror

Ayod

Wulu

Yei

Ezo

Kapoeta East

Baliet

Ibba

Abyei

Renk

Maban

DukAkobo

Tambura

Bor South

Torit Budi

Nagero

Melut

Maridi

Nyirol

Pariang

Yambio

Terekeka

Jur River

Nzara

Fangak

Tonj North

Manyo

Pochalla

Mvolo

Koch

Twic

Aweil Centre

Guit

Ulang

Magwi

Cueibet

Longochuk

Twic East

Panyijiar

Aweil East

Awerial

Yirol East

Mayom

Ikotos

Aweil North

Lainya

Maiwut

Panyikang

Yirol West

Tonj East

Canal/Pigi

Fashoda

Kajo-Keji

Tonj South

Mundri West

Aweil West

Mundri East

Rubkona

Kapoeta North

Leer

Gogrial East

Luakpiny/Nasir

Gogrial West

Mayendit

Rumbek North

Rumbek EastRumbek Centre

Abiemnhom

Morobo

Aweil South

Malakal

Kapoeta South

Copyright:© 2014 Esri

0 17085KM

±

World HealthOrganizationCompleteness of Health Facility reporting rate by Counties, Week 11.

The information shown on this map does not implyofficial recognition or endorsement of any physical,political boundaries or feature names by the UnitedNations or other collaborative organizations.

Source: Health data: MoH/WHO Admin boundaries: UNOCHAProduction date: 30.03.2017

International_Boundaries

State _ Boundaries

NR

01 - 60%

61 - 70%

71 - 90%

91 - 100%

Legend

Counties_Boundaries

Sudan

Ethiopia

KenyaDemocratic Republic of

CongoUganda

Central African Republic

Jonglei

Upper Nile

Lakes

Unity

Warrap

Western Equatoria Eastern

Equatoria

Western Bahr el Ghazal

Central Equatoria

Northern Bahr el Ghazal

Raga

Pibor

Wau

Juba

Lafon

Uror

Ayod

Wulu

Yei

Ezo

Kapoeta East

Baliet

Ibba

Abyei

Renk

Maban

DukAkobo

Tambura

Bor South

Torit Budi

Nagero

Melut

Maridi

Nyirol

Pariang

Yambio

Terekeka

Jur River

Nzara

Fangak

Tonj North

Manyo

Pochalla

Mvolo

Koch

Twic

Aweil Centre

Guit

Ulang

Magwi

Cueibet

Longochuk

Twic East

Panyijiar

Aweil East

Awerial

Yirol East

Mayom

Ikotos

Aweil North

Lainya

Maiwut

Panyikang

Yirol West

Tonj East

Canal/Pigi

Fashoda

Kajo-Keji

Tonj South

Mundri West

Aweil West

Mundri East

Rubkona

Kapoeta North

Leer

Gogrial East

Luakpiny/Nasir

Gogrial West

Mayendit

Rumbek North

Rumbek EastRumbek Centre

Abiemnhom

Morobo

Aweil South

Malakal

Kapoeta South

Copyright:© 2014 Esri

0 17085KM

±

World HealthOrganizationCumulative Completeness of Health Facility reporting by Counties, Week 1-11.

LegendInternational_Boundaries

State _ Boundaries

NR

01 - 30%

31 - 50%

51 - 70%

71 - 100%

Counties_Boundaries

The information shown on this map does not implyofficial recognition or endorsement of any physical,political boundaries or feature names by the UnitedNations or other collaborative organizations.

Source: Health data: MoH/WHO Admin boundaries: UNOCHAProduction date: 30.03.2017

12% 2%

31%

0.045%

55%

Figure1a|IDSRProportionalmorbidityWK11,2017

AWD

ABD

Malaria

Measles

Others

IDSR and EWARN Reporting Performance by Partner and County in 2017

Trends for top causes of Morbidity

This week, only 20 hospitals (39%), 133 PHCCs (41%), and 368 PHCUs(36%) in 50 counties submitted their IDSR reports (Table 2).

Number of counties that did not submit any IDSR report decreased from30 in week 10 to 25 in week 11 (Table 2). However eight of these countiessubmit their data through EWARS (Table 2).

Eight partner-supported health facilities in the IDP sites did not submittheir reports (Table 2).

!

Table 2 | Reporting Performance [Timeliness and Completeness] by Partner and County as of W11 2017

Figure 6b | EWARN Priority Disease Proportionate Morbidity W52 2013 to W11 2017

Table 4 | Top causes of morbidity in 2016 and 2017

Figure 6a | IDSR priority disease morbidity trends W1 to W11 2017

Overall morbidity trends for 2017

This week, the eight health facilities in the IDP sites that didnot submit their reports are supported by SMC, IOM, MedAir,MSF-H, and IMA (Table 2).

The best performing partner-supported facilities duringthe week were GOAL, IRC, UNKEA, MSF-E, IMC, WorldRelief, & HLSS.

No.IDSR IDSR

SilentCountiesW11 2017 SilentCountiesW911 2017

LainyaMoroboAkoboAyod*DukFangakNyirolPiborPochallaTwicEasturorRumbekEastYirolEastGuitPariangPayinjiar*Akoka

Luakpiny/Nasir*MaiwutMelutPanyikangRenk*JurRiverWauAbyei

*Countieswith EWARSreportingsites,

Malaria remains the top cause of morbidity in the IDSR reporting sitesfollowed by Acute watery diarrhea while for the IDP sites ARI* is theleading cause of morbidity followed by malaria .(Figures 1a, 1b, 6a,6b, Table 4).

Consultations Table 3 | Consultations in South Sudan as of W11 2017

SurveillanceSystem

Consultationsinweek11 of2017 Cumulativeconsultationsfor2017

<5years ≥5years Total <5years ≥5years Total

IDSR 36545 54,120 90,665 297,647 467,451 765,098EWARN 29;517 309,361

Total 120,182 1,074,729

Partner Numberofhealthfacilities

W11 2017Completeness Timeliness

# # % # %

COSV 0 0 0% 0 0% GOAL 2 2 100% 2 100% HLSS 2 2 100% 2 100% IMA 5 3 40% 3 40% IMC 8 8 75% 6 75%

IOM 12 11 92% 11 92% IRC 1 1 100% 1 100%

Medair 2 0 0% 0 0% MSF-E 2 2 100% 2 100% MSF-H 4 3 75% 3 75% SMC 6 4 67% 4 67% UNIDO 0 0 0% 0 0% UNKEA 2 2 100% 2 100%

WorldRelief 1 1 100% 1 100% Total 47 39 83% 39 83%

System Disease NewcasesW10 Cumulativecasesweek1toweek11of

2016 2017 2016 2017IDSR Malaria 21,787 28,173 262,315 242,779

AWD 6,996 10,879 70,335 80,344Meningitis 0 0 9 2

ABD 1,389 1,638 14,073 12,453Measles 5 41 218 168AJS 0 0 6 13

EWARN Malaria 7847 3739 87045 42900AWD 3,737 2445 33817 28233ARI 6231 8105 62647 83459

ABD 529 280 4232 2474

Measles 12 3 147 211AJS 185 14 686 161

Meningitis 0 0 9 17

Disease/Year 2016 2017

Malaria 349,360 285,679

AWD 104,152 108,577

ARI* 62647 83459

ABD 18,305 14,927

AJS 692 174

Measles 365 379

Meningitis 18 19

Figure 4b | Cumulative for top causes of morbidity as of week 11 of 2016 and 2017

*ARIisonlyreportedonfromtheIDPsites

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1 3 5 7 9 11

Completen

ess(%)

casesp

er100,000pop

ulation

Epidemiologicalweekofreportingin2015

IDSRPriorityDiseaseMorbiditytrendsfromweek01toweek11,2017

Completeness ABD MalariaMeasles AWD

0%

10%

20%

30%

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50%

60%

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80%

2013

-12-15

2014

-07-13

2015

-02-08

2015

-09-06

2016

-04-03

2016

-10-30

Percen

tageofallconsultatio

ns

%_Malaria %_ARI %_Measles

Malaria

Malaria

Status: Urgent

!

Malaria remains the leading cause of morbidity across the country,accounting for 31 % and 13% of all consultations in the IDSR and IDPsites respectively (Fig. 1a, 1b). The incidence (cases per 100,000) ofMalaria increased from 151.2 in Week 10 to 230.3 . Comparatively, theincidence in week 11 of 2017, is higher than the same period in 2014 and2016 but equal to 2015.As seen from Figs. 8a-f, analysis of malaria trends at state level showedthat malaria cases were within expected levels in some of thestates*.(Fig 8a-d).

The malaria incidence in the IDP sites has remained within expected levels. (Figs. 10a-d)

A total of five (5) malaria deaths were reported from Cueibet, Yirol WestAweil west ; Torit and Juba West (Tables 5, 6).

*Actual diseasetrendsmaybemaskedbylowreportingrates

Malariatrendsbystatehub

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400

500

600

1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51 53

Casesp

er100,000Pop

ulation

Epidemiologicalweekofreporting

Figure7|IDSRmalariatrendsbyweek,2014- 2017

2014 2015 2016 2017

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600

800

1000

1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51

casesper100,000

Epidemiologicalweek

Figure8c|IDSRtrendsforMalariaAweil,AweilEast,Lol

fromweek01to11,2017

Thirdquartile2012-2015 2017

0

100

200

300

400

500

600

1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51

casesper100,000

Epidemiologicalweek

Figure8d| IDSRtrendsformalariainWesternLakes,Eastern

Lakes,andGokstates,Wk01toWk11,2017


0

200

400

600

800

1000

1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51

casesp

er100,000

EpidemiologicalWeek

Figure8b|IDSRtrendsformalariaGogrial,Tonj,Twic,Wk01toWk11,2017


0

200

400

600

800

1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51

casesp

er100,000

Epidemiologicalweek

Figure8f| IDSRtrendsforMalariainGbudwe,Maridi,andAmadistatesfromweek01to11,2017


0.0

100.0

200.0

300.0

1 4 7 10 13 16 19 22 25 28 31 34 37 40 43 46 49 52

EpidemiologicalWeek

MalariaIncidenceforUnitystatefromweek01to11,2017

2017 Thirdquartile2012-2015

0

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400

500

600

1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51

casesper100,000

Epidemiologicalweek

Figure8e| IDSRMalariatrendsforImatongandLomurnyang,

week1- 11,2017


Malaria in IDPs

!

Acute Respiratory Infection (ARI)

The ARI proportionate morbidity declined from 27.73% in week10 to 27.46% in week 11. Overall the ARI proportionatemorbidity in 2017 is still high compared to same period in 2014,2015 and 2016.

Figure 11b shows ARI morbidity by IDP site in week 11 of 2017, thereporting site with the highest Proportionate morbidity of ARI is MSFHospital in Bentiu PoC with ARI proportionate mornidity of 55.18%.

-

1,000

1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51 53

casesp

er10,000

Weekofreporting

Figure10a|MalariatrendforIDPsinBentiuPoC2015to2017

incidence2017 Thirdquartile incidence2015 incidence2016

-

1,000

1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51 53

casesp

er10,000

Weekofreporting

Figure10b|MalariatrendforIDPsinMalakalPoC2015to2017

incidence2015 incidence2017Thirdquartile incidence2016

-

200

400

600

1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51 53

casesp

er10,000

Weekofreporting

Figure10c|EWARNtrendsforMalariainUNHousePoC2015to2017

incidence2017 incidence2015 incidence2016

-

200

400

1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51

Figure10|EWARNtrendsforMalariainRenk,2015to2017

incidence2015 incidence2016incidence2017 Thirdquartile

0%

5%

10%

15%

20%

25%

30%

35%

01 03 05 07 09 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51 53

Percen

toftotalcon

sulta

tions


Figure11|ARItrendsinIDPsW512013toW112017

2014 2015

0% 10% 20% 30% 40% 50% 60%

MSF-HBen

tiuPoC

Hospital

GOALDetho

maCamp2

IOMGergerM

obileClinic

MSF-HBen

tiuTow

nClinic

IMADe

lalA

jakMob

ileClinic

IMCMalakalPoC

Clinic2

IMCUNHou

seClinic1

MSF-HLankien

PHC

CIOMCathe

dralChu

rchIDP…

IOMBen

tiuSector5

PoC

…IOMW

onthou

Mob

ileClinic

IOMBen

tiuSector1

PoC

…IRCSector4Clinic

IOMNazarethIDPCampClinic

MSF-EM

alakalTow

nPH

CCIOMBen

tiuSector3

PoC

…GO

ALKoradarID

Pclinic

IOMRam

elaMob

ileClinic

IMAKo

dokMob

ileClinic

IOMM

alakalPoC

Clinic

IMCAk

oboHo

spita

lWorldReliefP

HCC

IMCMalakalPoC

Clinic1

HLSSBorClinic

IOMW

auPoC

Clinic

MSF-EHospital

IOMHalakaMob

ileClinic

SMCPadietM

obileClinic

AburocPHC

U

Percen

tofallconsultatio

ns

Figure11b|ARIIncidencebyIDPSiteinW112017

Meningitis (suspected)

!

There were no suspected meningitis casesreported in week 11.

Since week 47 of 2016, a total of 18 rapidpastorex Streptococcus pneumoniae caseshave been reported (Fig. 11c). Only one rapidpastorex Neisseria meningitidis Y/W135 casehas been reported since week 47 of 2016 (Fig.11c).

Figure 11d shows the attack rates (cases per100,000) and case fatality rates by week forsuspect meningitis cases in Bentiu PoC. Whilethe alert threshold has been surpassed for atleast four weeks since week 47, the epidemicthreshold has not been reached. The currenttrends are still below the epidemic threshold.Surveillance for suspect cases of meningitis ishigh in Bentiu PoC and countrywide.

Nearly 40% of the cases are below one yearand 68% are below five years of age. Childrenand young adults constitute 53% of the cases.Males constitute 61% of the total casesreported (Table 4c).

Heighten Surveillance for meningitis has beenmaintained across the country, especially in thehigh risk locations Like Malakal and BentiuPoC.

This being the meningitis Season all healthfacilities and Partners have been urged toincrease their index of suspicion, and to ensurethat all patients meeting the suspect casedefinition for meningitis are investigated andwhere possible samples collected andnotifications sent to the next level for promptaction.

The second phase of the MenAfriVacpreventive campaigns are slated for the fourthquarter of 2017 targeting the states in thegreater Upper Nile region.

0

1

2

3

4

5

6

7

No.cases

Weekofonset

Fig.11c:SuspectmeningitisEpi-curveshowingrapidpastorexresults,BentiuPoC,week47of2016toweek10,2017

H.Influenzaeb N.meningitidisY/W135 Negative S.Pneumonlae

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16-52

2017-01

2017-02

2017-03

2017-04

2017-05

2017-06

2017-07

2017-08

2017-09

2017

-10

Epiweekofonset

CFR[%

]

casesp

er100,000

Fig.11d:Suspectmeningitisattackrates&CFRbyweek,BentiuPoC

AR Alertthreshold Actionthreshold CFR

CountofSN ColumnLabelsAge Female Male Total Percentage<1yr 8 7 15 39%1-4yrs 2 9 11 29%5-14yrs 2 3 5 13%15-29yrs 1 3 4 11%30+yrs 2 1 3 8%Total 15 23 38 100%

Table4c:Suspectmeningitiscaseage&sexdistribution,BentiuPoC,wk47,2016towk10,2017

Acute bloody diarrhoea (ABD)

Acute bloody diarrhoea (ABD)

!

Acute watery diarrhoea (AWD)

Acute watery diarrhoea (AWD)

In week 11 AWD accounted for 12% and `8% of all consultationsin the routine reporting(IDSR) and IDP sites respectively (Fig. 1a,1b).

The overall AWD incidence [cases per 100,000] increasedsharply from 54.8 in Week 10 to 88.9 in Week 11 from the IDSRreporting sites.(Fig. 12).

In the IDP sites, AWD morbidity in week 11 is lower than thesame in 2014, 2015 and 2016 (Fig. 13). Figure 14 shows AWDmorbidity by IDP site in week 9 of 2017

In Week 11 ABD accounted for 2% and 1% of allconsultations in the IDSR and IDP sites respectively (Fig. 1a,1b).

For the routine reporting sites ABD incidence [cases per100,000] increased for the second consecutive week from9.3 in Week 10 to 13.4 in week 11 (Fig. 15).

Among the IDPs, the current ABD burden also increase inWeek 11 but remains low compared to the correspondingperiod in 2014-2016 (Fig. 16 and 17).

Figure 17 shows the number of ABD cases by IDP clinic inweek 11 of 2017.

0

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1 4 7 10 13 16 19 22 25 28 31 34 37 40 43 46 49 52

Casesp

er100,000

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latio

n


Figure15|IDSRABDtrendbyweek,2013-2017

2014 2015 2016 2017

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15%

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25%

01 03 05 07 09 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51 53

Percen

tofallconsultatio

ns

Figure13|AWDtrendsinIDPsW512013toW112017

2014 2015 2016 2017

0% 5%

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

MSF-HBen

tiuTow

nClinic

AburocPHC

UMSF-HLa

nkienPH

CCIM

CMalakalPoC

Clinic1

MSF-HBen

tiuPoC

Hospital

IRCSector4Clinic

GOALDetho

maCamp2

IMCER

PoC

1Ga

pMed

icalM

obileClinic

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elaMob

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CAk

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…IOMCathe

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PoC

…IOMW

onthou

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alakalPoC

Clinic

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ileClinic

SMCAy

uelditMob

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Figure11b|AWDIncidencebyIDPSiteinW112017

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010305070911131517192123252729313335373941434547495153

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Figure16|ABDtrendsinIDPsW512013toW112017

2014 20152016 2017

0% 5%

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UNKEAJikmirPH

CC

IOMGergerM

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Figure17|ABDIncidencebyIDPSiteinW112017

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Figure12|IDSRAWDtrendsbyweek,2014- 2017

2014 2015

!

Measles A total of 46 new suspect measles cases were reported fromMayom(15) Yambio(10) Juba(4) Gogrial East(1), Gogrial West(8) Jubek (4), Torit (2) Aweil Center (1), Tonj North (2) andWau POC(3) in week 11. (Table 4.1).

At least 475 suspect measles cases including 4 deaths (CFR0.84%) have been reported from 17 counties in 2017.

Most of the cases have been reported from Wau, Gogrial East,and Gogrial West counties (Figure 18.1).

The majority of the cases are under five years of age (Figure18.3).

Since the beginning of 2017, measles outbreaks have beenconfirmed in five counties - Wau, Aweil South, Gogrial West,Gogrial East, and Juba (Table 4.1 and Figure 18.2).

At least 33 measles IgM positive and 26 rubella IgM caseshave been confirmed in 2017 (Table 4.1 and Figure 18.2).

Most counties have not attained the non-measles febrile/rashillness rate of at least 1/100,000 (Figure 18.4). This highlightsthe need to enhance measles case-based investigation andsample collection.

The follow-up measles campaign is scheduled for 17th to 28thApril 2017.

Table4.1|MeaslescasesbylocationandstatusasatW11of2017

CountyNewsuspectcasesW11,

2017

Suspectcasesin2017

ConfirmedMeasles2017

ConfirmedRubella2017

Samplestestedin2017

Outbreakstatusin2017

WauIDPs 3 279 11 26 92 Confirmed

MalakalPoC 0 2 0 2 Alert

GogrialEast 1 43 5 8 Alert

GogrialWest 8 35 15 24 Confirmed

TonjNorth 2 5 0 0 0 Alert

AweilSouth 0 6 7 7 Confirmed

Yambio 10 34 0 0 7 Alert

Mayom 15 15 0 0 0 Alert

Nzara 0 1 0 Alert

Ezo 0 1 0 0 0 Alert

AweilWest 0 9 0 1 Alert

Aweil Center1 1 0 0 0 Alert

Kajo-keji 0 5 0 0 Alert

Juba 4 21 6 8 Alert

Torit 2 2 0 0 39 Alert

Duk 0 15 0 0 Alert

MundriWest 0 1 1 Alert

Total 46 475 33 26 189

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Epidemiologicalweekin2017

Fig.18.1|MeaslescasesbyEpidemiologicalweekandcounty,week

1-12,2017

Juba GogrialWest AweilSouth AweilCenter Malakal

Wau JurRiver Yambio Torit GogrialEast

0% 10% 20% 30% 40% 50% 60% 70% 80% 90%

100%

Juba Gogrial

West

Aweil

South

Aweil

Center

Malakal Wau Jur

River

Yambio Torit Gogrial

East

Agedistrib.%

Fig.18.3|Measlescasedistributionbyagegroupandcounty,week

1-12,2017

<1yr 1-4yrs 5-9yrs 10-14yrs 15+yrs

Non-Measles Febrile/Rash Illness Rates by County / 2016-2017*

2017

2016

County level

Categories

Counties by category

Number Percent

NM-FRI rate =0.00-0.00 42 53%

NM-FRI rate >0.01-0.99

2 3%


5 6%

NM-FRI rate >2.00 30 38% Total 79 100%

* As of Week 12, 2017

Categories


Number Percent

NM-FRI rate =0.00-0.00 69 87%


0 0%


0 0%

NM-FRI rate >2.00 10 13% Total 79 100%

Counties with Confirmed Outbreaks in 2017*

* As of Week 12, 2017

Month of Out Break

District of Residence Province Of Residence

Suspected Cases Confirmed_Lab

Number Of Samples

Number Rubella Cases

Number Of Clinicals

Number Of Discarded

Number Of Pendings Admitted_Alive Non_Admitted_Alive Dead

Jan AWEIL SOUTH NORTHERN BAHR EL GHAZAL 6 4 6 0 0 2 0 1 3 0Jan GOGRIAL EAST WARRAP 5 5 5 0 0 0 0 0 5 0Jan GOGRIAL WEST WARRAP 11 7 11 0 1 3 0 3 5 0Jan WAU WESTERN BAHR EL GHAZAL 63 5 63 26 7 50 1 2 10 0Feb GOGRIAL WEST WARRAP 3 3 3 0 0 0 0 2 1 0Feb JUBA CENTRAL EQUATORIA 8 4 8 0 0 4 0 1 3 0Mar WAU WESTERN BAHR EL GHAZAL 8 5 8 2 0 3 0 5 0 0

Non-Measles Febrile/Rash Illness Rates by County / 2016-2017*

2017

2016

County level

Categories


Number Percent

NM-FRI rate =0.00-0.00 42 53%


2 3%


5 6%

NM-FRI rate >2.00 30 38% Total 79 100%

* As of Week 12, 2017

Categories


Number Percent

NM-FRI rate =0.00-0.00 69 87%


0 0%


0 0%

NM-FRI rate >2.00 10 13% Total 79 100%

Fig18.2|CountieswithconfirmedmeaslesoutbreaksasatW11of2017

Fig18.4|Non-measlescasesFebrile/Rashillnessper100,000bycounty

asatW11of2017

!

Visceral Leishmaniasis | Kala-azar

Hepatitis E Virus (HEV)

In week 11, three (3) health facilities reported 29 cases, 20 new cases, 8relapses and 1 PKDL. No death or defaulters reported.

Since Week 1, a total of 741 cases including 11 deaths (CFR 1.5%) and1 (0.1%) defaulters have been reported from 15 treatment centers. Ofthe 741 cases reported, 620(83.7%) were new cases, 45(6.1%) PKDLand 76(10.3 %) relapses.

In the corresponding period in 2016, a total of 405 cases including 16deaths (CFR 4.0%) and 17(4.2%) defaulters were reported from 21treatment centers. Majority of cases were reported from Old fangak(262) Lankien (232), Kurwai (79) , Malakal IDP (29) Walgak (28), andUlang (14)

The most affected groups included, males [241 cases (54.7%)], thoseaged ≥15years and above [197 (45.5%) and 5 - 14years [177 cases(41.3)]. A total of 67 cases (15.7%)] occurred in children <5years.

Fourteen (14) HEV cases reported from Bentiu PoC (Fig. 19)were reported in week 11. Since the beginning of 2017, a totalof 152 HEV cases have been reported from Bentiu PoC. Thetransmission of HEV is also reported in Bentiu town and allhave been linked to sub-optimal access to safe water andsanitation. .

Cumulatively, from the beginning of the crisis, 3,400 HEVcases including 25 deaths (CFR 0.74%) reported in Bentiu;174 cases including seven deaths (CFR 4.4%) in Mingkaman;38 cases including one death (CFR 2.6%) in Lankien; 3confirmed HEV cases in Melut; 3 HEV confirmed cases inGuit;1 HEV confirmed case in Leer; and Mayom/Abyei [57cases including 15 deaths with 7 HEV PCR positive cases.

Other diseases of public health importanceAcute Flaccid Paralysis | Suspected Polio

In Week 11, Ten (10) new AFP cases were reported with date of onset in 2017 from Warrap (7 ), Jonglei (1),Upper Nile(1) and Eastern Equatoria Hubs (1).

During 2017, a cumulative of 30 AFP cases have been reported countrywide. the annualized non-Polio AFP (NPAFP) rate (cases per 100,000 population children 0-14 years) is 2.10 per 100,000 population of children 0-14 years (target ≥2 per 100,000 children 0-14 years).

Stool adequacy was 89% in 2017, a rate that is higher than the targetof ≥80%.

Guinea Worm | Dracunculiasis

In week 11, there was no report of any suspectedGuinea worm from across the Country.

Cumulatively in 2016; six (6) confirmed Guinea wormcases were reported compared to Four (4) cases in2015.

The Ministry of Health through the South Sudan Guinea Worm Eradication Program(SSGWEP) continues to offer cash reward of 5,000 SSP. for reporting a Guinea worm.

Viral Haemorrhagic FeverNo new suspect hemorrhagic fever cases reported from across theCountry in week 11.

Animal bites | Suspected rabies

There were no suspect rabies cases in the week 11 .

Table.|NonPolioAFPratebycountyasofweek11of2017

050100150200250300350

0246810121416

3 9 15212733394551 5 1117232935414753 6 12182430364248 2 8

2014 2015 2016 2017

No.casesinBen

tiu

No,casesinothersites

Epidemiologicalweek

Figure19|HEVtrendsinMingkaman,Bentiu&LankienW102014toW112017

Awerial Lankien Bentiu

!

Cholera

Figure 1.0: Cholera incidence (cases per 10,000) and casefatality rate (%) as of 13 October 2016

• Cumulatively, 5,856 cholera cases including 144 deaths (65facilities and 79 community) (CFR 2.46%) have been reportedin South Sudan (Figs 19.2&19.3; Table 4.2)

• The counties with active cholera transmission includeYirol East, Awerial, Panyijiar, and Bor (Figs 19.2&19.3;Table 4.2).

• Suspect cholera cases are being verified/investigated inPadiet, Duk; Juaibor and Keew in Old Fangak; andJachor, Nyawit, Pagil, Gorwai, and Pajiek in Ayod (Figs19.2&19.3; Table 4.2).

Table4.2|Choleracasesanddeathsbycountyasof31Mar2017

Figure19.2|CholeraEpidemiccurveinSouthSudanasof31Mar2017

ReadersarereferredtothecholerasituationreportfordetailsontheongoingcholeraresponseinSouthSudan

Reportingsites Totalcases TotalFacilitydeaths Totalcommunitydeaths TotaldeathsJubacounty 2,045 8 19 27

Dukcounty 100 3 5 8

Bor county 82 1 4 5

Terekekacounty 22 0 8 8

Awerialcounty 671 2 8 10

Yirol East 438 12 23 35

Pagericounty 29 0 1 1

Fangakcounty 270 4 0 4

Rubkonacounty 1176 7 2 9

Leercounty 94 3 0 3

Panyijiarcounty 501 20 4 24

Mayenditcounty 226 0 5 5

Pigicounty 181 5 5

Malakal 16 0 0

Total 5,856 65 77 144

Figure19.3|Choleraincidence(casesper10,000)andcasefatalityrate(%)asof31Mar2017

- - -

21.05

16.92

2.05 1.85

0.62 0.861.42 1.55

2.753.33

0.421.35

0.76

4.48

3.33

0.75

2.26 2.42

0.82

2.00

0.63

1.761.27

0.57

2.24

0.79 0.60

2.30

3.49

6.67

5.11

6.91

-

5.754.84

4.21

1.49 1.61

- 0

5

10

15

20

25

0

50

100

150

200

250

300

350

22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 1 2 3 4 5 6 7 8 9 10 11 12 13

2016 2017

CFR[%]

Numberofca

ses

Epidemiologicalweekofonset

Jonglei Jubek Terekeka Imatong EasternLakes WesternBieh NorthernLiech SouthernLiech CentralUpperNile CFR[%]

Raga

Pibor

Wau

Juba

Lafon

Uror

Ayod

Wulu

Yei

IbbaKapoeta East

Baliet

Ezo

Renk

Abyei

Maban

Duk

Tambura

Akobo

Bor South

Torit

Melut

Budi

Maridi

Nagero

Nyirol

Yambio

Terekeka

Pariang

Tonj North

Nzara

Fangak

Manyo

Pochalla

Mvolo

Twic

Aweil Centre

Koch

Guit

Ulang

Magwi

Longochuk

Cueibet

Awerial

Twic East

Aweil East

Yirol East

Ikotos

Mayom

Aweil North

Lainya

Maiwut

Panyikang

Yirol West

Tonj East

Canal/Pigi

Fashoda

Kajo-Keji

Jur River

Tonj South

Panyijiar

Mundri West

Aweil West

Mundri East

Rubkona

Kapoeta North

Leer

Gogrial East

Luakpiny/Nasir

Gogrial West

Mayendit

Rumbek North

Rumbek East

Rumbek Centre

Abiemnhom

Morobo

Aweil South

Malakal

Kapoeta South

8

1.32

5.75

1.48

36.36

8.02

4.79

3.45

1.64

2.76

0.77

2.28

0

3.19

Monday, March 27, 2017

River_Nile

Cases /10,000 PopulationNo Case

0.1 - 15

16 - 30

31 - 45

46 - 60

> 60

Data_source: HF_data_by-WHO_states_hubs/ Data_as_of_Jan_2017

0 18090

KM

±

World HealthOrganization

Cholera Fatality Density Map by CFR, Week 24 to Week 12, 2017

Case Fatality Rate ( CFR )

Continues with Cholera Alert

Mortality

Crude and under five mortality rates in IDPs

Overall mortality in 2017

Five (5) deaths were reported through IDSR in Week 11, All wereattributed to malaria (Table 5). Four out of the five deaths were inchildren aged 5 years or younger.

Mortality data was submitted from Akobo, Bentiu, Juba 3 and Malakal IDP sites. (Table 6), Nineteen (19) deaths were reported from these sites in Week 11. Bentiu PoC continues to report the highest mortality with 14 out of the 19 deaths reported. Overall 3 out of the 19 deaths were children aged <5 years (Table 6).

This week there were varied causes of Mortality of Mortality in the IDP Sites(Table 6).

The U5MR in all the IDP sites that submitted mortality data in week 10 of 2017 is below the emergency threshold of 2 deaths per 10,000 per day (Fig. 20).

Note: Mortality rates are calculated for PoC sites only and are based on the latest available population data from OCHA. They are reported from line lists and should include community and facility-based deaths. However, due to rapid in/out migration from the PoC sites, and possible under-reporting of community-level deaths, they should be interpreted carefully.

!

Table 6 | Proportional mortality by cause of death in IDPs W11 2017Table 5 | Mortality from IDSR reports countrywide W11 2017

A total of 208deaths have beenreported from theIDP sites from sWeek 01 of 2017.(Table 7).

The top causes ofmortality in the IDPsin 2017 are shownin table 7.

The Crude Mortality Rates [CMR] in all the IDP sites that submittedmortality data in week 11 of 2017 were below the emergency threshold of 1death per 10,000 per day (Fig. 21).

The other causes of mortality in the week are shown in Tables 5 and 6.

Table 7 | Mortality by IDP site and cause of death W11 2017

County

Malaria

<5yrs

Malaria

≥5yrs

Total

deaths<5yrs

Totaldeaths

≥5yrsTorit

1 0 1 0Cuiebet

1 0 1 0Yirol West

0 1 0 1Aweil West

1 1 0Juba

1 1 0Total 4 1 4 1

0.0

1.0

2.0

3.0

1 3 5 7 9 111315171921232527293133353739414345474951 1 3 5 7 9

2016 2017deathsper10,000pe

rday

Epidemiologicalweek

Figure20|EWARNU5MRbySite- W12016toW11of2017

Bentiu Juba3 Malakal Mingkaman

Melut Akobo WauShiluk Threshold

0.0

0.2

0.4

0.6

0.8

1.0

1.2

1 3 5 7 9 111315171921232527293133353739414345474951 1 3 5 7 9

2016 2017

deathsper10,000pe

rday

Epidemiologicalweek

Figure21|EWARNCrudeMortalityRateforW12016toW11of2017

Bentiu Juba3 Malakal Mingkaman Melut

Akobo WauShiluk Threshold WauPoC

IDPSITE TB/H

IV/A

IDS

Unkn

own

Severe

malaria

severe

pneumonia

SAM

AWD

Chronic

illness

Cardiac

arrest

Sepsis

HeartFailure

Meningitis

chronic

illness

CAstomach

IUFD

Renalfailure

Kala-Azar

GSW

maternal

death

others

Grandtotal

Bentiu 17 30 2 5 13 2 2 4 2 2 2 1 2 2 32 118Juba3 15 6 3 1 1 1 1 2 6 36Kodok 1 1 1 3Malakal 1 2 1 1 1 1 10 15Akobo 1 7 5 2 1 2 6 24

WauPoC 2 6 2 10

GrandTotal 36 32 15 14 13 11 4 4 3 3 2 2 2 2 2 2 2 2 57 208

CauseofDeathbyIDPsite

Akobo Bentiu Juba3 Malakal

GrandTotal

Proporti

onatemortalit

y[%]≥5 <5yrs ≥5 ≥5 ≥5

chronicillness 1 1 5GSW 1 1 5PUD 1 1 5RTA 1 1 5

SevereAnaemia 1 1 5Unknown 1 5 2 8 42

UpperGIBleeding 1 1 5snakebite 1 1 5

PyrexiaofUnknownorigin 1 1 5

Susp.cancerofthekidney 1 1 5

Severemalnutrition+diarrhoea 1 1 5

Urineretention 1 1 5GrandTotal 2 2 12 1 2 19 100

Data sources

Editorial

Acknowledgements

This bulletin presents disease trends from the Integrated Disease Surveillance and Response (IDSR) System and the Early Warning Alert and Disease Network (EWARN).

The respective data is submitted by public health facilities serving host communities (non-conflict affected states or non IDP sites) and partner-supported facilities serving internally displaced persons (IDP) in the Republic of South Sudan.

MoH and WHO gratefully acknowledge the support of all MoH staff in the states, WHO Field Officers, and implementing-health cluster partners in collecting and reporting the data used in this bulletin.

Contact

For more information, please contact: Department of Epidemics, Preparedness and ResponseMoH Republic of South Sudan

Email: [email protected]

Outbreak toll-free line using vivacell:1144

This bulletin is produced by the Ministry of Health with technical support from the WHO

Editorial:Dr.AliceL.Igale,Dr.AbrahamAdut,KorsukL.Scopus,RobertM.Lasu,RoseA.Dagama,JanePita,Dr.Patrick,R.Otim,GabrielWaat,Dr.AllanM.Mpairwe,Dr.JosephF.Wamala,Dr.JohnP.Rumunu

Supported by the Global EWARS project | [email protected]

weekly epidemiological bulletin republic of south sudan · maridi nyiro l p aring yambio er ka...

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