South Sudan. Integrated Disease Surveillance and Response (IDSR) Annexes W (Dec 18-Dec 24) Ministry of Health Republic of South Sudan

Transcription

1 South Sudan Integrated Disease Surveillance and Response (IDSR) Annexes W (Dec 18Dec 24) Ministry of Health Republic of South Sudan Printed: 18:19 Sunday, 31 December 217 UTC

2 Contents Access and Utilisation Slide 2 Map 1 Map of consultations by county (217) Acute Watery Diarrhoea (AWD) Slide 8 Trend in AWD cases over time Indicatorbased surveillance Slide 9 AWD maps and alert management Slide 3 Figure 1 Proportional mortality Bloody diarrhoea Slide 4 Figure 2 Proportional morbidity Slide 1 Trend in bloody diarrhoea cases over time Slide 5 Figure 3 Trend in consultations and key diseases Slide 11 Bloody diarrhoea maps and alert management Disease trends and maps Malaria Slide 6 Trend in malaria cases over time Measles Slide 12 Slide 13 Trend in measles cases over time Measles maps and alert management Slide 7 Malaria maps and alert management Sources of data 1. Weekly IDSR Reporting Form 2. Weekly EWARS Reporting Form 1 W (Dec 18Dec 24)

3 Access and Utilisation Map of consultations by county Map 1 Map of total consultations by county (W51 217) Hub W Aweil 2, ,757 Raja Renk Manyo Melut Fashoda Maban Abyei Pariang Malakal Abiemnhom Panyikang Baliet Aweil North Aweil East Rubkona Longechuk Twic Guit Mayom FangakCanal Pigi Aweil West Luakpiny Nasir Aweil South Maiwut Gogrial Gogrial West East Koch Nyirol Ulang Aweil Centre Tonj North Ayod Mayendit Leer Tonj East Akobo Jur River Rumbek North Panyijiar Duk Uror Wau Tonj South Cueibet Rumbek Centre Twic East Pochalla Rumbek East Yirol East Nagero Yirol West Bor Pibor Tambura Wulu Awerial Mvolo Terekeka Ezo Nzara Mundri East Lopa Lafon Kapoeta North Yambio Mundri West Ibba Maridi Kapoeta East Juba Kapoeta South Yei Lainya Torit Budi Ikotos Kajo Keji Magwi Morobo Bentiu 6, ,471 Bor 4,42 441,376 Juba 4, ,38 Kwajok 5,11 874,587 Malakal 4, ,575 Rumbek 1,96 839,521 Torit 34 37,377 Wau 5, ,732 Yambio 6,7 522,619 South Sudan 51,575 6,75,53 Number of consultations 1 1, 2,5 5, 2 W (Dec 18Dec 24)

4 Proportional morbidity Figure 2 Proportional morbidity (217) Syndrome W # cases % morbidity # cases % morbidity Malaria 15, % 2,45, % ARI 5, % 436, % AWD 3, % 548, % Bloody diarrhoea % 84, % AJS 1.% 1,63.% Measles 1.% 1,179.% Other 7, % 551, % Total cases 31,846 1% 4,75,537 1% Malaria Acute Respiratory Infection (ARI) Acute Watery Diarrhoea Bloody diarrhoea Acute Jaundice Syndrome (AJS) Measles Other 4 W (Dec 18Dec 24)

5 Trend in consultations and key diseases IDSR trends in absolute counts Figure 3 Trend in total consultations and key diseases (W51) Number W W5 217 W9 217 W W W W W W W W W Total consultations Malaria Acute Respiratory Infection (ARI) Acute Watery Diarrhoea Acute Jaundice Syndrome (AJS) Measles 5 W (Dec 18Dec 24)

6 Trend in consultations and key diseases IDSR Proportionate morbidity trends Morbidity % 7.% 6.% 5.% 4.% 3.% 2.% 1.%.% Fig. 1 IDSR Proportionate morbidity trends, week 1 to 51, Epidemiological week of reporting in 217 Consultations Malaria ARI AWD ABD Measles Number of consultations Thousands In the relatively stable states, malaria is the top cause of morbidity accounting for 36.6% of the consultations in week 51 (representing an decline from 38% in week 5) and a cumulative 41.1% in 217. Malaria has been on the decline since week 38 of 217.

7 Trend in consultations and key diseases IDP Proportionate morbidity trends % of Mobidity 45% 4% 35% 3% 25% 2% 15% 1% 5% % Fig. 2 IDP Proportionate morbidity trends, week 151, Epi week 217 Consultations Malaria ARI AWD ABD Measles Skin diseases GSW Injuries 5, 45, 4, 35, 3, 25, 2, 15, 1, 5, Consultations Among the IDPs, ARI and malaria accounted for 1.1% and 18.% of consultations in week 51. The other significant causes of morbidity in the IDPs include AWD, skin diseases, and injuries.

8 Trend in consultations and key diseases IDP Proportionate morbidity trends Proportionate morbidity [%] 25.% 2.% 15.% 1.% 5.%.% Causes of morbidity among the IDPs weeks 1 to 51, % 21.% 7.8% 3.97%.7%.2%.2% 1.63% Malaria ARI AWD ABD Measles Skin diseases GSW Injuries The top causes of morbidity in the IDPs in 217 include ARI, malaria, AWD, skin diseases, injuries, and ABD.

9 Proportional mortality Figure 1 Proportional mortality (217) Syndrome W # deaths % mortality # deaths % mortality Malaria 3 5.% 1, % ARI.% 4 2.3% AWD.% 9 5.3% Bloody diarrhoea.% % AJS.% 1.1% Measles.% 12.7% Other 3 5.% % Total deaths 6 1% 1,76 1% Malaria Acute Respiratory Infection (ARI) Acute Watery Diarrhoea Bloody diarrhoea Acute Jaundice Syndrome (AJS) Measles Other 3 W (Dec 18Dec 24)

10 Acute Watery Diarrhoea Trends over time Figure 5a Trend in AWD cases over time (South Sudan) Jan Mar May Jul Sep Nov Graph legend Key AWD indicators (217) Figure 5b % morbidity Figure 5c Age breakdown 548, Cases Deaths Alerts 8 W (Dec 18Dec 24)

11 Acute Watery Diarrhoea Maps and Alert Management Map 4 Map of AWD cases by county (217) a. 214 b. 215 c. 216 d. 217 Map 5 Map of AWD alerts by county (217) Map legend Risk Assessment Number of AWD cases 1 5, 1, 2, Number of AWD alerts 1 1 Alert threshold Twice the average number of cases over the past 3 weeks. Source: IDSR 9 W (Dec 18Dec 24) 77 3 Alerts Verified Low Risk Moderate Risk High Risk Very High Risk

12 Acute Bloody Diarrhoea Trends over time Figure 6a Trend in bloody diarrhoea cases over time (South Sudan) Jan Mar May Jul Sep Nov Graph legend Key bloody diarrhoea indicators (217) Figure 6b % morbidity Figure 6c Age breakdown 84, Cases Deaths Alerts 1 W (Dec 18Dec 24)

13 Acute Bloody Diarrhoea Maps and Alert Management Map 6 Map of bloody diarrhoea cases by county (217) a. 214 b. 215 c. 216 d. 217 Map 7 Map of bloody diarrhoea alerts by county (217) Map legend Risk Assessment Number of bloody diarrhoea cases 1 5 1, 2, Number of alerts 1 1 Alert threshold Twice the average number of cases over the past 3 weeks. Source: IDSR 11 W (Dec 18Dec 24) Alerts Verified Low Risk Moderate Risk High Risk Very High Risk

14 Measles Trends over time Figure 7a Trend in number of cases over time (South Sudan) Jan Mar May Jul Sep Nov Graph legend Key measles indicators (217) Figure 7b % morbidity Figure 7c Age breakdown 1, Cases Deaths Alerts Since the beginning of 217, at least 1,179 suspect measles cases including at least 12 deaths (CFR 1.2%) have been reported. Of these, 832 suspect cases have undergone measles casebased laboratorybacked investigation. At least 297 samples have been collected, with a total of 84 measles cases being laboratory confirmed, while 321 cases and 24 cases were epidemiologically and clinically confirmed respectively. Consequently, measles outbreaks were confirmed in nine counties Panyijiar, Aweil South, Gogrial East, Gogrial West, Wau, Juba, Torit, Yambio, and Jur River. Measles follow up campaign implemented from May 217 in 1 state hubs where 1,742,725 children six to 59 months (75%) were reached with measles vaccine.

15 Measles Maps and Alert Management Map 7 Map of measles cases by county (217) a. 214 b. 215 c. 216 d. 217 Map 8 Map of measles alerts by county (217) Map legend Risk Assessment Number of measles cases Number of measles alerts 1 1 Alert threshold 1 case. Source: IDSR 13 W (Dec 18Dec 24) Alerts Verified Low Risk Moderate Risk High Risk Very High Risk

16 Malaria Trends over time Figure 4a Trend in number of cases over time (South Sudan) Jan Mar May Jul Sep Nov Graph legend Key malaria indicators (217) Figure 4b % morbidity Figure 4c Age breakdown 2,45,3281, Cases Deaths Alerts 6 W (Dec 18Dec 24)

17 Malaria Maps and Alert Management Map 2 Map of malaria cases by county (217) a. 214 b. 215 c. 216 d. 217 Map 3 Map of malaria alerts by county (217) Map legend Risk Assessment Number of malaria cases 1 1, 2, 5, Number of malaria alerts 1 1 Alert threshold Twice the average number of cases over the past 3 weeks. Source: IDSR 7 W (Dec 18Dec 24) Alerts Verified Low Risk Moderate Risk High Risk Very High Risk

18 o At least 3 countries Awerial, Yirol East, and Twic East continue to register increasing trends at or above the third quartile. o The malaria trends in the other 2 counties are returning to normal offtransmission season levels

19 Malaria trends by county 16, Malaria trends for Aweil East County in , 12, 2,5 Malaria trends for Yirol East County in 217 1, 8, 3rd Quartile Csum 217 2, 3rd Quartile Csum 217 6, 1,5 4, 2, 1, 5 4, Malaria trends for Aweil North County in 217 3,5 3, 2,5 3rd Quartile Csum 217 7, Malaria trends for Yirol West County in 217 2, 6, 1,5 5, 3rd Quartile Csum 217 1, 4, 5 3, 2, 1, 3,5 Malaria trends for Aweil South County in 217 3, 2,5 2, 3rd Quartile Csum 217 1,5 1, 5 2,5 Malaria trends for Awerial County in 217 2, 1,5 3rd Quartile Csum 217 1, 5

20 Malaria trends by county 2,5 Malaria trends for Cueibet County in 217 2, 3, Malaria trends for Jur River County in 217 2,5 1,5 3rd Quartile Csum 217 3rd Quartile Csum 217 2, 1, 1,5 5 1, Malaria trends for Duk County in Malaria trends for Kapoeta East County in rd Quartile Csum rd Quartile Csum , 4,5 Malaria trends for Gogrial East County in Malaria trends for Kapoeta North County in 217 4, 7 3,5 3, 3rd Quartile Csum rd Quartile Csum 217 2,5 4 2, 1,5 3 1, ,2 Malaria trends for Ikotos County in 217 1,6 Malaria trends for Kapoeta South County in 217 1, 3rd Quartile Csum 217 1,4 1,2 3rd Quartile Csum ,

21 Malaria trends by county 1,4 Malaria trends for Rubkona County in 217 4,5 Malaria trends for Tonj North County in 217 1,2 4, 1, 3rd Quartile Csum 217 3,5 3, 3rd Quartile Csum ,5 6 2, 4 1,5 1, 2 5 9, Malaria trends for Rumbek East County in 217 3, Malaria trends for Tonj South County in 217 8, 7, 3rd Quartile Csum 217 2,5 3rd Quartile Csum 217 6, 2, 5, 4, 1,5 3, 1, 2, 1, 5 1,2 Malaria trends for Rumbek North County in Malaria trends for Twic East County in 217 1, 8 3rd Quartile Csum rd Quartile Csum ,8 1,6 Malaria trends for Terekeka County in 217 1,2 Malaria trends for Wulu County in 217 1,4 3rd Quartile Csum 217 1, 1,2 3rd Quartile Csum 217 1,

22 Malaria trends by county 2,5 Malaria trends for Yirol East County in 217 2, 3rd Quartile Csum 217 1,5 1, 5 7, Malaria trends for Yirol West County in 217 6, 5, 3rd Quartile Csum 217 4, 3, 2, 1,

23 Malaria trends in select IDP sites 7 Figure 1a Malaria trend for IDPs in Bentiu PoC 217 Figure 1b Malaria trend for IDPs in Malakal PoC, 217 Proportionate morbidity % Proportionate morbidity % Epi Week Third quartile Prop mob Week of reporting Third quartile Prop mob Figure 1c EWARN trends for Malaria in UN House, Figure 1d EWARN trends for Malaria in Renk, 217 Proportionate mrobidity % Proportionate morbidity % Epi week Third quartile Prop mob 217 Third quartile Prop mob 217 Malaria trends in four of the large IDP sites Bentiu Poc; UN House Poc; Malakal PoC; and Renk are below the third quartile

24 Visceral Leishmaniasis Kalaazar Kalaazar is endemic in Upper Nile, Unity, Jonglei, & Kapoeta. Response interventions have been complicated by insecurity, population displacement, poor living conditions, increasing food insecurity, closure of treatment facilities; and low treatment completion rates. Since the beginning of 217, a total of 2,722 cases including 56 deaths (CFR 2.1%); 23 (.8%) defaulters; 2,339 (85.9%) new cases; 119(4.4%) PKDL; and 264(9.7%) relapses all reported from less than half of the 23 treatment centers. In the corresponding period of 216, a total of 3,513 cases including 85 deaths (CFR 2.6%) and 65(2.%) defaulters were reported from 21 treatment centers. The majority of cases in 217 have been reported from Lankien (1,181), Old Fangak (733), Kurwai (21), Chuil (13), Walgak (122), Pagil (62), Malakal IDP (96), Kapoeta (42), and Bunj (45). The most affected groups include, males [1,322 cases (48.6%)], those aged 5 14years [1,112(4.9%) and 15years and above [922 cases (33.9%)]. A total of 519 cases (19.1%)] occurred in children <5years. We are currently in the peak transmission season [September to December]. Hence current efforts by the taskforce entail training of health workers, and stocking ample supplies of diagnostics and medicines at all designated treatment centers. In recent years, we have seen more than expected transmission from September to December in areas affected by conflict, displacement, severe food insecurity, and poor living conditions.

25 Hepatitis E Virus (HEV) Hepatitis E virus transmission continues to be reported in displaced populations. Genotype 1 has been isolated 14 3 from these outbreaks since This therefore suggests 1 suboptimal access to safe 2 water and sanitation as 8 transmission drivers Cumulatively, a total of HEV cases have been reported from Bentiu PoC in 217 [one case reported in the week]. (Fig. 19). Current response entails behavior change communication to improve Epidemiological week hygiene, access to safe water, and sanitation. Awerial Lankien Bentiu Since the beginning of the crisis, 3,694 HEV cases including 25 deaths (CFR.68%) reported in Bentiu; 174 cases including seven deaths (CFR 4.4%) in Mingkaman; 38 cases including one death (CFR 2.6%) in Lankien; 3 confirmed HEV cases in Melut; 3 HEV confirmed cases in Guit;1 HEV confirmed case in Leer; and Mayom/Abyei [75 cases including 13 deaths with 7 HEV PCR positive cases. No, cases in other sites No. cases in Bentiu

26 Acute Flaccid Paralysis Suspected Polio In week 47, nine new AFP cases were reported [five in Eastern Equatoria; one in Unity; one in Upper Nile; one in Warrap; and one in Western Equatoria]. 217 During 217, a cumulative of 34 AFP cases have been reported countrywide. The annualized non Polio AFP (NPAFP) rate (cases per 1, population children 14 years) is 4.57 per 1, population of children 14 years (target 2 per 1, children 14 years). Stool adequacy was 89% in 217, a rate that is higher than the target of 8%. Environmental surveillance ongoing since May 217; with 2 samples testing positive for nonpolio enterovirus. Source: South Sudan Weekly AFP Bulletin # of Counties / stool adequacy rates in 217* State Hubs = ><8 889% >9 Total CENTRAL EQUATORIA HUB EASTERN EQUATORIA HUB JONGLEI HUB LAKES HUB NORTHERN BAHR EL GHAZAL HUB UNITY HUB UPPER NILE HUB WARRAP HUB WESTERN BAHR EL GHAZAL HUB WESTERN EQUATORIA HUB 1 1 Total number Percent 2% 16% 8% 56% 1% *As of epidemiological week 47/217

27 Mortality in the IDPs Cause of Death by IDP site Akobo Bentiu Juba 3 Total Proportionate <5yrs <5yrs 5yrs <5yrs 5yrs deaths mortality [%] Acute Abdomen Cancer Liver Cirrhosis Malaria Perinatal death pneumonia Unknown HIV/AIDS Susp. TB TB Bowel perforation Rabies (Dog Bite) Neurosepsis Grand Total Table 6 Proportional mortality by cause of death in IDPs W Among the IDPs from these locations, mortality data was received from Akobo, Bentiu PoC, and UN House PoC in week 51. (Table 6). A total of 19 deaths were reported during the week. Bentiu PoC reported 13 (68%) deaths in the week. During the week, 8 (42%) deaths were recorded among children <5 years in (Table 6). The causes of death during week 51 are shown in table 6.

28 Crude and under five mortality rates in IDPs deaths per 1, per day Figure 2 EWARN U5MR by Site W1 216 to W 51 of Epidemiological week Bentiu Juba 3 Malakal Threshold Wau PoC deaths per 1, per day Figure 21 EWARN Crude Mortality Rate for W1 216 to W 51 of Epidemiological week Bentiu Juba 3 Malakal Melut Akobo Wau Shiluk Threshold Wau PoC The U5MR in all the IDP sites that submitted mortality data in week 51 of 217 is below the emergency threshold of 2 deaths per 1, per day (Fig. 2). The Crude Mortality Rates [CMR] in all the IDP sites that submitted mortality data in week 51 of 217 were below the emergency threshold of 1 death per 1, per day (Fig. 21).

29 Overall mortality in the IDPs in 217 Table 7 Mortality by IDP site and cause of death as of W51, 217 Acute watery diarrhoea cancer Gunshot wound Heart Failure Hepatitis E hypertension KalaAzar malaria maternal death Meningitis Perinatal death IDP site Bentiu Juba Kodok Malakal Akobo Bor POC Wau PoC Grand Total Proportionate mortality [%] ## Pneumonia Rabies SAM Stroke Cholera HIV/AIDS Susp. TB TB MDRTB + HIV Injuries Others Grand Total A total of 897 deaths have been reported from the IDP sites in 217 Table 7. The top causes of mortality in the IDPs in 217 include malaria, medical complications of malnutrition, pneumonia, perinatal complications, and TB are shown in Table 7.

30 For more help and support, please contact: Dr. Pinyi Nyimol Mawien Director General Preventive Health Services Ministry of Health Republic of South Sudan Telephone: Dr. Mathew Tut Moses Director Emergency Preparedness and Response (EPR) Ministry of Health Republic of South Sudan Telephone: Notes 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 Ministry of Health Republic of South Sudan