South Sudan. Integrated Disease Surveillance and Response (IDSR) Epidemiological Update W (Nov 06-Nov 12)

Transcription

1 South Sudan Integrated Disease Surveillance and Response (IDSR) Epidemiological Update W (Nov 06-Nov 12) Ministry of Health Republic of South Sudan Printed: 12:38 Saturday, 18 November 2017 UTC

2 Contents Surveillance Response Slide 1 Table 1 IDSR surveillance performance indicators by county (W45) Cholera Table 2 Summary of key IDSR surveillance indicators Table 3 IDSR report submissions (W45) Slide 8 Slide 9 Table 11 Summary of key cholera response indicators Figure 2 Cholera epidemic curve (National) Slide 2 Slide 3 Slide 4 Figure 1 Trend in IDSR completeness over time Map 1a Map of IDSR completeness by county (W45) Map 1b Map of IDSR timeliness by county (2017) Table 4 EWARS surveillance performance indicators by partner (W45) Table 5 Summary of key EWARS surveillance indicators Table 6 EWARS report submissions (W45) Slide 10 Map 3a - 3d Maps of distribution of cholera cases (Jul present) Slide 11 Slide 12 Figure 3a - 3k Cholera epidemic curves by county 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) Alert Slide 5 Slide 6 Slide 7 Table 7 Alert performance indicators by Hub (W45) Table 8 Summary of key alert indicators Table 9 Alert performance indicators by event (W45) Table 10 Event risk assessment Map 2a - 2f Maps of key disease alerts by county (W45) Sources of data 1. Weekly IDSR Reporting Form 2. Weekly EWARS Reporting Form 3. Daily cholera line list 4. Event based surveillance form W (Nov 06-Nov 12)

3 Highlights W Completeness for IDSR reporting is 61% at county level and 78% for the IDP sites Bloody diarrhoea remains the most frequent alert with a total of seven counties affected in week 45 A total of 46 new measles cases were reported from Panyijiar. Reactive vaccination has been completed A cholera flare-up reported in Juba with at least 40 cases (16 confirmed) reported from New Bongo. A multisectoral response has been rolled out to the area Cholera has continued to decline in Budi with only sporadic transmission reported from Kimotong, Ngauro, and Lorema. A reactive oral cholera vaccine campaign is underway in the county.

4 Highlights W Surveillance Completeness for IDSR reporting at county level was 61%. Completeness for EWARS reporting from IDP sites was 78%. Alert A total of 20 alerts were reported, of which 70% have been verified. 1 alert was risk assessed and 1 required a response. Response A total of 66 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 21,520 cases and 441 deaths (CFR 2.0% )*. * Note: The cholera data may be subject to adjustments as linelist data continues to received and entered from the field. W (Nov 06-Nov 12)

5 Table 1 IDSR surveillance performance indicators by county (W ) Hub Reporting Performance Table 2 Summary of key IDSR surveillance indicators W45 Cumulative (2017) # counties # reports received Completeness Timeliness 80 - Number of counties Aweil % 100% Bentiu % 56% Bor % 36% Juba % 67% Kwajok % 57% Malakal % 0% Rumbek % 100% Torit % 75% Wau % 100% Yambio % 100% South Sudan % 61% 61% 73% Completeness 61% 65% Timeliness Table 3 IDSR report submissions W45 Cumulative (2017) 49 2,701 total submissions submissions by mobile submissions by web Completeness for IDSR reporting at county level was 61% in week 44 and cumulatively at 73% for 2017 Timeliness for IDSR reporting at county level was 61% in week 44 and cumulatively at 65% for 2017

6 Surveillance Trend in IDSR completeness Figure 1 Trend in IDSR completeness over time 100% 80% 60% Percent 40% 20% 0% W W W W W W W W W W W W Completeness 2 W (Nov 06-Nov 12)

7 Surveillance Maps of IDSR completeness by county Map 1a Map of IDSR completeness by county (W ) es that submitted IDSR reports in W44 are in green in map 1a Map 1b Map of IDSR completeness by county (2017) es that did not submit IDSR reports in W44 wn in grey in map 1a Renk Manyo Renk Manyo Raja Melut Fashoda Maban Abyei Pariang Abiemnhom Malakal Aweil North Panyikang Baliet Aweil East Rubkona Mayom Guit Longechuk Twic Fangak Canal Pigi Aweil West Luakpiny Nasir Aweil Maiwut Gogrial South Gogrial WestEast 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 Wulu Tambura Awerial Mvolo Terekeka Ezo Nzara Mundri East Lopa Lafon Kapoeta North Yambio Mundri West Ibba Maridi Kapoeta East Raja Melut Fashoda Maban Abyei Pariang Abiemnhom Malakal Aweil North Panyikang Baliet Aweil East Rubkona Mayom Guit Longechuk Twic Fangak Canal Pigi Aweil West Luakpiny Nasir Aweil Maiwut Gogrial South Gogrial WestEast 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 Wulu Tambura Awerial Mvolo Terekeka Ezo Nzara Mundri East Lopa Lafon Kapoeta North Yambio Mundri West Ibba Maridi Kapoeta East Juba YeiLainya Kajo KejiMagwi Morobo Kapoeta South Torit Budi Ikotos Juba YeiLainya Kajo KejiMagwi Morobo Kapoeta South Torit Budi Ikotos Counties that submitted IDSR reports in W45 are shown in green in map 1a Counties that did not submit IDSR reports in W45 are shown in grey in map 1a Completeness 0 25% 50% 75% 100% Completeness 0 25% 50% 75% 100% 3 W (Nov 06-Nov 12)

8 Surveillance EWARS surveillance indicators Table 4 EWARS surveillance performance indicators by partner (W ) Partner Performance Reporting Table 5 Summary of key EWARS surveillance indicators W45 Cumulative (2017) # sites # reports received Completeness Timeliness 46 - Number of EWARS reporting sites CMD % 100% GOAL % 100% HLSS 1 0 0% 0% IMA % 100% IMC % 75% IOM % 100% IRC % 100% Medair % 100% MSF-E % 100% MSF-H % 100% SMC % 100% UNIDO % 100% 78% 66% Completeness 78% 62% Timeliness Table 6 EWARS report submissions W45 Cumulative (2017) 36 1,398 total submissions 1 81 submissions by mobile submissions by web UNKEA % 100% World Relief % 100% Total % 78% Timeliness and completeness for EWARN/IDP reporting stands at 78% for week 45 while cumulatively, completeness and timeliness are 66% and 62% respectively for 2017

9 Alert Alert performance indicators Table 7 Alert performance indicators by Hub Hub W45 Cumulative (2017) Table 8 Summary of key alert indicators W45 Cumulative (2017) # alerts % verif. # alerts % verif. Aweil 0 0% 9 33% Bentiu 2 50% 82 44% Bor 1 100% % Juba 1 100% 71 13% Kwajok 1 100% 41 34% Malakal 3 0% 62 48% Rumbek 4 100% % Torit 1 100% 70 59% Total alerts raised 70% 38% % verified 0% 25% % auto-discarded 5% 5% % risk assessed 5% 2% % requiring a response Wau 1 0% 65 14% Yambio 6 83% 60 37% South Sudan 20 70% % A total of 20 alerts triggered in week 45; 38% verified and 5% risk assessed with 2% requiring a response A cumulative of 696 alerts have been triggered in 2017 out of which; 38% have been verified

10 Alert Event risk assessment Table 9 Alert performance indicators by event Event W45 Cumulative (2017) Table 10 Event risk assessment W45 Cumulative (2017) # alerts % verif. # alerts % verif. Indicator-based surveillance Malaria 2 100% 71 32% AWD 5 60% 68 32% Bloody Diarr. 6 33% % Measles 3 100% 55 36% 0 10 Low risk 1 1 Medium risk 0 8 High risk 1 15 Very high risk Meningitis 0 0% 0 0% Cholera 0 0% % Yellow Fever 0 0% 10 80% Guinea Worm 2 100% 83 43% AFP 1 100% 30 67% VHF 0 0% % Neo. tetanus 0 0% 6 100% Event-based surveillance EBS total 1 100% 26 96% During week 45; the infectious hazard with the highest number of alerts triggered was acute bloody diarrhoea. The EPR committee has commissioned a special investigation into bloody diarrhoea cases

11 Alert by disease county in week 45, 2017 Count of uuid Column Labels Acute Watery Bloody Guinea Total County Diarrhoea AFP Diarrhoea Cholera EBS Worm Malaria Measles Alerts Awerial 1 1 Ayod 1 1 Budi 1 1 Cueibet 1 1 Fashoda 1 1 Gogrial West 1 1 Ibba 1 1 Juba 1 1 Malakal 1 1 Manyo 1 1 Mundri West 1 1 Mvolo Nagero 1 1 Raja 1 1 Rubkona Tambura 1 1 Torit 1 1 Wau 1 1 Yirol East 1 1 Yirol West 1 1 Total Alerts During week 45 a total of 22 alerts were triggered Mvolo and Rubkona reported reported two alerts each Bloody diarrhoea and AWD had the highest number of alerts in week 45 Number of Alerts Acute Watery Diarrhoea Alerts by disease in week 45 and 46 of AFP 4 7 Bloody Diarrhoea Cholera EBS Guinea Worm wk45 wk Malaria 1 3 Measles During the last two weeks - bloody diarrhoea; acute watery diarrhoea; and measles have had the highest number of alerts

12 Cumulative alerts by disease and county for Acute Watery Diarrhoea 30 AFP Number of Alerts by disease, South Sudan, week 1-46, 2017 n=691 alerts 125 Bloody Diarrhoea 178 Cholera 26 EBS 82 Guinea Worm Malaria Measles Neonatal Tetanus Viral Haemorrhagic Fever Yellow Fever Mayom Budi Tonj South Uror Tonj East Kapoeta North Rumbek North Duk Panyijiar Malakal Ulang Kapoeta East Bor Nyirol Jur River Awerial Yirol West Yirol East Rubkona Wau Ayod Juba Number of alerts by county, week 1-46, Number of alerts Since the beginning of 2017; a total of 691 alerts have been triggered Cholera registered the highest number (178) alerts in Most alerts have been reported from Juba, Ayod, Wau, Rubkona, and Yirol East

13 Alert Maps of key disease alerts by county Map 2a Malaria (W ) Map 2b Bloody diarrhoea (W ) Map 2c Measles (W ) Malakal Rubkona Raja Cueibet Nagero Awerial Tambura Mundri West Mvolo Ibba Torit Number of alerts 0 1 Number of alerts 10 Map 2d Cholera (W ) 0 1 Number of alerts 10 Map 2e Guinea Worm (W ) Map 2f Event-based surveillance (W ) Yirol East Yirol West Juba Number of alerts 0 7 W (Nov 06-Nov 12) 1 Number of alerts Number of alerts

14 Alert Event risk assessment Marburg Alert The Government of Uganda declared a Marburg outbreak on 19 Oct 2017 after a Marburg case was confirmed in Kween district, Eastern Uganda Cumulative cases are 4 (2 confirmed; 1 probable; 1 suspect) and 55 contacts under surveillance. The following actions have been undertaken to enhance Marburg preparedness in South 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 enhance awareness Key messages on Marburg virus disease presentation, prevention, and control have been drafted for review and 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

15 Response Confirmed epidemics Summary of new and ongoing confirmed epidemics Aetiologic agent Location (county) New epidemics: no new epidemic Date first reported New cases since last bulletin Cumulative cases to date (attack rate %) Case management Interventions Vaccination Health promotion WASH Ongoing epidemics: Measles Panyijiar 2/07/ (0.29) Yes Yes Yes N/A Cholera 27counties 18/06/ ,530 (0.463) Yes Yes Yes Yes Ongoing epidemics epidemics There are two ongoing epidemics Cholera transmission in two counties - Juba and Budi where transmission has declined though Juba registered a recent flare-up of cases in New Bongo village, Luri payam starting 10 Nov The measles outbreak in Panyijiar is still ongoing - but reactive measles vaccination has been completed.

16 Response Confirmed epidemics Ongoing epidemics - Epidemic description - Measles in Panyijiar county Number of cases/deaths Measles Epidemic curve, Panyijiar county, weeks 26 to 46, 2017 Alive Died Epidemiological week of rash onset Age (years) Female (n) Male (n) Total cases Percentage Cum. % <1yr % 23.8% 1-4yrs % 78.7% 5-14yrs % 92.1% 15+yrs % 100.0% Total cases % Case proportion 35% 30% 25% 20% 15% 10% 5% 0% Measles case distribution by Payam, Panyijiar county, wk 26 - wk 46, % Nyal 17.2% 19.1% kol kathieth 10.8% Ganyliel 4.9% 3.9% 3.4% 2.0% 2.0% 1.0% 0.5% 0.5% 0.5% 0.5% 0.5% Mayom Tiap Pachienjok Jiech Pachak Yai chuk Kathieth(IDP) wikir (blank) Thornhuom Measles transmission still ongoing in Panyijiar 204 cases including 4 deaths (CFR 1.96%) have been reported since early July 2017 Most cases 159 (79%) are <5 years of age Thirteen (13) payams have reported cases with the most affected being Nyal; Kol; Katieth; & Ganyliel Vaccination target child 6-59 mths completed Cases managed Ganyliel PHCC and Nyal PHCC by IRC and UNIDO 300 community HCW community surveillance

17 Response Cholera response indicators Table 11 Summary of key cholera response indicators W45 % n Cumul. 1 % n Indicator 66 21, Total number of cases reported 27% 18 12% 2, % tested with cholera RDT 2 89% 16 71% 1, % tested with cholera RDT that were positive 77% 51 56% 12, % admitted to CTC 3 0.0% 0 2.0% Case Fatality Rate (CFR) 4 0% 0 49% % deaths in community W W 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 8 W (Nov 06-Nov 12)

18 Response Cholera epidemic curve Figure 2 Cholera epidemic curve (W W ) Number W W W W W W W W W W W W W W W W W Cases Deaths 9 W (Nov 06-Nov 12)

19 Response Maps of cholera distribution over time by county Map 3a Distribution of cholera cases (Jul Sep 2016) Map 3b Distribution of cholera cases (Jul Dec 2016) Rubkona Fangak Canal Pigi Panyijiar Bor Awerial Bor Awerial Juba Juba Map 3c Distribution of cholera cases (Jul Mar 2017) Map 3d Distribution of cholera cases (Jul present) Fashoda Rubkona Fangak Canal Pigi Mayendit Panyijiar Duk Yirol East Bor Awerial Rubkona Fangak Canal Pigi Mayendit Ayod Tonj East Panyijiar Duk Yirol East Yirol West Bor Awerial Juba Juba Kapoeta North Kapoeta East Kapoeta South Budi Number of cholera cases W (Nov 06-Nov 12)

20 Response Cholera response indicators by county Table 12 Summary of key cholera response indicators in counties with active transmission County W45 County Cumulative (W W ) 1 2 Cases Deaths CFR % adm. % comm. 3 deaths 1 2 Cases Deaths CFR % adm. % comm. 3 deaths Awerial % 0% 0% Ayod % 0% 0% Canal Pigi % 0% 0% Duk % 0% 0% Fashoda % 0% 0% Juba % 94% 0% Awerial 1, % 57% 85% Ayod 3, % 8% 97% Canal Pigi % 86% 0% Duk % 94% 89% Fashoda % 73% 8% Juba 2, % 86% 62% Kapoeta East % 0% 0% Kapoeta East 2, % 43% 62% Kapoeta North % 0% 0% Kapoeta North % 96% 0% Kapoeta South % 0% 0% Kapoeta South 1, % 88% 60% Nyirol % 0% 0% Panyijiar % 0% 0% Tonj East % 0% 0% Uror % 0% 0% Yirol East % 0% 0% Yirol West % 0% 0% Nyirol % 93% 0% Panyijiar % 73% 10% Tonj East 2, % 60% 56% Uror % 0% 0% Yirol East 1, % 96% 0% Yirol West % 96% 0% Case 12 Fatality W Rate (Nov 06-Nov % admitted 12) to cholera treatment centre (CTC) % deaths that occurred in the commmunity

21 Response Cholera cases by sex, age and outcome Figure 4a Cholera cases by sex (2017) Figure 4b Cholera cases by age (2017) Figure 4c Cholera cases by outcome (2017) ) Male ( 47% ; n = 8,042 ) Female ( 53% ; n = 9,038 < 5 ( 21% ; n = 3,617 ) 5-14 ( 25% ; n = 4,323 ) ( 42% ; n = 7,201 ) > 45 ( 12% ; n = 2,010 ) Discharged ( 69.9% ; n = 12,120 ) Defaulted ( 0.4% ; n = 72 ) Died ( 2.1% ; n = 359 ) Admitted ( 6.3% ; n = 1,090 ) 13 W (Nov 06-Nov 12)

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: 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