Highlights. Epidemiology

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Flora Leonard
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Malaria and VHF Outbreak in, Sudan Situation Report No 13, covering the period 26 December - 17 January 16 Federal Ministry of Health World Health Organization Highlights In, a total of 535 suspected

Forty seven cases and zero deaths have been added to the line list over week no 52/215, and week 1, and 2 in 216 (with twenty new cases).

1 Malaria and VHF Outbreak in, Sudan Situation Report No 13, covering the period 26 December - 17 January 16 Federal Ministry of Health World Health Organization Highlights In, a total of 535 suspected Dengue fever (DF) cases including 99 deaths were reported in the period of 29 th August to 15 th January, 216. Forty seven cases and zero deaths have been added to the line list over week no 52/215, and week 1, and 2 in 216 (with twenty new cases). In Kordofan, a total of 46 suspected cases of DF with 4 deaths were reported in the period of 17 th of October 215 to 15 th January, 216. The last case was reported on 3 th of December 215. Ten localities are affected in North, West and South Kordofan. Six blood samples were found positive for DF (Two in South Kordofan, three in West Kordofan and one in North Kordofan). In addition, 3 positive samples for hepatitis E in Shiekan locality of North Kordofan. In Kassala state, 7 suspected cases of DF were reported in the period 23 rd November to 15 th January 216. The cases were reported in Kassala town. The last case was reported on 11 th January 216. Blood samples were taken from all the reported cases and revealed 4 DF positive by ELISA IgM. Laboratory analysis of 117 samples collected from cases, done at the Central Public Health Laboratory in Khartoum revealed 33 positive for DF (6 positive for DF in Central, 24 positive for DF in West, 1 positive for DF in North and 2 positive for DF in South ). There were also 8 samples positive for West Nile virus and 1 positive for Chikungunya. All the samples tested negative for Yellow fever, Crimean Congo Hemorrhagic Fever (CCHF), and Rift Valley Fever. From 18 samples collected from contacts, 24 tested positive for DF (2 in Central, 2 in West, and 1 in each of North and East ) using ELISA IgM. Laboratory analysis also showed 1 positive sample for West Nile, and 3 positive for Chikungunya. All the samples tested negative for Yellow fever, CCHF, and Rift Valley Fever. Epidemiology The number of affected localities across remains 27 as listed in the table below. Out of reported cases, 57.9% are from West, 13.6% from Central, 22% from North, 2.8% from East and 3.7% are from South. 53% of all reported cases are males and 47% are females. The age distribution of the cases is as follows: 5.3% in the age group -1.9 years, 12.9% in the age group years, 41.6% in the age group years, 22.8% in the age group years, 9% in the age group years and 8.4% in the age group 45 years. There is no evidence of person to person transmission, as well as no reported cases among medical staff No neurological or ocular signs have been reported among the cases Reports indicate that people with suspected VHF have not presented with profuse bleeding requiring transfusion. There has therefore been no increase in the request for blood and blood products for clinical management of these cases. 1

2 no of reported cases Fig: Reported cases of suspected VHF by date of onset in in the period 29 August up till 15 of January 216 (source FMoH). 3 Reported cases of suspected VHF by date of onset in in the period 29 August up till 15 of January 216 (source FMoH) Fig below shows the weekly reported cases and deaths in in the period W 35 to W 2, 216 (ending on 15 th of January). 1 8 Reported cases and deaths, per week, due to malaria and VHF in in the period 3 August 215 to 15 January 216 (Source FMoH) deaths cases Table below shows attack rate (AR); case fatality rate (CFR); and date of last reported case, per locality, in in the period 29 th August up to 15 of January

3 State Central West North South East Locality No. of Cases No. of Deaths CFR AR/1 Date of Last Case Admitted 3-Dec-15 Date of Last Case Reported 31-Dec-15 Zalingei Azoom Nov Nov-15 Mukjer Nov Nov-15 Nertity Nov Nov-15 Wadi Salih Nov-15 3-Nov-15 Bendecy Nov Nov-15 Um Dukhun Nov Nov-15 Total Keraink Jan-15 1-Jan-15 Genaina Dec Dec-15 Habela Oct Oct-15 Beida Nov-15 4-Nov-15 Sirba Nov-15 6-Nov-15 Total Elseref Jan Jan-15 Saraf Omra Oct Oct-15 Aliaat Nov Nov -15 El Fasher Nov Nov-15 Total Kubum Nov-15 8-Nov-15 Belail Nov Nov-15 Kass Nov Nov-15 Alsalam Nov Nov-15 Sharq 6 1 Algabal Nov Nov-15 Nyala Shimal Dec Dec-15 Total Eddaein Dec-15 2-Dec-15 Asalaya Nov Nov-15 Adeela Nov Dec -15 Bahar Arab Dec - 27-Dec Alfirdos Dec Dec Total Total

4 % The most frequent symptoms were fever (1%), bleeding (98.3%), joint pain (49.2%) and jaundice (2.9%) as shown below. % of reported sysmptoms among the reported cases of VHF in in the period 3 August to 15 January 216 (Source FMoH) fever bleeding joint pain loss of conscousness jaundice Table below shows the attack rate (AR); case fatality rate (CFR); and date of last reported case, per locality, in Kordofan in the period 17th of October to 15 th January 216. State West Kordofan South Kordofan North Kordofan Date of Date of No. of No. of Locality CFR AR/1 Last Case Last Case Cases Deaths Admitted Reported Abyei Nov Nov-15 Kailak 6.6 Babanousa 1.16 Alsinoot 1.1 Alsalam 1.2 Total Rif Sharqi 3.6 Kadugli 1.1 Habila Lagawa 1. Total Sheikan Total Total Dec-15 6-Dec Dec-15 1-Jan Dec-15 9-Oct Oct Dec-15 2-Nov-15 1-Dec-15 7-Dec-15 3-Dec-15 1-Jan Dec Oct Nov Dec-15 2-Nov-15 4

5 Table below shows attack rate (AR), case fatality rate (CFR), and date of last reported case per locality, in Kassala state in the period 23 November to 15 th January 216. Date of Date of No. of No. of State Locality CFR AR/1 Last Case Last Case Cases Deaths Admitted Reported Kassala Kassala Jan Jan-16 Actions taken WHO Technical mission deployed to in early November recommended to systematically use the standard case-based reporting form to report any VHF. Accordingly, in the period December 215 joint WHO/FMoH mission was deployed to West and Central to facilitate filling the viral hemorrhagic fever (VHF) case investigation form correctly and completely and to collect optimal blood samples. Accordingly, doubled, 1 blood samples were collected and three of them showed DF positive. Arrangements are under way to share these latter samples with WHO CC in Dakar. The GOARN previously Identified laboratory support (Public health Canada) is not available anymore. GOARN is following up for identifying another lab support and deployment of an epidemiologist and working on visa process with the Sudan embassy and WCO. Save the Children Sweden in WD: 723 household visited for awareness sessions and vector inspection in Habila, Morni and Keraink in which 235 beneficiaries reached and 67 water pots inspected. IOM: Indoor spraying, fogging and vector surveillance were ongoing. Space spraying and vector surveillance area supported by FMOH and larvae inspection by WHO and IOM. IOM in collaboration with SMOH conducted training on Surveillance System (rumors investigation, reporting). In addition, 265 mosquito nets distributed beside ongoing health promotion campaign in Elseriaf Town and the surrounding villages. 6 community health volunteers in Genaina were trained for two days by MoH and Concern, they were equipped with the necessary health education messages (IEC materials) specifically designed to combat Malaria and Dengue and working within their respective communities to spread the messages across Genaina IDPs camps (Riaydh, Abuzar, Durti and Ardamata). In addition, 317 mosquito bed nets distributed to beneficiaries in Kublus and Jebel Moon localities. 36 mosquito nets for caregivers of malnourished children and PLW in Genaina IDPs camps. Awareness sessions were conducted in Genaina reaching 3477 beneficiaries, Morni reaching 2718 beneficiaries and in Jebel Moon reaching 877 beneficiaries. A daily and weekly interactive radio programme supported by OFDA (6 days/week/15 minutes) via Genaina FM radio station broadcasting Malaria, VHF (Dengue), and Diarrhea and IYCF messages is ongoing. Concern conducted 3 days case management training for 21 health workers from Krenick (Mornei) and Jebel Moon localities. Recommendations Identify the causative agent (even retrospectively) and to ensure national lab capacity was emphasized. It is recommended to accelerate share the samples collected during the enhancedcase-based investigation period, with Institute Pasteur in Dakar (WHO CC). 5

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Yellow Fever Outbreak in Darfur Situation Report 4 9 November 2012

Yellow Fever Outbreak in Darfur Situation Report 4 9 November 2012 Health cadres treat suspected yellow fever cases in Darfur (left photo) as well as ensure that containment measures are in place such