South Sudan. Integrated Disease Surveillance and Response (IDSR) Epidemiological Update W (Jan 8-Jan 14)

Transcription

1 South Sudan Integrated Disease Surveillance and Response (IDSR) Epidemiological Update W 08 (Jan 8-Jan 4)

2 Contents Surveillance Response Slide Slide Slide 3 Slide 4 Table IDSR surveillance performance indicators by county (W) Table Summary of key IDSR surveillance indicators Table 3 IDSR report submissions (W) Figure Trend in IDSR completeness over time Map a Map of IDSR completeness by county (W) Map b Map of IDSR timeliness by county (08) Table 4 EWARS surveillance performance indicators by partner (W) Table 5 Summary of key EWARS surveillance indicators Table 6 EWARS report submissions (W) Cholera Slide 8 Slide 9 Table Summary of key cholera response indicators Figure Cholera epidemic curve (National) Slide 0 Map 3a - 3d Maps of distribution of cholera cases (Jul 06 - present) Slide Slide Figure 3a - 3k Cholera epidemic curves by county Table Summary of response indicators by Hub Slide 3 Figure 4a Cholera cases by sex (08) Figure 4b Cholera cases by age (08) Figure 4c Cholera cases by patient outcome (08) Alert Slide 5 Slide 6 Slide 7 Table 7 Alert performance indicators by Hub (W) Table 8 Summary of key alert indicators Table 9 Alert performance indicators by event (W) Table 0 Event risk assessment Map a - f Maps of key disease alerts by county (W) Sources of data. Weekly IDSR Reporting Form. Weekly EWARS Reporting Form 3. Daily cholera line list 4. Event based surveillance form

3 Major Epidemiological Developments W 08 Completeness for IDSR reporting is 57% at county level and 77% for the IDP sites. A total of alerts were reported, of which 7% have been verified. 0 alerts were risk assessed and 0 required a response. [Whooping cough alerts - in Yirol East; AWD - 5 cases (0 death) - in Gunyoro (Torit). Rift Valley Fever outbreak - Yirol East with 5 suspect human cases including 3 confirmed; 3 probable; 4 none-cases; and 5 pending classification. One confirmed animal case (cow). Measles in Panyijiar on the decline with 3 cases reported in week 3; new measles outbreak confirmed in Cueibet - reactive vaccination plans underway. A total of 0 new cholera cases and 0 deaths (CFR 0.0% ) were reported. The cumulative total since the start of the current outbreak on 8 June 06 is 0,438 cases and 436 deaths (CFR.3% ). 3

4 Surveillance IDSR surveillance indicators Table IDSR surveillance performance indicators by county (W 08) Hub Reporting Performance (W 08) Performance (Cumulative 08) # counties # reports received Completeness Timeliness Completeness Timeliness Aweil % 00% 00% 00% Bentiu 9 % % % % Bor 8% 8% 7% 3% Juba % 67% 67% 67% Kwajok % 00% 00% 79% Malakal 3 0 0% 0% 0% 0% Rumbek % 00% 00% 88% Torit % 88% 63% 63% Wau 3 67% 67% 67% 67% Yambio % 90% 95% South Sudan % 57% 57% 57% Completeness for IDSR reporting at county level was 57% in week and cumulatively at 57% for 08 Timeliness for IDSR reporting at county level was 57% in week and cumulatively at 57% for 08 4

5 Surveillance Trend in IDSR completeness Figure Trend in IDSR completeness over time 00% 80% 60% Percent 40% 0% 0% W05 07 W09 07 W3 07 W8 07 W 07 W6 07 W3 07 W35 07 W39 07 W44 07 W48 07 W0 08 Completeness The graph shows completeness for weekly reporting at county level. The national average currently stands at less than 60%. 5

6 Surveillance Maps of IDSR completeness by county Map a Map of IDSR completeness by county (W 08) Map b Map of IDSR completeness by county (08) Renk Manyo Renk Manyo Raja Melut Fashoda Maban Abyei Pariang Abiemnhom Malakal Panyikang Baliet Aweil North Aweil East Rubkona Longechuk Twic Mayom Guit Fangak Canal Pigi Aweil West Luakpiny Nasir Aweil Gogrial South Maiwut 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 Panyikang Baliet Aweil North Aweil East Rubkona Longechuk Twic Mayom Guit Fangak Canal Pigi Aweil West Luakpiny Nasir Aweil Gogrial South Maiwut 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 W are shown in green in map a Counties that did not submit IDSR reports in W are shown in grey in map a Completeness Completeness 0% 0% 40% 60% 80% 00% 0% 0% 40% 60% 80% 00% 6

7 Surveillance EWARS surveillance indicators Table 4 EWARS surveillance performance indicators by partner (W 08) Partner Performance Reporting (W 08) Reporting (Cumulative 08) # sites # reports received Completeness Timeliness Completeness Timeliness CMD 00% 00% 00% 00% GOAL 0 0% 0% 0% 0% HLSS 00% 00% 00% 00% IMA % 00% 88% 63% IMC % 75% 69% 69% IOM % 00% 00% 00% IRC 00% 00% 00% 00% Medair 00% 00% 00% 00% MSF-E 00% 00% 00% 00% MSF-H 00% 00% 00% 00% SMC 3 67% 67% 83% 83% UNIDO 00% 00% 00% 00% UNKEA 0 0% 0% 0% 0% World Relief 00% 00% 00% 00% Total % 77% 76% 73% Timeliness and completeness for EWARN/IDP reporting stands at 77% for week while cumulatively, completeness and timeliness are 76% and 73% respectively for 08 7

8 Alert Alert performance indicators Table 7 Alert performance indicators by Hub Hub W Cumulative (08) Table 8 Summary of key alert indicators W Cumulative (08) # alerts % verif. # alerts % verif. Aweil 5 0% 6 33% Bentiu 0 0% 0 0% Bor 0% 50% Juba 3 33% 5 40% Kwajok 4 75% 4 75% Malakal 0% 0% Rumbek 4 0% 4 0% Torit 00% 3 67% Wau 0 0% 0 0% 3 Total alerts raised 7% 39% % verified 0% 0% % auto-discarded 0% 0% % risk assessed 0% 0% % requiring a response Yambio 3 0% 6 South Sudan 7% 3 39% A total of alerts were reported in week [majority reported from Aweil]. Only 7% of the alerts reported in week were verified; 0 were risk assessed and 0 required a response. 8

9 Alert Event risk assessment Table 9 Alert performance indicators by event Event W Cumulative (08) Table 0 Event risk assessment W Cumulative (08) # alerts % verif. # alerts % verif. Indicator-based surveillance Malaria 50% 3 67% AWD 5 0% 87 33% Bloody Diarr. 8 3% 40% Measles 5 40% 8 63% Meningitis 0 0% 0 0% Cholera 0 0% 0 0% Yellow Fever 0 0% 0 0% Guinea Worm 0% 0% AFP 0 0% 33 0% VHF 0 0% 0 0% Neo. tetanus 0 0% 0 0% 0 0 Low risk 0 0 Medium risk 0 0 High risk 0 0 Very high risk Event-based surveillance EBS total 00% 50% During the week, acute bloody diarrhoea, suspect measles, and acute watery diarrhoea were the most frequent infectious hazards reported. 9

10 Alert by disease and county in W3 08 Count of uuid Column Labels Acute Watery Bloody Guinea Total County Diarrhoea Diarrhoea EBS Worm Measles Malaria Alerts Duk Ezo 3 Juba Malakal Terekeka Tonj North 3 Tonj South Torit Yirol West Aweil South 3 Total Alerts Number of Alerts Acute Watery Diarrhoea Bloody Diarrhoea Alerts by disease in week and 3 of 08 EBS Guinea Worm wk Measles wk3 Malaria 8 Total alerts 7 During week 3, a total of 7 alerts triggered Bloody diarrhoea; acute watery diarrhoea; and suspect measles were the most frequent infectious hazards reported in the week. During the week, 0 suspect whooping cough cases were reported and treated from Nyang PHCC, Yirol East County. Five AWD cases including one death in a child were reported in Gunyoro (km from Torit). Four children were treated in Torit and ICRC conducted verification mission to Gunyoro on 9 Jan 08. Findings to follow. 0

11 Cumulative alerts by disease for 08 Number of Alerts by disease, South Sudan, week -3, 08 n=3 alerts 0 Number of alerts Acute Watery Diarrhoea Bloody Diarrhoea EBS Guinea Worm Malaria Measles The Figure shows the cumulative number of alerts triggered in 08 by hazard and location. Since the beginning of 08, most alerts are due to Bloody diarrhoea, measles, and acute watery diarrhoea A special investigation into the bloody diarrhoea cases is planned (protocol and case form finalised).

12 Cumulative alerts for the top 0 counties for 08 Cumulative alerts by county, week -3, 08 Yambio Tonj South Mvolo Mundri East Malakal Lainya Duk Bor Aweil North Yirol West Terekeka Mundri West Aweil South Tonj North Ezo Juba Torit Number of alerts The Figures show the cumulative alerts triggered in 08 by location Most alerts have been reported from Juba and Torit

13 Cumulative alerts by risk assessment stage in 08 County OUTCOME RISK_ASSESS VERIFICATION Total Alerts Acute Watery Diarrhoea 7 7 Bloody Diarrhoea 0 0 EBS Guinea Worm 3 Malaria 3 3 Measles 6 7 Total Alerts 30 3 The Figures show the cumulative alerts by risk assessment state in 08 Of the 3 alerts reported in 08; a total of 30 alerts have been verified; and one has been risk assessed and characterized with an outcome. 3

14 Response Summary of major ongoing outbreaks 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 Health Vaccination promotion WASH Ongoing epidemics: RVF Yirol East 8// (0.03) Yes N/A Yes N/A Measles Cueibet 4/0/ (0.0) Yes No Yes N/A Measles Panyijiar /07/ (0.47) Yes Yes Yes N/A Cholera 7 counties 8/06/06 0 0,438 (0.49) Yes Yes Yes Yes Epidemics - Update (RVF, Yirol East) A Rift Valley Fever (RVF) outbreak reported in Thonabutkok village, Yali Payam, Yirol East county with the initial case dating back to 7 December 07. As of January 08, a total of 5 suspect RVF human cases have been reported in Eastern Lakes State. Out of the 5 suspect human cases reported since 7 December 07, three human cases have been confirmed, three died and were classified as probable cases with epidemiological linkage to the three confirmed cases, four were classified as none-cases following negative laboratory results for RVF, and laboratory testing is pending for the other five suspect cases. At the moment - field investigation (human, animal, entomological) are ongoing; supportive care to suspect cases; and social mobilisation and risk communication. Discussions on a joint Ministry of Health and Ministry of Livestock and Fisheries outbreak declaration are ongoing at the highest levels of Government. Taskforce meetings are ongoing at national and sub-national levels; ToRs for the multisectoral taskforce have been drafted and the first draft of the RVF response plan 4has been circulated.

15 Response Confirmed epidemics Ongoing epidemics - Epidemic description - Measles in Cueibet county Number of cases Measles Trends in Cueibet County week 4-5, Epidemiological week of rash onset 07 Measles case distribution by Payam and village, Cueibet county, wk 39 - wk 5, 07 Mekodi Achot Mabor-tiit Pan-Ruup Cueibet Pagor 5 Age (years) 5 Female (n) Male (n) Total cases Percentage Cum.% <yr 3 4 0% 0% -4yrs % 65% 5-4yrs 3 5 5% 90% 5+yrs 0 0% 00% Grand Total % Measles outbreak confirmed in week 50 of 07 with 3 measles IgM cases At least 0 cases including one community death (CFR 5%) line listed since week 4 of 07. Most cases reported from Pagor PHCU and Cueibet hospital 3 (65%) are <5 years of age Two payams affected - Cueibet and Pagor Most affected villages are Mekodi and Pan-ruup Reactive vaccination plans underway - CHD, HC, CUAAM, HPF

16 Response Confirmed epidemics Ongoing epidemics - Epidemic description - Measles in Panyijiar county Number of cases/deaths Measles Epidemic curve, Panyijiar county, weeks 6,07 to week 3, 08 Alive Died Age (years) Female (n) Male (n) Total cases Percentage Cum. % <yr % 5.5% -4yrs % 78.5% 5-4yrs % 89.7% 5+yrs % 00.0% Epidemiological week seen at HF Total cases % Case proportion 40% 35% 30% 5% 0% 5% 0% 5% 0% Measles case distribution by Payam, Panyijiar county, wk 6, 07 to week 3, % Nyal.5% 4.6% 7.6% kol kathieth Ganyliel 4.0% 5.0% 3.7%.8%.9% 0.9% 0.3% 0.3% 0.3% 0.3% 0.6% 0.3% 0.3%.% Mayom Tiap Pachienjok Jiech Pachak Yai chuk Kathieth(IDP) wikir (blank) Thornhuom Wuangkeay Morgok Pachar 6 Transmission has declined in Panyijiar 3 cases reported in week 3 of 08 Four of the recent cases reported among IDPs from Mayendit Mop up vaccination ongoing in area with new cases - [new IDPs and area that were not vaccinated due to flooding] Three samples collected as part of the post campaign outbreak surveillance to determine if measles transmission has been interrupted.

17 Response Confirmed epidemics Ongoing epidemics - Epidemic description - Cholera in South Sudan Number of cases Cholera cases in South Sudan April 04 - December Week of onset TABLE Cholera Outbreaks in South Sudan Summary measure /7 No. cases 6,4,88 0,438 No. deaths CFR%.60%.59%.3% No. counties affected Duration (weeks) 9 9 (85) Ongoing Outbreak start date 4/04/06 8/05/06 8/06/06 Date of last case 3//06 4/09/06 Ongoing Attack rate [per 0,000] No transmission in any of the 4 counties where cholera was confirmed in 07. Most recent cases reported in week in Juba and week in Budi. Active AWD/cholera surveillance initiated to support end-of-cholera outbreak declaration especially in the Juba and other counties with AWD alerts Five AWD cases including one death reported in Gunyoro (km from Torit). ICRC conducted a verification mission to the area on 9 Jan 08. During the week three samples [one from Munuki (Juba) and two from Bentiu PoC] tested negative for cholera (following culturing). The nd round of oral cholera vaccination in Budi is scheduled for -7 Jan 08. 7

18 For more help and support, please contact: Notes 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: 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