South Sudan. Integrated Disease Surveillance and Response (IDSR) Epidemiological Update W (Oct 16-Oct 22)

Transcription

1 South Sudan Integrated Disease Surveillance and Response (IDSR) Epidemiological Update W (Oct 16-Oct 22) Ministry of Health Republic of South Sudan Printed: 05:27 Sunday, 29 October 2017 UTC

2 Contents Surveillance Response Slide 1 Table 1 IDSR surveillance performance indicators by county (W42) Cholera Table 2 Summary of key IDSR surveillance indicators Table 3 IDSR report submissions (W42) 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 (W42) Map 1b Map of IDSR timeliness by county (2017) Table 4 EWARS surveillance performance indicators by partner (W42) Table 5 Summary of key EWARS surveillance indicators Table 6 EWARS report submissions (W42) 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 (W42) Table 8 Summary of key alert indicators Table 9 Alert performance indicators by event (W42) Table 10 Event risk assessment Map 2a - 2f Maps of key disease alerts by county (W42) Sources of data 1. Weekly IDSR Reporting Form 2. Weekly EWARS Reporting Form 3. Daily cholera line list 4. Event based surveillance form W (Oct 16-Oct 22)

3 Highlights W Surveillance Completeness for IDSR reporting at county level was 71%. Completeness for EWARS reporting from IDP sites was 79%. Alert A total of 13 alerts were reported, of which 54% have been verified. 0 alerts were risk assessed and 0 required a response. Response A total of 27 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 21,268 cases and 436 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 (Oct 16-Oct 22)

4 Surveillance IDSR surveillance indicators Table 1 IDSR surveillance performance indicators by county (W ) Hub Reporting Performance Table 2 Summary of key IDSR surveillance indicators W42 Cumulative (2017) # counties # reports received Completeness Timeliness 80 - Number of counties Aweil % 100% Bentiu % 100% Bor % 55% Juba % 83% Kwajok % 100% Malakal % 0% Rumbek % 100% Torit % 63% Wau % 67% Yambio % 100% South Sudan % 71% 71% 71% Completeness 71% 64% Timeliness Table 3 IDSR report submissions W42 Cumulative (2017) 57 2,512 total submissions submissions by mobile submissions by web 1 W (Oct 16-Oct 22)

5 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 (Oct 16-Oct 22)

6 Surveillance Maps of IDSR completeness by county Map 1a Map of IDSR completeness by county (W ) Map 1b Map of IDSR completeness by county (2017) 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 Completeness 0 25% 50% 75% 100% Completeness 0 25% 50% 75% 100% 3 W (Oct 16-Oct 22)

7 Surveillance EWARS surveillance indicators Table 4 EWARS surveillance performance indicators by partner (W ) Partner Performance Reporting Table 5 Summary of key EWARS surveillance indicators W42 Cumulative (2017) # sites # reports received Completeness Timeliness 47 - Number of EWARS reporting sites CMD % 100% GOAL % 100% HLSS 1 0 0% 0% IMA % 100% IMC % 88% IOM % 100% IRC % 100% Medair % 100% MSF-E % 100% MSF-H % 75% SMC % 100% UNIDO % 100% 79% 66% Completeness 79% 62% Timeliness Table 6 EWARS report submissions W42 Cumulative (2017) 37 1,369 total submissions 1 75 submissions by mobile submissions by web UNKEA % 100% World Relief % 100% Total % 79% 4 W (Oct 16-Oct 22)

8 Alert Alert performance indicators Table 7 Alert performance indicators by Hub Hub W42 Cumulative (2017) Table 8 Summary of key alert indicators W42 Cumulative (2017) # alerts % verif. # alerts % verif. Aweil 2 50% 9 33% Bentiu 3 100% 79 44% Bor 2 50% % Juba 0 0% 67 12% Kwajok 1 0% 34 35% Malakal 1 100% 57 49% Rumbek 1 100% 99 43% Torit 0 0% 64 63% Total alerts raised 54% 39% % verified 0% 27% % auto-discarded 0% 6% % risk assessed 0% 2% % requiring a response Wau 0 0% 62 15% Yambio 3 0% 50 34% South Sudan 13 54% % 5 W (Oct 16-Oct 22)

9 Alert Event risk assessment Table 9 Alert performance indicators by event Event W42 Cumulative (2017) Table 10 Event risk assessment W42 Cumulative (2017) # alerts % verif. # alerts % verif. Indicator-based surveillance Malaria 0 0% 62 31% AWD 3 0% 58 33% Bloody Diarr. 4 75% % Measles 3 67% 51 33% 0 10 Low risk 1 1 Medium risk 0 8 High risk 0 14 Very high risk Meningitis 0 0% 0 0% Cholera 1 100% % Yellow Fever 0 0% 10 80% Guinea Worm 2 50% 78 44% AFP 0 0% 27 67% VHF 0 0% % Neo. tetanus 0 0% 6 100% Event-based surveillance EBS total 0 0% 25 96% 6 W (Oct 16-Oct 22)

10 Alert Maps of key disease alerts by county Map 2a Malaria (W ) Map 2b Bloody diarrhoea (W ) Map 2c Measles (W ) Melut Pariang Aweil North Aweil Centre Panyijiar Bor Ezo 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 ) Mayom Tonj East Yirol West Number of alerts 0 7 W (Oct 16-Oct 22) 1 Number of alerts Number of alerts

11 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 6 (2 confirmed; 1 probable; 3 suspected) with one suspect case on admission and 30 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 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

12 Response Confirmed epidemics Summary of new and ongoing confirmed epidemics Aetiologic agent Location (county) Date first reported New cases since last bulletin Cumulative cases to date (attack rate %) Case management Interventions Vaccination Health promotion New epidemics: Measles Panyijiar 2/07/ (0.14) Yes No Yes N/A WASH Ongoing epidemics: Cholera 26 counties 18/06/ ,268 (0.46) Yes Yes Yes Yes New epidemic - measles Panyijiar New measles outbreak confirmed in Panyijiar after 5 samples tested positive for measles IgM on 23 Oct. 17 At least 115 cases including 3 deaths (CFR 2.6%) have been reported since early July Most cases 88 (77%) are below five years of age. The payams reporting most cases include Nyal 39 (33.9%); Kol 26 (22.6%); and Katieth 26 (22.6%) The cases in Katieth and Nyal have been involved in IDPs None of the affected cases have received measles vaccine Panyijiar is one of the counties where the measles follow up campaign is pending Cases are being managed in Ganyliel PHCC and Nyal PHCC with IRC and UNIDO as the implementing partners 300 community health workers have been trained to identify and refer cases from the community A reactive vaccination micro-plan has been drafted

13 Response Confirmed epidemics New epidemic - Epidemic description - Measles in Panyijiar county Number of cases/deaths Measles Epidemic curve, Panyijiar county, weeks 26 to 43, 2017 Alive Epidemiological week of rash onset Total Age (years) Female (n) Male (n) cases Percentage Cum. % <1yr % 24.3% 1-4yrs % 77.4% 5-14yrs % 92.2% 15+yrs % 100.0% Total cases % Measles case distribution by Payam, Panyijiar county, wk 26 - wk 43, % 35% 33.9% Case proportion 30% 25% 20% 15% 10% 5% 0.9% 4.3% 0.9% 4.3% 0.9% 18.3% 22.6% 7.0% 0.9% 0.9% 2.6% 0.9% 0.9% 0%

14 Response Cholera response indicators Table 11 Summary of key cholera response indicators W42 % n Cumul. 1 % n Indicator 27 21, Total number of cases reported 19% 5 12% 2, % tested with cholera RDT 2 20% 1 71% 1, % tested with cholera RDT that were positive 81% 22 57% 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 (Oct 16-Oct 22)

15 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 Cases Deaths 9 W (Oct 16-Oct 22)

16 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 (Oct 16-Oct 22)

17 Response Cholera response indicators by county Table 12 Summary of key cholera response indicators in counties with active transmission County W42 County Cumulative (W W ) 1 2 Cases Deaths CFR % adm. % comm. deaths Cases Deaths CFR % adm. % comm. deaths 3 Awerial % 0% 0% Ayod % 0% 0% Canal Pigi % 0% 0% Duk % 0% 0% Fashoda % 0% 0% Juba % 81% 0% Awerial 1, % 57% 85% Ayod 3, % 8% 97% Canal Pigi % 86% 0% Duk % 94% 89% Fashoda % 73% 8% Juba 2, % 85% 66% 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 (Oct 16-Oct % admitted 22) to cholera treatment centre (CTC) % deaths that occurred in the commmunity

18 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 = 7,899 ) Female ( 53% ; n = 8,922 < 5 ( 21% ; n = 3,586 ) 5-14 ( 25% ; n = 4,278 ) ( 42% ; n = 7,071 ) > 45 ( 12% ; n = 1,957 ) Discharged ( 69.8% ; n = 11,927 ) Defaulted ( 0.4% ; n = 68 ) Died ( 2.1% ; n = 355 ) Admitted ( 6.4% ; n = 1,089 ) 13 W (Oct 16-Oct 22)

19 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