South Sudan Integrated Disease Surveillance and Response (IDSR) Epidemiological Update W24 217 (Jun 12-Jun 18) Ministry of Health Republic of South Sudan Printed: 8:58 Wednesday, 28 June 217 UTC
Contents Surveillance Response Slide 1 Table 1 IDSR surveillance performance indicators by county (W24) Cholera Table 2 Summary of key IDSR surveillance indicators Table 3 IDSR report submissions (W24) 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 (W24) Map 1b Map of IDSR timeliness by county (217) Table 4 EWARS surveillance performance indicators by partner (W24) Table 5 Summary of key EWARS surveillance indicators Table 6 EWARS report submissions (W24) Slide 1 Map 3a - 3d Maps of distribution of cholera cases (Jul 216 - 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 (217) Figure 4b Cholera cases by age (217) Figure 4c Cholera cases by patient outcome (217) Alert Slide 5 Slide 6 Slide 7 Table 7 Alert performance indicators by Hub (W24) Table 8 Summary of key alert indicators Table 9 Alert performance indicators by event (W24) Table 1 Event risk assessment Map 2a - 2f Maps of key disease alerts by county (W24) Sources of data 1. Weekly IDSR Reporting Form 2. Weekly EWARS Reporting Form 3. Daily cholera line list 4. Event based surveillance form W24 217 (Jun 12-Jun 18)
Highlights W24 217 Surveillance Completeness for IDSR reporting at county level was 74%. Completeness for EWARS reporting from IDP sites was 86%. Alert A total of 8 alerts were reported, of which 75% have been verified. 3 alerts were risk assessed and 1 required a response. Response A total of 116 new cholera cases and 3 deaths (CFR 2.5% ) were reported. The cumulative total since the start of the current outbreak on 18 June 216 is 11,21 cases and 189 deaths (CFR 1.7% )*. * Note: The number of cholera deaths reported in Excel line lists prior to W21 217 is currently being verified. When this is completed, the number of cumulative deaths and cumulative CFR is likely to increase. W24 217 (Jun 12-Jun 18)
Surveillance IDSR surveillance indicators Table 1 IDSR surveillance performance indicators by county (W24 217) Hub Reporting Performance Table 2 Summary of key IDSR surveillance indicators W24 Cumulative (217) # counties # reports received Completeness Timeliness 8 - of counties Aweil 5 5 1% 1% Bentiu 9 7 78% 78% Bor 11 6 55% 55% Juba 6 5 83% 83% Kwajok 7 5 71% 71% Malakal 13 4 31% 31% Rumbek 8 7 88% 75% Torit 8 7 88% 63% Wau 3 3 1% 1% Yambio 1 1 1% 1% South Sudan 8 59 74% 7% 74% 73% Completeness 7% 65% Timeliness Table 3 IDSR report submissions W24 Cumulative (217) 59 1,518 total submissions 21 121 submissions by mobile 38 351 submissions by web 1 W24 217 (Jun 12-Jun 18)
Surveillance Trend in IDSR completeness Figure 1 Trend in IDSR completeness over time 1% 8% 6% Percent 4% 2% % W26 216 W31 216 W39 216 W44 216 W48 216 W52 217 W5 217 W9 217 W13 217 W22 217 Completeness 2 W24 217 (Jun 12-Jun 18)
Surveillance Maps of IDSR completeness by county Map 1a Map of IDSR completeness by county (W24 217) Map 1b Map of IDSR completeness by county (217) Completeness 25% 5% 75% 1% Completeness 25% 5% 75% 1% 3 W24 217 (Jun 12-Jun 18)
Surveillance EWARS surveillance indicators Table 4 EWARS surveillance performance indicators by partner (W24 217) Partner Performance Reporting Table 5 Summary of key EWARS surveillance indicators W24 Cumulative (217) # sites # reports received Completeness Timeliness 37 - of EWARS reporting sites COSV 1 % % GOAL 2 2 1% 1% HLSS 1 1 1% 1% IMA IMC 8 8 1% 1% IOM 7 7 1% 1% IRC 1 1 1% 1% Medair 2 2 1% 1% MSF-E 2 2 1% 1% MSF-H 4 3 75% 75% SMC 2 2 1% 1% UNIDO 86% 85% Completeness 86% 81% Timeliness Table 6 EWARS report submissions W24 Cumulative (217) 32 814 total submissions 1 44 submissions by mobile 31 77 submissions by web UNKEA 2 % % World Relief 1 % % Total 37 32 86% 86% 4 W24 217 (Jun 12-Jun 18)
Alert Alert performance indicators Table 7 Alert performance indicators by Hub Hub W24 Cumulative (217) Table 8 Summary of key alert indicators W24 Cumulative (217) # alerts % verif. # alerts % verif. Aweil % 2 5% Bentiu 2 1% 41 32% Bor 1 % 27 3% Juba % 21 24% Kwajok % 8 25% Malakal % 1 5% Rumbek 1 % 28 46% Torit 4 1% 11 91% 8 181 Total alerts raised 75% 34% % verified % 54% % auto-discarded 38% 11% % risk assessed 13% 4% % requiring a response Wau % 28 7% Yambio % 5 4% South Sudan 8 75% 181 34% 5 W24 217 (Jun 12-Jun 18)
Alert Event risk assessment Table 9 Alert performance indicators by event Event W24 Cumulative (217) Table 1 Event risk assessment W24 Cumulative (217) # alerts % verif. # alerts % verif. Indicator-based surveillance Malaria 1 1% 15 47% AWD % 7 71% Bloody Diarr. 2 5% 14 5% Measles % 15 2% 1 6 Low risk 1 1 Medium risk 1 4 High risk 1 8 Very high risk Meningitis % % Cholera 2 5% 33 39% Yellow Fever % 1 1% Guinea Worm % 11 55% AFP % 1 % VHF % 3 1% Neo. tetanus % % Event-based surveillance EBS total 3 1% 12 92% 6 W24 217 (Jun 12-Jun 18)
Alert Maps of key disease alerts by county Map 2a Malaria (W24 217) Map 2b Bloody diarrhoea (W24 217) Map 2c Measles (W24 217) of alerts 1 1 of alerts 1 1 of alerts 1 1 Map 2d Cholera (W24 217) Map 2e Guinea Worm (W24 217) Map 2f Event-based surveillance (W24 217) of alerts 1 1 of alerts 1 1 of alerts 1 1 7 W24 217 (Jun 12-Jun 18)
Response Cholera response indicators Table 11 Summary of key cholera response indicators W24 % n Cumul. 1 % n Indicator 116 11,21 1. Total number of cases reported 4% 5 15% 1,721 2. % tested with cholera RDT 2 8% 4 7% 1,25 3. % tested with cholera RDT that were positive 68% 79 75% 8,431 4. % admitted to CTC 3 2.5% 3 1.7% 189 5. Case Fatality Rate (CFR) 4 % 7% 13 6. % deaths in community 1 2 3 4 W24 216 - W24 217 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 W24 217 (Jun 12-Jun 18)
Response Cholera epidemic curve Figure 2 Cholera epidemic curve (W24 216 - W24 217) 9 8 7 6 5 4 2 1 W26 216 W31 216 W39 216 W44 216 W48 216 W52 217 W5 217 W9 217 W13 217 W22 217 Cases Deaths 9 W24 217 (Jun 12-Jun 18)
Response Maps of cholera distribution over time by county Map 3a Distribution of cholera cases (Jul 216 - Sep 216) Map 3b Distribution of cholera cases (Jul 216 - Dec 216) Map 3c Distribution of cholera cases (Jul 216 - Mar 217) Map 3d Distribution of cholera cases (Jul 216 - present) of cholera cases 1 1 5 1 1 W24 217 (Jun 12-Jun 18)
Response Cholera epidemic curves by county Figure 3a Bor Hub > Ayod county Figure 3b Bor Hub > Duk county Figure 3c Bor Hub > Fangak county 25 25 25 2 2 2 15 15 15 1 1 1 5 5 5 W52 217 Figure 3d Bor Hub > Pigi Canal county Figure 3e Rumbek Hub > Awerial county Figure 3f Rumbek Hub > Yirol East county 25 2 15 1 5 W52 217 W52 217 W52 217 W52 217 25 25 2 2 15 15 1 1 5 5 W52 217 Cases Deaths 11 W24 217 (Jun 12-Jun 18)
Response Cholera epidemic curves by county Figure 3g Rumbek Hub > Yirol West county Figure 3h Torit Hub > Kapoeta East county Figure 3i Torit Hub > Kapoeta North 25 25 25 2 2 2 15 15 15 1 1 1 5 5 5 W52 217 Figure 3j Torit Hub > Kapoeta South county Figure 3k Kwajok Hub > Tonj East county 25 2 15 1 5 W52 217 W52 217 W52 217 W52 217 6 5 4 2 1 Cases Deaths 11 W24 217 (Jun 12-Jun 18)
Response Cholera response indicators by county Table 12 Summary of key cholera response indicators in counties with active transmission County W24 County Cumulative (W24 216 - W24 217) 1 2 Cases Deaths CFR % adm. % comm. 3 deaths 1 2 Cases Deaths CFR % adm. % comm. 3 deaths Awerial.% % % Ayod 37.% 59% % Canal Pigi 1.% 1% % Duk.% % % Fashoda.% % % Juba 5.% % % Awerial 1,199 4.3% 57% % Ayod 514.% 49% % Canal Pigi 26 5 2.4% 86% % Duk 534 8 1.5% 93% % Fashoda 262 2.8% 1% % Juba 2,77 32 1.5% 81% % Kapoeta East.% % % Kapoeta East 274 1 3.6% 64% 9% Kapoeta North 7.% 1% % Kapoeta North 459 1.2% 99% % Kapoeta South 7.% 71% % Kapoeta South 242 4 1.7% 71% 1% Nyirol.% % % Panyijiar 38 3 7.9% 61% % Tonj East 17.% 1% % Uror.% % % Yirol East.% % % Yirol West 4.% 1% % Nyirol 2 1 5.% 1% % Panyijiar 612 14 2.3% 73% % Tonj East 1,54 19 1.8% 99% % Uror.% % % Yirol East 1,43 65 4.5% 96% % Yirol West 22.% 95% % 1 2 3 Case 12 Fatality W24 217 Rate (Jun 12-Jun % admitted 18) to cholera treatment centre (CTC) % deaths that occurred in the commmunity
Response Cholera cases by sex, age and outcome Figure 4a Cholera cases by sex (217) Figure 4b Cholera cases by age (217) Figure 4c Cholera cases by outcome (217) ) Male ( 46% ; n = 3,225 ) Female ( 53% ; n = 3,696 < 5 ( 18% ; n = 1,223 ) 5-14 ( 28% ; n = 1,922 ) 15-44 ( 43% ; n = 2,961 ) > 45 ( 12% ; n = 86 ) Discharged ( 43.6% ; n = 3,24 ) Defaulted (.2% ; n = 15 ) Died ( 1.6% ; n = 114 ) Admitted ( 8.3% ; n = 574 ) 13 W24 217 (Jun 12-Jun 18)
For more help and support, please contact: Dr. Pinyi Nyimol Mawien Director General Preventive Health Services Ministry of Health Republic of South Sudan Telephone: +211 955 64 2 Dr. Mathew Tut Moses Director Emergency Preparedness and Response (EPR) Ministry of Health Republic of South Sudan Telephone: +211 955 295 257 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 http://ewars-project.org Ministry of Health Republic of South Sudan