South Sudan

Ministry of HealthRepublic of South Sudan Printed: 04:18 Monday, 28 August 2017 UTC

Integrated Disease Surveillance andResponse (IDSR)

Epidemiological Update W33 2017 (Aug 14-Aug 20)

Surveillance

Slide 1 Table 1 IDSR surveillance performance indicators by county (W33)

Table 2 Summary of key IDSR surveillance indicators

Table 3 IDSR report submissions (W33)

Slide 2 Figure 1 Trend in IDSR completeness over time

Slide 3 Map 1a Map of IDSR completeness by county (W33)

Map 1b Map of IDSR timeliness by county (2017)

Slide 4 Table 4 EWARS surveillance performance indicators by partner(W33)

Table 5 Summary of key EWARS surveillance indicators

Table 6 EWARS report submissions (W33)

Alert

Slide 5 Table 7 Alert performance indicators by Hub (W33)

Table 8 Summary of key alert indicators

Slide 6 Table 9 Alert performance indicators by event (W33)

Table 10 Event risk assessment

Slide 7 Map 2a - 2f Maps of key disease alerts by county (W33)

Response

Cholera

Slide 8 Table 11 Summary of key cholera response indicators

Slide 9 Figure 2 Cholera epidemic curve (National)

Slide 10 Map 3a - 3d Maps of distribution of cholera cases (Jul 2016 -present)

Slide 11 Figure 3a - 3k Cholera epidemic curves by county

Slide 12 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)

Sources of data

1. Weekly IDSR Reporting Form

2. Weekly EWARS Reporting Form

3. Daily cholera line list

4. Event based surveillance form

Contents

W33 2017 (Aug 14-Aug 20)

Highlights W33 2017

Surveillance

Completeness for IDSR reporting at county level was 68% . Completeness forEWARS reporting from IDP sites was 81% .

Alert

A total of 84 alerts were reported, of which 60% have been verified. 0 alerts wererisk assessed and 0 required a response.

Response

A total of 31 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 is19,846 cases and 355 deaths (CFR 1.8% )*.

* Note: The cholera data may be subject to adjustments as linelist data continues to received and entered from the field.

W33 2017 (Aug 14-Aug 20)

Hub Reporting Performance

# counties # reportsreceived Completeness Timeliness

Aweil 5 5 100% 100%

Bentiu 9 7 78% 78%

Bor 11 4 36% 36%

Juba 6 4 67% 67%

Kwajok 7 6 86% 86%

Malakal 13 1 8% 8%

Rumbek 8 8 100% 100%

Torit 8 7 88% 88%

Wau 3 2 67% 67%

Yambio 10 10 100% 100%

South Sudan 80 54 68% 68%

Table 1 | IDSR surveillance performance indicators by county (W33 2017) Table 2 | Summary of key IDSR surveillance indicators

W33 Cumulative (2017)

80 - Number of counties

68% 71% Completeness

68% 64% Timeliness

Table 3 | IDSR report submissions

W33 Cumulative (2017)

54 1,991 total submissions

21 308 submissions by mobile

33 637 submissions by web

Surveillance | IDSR surveillance indicators

1 W33 2017 (Aug 14-Aug 20)

Figure 1 | Trend in IDSR completeness over time

Completeness

Surveillance | Trend in IDSR completeness

2 W33 2017 (Aug 14-Aug 20)

Per

cent

W35 2016 W39 2016 W44 2016 W48 2016 W52 2016 W05 2017 W09 2017 W13 2017 W18 2017 W22 2017 W26 2017 W31 20170%

20%

40%

60%

80%

100%

Map 1a | Map of IDSR completeness by county (W33 2017)

Completeness 0 25% 50% 75% 100%

Map 1b | Map of IDSR completeness by county (2017)

Completeness 0 25% 50% 75% 100%

Surveillance | Maps of IDSR completeness by county

3 W33 2017 (Aug 14-Aug 20)

Manyo

Rumbek North Uror

Tambura

Rumbek Centre Twic East

Malakal

Aweil West

Wulu

Ulang

Magwi

BudiYei

Aweil North GuitMayom

Abiemnhom

Tonj North

ToritLainya

Tonj East

Mundri West

Bor

Mundri East

Cueibet

Rumbek EastYirol East

Nyirol

Juba

Fashoda

Ibba

Mayendit

Awerial

Pochalla

Koch

Pariang

Yambio

Panyijiar

Baliet

DukAkobo

Ayod

Jur River

Tonj South

Terekeka

Kajo Keji

MaridiKapoeta North

Renk

Ikotos

Kapoeta East

Kapoeta South

Lopa Lafon

Panyikang

Morobo

Twic

Raja

RubkonaCanal Pigi

Wau

Mvolo

Nagero

Maiwut

Pibor

Gogrial East

Nzara

Abyei

Ezo

Aweil East

Gogrial WestAweil SouthAweil Centre

FangakLongechuk

Yirol West

Maban

Melut

Luakpiny Nasir

Leer

Manyo

Rumbek North Uror

Tambura

Rumbek Centre Twic East

Malakal

Aweil West

Wulu

Ulang

Magwi

BudiYei

Aweil North GuitMayom

Abiemnhom

Tonj North

ToritLainya

Tonj East

Mundri West

Bor

Mundri East

Cueibet

Rumbek EastYirol East

Nyirol

Juba

Fashoda

Ibba

Mayendit

Awerial

Pochalla

Koch

Pariang

Yambio

Panyijiar

Baliet

DukAkobo

Ayod

Jur River

Tonj South

Terekeka

Kajo Keji

MaridiKapoeta North

Renk

Ikotos

Kapoeta East

Kapoeta South

Lopa Lafon

Panyikang

Morobo

Twic

Raja

RubkonaCanal Pigi

Wau

Mvolo

Nagero

Maiwut

Pibor

Gogrial East

Nzara

Abyei

Ezo

Aweil East

Gogrial WestAweil SouthAweil Centre

FangakLongechuk

Yirol West

Maban

Melut

Luakpiny Nasir

Leer

Partner Performance Reporting

# sites # reportsreceived Completeness Timeliness

CMD 2 2 100% 100%

GOAL 2 2 100% 100%

HLSS 1 1 100% 100%

IMA 0 0

IMC 6 6 100% 100%

IOM 6 6 100% 100%

IRC 1 1 100% 100%

Medair 2 2 100% 100%

MSF-E 1 1 100% 100%

MSF-H 4 3 75% 75%

SMC 3 3 100% 100%

UNIDO 1 0 0% 0%

UNKEA 2 2 100% 100%

World Relief 8 6 75% 75%

Total 37 30 81% 81%

Table 4 | EWARS surveillance performance indicators by partner (W33 2017) Table 5 | Summary of key EWARS surveillance indicators

W33 Cumulative (2017)

37 - Number of EWARS reporting sites

81% 69% Completeness

81% 66% Timeliness

Table 6 | EWARS report submissions

W33 Cumulative (2017)

30 892 total submissions

2 62 submissions by mobile

28 830 submissions by web

Surveillance | EWARS surveillance indicators

4 W33 2017 (Aug 14-Aug 20)

Hub W33 Cumulative (2017)

# alerts % verif. # alerts % verif.

Aweil 0 0% 5 40%

Bentiu 0 0% 65 37%

Bor 31 77% 86 44%

Juba 3 0% 43 16%

Kwajok 3 67% 26 38%

Malakal 12 67% 26 54%

Rumbek 22 55% 79 39%

Torit 3 33% 40 75%

Wau 3 33% 46 9%

Yambio 7 29% 34 38%

South Sudan 84 60% 450 38%

Table 7 | Alert performance indicators by Hub Table 8 Summary of key alert indicators

W33 Cumulative (2017)

84 450 Total alerts raised

60% 38% % verified

0% 38% % auto-discarded

0% 7% % risk assessed

0% 3% % requiring a response

Alert | Alert performance indicators

5 W33 2017 (Aug 14-Aug 20)

Event W33 Cumulative (2017)

# alerts % verif. # alerts % verif.

Indicator-based surveillance

Malaria 6 0% 40 33%

AWD 11 18% 32 34%

Bloody Diarr. 11 36% 56 45%

Measles 8 75% 37 32%

Meningitis 0 0% 0 0%

Cholera 12 50% 100 31%

Yellow Fever 6 100% 7 100%

Guinea Worm 11 64% 55 42%

AFP 7 100% 17 65%

VHF 6 100% 12 92%

Neo. tetanus 6 100% 6 100%

Event-based surveillance

EBS total 0 0% 19 95%

Table 9 | Alert performance indicators by event Table 10 | Event risk assessment

W33 Cumulative (2017)

0 7 Low risk

1 1 Medium risk

0 6 High risk

0 14 Very high risk

Alert | Event risk assessment

6 W33 2017 (Aug 14-Aug 20)

Map 2a | Malaria (W33 2017)

Number of alerts 0 1 10

Map 2d | Cholera (W33 2017)

Number of alerts 0 1 10

Map 2b | Bloody diarrhoea (W33 2017)

Number of alerts 0 1 10

Map 2e | Guinea Worm (W33 2017)

Number of alerts 0 1 10

Map 2c | Measles (W33 2017)

Number of alerts 0 1 10

Map 2f | Event-based surveillance (W33 2017)

Number of alerts 0 1 10

Alert | Maps of key disease alerts by county

7 W33 2017 (Aug 14-Aug 20)

Ulang

Yirol East

Awerial

Ayod

Ulang

Budi

Tonj East

Yirol East

Nyirol

Juba

Awerial

Ayod

Kapoeta NorthKapoeta East

Tambura

Ulang

Yirol East

Juba

Awerial

Ayod

Nagero

Nzara

Luakpiny Nasir

Rumbek Centre

Ulang

Yirol East

Awerial

Ayod

Jur RiverTonj SouthWau

Yirol West

Ulang

Yirol East

Juba

Awerial

Ayod

Wau

W24 2016 - W33 2017 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

W33

% n

31

68% 21

52% 11

100% 31

0.0% 0

0% 0

Cumul.

% n Indicator

19,846 1. Total number of cases reported

11% 2,135 2. % tested with cholera RDT

72% 1,530 3. % tested with cholera RDT that were positive

57% 11,361 4. % admitted to CTC

1.8% 355 5. Case Fatality Rate (CFR)

48% 169 6. % deaths in community

Response | Cholera response indicators

Table 11 | Summary of key cholera response indicators

8 W33 2017 (Aug 14-Aug 20)

1

2

3

4

1 2 3

4

Figure 2 Cholera epidemic curve (W24 2016 - W33 2017)

Cases Deaths

Response | Cholera epidemic curve

9 W33 2017 (Aug 14-Aug 20)

Num

ber

W26

201

6

W31

201

6

W35

201

6

W39

201

6

W44

201

6

W48

201

6

W52

201

6

W05

201

7

W09

201

7

W13

201

7

W18

201

7

W22

201

7

W26

201

7

W31

201

7

0

200

400

600

800

1000

1200

1400

1600

1800

2000

Map 3a | Distribution of cholera cases (Jul 2016 - Sep 2016)

Map 3c | Distribution of cholera cases (Jul 2016 - Mar 2017)

Map 3b | Distribution of cholera cases (Jul 2016 - Dec 2016)

Map 3d | Distribution of cholera cases (Jul 2016 - present)

Number of cholera cases 0 1 10 50 100

Response | Maps of cholera distribution over time by county

10 W33 2017 (Aug 14-Aug 20)

Bor

Juba

Awerial

BorYirol East

Juba

Mayendit

Awerial

PanyijiarDuk

Rubkona Canal PigiFangak

Bor

Juba

Awerial

Panyijiar

Rubkona Canal PigiFangak

Tonj East

BorYirol East

Juba

Fashoda

Mayendit

Awerial

PanyijiarDuk

Ayod

Kapoeta NorthKapoeta East

Kapoeta South

Rubkona Canal PigiFangak

Yirol West

Figure 3a | Bor Hub > Ayod county

Figure 3d | Bor Hub > Pigi Canal county

Figure 3b | Bor Hub > Duk county

Figure 3e | Rumbek Hub > Awerial county

Cases Deaths

Figure 3c | Bor Hub > Fangak county

Figure 3f | Rumbek Hub > Yirol East county

Response | Cholera epidemic curves by county

11 W33 2017 (Aug 14-Aug 20)

Num

ber

W35

201

6

W52

201

6

W18

201

7

0

500

1000

1500

2000

Num

ber

W35

201

6

W52

201

6

W18

201

7

0

50

100

150

200

250

300

Num

ber

W35

201

6

W52

201

6

W18

201

7

0

50

100

150

200

250

300

Num

ber

W35

201

6

W52

201

6

W18

201

7

0

50

100

150

200

250

300

Num

ber

W35

201

6

W52

201

6

W18

201

7

0

50

100

150

200

250

300

Num

ber

W35

201

6

W52

201

6

W18

201

7

0

50

100

150

200

250

300

Figure 3g | Rumbek Hub > Yirol West county

Figure 3j | Torit Hub > Kapoeta South county

Figure 3h | Torit Hub > Kapoeta East county

Figure 3k | Kwajok Hub > Tonj East county

Cases Deaths

Figure 3i | Torit Hub > Kapoeta North

Response | Cholera epidemic curves by county

11 W33 2017 (Aug 14-Aug 20)

Num

ber

W35

201

6

W52

201

6

W18

201

7

0

50

100

150

200

250

300

Num

ber

W35

201

6

W52

201

6

W18

201

7

0

50

100

150

200

250

300

Num

ber

W35

201

6

W52

201

6

W18

201

7

0

100

200

300

400

500

600

700

800

900

1000

Num

ber

W35

201

6

W52

201

6

W18

201

7

0

100

200

300

400

500

600

Num

ber

W35

201

6

W52

201

6

W18

201

7

0

50

100

150

200

250

300

Case Fatality Rate % admitted to cholera treatment centre (CTC) % deaths that occurred in the commmunity

County W33

Cases Deaths CFR % adm. % comm.deaths

Awerial 0 0 0.0% 0% 0%

Ayod 0 0 0.0% 0% 0%

Canal Pigi 0 0 0.0% 0% 0%

Duk 0 0 0.0% 0% 0%

Fashoda 0 0 0.0% 0% 0%

Juba 31 0 0.0% 100% 0%

KapoetaEast

0 0 0.0% 0% 0%

KapoetaNorth

0 0 0.0% 0% 0%

KapoetaSouth

0 0 0.0% 0% 0%

Nyirol 0 0 0.0% 0% 0%

Panyijiar 0 0 0.0% 0% 0%

Tonj East 0 0 0.0% 0% 0%

Uror 0 0 0.0% 0% 0%

Yirol East 0 0 0.0% 0% 0%

Yirol West 0 0 0.0% 0% 0%

County Cumulative (W24 2016 - W33 2017)

Cases Deaths CFR % adm. % comm.deaths

Awerial 1,199 13 1.1% 57% 85%

Ayod 3,856 39 1.0% 8% 97%

Canal Pigi 206 5 2.4% 86% 0%

Duk 547 36 6.6% 94% 89%

Fashoda 771 12 1.6% 73% 8%

Juba 2,454 35 1.4% 84% 66%

KapoetaEast

2,105 26 1.2% 43% 62%

KapoetaNorth

737 1 0.1% 95% 0%

KapoetaSouth

1,017 10 1.0% 88% 60%

Nyirol 65 2 3.1% 94% 0%

Panyijiar 612 30 4.9% 73% 10%

Tonj East 2,399 41 1.7% 59% 54%

Uror 0 0 0.0% 0% 0%

Yirol East 1,502 67 4.5% 96% 0%

Yirol West 238 0 0.0% 96% 0%

Response | Cholera response indicators by county

Table 12 | Summary of key cholera response indicators in counties with active transmission

12 W33 2017 (Aug 14-Aug 20)

1 23

1 23

1 2 3

Figure 4a Cholera cases by sex (2017)

Male ( 46% ; n = 7,186 ) Female ( 53% ; n = 8,248)

Figure 4b Cholera cases by age (2017)

< 5 ( 21% ; n = 3,273 ) 5-14 ( 26% ; n = 4,025 ) 15-44 ( 41% ; n = 6,394 ) > 45 ( 12% ; n = 1,788 )

Figure 4c Cholera cases by outcome (2017)

Discharged ( 70.4% ; n = 10,931 ) Defaulted ( 0.3% ; n = 47 ) Died ( 1.8% ; n = 273 ) Admitted ( 6.3% ; n = 980 )

Response | Cholera cases by sex, age and outcome

13 W33 2017 (Aug 14-Aug 20)

For more help and support,please contact:

Dr. Pinyi Nyimol MawienDirector General Preventive Health ServicesMinistry of HealthRepublic of South Sudan

Telephone: +211 955 604 020

Dr. Mathew Tut MosesDirector Emergency Preparedness and Response (EPR)Ministry of HealthRepublic of South Sudan

Telephone: +211 955 295 257 NotesWHO 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 andUSAID for providing financial support.

The data has been collected with support from the EWARS project. This is an initiative to strengthenearly warning, alert and response in emergencies. It includes an online, desktop and mobileapplication that can be rapidly configured and deployed in the field. It is designed with frontline usersin mind, and built to work in difficult and remote operating environments. This bulletin has beenautomatically published from the EWARS application.

More information can be found at http://ewars-project.org

Ministry of HealthRepublic of SouthSudan