South Sudan

Ministry of Health

Republic of South Sudan

Integrated Disease Surveillance and

Response (IDSR)

Epidemiological Update W20 2017 (May 15-May 21)

Surveillance

Slide 1 Table 1 IDSR surveillance performance indicators by county (W20)

Table 2 Summary of key IDSR surveillance indicators

Table 3 IDSR report submissions (W20)

Slide 2 Figure 1 Trend in IDSR completeness over time

Slide 3 Map 1a Map of IDSR completeness by county (W20)

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

Slide 4 Table 4 EWARS surveillance performance indicators by partner (W20)

Table 5 Summary of key EWARS surveillance indicators

Table 6 EWARS report submissions (W20)

Alert

Slide 5 Table 7 Alert performance indicators by Hub (W20)

Table 8 Summary of key alert indicators

Slide 6 Table 9 Alert performance indicators by event (W20)

Table 10 Event risk assessment

Slide 7 Map 2a - 2f Maps of key disease alerts by county (W20)

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 - 3f 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

1 W20 2017 (May 15-May 21)

Hub Reporting Performance

# counties # reports received Completeness Timeliness

Aweil 5 5 100% 100%

Bentiu 9 8 89% 11%

Bor 11 4 36% 18%

Juba 6 3 50% 50%

Kwajok 7 6 86% 0%

Malakal 13 5 38% 38%

Rumbek 8 8 100% 50%

Torit 8 8 100% 50%

Wau 3 3 100% 100%

Yambio 10 10 100% 100%

South Sudan 80 60 75% 46%

Table 1 | IDSR surveillance performance indicators by county (W20 2017) Table 2 | Summary of key IDSR surveillance indicators

W20 Cumulative (2017)

80 - Number of counties

75% 69% Completeness

46% 62% Timeliness

Table 3 | IDSR report submissions

W20 Cumulative (2017)

60 1,222 total submissions

17 42 submissions by mobile

43 133 submissions by web

Surveillance | IDSR surveillance indicators

1 W20 2017 (May 15-May 21)

Figure 1 | Trend in IDSR completeness over time

Completeness

Surveillance | Trend in IDSR completeness

2 W20 2017 (May 15-May 21)

Perc

ent

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

0%

20%

40%

60%

80%

100%

Map 1a | Map of IDSR completeness by county (W20 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 W20 2017 (May 15-May 21)

Partner Performance Reporting

# sites # reports received Completeness Timeliness

COSV 1 0 0% 0%

GOAL 2 2 100% 100%

HLSS 2 1 50% 50%

IMA 0 0

IMC 8 8 100% 100%

IOM 12 11 92% 92%

IRC 1 1 100% 0%

Medair 2 2 100% 100%

MSF-E 2 2 100% 100%

MSF-H 4 3 75% 75%

SMC 2 2 100% 100%

UNIDO 0 0

UNKEA 2 2 100% 100%

World Relief 1 1 100% 100%

Total 39 35 90% 87%

Table 4 | EWARS surveillance performance indicators by partner (W20 2017) Table 5 | Summary of key EWARS surveillance indicators

W20 Cumulative (2017)

39 - Number of EWARS reporting sites

90% 82% Completeness

87% 79% Timeliness

Table 6 | EWARS report submissions

W20 Cumulative (2017)

35 703 total submissions

2 49 submissions by mobile

33 654 submissions by web

Surveillance | EWARS surveillance indicators

4 W20 2017 (May 15-May 21)

Hub W20 Cumulative (2017)

# alerts % verif. # alerts % verif.

Aweil 0 0% 0 0%

Bentiu 0 0% 4 9%

Bor 2 33% 7 7%

Juba 0 0% 0 0%

Kwajok 2 0% 3 0%

Malakal 0 0% 2 50%

Rumbek 0 0% 2 33%

Torit 0 0% 0 0%

Wau 0 0% 1 5%

Yambio 0 0% 0 0%

South Sudan 4 17% 19 13%

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

W20 Cumulative (2017)

4 19 Total alerts raised

17% 13% % verified

69% 69% % auto-discarded

2% 2% % risk assessed

0% 1% % requiring a response

Alert | Alert performance indicators

5 W20 2017 (May 15-May 21)

Event W20 Cumulative (2017)

# alerts % verif. # alerts % verif.

Indicator-based surveillance

Malaria 0 0% 0 0%

Acute WateryDiarrhoea

0 0% 0 0%

Bloody Diarrhoea 0 0% 0 0%

Measles 0 0% 1 100%

Meningitis 0 0% 0 0%

Cholera 3 0% 8 25%

Yellow Fever 0 0% 0 0%

Guinea Worm 1 0% 2 50%

AFP 0 0% 0 0%

VHF 0 0% 0 0%

Neonatal tetatnus 0 0% 0 0%

Event-based surveillance

EBS total 0 0% 0 0%

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

W20 Cumulative (2017)

1 1 Low risk

1 1 Medium risk

0 0 High risk

0 0 Very high risk

Alert | Event risk assessment

6 W20 2017 (May 15-May 21)

Map 2a | Malaria (W20 2017)

Number of alerts

0 1 10

Map 2b | Cholera (W20 2017)

Number of alerts

0 1 10

Map 2c | Bloody diarrhoea (W20 2017)

Number of alerts

0 1 10

Map 2d | Guinea Worm (W20 2017)

Number of alerts

0 1 10

Map 2e | Measles (W20 2017)

Number of alerts

0 1 10

Map 2f | Viral Haemorrhagic Fever (W20 2017)

Number of alerts

0 1 10

Alert | Maps of key disease alerts by county

7 W20 2017 (May 15-May 21)

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

W20

% n

472

28% 131

95% 125

100% 472

0.6% 3

33% 1

Cumulative (2017)

% n Indicator

4,535 1. Total number of cases reported

16% 712 2. % tested with cholera RDT

79% 560 3. % tested with cholera RDT that were positive

85% 3,875 4. % admitted to CTC

3.4% 161 5. Case Fatality Rate (CFR)

70% 113 6. % deaths in community

Response | Cholera response indicators

Table 11 | Summary of key cholera response indicators

8 W20 2017 (May 15-May 21)

1

2

3

1

2

3

Figure 2 Cholera epidemic curve (W26 2016 - W20 2017)

Cases Deaths

Response | Cholera epidemic curve

9 W20 2017 (May 15-May 21)

Num

ber

W26 2

016

W31 2

016

W35 2

016

W39 2

016

W44 2

016

W48 2

016

W52 2

017

W05 2

017

W09 2

017

W13 2

017

W18 2

017

0

50

100

150

200

250

300

350

400

450

500

550

600

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

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

Map 3c | Distribution of cholera cases (Jul 2016 - Mar 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 W20 2017 (May 15-May 21)

Figure 3a | Duk county

Figure 3b | Yirol East county

Figure 3c | Fangak county

Figure 3d | Awerial county

Cases Deaths

Figure 3e | Ayod county

Figure 3f | Pigi Canal county

Response | Cholera epidemic curves by county

11 W20 2017 (May 15-May 21)

Num

ber

W26 2

016

W39 2

016

W52 2

017

W13 2

017

0

50

100

150

200

250

300

Num

ber

W26 2

016

W39 2

016

W52 2

017

W13 2

017

0

50

100

150

200

250

300N

um

ber

W26 2

016

W39 2

016

W52 2

017

W13 2

017

0

50

100

150

200

250

300

Num

ber

W26 2

016

W39 2

016

W52 2

017

W13 2

017

0

50

100

150

200

250

300

Num

ber

W26 2

016

W39 2

016

W52 2

017

W13 2

017

0

50

100

150

200

250

300

Num

ber

W26 2

016

W39 2

016

W52 2

017

W13 2

017

0

50

100

150

200

250

300

Case Fatality Rate

% admitted to cholera treatment centre (CTC)

% deaths that occurred in the commmunity

Hub W20

Cases Deaths CFR % adm. % comm.

deaths

Aweil 0 0 0.0% 0% 0%

Bentiu 0 0 0.0% 0% 0%

Bor 35 0 0.0% 100% 0%

Juba 0 0 0.0% 0% 0%

Kwajok 115 1 0.9% 100% 100%

Malakal 99 0 0.0% 100% 0%

Rumbek 136 2 1.5% 100% 0%

Torit 87 0 0.0% 100% 0%

Wau 0 0 0.0% 0% 0%

Yambio 0 0 0.0% 0% 0%

South Sudan 472 3 0.6% 100% 33%

Hub Cumulative (2017)

Cases Deaths CFR % adm. % comm.

deaths

Aweil 0 0 0.0% 0% 0%

Bentiu 613 22 3.6% 57% 36%

Bor 1,192 76 6.4% 75% 86%

Juba 39 0 0.0% 100% 0%

Kwajok 118 1 0.8% 100% 100%

Malakal 195 4 2.1% 99% 25%

Rumbek 2,055 57 2.8% 95% 67%

Torit 323 1 0.3% 100% 0%

Wau 0 0 0.0% 0% 0%

Yambio 0 0 0.0% 0% 0%

South Sudan 4,535 161 3.4% 85% 70%

Response | Cholera response indicators by Hub

Table 12 | Summary of key cholera response indicators by Hub

12 W20 2017 (May 15-May 21)

1 23

1 23

1

2

3

Figure 4a Cholera cases by sex (2017)

Male ( 46% ; n = 2,066 )

Female ( 51% ; n = 2,326 )

Figure 4b Cholera cases by age (2017)

< 5 ( 17% ; n = 755 )

5-14 ( 31% ; n = 1,404 )

15-44 ( 41% ; n = 1,842 )

> 45 ( 11% ; n = 514 )

Figure 4c Cholera cases by outcome (2017)

Discharged ( 41.5% ; n = 1,882 )

Defaulted ( 0.1% ; n = 5 )

Died ( 3.6% ; n = 161 )

Admitted ( 48.4% ; n = 2,197 )

Response | Cholera cases by sex, age and outcome

13 W20 2017 (May 15-May 21)

For more help and support,

please contact:

Dr. Pinyi Nyimol Mawien

Director General Preventive Health Services

Ministry of Health

Republic of South Sudan

Telephone: +211 955 604 020

Dr. Alice Igale

Director (a.i) IDSR

Ministry of Health

Republic of South Sudan

Telephone: +211 956 420 189Notes

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