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South Sudan
Ministry of HealthRepublic of South Sudan
Printed: 05:27 Sunday, 29 October 2017 UTC
Integrated Disease Surveillance andResponse (IDSR)
Epidemiological Update W42 2017 (Oct 16-Oct 22)
Surveillance
Slide 1 Table 1 IDSR surveillance performance indicators by county (W42)
Table 2 Summary of key IDSR surveillance indicators
Table 3 IDSR report submissions (W42)
Slide 2 Figure 1 Trend in IDSR completeness over time
Slide 3 Map 1a Map of IDSR completeness by county (W42)
Map 1b Map of IDSR timeliness by county (2017)
Slide 4 Table 4 EWARS surveillance performance indicators by partner(W42)
Table 5 Summary of key EWARS surveillance indicators
Table 6 EWARS report submissions (W42)
Alert
Slide 5 Table 7 Alert performance indicators by Hub (W42)
Table 8 Summary of key alert indicators
Slide 6 Table 9 Alert performance indicators by event (W42)
Table 10 Event risk assessment
Slide 7 Map 2a - 2f Maps of key disease alerts by county (W42)
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
W42 2017 (Oct 16-Oct 22)
Highlights W42 2017
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.
W42 2017 (Oct 16-Oct 22)
Hub Reporting Performance
# counties # reportsreceived
Completeness Timeliness
South Sudan 80 57 71% 71%
Table 1 | IDSR surveillance performance indicators by county (W42 2017) Table 2 | Summary of key IDSR surveillance indicators
W42 Cumulative (2017)
80 - Number of counties
71% 71% Completeness
71% 64% Timeliness
Table 3 | IDSR report submissions
W42 Cumulative (2017)
57 2,512 total submissions
22 534 submissions by mobile
35 932 submissions by web
Surveillance | IDSR surveillance indicators
1 W42 2017 (Oct 16-Oct 22)
Aweil 5 5 100% 100%
Bentiu 9 9 100% 100%
Bor 11 6 55% 55%
Juba 6 5 83% 83%
Kwajok 7 7 100% 100%
Malakal 13 0 0% 0%
Rumbek 8 8 100% 100%
Torit 8 5 63% 63%
Wau 3 2 67% 67%
Yambio 10 10 100% 100%
Figure 1 | Trend in IDSR completeness over time
Completeness
Surveillance | Trend in IDSR completeness
2 W42 2017 (Oct 16-Oct 22)
Perc
ent
W44 2016 W48 2016 W52 2016 W05 2017 W09 2017 W13 2017 W18 2017 W22 2017 W26 2017 W31 2017 W35 2017 W39 2017
0%
20%
40%
60%
80%
100%
Map 1a | Map of IDSR completeness by county (W42 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 W42 2017 (Oct 16-Oct 22)
Manyo
Rumbek North Uror
Tambura
Rumbek Centre Twic East
Aweil West
Wulu
Ulang
Magwi
BudiYei
Aweil NorthGuitMayom
Abiemnhom
Tonj North
ToritLainya
Tonj East
Bor
Mundri East
Cueibet
Rumbek EastYirol East
Nyirol
Juba
Ibba
Awerial
Pochalla
Koch
Pariang
Yambio
Baliet
DukAkobo
Jur River
Tonj South
Terekeka
Kajo Keji
MaridiKapoeta North
Renk
Ikotos
Kapoeta East
Kapoeta South
Lopa Lafon
Panyikang
Morobo
Twic
Raja
Canal 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
Fashoda
Panyijiar
Mayendit
Malakal
Rubkona
Ayod
Mundri West
Manyo
Rumbek North Uror
Tambura
Rumbek Centre Twic East
Aweil West
Wulu
Ulang
Magwi
BudiYei
Aweil NorthGuitMayom
Abiemnhom
Tonj North
ToritLainya
Tonj East
Bor
Mundri East
Cueibet
Rumbek EastYirol East
Nyirol
Juba
Ibba
Awerial
Pochalla
Koch
Pariang
Yambio
Baliet
DukAkobo
Jur River
Tonj South
Terekeka
Kajo Keji
MaridiKapoeta North
Renk
Ikotos
Kapoeta East
Kapoeta South
Lopa Lafon
Panyikang
Morobo
Twic
Raja
Canal 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
Fashoda
Panyijiar
Mayendit
Malakal
Rubkona
Ayod
Mundri West
Partner Performance Reporting
# sites # reportsreceived
Completeness Timeliness
CMD 2 2 100% 100%
GOAL 2 2 100% 100%
HLSS 1 0 0% 0%
IMA 2 2 100% 100%
IMC 8 7 88% 88%
IOM 7 7 100% 100%
IRC 1 1 100% 100%
Medair 2 2 100% 100%
MSF-E 2 2 100% 100%
MSF-H 4 3 75% 75%
SMC 3 3 100% 100%
UNIDO 1 1 100% 100%
UNKEA 2 2 100% 100%
World Relief 1 1 100% 100%
Total 47 37 79% 79%
Table 4 | EWARS surveillance performance indicators by partner (W42 2017) Table 5 | Summary of key EWARS surveillance indicators
W42 Cumulative (2017)
47 - Number of EWARS reporting sites
79% 66% Completeness
79% 62% Timeliness
Table 6 | EWARS report submissions
W42 Cumulative (2017)
37 1,369 total submissions
1 75 submissions by mobile
36 1294 submissions by web
Surveillance | EWARS surveillance indicators
4 W42 2017 (Oct 16-Oct 22)
Hub W42 Cumulative (2017)
# alerts % verif. # alerts % verif.
South Sudan 13 54% 644 39%
Table 7 | Alert performance indicators by Hub Table 8 Summary of key alert indicators
W42 Cumulative (2017)
13 644 Total alerts raised
54% 39% % verified
0% 27% % auto-discarded
0% 6% % risk assessed
0% 2% % requiring a response
Alert | Alert performance indicators
5 W42 2017 (Oct 16-Oct 22)
Aweil 2 50% 9 33%
Bentiu 3 100% 79 44%
Bor 2 50% 123 43%
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%
Wau 0 0% 62 15%
Yambio 3 0% 50 34%
Event W42 Cumulative (2017)
# alerts % verif. # alerts % verif.
Indicator-based surveillance
Malaria 0 0% 62 31%
AWD 3 0% 58 33%
Bloody Diarr. 4 75% 106 41%
Measles 3 67% 51 33%
Meningitis 0 0% 0 0%
Cholera 1 100% 138 30%
Yellow Fever 0 0% 10 80%
Guinea Worm 2 50% 78 44%
AFP 0 0% 27 67%
VHF 0 0% 14 100%
Neo. tetanus 0 0% 6 100%
Event-based surveillance
EBS total 0 0% 25 96%
Table 9 | Alert performance indicators by event Table 10 | Event risk assessment
W42 Cumulative (2017)
0 10 Low risk
1 1 Medium risk
0 8 High risk
0 14 Very high risk
Alert | Event risk assessment
6 W42 2017 (Oct 16-Oct 22)
Map 2a | Malaria (W42 2017)
Number of alerts
0 1 10
Map 2d | Cholera (W42 2017)
Number of alerts
0 1 10
Map 2b | Bloody diarrhoea (W42 2017)
Number of alerts
0 1 10
Map 2e | Guinea Worm (W42 2017)
Number of alerts
0 1 10
Map 2c | Measles (W42 2017)
Number of alerts
0 1 10
Map 2f | Event-based surveillance (W42 2017)
Number of alerts
0 1 10
Alert | Maps of key disease alerts by county
7 W42 2017 (Oct 16-Oct 22)
Mayom
Bor
Pariang
Ezo
Melut
Tonj East
Yirol West
Aweil North
Aweil Centre
Panyijiar
Event W42 Cumulative (2017)
# alerts % verif. # alerts % verif.
Indicator-based surveillance
Malaria 0 0% 62 31%
AWD 3 0% 58 33%
Bloody Diarr. 4 75% 106 41%
Measles 3 67% 51 33%
Meningitis 0 0% 0 0%
Cholera 1 100% 138 30%
Yellow Fever 0 0% 10 80%
Guinea Worm 2 50% 78 44%
AFP 0 0% 27 67%
VHF 0 0% 14 100%
Neo. tetanus 0 0% 6 100%
Event-based surveillance
EBS total 0 0% 25 96%
Table 9 | Alert performance indicators by event Table 10 | Event risk assessment
W42 Cumulative (2017)
0 10 Low risk
1 1 Medium risk
0 8 High risk
0 14 Very high risk
Alert | Event risk assessment
6 W42 2017 (Oct 16-Oct 22)
Marburg Alert
• The Government of Uganda declared a Marburg outbreak on 19 Oct 2017 after aMarburg case was confirmed in Kween district, Eastern Uganda
• Cumulative cases are 6 (2 confirmed; 1 probable; 3 suspected) with one suspect caseon admission and 30 contacts under surveillance.
• The following actions have been undertaken to enhance Marburg preparedness inSouth 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 enhanceawareness
• Key messages on Marburg virus disease presentation, prevention, and controlhave 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
Response| Confirmed epidemics
Summaryofnewandongoingconfirmedepidemics
Aetiologicagent
Location(county)
Datefirstreported
Newcasessincelastbulletin
Cumulativecasestodate(attackrate%)
InterventionsCase
management Vaccination Healthpromotion WASH
Newepidemics:Measles Panyijiar 2/07/2016 30 115 (0.14) Yes No Yes N/A
Ongoingepidemics:Cholera 26 counties 18/06/2016 225 21,268(0.46) Yes Yes Yes Yes
Newepidemic-measlesPanyijiar• NewmeaslesoutbreakconfirmedinPanyijiarafter5samplestestedpositiveformeaslesIgMon23Oct.
17• Atleast115casesincluding3deaths(CFR2.6%)havebeenreportedsinceearlyJuly2017.• Mostcases88(77%)arebelowfiveyearsofage.• ThepayamsreportingmostcasesincludeNyal39(33.9%);Kol26(22.6%);andKatieth26(22.6%)• ThecasesinKatiethandNyalhavebeeninvolvedinIDPs• Noneoftheaffectedcaseshavereceivedmeaslesvaccine• Panyijiarisoneofthecountieswherethemeaslesfollowupcampaignispending• CasesarebeingmanagedinGanylielPHCCandNyalPHCCwithIRCandUNIDOastheimplementing
partners• 300communityhealthworkershavebeentrainedtoidentifyandrefercasesfromthecommunity• Areactivevaccinationmicro-planhasbeendrafted
Response| Confirmed epidemics
Newepidemic- Epidemicdescription- MeaslesinPanyijiarcounty
0
5
10
15
20
23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43
Num
bero
fcases/deaths
Epidemiologicalweekofrashonset
MeaslesEpidemiccurve,Panyijiarcounty,weeks26to43,2017
Alive
Age(years) Female(n) Male(n)Totalcases PercentageCum.%
<1yr 14 14 28 24.3% 24.3% 1-4yrs 34 27 61 53.0% 77.4% 5-14yrs 10 7 17 14.8% 92.2%
15+yrs 7 2 9 7.8% 100.0%
Totalcases 65 50 115 100.0%
0.9% 4.3%
0.9% 4.3%
0.9%
18.3% 22.6%
7.0%
0.9%
33.9%
0.9% 2.6% 0.9% 0.9% 0% 5%
10% 15% 20% 25% 30% 35% 40%
Casepropo
rtion
MeaslescasedistributionbyPayam,Panyijiarcounty,wk26- wk43,2017
W24 2016 - W42 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
W42
% n
27
19% 5
20% 1
81% 22
0.0% 0
0% 0
Cumul.
% n Indicator
21,268 1. Total number of cases reported
12% 2,471 2. % tested with cholera RDT
71% 1,753 3. % tested with cholera RDT that were positive
57% 12,028 4. % admitted to CTC
2.0% 436 5. Case Fatality Rate (CFR)
49% 214 6. % deaths in community
Response | Cholera response indicators
Table 11 | Summary of key cholera response indicators
8 W42 2017 (Oct 16-Oct 22)
1
2
3
4
1 2 3
4
Figure 2 Cholera epidemic curve (W24 2016 - W42 2017)
Cases Deaths
Response | Cholera epidemic curve
9 W42 2017 (Oct 16-Oct 22)
Num
ber
W26 2
016
W31 2
016
W35 2
016
W39 2
016
W44 2
016
W48 2
016
W52 2
016
W05 2
017
W09 2
017
W13 2
017
W18 2
017
W22 2
017
W26 2
017
W31 2
017
W35 2
017
W39 2
017
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 W42 2017 (Oct 16-Oct 22)
Bor
Juba
Awerial
BorYirol East
Juba
Awerial
Duk
Canal PigiFangak
Panyijiar
Mayendit
Rubkona
Bor
Juba
Awerial
Canal PigiFangak
Panyijiar
Rubkona
Budi
Tonj East
BorYirol East
Juba
Awerial
Duk
Kapoeta NorthKapoeta East
Kapoeta South
Canal PigiFangak
Yirol West
Fashoda
Panyijiar
Mayendit
Rubkona
Ayod
Case Fatality Rate % admitted to cholera treatment centre (CTC) % deaths that occurred in the commmunity
County W42
Cases Deaths CFR % adm. % comm.deaths
County Cumulative (W24 2016 - W42 2017)
Cases Deaths CFR % adm. % comm.deaths
Response | Cholera response indicators by county
Table 12 | Summary of key cholera response indicators in counties with active transmission
12 W42 2017 (Oct 16-Oct 22)
1 23
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 27 0 0.0% 81% 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%
1 23
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 2,808 35 1.2% 85% 66%
KapoetaEast
2,105 26 1.2% 43% 62%
KapoetaNorth
993 1 0.1% 96% 0%
KapoetaSouth
1,017 10 1.0% 88% 60%
Nyirol 72 2 2.8% 93% 0%
Panyijiar 612 30 4.9% 73% 10%
Tonj East 2,462 43 1.7% 60% 56%
Uror 0 0 0.0% 0% 0%
Yirol East 1,502 67 4.5% 96% 0%
Yirol West 238 0 0.0% 96% 0%
1 2 3
Figure 4a Cholera cases by sex (2017)
Male ( 47% ; n = 7,899 )
Female ( 53% ; n = 8,922)
Figure 4b Cholera cases by age (2017)
< 5 ( 21% ; n = 3,586 )
5-14 ( 25% ; n = 4,278 )
15-44 ( 42% ; n = 7,071 )
> 45 ( 12% ; n = 1,957 )
Figure 4c Cholera cases by outcome (2017)
Discharged ( 69.8% ; n = 11,927 )
Defaulted ( 0.4% ; n = 68 )
Died ( 2.1% ; n = 355 )
Admitted ( 6.4% ; n = 1,089 )
Response | Cholera cases by sex, age and outcome
13 W42 2017 (Oct 16-Oct 22)
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. Mathew Tut Moses
Director Emergency Preparedness and Response (EPR)
Ministry of Health
Republic of South Sudan
Telephone: +211 955 295 257Notes
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