Integrated Disease Surveillance and Response

This Bulletin is Produced by the Ministry of Health with Technical Support from the WHO 1

WEEKLY DISEASE SURVEILLANCE BULLETIN - REPUBLIC OF SOUTH SUDAN ()

Week 47 16 - 22 November 2015

HIGHLIGHTS

Completeness for weekly reporting was 57.4% for the non-conflict affected counties and 79% for the IDP sites. Malaria was the commonest cause of morbidity in both non-conflict affected counties (47%) and IDP sites (67%). Malaria epidemics reported in three states (Warrap, Northern Bahr el Ghazal, and Western Bahr el Ghazal) and two

IDP sites (Bentiu and Malakal PoCs). Five new suspect measles cases reported from CES (2), Lakes State (1), Bentiu State hosptal (1) and Bentiu PoC (1).

Only one out of the 23 health facilities reported zero case of Kala-azar. The Crude mortality rate and under five mortality were below the emergency threshold of 2 cases per day per

10,000 population for all the non-IDP and IDP sites that submitted mortality data during this reporting week.

EDITORIAL NOTE

This bulletin presents disease trends from the Integrated Disease Surveillance and Response (IDSR) System and the Early Warning Alert and Response Network (EWARN). The respective data is submitted by public health facilities serving host communities (non-conflict affected states or non-IDP sites) and partner-supported facilities serving internally displaced persons (IDP) in the Republic of South Sudan.

TIMELINESS AND COMPLETENESS OF REPORTING

Timeliness and Completeness for both non-conflict affected states and IDP sites are shown in Table 1, Figures 1, 2

Completeness-reporting rate in Western Equatoria and Warrap States above the target of 80%. Figure 1. A total of 574 (57%) of PHCUs, 197 (60%) of PHCCs and 26 (51%) of the hospitals submitted their IDSR reports. No reports received from 14 health facilities in the IDP sites and 3 Counties in the non-IDP areas. Table 2.

Table 1: Timeliness and completeness for weekly reporting in South Sudan as of week 47 of 2015 Surveillance System Number of Health

Facilities Timelines Completeness Timeliness Completeness

In week 47 of 2015 Cumulative for 2015

IDSR/ non IDP sites 1389 50.3% 57.4% 50% 57%

EWARN/ IDP sites 66 50% 79% 50% 86.2%

Figure 1

Figure 2

Table 2: No IDSR EWARN

Silent Counties in week 46 of 2015 Silent Facilities in week 46 of 2015

1. Ikotos Guolyaar mobile clinic (SMC) Maluak PHCU (IRC) Koradar IDP clinic (Goal)

2. Rumbek East SMC Malou Janglow PHCU (IRC) Dethoma Camp 2 (Goal)

3. Magwi Yuai (MSF-OCA) Machar PHCU (IRC) Makal west PHCU (IMA)

4. World Relief PHCC (Bentiu) Kol PHCU (IRC) Wau Shiluk PHCC (IMA)

5. Mangatain IDP (MoH) Wau Shiluk IDP Mobile clinic (IMA)

63%

27%20%

69%63%

30%

49%

65%

95%

86%

51%

27%20%

69%

39%

0%

45%

65%

84% 86%

0%

20%

40%

60%

80%

100%

CES EES Jonglei Lakes NBeG Unity UNS WBeG WES Warrap

He

alt

h F

aci

liti

es

rep

ort

ing

[%

]

IDSR weekly reporting performance by state in week 47 of 2015

Completeness Timeleness Target

0

20

40

60

80

100

120

01 03 05 07 09 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51

Co

mp

lete

ne

ss [

%]

Reporting Completeness for EWARN Health Facilities, 2014 - 2015

2014 2015 Target

This Bulletin is Produced by the Ministry of Health with Technical Support from the WHO 2

CONSULTATIONS (All patients seen at Outpatient and Inpatient facilities)

The total consultations from both IDP and non-IDP sites are summarized in Table 3 and Figure 3. The annualised outpatients department (OPD) utilization among IDPs in 2015 is 1.3 consultations per person per

year. The IDP site-specific annualised OPD utilization rates are shown in Figure 4.

Table 3: Consultations by surveillance system in South Sudan as of week 47 of 2015 Surveillance System

Consultations in week 47 of 2015 Cumulative consultations for 2015

<5 years ≥5 years Total <5 years ≥5 years Total

IDSR / non IDP sites 42,522 71,872 114,394 1,930,708 3,115,993 5,046,701

EWARN / IDP sites 26,251 1,044,495

Total 140,645 6,091,196

Figure 3

Figure 4

OVERALL TRENDS OF PRIORITY EPIDEMIC-PRONE DISEASES

Malaria was the top cause of morbidity in both non-conflict affected states and IDP sites and registered a proportionate morbidity of 47% and 67% respectively. Table 4 and Figures 5, 6, 7.

The other causes of morbidity in week 47 of 2015 are shown in Table 4 and Figures 5, 6 and 7.

Table 4: Top causes of morbidity in 2015 as compared 2014 Surveillance System

Disease New cases for week 47 Cumulative cases week 1 to week 46

2014 2015 2014 2015

IDSR Malaria 37,433 54,330 1,364,790 2,024,070

AWD 6,583 8,570 258,352 455,619

Meningitis 2 0 85 51

ABD 1,472 1,524 55,204 93,366

Measles 32 3 1,117 686

Acute Jaundice Syndrome 4 0 225 1,757

EWARN Malaria 3,928 16,513 136,833 310,028

AWD 1,488 2,064 60,844 87,168

ARI 2,221 5,545 104,647 200,139

ABD 265 233 10,136 10,884

Measles 12 2 1,513 604

Acute Jaundice Syndrome 0 47 124 2,291

Meningitis 0 4 24 26

610

723

2521

2012 1035420

0%

20%

40%

60%

80%

100%

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EWARN Consultations by IDP Camp and Partner, week 47 2015

CCM IMC IOM IRC MSF-E MSF-OCB MSF-OCA Medair

1.5

3.0

4.4

2.1

3.2

0.8

1.9

0.1

2.9

1.3

2.1

0.7

5.9

0.6 0.6 0.6 0.0

0.4 0.4 0.2 0.2 0.2 0.0

1.4

0.2 0.4 0.1

0.3

1.3

-

1.0

2.0

3.0

4.0

5.0

6.0

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EWARN Consultations per person per year, week 47, 2015

Integrated Disease Surveillance and Response

This Bulletin is Produced by the Ministry of Health with Technical Support from the WHO 3

Figure 5

Figure 6

Figure 7

SPECIFIC PRIORITY EPIDEMIC-PRONE DISEASES

Acute Respiratory Infection (ARI)

The ARI trend is monitored under EWARN as a priority disease among IDPs ARI registered the second highest proportionate morbidity of 21%, which is higher when compared to 19.4% in

week 46 of 2015 and 13.6 in the corresponding period of 2014. Figures 5 and 8 UN House registered the highest ARI incidence (201 cases per 10,000) followed by Malakal PoC (195). In the

corresponding week of 2014, UN house PoC (269.2) had the highest ARI incidence followed by Bentiu (160) PoC and Man Awan. Figure 9

Figure 8

Figure 9

Acute Watery Diarrhoea (AWD)

AWD was the second commonest cause of morbidity with 8,570 cases (7.5% consultations) and an incidence (cases per 100,000) of 71.4 reported from the non-conflict affected counties. Upper Nile and Warrap were the most

AWD, 7%ABD, 1%

Malaria, 47%

Measles, 0%

Others, 45%

IDSR Proportionate morbidity, week 47 of 2015

AWD

ABD

Malaria

Measles

Others

Malaria63%

AWD8%

ABD1%

ARI21%

Measles0% Others

7%

EWARN Proportionate Morbidity in week 46 of 2015

Malaria

AWD

ABD

ARI

Measles

Others

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IDSR Priority Disease Morbidity trends from week 1 to 47 of 2015

Completeness ABD Malaria Measles AWD

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90%

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51 02 05 08 11 14 17 20 23 26 29 32 35 38 41 44 47 50 1 4 7 10 13 16 19 22 25 28 31 34 37 40 43 46

2013 2014 2015

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Epidemiologic Week

EWARN priority disease proportionate morbidity, week 51 of 2013 - week 47 of 2015

Completeness ARI Bloody Diarrhea

Malaria Suspected Measles Watery Diarrhoea

0.0

5.0

10.0

15.0

20.0

25.0

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01 03 05 07 09 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51Per

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Epidemiologic Week

EWARN Proportionate Morbidity trends for ARI, week 51 of 2013 to week 47 of 2015

2013 2014 2015

3216089 0 0 69269 7 94 61 38 50 5 12420

112110

24

146

195

0

201

139

5426

40

86

0

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50

100

150

200

250

300

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EWARN trends for ARI Incidence by IDP Site in week 47 of 2014 and 2015

wk 47 of 2014

wk 47 of 2015

This Bulletin is Produced by the Ministry of Health with Technical Support from the WHO 4

19

79

58

18 21

83 81

10

77

55

39

23

8

36

64

28

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12

44

57

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46

0

159

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EWARN trends for AWD Incidence by IDP Site in week 47 of 2014 and 2015

wk 47 of 2014

wk 47 of 2015

affected states. AWD trend has been increasing since week 44 of 2015 with the incidence higher when compared to corresponding period of 2013 (60.1) and 2014 (55.7). (Figures 5, 10 and Table 5)

Among the IDPs, AWD was the 3rd cause of morbidity and registered a proportionate morbidity of 8% with is comparable to the corresponding period 2014 but being higher week 46 of 2015. The AWD incidence among IDPs is highest in UN House PoC followed by Malakal PoC, Lankien and Awerial (Figures 11, 12).

Figure 10

Table 5

AWD State C D IR CFR

WES 428 0 55.49 0.00

EES 452 0 40.95 0.00

CES 617 0 40.33 0.00

JNG 454 1 29.93 0.22

WRP 1729 0 126.1 0.00

LKS 792 0 79.82 0.00

NBGZ 612 0 48.63 0.00

WBGZ 558 0 111.1 0.00

UNS 2391 1 181.5 0.04

UNITY 537 0 49.95 0.00

TOTAL 8570 2 74.92 0.02

Figure 11

Figure 12

Dysentery / Acute Bloody Diarrhoea (ABD)

ABD was the 3rd cause of morbidity in the non-conflict affected counties with 1,524 cases, a proportionate morbidity of 1% and incidence (cases per 100,000) of 12.7. Unity, Warrap and Central Equatoria States were the most affected. The current ABD trend is stable with the incidence being lower when compared to the corresponding period of 2013 but higher when compared to 2014. (Figures 5, 13 and Table 6)

0

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IDSR trends for Acute Watery Diarrhoea by week, 2013 - 2015 2013

2014

2015

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EWARN Proportionate Morbidity trends for ARI, week 51 of 2013 to week 47 of 2015

2013 2014 2015

Figure 13

Table 6

ABD State C D IR CFR

WES 190 0 24.6 0.00

EES 83 0 7.52 0.00

CES 220 0 14.4 0.00

JNG 42 0 2.77 0.00

WRP 261 0 19 0.00

LKS 164 0 16.5 0.00

NBGZ 54 0 4.29 0.00

WBGZ 112 0 22.3 0.00

UNS 297 0 22.6 0.00

UNITY 101 0 9.39 0.00

TOTAL 1524 0 13.3 0.00

0

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IDSR trends for Acute Bloody Diarrhoea by week, 2013 - 2015 2013

2014

2015

Integrated Disease Surveillance and Response

This Bulletin is Produced by the Ministry of Health with Technical Support from the WHO 5

Among the IDPs, ABD was the 4th commonest cause of morbidity and registered a proportionate morbidity of 1%, which is lower when compared to 1.4% in week 47 of 2014. The ABD trend in IDPs is stable and the incidence is lower when compared to 2014. In week 47 of 2015, the ABD incidence among IDPs was highest in Mayendit and Renk (Figures 5, 14 and 15).

Measles

Measles was the 5th cause of morbidity with three suspect measles case reported from CES (Lainya county - 2) and Lake State (Yirol West county - 1), a proportionate morbidity of 0.003% and incidence (cases per 100,000) of 0.0 reported. (Figure 5 and Tables 5, 7).

Since the beginning of 2015, the total suspect measles cases investigated countrywide is 494, of which 46 (9%) were laboratory confirmed measles (IgM+) cases, 79 epidemiological linked and 205 clinically compatibles.

The total confirmed Rubella cases is 47. The annualised measles incidence is 35.8 per 1,000,000 population Low performance of surveillance indicators: 227 (46.0 %) samples collected out of the 494 suspected measles cases

(target >80%), the annualized reporting rate of Non-measles Febrile/rash illness is 1.6/100,000 population (target ≥2/100,000 population), annualized blood samples collection rate at national level is 2.2/100,000, and percentage of counties with at least one case with blood specimen is 44.3%.

Among the IDPs, measles was the fifth commonest cause of morbidity with two cases reported from Bentiu PoC (1) and Bentiu State Hospital (1), representing a proportionate morbidity of 0.007%. (Figures 5, 16, 17, and 18). The suspect measles proportionate morbidity was higher (0.1%) in week 47 of 2014.

The suspect measles trend in IDPs is stable and the current incidence is lower when compared to 2014 (Figure 16). Figure 16

Table 7

Measles State C D IR CFR

WES 0 0 0.00 0.00

EES 0 0 0.00 0.00

CES 2 0 0.13 0.00

JNG 0 0 0.00 0.00

WRP 0 0 0.00 0.00

LKS 1 0 0.10 0.00

NBGZ 0 0 0.00 0.00

WBGZ 0 0 0.00 0.00

UNS 0 0 0.00 0.00

UNITY 0 0 0.00 0.00

TOTAL 3 0 0.03 0.00

Malaria

Malaria was the commonest cause of morbidity with 54,330 cases, a proportionate morbidity of 47% and incidence (cases per 100,000) of 452 reported from non-conflict affected counties. Warrap, Upper Nile, Central Equatoria, Northern Bahr el Ghazal and Lakes were the most affected states (Figure 5 and Table 8).

Since week 22 of 2015, malaria trend has been rising with the current incidence being higher when compared to the corresponding period of 2013 (280.5) and 2014 (316.9). In the recent weeks, the malaria trend in Warrap,

0.0

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EWARN Proportionate Morbidity trends for suspect measles, week 51 of 2013 to week 47 of 2015

2013

2014

2015

Figure 14

Figure 15

0.0

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EWARN Proportionate Morbidity trends for ABD from week 51 of 2013 to week 47 of 2015

2013 2014 2015

3 8 4 4 2 1420

0

44

113

2 0 4 14 4

1

108 6

1 1 2 2

47

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EWARN trends for ABD Incidence by IDP Site in week 47 of 2014 and 2015

wk 47 of 2014

wk 47 of 2015

This Bulletin is Produced by the Ministry of Health with Technical Support from the WHO 6

Northern Bahr el Ghazal, and Western Bahr el Ghazal reached epidemic levels with positivity rates of up to 90% registered in Gogrial west county, Warrap state (Figures 19, 20).

Figure 19

Table 8

Malaria State C D IR CFR

WES 2466 0 319.7 0.00

EES 2169 0 196.5 0.00

CES 7450 3 487 0.04

JNG 1575 0 103.8 0.00

WRP 14402 0 1050 0.00

LKS 5754 5 579.9 0.09

NBGZ 5520 3 438.6 0.05

WBGZ 2851 1 567.8 0.04

UNS 9738 5 739.4 0.05

UNITY 2405 1 223.7 0.04

TOTAL 54330 18 475 0.03

Figure 20

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IDSR trends for Malaria in Warrap from week 1 to 47,2015

2015 Third quartile 2012-2014

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IDSR trends for Malaria in Northern Bhar el Ghazal from week 1 to 47, 2015

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Malaria Incidence for Western Bhar el Ghazal from week 1 to 47, 2015

2015 Third quartile 2012-2014

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IDSR Malaria trends for Central Equatoria from week 1 to 47, 2015

2015 Third quartile 2012-2014

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IDSR Malaria trends for Eastern Equatoria from week 1 to 47, 2015

2015 Third quartile 2012-2014

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IDSR Malaria trends in Lakes from week 1 to 47, 2015

2015 Third quartile 2012-2014

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IDSR trends for Malaria in WES, week 1 to 47, 2015

2015 Third quartile 2012-2014

Integrated Disease Surveillance and Response

This Bulletin is Produced by the Ministry of Health with Technical Support from the WHO 7

Among the IDPs, malaria was the commonest cause of morbidity with a proportionate morbidity of 63%, which is

more than two times higher when compared to the corresponding week of 2014. The trend has been rising since week 19 of 2015 with the incidence being higher when compared to 2014 (Figures 5, 21).

Bentiu PoC registered the highest malaria incidence (cases per 10,000) of 711, followed by Lankien (606) Malakal PoC (405) as seen in Figure 22.

The malaria incidence in Bentiu PoC and Malakal PoC exceeds the epidemic threshold. The malaria incidence in Renk, UN House, and Mingkaman are currently within the expected levels (Figure 23).

The proportionate morbidity for malaria was 66% and 49% in Bentiu PoC and Malakal PoC respectively. Laboratory data from IRC clinic in Bentiu PoC show that the rapid diagnistic test (RDT) malaria positivity rate stands

at 80% with a peak of 86% in week 40 of 2015. Since week 31 of 2015, the positivity rate has leveled off with an average seropositivity rate of 81% per week (Figure 23).

Ongoing national malaria taskforce meetings to coordinate the malaria preparedness and response activities. Response activities include coordination meetings; availability of adequate anti malaria drug stocks; prompt access to diagnostic and care at health facilities; community case management and referral; vector control activities (Indoor residual spraying, larvae control and distribution of Long Lasting Insecticide Treated Nets); and effective behavioural change communication strategies.

Figure 21

Figure 22

Figure 23

21.2

44.12

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EWARN Proportionate Morbidity trends for malaria from week 51 of 2013 to week 47 of 2015

2013 2014 2015

65 88 164 89 77 109 163 40259

20 103 134 15 31 156 24 34

96

711

157

606

405

6

188146

0

184

53 71 4282

178

11 11 6

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EWARN trends for Malaria Incidence by IDP Site in week 47 of 2014 and 2015

wk 47 of 2014 wk 47 of 2015

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incidence 2014 incidence 2015 Third quartile

This Bulletin is Produced by the Ministry of Health with Technical Support from the WHO 8

Hepatitis E Virus (HEV)

No new Acute Jaundice Syndrome (AJS) cases reported from the non-conflict affected states.

Among the IDPs, Hepatitis E Virus remains a major public health problem and confirmed in six IDP sites

(Mingkaman, Bentiu, Lankien, Melut, Guit, and Leer). Figures 24 and 25.

Bentiu PoC reported 240 new HEV cases. A cumulative of 2,289 HEV cases including 17 deaths (CFR 0.74%) reported

in Bentiu; 158 cases including seven deaths (CFR 4.4%) in Mingkaman; and 37 cases including one death (CFR 2.7%)

in Lankien. In Bentiu, majority of cases were male (52%), aged 2-9 years (38%) and 15-44 years (41%) (Tables 9).

Distribution of cases by location is summarised in table 10.

Figure 24

Figure 25

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incidence 2014 incidence 2015 Third quartile

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3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51 1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47

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ca

ses

in B

en

tiu

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ses

in t

he

r ID

P s

ite

s

Epidemiological week

Acute Jaundice Syndrome cases by IDP site from week 03, 2014 to week 47, 2015

Awerial Bor Malakal Tongping Lul Juba 3 Lankien Bentiu

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350

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2

4

6

8

10

12

14

16

3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51 1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47

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. cas

es i

n B

enti

u

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, cas

es i

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ther

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es

Epidemiological week

Hepatitis E Virus trends in Mingkaman, Bentiu, and Lankien from week 10, 2014 to week 47, 2015

Awerial Lankien Bentiu

Integrated Disease Surveillance and Response

This Bulletin is Produced by the Ministry of Health with Technical Support from the WHO 9

Table 9: Distribution of HEV cases by age and sex in Bentiu PoC

Age in years Female n (%)

Male n (%)

(Unknown) Total n (%)

<2 years 3 (3) 3 (2) 0 6 (3)

2-4 years 17(15) 31 (25) 0 48 (20)

5-9 years 23 (20) 20 (16) 0 43 (18)

10-14 years 19 (17) 11 (9) 0 30 (13)

15-44 years 47 (41) 51 (41) 0 98 (41)

≥45 years 5 (4) 7 (6) 0 12 (5)

(Blank) 0 1 (1) 2 3 (1)

Grand Total 114 (48) 124 (52) 2 240 (100)

Most cases in Bentiu have originated from Sectors 5, 4, and 3 as shown in Table 10.

Table 10: HEV case distribution by PoC/sector in Bentiu PoC

Camp Positive n (%)

Negative n (%)

Unknown Grand Total n (%)

Outside 2 (1.8) 3 (2.4) - 5 (2.1)

PoC 1 13 (11.7) 17 (13.4) - 30 (12.5)

PoC 2 10 (9) 11 (8.7) - 21 (8.8)

PoC 3 13 (11.7) 13 (10.2) - 26 (10.8)

PoC 4 32 (28.8) 37 (29.1) - 69 (28.8)

PoC 5 19 (17.1) 16 (12.6) - 35 (14.6)

PoC 6 2 (1.8) 7 (5.5) - 9 (3.8)

PoC1 0 (0) 1 (0.8) - 1 (0.4)

PoC3 0 (0) 1 (0.8) - 1 (0.4)

PoC4 0 (0) 4 (3.1) - 4 (1.7)

PoC5 1 (0.9) 1 (0.8) - 2 (0.8)

PoC6 0 (0) 1 (0.8) - 1 (0.4)

Sector 2 0 (0) 1 (0.8) - 1 (0.4)

Sector 3 7 (6.3) 1 (0.8) - 8 (3.3)

Sector 4 3 (2.7) 2 (1.6) 1 6 (2.5)

Sector 5 4 (3.6) 1 (0.8) 1 6 (2.5)

(blank) 5 (4.5) 10 (7.9) - 15 (6.3)

Grand Total 111 (46.3) 127 (52.9) 2 240 (100)

Response to HEV is underway guided by the comprehensive HEV response strategy with priority interventions being supportive case management, targeted preventive interventions during antenatal visits, soap distribution, shock chlorination of boreholes, as well as house-to-house hygiene and sanitation promotion.

NUTRITION

Bentiu PoC: week 46 of 2015: (source: Nutrition Cluster) A steady trend of new admissions in outpatient therapeutic feeding programs. A total of 212 children <5 years with

SAM were admitted in nutrition programs in Bentiu PoC as compared to 212 in week 45 of 2015 A total of 35 SAM children with medical complications admitted in the stabilization centre as compared to 28 in

week 45. No major changes observed in proxy GAM rate which was 12% as compared to 13% in the previous week. Fig 26: Admission trends - SAM admissions comparison 2014-15 - Bentiu PoC

Figure 27: Admission trend of malnourished children with medical complications at stabilization centre - 2015, Bentiu PoC

Cholera

Intensified surveillance and preparedness activities are ongoing in light of the prolonged rains. The Ministry of Health and the World Health Organization strongly encourage health cluster partners to attend the bi-weekly cholera task force meetings.

212

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5

17

117

1612 11

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1513

7 8

13

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19

24 24

19

28

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34

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34

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4850

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29 3028

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This Bulletin is Produced by the Ministry of Health with Technical Support from the WHO 10

Acute Flaccid Paralysis (AFP)

Five(5) new suspected AFP cases were reported from Lakes (Rumbek North-(1), Unity (Pariang-1), Upper Nile

(Lungchock-1), Warrap (Tonj South-1), Western Equatoria (Ezo-1).

Since the beginning 2015, 296 suspected AFP cases reported of which one was laboratory confirmed VDPV case

The annualized non-polio AFP rate stands at 4.00 per 100,000 (target ≥2 cases per 100,000 children 0-14 years). All

the states have met 2/100,000 except Upper Nile and Unity states in the war torn region.

The early detection rate (within 7 days of onset) of the cases in 2015 is 86%.

The adequate stool samples collection rate stands at 95% (target ≥80%) and the non-polio enterovirus (NPEV)

detection rate (a measure of the quality of the specimen cold chain) among AFP cases in 2015 is 15.7% (target

≥10%). The immunity profile of the AFP cases (6-59 months) shows coverage rate of 4+ OPV doses 77%.

Intensified surveillance activities in the conflict affected states (Jonglei, Unity, Upper Nile) include recruitment and

training of staff in AFP surveillance (27 field coordinators and 78 Field assistants), engage NGOs in AFP surveillance

activities, reestablishment of the cold chain in strategic locations (depending on stability and partners on ground),

complete the remaining one round of SNIDs, strengthening of routine immunization, and expand permanent

vaccination posts both international borders and crossing points of conflict affected states

OTHER DISEASES OF PUBLIC HEALTH IMPORTANCE

Guinea worm (Dracunculiasis)

Two new suspect cases of Guinea worm reported during week 47 of 2015 for Yirol East in Lakes State.

Viral Haemorrhagic Fever

No Ebola/Marburg cases confirmed in South Sudan. The Republic of South Sudan continues to enhance its readiness capacities for Ebola/Marburg virus disease, the national Ebola/Marburg taskforce coordinates implementation of interventions guided by a national Ebola/Marburg contingency plan.

Visceral Leishmaniasis (Kala-azar)

Only one health facility (Walga) reported 0 cases during this reporting week Since the beginning of 2015, 3,036 cases [2,449 (80.7%) new and 587 (19.3%) relapses/PKDL] including 101 deaths

(CFR 3.3%) and 111(3.7%) defaulters have been reported from 23 treatment centers.

Majority of cases were reported from Lankien (1,362) followed by Walgak (335) and Pagil (176). Male [1,706 cases

(56.2%)], those aged ≥15years [1,374 cases (45.3%]) and 5-14years [1,207 (39.8%) were the most affected groups.

In the corresponding period in 2014, a total of 6,989 cases including 196 deaths (CFR 2.8%) and 222 (3.3%)

defaulters were reported from 21 treatment centers. Generally cases reported in 2015 are lower when compared

to 2014. During the peak season of 2015, an average of 11 to 30 cases were reported weekly as compared to 250 or

more during the peak season of 2014. The reduced number of cases this years may be attributed to the low

number of reporting health facilities, withdrawal of some heath partners and inaccessibility to health facilities due

to insecurity and flooding.

Although, the trend of the disease has been stable since week 36 of 2015, vigilance should be maintained as well as

implementation of of preparedness activities for the peak season.

Meningitis

No new suspect cases of meningitis reported in week 47 of 2015.

Animal bites (suspect rabies)

Integrated Disease Surveillance and Response

This Bulletin is Produced by the Ministry of Health with Technical Support from the WHO 11

No new suspect cases of rabies ported in week 47 of 2015.

MORTALITY

Nineteen (19) deaths including 10 (52.6%) in children <5 years and 14 (73.7%) attributed to malaria were reported from the non-conflict affected counties. Table 12.

The mortality data received from five IDP sites as summarized in table 13. A total of 43 deaths were reported including among 15 (34.9%) in children <5 years , 25 (58.1%) in Bentiu PoC and 8 (18.6%) related to malaria. In week 47 of 2014, 19 deaths reported. Tables 13, 14, 15.

Table 12: Mortality by cause, age, and county in week 47 of 2015 States Counties AWD

<5 yrs AWD ≥5 yrs

ABD <5 yrs

Malaria <5 yrs

Malaria ≥5 yrs

Total deaths <5 yrs

Total deaths ≥5 yrs

Total deaths

U5MR per 10,000 per day

CRM per 10,000 per day

CES Juba - - - 1 1 1 1 2 - -

Morobo - - - 2 - 2 - 2 - -

EES Budi - - 1 - - 1 - 1 - -

Lopa - - - 1 - 1 - 1 - -

LAKES Cuiebet - - - 1 - 1 - 1 - -

Rumbek Centre - - - 1 - 1 - 1 - -

WBGZ Wau - 1 - - 2 - 3 3 - -

WRP Tonj South - - - - - - - 0 - -

NBGZ Aweil North - 2 - - - - 2 2 - -

JNG Duk 1 - - - - 1 - 1 - -

UNS Fashoda - - - - 1 - 1 1 - -

Renk - - - 1 - 1 - 1 - -

Warrap Tong South - - - 1 2 1 2 3 - -

Total Deaths 1 3 1 8 6 10 9 19 0.042 0.016

Table 13: Deaths by IDP camp, week 46 of 2015 as compared to week 47 of 2015

Cause of Death by IDP site

2014 2015

<5yrs ≥5yrs <5yrs ≥5yrs

Akobo - - - 1

Bentiu - 4 8 17

Juba 3 - 1 5 5

Malakal - 1 1 5

Melut 2 1 - -

Mingkaman - 2 1 -

Tomping - 3 - -

Wau Shiluk - 5 - -

Grand Total 2 17 15 28

Table 14: Proportionate mortality by cause of death and IDP site in week 47 of 2015 Cause of Death by IDP site

Akobo

Bentiu Juba 3 Malakal Mingkaman

Grand

Total ≥5yrs <5yrs

≥5yrs

<5yrs

≥5yrs

<5yrs

≥5yrs

<5yrs

acute bloody diarrhoea

- - 1 - - - - - 1

acute watery diarrhoea

- - 1 1 - - - 1 3

Cardiopulmonary failure

- - - - - 1 - - 1

Gunshot wound - - 2 - - - - - 2

Heart failure - - 1 - - - - - 1

hypoglycemia - - - 2 - - 2

malaria 1 3 1 2 - - 1 - 8

perinatal death - - 1 - - - - 1

pneumonia - - 1 - - - - - 1

SAM - 2 1 1 - - 1 - 5

Stroke - - 1 - - 1

Suspected meningitis - 1 1 - - - 2

TB/HIV/AIDS - 1 3 - 2 - - 6

TB/HIV/AIDS, SAM - 1 - - - 2 - 3

Unknown - 1 4 - - - - 5

Cough and odema - - - - 1 - 1

Grand Total 1 8 17 5 5 1 5 1 43

Under-five Mortality Rate (U5MR) among IDPs

Figure 28

The U5MR in the IDP sites, that submitted mortality data, was below the emergency threshold of 2 deaths per 10,000 per day

02468

1012141618

51 2 5 8 11 14 17 20 23 26 29 32 35 38 41 45 48 51 2 5 8 11 14 17 20 23 26 29 32 35 38 41 44 47

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Bentiu Bor Juba 3 Malakal Mingkaman

This Bulletin is Produced by the Ministry of Health with Technical Support from the WHO 12

Crude Mortality Rate among IDPs

The CMRs were below the emergency threshold for all the five IDP sites that submitted mortality data. Figure 29

Overall Mortality among the IDPs

Since the beginning of 2015, a total of 1,429 deaths have been reported from the all IDP sites of which malaria accounted for 251 (17.6%). Most of deaths occurred in Bentiu, Malakal, Juba 3 PoC and, Juba 3 (Table 15).

Table 15: Mortality trend by IDP site, week 1 of 2015 to week 47 of 2015

IDP

sit

e

Acu

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e

Syn

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acu

te w

ater

y

dia

rrh

oe

a

can

cer

Gu

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ot

wo

un

d

Hea

rt d

ise

ase

Hep

atit

s E

hyp

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nsi

on

Kal

a-A

zar

mal

aria

mat

ern

al d

eath

mea

sles

pn

eum

on

ia

SAM

Sep

tice

mia

TB/H

IV/A

IDS

Trau

ma

Oth

ers

Gra

nd

To

tal

Bentiu 6 45 10 15 6 18 1 7 198 11 47 71 28 43 347 853

Bor 1 1 7 9

Juba 3 13 1 1 4 14 1 22 8 5 36 81 186

Malakal 4 2 1 9 2 5 18 19 21 1 20 1 112 215

Melut 1 1 1 6 1 1 1 2 7 7 28

Mingkaman 4 1 4 5 4 2 1 18 39

Akobo 3 2 1 4 8 3 1 1 2 1 12 38

Wau Shiluk 4 1 4 2 8 1 2 39 61

Grand Total 7 74 15 20 20 19 9 22 251 2 12 97 105 37 113 3 623 1429

Proportionate mortality [%]

0.5 5.2 1.0 1.4 1.4 1.3 0.6 1.5 17.6 0.1 0.8 6.8 7.3 2.6 7.9 0.2 ### 100

RESPONSE INTERVENTIONS AND GENERAL RECOMMENDATIONS

In response to the current malaria trends a coordinated response has been initiated by the national malaria taskforce to improve access to treatment, interrupt transmission, and engage communities. This includes mass presumptive treatment of fever cases for malaria, distribution of LLINs, larviciding, indoor residual spraying, and behavioral change communication.

Comprehensive HEV response activities implemented include proper case management; preventive interventions during antenatal care visits; improving access to safe drinking water and sanitation facilities; interventions for a safe water chain; preventive vaccination using HEV vaccine for groups with a high risk for adverse clinical outcomes including mortality; and house-to-house hygiene and sanitation promotion including distribution of NFIs like soap and jerry cans.

Following the recent integrated measles and polio vaccination campaigns in Bentiu and UN House PoC surveillance and routine immunization have been enhanced.

Enhanced nutrition screening at health facilities, and during house-to-house visits are underway to identify and initiate early treatment for malnourished cases.

Integrate TB/HIV/AIDS prevention and control into the routine healthcare services in all the IDP sites.

Emphasis on collection of specimens from patients and shipping to Juba for laboratory confirmation of measles, AJS, bloody diarrhea, and cholera cases.

0

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51 1 3 5 7 9 111315171921232527293133353741414345474951 1 3 5 7 9 11131517192123252729313335373941434547

2013 2014 2015

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EWARN Crude Mortality Rate per 10,000 persons per day, week 51 of 2013 to week 47 of 2015

Bentiu Bor Juba 3 Malakal Mingkaman

Integrated Disease Surveillance and Response

This Bulletin is Produced by the Ministry of Health with Technical Support from the WHO 13

Strengthen integrated Kala-azar response activities entail enhanced surveillance, proper case management, training of healthcare workers, replenishing of drug stocks in endemic areas, and effective social mobilization and communication on Kala-azar prevention and control.

Support the implementation of the Ebola preparedness and response in order to enhance capacities for case detection, investigation, response and community awareness on Ebola prevention and control.

Please send all disease surveillance information and any outbreak rumours to outbreak_ss_2010@yahoo.com. IDSR reports should be submitted by COB Monday after the close of each epidemiologic week.

For comments or questions, please contact Department of Epidemics, Preparedness and Response, MoH-RSS

E-mail: outbreak_ss_2010@yahoo.com, HF radio frequency: 8015 USP; Selcall: 7002

Editorial: Dr. Thomas A. Ujjiga, John M. Juma, Sheila Baya, Dr. Alice L. Igale, Dr. George W. Worri, Korsuk Scopus, Robert M. Lasu, Rose A. Dagama, Jane Pita, Marina Adrianopoli, Morris Gargar, Dr. Asta Kone Coulibaly, Dr. Lincoln Charimari, Dr. Allan M. Mpairwe, Dr. Joseph F. Wamala

Founders: Dr. John P. Rumunu, Dr. John Lagu, Dr. Abdinasir Abubakar

Acknowledgments: Many thanks to all our colleagues at MOH in the States, WHO Field Offices and implementing Health Cluster Partners who have helped to gather the information presented here.

This Bulletin is Produced by the Ministry of Health with Technical Support from the WHO 14

Summary for epidemiological reports received for week 47 of 2015 [week ending 15 November 2015] Epi week 47 of 201 Cholera AWD ABD Meningitis Measles AJS Malaria AFP NT VHF ILI Guinea

Worm Total Curative Consultation

States Counties HFs that reported

C D C D C D C D C D C D C D C D C D C D C D C D C D

WES Yambio 95% 0 0 119 0 59 0 0 0 0 0 0 0 865 0 0 0 4 0 0 0 0 0 0 0 2658 0

WES Nzara 100% 0 0 21 0 30 0 0 0 0 0 0 0 156 0 0 0 0 0 0 0 0 0 0 0 728 0

WES Ezo 100% 0 0 56 0 25 0 0 0 0 0 0 0 236 0 0 0 0 0 0 0 0 0 0 0 1278 0

WES Ibba 108% 0 0 19 0 10 0 0 0 0 0 0 0 253 0 0 0 0 0 0 0 0 0 0 0 624 0

WES Maridi 100% 0 0 46 0 21 0 0 0 0 0 0 0 298 0 0 0 0 0 0 0 0 0 0 0 1228 0

WES Mvolo 100% 0 0 18 0 3 0 0 0 0 0 0 0 110 0 0 0 0 0 0 0 0 0 0 0 450 0

WES Tambura 95% 0 0 100 0 18 0 0 0 0 0 0 0 225 0 0 0 0 0 0 0 0 0 0 0 734 0

WES Mundri East 76% 0 0 18 0 7 0 0 0 0 0 0 0 90 0 0 0 0 0 0 0 0 0 0 0 483 0

WES Mundri West 89% 0 0 17 0 13 0 0 0 0 0 0 0 139 0 0 0 0 0 0 0 0 0 0 0 597 0

WES Nagero 88% 0 0 14 0 4 0 0 0 0 0 0 0 94 0 0 0 0 0 0 0 0 0 0 0 297 0

CES Terekeka 33% 0 0 51 0 6 0 0 0 0 0 0 0 333 0 0 0 0 0 0 0 0 0 0 0 657 0

CES Juba 66% 0 0 221 0 67 0 0 0 0 0 0 0 3101 3 0 0 0 0 0 0 0 0 0 0 7486 0

CES Lainya 73% 0 0 113 0 40 0 0 0 2 0 0 0 701 0 0 0 0 0 0 0 0 0 0 0 1520 0

CES Yei 60% 0 0 110 0 26 0 0 0 0 0 0 0 1504 0 0 0 0 0 0 0 0 0 0 0 1809 0

CES Morobo 85% 0 0 63 0 33 0 0 0 0 0 0 0 432 0 0 0 0 0 0 0 0 0 0 0 1276 0

CES Kajo-keji 70% 0 0 59 0 48 0 0 0 0 0 0 0 1379 0 0 0 0 0 0 0 0 0 0 0 2505 1

EES Torit 36% 0 0 136 0 27 0 0 0 0 0 0 0 923 0 0 0 0 0 0 0 0 0 0 0 1518 0

EES Lofan 50% 0 0 38 0 17 0 0 0 0 0 0 0 210 0 0 0 0 0 0 0 0 0 0 0 730 0

EES Kapoeta North 25% 0 0 33 0 1 0 0 0 0 0 0 0 63 0 0 0 0 0 0 0 0 0 0 0 436 0

EES Kapoeta South 67% 0 0 102 0 8 0 0 0 0 0 0 0 383 0 0 0 0 0 0 0 0 0 0 0 1275 0

EES Kapoeta East 72% 0 0 114 0 17 0 0 0 0 0 0 0 429 0 0 0 0 0 0 0 0 0 0 0 1359 0

EES Budi 14% 0 0 29 0 13 0 0 0 0 0 0 0 161 0 0 0 0 0 0 0 0 0 0 0 290 1

EES Ikotos 0% 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

EES Magwi 0% 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

LAKES Cueibet 100% 0 0 73 0 21 0 0 0 0 0 0 0 757 1 0 0 0 0 0 0 0 0 0 0 1552 1

LAKES Rumbek North 100% 0 0 112 0 27 0 0 0 0 0 0 0 358 0 0 0 0 0 0 0 0 0 0 0 1332 0

LAKES Rumbek Centre

100% 0 0 248 0 40 0 0 0 0 0 0 0 2260 2 0 0 0 0 0 0 0 0 0 0 2561 3

LAKES Rumbek East 0% 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

LAKES Wulu 45% 0 0 55 0 7 0 0 0 0 0 0 0 176 0 0 0 0 0 0 0 0 0 0 0 238 0

LAKES Yirol West 82% 0 0 92 0 38 0 0 0 1 0 0 0 799 2 0 0 0 0 0 0 0 0 0 0 2259 4

LAKES Yirol East 78% 0 0 79 0 16 0 0 0 0 0 0 0 632 0 0 0 0 0 0 0 0 0 2 0 1029 0

LAKES Awerial 83% 0 0 133 0 15 0 0 0 0 0 0 0 772 0 0 0 0 0 0 0 0 0 0 0 1548 0

WBGZ Raga 80% 0 0 174 0 64 0 0 0 0 0 0 0 847 0 0 0 0 0 0 0 0 0 0 0 1620 0

WBGZ Jur River 81% 0 0 187 0 33 0 0 0 0 0 0 0 770 1 0 0 0 0 0 0 0 0 0 0 1635 0

WBGZ Wau 45% 0 0 197 0 15 0 0 0 0 0 0 0 1234 0 0 0 0 0 0 0 0 0 0 0 2287 0

NBGZ Aweil North 57% 0 0 103 0 17 0 0 0 0 0 0 0 1133 0 0 0 0 0 0 0 0 0 0 0 2040 0

NBGZ Aweil East 65% 0 0 154 0 12 0 0 0 0 0 0 0 1895 3 0 0 0 0 0 0 0 0 0 0 3472 0

NBGZ Aweil Centre 36% 0 0 84 0 13 0 0 0 0 0 0 0 342 0 0 0 0 0 0 0 0 0 0 0 675 0

NBGZ Aweil South 50% 0 0 34 0 0 0 0 0 0 0 0 0 724 0 0 0 0 0 0 0 0 0 0 0 898 0

Integrated Disease Surveillance and Response

This Bulletin is Produced by the Ministry of Health with Technical Support from the WHO 15

NBGZ Aweil West 86% 0 0 237 0 12 0 0 0 0 0 0 0 1426 0 0 0 0 0 0 0 0 0 0 0 2910 0

WRP Abyei 40% 0 0 36 0 10 0 0 0 0 0 0 0 790 0 0 0 0 0 0 0 0 0 0 0 2041 0

WRP Twic 92% 0 0 274 0 52 0 0 0 0 0 0 0 4738 0 0 0 0 0 0 0 0 0 0 0 6929 0

WRP Gogrial West 90% 0 0 363 0 92 0 0 0 0 0 0 0 3734 0 1 0 0 0 0 0 0 0 0 0 6503 0

WRP Gogrial East 93% 0 0 86 0 5 0 0 0 0 0 0 0 1041 0 0 0 0 0 0 0 0 0 0 0 1795 0

WRP Tonj North 93% 0 0 240 0 21 0 0 0 0 0 0 0 1145 0 0 0 0 0 0 0 0 0 0 0 2216 0

WRP Tonj East 100% 0 0 508 0 58 0 0 0 0 0 0 0 1776 0 0 0 0 0 0 0 0 0 0 0 3509 0

WRP Tonj South 75% 0 0 222 0 23 0 0 0 0 0 0 0 1178 0 0 0 0 0 0 0 0 0 0 0 2385 0

UNITY Pariang 0% 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

UNITY Abiemnhom 400% 0 0 59 0 19 0 0 0 0 0 0 0 450 0 0 0 0 0 0 0 0 0 0 0 958 0

UNITY Mayom 100% 0 0 195 0 37 0 0 0 0 0 0 0 1793 1 0 0 0 0 0 0 0 0 0 0 4256 4

UNITY Rubkona 0% 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

UNITY Guit 0% 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

UNITY Koch 0% 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

UNITY Leer 17% 0 0 40 0 0 0 0 0 0 0 0 0 11 0 0 0 0 0 0 0 0 0 0 0 126 0

UNITY Mayendit 8% 0 0 85 0 15 0 0 0 0 0 0 0 18 0 0 0 0 0 0 0 0 0 0 0 280 0

UNITY Panyijiar 33% 0 0 158 0 30 0 0 0 0 0 0 0 133 0 0 0 0 0 0 0 0 0 0 0 1276 0

JNG Fangak 0% 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

JNG Canal/Pigi 0% 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

JNG Ayod 24% 0 0 132 0 6 0 0 0 0 0 0 0 425 0 0 0 0 0 0 0 0 0 0 0 1496 1

JNG Duk 40% 0 0 66 0 7 0 0 0 0 0 0 0 320 0 0 0 0 0 0 0 0 0 0 0 916 0

JNG uror 0% 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

JNG Nyirol 0% 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

JNG Akobo 0% 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

JNG Pochalla 0% 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

JNG Pibor 22% 0 0 51 0 2 0 0 0 0 0 0 0 105 0 0 0 0 0 0 0 0 0 0 0 453 0

JNG Twic East 33% 0 0 44 0 3 0 0 0 0 0 0 0 108 0 0 0 0 0 0 0 0 0 0 0 392 0

JNG Bor South 55% 0 0 161 1 24 0 0 0 0 0 0 0 617 0 0 0 0 0 0 0 0 0 0 0 1402 0

UNS Renk 67% 0 0 363 0 76 0 0 0 0 0 0 0 960 2 0 0 0 0 0 0 0 0 0 0 3332 2

UNS Manyo 40% 0 0 65 0 7 0 0 0 0 0 0 0 90 0 0 0 0 0 0 0 0 0 0 0 266 0

UNS Fashoda 60% 0 0 78 1 15 0 0 0 0 0 0 0 558 1 0 0 0 0 0 0 0 0 0 0 2085 2

UNS Melut 60% 0 0 29 0 1 0 0 0 0 0 0 0 48 0 0 0 0 0 0 0 0 0 0 0 154 0

UNS Maban 100% 0 0 1056 0 109 0 0 0 0 0 0 0 5843 0 0 0 0 0 0 0 0 0 0 0 13452 0

UNS Maiwut 67% 0 0 107 0 26 0 0 0 0 0 0 0 565 0 0 0 0 0 0 0 0 0 0 0 1247 0

UNS Luakpiny/Nasir 0% 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

UNS Longochuk 92% 0 0 368 0 25 0 0 0 0 0 0 0 953 2 0 0 0 0 0 0 0 0 0 0 2276 0

UNS Ulang 157% 0 0 274 0 23 0 0 0 0 0 0 0 553 0 0 0 0 0 0 0 0 0 0 0 2194 0

UNS Baliet 0% 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

UNS Malakal 8% 0 0 51 0 15 0 0 0 0 0 0 0 168 0 0 0 0 0 0 0 0 0 0 0 410 0

UNS Panyikang 0% 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

UNS Akoka 0% 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Grand Total 46.56365276 0 0 8570 2 1524 0 0 0 3 0 0 0 54330 18 1 0 4 0 0 0 0 0 2 0 118,343 19

This Bulletin is Produced by the Ministry of Health with Technical Support from the WHO 16

Key: Yellow: 100% reporting, Green: 80-99% reporting, white: Below 80% reporting HF= Health Facility; WES= Western Equatoria State; CES= Central Equatoria State; EES= Eastern Equatoria State; WBGZ= Western Bahr el Ghazal; NBGZ= Northern Bahr el Ghazal; WRP= Warrap; JNG= Jonglei; UNS= Upper Nile State