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South Sudan

Ministry of HealthRepublic of South Sudan Printed: 14:31 Thursday, 10 August 2017 UTC

Integrated Disease Surveillance andResponse (IDSR)

Epidemiological Update W31 2017 (Jul 31-Aug 06)

Surveillance

Slide 1 Table 1 IDSR surveillance performance indicators by county (W31)

Table 2 Summary of key IDSR surveillance indicators

Table 3 IDSR report submissions (W31)

Slide 2 Figure 1 Trend in IDSR completeness over time

Slide 3 Map 1a Map of IDSR completeness by county (W31)

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

Slide 4 Table 4 EWARS surveillance performance indicators by partner(W31)

Table 5 Summary of key EWARS surveillance indicators

Table 6 EWARS report submissions (W31)

Alert

Slide 5 Table 7 Alert performance indicators by Hub (W31)

Table 8 Summary of key alert indicators

Slide 6 Table 9 Alert performance indicators by event (W31)

Table 10 Event risk assessment

Slide 7 Map 2a - 2f Maps of key disease alerts by county (W31)

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

W31 2017 (Jul 31-Aug 06)

Highlights W31 2017

Surveillance

Completeness for IDSR reporting at county level was 56% . Completeness forEWARS reporting from IDP sites was 77% .

Alert

A total of 15 alerts were reported, of which 27% have been verified. 0 alerts wererisk assessed and 0 required a response.

Response

A total of 102 new cholera cases and 1 death (CFR 1.0% ) were reported.The cumulative total since the start of the current outbreak on 18 June 2016 is19,742 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.

W31 2017 (Jul 31-Aug 06)

Hub Reporting Performance

# counties # reportsreceived Completeness Timeliness

Aweil 5 4 80% 80%

Bentiu 9 3 33% 33%

Bor 11 5 45% 45%

Juba 6 4 67% 67%

Kwajok 7 6 86% 86%

Malakal 13 1 8% 8%

Rumbek 8 6 75% 75%

Torit 8 3 38% 38%

Wau 3 3 100% 100%

Yambio 10 10 100% 100%

South Sudan 80 45 56% 56%

Table 1 | IDSR surveillance performance indicators by county (W31 2017) Table 2 | Summary of key IDSR surveillance indicators

W31 Cumulative (2017)

80 - Number of counties

56% 73% Completeness

56% 66% Timeliness

Table 3 | IDSR report submissions


45 1,878 total submissions

18 258 submissions by mobile

27 574 submissions by web

Surveillance | IDSR surveillance indicators

1 W31 2017 (Jul 31-Aug 06)

Figure 1 | Trend in IDSR completeness over time

Completeness

Surveillance | Trend in IDSR completeness

2 W31 2017 (Jul 31-Aug 06)

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 (W31 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 W31 2017 (Jul 31-Aug 06)

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 0 0% 0%

SMC 2 2 100% 100%

UNIDO 0 0

UNKEA 0 0

World Relief 0 0

Total 30 23 77% 77%

Table 4 | EWARS surveillance performance indicators by partner (W31 2017) Table 5 | Summary of key EWARS surveillance indicators


30 - Number of EWARS reporting sites

77% 81% Completeness

77% 78% Timeliness

Table 6 | EWARS report submissions


23 779 total submissions

2 58 submissions by mobile

21 721 submissions by web

Surveillance | EWARS surveillance indicators

4 W31 2017 (Jul 31-Aug 06)

Hub W31 Cumulative (2017)

# alerts % verif. # alerts % verif.

Aweil 0 0% 5 40%

Bentiu 0 0% 59 29%

Bor 3 67% 51 24%

Juba 1 0% 37 19%

Kwajok 2 0% 22 32%

Malakal 0 0% 12 42%

Rumbek 1 0% 51 29%

Torit 1 100% 34 79%

Wau 3 33% 41 7%

Yambio 4 0% 23 43%

South Sudan 15 27% 335 31%

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


15 335 Total alerts raised

27% 31% % verified

0% 51% % auto-discarded

0% 9% % risk assessed

0% 4% % requiring a response

Alert | Alert performance indicators

5 W31 2017 (Jul 31-Aug 06)

Event W31 Cumulative (2017)

# alerts % verif. # alerts % verif.

Indicator-based surveillance

Malaria 0 0% 32 41%

AWD 0 0% 19 42%

Bloody Diarr. 6 17% 41 41%

Measles 1 0% 25 16%

Meningitis 0 0% 0 0%

Cholera 2 0% 78 27%

Yellow Fever 0 0% 1 100%

Guinea Worm 3 33% 38 32%

AFP 2 50% 10 40%

VHF 0 0% 4 75%

Neo. tetanus 0 0% 0 0%

Event-based surveillance

EBS total 1 100% 18 94%

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


0 7 Low risk

1 1 Medium risk

0 6 High risk

0 13 Very high risk

Alert | Event risk assessment

6 W31 2017 (Jul 31-Aug 06)

W24 2016 - W31 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

W31

% n

102

45% 46

39% 18

73% 74

1.0% 1

0% 0

Cumul.

% n Indicator

19,742 1. Total number of cases reported

11% 2,103 2. % tested with cholera RDT

72% 1,511 3. % tested with cholera RDT that were positive

57% 11,259 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 W31 2017 (Jul 31-Aug 06)

1

2

3

4

1 2 3

4

Figure 2 Cholera epidemic curve (W24 2016 - W31 2017)

Cases Deaths

Response | Cholera epidemic curve

9 W31 2017 (Jul 31-Aug 06)

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 W31 2017 (Jul 31-Aug 06)

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 W31 2017 (Jul 31-Aug 06)

Num

ber

W35

201

6

W52

201

6

W18

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W35

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W35

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W18

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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 W31 2017 (Jul 31-Aug 06)

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

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500

600

Num

ber

W35

201

6

W52

201

6

W18

201

7

0

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300

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

County W31

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 44 0 0.0% 100% 0%

KapoetaEast

36 1 2.8% 25% 0%

KapoetaNorth

0 0 0.0% 0% 0%

KapoetaSouth

15 0 0.0% 100% 0%

Nyirol 6 0 0.0% 83% 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 - W31 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 2,405 35 1.5% 83% 66%

KapoetaEast

2,105 26 1.2% 43% 62%

KapoetaNorth

737 1 0.1% 95% 0%

KapoetaSouth

963 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 W31 2017 (Jul 31-Aug 06)

1 23

1 23

1 2 3

Figure 4a Cholera cases by sex (2017)

Male ( 46% ; n = 7,139 ) Female ( 53% ; n = 8,197)

Figure 4b Cholera cases by age (2017)

< 5 ( 21% ; n = 3,257 ) 5-14 ( 26% ; n = 4,000 ) 15-44 ( 41% ; n = 6,346 ) > 45 ( 12% ; n = 1,775 )

Figure 4c Cholera cases by outcome (2017)

Discharged ( 70.2% ; n = 10,829 ) Defaulted ( 0.3% ; n = 47 ) Died ( 1.8% ; n = 273 ) Admitted ( 6.4% ; n = 980 )

Response | Cholera cases by sex, age and outcome

13 W31 2017 (Jul 31-Aug 06)

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

South SudanIntegrated Disease Surveillance and Response (IDSR)Epidemiological Update W31 2017 (Jul 31-Aug 06)

ContentsHighlights W31 2017Surveillance | IDSR surveillance indicatorsSurveillance | Trend in IDSR completenessSurveillance | Maps of IDSR completeness by countySurveillance | EWARS surveillance indicatorsAlert | Alert performance indicatorsAlert | Event risk assessmentAlert | Maps of key disease alerts by countyResponse | Cholera response indicatorsResponse | Cholera epidemic curveResponse | Maps of cholera distribution over time by countyResponse | Cholera epidemic curves by countyResponse | Cholera epidemic curves by countyResponse | Cholera response indicators by countyResponse | Cholera cases by sex, age and outcome

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