REPUBLIC OF SOUTH SUDAN

MINISTRY OF HEALTH

SITUATION UPDATE EBOLA VIRUS DISEASE (EVD) PREPAREDNESS

SOUTH SUDAN

Update #60 Week 6-7: 01-15 February 2020 www.humanitarianresponse.info/en/operations/south-sudan/ebola-preparedness Update on Ebola Virus Disease No.61 | 2

1. KEY HIGHLIGHTS

0 122 0 ALERTS DURING THE ALERTS SINCE AUGUST EVD CASES SINCE AUGUST PERIOD 2018 2018 a. No alert was reported in this period. The last alert on since 23 January 2020 in Yei. b. EVD preparedness planning for 2020 near completion, based on a transition period through to June 2020 during which activities will be folded back into the National Action Plan for Health Security, as appropriate.

2. SITUATION UPDATE FROM DEMOCRATIC REPUBLIC OF CONGO (DRC)

 As of 10 February, a total of 3,431 cases were reported, including 3,308 confirmed and 123 probable cases, 2,253 deaths (overall case fatality ratio 66 percent).  From 28 January to 10 February, eight new confirmed cases were reported, all in two health zones - Mabalako in North Kivu and Beni in Ituri.  No new cases have been reported since 07 February. Mambasa Health Zone in Ituri marked 42 days without a new confirmed case.  Figure 1 shows cases and deaths per health zone and days elapsed since the last confirmed cases.

Map 1: cases, and number of health areas affected, by health zone, North Kivu and Ituri Provinces Figure 1: Cases by week of illness onset by health

3. SOUTH SUDAN RISK STATEMENT

Although the rate of new cases in DRC has markedly decreased, the most recent WHO assessment in January concluded that the National and Regional risk levels remain very high, while global risk levels remain low. With no new cases reported in the Ituri province in the last nine days, and a continuing decline in new cases in the other locations in DRC, the risk of introduction to South Sudan is seen as decreasing, but nevertheless remains high in view of active transmission in DRC, population movements and weak national health systems. Insecurity, poor road infrastructure networks and telecommunication systems continue to hinder preparedness efforts in some high-risk locations in South Sudan, notably those close to the border with Ituri Province, DRC.

This report is published by the PHEOC, with support from the EVD Secretariat, WHO and partners Update on Ebola Virus Disease No.61 | 3

4. SOUTH SUDAN PREPAREDNESS UPDATE

4.1 COORDINATION AND PLANNING:

 The EVD Secretariat and WHO conducted field missions to support State level planning consultations in prioritizing activities, as well as mapping operational partners. The team visited Jubek, Nimule, Yambio and Yei, while tele-conferences were held with teams in Maridi, Tambura and Wau. At national level, work continues with pillar leads and partners. Plans are under development to commence state level ‘micro-planning’ to give greater, local expression to the parameters of the national plan once finalized.

4.2 EPI-SURVEILLANCE:

 In Juba, Joint Supportive Supervision (JSS) was completed in priority health facilities, with each site receiving additional EVD posters, hard copies of relevant SOP documents, updated copies of IDSR tools, and mentoring by the TWG. Lou Medical Clinic, Gabat PHCC, and Juba Military Hospital were visited. To ensure proper documentation and uploading of the JSS findings to the database, for easy access by all stakeholders, a one-page guidance document was drafted and distributed to IPC focal persons in the 11 priority Counties.  In Nimule, SPEDP, a national NGO supported by Core Group has completed recruitment of 15 Boma Health Promoters (BHP) for Community Based Surveillance (CBS) for former Pageri County. The BHP will conduct disease surveillance on EVD, measles, and polio to enhance early detection and response readiness.  Drafting of the Epi-Surveillance Standard Operating Procedures (SOPs) has been completed. Hard copies will be printed for distribution to all Health Facilities in the priority Counties, shared with RRT members, and other Stakeholders operating in the priority counties.

4.3 Vaccine and Therapeutics

 The vaccine protocol amendment has been submitted to the South Sudan Ethics and Institutional Review Boards for approval in case of future vaccination programme in country, and is awaiting approval. Until then, the previous compassionate use vaccine protocol remains in place. The proposed amendment includes the following major changes: - The dose will be changed from 1ml to 0.5 ml per person, in a 20 ml vial. - Women after the first trimester of pregnancy, and infants 6 months or older, will be eligible for vaccination during ring vaccination activities in the event of a confirmed EVD case in South Sudan.  25 people participated in two-day State-level vaccination team refresher trainings in Nimule and Yei River State. The trainings were led by WHO with assistance from CDC, UNICEF and State level leadership, to prepare teams for implementation of ring and geographic vaccination strategies in case of an EVD outbreak in South Sudan The training will be replicated in Yambio in coming week.  At the above mentioned training in Nimule and Yei, the WHO, CDC and UNICEF interviewed 22 front-line workers and front-line healthcare workers who received Ebola vaccine in 2019 to understand their experiences and perceptions of the vaccination process; and also some who did not receive the vaccine on whether they intend to do so should there be another opportunity. The team assessed information sessions, registration, informed consent, side-effects, and whether the interviewees would still make the same decisions about vaccination (acceptance/ refusal). Information gathered will be analyzed and findings shared.

This report is published by the PHEOC, with support from the EVD Secretariat, WHO and partners Update on Ebola Virus Disease No.61 | 4

4.4 LABORATORY:

 With support from CDC, two NHPL staff have been sponsored on a training in PCR, sequencing and diagnostic in Kinshasa, DRC.  In Nimule and Yambio, with WHO support, the laboratories have been upgraded ready for the GeneXpert machines installation and timely testing of samples at sub-national level. The upgrade has also commenced in Wau. Similar upgrades in Yei, Maridi, and Tambura will be funded by the Global Fund (GF) through UNDP. Improvement in the GeneXpert Lab in Nimule Hospital.  Harmonization of the GeneXpert and multi diagnostics plan is ongoing for the HIV, TB, and later HBV, and HCV, apart from the EVD testing.

4.5 CASE MANAGEMENT, IPC WASH, and SDB:

IPC WASH:

 IPC WASH partners continued to sustain and further improve EVD infection control measures at the existing four Isolation units in Juba, Nimule, Yambio and Yei, and seven Holding units set up within frontline health facilities in the EVD high risk states.  Routine monitoring, joint partner’s supportive supervision and mentorship on IPC measures was conducted in 23 health facilities and Isolation units across the high risk locations, providing on the job support and training to health facilities staff, and additional gaps identified for improvements.  At least 30,550 people were reached with hygiene promotion messages on IPC WASH and Ebola virus control and prevention in churches, markets and health facilities in Pageri, Magwi, Yei, Tambura and Gbudue States. 19 handwashing facilities were also installed in public places including market places and schools.  Critical supplies such as hand sanitizers, soap, chlorine powder (HTH), waste bins, heavy duty gloves, and aprons were distributed/replenished on demand in 32 health facilities, 10 primary schools, and markets to enhance prevention and control.  The construction of five temporary Holding areas in five health areas in Yei was finalized and equipped with IPC/WASH supplies and IEC materials to facilitate health education of patients.  In addition, five boreholes were rehabilitated in Yei River State, two boreholes drilled in Pageri/Nimule and a water pump was repaired in Nimule Hospital Isolation Unit. One water point was rehabilitated and equipped with a motorized pump in Gumbo PHCC in Juba. Five rainwater harvesting systems were installed in five health facilities in Yei River State, and a 4,000 liters’ water tank with tap was installed at the Nesitu PHCU in Juba, improving clean water situation in these facilities.  In Wau Holding unit, two blocks of latrines were completed, a water point rehabilitated, and a solar pump installed.

Case Management:

 Isolation facilities across the high risk State continue to provide services: In Juba a suspected case of Coronavirus was isolated in the IDU for two days until the laboratory result was communicated. Drills on case management were conducted in Yei, Juba and Yambio.

In Nimule, an ambulance training was conducted by Cordaid from 13 to 14 February, co-facilitated by WHO and UNICEF. The training benefited 15 people including five members of the ambulance team, and others including four drivers Ambulance training session on-going and six Case Management staff. Photo credit: WHO

This report is published by the PHEOC, with support from the EVD Secretariat, WHO and partners Update on Ebola Virus Disease No.61 | 5

4.6 BORDER HEALTH AND POINT OF ENTRY (BH & POE) SCREENING:

A total of 160,420 Primary and 143 Secondary screenings were conducted at 29 Points of Entry across the seven high-risk States. The cumulative number of Primary screenings since preparedness commenced following the onset of the outbreak in DRC in August 2018 has reached 5,088,315, while Secondary screenings reached 3,936.

PRIMARY SCREENED SECONDARY SCREENED During reporting Period Cumulative (since Sept 2018) During reporting period Cumulative (since Sept 2018) 160,464 5,088,315 143 3,936 Table 1: Summary of screenings from 29 points of entry.

Points of Entry (PoEs) transition process:

Three phases of gradual phase-out of points of entry have been approved by the Ministry of Health (MoH) and the Technical Working Group (TWG) commencing from end of March (13 PoEs), end of April (9 PoEs), and end of June 2020 (7 PoEs). The phasing out will be implemented in line with the geographical prioritization exercise that was developed during the EVD Strategic reset workshop in December 2019. The criteria include analysis of areas in South Sudan with high population inflows, close proximity to affected areas, and data analysis based on the number of travellers crossing per point of entry (PoEs), with the PoEs with the least population flows categorized under phase I. The transition to Phase III are PoEs whose official border points including airports that receive international flights- the following were prioritized: Juba International Airport, Nimule Checkpoint, Gangura Border, Yambio Airport, Wau Movcon Airstrip, Kaya, and Yei Airstrip. Phase III main activities will mostly incorporate maintenance of the PoEs until June 2020, and eventual handed over to the government, in line with the NAPHS. Meanwhile, PoE partners will continue to continue support screening, risk communications, and IPC/WASH at Health Facilities proximate to the PoEs.

4.7 RISK COMMUNICATION, SOCIAL MOBILIZATION AND COMMUNITY ENGAGEMENT (RCSMCE):

 During the reporting period, a total of 102,779 people (45,886 male & 56,893 female) were reached by Social Mobilizers with key EVD messages through the various interpersonal and group communication channels such as House to house visits, Schools, Health facilities, Markets, Churches and through Community meetings in all the EVD high risk locations, enhancing awareness, knowledge, and participation in EVD prevention. Further, UNICEF prepositioned 2,220 assorted EVD IEC materials to support partners and community mobilizers to target communities through health facilities, trading centres, markets, places of worship, POCs, Points of entry, security/police posts and schools and other strategic locations.  Programmatic supportive supervision was conducted in Maridi to follow-up and assess the impact/status of activities implemented by a partner whose contract expired in December 2019, also aimed to address gaps created.  The Ministry of Health participated in the Stakeholders’ Field Simulation Exercise meeting that took place on 5 to7 February 2020 in Entebbe, Uganda. As a follow-up, the East African Community (EAC) Secretariat with support from GIZ plans to have joint cross-border FSX along South Sudan-Uganda borders (Nimule-Elegu) in September 2020.

4.8 OPERATIONS AND LOGISTICS: NTR

This report is published by the PHEOC, with support from the EVD Secretariat, WHO and partners Update on Ebola Virus Disease No.61 | 6

5. KEY CHALLENGES DURING THE REPORTING PERIOD

 In Yei, access was limited by security concerns in some locations, while the Relief and Rehabilitation Commission (RRC) was reported to have declined approval for some humanitarian field deployments, including for some EVD related activities.  In Yambio, there is a gap created by temporary suspension of RCSMCE activities in Yambio Municipality and Nzara town due to funding gap. The activities are expected to resume in March once funding is secured.  In Nimule, Health Care Facilities in former Pageri County remain closed following on-going strike due to unpaid incentives for the last four months. The strike, which commenced in early January 2020, has impacted health care service delivery, with Nimule hospital facing a high number of patients and referrals.

6. RESOURCE MOBILIZATION (FUNDING)

BY DONOR BY PILLAR

2 Only pillar funding, excluding UNICEF operational and cross cutting funding

FOR MORE INFORMATION, PLEASE CONTACT:

Dr. Richard Lako Lino Dr. Pinyi Nyimol Mawien Dr. Mathew Tut Moses Incident Manager Director General, PHS Director, EPR & PHEOC Email: [email protected] Email: [email protected] Email: [email protected] Tel.: +211 926 592 520 Phone: +211 916 285 676 Tel.: +211 922 202 028

This report is published by the PHEOC, with support from the EVD Secretariat, WHO and partners