South Sudan
Integrated Disease Surveillance and Response (IDSR)
Annexes W51 2017 (Dec 18-Dec 24)
Ministry of Health Printed: 18:19 Sunday, 31 December 2017 UTC Republic of South Sudan
Contents
Access and Utilisation Acute Watery Diarrhoea (AWD) Slide 2 Map 1 Map of consultations by county (2017) Slide 8 Trend in AWD cases over time
Slide 9 AWD maps and alert management
Indicator-based surveillance Slide 3 Figure 1 Proportional mortality Bloody diarrhoea
Slide 4 Figure 2 Proportional morbidity Slide 10 Trend in bloody diarrhoea cases over time
Slide 5 Figure 3 Trend in consultations and key diseases Slide 11 Bloody diarrhoea maps and alert management
Disease trends and maps Measles Malaria Slide 12 Trend in measles cases over time Slide 13 Measles maps and alert management Slide 6 Trend in malaria cases over time
Slide 7 Malaria maps and alert management
Sources of data
1. Weekly IDSR Reporting Form 2. Weekly EWARS Reporting Form
1 W51 2017 (Dec 18-Dec 24)
Access and Utilisation | Map of consultations by county
Map 1 | Map of total consultations by county (W51 2017) Hub W51 2017
Aweil 2,787 786,757
Renk Bentiu 6,796 989,471 Manyo Bor 4,042 441,376
Melut Juba 4,642 517,038 Fashoda Maban Abyei Pariang Malakal Kwajok 5,110 874,587 Abiemnhom Panyikang Baliet Aweil North Aweil East RubkonGa uit Longechuk Twic Mayom FangakCanal Pigi Malakal 4,992 771,575 Aweil West Luakpiny Nasir Aweil South Maiwut Raja GogriaGl oWgerisatl East Koch Nyirol Ulang Aweil Centre Rumbek 10,960 839,521 Tonj North Ayod MayenLdeiter Torit 34 370,377 Tonj East Akobo Duk Uror Jur River Rumbek NPorathnyijiar Wau Wau 5,512 636,732 Pochalla Tonj SoCutuhReiubmetbek Centre Twic East Rumbek EaYstirol East Yambio 6,700 522,619 Nagero Yirol West Bor Pibor Wulu Awerial Tambura South Sudan 51,575 6,750,053 Mvolo Terekeka Ezo Nzara Mundri East Mundri West Lopa LaKfoanpoeta North Yambio Ibba Maridi Kapoeta East
Juba Kapoeta South Torit Budi Yei Lainya Ikotos Kajo Keji Magwi Morobo
Number of consultations
0 1 1,000 2,500 5,000
2 W51 2017 (Dec 18-Dec 24)
Proportional morbidity
Figure 2 | Proportional morbidity (2017) Syndrome W51 2017
# cases % morbidity # cases % morbidity
Malaria 15,277 48.0% 2,450,328 60.1%
ARI 5,316 16.7% 436,829 10.7%
AWD 3,616 11.4% 548,754 13.5%
Bloody 427 1.3% 84,989 2.1% diarrhoea
AJS 1 0.0% 1,603 0.0%
Measles 1 0.0% 1,179 0.0%
Other 7,208 22.6% 551,855 13.5%
Total cases 31,846 100% 4,075,537 100%
Malaria Acute Jaundice Syndrome (AJS)
Acute Respiratory Infection Measles
(ARI) Other
Acute Watery Diarrhoea
Bloody diarrhoea
4 W51 2017 (Dec 18-Dec 24)
Trend in consultations and key diseases Trend in consultations and key diseases IDSR trends in absolute counts
Figure 3 | Trend in total consultations and key diseases (W51) Figure 3 | Trend in total consultations and key diseases (W39)
200000 275000
2510705000
225000 150000
200000
125000 175000 r e b 100000 m 150000 r u e N b m u
N 125000 75000
100000
50000 75000
50205000
25000 0 7 7 7 6 7 7 7 7 7 7 7 7 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 2 2 2 2 2 2 2 2 2 2 2 2
0 9 8 3 2 2 6 5 1 9 5 8 4 0 1 1 5 2 2 0 3 3 3 4 4 6 7 6 6 7 7 6 7 7 7 7 7 7 1 1 1 1 1 1 1 1 1 1 1 1 1 W W W W W W W W W W W W 0 0 0 0 0 0 0 0 0 0 0 0 0 2 2 2 2 2 2 2 2 2 2 2 2 2
9 9 8 4 8 3 2 6 2 5 1 9 5 3 0 4 4 1 1 5 2 2 0 3 3 Total consultations Acute Watery Diarrhoea 3 W W W W W W W W W W W W W Malaria Acute Jaundice Syndrome (AJS) Total consultations Acute Watery Diarrhoea Acute Respiratory Infection (ARI) Measles Malaria Acute Jaundice Syndrome (AJS)
Acute Respiratory Infection (ARI) Measles
5 W51 2017 (Dec 18-Dec 24)
5 W39 2017 (Sep 25-Oct 01)
Trend in consultations and key diseases IDSR Proportionate morbidity trends
Figure 3 | Trend in total consultations and key diseases (W39)
275000 Fig. 1|IDSR Proportionate morbidity trends, week 1 to 51, 2017 250000 70.0% 160
225000 60.0% 140 200000 120 50.0% Thousands 175000 100 40.0% 150000 r
e 80 b m u
N 30.0% 125000 60 Morbidity %
100000 20.0% 40
75000 10.0% 20
50000 0.0% 0 1 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 Number of consultations 25000 Epidemiological week of reporting in 2017 0 6 7 6 6 7 7 6 7 7 7 7 7 Consultations Malaria ARI AWD ABD Measles 7 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 2 2 2 2 2 2 2 2 2 2 2 2 2
9 9 8 4 8 3 2 6 2 5 1 9 5 3 0 4 4 1 1 5 2 2 0 3 3 3 W W W W W W W W W W W W W In the relatively stable states, Total consultations malaria is the top cause of morbidity accounting Acute Watery Diarrhoea Malaria Acute Jaundice Syndrome (AJS) for 36.6% of the consultations in week Acute Respiratory Infection (ARI) 51 M(representing easles an decline from 38% in week 50) and a cumulative 41.1% in 2017. Malaria has been on the decline since week 38 of 2017. 5 W39 2017 (Sep 25-Oct 01)
Trend in consultations and key diseases IDP Proportionate morbidity trends
Figure 3 | Trend in total consultations and key diseases (W39)
275000 Fig. 2|IDP Proportionate morbidity trends, week 01-51, 2017 2500045%0 50,000 45,000 2250040%0 40,000 2000035%0 35,000 30% 175000 30,000 25% 150000 25,000 r e b % of Mobidity Consultations
m 20%
u 20,000 N 125000 15% 15,000 1000010%0 10,000
75000 5% 5,000 0 50000 0% 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51
25000 Epi week 2017 Consultations Malaria ARI AWD ABD Measles Skin diseases GSW Injuries 0 6 7 6 6 7 7 6 7 7 7 7 7 7 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 2 2 2 2 2 2 2 2 2 2 2 2 2
9 9 8 4 8 3 2 6 2 5 1 9 5 3 0 4 4 1 1 5 2 2 0 3 3 3 W W W W W W W W W W W W W
Total consultations Acute Watery Diarrhoea Among the IDPs, MaARI and malaria accounted for laria Acute Jaundice10.1 Syndrome% and (AJS) 18.0% of consultations in week Acute Respira51. tory InfecThe other significant causes of morbidity in the IDPs tion (ARI) Measles include AWD, skin diseases, and injuries.
5 W39 2017 (Sep 25-Oct 01)
Trend in consultations and key diseases IDP Proportionate morbidity trends
Figure 3 | Trend in total consultations and key diseases (W39)
275000 Causes of morbidity among the IDPs weeks 1 to 51, 2017 23.8% 250000 25.0% 21.0% 225000 20.0% 200000
175000 15.0% 150000 r e b m u
N 125000 10.0% 7.8%
100000 3.97% 75000
Proportionate morbidity [%] 5.0% 1.63% 0.7% 50000 0.02% 0.02% 0.0% 25000 Malaria ARI AWD ABD Measles Skin diseases GSW Injuries
0 6 7 6 6 7 7 6 7 7 7 7 7 7 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 2 2 2 2 2 2 2 2 2 2 2 2 2
9 9 8 4 8 3 2 6 2 5 1 9 5 3 0 4 4 1 1 5 2 2 0 3 3 3 W W W W W W W W W W W W W
Total consultations Acute Watery Diarrhoea The top causes of morbidity in the IDPs in 2017 include ARI, malaria, AWD, skin Malaria Acute Jaundice Syndrome (AJS) diseases, injuries, and ABD. Acute Respiratory Infection (ARI) Measles
5 W39 2017 (Sep 25-Oct 01)
Proportional mortality
Figure 1 | Proportional mortality (2017) Syndrome W51 2017
# deaths % mortality # deaths % mortality
Malaria 3 50.0% 1,178 69.1%
ARI 0 0.0% 40 2.3%
AWD 0 0.0% 90 5.3%
Bloody 0 0.0% 44 2.6% diarrhoea
AJS 0 0.0% 1 0.1%
Measles 0 0.0% 12 0.7%
Other 3 50.0% 341 20.0%
Total deaths 6 100% 1,706 100%
Malaria Acute Jaundice Syndrome (AJS)
Acute Respiratory Infection Measles
(ARI) Other
Acute Watery Diarrhoea
Bloody diarrhoea
3 W51 2017 (Dec 18-Dec 24)
Acute Watery Diarrhoea | Trends over time
Figure 5a | Trend in AWD cases over time (South Sudan)
20000
17500
15000
12500
10000
7500
5000
2500
0 Jan Mar May Jul Sep Nov
Graph legend Key AWD indicators (2017) Figure 5b | % morbidity Figure 5c | Age breakdown
2017 − · − · − · − − 2016 548,754 90 77 − − − − − − − 2015
· · · · · · · · · · 2014 Cases Deaths Alerts
8 W51 2017 (Dec 18-Dec 24)
Acute Watery Diarrhoea | Maps and Alert Management
Map 4 | Map of AWD cases by county (2017) Map 5 | Map of AWD alerts by county (2017) a. 2014 b. 2015
c. 2016 d. 2017
Map legend Risk Assessment Number of AWD cases
0 1 5,000 10,000 20,000
Number of AWD alerts 77 30 0 0 0 0
0 1 10 Alerts Verified Low Risk Moderate Risk High Risk Very High Risk Alert threshold Twice the average number of cases over the past 3 weeks. Source: IDSR
9 W51 2017 (Dec 18-Dec 24)
Acute Bloody Diarrhoea | Trends over time
Figure 6a | Trend in bloody diarrhoea cases over time (South Sudan)
3500
3000
2500
2000
1500
1000
500
0 Jan Mar May Jul Sep Nov
Graph legend Key bloody diarrhoea indicators (2017) Figure 6b | % morbidity Figure 6c | Age breakdown
2017 − · − · − · − − 2016 84,989 44 142 − − − − − − − 2015
· · · · · · · · · · 2014 Cases Deaths Alerts
10 W51 2017 (Dec 18-Dec 24)
Acute Bloody Diarrhoea | Maps and Alert Management
M(2a0p1 76) | Map of bloody diarrhoea cases by county Map 7 | Map of bloody diarrhoea alerts by county (2017) a. 2014 b. 2015
c. 2016 d. 2017
Map legend Risk Assessment Number of bloody diarrhoea cases
0 1 500 1,000 2,000
Number of alerts 142 59 1 0 0 0
0 1 10 Alerts Verified Low Risk Moderate Risk High Risk Very High Risk Alert threshold Twice the average number of cases over the past 3 weeks. Source: IDSR
11 W51 2017 (Dec 18-Dec 24)
Measles | Trends over time
Figure 7a | Trend in number of cases over time (South Sudan)
300
250
200
150
100
50
0 Jan Mar May Jul Sep Nov
Graph legend Key measles indicators (2017) Figure 7b | % morbidity Figure 7c | Age breakdown
2017 − · − · − · − − 2016 1,179 12 66 − − − − − − − 2015
· · · · · · · · · · 2014 Cases Deaths Alerts
Since the beginning of 2017, at least 1,179 suspect measles cases including at least 12 deaths (CFR 1.02%) have been reported. Of these, 832 suspect cases have undergone measles case12 W51 2017 (Dec 18-Dec 24) -based laboratory-backed investigation. At least 297 samples have been collected, with a total of 84 measles cases being laboratory confirmed, while 321 cases and 240 cases were epidemiologically and clinically confirmed respectively. Consequently, measles outbreaks were confirmed in nine counties – Panyijiar, Aweil South, Gogrial East, Gogrial West, Wau, Juba, Torit, Yambio, and Jur River. Measles follow up campaign implemented from May 2017 in 10 state hubs where 1,742,725 children six to 59 months (75%) were reached with measles vaccine. Measles | Maps and Alert Management
Map 7 | Map of measles cases by county (2017) Map 8 | Map of measles alerts by county (2017) a. 2014 b. 2015
c. 2016 d. 2017
Map legend Risk Assessment Number of measles cases
0 1 50 100 250
Number of measles alerts 66 21 0 0 1 1
0 1 10 Alerts Verified Low Risk Moderate Risk High Risk Very High Risk Alert threshold 1 case. Source: IDSR
13 W51 2017 (Dec 18-Dec 24)
Malaria | Trends over time
Figure 4a | Trend in number of cases over time (South Sudan)
120000
100000
80000
60000
40000
20000
0 Jan Mar May Jul Sep Nov
Graph legend Key malaria indicators (2017) Figure 4b | % morbidity Figure 4c | Age breakdown
2017 − · − · − · − − 2016 2,450,3281,178 77 − − − − − − − 2015
· · · · · · · · · · 2014 Cases Deaths Alerts
6 W51 2017 (Dec 18-Dec 24)
Malaria | Maps and Alert Management
Map 2 | Map of malaria cases by county (2017) Map 3 | Map of malaria alerts by county (2017) a. 2014 b. 2015
c. 2016 d. 2017
Map legend Risk Assessment Number of malaria cases
0 1 10,000 20,000 50,000
Number of malaria alerts 77 32 1 0 0 0
0 1 10 Alerts Verified Low Risk Moderate Risk High Risk Very High Risk Alert threshold Twice the average number of cases over the past 3 weeks. Source: IDSR
7 W51 2017 (Dec 18-Dec 24)
o At least 3 countries - Awerial, Yirol East, and Twic East continue to register increasing trends at or above the third quartile. o The malaria trends in the other 20 counties are returning to normal off- transmission season levels Malaria trends by county
16,000 Malaria trends for Aweil East County in 2017
14,000 2,500 Malaria trends for Yirol East County in 2017 12,000
10,000 3rd Quartile C-sum 2017 2,000 3rd Quartile C-sum 2017 8,000
6,000 1,500
4,000 1,000 2,000
- 500 Weeks - 4,000 Malaria trends for Aweil North County in 2017 Weeks 3,500 3,000 7,000 Malaria trends for Yirol West County in 2017 2,500 3rd Quartile C-sum 2017 6,000 2,000 3rd Quartile C-sum 2017 1,500 5,000
1,000 4,000
500 3,000 -
2,000 Weeks 1,000 - 3,500 Malaria trends for Aweil South County in 2017
Weeks 3,000 2,500 3rd Quartile C-sum 2017 2,000
1,500
1,000
500
-
Weeks
2,500 Malaria trends for Awerial County in 2017
2,000
1,500 3rd Quartile C-sum 2017
1,000
500
-
Weeks Malaria trends by county
2,500 Malaria trends for Cueibet County in 2017
3,000 Malaria trends for Jur River County in 2017 2,000
2,500 3rd Quartile C-sum 2017 1,500 3rd Quartile C-sum 2017 2,000
1,000 1,500
500 1,000
500 -
- Weeks Weeks
500 Malaria trends for Duk County in 2017 450 600 Malaria trends for Kapoeta East County in 2017
400 500 350 3rd Quartile C-sum 2017 3rd Quartile C-sum 2017 300 400 250
200 300
150 200 100
50 100
- -
Weeks Weeks
5,000 Malaria trends for Gogrial East County in 2017 800 Malaria trends for Kapoeta North County in 2017 4,500 700 4,000
3,500 600 3rd Quartile C-sum 2017 3rd Quartile C-sum 2017 3,000 500
2,500 400 2,000 300 1,500 200 1,000
500 100
- -
Weeks Weeks
1,200 Malaria trends for Ikotos County in 2017 1,600 Malaria trends for Kapoeta South County in 2017
1,400 1,000 3rd Quartile C-sum 2017 1,200 3rd Quartile C-sum 2017
800 1,000
600 800
600 400 400
200 200
- -
Weeks Weeks Malaria trends by county
1,400 Malaria trends for Rubkona County in 2017 4,500 Malaria trends for Tonj North County in 2017
4,000 1,200
3rd Quartile C-sum 2017 3,500 3rd Quartile C-sum 2017 1,000 3,000
800 2,500
600 2,000
1,500 400 1,000 200 500
- -
Weeks Weeks
9,000 Malaria trends for Rumbek East County in 2017 3,000 Malaria trends for Tonj South County in 2017 8,000
2,500 7,000 3rd Quartile C-sum 2017 3rd Quartile C-sum 2017 6,000 2,000 5,000
1,500 4,000
3,000 1,000 2,000
1,000 500
- -
Weeks Weeks
1,200 Malaria trends for Rumbek North County in 2017 600 Malaria trends for Twic East County in 2017
1,000 500 3rd Quartile C-sum 2017 3rd Quartile C-sum 2017 800 400
600 300
400 200
200 100
- -
Weeks Weeks
1,800 Malaria trends for Terekeka County in 2017 1,200 Malaria trends for Wulu County in 2017 1,600
1,400 3rd Quartile C-sum 2017 1,000
1,200 3rd Quartile C-sum 2017 800 1,000
800 600
600 400 400
200 200
-
- Weeks Weeks Malaria trends by county
2,500 Malaria trends for Yirol East County in 2017
2,000 3rd Quartile C-sum 2017
1,500
1,000
500
-
Weeks
7,000 Malaria trends for Yirol West County in 2017
6,000
3rd Quartile C-sum 2017 5,000
4,000
3,000
2,000
1,000
-
Weeks
Malaria trends in select IDP sites
Figure 10a | Malaria trend for IDPs in Bentiu PoC 2017 70 Figure 10b | Malaria trend for IDPs in Malakal PoC, 2017
60 80
70 50 60 40 50
30 40
30 20 20 Proportionate morbidity %
10 Proportionate morbidity % 10
- - 1 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 49 51 53 Week of reporting Epi Week Third quartile Prop mob 2017 Third quartile Prop mob 2017
Figure 10c | EWARN trends for Malaria in UN House, 2017 50 Figure 10d| EWARN trends for Malaria in Renk, 2017 50 45 45 40
40 35
35 30 30 25 25 20 20
Proportionate mrobidity % 15 15 Proportionate morbidity % 10 10 5 5
- - 1 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 49 51
Epi week Third quartile Prop mob 2017 Third quartile Prop mob 2017
Malaria trends in four of the large IDP sites - Bentiu Poc; UN House Poc; Malakal PoC; and Renk are below the third quartile
patients. Currently one team is in Kapoeta South and Kapoeta East the next teams will travel to Malakal and Fangak