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Republic of South Sudan EARLY WARNING and DISEASE

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Republic of South Sudan EARLY WARNING and DISEASE Early Warning and Disease Surveillance System Republic of South Sudan EARLY WARNING AND DISEASE SURVEILLANCE BULLETIN (IDP CAMPS AND COMMUNITIES) Week 43 20 October – 26 October 2014 General Overview Completeness for weekly reporting increased from 66% to 82% while timeliness increased from 36% to 54% in week 43 when compared to week 42. Malaria remains the top cause of morbidity with Malakal, Tongping, UN House, Renk, and Melut reporting the highest incidence in week 43. Malakal PoC had the highest incidence for Malaria, ARI, AWD, and ABD during week 43; highlighting the need to enhance communicable disease prevention and control interventions in the PoC. Sixteen measles cases were reported from Melut (11 cases), Lankien (4 cases), and Mingkaman (1 case). One new probable HEV case was reported in Bentiu PoC in week 43. The cumulative for HEV is 113 cases and 4 deaths (CFR 3.7%) after one new case was reported from Mingkaman in week 43. Forty seven cholera cases and two deaths were reported from Lobonok in Juba, Central Equatoria State, as well as Lofus, Lorum and Imatong in Ikotos County; Ohilang and Ibele in Lopa-Lafon County; and Kapoeta South Town in Eastern Equatoria State in week 43. The cumulative stands at 6,297 cases with 160 deaths (CFR 2.26%). Kala-azar trend continues to surge to its seasonal peak with 5,713 cases and 163 deaths reported this year. The under-five and crude mortality rates in all IDP sites were below the emergency threshold in week 43. Completeness and Timeliness of Reporting Completeness for weekly reporting increased from 33 (66%) in week 42, to 41 (82%) in week 43. Timeliness for weekly reporting increased from 18 (36%) in week 42 to 27 (54%) in week 43. Figure 1 Number of sites (clinics) reporting per week (n=50) 42 45 41 41 38 38 37 40 36 35 33 34 34 34 33 34 32 31 35 29 29 29 28 27 28 30 26 26 26 26 24 24 23 21 21 25 20 19 17 17 17 18 18 20 Number of sites of Number 15 13 15 8 10 5 6 2 5 1 0 51 52 01 02 03 04 05 06 07 08 09 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 Epidemiologic Week 2013 2014 This Bulletin is produced by MOH, RSS with Technical support from WHO 1 Early Warning and Disease Surveillance System In week 43, we did not receive reports from 6 facilities (table1). Three outreach sites including Yalakot mobile (IMC), Panculim mobile (IMC), and Man-Awan (Goal) were not visited but zero reports were submitted. Health facilities are requested to kindly submit their IDP reports for the preceding week, by 17:00 hrs on Monday. Table 1: List of silent health facilities during week 43, 2014 No. IDP site Health Facility/Partner 1 Mingkaman 1. Kalthouk PHCU CCM 2. Mingkaman PHCC CCM 2 Bentiu PoC 1. PoC2 Clinic IRC 2. Rubkona PHCC CARE 3 Lul Lul MSF-E 4 Malakal PoC PoC Clinic MSF-E Consultations (All patients seen at Outpatient and Inpatient facilities) The total number of consultations increased from 13,552 in week 42 to 15,809 in week 43. During week 43, most of the consultations were reported from Malakal, Renk, Awerial, Melut, UN House, and Bentiu (Figure 2). Figure 2 Overall Trends of Priority Epidemic-prone Diseases Figures 3 and 4 show the proportionate and incidence morbidity trends for Acute Respiratory Infection (ARI), Malaria, Acute Watery Diarrhoea (AWD), suspected measles and Acute Bloody Diarrhoea (ABD) in the IDP sites and communities. Malaria, ARI and AWD were the top three causes of morbidity among IDPs in week 43 (Figure 3 and 4). During week 43, malaria had the highest proportionate morbidity and incidence when compared to the other top five causes of morbidity among IDPs (Figure 3 and 4). The overall incidence for malaria, ARI, ABD, AWD, and suspected measles increased in week 43 when compared to week 42 (Figure 4). This Bulletin is produced by MOH, RSS with Technical support from WHO 2 Early Warning and Disease Surveillance System Figure 3 The weekly number of cases for the current and preceding weeks, and cumulative number of cases for the top five causes of morbidity are presented in Table 2. Table 2 New cases for weeks Cumulative cases since No. Disease 42 43 week 51 of 2013 1 Malaria 2968 3510 120,216 2 AWD 786 1068 55,013 3 ARI 1357 2941 94,375 4 ABD 136 218 9,205 5 Measles 7 16 1,473 Figure 4 Incidence for Priority Diseases, week 1 - 43, 2014 140 120 100 80 60 40 Cases per 10,000per Cases 20 - 01 03 05 07 09 11 13 15 17 Epidemiological19 21 23 Week25 201427 29 31 33 35 37 39 41 43 ARI Bloody Diarrhea Malaria Suspected Measles Watery Diarrhoea This Bulletin is produced by MOH, RSS with Technical support from WHO 3 Early Warning and Disease Surveillance System Specific Priority Epidemic-Prone Diseases Acute Respiratory Infection ARI remains a leading cause of morbidity among IDPs and has registered an increasing trend since the beginning of the year (Figures 3 and 5). ARI registered the second highest proportionate morbidity of 18.6% and incidence (52 cases per 10,000 population) in week 43 (Figure 5). Figure 5 During week 43, a total of 2941 cases of ARI were reported with the highest ARI incidence (cases per 10,000) being reported in Malakal (984), UN House (270), Bor (46), Bentiu (46), and Akoka (44). Acute Watery Diarrhoea As seen from Figure 6, the AWD proportionate morbidity increased from 5.9% to 6.8% and the overall AWD incidence (cases per 10,000) increased from 14 to 19 in week 43 when compared to week 42 (Figure 4). Overall, the AWD trend has been on the decline since the beginning of the year. Figure 6 This Bulletin is produced by MOH, RSS with Technical support from WHO 4 Early Warning and Disease Surveillance System During week 43, a total of 1068 AWD cases were reported with the highest AWD incidence (cases per 10,000) being reported in Malakal (120), Melut (78), UN House (52), Renk (44) and Akoka (37) as illustrated in Figure 7). Figure 7 AWD Incidence, by IDP site, for week 1 - 43, 2014 700 600 500 400 300 200 Cases Cases per 10,000 100 - 01 03 05 07 09 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 Epidemiological week 2014 Bentiu Renk Akoka Malakal UN House Tongping Melut Figure 7.1 shows the AWD trends by age-group. The incidence (cases per 10,000) of AWD is higher in children under five years of age. The high AWD incidence during weeks 17-25 corresponds to the peak of the cholera outbreak in South Sudan. These trends indicate that the background risk for acute watery diarrhoea is high especially in children under-five. Figure 7.1 AWD incidence by age group, for week 1 to 43, 2014 200 100% 180 90% 160 80% 140 70% s 120 60% e n e 0 t 0 e l 0 , 100 50% p 0 1 m o r e 80 40% C p s e s 60 30% a c 40 20% 20 10% 0 0% 01 03 05 07 09 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 Epidemiological week 2014 Completenes ≥5 yrs <5 yrs Dysentery / Acute Bloody Diarrhoea Figure 8 shows Acute Bloody Diarrhoea (ABD) trends during week 1-43 of 2014. The overall ABD trend has been on the decline since the beginning of the crisis with successively shorter peaks in weeks 2, 21, and 37. The incidence (cases per 10,000) of ABD increased from 2 to 4 while the proportionate morbidity (%) increased from 1.0 to 1.4 in week 43 when compared to week 42. Figure 9 shows ABD incidence trends by IDP site from week 1 to week 43 in 2014. During week 43, the highest ABD incidence was reported in Malakal PoC as compared to other IDP sites. During week 43, 218 ABD cases were reported with the highest ABD incidence (cases per 10,000) being reported in Malakal (21), Renk (19), Melut (14), Akoka (Rom) (12), and Ogod (9). This Bulletin is produced by MOH, RSS with Technical support from WHO 5 Early Warning and Disease Surveillance System Figure 8 These ABD trends highlight the need to improve access to safe drinking water and sanitation facilities in all IDP camps. Stool samples should be obtained from suspected cases to facilitate laboratory testing. Laboratory confirmation will allow better clinical case management and the initiation of tailored public health interventions. Figure 9 ABD Incidence, by IDP site, for week 1 - 43, 2014 200 180 160 140 120 Cases Cases per 10,000 100 80 60 40 20 - Epidemiological week 2014 01 03 05 07 09 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 Malakal Renk Akoka Bentiu Melut Ogod Measles The measles trend peaked at the beginning of the crisis with the highest peak occurring in week 3, followed by a decline with subsequent shorter peaks in week 5 and 13 (Figure 10). This trend is attributed to a series of reactive measles vaccination campaigns conducted to contain the outbreaks in UN House, Tongping IDP camp, Bor, Yuai, Lankien, Cueibet and in Thol Payam, Nyirol County in Jonglei State.
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