South Sudan Integrated Disease Surveillance and Response (IDSR) Epidemiological Update W12 2018 (Mar 19- Mar 25) Major Epidemiological Developments W12 2018 • Completeness for IDSR reporting at county level was 74% . Completeness for EWARS reporting from IDP sites was 86% . ________________________________________________________________________ • A total of 16 alerts were reported, of which 75% have been verified. 0 alerts were risk assessed and 0 required a response. ________________________________________________________________________ • Rift Valley Fever outbreak - Yirol East with 43 suspect human cases including 6 confirmed; 3 probable; 19 non-cases; and 15 pending classification. Nine confirmed animal cases (cattle). _________________________________________________________________________ • A new outbreak of Rubella confirmed in Juba county after 16 Rubella IgM positive cases were confirmed in March 2018. ________________________________________________________________________ • In Torit, suspect meningitis continued to decline with no new cases in week 13 and the weekly attack rate remaining below the alert threshold in weeks 11 , 12, & 13. At least 173 suspect cases (31 deaths) reported. PCR sample testing revealed no definitive etiological pathogen. _____________________________________________________________________________ 2 Surveillance| IDSR surveillance indicators • Completeness for IDSR reporting at county level was 74% in week 12 and cumulatively at 76% for 2018 • Timeliness for IDSR reporting at county level was 74% in week 12 and cumulatively at 74% for 2018 3 Surveillance| Trend in IDSR completeness The graph shows completeness for weekly reporting at county level. The national average currently stands at 76%. 4 Surveillance| Maps of IDSR completeness by county • Counties that submitted IDSR reports in W12 are shown in green in map 1a • Counties that did not submit IDSR reports in W12 are shown in grey5 in map 1a Surveillance| EWARS surveillance indicators Timeliness and completeness for EWARN/IDP reporting stands at 86% for week 12 while cumulatively, completeness and timeliness are 78% and 74% respectively for 2018 6 Alert| Alert performance indicators A total of 16 alerts were reported in week 12 [majority from Bentiu hub]. 75% of the alerts in week 12 were verified; 0% were risk assessed and 0% required a response. 7 Alert| Event risk assessment • During the week, measles and Malaria were the most frequent infectious hazards reported. 8 Alert by disease and county in W12 2018 Acute Watery • During weeK 12, a County Diarrhoea Bloody Diarrhoea EBS Measles Malaria Total Alerts total of 16 alerts Aweil East 1 1 were reported. Ezo 1 1 Juba 1 1 2 Lainya 1 1 • Measles and Leer 1 1 2 malaria were the Malakal 1 1 Mayendit 1 1 most frequently Mayom 1 1 reported Rubkona 1 1 conditions of the Rumbek East 1 1 Tonj North 1 1 weeK. UNKEA Mandeng PHCC 1 1 Maringindo PHCU 1 1 Nagero PHCC 1 1 Total Alerts 2 2 1 6 5 16 Alerts by haZard in week 11 and week 12, 2018 30 25 11 12 20 15 26 10 16 Number of cases 5 6 2 6 2 1 4 6 6 4 5 0 Acute Watery Bloody Diarrhoea EBS Guinea Worm Measles Malaria Total alerts Diarrhoea 9 Cumulative alerts by disease for 2018 Number of Alerts by disease, South Sudan, week 1-12, 2018 n=217 alerts 60 50 40 30 54 51 46 20 Number of alerts 28 10 3 3 8 10 10 0 EBS AFP Malaria Cholera Measles Diarrhoea Acute Watery Guinea Worm Bloody Diarrhoea Neonatal Tetanus • The Figure shows the cumulative number of alerts triggered in 2018 by haZard and location. 10 Cumulative alerts for the top 20 counties for 2018 Cumulative alerts by county, week 1-12, 2018 Melut 1 IMC UNMISS PoC Clinic 1 IOM Cathedral IDP Camp … 1 Kuach PHCU 1 Aburoc PHCU 1 Twic 1 Uror 1 Ulang 1 Tonj South 1 Tonj East 1 Rumbek North 1 Renk 1 Mayom 1 Mayendit 1 Maridi 1 Manyo 1 Lopa Lafon 1 Ikotos 1 Gogrial West 1 Fashoda 1 Nagero 2 Wau 2 Mundri East 2 Leer 2 Kapoeta North 2 Ibba 2 Cueibet 2 Twic East 3 Terekeka 3 Rubkona 3 Malakal 3 Lainya 3 Bor 3 Ayod 3 Aweil West 3 Aweil East 3 Aweil South 4 Mundri West 4 Koch 4 Guit 4 Duk 4 Aweil North 4 Yirol West 5 Yambio 5 Ezo 5 Abyei 5 Tonj North 6 Tambura 6 Torit 10 Juba 14 0 1 2 3 4 5 6 Number of alerts7 8 9 10 11 12 13 14 15 • The Figures show the cumulative alerts triggered in 2018 by location • Most alerts have been reported from Juba and Torit. 11 Cumulative alerts by risk assessment stage in 2018 County OUTCOME RISK_ASSESS VERIFICATION Total Alerts Acute Watery Diarrhoea 46 46 AFP 1 7 8 Bloody Diarrhoea 54 54 EBS 2 8 10 Guinea Worm 2 8 10 Neonatal Tetanus 2 1 3 Viral Haemorrhagic Fever 2 2 Yellow Fever 2 2 Measles 4 6 41 51 Cholera 3 3 Malaria 28 28 Total Alerts 8 9 200 217 • The Figures show the cumulative alerts by risk assessment state in 2018 • Of the 217 alerts reported in 2018; a total of 200 alerts are at verification stage; and the rest are at risk assessment stage (9 alerts); 8 at outcome stage. 12 Confirmed Outbreaks South Sudan – 2 April 2018 � Aweil East � Aweil Center � Jur River � Cueibet ®Yirol East Measles � � Rubella � Juba Rift Valley Fever ® 13 Suspect Outbreaks South Sudan – 2 April 2018 _ Ⓜ� � Pariang Abyei Ⓜ � Aweil East � Rubkona Ⓜ ⓂTwic Mayom Aweil West Ⓜ Aweil South Mayendit Ⓜ � Ⓜ Duk Wau Jur River Ⓜ Ⓜ Ⓜ Cueibet � Pibor Yirol East �� Bor South Meningitis Ⓜ Measles � Rabies � Health effects of �S petroleum drilling Pertussis � Torit Foodborne disease � Ⓜ 14 Response| Summary of major ongoing outbreaks New cases Cumulative Interventions Location Date first Aetiologic agent since last cases to date Case Health (county) reported Vaccination WASH bulletin (attack rate %) management promotion New epidemics: New epidemics Rubella Juba 26/02/2018 22 22 (0.0037) Yes No Yes N/A Ongoing epidemics: Measles Aweil Center 6/Jan/2018 8 22 (0.021) Yes Yes Yes N/A RVF Yirol East 28/12/2017 1 40 (0.037) Yes N/A Yes N/A Measles Cueibet 14/10/2017 0 20 (0.012) Yes Yes Yes N/A Measles Aweil East 05/02/2018 10 31 (0.006) Yes No Yes N/A Rubella Jur River 14/02/2018 20 54 (0.028) Yes No Yes N/A Epidemics - Update • A new Rubella outbreak confirmed in Juba after 16 rubella IgM positive cases and 2 measles IgM positive cases were confirmed during March 2018. The current response entails case identification, line listing, supportive care for suspect cases; and community mobilization for enhanced routine immunization • Measles was confirmed in Aweil East after four samples tested measles IgM positive on 24 Feb 2018. A total of 21 measles cases have been line listed. IOM will support IRC the local implementing partner to conduct the reactive measles campaign. MSF to support cold chain. Target age group will include children 6months to 59 months. The campaign implemented during March 26, 2018 and 31 Mar 2018. • In Aweil Center; a reactive measles vaccination campaign targeting under fives has been completed. Campaign led by two – partners – MedAir and MSF-F. Preliminary data from the coverage survey indicates at least 85% of the target population was reached. 15 Response| Confirmed epidemics Ongoing epidemics - Epidemic description - RVF Eastern Lakes state RVF case distribution by age and sex, week 49, 2017 - Mar 2018 RVF cases by County and Payam, classification, Eastern Lakes wk 49, 2017 to wk 12, 2018 50-59 4.20 4.20 20 18 40-49 0.00 4.20 16 14 confirmed probable suspected 30-39 12.50 0.00 12 11 10 20-29 25.00 8.30 Age in years 8 6 3 10-19 12.50 16.70 Number cases/death 4 2 4 0-9 8.30 4.20 2 0 1 1 1 1 Mangar Pagarau Yali Khap Adior Aluakluak 30 25 20 15 10 5 0 5 10 15 20 Yirol east Yirol West Percentage % RFV case distribution by classification in Yirol East, wk 49, 2017 to week 12, 2018 5 Sno. Description Number 4 1Suspect cases 43 confirmed probable suspected 2Total deaths 4 3 3Confirmed cases 6 4Probable cases 3 Number of cases 2 5Cases pending testing 15 1 6Non-cases 19 7Cases on admission 0 0 47 48 49 50 51 52 1 2 3 4 5 6 7 8 9 10 11 12 8Total human samples collected 37 Epidemiological week of onset in 2017 and 2018 9Total animal samples collected 28 10Positive animal cases 9 • In the period 7 December 2017 to 2 April 2018, a total of 43 suspect RVF cases were reported in Eastern Lakes. • These were reclassified based on investigations and laboratory results, such that as of 2nd April 2018, there were a total of six (6) RVF confirmed cases, three (3) probable, and fifteen (15) suspect RVF cases (laboratory results are pending). • Nineteen (19) cases were discarded as non-cases following negative laboratory results for RVF and other common causes of viral haemorrhagic fever. • A total of nine animal samples have been confirmed serologically (3IgM and 6IgG). • Current response entails surveillance, laboratory testing, supportive care for suspect cases, and16 community sensitization on hygienic animal handling Response| Suspect epidemics Suspect meningitis Torit county Fig. 1|Suspect meningitis cases Iyire and Imurok payams, Fig. 3|Suspect case and CFR distriBution By age in Iyire and Imurok payam, Torit, week 1-12 2018 120 Torit, week 1-12, 2018 (n=173) 200 (n=173) 45 182 180 41 40 100 AR cases/100,000 CFR 160 CFR= 31/173 (17.92%) 35 140 80 30 120 110 Alive Died 25 60 100 20 CFR% 80 73 15 40 Cases per 100,000 15 No.