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This Bulletin is Produced by the Ministry of Health with Technical Support from WHO 1
WEEKLY DISEASE SURVEILLANCE BULLETIN - REPUBLIC OF SOUTH SUDAN
() Week 42 12 - 18 October 2015
General Overview
Completeness for weekly reporting in week 42 of 2015 was 60% in non-IDP sites and 88% for IPD sites.
In week 42 of 2015, malaria was the commonest cause of morbidity and accounted for 46% of the consultations in the non-IPD sites and 40% in the IDP sites.
In week 42 of 2015, 12 new suspect measles were reported from Wau county (1), Bentiu PoC (8) and UN House PoC (3).
Since 18 May 2015, a total of 1,818 including 47 deaths [CFR 2.58%] reported from Juba, Kajo Keji, and Bor Counties. The last laboratory culture confirmed case was on 5 October 2015 from Juba County.
In week 42 of 2015, Juba County reported one suspect Acute Jaundice Syndrome case for while Bentiu PoC and Mingkaman reported 47 and one case of Hepatitis E Virus respectively.
In week 41 of 2015, a total of 311 children under five years with severe acute malnutrition were admitted to the Outpatient Therapeutic Program while 38 admitted to the Inpatient Therapeutic Program in Bentiu PoC.
In week 42 of 2015, the under-5 mortality rate for Bentiu PoC was 0.655 deaths per 10,000 per day, which is below
the U5MR emergency threshold of 2 deaths per 10,000 per day.
Editorial Note This bulletin presents disease trends from the Integrated Disease Surveillance and Response (IDSR) System and the Early Warning Alert and Disease Network (EWARN). The respective data is submitted by public health facilities serving host communities (non IDP sites) and health partner-supported facilities serving internally displaced persons (IDP sites) in South Sudan.
Timeliness and Completeness of Reporting for week 42 of 2015 Timeliness and completeness for reporting for non-IDP sites
Timeliness for weekly reporting was 37% and Completeness 60% as shown is table 1. The completeness-reporting rate was above the target of 80% in Warrap, Western Equatoria, and Northern Bahr el
Ghazal states. (Figure 1). This week 599 (62%) PHCUs, 194 (58%) PHCCs and 23 (43%) hospitals submitted their IDSR reports. (Table 2).
Timeliness and completeness for reporting for IDP sites Timeliness for weekly reporting was 59% and completeness 88%. This week, 12 facilities did not submit their
EWARN reports (Table 2 and Figure 2).
Table 1: Timeliness and completeness for weekly reporting, South Sudan, as of week 42 of 2015 Surveillance System No. of Health
Facilities expected to
report in week 42 of 2015
Timelines Completeness Cumulative for 2015
In week 42 of 2015 Timeliness Completeness
IDSR/ non IDP sites 1357 503 (37%) 816 (60%) 570 (42%) 779 (57%)
EWARN/ IDP sites 65 38 (59%) 57 (88%) 26 (50%) 43 (86%)
This Bulletin is Produced by the Ministry of Health with Technical Support from WHO
2
Figure 1
Figure 2
Table 2: Counties and health facilities that did not submit their reports in week 42 of 2015 No. IDSR/ non IDP sites EWARN/ IDP sites
Silent Counties in week 42 of 2-15 Silent Health Facilities in week 42 of 2015
1 Kajo Keji Bentiu PoC, Sector 2 clinic (IRC)
2 Rumbek East Nyal MSF Project (MSF-OCA)
3 Leer Mobile clinic (MedAir)*
4 Mayendit mobile clinic (MedAir)*
5 Yuai (MSF-OCA)
6 Malakal IDP mobile clinic (IMA)
7 Jikmir PHCC (UNKEA)
8 Melut (MSF-E)
*No reports submitted due to security reasons
Consultations (All patients seen at Outpatient and Inpatient facilities)
Table 3: Consultations by surveillance system in South Sudan as of week 42 of 2015 Surveillance System
Consultations in week 42 of 2015 Cumulative consultations week 1-week 42 of 2015
<5 years ≥5 years Total <5 years ≥5 years Total
IDSR 46,012 73,416 119,428 1,730,041 2,782,893 4,512,934
EWARN 35,927 877,237
Total 155,355 5,390,171
Figure 3
55%71%
20%
63%
91%
2%35%
73%89% 89%
38%6% 15%
63%51%
0% 20%
63% 56%67%
0%
20%
40%
60%
80%
100%
CES EES Jonglei Lakes NBeG Unity UNS WBeG WES WarrapHea
lth
Fac
ilit
ies
Rep
ort
ing
[%
]
IDSR weekly reporting performance by state in week 42 of 2015
Completeness Timeleness Target
0
20
40
60
80
100
120
01 03 05 07 09 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51
Co
mp
lete
ne
ss [
%]
EWARN weekly reporting Completeness by health facilities, 2014 - 2015
2014 2015 Target
494
7144104
1782 775
3310
1952
1916
2747 881
359 558
212
4634
936
792
2067967
203
1456
33
428 191 284
163
358
231
206
373 498
435
0%
20%
40%
60%
80%
100%
Aw
eria
l
Ben
tiu
Bo
r
Lan
kie
n
Mal
akal
Mel
ut
UN
HO
USE
Ren
k
Ko
do
k
Lu
l
Ogo
d
Ak
ob
o
Wau
Sh
illu
k
Tw
ic E
ast
DU
K
Man
yo
Pan
yij
iar
Ben
tiu
Sta
teH
osp
ital
Ru
bk
on
a
Nu
mb
er o
f co
nsu
ltat
ion
s
Consultations by IDP Camp and Partner, week 42 2015
CCM IMC IOM IRC MSF-E (blank) MSF-OCA Medair HealthLink GOAL IMA SMC World Relief UNIDO
This Bulletin is Produced by the Ministry of Health with Technical Support from WHO 3
In week 42 of 2015, a total of 155,355 consultations were registered of which 119,428 from the non IDP sites and 35,927 from the IDP sites as summarized in Table 3 and Figure 3.
The annualised outpatients department (OPD) utilization among IDPs in 2015 is 1.3 consultations per person per year (Figure 4). The IDP site-specific annualised OPD utilization rates are shown in Figure 4.
Figure 4
Overall Trends of Priority Epidemic-prone Diseases
In week 42 of 2015, malaria was the top cause of morbidity among general population and IDPs with a proportionate morbidity of 46% and 40% respectively. Malaria is followed by Acute Watery Diarrhoea (AWD) and Acute Respiratory tract Infections (ARI) in IDSR and EWARN respectively (Table 4, Figure 5).
The other causes of morbidity in week 42 of 2015 are shown in table 4 and Figures 5, 6 and 7.
Table 4: Top causes of morbidity in week 42 of 2015 as compared to week 42 of 2014 Surveillance System Disease
New cases for weeks Cumulative cases since week01 of 2015 42 of 2014 42 of 2015
IDSR
Malaria 46,374 55,393 1,778,128
AWD 6,414 7,690 419,441
Meningitis 1 0 51
ABD 1,074 1,192 86,633
Measles 10 1 671
Acute Jaundice Syndrome 1 1 618
EWARN
Malaria 3,042 14,364 232,839
AWD 796 2,390 75,486
ARI 1,408 7,858 168,111
ABD 136 241 9,441
Measles 7 11 559
Acute Jaundice Syndrome 0 48 1,706
Meningitis 0 0 19
Figure 5
1.5 2.8
5.7
1.9 3.1
0.9
3.4
0.3 2.8
6.4
1.5 1.1
8.9
2.0 0.7
5.4
0.6 0.4 0.6 0.0 0.4 0.2 0.1 0.1 0.2 0.0 0.8 0.1 0.1 1.3 -
1.0
2.0
3.0
4.0
5.0
6.0
Aw
eria
l
Ben
tiu
Bo
r
Lan
kie
n
Mal
akal
Man
-Aw
an
Mel
ut
Nas
ir
UN
HO
USE
Yu
ai
Man-…
Ak
ok
a
Ren
k
Ko
do
k
Lu
l
Ogo
d
Ak
ob
o
Wau…
Tw
ic E
ast
Nyi
rol
DU
K
Ayo
d
Man
yo
Pan
yij
iar
May
om
Lee
r
May
end
it
Bentiu…
Ru
bk
on
a
Ove
rall
con
sult
atin
s p
er p
erso
n p
er y
ear
Consultations per person per year by IDP camp, week 42, 2015
AWD, 6%
ABD, 1%
Malaria, 46%
Measles, 0%
Others , 46%
IDSR Proportionate Morbidity in week 42 of 2015
AWD
ABD
Malaria
Measles
OthersARI, 21.9%
ABD, 0.67%Malaria, 40.0%
Measles, 0.03%
AWD, 6.7%
EWARN Proportionate Morbidity in week 42 of 2015
ARI
ABD
Malaria
Measles
AWD
This Bulletin is Produced by the Ministry of Health with Technical Support from WHO
4
Figure 6
Figure 7
Specific Priority Epidemic-Prone Diseases
Acute Respiratory Infection (ARI)
The ARI is part of the prioriy disease trends monitored among IDPs under the EWARN. During week 42 of 2015, ARI registered the second highest proportionate morbidity of 21.9% (Figure 8) which is
higher when compared to 10.4% in week 42 of 2014 and 19.8% in week 41 of 2015 (Figure 5). Malakal PoC registered the highest ARI incidence (cases per 10,000) of 630 followed by Bor PoC (226), UN House
PoC (210), and Bentiu PoC (183). During week 42 of 2014, the ARI incidence (cases per 10,000) was 231 in UN House and 164 in Man Awan. (Figure 5.1).
Figure 8
Figure 9
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
80.0
90.0
0.0
100.0
200.0
300.0
400.0
500.0
600.0
700.0
800.0
1 Wk 03 Wk 05 Wk 07 Wk 09 Wk 11 Wk 13 Wk 15 Wk 17 Wk 19 Wk 21 Wk 23 Wk 25 Wk 27 Wk 29 Wk 31 Wk 33 Wk 35 Wk 37 Wk 39 Wk 41
Co
mp
lete
nes
s (%
)
case
s p
er 1
00
,00
0 p
op
ula
tio
n
Epidemiological Week of reporting in 2015
IDSR Priority Disease Morbidity trends from week 1 to 42 of 2015
Completeness ABD Malaria Measles AWD
0%
20%
40%
60%
80%
100%
0%
10%
20%
30%
40%
50%
60%
51 01 03 05 07 09 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
2013 2014 2015
Co
mp
lete
nes
s
Per
cen
t o
f all
co
nsu
ltat
ion
s
Epidemiologic Week
EWARN Priority Disease Proportionate Morbidity from week 51 of 2013 to week 42 of 2015
Completeness ARI Bloody Diarrhea Malaria Suspected Measles Watery Diarrhoea
10.4
21.9
0.0
5.0
10.0
15.0
20.0
25.0
30.0
01 03 05 07 09 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51
Per
cen
t o
f to
tal c
on
sult
atio
ns
Epidemiologic Week
ARI Proportionate Morbidity trends among the IDPs, week 51 of 2013 to week 42 of 2015
2013 2014 2015
20 56 0 0 162 22231
0 0 0 0 78 0 13 22 38 0 164 0 0 0 0 0 0 0 0 0123 183 22694
630
210 93 37 4
-
200
400
600
800
Ca
ses
pe
r 1
0,0
00
ARI Incidence by IDP Site in week 42 of 2014 and 2015
wk 42 of 2014 wk 42 of 2015
This Bulletin is Produced by the Ministry of Health with Technical Support from WHO 5
Acute Watery Diarrhoea (AWD)
In week 42 of 2015, AWD was the second commonest cause of morbidity with 7,690 cases, a proportionate morbidity of 6% and incidence (cases per 100,000) of 67 reported from non IDP sites. Western Bahr el Ghazal, Warrap, and Upper Nile were the most affected states (Figure 5, Table 5).
The overall AWD trend is stable with the current incidence being higher as compared to corresponding period in 2014 and lower in 2013 (Figure 10).
Among the IDPs, AWD was the third commonest cause of morbidity with a proportionate morbidity of 6.7% in week 42 of 2015 as compared to 5.9% in week 42 of 2014.
The AWD trend in IDPs is stable with the current incidence being comparable to 2014 (Figure 11). The AWD incidence was highest in Bor PoC, Renk, Malakal PoC, and Bentiu PoC (Figure 12).
Table 5
Figure 10
Figure 11
Figure 12
Dysentery / Acute Bloody Diarrhoea (ABD)
In week 42 of 2015, ABD was the third commonest cause of morbidity with Table 6
State C D IR CFR
WES 613 0 79.47 0.00
EES 881 0 79.82 0.00
CES 430 0 28.11 0.00
JNG 393 0 25.9 0.00
WRP 1720 2 125.4 0.12
LKS 819 0 82.54 0.00
NBGZ 821 0 65.23 0.00
WBGZ 918 0 182.8 0.00
UNS 1079 0 81.93 0.00
UNITY 16 0 1.488 0.00
TOTAL 7690 2 67.23 0.03
AWD
0
20
40
60
80
100
120
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
case
s p
er 1
00
,00
0 P
op
ula
tio
n
Epidemiological Week of reporting
Trends of Acute Watery Diarrhoea among general population by week, 2013 - 2015
2013
2014
2015
0.0
10.0
20.0
30.0
40.0
01 03 05 07 09 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51Per
cen
t o
f to
tal c
on
sult
atio
ns
Epidemiologic Week
Trends of AWD Proportionate Morbidity among the IDPsweek 51 of 2013 to week 42 of 2015
2013 2014 2015
12 20 8 851
17
62
447 49
78
3457
118
11
89
34 39 0
95
14 25 6 25 25
-
50
100
150AWD Incidence by IDP Site in week 42 of 2015 as compared to week 42 of 2014
wk 42 of 2014 wk 42 of 2015
This Bulletin is Produced by the Ministry of Health with Technical Support from WHO
6
1,192 cases, a proportionate morbidity of 1% and incidence (cases per 100,000) of 10 reported from the non-IDP sites. (Figure 5 and Table 6).
The current ABD trend is stable with the incidence being comparable to 2014 but lower than the incidence in 2013 (Figure 13).
Among the IDPs, ABD was the 4th commonest cause of morbidity and registered a proportionate morbidity of 0.67% in week 42 of 2015 as compared to 1% in week 42 of 2014.
The ABD trend in IDPs is stable with an incidence lower when compared to 2014 (Figure 14). The ABD incidence among IDPs is highest in Bor PoC, Renk, Melut, and Panyijiar (Figure 15).
Figure 13
Figure 14
Figure 15
Measles
In week 42 of 2015, measles was the 4th commonest cause of morbidity with one suspect measles case reported from Wau County in Western Bahr el Ghazal (Figure 5 and Table 5). This represents a proportionate morbidity of 0.002% and incidence (cases per 100,000) of 0.10 (Figure 5 and Table 7).
Since the beginning of 2015, 460 suspect measles cases investigated countrywide, of which 40 (9%) laboratory confirmed measles (IgM+). The current annualised measles incidence is 35.4 per 1,000,000 population.
Since the beginning of 2015, a total of 41 Rubella cases have been confirmed.
Table 7
State C D IR CFR
WES 133 0 17.2 0.00
EES 200 0 18.1 0.00
CES 150 0 9.8 0.00
JNG 70 0 4.61 0.00
WRP 218 0 15.9 0.00
LKS 110 0 11.1 0.00
NBGZ 97 0 7.71 0.00
WBGZ 68 0 13.5 0.00
UNS 143 0 10.9 0.00
UNITY 3 0 0.28 0.00
TOTAL 1192 0 10.4 0.00
ABD
0.0
5.0
10.0
15.0
20.0
25.0
30.0
35.0
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
case
s p
er 1
00
,00
0 P
op
ula
tio
n
Epidemiological Week of reporting
Trends of ABD among the general population by week, 2013 - 2015 2013
2014
2015
3.2
0.0
2.0
4.0
6.0
8.0
01 03 05 07 09 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51Per
cen
t o
f to
tal c
on
sult
atio
ns
Epidemiologic Week
Trends of ADB Proportionate Morbidity among IDPs, week 51 of 2013 to week 42 of 2015
2013 2014 2015
2 4 07
4 5
18
122
02
15
5
1215
1 1 8 7
-
5
10
15
20
Cas
es p
er 1
0,0
00
ABD Incidence by IDP Site, week 42 of 2015 as compared to week42 of 2014
wk 42 of 2014 wk 42 of 2015
State C D IR CFR
WES 0 0 0.00 0.00
EES 0 0 0.00 0.00
CES 0 0 0.00 0.00
JNG 0 0 0.00 0.00
WRP 0 0 0.00 0.00
LKS 0 0 0.00 0.00
NBGZ 0 0 0.00 0.00
WBGZ 1 0 0.20 0.00
UNS 0 0 0.00 0.00
UNITY 0 0 0.00 0.00
TOTAL 1 0 0.01 0.00
Measles
This Bulletin is Produced by the Ministry of Health with Technical Support from WHO 7
Among the IDPs, measles was the 5th commonest cause of morbidity with a proportionate morbidity of 0.03% as compared to (0.052%) in week 42 of 2014.
In week 42 of 2015, 11 measles cases were reported from UN House PoC (3) and Bentiu PoC (8). Figures 5, 17, 18. Since the beginning of 2015, a total of 478 measles cases including 14 deaths (CFR 2.87%) have been registered in
Bentiu PoC (Figure 17). Surveillance and routine vaccination activities are being enhanced in the PoCs.
The suspect measles trend among IDPs is stable but the incidence is lower when compared to 2014 (Figure 16).
Figure 16
Figure 17
Figure 18
Malaria
In week 42 of 2015, malaria was the commonest cause of morbidity with 55,393 cases, a proportionate morbidity of 46% and incidence (cases per 100,000) of 484 reported from non IDP sites. The most afftected states included Warrap, Western Bahr el Ghazal, Northern Bahr el Ghazal, and Lakes. Figure 5 and Table 8.
The malaria trend has been rising since week 19 of 2015 with the incidence being higher when compared to the corresponding period in 2013 and 2014 (Figure 19). The malaria trend in Warrap, Northern Bahr el Ghazal, and Western Bahr el Ghazal is consistent with a malaria epidemic (Figure 20).
Among the IDPs, malaria was the commonest cause of morbidity with a proportionate morbidity of 40% in week 42 of 2015 as compared to 22% in week 42 of 2014. The malaria trend in IDPs has been rising since week 19 of 2015.
This week Malakal PoC registered the highest malaria incidence (cases per 10,000) of 615, followed by Bentiu PoC (605), Bor (306), and UN House. Figures 5, 21,23
0.0
0.5
1.0
1.5
2.0
2.5
01 03 05 07 09 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51Per
cen
t o
f to
tal c
on
sult
atio
ns
Epidemiologic Week
Trends of Suspected Measles Proportionate Morbidity, week 51 of 2013 to week 42 of 2015
2013
2014
2015
0
10
20
30
40
50
1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41
Nu
mb
er o
f m
easl
es c
ases
Week of rash onset in 2014
Measles epidemic curve in Bentiu PoC, week 1 of 2015- week 42 of 2015 alive
died
0
2
4
6
8
10
36 37 38 39 40 41 42
Nu
mb
er o
f cas
es
Epidemiological week of rash onset in 2015
Measles cases in UN House PoC, weeks 38 to 42 of 2015
PoC 3
PoC 1
This Bulletin is Produced by the Ministry of Health with Technical Support from WHO
8
The proportionate morbidity for malaria was 58% in Bentiu PoC and 40% Malakal PoC (Figure 22). Malaria trend in Bentiu and Malakal PoCs is consistent with a malaria epidemic (Figure 24).
The malaria incidence in Renk has been rising and exceeded the epidemic threshold but remains below the 2014 levels (Figure 24).
The national malaria taskforce was set up to coordinate the overall preparedness and response activities. The malaria epidemic preparedness and response plan was updated to guide response activities.
The main thrust of the response in affected areas entails prompt access to diagnostic and treatment at health facilities and community home based care management and referral. The vector control, distribution of LLITNs and Behavioural Change communication should be implemented simultaneously.
Currently, adequate stocks of antimalarial drugs are available at the national level. However, there is no mechanism to establish stock levels at facility level.
Figure 19 Table 8
Figure 20
0.0
100.0
200.0
300.0
400.0
500.0
600.0
2 4 6 8 10 12 14 16 18 20 22 24 26 28 30 32 34 36 38 40 42 44 46 48 50 52
case
s p
er 1
00
,00
0 P
op
ula
tio
n
Epidemiological Week of reporting
Malaria Incidence Trends by week, Non-crisis affected States, 2013 - 2015
2013
2014
2015
State C D IR CFR
WES 2870 0 372.1 0.00
EES 4361 1 395.1 0.02
CES 5750 1 375.8 0.02
JNG 1643 0 108.3 0.00
WRP 18334 2 1337 0.01
LKS 5274 1 531.5 0.02
NBGZ 8663 2 688.3 0.02
WBGZ 5107 0 1017 0.00
UNS 3375 0 256.3 0.00
UNITY 16 0 1.488 0.00
TOTAL 55393 7 484.3 0.01
Malaria
0
200
400
600
800
1000
1200
1400
1600
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
case
s p
er 1
00
,00
0
Epidemiological week 2015
Malaria Incidence for Warrap from week 1 to 41, 2015
2015 Third quartile
0
200
400
600
800
1000
1200
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
case
s p
er 1
00
,00
0
Epidemiological week 2015
Malaria Incidence for Northern Bhar el Ghazal, week 1 to 41, 2015
2015 Third quartile
0
200
400
600
800
1000
1200
1400
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
case
s p
er 1
00
,00
0
Epidemiological week 2015
Malaria Incidence for Western Bhar el Ghazal from week 1 to 41, 2015
2015 Third quartile
0
100
200
300
400
500
600
700
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
case
s p
er 1
00
,00
0
Epidemiological week 2015
Malaria Incidence for Central Equatoria from week 1 to 41, 2015
2015 Third quartile
This Bulletin is Produced by the Ministry of Health with Technical Support from WHO 9
Figure 21
Figure 22
Figure 23
0
200
400
600
800
1000
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
case
s p
er 1
00
,00
0
Epidemiological week 2015
Malaria Incidence for Eastern Equatoria from week 1 to 41, 2015
2015 Third quartile
0
100
200
300
400
500
600
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
case
s p
er 1
00
,00
0
Epidemiological week 2015
Malaria Indence for Lakes from week 1 to 41, 2015
2015 Third quartile
0
100
200
300
400
500
600
700
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
case
s p
er 1
00
,00
0
Epidemiological week 2015
Malaria Incidence for Western Equatoria, week 1 to 41, 2015
2015 Third quartile
47.8
40
0.0
10.0
20.0
30.0
40.0
50.0
60.0
01 03 05 07 09 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51Per
cen
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atio
ns
Epidemiologic Week
Trends of Malaria Proportionate Morbidity among the IDPs, week 51 of 2013 to week 43 of 2015
2013 2014 2015
2
9
58
-
10
20
30
40
50
60
70
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
Pro
po
rtio
nat
e m
orb
idit
y [%
]
Week of reporting
Trends of Malaria Proportionate Morbitity in Bentiu PoC, 2014-2015
Prop mob 2014 Prop mob 2015
18
40
-
10
20
30
40
50
60
70
80
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
Pro
po
rtio
nat
e m
orb
idit
y [%
]
Week of reporting
Trends of Malaria Proportionate Morbidity in Malakal PoC, 2014-2015
Prop mob 2014 Prop mob 2015
69 15 61 40233
60 196 13 0 0 33239
92
605
306
615
88 143 0 95 30 119 20 71 5 5
-
200
400
600
800
Ca
ses
pe
r 1
0,0
00
Malaria Incidence by IDP Site in week 42 of 2015 as compared to week 42 of 2014
wk 42 of 2014 wk 42 of 2015
This Bulletin is Produced by the Ministry of Health with Technical Support from WHO
10
Figure 24
Hepatitis E Virus (HEV)
In week 42 of 2915, one Acute Jaundice Syndrome (AJS) case was reported in Juba County and the case
investigation is underway.
Among the IDPs, Hepatitis E Virus (HEV) remains a major public health problem and was confirmed in three of the
eight IDP sites where AJS cases have been reported (Figures 25 and 26).
During week 42 of 2015, 13 new HEV cases were admitted in MSF hospital in Bentiu PoC giving a cumulative of 110
admitted cases including 14 deaths (CFR 12.7%).
Figure 25
In week 42 of 2015, Bentiu PoC reported 47 new HEV cases and Mingkaman one new HEV case. The cumulative for
HEV is 1,679 cases including 14 deaths (CFR 0.83%) in Bentiu; 155 cases including seven deaths (CFR 4.5%) in
1
595
-
100
200
300
400
500
600
700
800
900
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
case
s p
er 1
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00
Week of reporting
Malaria Incidence Trends in Bentiu PoC 2014 to 2015
incidence 2014 incidence 2015 Third quartile
-
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700
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
case
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er 1
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Malaria Incidence Trends in Malakal PoC 2014 to 2015
incidence 2014 incidence 2015 Third quartile
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250
300
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
case
s p
er 1
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Week of reporting
Malaria Incidence Trends in UN House PoC 2014 to 2015
incidence 2014 incidence 2015 Third quartile
-
100
200
300
400
500
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
case
s p
er 1
0,0
00
Week of reporting
Malaria Incidence Trends in Renk, 2014 to 2015
incidence 2014 incidence 2015 Third quartile
-
50
100
150
200
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
case
s p
er 1
0,0
00
Week of reporting
Malaria Incidence Trends Mingkaman, 2014 to 2015
incidence 2014 incidence 2015 Third quartile
30
50
100
150
200
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300
350
0
5
10
15
20
3 5 7 9 111315171921232527293133353739414345474951 1 3 5 7 9 11131517192123252729313335373941
2014 2015
No
ca
ses
in B
en
tiu
No
ca
ses
in t
he
r ID
P s
ite
s
Epidemiological week
Acute Jaundice Syndrome cases by IDP site from week 03, 2014 to week 42, 2015
Awerial Bor Malakal Tongping Lul Juba 3 Lankien Bentiu
This Bulletin is Produced by the Ministry of Health with Technical Support from WHO 11
Mingkaman; and 37 cases including one death (CFR 2.7%) in Lankien. In Bentiu, 14 deaths have been registered
giving an overall CFR of 0.83%.
Distribution of HEV cases line listed in Bentiu by age, sex and place is shown in table 9 and 10
Figure 26
Table 9: HEV cases by age and sex in Bentiu PoC
Age in years Female n (%)
Male n (%) (Unknown)
Total n (%)
<2 years 25 (3) 28 (3) 0 53 (3)
2-4 years 173 (24) 271 (30) 0 444 (27)
5-9 years 213 (29) 312 (35) 0 525 (32)
10-14 years 114 (16) 125 (14) 1 239 (15)
15-44 years 183 (25) 136 (15) 0 319 (20)
≥45 years 18 (2) 10 (1) 0 28 (2)
(Blank) 4(1) 11 (1) 3 15 (1)
Grand Total 730 (45) 893 (55) 4 1627 (100)
Table 10: HEV case distribution by PoC/sector in Bentiu PoC
Camp Positive
n (%) Negative
n (%) Unknown Grand Total
n (%)
Outside 7 (2.9) 4 (0.5) 11 22 (1.4)
PoC 1 14 (5.7) 20 (2.6) 5 39 (2.4)
PoC 2 14 (5.7) 18 (2.3) 12 44 (2.7)
PoC 3 18 (7.3) 37 (4.8) 30 85 (5.2)
PoC 4 34 (13.9) 42 (5.4) 1 77 (4.7)
PoC 5 23 (9.4) 21 (2.7) 0 44 (2.7)
PoC 6 6 (2.4) 29 (3.8) 13 48 (3.0)
Sector 1 4 (1.6) 50 (6.5) 63 117 (7.2)
Sector 2 4 (1.6) 24 (3.1) 11 39 (2.4)
Sector 3 30 (12.2) 149 (19.3) 125 304 (18.7)
Sector 4 34 (13.9) 162 (21.0) 169 365 (22.4)
Sector 5 48 (19.6) 190 (24.6) 167 405 (24.9)
(Blank) 9 (3.7) 27 (3.5) 2 38 (2.3)
Grand Total 245 (15.1) 773 (47.5) (609) 1627 (100)
Response to HEV is underway guided by the comprehensive HEV response strategy with priority interventions being supportive case management, targeted preventive interventions during antenatal visits, soap distribution, shock chlorination of boreholes, as well as house-to-house hygiene and sanitation promotion.
Nutrition in Bentiu PoC_source Nutrition Cluster in Bentiu
In weeks 41 and 42, a proxy GAM rate of 13.74% was recorded in Bentiu POC, based on MUAC screening of a total of 13,047 children under 5 years old (586 (4.49%) SAM; and 1,208 (9.25%) MAM).
Active screening for new arrivals into the PoC showed a proxy GAM rate of 28.46% which represents an increase when compared to previous weeks (57 (5.66%) SAM and 230 (22.8%) MAM out of 1,007 under 5 children screened) (source: World Relief)
Declining trend is observed in new admissions in outpatient therapeutic feeding programs, to treat children with Severe Acute Malnutrition [SAM] (311 total admissions), while number of admissions of SAM children with medical complications in the stabilization centre slightly increased compared to week 39 (Figures 27 and 28).
0
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350
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4
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8
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12
14
16
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
2014 2015
No
. cas
es in
Ben
tiu
No
, ca
ses
in o
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r si
tes
Epidemiological week
Hepatitis E Virus trends in Mingkaman, Bentiu, and Lankien from week 10, 2014 to week 42, 2015
Awerial Lankien Bentiu
This Bulletin is Produced by the Ministry of Health with Technical Support from WHO
12
Figure 27
Source: Nutrition cluster Bentiu Poc
Figure 28
Cholera
As of 18 October 2015, a total of 1,818 cholera cases including 47 deaths (CFR 2.58%) were reported from Central Equatoria state (Juba and Kajo Keji Counties) and Jonglei State (Bor County). The last laboratory culture confirmed cholera case was on 5 October 2015 from Juba County.
Acute Flaccid Paralysis (AFP)
Since the beginning of 2015, a cumulative of 253 AFP cases have been reported countrywide (Table 13). The annualized non-Polio AFP (NPAFP) rate (cases per 100,000 population children 0-14 years) is 3.90 per 100,000
population of children 0-14 years (target ≥2 per 100,000 children 0-14 years) (Table 13). Jonglei, Unity, and Upper Nile States have attained the targeted NPAFP rate of ≥2 per 100,000 children 0-14 years.
The non-Polio Enterovirus (NPEV) isolation rate (a measure of the quality of the specimen cold chain) is 15.7% (target ≥10%).
The cumulative for circulating Vaccine Derived Poliovirus type 2 (cVDPV2) cases stands at three cases with only one case reported in 2015.
Other Diseases of Public Health Importance
Guinea worm (Dracunculiasis)
There was no new suspect Guinea worm disease case reported during week 42 of 2015.
Viral Haemorrhagic Fever
No Ebola/Marburg cases have been confirmed in South Sudan but six alerts have been investigated in Ezo, Nzara, Terekeka (Tali) and Juba (Hai Jalaba and Gudele) since 2014.
The Republic of South Sudan continues to enhance its readiness capacities for Ebola/Marburg virus disease. The national Ebola/Marburg taskforce was set up to coordinate the implementation of Ebola preparedness and response interventions, and the national Ebola/Marburg contingency plan developed.
Visceral Leishmaniasis (Kala-azar)
20 14 21 2469 53 76
153116
76 96132145126
55
273278
94 10810610047 61 33
72 65 68 47 65 53 3492 68 83
214149
93 1048310411212811982 61 66 75
14111710680
186168197185
140156118
228278
480
615
511
358
466484436
507514500
355358336332
504522
678
545
365311
0
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800
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Epidemiological Week of admission
Severe Acute Malnutrition admissions in Bentiu PoC in 2014 and 2015
Admissions 2014
5 5 69
5
1711
7
1612 11 9 7 8
15 137 8
136
11 1215
1924 24
19
28
18
34
46
37
29 2734
4248 50
3237 38
0
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Epidemiological week of admission in 2015
Admissions to the stabilisation centre in Bentiu PoC for weeks 1-41 of 2015
This Bulletin is Produced by the Ministry of Health with Technical Support from WHO 13
In week 42 of 2015, four health facilities (Lankien, Melut IDP, Bentiu, and Batil) reported 14 cases (12 new and 2 secondary cases).
Since the beginning of 2015, a total of 2,888 cases (2,320 [80.3%] new cases; 568 [19.7%] relapses/PKDL; 107 [3.7% defaulters]; and 91 [3.2%] deaths) have been reported from 23 treatment centres.
In week 42 of 2014, a total of 5,893 cases (5,501 new cases; 392 relapses/PKDL; 213 defaulters and; 170 deaths (CFR 2.8%) were reported from 23 treatment centres.
Generally the number of cases reported in 2015 is lower when compared to 2014, which may be attributed to the low reporting completeness, withdrawal of some partners from health facilities due to insecurity, and the tail end of the transmission season.
WHO and partners continue to support enhanced surveillance, case management and interventions to interrupt transmission through the following: supporting implementing partners with case management supplies; training frontline healthcare workers on Kala-azar case management; support supervision of treatment facilities; supporting community sensitisation on Kala-azar; and distribution of LLITNs in affected and high-risk areas.
Meningitis
There was no new suspect meningitis case reported in week 42 of 2015.
Animal bites (suspect rabies)
There was no new suspect rabies case reported in week 42 of 2015.
All-Causes Mortality Data
In week 42 of 2015, a total of 84 deaths were reported from the non-IDP sites (Table 14). Of the 84 deaths, 22 (26%) occurred in children <5 years and 7 (8.3%) were attributed to malaria. The <5 and crude mortality rates were within expected levels for the 11 counties that submitted mortality data in week 42 of 2015 (Table 11).
Table 11: Mortality by cause, age, and County in week 42 of 2015 States Counties Population AWD
<5 yrs Malaria <5 yrs
Total deaths <5 yrs
Total deaths ≥5 yrs
Total deaths
U5MR per 10,000 per
day
CMR per 10,000 per
day
CES Juba 501659 0 1 1 0 1 0.014 0.003
EES Ikotos 129557 0 1 1 0 1 0.055 0.011
EES Magwi 204717 0 0 1 0 1 0.035 0.007
LAKES Yirol West 161556 0 1 1 0 1 0.044 0.009
WBGZ Jur River 201947 0 0 0 1 1 0.000 0.007
NBGZ Aweil North 147675 0 0 0 1 1 0.000 0.010
NBGZ Aweil West 190092 0 2 2 0 2 0.075 0.015
WRP Gogrial East 118119 0 0 1 0 1 0.060 0.012
WRP Tonj South 99030 2 2 2 1 3 0.144 0.043
Total Deaths 2058920 2 7 9 3 12 0.031 0.008
Among the IDPs, Bentiu PoC, Juba 3 PoC, Akobo, Mingkaman, and Malakal PoCs submitted mortality data in week 42 of 2015 (Table 13).
A total of 41 deaths were reported during week 42 of 2015 including 24 (59%) deaths from Bentiu PoC and 18 (44%) among children under five years. During the corresponding week of 2014, a comparatively lower number of deaths (19) were reported as seen in Tables 12 and 13.
This week malaria registered the highest proportionate mortality of 22% (25% in week 41 of 2015), followed by
pneumonia (22%), and TB/HIV/AIDS (7%) (Table 13).
Table 12: Number of deaths by IDP camp during week 42 of 2015 and 2015 Cause of Death by
IDP site
2014 2015
<5yrs ≥5yrs <5yrs ≥5yrs
Akobo - - - 1
Bentiu - 2 11 13
Juba 3 5 2 3 4
Malakal - 8 3 5
Melut - 1 - -
Mingkaman - - 1 -
Tongping - 1 - -
Grand Total 5 14 18 23
This Bulletin is Produced by the Ministry of Health with Technical Support from WHO
14
All the nine malaria deaths reported in week 42 of 2015 occurred in Bentiu PoC with 4 (44%) among children <5
years (Table 13).
Table 13: Proportionate mortality by cause of death and IDP site, week 42 of 2015 and 2015
Cause of Death by IDP site
Akobo Bentiu Juba 3 Malakal Mingkaman Grand Total
Proportionate mortality % ≥5yrs <5yrs ≥5yrs <5yrs ≥5yrs <5yrs ≥5yrs <5yrs
Acute watery diarrhoea - - 3 - - - - - 3 7
Chronic cough - - 1 - - - - - 1 2
Chronic diarrhoea - - 1 - - - - - 1 2
Liver Disease - -
- 1 - - - 1 2
Malaria - 4 5 - - - - - 9 22
Perinatal death - 1 - - - - - - 1 2
Pneumonia 1 1 - 2 - 3 1 1 9 22
Stroke -
- - 1 - - - 1 2
TB/HIV/AIDS - 1 - - 1 - 1 - 3 7
Unknown - 1 1 1
- - - 3 7
Wasting syndrome - -
- 1 - - - 1 2
Anaemia - - 1 - - - - - 1 2
SAM - 2 - - - - - - 2 5
Septicemia - 1 - - - - - - 1 2
Heart failure - - - - - - 2 - 2 5
Unknown - - 1 - - -
- 1 2
Edema + Diarrhoea - - - - - - 1 - 1 2
Grand Total 1 11 13 3 4 3 5 1 41 100
Under-five Mortality Rate (U5MR) among IDPs
In week 42 of 2015, with a population of 120,004 and 11 new deaths among under-fives in Bentiu PoC, the U5MR was 0.655 deaths per 10,000 per day, which is below the U5MR emergency threshold of 2 deaths per 10,000 per day (Figures 29 and 30).
The notable causes of death in children <5 years in Bentiu during week 42 of 2015 included malaria, malnutrition, and pneumonia.
Figure 29
Figure 30
Crude Mortality Rate among IDPs
During week 42 of 2015, the CMRs were below the emergency threshold for the five IDP sites that submitted mortality data. The CMR for Bentiu PoC in week 42 of 2015 was 0.324 deaths per 10,000 per day. Figure 31.
This Bulletin is Produced by the Ministry of Health with Technical Support from WHO 15
Figure 31
Disease Specific Mortality Mortality due to Acute Watery Diarrhoea among IDPs
Since the beginning of 2015, a total of 68 AWD related deaths have been reported among IDPs including 43 (63.2%) in Bentiu, 11 (16.2%) in UN House, 4 (5.9%) in Wau Shiluk, 3 (4.4%) in Akobo, 3 (4.4%) in Mingkaman, and 4 (5.9%) in Malakal PoC. Overall, 220 AWD deaths have been reported since the onset of the crisis with majority from Bentiu PoC (Figure 18).
Figure 32
Mortality due to Malaria among IDPs
During week 42 of 2015, a total of nine malaria deaths were reported from Bentiu PoC. Overall, Bentiu PoC has reported the highest number of deaths (732 deaths) since the beginning of the year with 170 (23.2%) of the deaths attributed to malaria (Figure 34 and Table 17).
Figure 33
0
2
4
6
8
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12
14
5152 1 2 3 4 5 6 7 8 9 1011121314151618192021222324252627283537434546495051 2 3 5 7 121314151617181920212223242526272829303233343839404142
2013 2014 2015
Nu
mb
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f d
eath
s
Epidemiological week
Mortality due to AWD by IDP camp, week 51 of 2013 to week 42 of 2015
Wau Shiluk Akobo Mingkaman Malakal Juba 3 Bor Bentiu
0
5
10
15
20
25
30
35
52 1 2 3 4 5 6 7 8 9 101214172223242526272829303133343537394042434647484950 1 2 3 6 8 9 1011151920222324252627282930313233343536373839404142
2013 2014 2015
Nu
mb
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f d
eath
s
Epidemiological week
Mortality due to malaria by IDP camp, week 51 of 2013 to week 42 of 2015
Wau Shiluk Akobo Mingkaman Malakal Juba 3 Bor Bentiu
This Bulletin is Produced by the Ministry of Health with Technical Support from WHO
16
Overall Mortality among the IDPs
Since the beginning of 2015, 1,223 deaths have been reported from the IDP sites of which 595 (48.7%) were children under-5 years. Most of the deaths occurred in Bentiu, Malakal, Juba 3 PoC and, Wau Shiluk (Table 17).
Since the beginning of 2015, malaria has registered the highest proportionate mortality of 17.1% followed by TB/HIVAIDS (7.8%), pneumonia (6.9%), and malnutrition (6.9%), and (Table 17).
Table 14: Mortality trend by IDP site, week 1 of 2015 to week 42 of 2015 IDP site
Acu
te J
aun
dic
e
Syn
dro
me
Acu
te w
ater
y
dia
rrh
oea
Can
cer
Gu
nsh
ot
wo
un
d
Hea
rt d
isea
se
Hyp
erte
nsi
on
Kal
a-A
zar
Mal
aria
Mat
ern
al d
eath
Mea
sles
Pe
rin
atal
dea
th
Pn
eum
on
ia
SAM
Sep
tice
mia
TB/H
IV/A
IDS
Trau
ma
Hep
atit
is E
Oth
ers
Gra
nd
To
tal
Bentiu 6 43 10 12 6 1 5 170 10 27 40 57 27 36 1 15 266 732
Bor 1 - - - - - - - - - 5 - - - 1 - - 2 9
Juba 3 - 11 1 1 4 12 1 - 17 19 7 3 29 - - 49 154
Malakal - 4 2 1 9 2 5 10 - 18 17 15 1 18 - - 77 179
Melut - 1 1 5 1 1 - 3 1 1 7 - - 3 24
Mingkaman - 3 - - - - - 2 - - 2 4 4 1 - 1 13 30
Akobo - 3 - 2 1 4 6 - - 2 3 1 1 2 - - 9 34
Wau Shiluk - 4 1 4 2 8 - 1 1 - - - 2 - - 38 61
Grand Total 7 68 15 17 20 9 19 209 2 11 75 84 84 33 96 1 16 457 1223
Proportionate mortality [%]
0.6 5.6 1.2 1.4 1.6 0.7 1.6 17.1 0.2 0.9 6.1 6.9 6.9 2.7 7.8 0.1 1.3 37.4 100
Response interventions and general recommendations
The national malaria taskforce was set up to coordinate malaria response operations to improve access to treatment, interrupt transmission, and engage communities. This includes mass presumptive treatment of fever cases for malaria, distribution of LLINs, larviciding, indoor residual spraying, and behavioral change communication.
Consistent and sustained implementation of a comprehensive HEV response is already underway and includes supportive case management for symptomatic cases, targeted preventive interventions during antenatal visits; improving access to safe drinking water and improved sanitation facilities; instituting interventions for a safe water chain; preventive vaccination using HEV vaccine for groups with a high risk for adverse clinical outcomes including mortality; and house-to-house hygiene and sanitation promotion including distribution of NFIs like soap and jerry cans.
Following the recent integrated measles and polio vaccination campaigns in Bentiu and UN House PoC surveillance and routine immunization have been enhanced.
Enhanced nutrition screening at designated clinics, mobile clinics, and during the house-to-house visits are underway to identify and initiate early treatment for malnourished cases.
The national and state level cholera taskforce committees should continue implementing cholera preparedness and response interventions to control the outbreaks in Juba and Bor.
Integrate TB/HIV/AIDS prevention and control into the routine healthcare services in all the IDP sites.
Biological samples should be obtained and shipped to Juba to allow laboratory confirmation of emerging outbreaks of measles, AJS, bloody diarrhea, and cholera.
The ongoing integrated response to Kala-azar that entails enhanced surveillance, improved access to diagnosis and treatment facilities, refresher training of healthcare workers on Kala-azar case management, replenishing of drug stocks in endemic areas, as well as communication on Kala-azar prevention and control should be sustained.
Support the implementation of the Ebola preparedness and response so as to enhance capacities for case detection, investigation, response and community awareness on Ebola prevention and control.
Please send all disease surveillance information and any outbreak rumours to [email protected]. IDSR reports should be submitted by COB Monday after the close of each epidemiologic week.
For comments or questions, please contact
Department of Epidemics, Preparedness and Response, MoH-RSS E-mail: [email protected],
HF radio frequency: 8015 USP; Selcall: 7002
