Public Health Priorities

Highlights

Early Warning, Alert and Response

• Completeness for weekly reporting was 59% IDSR sites and 81% forthe IDP sites.

• Malaria remains the leading cause of morbidity in nonconflict areaswhile ARI is the leading cause of morbidity in the IDPs.

• A total of 20 suspect measles cases were reported from Wau,Yambio, Tonj North, Jur River, Nzara and Gogrial West.

• A new cholera outbreak confirmed in Ayod county.

• A total of 10 HEV cases reported from Bentiu POC in week 13.

• One suspect Guinea worm case reported from Bentiu PoC in theweek.

• Complications of Severe acute malnutrition and TB/HIV/AIDS were theleading causes of mortality in the IDP sites

System performance

Special focus on cholera• Cumulatively, 6,147 cholera cases including 171 deaths (65 facilities

and 106 community) (CFR 2.75%) have been reported in South Sudan(Figs 19.2&19.3; Table 4.2)

• New cholera outbreak confirmed in Ayod - with active transmissionin Yirol East, Mingkaman, and Duk (Figs 19.2&19.3; Table 4.2).

• Suspect cholera cases reported in Mayom, Juba, Kodok, and YirolWest (Figs 19.2&19.3; Table 4.2).

Completeness for weekly reporting was 59% for the routinesurveillance(IDSR sites) and 81% for the EWARS (IDP sites)(Table 1).

In the reporting week, thirteen (13) counties attained 100%completeness of reports. A total of 32 (40%) countiesattained the target completeness of at least 80% (Figures 1c)in Week 13 compared to 29 and 34 in Weeks 12 and 11respectively.

Timeliness for weekly reporting stands at 47% for the routinereporting sites and 75% for the IDP sites (Table 1).

Table 1 | Surveillance performance in South Sudan as of W13 2017

Republic of South SudanW13|27th Mar - 2nd April 2017

Weekly Epidemiological BulletinIntegrated Disease Surveillance and Response (IDSR)

!

!

Active responses

CholeraMeaslesKala azar Hepatitis E virus Guinea worm

SystemTotal

Facilities

Timelines Completeness Timeliness Completeness

inweek 13of2017 Cumulativefor2017

IDSR 1155 538(47%) 676(59%) 409(29%) 563(40%))

EWARN 47 37(75%) 38(81%) 35(72%) 37(76%)

Figure 1c -d | IDSR Completeness by county in W13 and Weeks 1-12 2017

Event based surveillance W13 of 2017

Active alerts:

Guinea Worm

In Week 13, Events based surveillance data was received from two hubsof Torit and Wau. Five Events were reported 4 suspected measles fromJur river, County and 1 suspected meningitis from Torit County.Investigation was initiated with 72 hours for the meningitis team by theMeasles were still pending.

0% 10%

27%

10% 1%

52%

Figure1b|ProportionalmorbidityinIDPsW132017

Measles

Malaria

ARI

AWD

ABD

Other

11% 2%

28%

0.021%

60%

Figure1a|IDSRProportionalmorbidityWK13,2017

AWD

ABD

Malaria

Measles

Others

IDSR and EWARN Reporting Performance by Partner and County in 2017

Trends for top causes of Morbidity

This week 24 hospitals (47%), 161 PHCCs (49%), and 491 PHCUs (48%)in 52 counties submitted their IDSR reports (Table 2). A significantimprovement from the previous weeks

Number of counties that did not submit any IDSR report decreased from34 in Week 12 to 28 in Week 13 (Table 2). However, eight of these countiessubmit their data through EWARS (Table 2).Nine partner-supported health facilities in the IDP sites did not submittheir reports (Table 2).

!

Table 2 | Reporting Performance [Timeliness and Completeness] by Partner and County as of W13 2017

Figure 6b | EWARN Priority Disease Proportionate Morbidity W52 2013 to W13 2017

Table 4 | Top causes of morbidity in 2016 and 2017

Figure 6a | IDSR priority disease morbidity trends W1 to W13 2017

Overall morbidity trends for 2017

This week, the Nine health facilities in the IDP sites that didnot submit their reports are supported by SMC, IOM, MSF-H,IMC and IMA (Table 2).

The best performing partner-supported facilities duringthe week were GOAL, IRC, Medair, HLSS MSF-E, WorldRelief and UNKEA

No.IDSR IDSR

SilentCountiesW13 2017 SilentCountiesW11 2017IbbaJurRiverCueibetWuluAweilWestAbiemnhomKochLongochukManyoRagaMvoloGogrialWestTonjSouthMaridiTamburaMundriEastMundriWestEzoGogrialEastYirolWestAweilEastLeerMayomRumbekNorthUlangTonjNorthAweilNorth

AwerialKajo-kejiYeiWauKapoetaEastTerekekaAweilCentreAweilSouthMayenditMabanNageroFashodaRumbekCentreNzaraYambioJubaBorSouthRubkonaNationalBudiMagwiTwicMayarditCanal/PigiAbyei

*Countieswith EWARSreportingsites,

Malaria remains the top cause of morbidity in the IDSR reporting sitesfollowed by Acute watery diarrhea while for the IDP sites ARI* is theleading cause of morbidity followed by malaria .(Figures 1a, 1b, 6a,6b, Table 4).

Consultations Table 3 | Consultations in South Sudan as of W13 2017

SurveillanceSystem

ConsultationsinWeek13 of2017 Cumulativeconsultationsfor2017

<5years ≥5years Total <5years ≥5years Total

IDSR 35314 54,177 89,491 398,913 621,176 1,020,089

EWARN 30,568 367,415

Total 120,059 1,387,504

Partner Numberofhealthfacilities

W13 2017Completeness Timeliness

# # % # %

COSV 0 0 0% 0 0%

GOAL 2 2 100% 2 100%

HLSS 2 2 100% 2 100%

IMA 5 2 40% 2 40%

IMC 8 6 75% 6 25%

IOM 12 11 92% 11 92%

IRC 1 1 100% 1 100%

Medair 2 2 100% 0 0%

MSF-E 2 2 100% 2 100%

MSF-H 4 3 75% 3 75%

SMC 6 4 67% 3 50%

UNIDO 0 0 0% 0 0%

UNKEA 2 2 100% 2 100%

WorldRelief 1 1 100% 0 100%

Total 47 38 81% 35 75%

System Disease NewcasesW13 Cumulativecasesweek1toweek13of

2016 2017 2016 2017IDSR Malaria 16,137 26,213 294,589 290,287

AWD 18,290 9,665 89,661 98,313Meningitis 0 0 9 2

ABD 1,453 1,581 21,077 15,367Measles 6 20 227 208AJS 1 0 7 13

EWARNMalaria 6,375 3,153 100,953 49,750

AWD 3,839 3,011 41565 33,641ARI 6231 8105 74,424 98,403ABD 421 207 5,172 2,879

Measles 7 1 156 216AJS 126 10 919 187

Meningitis 0 0 10 18

Disease/Year 2016 2017

Malaria 395,542 340,037

AWD 131,226 131,954

ARI* 74,424 98,403

ABD 26,249 18,246

AJS 926 200

Measles 383 424

Meningitis 19 20

Figure 4b | Cumulative for top causes of morbidity as of Week 13 of 2016 and 2017

*ARIisonlyreportedonfromtheIDPsites

0102030405060708090

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1 3 5 7 9 11 13

Completen

ess(%)

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IDSRPriorityDiseaseMorbiditytrendsfromweek01toweek13,2017

Completeness ABD Malaria Measles AWD

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-10-30

Percen

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ns

%_Malaria %_ARI %_Measles

Malaria

Malaria

Status: Urgent

!

This Week Malaria accounted for 28% and 10% of all consultations inthe IDSR and IDP sites respectively (Fig. 1a, 1b). The incidence (casesper 100,000) of Malaria increased from 174.1 in Week 12 to 175.5 .

As the Malaria season approaches, the incidence in Week 13 of 2017 iscomparatively equal to the corresponding periods in 2014, 2015 and2016.As seen from Figs. 8a-f, analysis of malaria trends at state level showedthat malaria cases were within expected levels in some of thestates*.(Fig 8a-d).

The malaria incidence in the IDP sites has remained within expected levels. (Figs. 10a-d)

A total of Four (4) malaria deaths were reported from Tabura(3) and YirolWest(1)(Tables 5, 6).

*Actual diseasetrendsmaybemaskedbylowreportingrates

Malariatrendsbystatehub

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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 53

Casesp

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Figure7|IDSRmalariatrendsbyweek,2014- 2017

2014 2015 2016 2017

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casesp

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Figure8c|IDSRtrendsforMalariaAweil,AweilEast,Lolfromweek01to13,2017

Thirdquartile2012-2015 2017

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casesp

er100,000

EpidemiologicalWeek

Figure8b|IDSRtrendsformalariaGogrial,Tonj,Twic,Wk01toWk13,2017

Thirdquartile2012-2015 2017

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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

casesp

er100,000

Epidemiologicalweek

Figure8d| IDSRtrendsformalariainWesternLakes,EasternLakes,andGokstates,Wk01toWk13,2017

Thirdquartile2012-2015 2017

0

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800

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

casesp

er100,000

Epidemiologicalweek

Figure8f| IDSRtrendsforMalariainGbudwe,Maridi,andAmadistatesfromweek01to13,2017

Thirdquartile2012-2015 2017

0

500

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1500

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casesp

er100,000

Epidemiologicalweek

Figure8a|MalariaIncidenceforWaustate,week01to13,2017

Thirdquartile2012-2015 2017

0.0

100.0

200.0

300.0

1 4 7 10 13 16 19 22 25 28 31 34 37 40 43 46 49 52EpidemiologicalWeek

MalariaIncidenceforUnitystatefromweek01to13,2017

2017 Thirdquartile2012-2015

Malaria in IDPs

!

Acute Respiratory Infection (ARI)

In Week 13 the ARI proportionate morbidity increased from24.42% in week 12 to 26.93%. Comparatively, the ARIproportionate morbidity in 2017 is higher than thecorresponding period in 2014, 2015 and 2016.

Figure 11b shows ARI morbidity by IDP site in Week 13 of 2017,the reporting site with the highest Proportionate morbidity of ARI isMedair Abayok Clinic with ARI proportionate morbidity of 67.4%.

0%

5%

10%

15%

20%

25%

30%

35%

010305070911131517192123252729313335373941434547495153

Percen

toftotalcon

sulta

tions

Epidemiologicalweekofreporting

Figure11|ARItrendsinIDPsW512013toW132017

2014 2015 2016 2017

0% 10% 20% 30% 40% 50% 60% 70% 80%

Med

airA

bayokClinic

MSF-HBen

tiuPoC

Hospital

Med

airW

onthow

Clinic

MSF-HLankien

PHC

CIOMGergerM

obileClinic

SMCMalou

IRCSector4Clinic

GOALKoradarID

Pclinic

MSF-HBen

tiuTow

nClinic

IOMBen

tiuSector1

PoC

…IOMW

onthou

Mob

ileClinic

IMCMalakalPoC

Clinic2

GOALDetho

maCamp2

IMADe

lalA

jakMob

ileClinic

IOMBen

tiuSector3

PoC

…IM

CAk

oboHo

spita

lIM

CUN

Hou

seClinic1

IOMM

alakalPoC

Clinic

IOMNazarethIDPCamp…

IOMCathe

dralChu

rchIDP…

IOMHalakaMob

ileClinic

MSF-EM

alakalTow

nPH

CCWorldReliefP

HCC

GoaMed

icalM

obileClinic

GapMed

icalM

obileClinic

IMAKo

dokMob

ileClinic

IOMBen

tiuSector5

PoC

…MSF-EHospital

IOMRam

elaMob

ileClinic

Percen

tofallconsultatio

ns

Figure11b|ARIIncidencebyIDPSiteinW132017

Meningitis (suspected)

!

In week 13, there was no suspected meningitiscase reporting from across the country.

Even as the meningitis season is coming toan end, partners are still urged to maintainheightened surveillance, and to ensure thatall patients meeting the suspect case definitionfor meningitis are investigated and wherepossible samples collected and notificationssent to the next level for prompt action.

Cumulatively from week 47 of 2016, a total of18 rapid pastorex Streptococcus pneumoniaecases have been reported (Fig. 11c). Only onerapid pastorex Neisseria meningitidis Y/W135case has been reported since week 47 of 2016(Fig. 11c).

Figure 11d shows the attack rates (cases per100,000) and case fatality rates by week forsuspect meningitis cases in Bentiu PoC. Whilethe alert threshold has been surpassed for atleast four weeks since week 47, the epidemicthreshold has not been reached. The currenttrends are still below the epidemic threshold.Surveillance for suspect cases of meningitis ishigh in Bentiu PoC and countrywide.

Nearly 40% of the cases are below one yearand 68% are below five years of age. Childrenand young adults constitute 53% of the cases.Males constitute 61% of the total casesreported (Table 4c).

Heighten Surveillance for meningitis has beenmaintained across the country, especially in thehigh risk locations Like Malakal and BentiuPoC.

The second phase of the MenAfriVacpreventive campaigns are slated for the fourthquarter of 2017 targeting the states in thegreater Upper Nile region.

Table4c:Suspectmeningitiscaseage&sexdistribution,BentiuPoC,wk47,2016towk10,2017

0

1

2

3

4

5

6

7

No.cases

Weekofonset

SuspectmeningitisEpi-curveshowingrapidpastorexresults,BentiuPoC,week47of2016toweek12,2017

H.Influenzaeb N.meningitidis Y/W135 Negative S.Pneumonlae

0

5

10

15

20

25

30

0

2

4

6

8

10

12

2016

-45

2016

-46

2016

-47

2016

-48

2016

-49

2016

-50

2016

-51

2016

-52

2017

-01

2017

-02

2017

-03

2017

-04

2017

-05

2017

-06

2017

-07

2017

-08

2017

-09

2017

-10

2017

-11

2017

-12

CFR[%]

Epiweekofonset

casesp

er100,000

Suspectmeningitis attackrates&CFRbyweek,BentiuPoC

AR Alertthreshold Actionthreshold CFR

CountofSN ColumnLabelsAge Female Male Total Percentage<1yr 8 8 16 41%1-4yrs 2 9 11 28%5-14yrs 2 3 5 13%15-29yrs 1 3 4 10%30+yrs 2 1 3 8%Total 15 24 39 100%

Acute bloody diarrhoea (ABD)

Acute bloody diarrhoea (ABD)

!

Acute watery diarrhoea (AWD)

Acute watery diarrhoea (AWD)

AWD remains among the top three causes of morbidity in theCountry, this week it accounted for 11% and `10% of allconsultations in the routine reporting(IDSR) and IDP sitesrespectively (Fig. 1a, 1b).

Overall from Week 7 of 2017 the AWD incidence has been onupward trend. The Incidence [cases per 100,000] in week 13increased from 67.9 in Week 12 to 79.0 from the IDSR reportingsites.(Fig. 12).

In the IDP sites, AWD morbidity has increase over the last twoconsecutive weeks , this week the proportionate morbidity ishigher than the corresponding period in 2014 but lower than 2015and 2016 (Fig. 13). Figure 14 shows AWD morbidity by IDP sitein Week 13 of 2017

For the third consecutive week, the ABD burden remained at2% and 1% of all consultations in the IDSR and IDP sitesrespectively (Fig. 1a, 1b).

For the routine reporting sites ABD incidence [cases per100,000] increased from 10.9 in Week 12 to 12.9 in Week 13(Fig. 15).

Among the IDPs, the current ABD proportionate morbiditydecreased in Week 13 and still remains low compared to thecorresponding period in 2014, 2015 and 2016 (Fig. 16 and17).

Figure 17 shows the number of ABD cases by IDP clinic inWeek 13 of 2017.

0%

1%

2%

3%

4%

5%

6%

010305070911131517192123252729313335373941434547495153

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Figure16|ABDtrendsinIDPsW512013toW132017

2014 20152016 2017

0% 2% 4% 6% 8%

10% 12% 14% 16% 18%

Med

airA

bayokClinic

UNKEAJikmirPH

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maCamp2

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Pclinic

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icalM

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tiuSector3

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Figure17|ABDIncidencebyIDPSiteinW132017

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Figure12|IDSRAWDtrendsbyweek,2014- 2017

2014 2015 2016 2017

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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 53

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Figure13|AWDtrendsinIDPsW512013toW132017

2014 2015 2016 2017

0% 5%

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MSF-HBen

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CAk

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Figure11b|AWDIncidencebyIDPSiteinW132017

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Figure15|IDSRABDtrendbyweek,2013- 2017

2014 2015 2016 2017

!

Measles In Week 13, Twenty(20) new suspect measles cases werereported Jur River(2), Wau(4), Yambio(3), Nzara(2) andGogrial West (3), Tonj North(3) (Table 4.1).

Cumulatively, in 2017 a total of least 515 suspect measlescases including 4 deaths (CFR 0.78%) have been reportedfrom 17 counties..

Most of the cases have been reported from Wau, Gogrial East,Gogrial West and Yambio counties (Figure 18.1).

The majority of the cases are under five years of age (Figure18.3).

Since the beginning of 2017, measles outbreaks have beenconfirmed in five counties - Wau, Aweil South, Gogrial West,Gogrial East, and Juba (Table 4.1 and Figure 18.2).

At least 46 measles IgM positive and 36 rubella IgM caseshave been confirmed in 2017 (Table 4.1 and Figure 18.2).

Most counties have not attained the non-measles febrile/rashillness rate of at least 1/100,000 (Figure 18.4). This highlightsthe need to enhance measles case-based investigation andsample collection.

The follow-up measles campaign is scheduled for 17th to 28th

April 2017.

Table4.1|MeaslescasesbylocationandstatusasatW13of2017

CountyNewsuspectcasesW13,

2017

Suspectcasesin2017

ConfirmedMeasles2017

ConfirmedRubella2017

Samplestestedin2017

Outbreakstatusin2017

WauIDPs 4 281 15 26 96 Confirmed

MalakalPoC 0 2 0 2 Alert

GogrialEast 0 43 5 8 Alert

GogrialWest 3 48 15 24 Confirmed

TonjNorth 3 8 0 0 0 Alert

AweilSouth 0 6 7 7 Confirmed

Yambio 3 47 2 10 19 Alert

Mayom 0 15 0 0 0 Alert

Nzara 2 3 0 Alert

Ezo 0 1 0 0 0 Alert

AweilWest 0 9 0 1 Alert

Aweil Center 0 1 0 0 0 Alert

Kajo-keji 0 5 0 0 Alert

Juba 0 21 7 17 Alert

Torit 0 2 0 0 39 Alert

Duk 0 15 0 0 Alert

JurRiver 2 2 0 0 0 Alert

MundriWest 0 1 0 0 1 Alert

Total 17 510 46 36 214

Fig18.2|CountieswithconfirmedmeaslesoutbreaksasatW13of2017

Fig18.4|Non-measlescasesFebrile/Rashillnessper100,000bycountyasatW13of2017

Non-Measles Febrile/Rash Illness Rates by County / 2016-2017*

2017

2016

County level

Categories

Counties by category

Number Percent

NM-FRI rate =0.00-0.00 42 53%

NM-FRI rate >0.01-0.99

2 3%

NM-FRI rate >1.00-1.99

5 6%

NM-FRI rate >2.00 30 38% Total 79 100%

* As of Week 13, 2017

Categories

Counties by category

Number Percent

NM-FRI rate =0.00-0.00 69 87%

NM-FRI rate >0.01-0.99

0 0%

NM-FRI rate >1.00-1.99

0 0%

NM-FRI rate >2.00 10 13% Total 79 100%

Non-Measles Febrile/Rash Illness Rates by County / 2016-2017*

2017

2016

County level

Categories

Counties by category

Number Percent

NM-FRI rate =0.00-0.00 42 53%

NM-FRI rate >0.01-0.99

2 3%

NM-FRI rate >1.00-1.99

5 6%

NM-FRI rate >2.00 30 38% Total 79 100%

* As of Week 12, 2017

Categories

Counties by category

Number Percent

NM-FRI rate =0.00-0.00 69 87%

NM-FRI rate >0.01-0.99

0 0%

NM-FRI rate >1.00-1.99

0 0%

NM-FRI rate >2.00 10 13% Total 79 100%

0

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1 2 3 4 5 6 7 8 9 10 11 12 13 14

Num

berofcases

Epidemiological weekin2017

Measles casesbyEpidemiologicalweekandcounty,week1-14,2017

Juba GogrialWest Aweil South Aweil Center MalakalWau JurRiver Yambio Torit GogrialEast

0%

10%

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Juba GogrialWest Aweil South Aweil Center Malakal Wau JurRiver Yambio Torit GogrialEast

Agedistrib.%

Measles casedistributionbyagegroupandcounty,week1-14,2017

<1yr 1-4yrs 5-9yrs 10-14yrs 15+yrs

Fig18.3|Measlescasedistributionbyagegroupandcountry,week1-14,2017

!

Visceral Leishmaniasis | Kala-azar

Hepatitis E Virus (HEV)

In week 13, Seven (7) health facilities reported 24 cases, 18 new cases, 6relapses and 0 PKDL. 3 deaths and 3 defaulters reported.Since the beginning of 2017, a total of 880 cases including 18 deaths(CFR 2.0%) and 4(0.5%) defaulters have been reported from 16 treatmentcenters however, currently 12 treatment centers are reporting. Of the 880cases reported, 724 (82.3%) were new cases, 55(6.3%) PKDL and101(11.5%) relapses.In the corresponding period in 2016, a total of 475 cases including 25deaths (CFR 5.3%) and 18(3.8%) defaulters were reported from 21treatment centers.Majority of cases were reported from Lankien (316), Old Fangak (313),Kurwai (97) , Malakal IDP (35), Walgak (34), KCH (24) and Ulang (15) etc.The most affected groups included, males [306 cases (54.7%)], thoseaged 5 - 14years [246(29.3%) and ≥15years and above [245 cases(28.5)]. A total of 83 cases (10.0%)] occurred in children <5years.

The number of cases reported in 2017 is higher than those reported in2016 despite the transmission season. However, the trend of the graph ismore or less the same.

A total of Ten (10) HEV cases reported from Bentiu PoC (Fig. 19)were reported in Week 13.Cumulatively, a total of 178 HEV cases have been reported fromBentiu PoC in 2017 . The transmission of HEV is also reported inBentiu town and all have been linked to sub-optimal access tosafe water and sanitation. Multis-sectoral response has madesome progress in reducing the incident but control is yet to beattained due to a multiplicity of factors. (Fig. 19)

Cumulatively, from the beginning of the crisis, 3,426 HEV casesincluding 25 deaths (CFR 0.73%) reported in Bentiu; 174 casesincluding seven deaths (CFR 4.4%) in Mingkaman; 38 casesincluding one death (CFR 2.6%) in Lankien; 3 confirmed HEVcases in Melut; 3 HEV confirmed cases in Guit;1 HEV confirmedcase in Leer; and Mayom/Abyei [57 cases including 15 deathswith 7 HEV PCR positive cases.

Other diseases of public health importanceAcute Flaccid Paralysis | Suspected Polio

In Week 12, Eleven (11) new AFP cases were reported with date of onset in 2017 from Northern Bar Ghazal(5), Jonglei (1),Unity(1) Central Equatoria(1) and Eastern Equatoria Hubs (2).

During 2017, a cumulative of 64 AFP cases have been reported countrywide. the annualized non-Polio AFP (NPAFP) rate (cases per 100,000 population children 0-14 years) is 3.4 per 100,000 population of children 0-14 years (target ≥2 per 100,000 children 0-14 years).

Stool adequacy was 92% in 2017, a rate that is higher than the targetof ≥80%. The percent of silent Counties is 53%.

Guinea Worm | Dracunculiasis

One suspect Guinea worm case reported from BentiuPoC in the week. More than 3,000 alerts have beeninvestigated in 2017 with three samples collected out ofwhich two were negative while the third is still pending.

Cumulatively in 2016; six (6) confirmed Guinea wormcases were reported compared to Four (4) cases in2015.

The Ministry of Health through the South Sudan Guinea Worm Eradication Program(SSGWEP) continues to offer cash reward of 5,000 SSP. for reporting a Guinea worm.

Viral Haemorrhagic FeverNo new suspect hemorrhagic fever cases reported from across theCountry in Week 13.

Animal bites | Suspected rabies

There were no suspect rabies cases in the Week 13 .

Table.|NonPolioAFPratebycountyasofWeek13of2017

2

ANALYSIS:

x In week 13, Seven (7) health facilities reported 24 cases, 18 new cases, 6 relapses and 0 PKDL. 3 deaths and 3 defaulters reported. Table 2

x Since the beginning of 2017, a total of 880 cases including 18 deaths (CFR 2.0%) and 4(0.5%) defaulters have been reported from 16 treatment centers however, currently 12 treatment centers are reporting. Of the 880 cases reported, 724 (82.3%) were new cases, 55(6.3%) PKDL and 101(11.5%) relapses.

x In the corresponding period in 2016, a total of 475 cases including 25 deaths (CFR 5.3%) and 18(3.8%) defaulters were reported from 21 treatment centers.

x Majority of cases were reported from Lankien (316), Old fangak (313), Kurwai (97) , Malakal IDP (35), Walgak (34), KCH (24) and Ulang (15) etc

x The most affected groups included, males [306 cases (54.7%)], those aged 5 - 14years [246(29.3%) and ≥15years and above [245 cases (28.5)]. A total of 83 cases (10.0%)] occurred in children <5years. Table 1

x The number of cases reported in 2017 is higher than those reported in 2016 despite the transmission season. However, the trend of the graph is more or less the same.

x The low number of cases reported in weeks 13 was as a result of few number of health facilities reporting.

x WHO/MOH in collaboration with IMA and KalaCore continue to ensuring that all implementing partners have access to KA test kits and medicine and onsite monitoring of Kala azar activities to ensure proper treatment provided to patients.

x WHO/MOH in collaboration with IMA and KalaCore plan to conduct training and establish DAT testing at the National Public Health Laboratory.

Graph:1Cummulative number of VL new cases by WEEK 13(27th Marc 2017 –2nd April 2017).

0

50

100

150

200

250

300

350

0246810121416

3 9 15 21 27 33 39 45 51 5 11 17 23 29 35 41 47 53 6 12 18 24 30 36 42 48 2 8

2014 2015 2016 2017

No.casesinBen

tiu

No,casesinothersites

Epidemiologicalweek

Figure19|HEVtrendsinMingkaman,Bentiu&LankienW102014toW132017

Awerial Lankien Bentiu

!

Cholera

Figure 1.0: Cholera incidence (cases per 10,000) and casefatality rate (%) as of 13 October 2016

• Cumulatively, 6,147 cholera cases including 171 deaths (65facilities and 106 community) (CFR 2.75%) have beenreported in South Sudan (Figs 19.2&19.3; Table 4.2)

• New cholera outbreak confirmed in Ayod - with activetransmission in Yirol East, Mingkaman, and Duk (Figs19.2&19.3; Table 4.2).

• Suspect cholera cases reported in Mayom, Juba, Kodok, andYirol West (Figs 19.2&19.3; Table 4.2).

Table4.2|Choleracasesanddeathsbycountyasof12th April2017

Figure19.2|CholeraEpidemiccurveinSouthSudanasof12Apr2017

ReadersarereferredtothecholerasituationreportfordetailsontheongoingcholeraresponseinSouthSudan

Reportingsites Totalcases TotalFacili6ydeaths Totalcommunitydeaths TotaldeathsJubacounty 2,045 8 19 27Dukcounty 100 3 5 8Bor county 82 1 4 5Terekekacounty 22 0 8 8Awerialcounty 836 2 10 12Yirol East 499 12 23 35Pagericounty 29 0 1 1Fangakcounty 270 4 0 4Ayodcounty 60 0 25 25Rubkonacounty 1176 7 2 9Leercounty 94 3 0 3Panyijiarcounty 501 20 4 24Mayenditcounty 226 0 5 5Pigicounty 181 5 5Malakal 19 0 0Total 6,147 65 106 171

Figure19.3|Choleraincidence(casesper10,000)andcasefatalityrate(%)asof12Apr2017

- - -

21.05

16.92

2.05 1.85

0.62 0.861.42 1.55

2.753.33

0.421.35

0.76

4.48

3.33

0.75

2.26 2.42

0.82

2.00

0.63

1.761.27

0.57

2.24

0.79 0.60

2.30

3.49

6.67

5.11

6.91

-

5.754.84

4.12

2.86

1.47

14.04

- - 0

5

10

15

20

25

0

50

100

150

200

250

300

350

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 52 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

2016 2017

CFR[%]

Numberofca

ses

Epidemiologicalweekofonset

Jonglei Jubek Terekeka Imatong EasternLakes Fangak NorthernLiech SouthernLiech CentralUpperNile CFR[%]

Mortality

Crude and under five mortality rates in IDPs

Overall mortality in 2017

in Week 13 Three (3) deaths were reported through IDSR , allthree were to malaria (Table 5). Two out of the three deaths werein children aged 5 years or younger.

This reporting wee Mortality data was received from only Bentiu and Malakal IDP sites. (Table 6). Eleven (11) deaths were reported from these sites. Bentiu PoC continues to report the highest mortality with 9 out of the 11 deaths reported. Overall, 3 out of the 20 deaths were children <5 years (Table 6).

This week Severe Malaria, Chronic Illness and complications of Gunshot wounds were the leading causes of Mortality in the IDP Sites(Table 6). A significant proportion of the mortality(30%) were due to unknown causes.

The U5MR in all the IDP sites that submitted mortality data in Week 13 of 2017 is below the emergency threshold of 2 deaths per 10,000 per day (Fig. 20).

Note: Mortality rates are calculated for PoC sites only and are based on the latest available population data from OCHA. They are reported from line lists and should include community and facility-based deaths. However, due to rapid in/out migration from the PoC sites, and possible under-reporting of community-level deaths, they should be interpreted carefully.

!

Table 6 | Proportional mortality by cause of death in IDPs W13 2017Table 5 | Mortality from IDSR reports countrywide W13 2017

A total of 236 deathshave been reportedfrom the IDP sitesfrom Week 01 of2017. (Table 7).

The top causes ofmortality in the IDPsin 2017 are shown intable 7.

The Crude Mortality Rates [CMR] in all the IDP sites that submittedmortality data in Week 13 of 2017 were below the emergency threshold of1 death per 10,000 per day (Fig. 21).

The other causes of mortality in the week are shown in Tables 5 and 6.

Table 7 | Mortality by IDP site and cause of death W13 2017

CountyMalaria<5yrs

Malaria≥5yrs

Totaldeaths<5yrs

Totaldeaths≥5yrs

Yambio

1 0 1 0GogrialWest

1 1 1 1Total 2 1 2 1

IDPSITE TB/H

IV/A

IDS

Severe

malaria

Unk

nown

severe

pneu

mon

ia

SAM

AWD

Cardiaca

rrest

Chronicilln

ess

HeartF

ailure

cholera

GSW

IUFD

Kala-Azar

materna

lde

ath

Others

Gran

dTo

tal

Bentiu 19 3 34 4 16 4 4 2 2 2 5 2 47 144Juba3 15 6 3 1 1 1 2 9 38Malakal 2 2 1 1 13 19Akobo 1 8 5 2 2 7 25WauPoC 2 6 2 10GrandTotal 39 17 36 13 16 13 4 4 3 2 5 2 2 2 78 236

0.0

0.5

1.0

1.5

2.0

2.5

1 3 5 7 9 111315171921232527293133353739414345474951 1 3 5 7 9 1113

2016 2017deathsper10,000pe

rday

Epidemiologicalweek

Figure20|EWARNU5MRbySite- W12016toW13of2017

Bentiu Juba3 Malakal Mingkaman

Melut Akobo WauShiluk Threshold

0.0

0.2

0.4

0.6

0.8

1.0

1.2

1 3 5 7 9 111315171921232527293133353739414345474951 1 3 5 7 9 1113

2016 2017

deathsper10,000pe

rday

Epidemiologicalweek

Figure21|EWARNCrudeMortalityRateforW12016toW13of2017

Bentiu Juba3 MalakalMingkaman Melut AkoboWauShiluk Threshold WauPoC

CauseofDeathbyIDPsite

Bentiu MalakalGrandTotal

Proportionate

mortality<5yrs ≥5 ≥5

Abdominaldistension 1 1 9

drowning 1 1 9

Respiratorydistress 1 1 9

SAM 2 2 18

TB/HIV/AIDS 1 1 2 18

Unknown 2 1 3 28

Cardiacarrest 1 1 9

GrandTotal 3 6 2 11 100

Data sources

Editorial

Acknowledgements

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-conflict affected states or non IDP sites) and partner-supported facilities serving internally displaced persons (IDP) in the Republic of South Sudan.

MoH and WHO gratefully acknowledge the support of all MoH staff in the states, WHO Field Officers, and implementing-health cluster partners in collecting and reporting the data used in this bulletin.

Contact

For more information, please contact: Department of Epidemics, Preparedness and ResponseMoH Republic of South Sudan

Email: outbreak_22_2010@yahoo.com

Outbreak toll-free line using vivacell:1144

This bulletin is produced by the Ministry of Health with technical support from the WHO

Editorial:Dr.AliceL.Igale,Dr.AbrahamAdut,KorsukL.Scopus,RobertM.Lasu,RoseA.Dagama,JanePita,Dr.Patrick,R.Otim,GabrielWaat,Dr.AllanM.Mpairwe,Dr.JosephF.Wamala,Dr.JohnP.Rumunu

Supported by the Global EWARS project | info@ewars.ws