South Sudan IDP South Sudan IDP P Sur veillance P Sur veillance Epidemiology upd p gy p date based on Weekly Disease Surveil lance System Report as of 17 th Ma arch 2014 9pm Prepared by Dr. Boris Pavlin, W d b i li HO Surge Team Epidemiologist O S id i l i Email: outbreak_ss_2007@ _ _ @y @ @yahoo.com CSR - DD DC AFRO
Caveat about all following slides: Caveat about all following slides: Most sites have not reported on prev vious week by Monday evening when HC Meeting Presentation is pre when HC Meeting Presentation is pre epared, hence they may give a epared, hence they may give a misleading suggestion that cases of a all diseases are decreasing. Recommendation: If at all possib le, health partners are requested to send previous surveillance wee ek reports by Monday evening, so HC Meeting get HC Meeting get ts accurate data ts accurate data
Completeness and Timel Completeness and Timel iness Data for the past iness Data for the past week • Clinics are requested to repo ort by Monday PM on data for p previous epidemiologic week p g k (Monday ‐ Sunday) ( y y) • Data By Camp • Camps reporting 7/21 p p g / • Reports received on time: 6/2 21 • Data By Site/Clinic • Sites reporting: 8/44 • Reports received on time: 8/4 44
Completeness Data Completeness Data • Most sites do not provide da ata consistently, making it difficult to describe trends m meaningfully g y • There has been a modest up ward trend in completeness overall overall • Faltering over last few week s • Recommendation: to improv ve completeness (particularly from rarely ‐ reporting sites), y p g ), , surveillance team should , actively follow up with sites s each Monday.
1200 Total Consultations by Camp, Week 11,2014 1081 1050 1000 808 800 800 639 60 00 575 600 600 400 200 92 0 UN House Tomping Bor Ben ntiu Melut Nasir Gorom
3000 Trend of Priority Diseases, Week 51 1 ‐ 2013 to Week 11, 2014 2500 2000 2000 Cases Bloody Diarrhoea 1500 C Malaria Suspected Measles Watery diarrhoea 1000 500 0 2013 ‐ 2013 ‐ 2014 ‐ 2014 ‐ 2014 ‐ 2014 ‐ 2014 ‐ 2014 ‐ 2014 ‐ 2014 ‐ 2014 ‐ 2014 ‐ 2014 ‐ 51 52 01 02 03 04 05 06 07 08 09 10 11 Week Number Proportional morbidity in Week 11 contribute ed by these four diseases together was 32% • • Malaria and watery diarrhoea remain by far t y y the greatest burden g
350 Trend of Priority Diseases, Week 51 1 ‐ 2013 to Week 11, 2014 300 300 Cumulative l Count 2102 250 200 Cases C Bloody Diarrhoea 150 100 100 50 0 2013 ‐ 2013 ‐ 2014 ‐ 2014 ‐ 2014 ‐ 2014 ‐ 2014 ‐ 2014 ‐ 2014 ‐ 2014 ‐ 2014 ‐ 2014 ‐ 2014 ‐ 51 52 01 02 03 04 05 06 07 08 09 10 11 Week Number • Cases of ABD are decreasing, but this is largely y a reflection of non ‐ reporting by sites that had previously reported a high burden of ABD
Cumulative count 2000 Trend of Priority Diseases, Week 51 1 ‐ 2013 to Week 11, 2014 1800 13501 1600 1400 1200 Cases 1000 C Watery diarrhoea 800 600 600 400 200 200 0 2013 ‐ 2013 ‐ 2014 ‐ 2014 ‐ 2014 ‐ 2014 ‐ 2014 ‐ 2014 ‐ 2014 ‐ 2014 ‐ 2014 ‐ 2014 ‐ 2014 ‐ 51 52 01 02 03 04 05 06 07 08 09 10 11 Week Number • AWD Cases remain steady
Cumulative count 180 Trend of Priority Diseases, Week 51 1 ‐ 2013 to Week 11, 2014 160 756 756 140 120 120 100 Cases C 80 Suspected Measles 60 40 20 20 0 2013 ‐ 2013 ‐ 2014 ‐ 2014 ‐ 2014 ‐ 2014 ‐ 2014 ‐ 2014 ‐ 2014 ‐ 2014 ‐ 2014 ‐ 2014 ‐ 2014 ‐ 51 52 01 02 03 04 05 06 07 08 09 10 11 Week Number • Measles again on rise – let’s take a closer look
Measles Epidemic Curve, Wee ek 51 2013 ‐ Week 10 2014 Where is this rise coming from? 350 350 300 250 200 Cases 150 100 50 0 51 52 01 02 03 04 05 06 07 08 09 10 2013 2014 Epid demiologic Week 2013 2014 51 52 01 02 03 04 4 05 06 07 08 09 10 Sum of Deaths 0 0 0 22 24 0 0 35 18 0 0 0 0 Sum of Cases Sum of Cases 0 0 6 6 18 18 102 102 262 262 15 15 58 58 281 281 324 324 86 86 44 44 36 36 106 106
Measles Epidemic Curv ve, Week 7 ‐ 10 2014 120 100 Yuai Yida 80 80 UN HOUSE Tomping Nasir Cases 60 Melut Malakal Lankien 40 Gorom Bor Bor Bentiu 20 Awerial 0 07 08 09 10 Epidemiologic W Week Zooming in on the last few weeks, it is clear that g most cases now occurring in Yida and Yuai g No reports received from Yida and Yuai for wee k 11 Recommendation: urgent vaccination needed h ere Vaccination done in Lankien
Cumulative count 3000 Trend of Priority Diseases, Week 51 1 ‐ 2013 to Week 11, 2014 26137 26137 2500 2000 Cases 1500 Malaria 1000 500 500 0 2013 ‐ 2013 ‐ 2014 ‐ 2014 ‐ 2014 ‐ 2014 ‐ 2014 ‐ 2014 ‐ 2014 ‐ 2014 ‐ 2014 ‐ 2014 ‐ 2014 ‐ 51 52 01 02 03 04 05 06 07 08 09 10 11 Week Number • Cases generally increasing, likely because of ra ains Recommendation: improve drainage; distribute m mosquito nets
Meningitis Meningitis • No cases reported in Week 11 • 2 cases reported from IMC Malak kal in week 10 (from IDSR) Two <5 • • No additional info at present • 2 cases reported in Juba 3 in week 10 (from line list) • 2 17yo F, both with clear CSF and negat tive Pastorex (CSF referred to AMREF) Recommendation: need to follow up with IMC Malakal for more information – esp whether any samples taken for testing
M Meningitis Update i iti U d t e Jan ‐ March 2014 J M h 2014 • Meningitis outbreak was confirmed d in South Sudanese refugee camps in Northern Uganda. As of 10 th March h cases reported among refugees in Arua (6/57=10 5%) and Adjumani (23/60 (6/57=10.5%) and Adjumani (23/60 0=38 3%) 0=38.3%). • Seven suspected meningitis cases a and five deaths (CFR=71.4%) were recorded in Kapoeta North and Bud di county between week 6 and 8. One CSF sample sent to AMREF was neg CSF l t t AMREF gative for Neisseria meningitidis. ti f N i i i itidi • Nine (9) suspected meningitis case s and 3 deaths (CFR= 37.5%) reported from Kajo Keji county between wee ek 7 and 11. Three CSF samples forwarded to AMREF were all negat tive for Neisseria meningitidis. • A total of 27 cases have been reporte ed from Aweil Civil Hospital, Northern Bahr el ghazal between week 1 and 9 el ghazal between week 1 and 9 • One suspected case reported from M Mingkaman PHCC, Lakes • Abyei reported 1 death in week 9 • Juba 3 reported 2 cases in week 10.
Other Diseases of Public Other Diseases of Public Health Importance Health Importance • No reported cases of cholera, NN NT, AJS, VHF • One case AFP in Awerial, testing o ongoing • ~150 cases of pruritic skin rash re eported from Tomping (Rwanda area) in Week 11 area) in Week 11 • Whole ‐ body pruritic maculopapular ras sh, no other symptoms • Both sexes, all ages • Cases highest at beginning of week, virt C hi h b i i f k i tually none by Thursday ll b Th d Hypothesized to be allergic reaction to food or environment (excessive chlorine in • water?) Recommendations: Tomping health partne R d ti T i h lth t ers to maintain vigilance for return of this t i t i i il f t f thi condition and notify outbreak_ss_2007 if o occurs so that investigation can be undertaken. • Measles, meningitis and hepatitis s E outbreaks reported from Northern Uganda g • As of now, no reports of SSd refugees r eturning to SSd from there • Nevertheless, must maintain vigilance f for these diseases
Under 5 Mortality Rates in IDP camps, week k 51 2013 ‐ week 11 2014 (per 10,000 per day) 18 16 14 12 12 y er 10,000 per day Emergency threshold 10 U5MR: ≥ 2 per 10,000 per day Deaths pe 8 8 6 4 2 0 Wks 51 Wks 52 Wks 1 Wks 2 Wks 3 Wks 4 Wks 5 Wks 6 Week 7 Week 8 Week 9 Week 10 Week 11 Tomping UN House Bor r Bentiu Malakal Awerial A decline in Mortality rates is observed in all IDP cam ps. By week 9, the under 5 mortality rates were below the emergency threshold in all camps.
Crude Mortality rates in IDP Camp ps, week 51 2013 ‐ week 11 2014 (per 10 000 (per 10,000 0 per day) 0 per day) 4.5 4 3.5 3 day s per 10,000 per d Emergency threshold CMR: ≥ 1 per 10,000 per day 2.5 2 Deaths 1.5 1 1 0.5 0 0 Wks 51 Wks 52 Wks 1 Wks 2 Wks 3 Wks 4 Wks 5 Wks 6 Week 7 Week 8 Week 9 Week 10 Week 11 Tomping UN House Bor Bentiu Malakal Awerial Crude Mortality rates are below the emergency thresho old in all camps reporting
Location of death (week 51 Location of death (week 51 2013 week 11 2014) 2013 – week 11 2014) Place of Total Camp Death Deaths • 75% of the deaths occurred in the camps Outs Clinic or • 23% of the deaths 23% of the deaths Camp Camp ide Hospital ide Hospital outside camps Bentiu 30 3 3 3 36 • 2% occurred in clinics or Bor 27 19 9 46 hospitals hospitals UN House 6 1 11 1 18 M l k l Malakal 72 72 1 1 9 9 9 9 82 82 Awerial 34 2 9 9 45 Tomping p g 106 33 3 139 Grand Total 275 7 84 4 366 CSR - DD DC AFRO
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