South Sudan IDP Surveillance Epidemiology update Week 05 of 2016 (17 th February, 2016) CSR - DDC AFRO

Completeness Week 5 and Cumulative Completeness SystemNo. HFWeek 5Cumulative 2016 EWARS6542/65 (65%)233 (72%)

Sum of Consultations – Week 05 and the cumulative for 2016 The total consultations since 2014 is above 10,000 minimum and the maximum is above 30, 000 per week. Consultations in W05 of 2016Cumulative consultations for 2016 EWARS 23, ,167

CSR - DDC AFRO The highest consultations were recorded by IRC Sector 4 Clinic followed by World Relief PHCC Consultations by IDP Sites week 05, 2016

CSR - DDC AFRO ARI has surpassed Malaria as the top cause of morbidity among IDPs in week 05 Top Causes of Morbidity among IDPs,

Diseases Trend – week 05, 2016 DiseaseNo. cases in W % morbidity Measles190% Malaria5,79925% ARI597826% AWD229010% ABD2151% Other8,83138%

ARI incidence by site - week to 5 of 2016 ARI incidence is higher in week 05 of 2016 When compared to 2014 and 2015 the same week.

Sum of ARI by site - week 05 of 2016 The highest cumulative % for ARI cases were reported in UNIDO Duong PHCC and UNIDO Nyaduong PHCU

AWD incidence for 2016 is lower when compared to 2014 and higher when compared to AWD by IDP site for week 51, 2013 to 05 of 2016

The highest cumulative % for AWD cases were reported from UNIDO Mayendit PHCC and IRC ER PoC Sum of AWD IDP site for week 05 of 2016

Kala-Azar Updates week 5, 2016  In week 5 no health facility reported.  2016 Cumulative cases: 82 including 2 deaths (CFR 2.4%)  Primary Cases 71 (87%)  Relapse 9 (11%)  Defaulters 1 (1.2%)  Most affected groups  Male: 59 (72%)  Persons aged ≥ 15 yrs 34 (42%)  Locations: Majority of cases reported from  Lankien: 35  Ulang: 20  Melut: 13

Measles Updates

Brief on Measles in RSS in 2016 as at 15 Feb 2016 At least 125 suspect measles cases reported from 7 IDP sites and 10 counties with the majority reported from Mayom, Agok, and Mayendit. 10 measles cases confirmed in Agok (1), Mayendit (2), Rumbek Center (2), Mangatain IDP (2), UN House PoC (1), Gogrial West (1), and Aweil Center (1). A total of 18 additional measles samples were received in the NPHL and will be tested on 16 Feb 2016.

Summary of measles cases by location in 2016 StateCounty Measles suspect cases Measles confirmed Samples tested Pending samples Partners CESMangatain IDP222 Youth for mission Organization CESUN House PoC111 IMC, Magna CESJuba1 EESMagwi77 LakesRumbek Center424 LakesYirol East10 LakesYirol West2 NBGAweil Center111 1 UnityAbiemnhom1 UnityMayendit16212 MSF-OCA, UnityMayom262 4CARE, MSF-CH UnityLeer (Adoc)42 2MedAir UnityBentiu PoC16 IRC, IOM, World Relief, MedAir WarrapAgok MSF-CH, Goal WarrapGogrial West212 WarrapTwic40 GOAL WBGWau40 WESIbba11 WESTambura30 Total

Suspect measles case distribution by week in 2015/16

Suspect measles case distribution by age and sex in 2016

Meningitis Updates

Since the beginning of 2016, clusters of suspect meningitis cases have been reported in two main locations. – In Eastern Equatoria, a total of 8 suspect cases including 3 deaths (Case Fatality Rate [CFR] 37.5%) have been reported since 5 th January – In Bentiu PoC, 3 suspect cases including 1 death have been reported since beginning of No new suspect cases reported since the update of 12 February 2016.

Eastern Equatoria 2 counties in EES, Torit and Magwi are affected with most cases reported from Torit 7 (87.5%) Torit County: 7 suspect cases have been reported from week 53 of 2015 all from Nyong Payam where Airport view and Hai Korton are the most affected villages. with the weekly attack rates varying from cases per 100,000 population which is way below the alert threshold of 5 cases per 100,000 population. Magwi County, 1 suspect case was reported in week 53 of 2015 with an attack rate of 0.4 cases per 100,000 population

The suspect meningitis cases in Torit are distributed as follows: – The initial case was a 19-year-old female from Airport view village, Nyong Payam in Torit county with 2 January as the date of onset of symptoms – There are 3 suspect cases admitted presently in Torit State Hospital – Of the 8 suspect cases reported from Torit, 5 (62.5%) were years while the rest 3 (37.5%) were 1-14 years of age.

AgeFMTotal% <1yr yrs yrs yrs Total Case Distribution by Age and Sex

Overall, the observed trend in both areas remains below the alert and epidemic threshold for epidemic meningitis. In IDP sites, at least 2 confirmed cases of epidemic meningitis are required to confirm an outbreak. Preliminary culture results for the three samples collected in Torit and tested at the National Public Health Laboratory showed that two of the samples were contaminated while the third sample showed no growth after 72 hours of microbial culturing.

Bentiu PoC In Bentiu PoC a total of 3 cases including 1 death have been reported in 2015 with a cumulative of 15 suspect cases including 7 deaths reported since week 48 of None of these cases tested positive for epidemic meningitis following rapid diagnostic testing. There are currently no suspect cases admitted in Bentiu PoC with the last case reported in week 3 of 2016.

Progress in Responding to the suspect meningitis outbreaks At the national level, all preparedness and response activities are being coordinated by the national Epidemic Preparedness and response committee. At the local level, the state taskforce in Torit has been activated to coordinate preparedness and response activities The state rapid response team has been deployed to support preparedness and response activities and has submitted four samples to the national level. On 16 February 2016, the national rapid response team travelled to Torit to support preparedness, investigation and response activities at the local level preparations are underway to conduct preventive vaccination campaign using MenAfriVac in the seven nonconflict affected states.

Planned activities and Way forward Surveillance for suspect meningitis cases is ongoing countrywide Support local response teams and health care workers on meningitis case detection, sample collection and processing, case management, social mobilization, and reactive vaccination. Sensitize the public on meningitis presentation, prevention, and control Disseminate regular updates as the situation evolves

IDP Mortality Trends – Week 05, 2016 Total of 30 deaths were reported from mortality line lists received from:  Bentiu (25)  Malakal (1)  Juba 3 (3)  Akobo (1)  Wau Shiluk (0) 37% (11) in under 5 years with the most common cause of in morbidity all age groups being SAM

Mortality by IDP site & age in week 05 of 2016 AkoboBentiu Juba 3 MalakalGrand Total Cause of Death by IDP site ≥5<5yrs≥5<5yrs≥5 Chronic cough 2 2 Chronic diarrhoea 1 1 malaria 1 1 pneumonia Rabies 1 1 SAM 3 3 Unknown Severe Acute Asthma 1 1 Pulmonary TB 1 1 Apneic attack 2 2 Respiratory failure + nephrotic syndrome 1 1 Post trauma 1 1 Neurological disease 1 1 Chronic diarrhoea 1 1 Anaemia + bloody diarrhoea 1 1 Vomiting + abdominal distension 1 1 Liver abscess 1 1 Kwashiorkor + Severe acute malnutrition 1 1 Dehydration + AWD 1 1 Severe dehydration 1 1 Gastro-enteritis 1 1 Thryroid Cancer 1 1 Grand Total

Under 5 Mortality Rate – Week 51, 2013 to Week 05, 2016 CSR - DDC AFRO The U5MR were below the emergency threshold of 2 death per 10,000 per day

Crude Mortality Rate – week 51, 2013 to week 05, 2016 CSR - DDC AFRO The CMR is below the emergency threshold of 1 death per 10,000 per day

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