South Sudan Surveillance Highlights – IDSR & EWARN Epidemiology update Week 47 of 2016 Bulletin available at: http://www.who.int/hac/crises/ssd/epi/en/ CSR - DDC AFRO

Highlights week 47 of 2016 IDSR EWARN System Performance 43% (27 counties attached target completeness of 80%) Top Causes of Morbidity Malaria (40%) AWD (7%) Top cause of mortality S. Malaria 7/24 (29%) EWARN System Performance 67% Top Causes of Morbidity Malaria (20%) ARI (27%) AWD (7%) Top causes of mortality AWD - 3 deaths from Bentiu (2)& Juba 3 PoC (1)

IDSR completeness by week 2014 to 2016

EWARN reporting performance by partner in week 47 of 2016

Highlights Preparedness and response actions Malaria Malaria accounted for 40% and 27% of consultations in nonconflict-affected and IDP areas Analysis of malaria trends at state hub level showed that malaria cases were within expected levels. In the 26 (33%) affected counties; the malaria trends have either returned to normal or are slowly returning to normal Malaria accounted for 29% of mortality in the non conflict areas & 4% deaths in IDPs.

Malaria trends for 2014 to 2016

Malaria trends by state as of week 47 of 2016

Malaria trends in the IDP sites as of week 47 of 2016 Malaria trend in IDPs within expected levels

Cholera Cholera confirmed in nine states [Jubek, Terekeka, Jonglei, Imatong, Eastern Lakes; Western Bieh, Northern Liech; Southern Liech; & Eastern Nile states]. Cumulatively, 3,307 cholera cases including 58 deaths (24 facilities and 34 community) (CFR 1.75%) have been reported in South Sudan Cumulatively 128 (34%) of the samples tested positive for Vibrio Cholerae in the NPHL National and state level cholera taskforce committees are coordinating preparedness and response activities Active transmission currently restricted to Bentiu PoC.

Epidemic curve for cholera cases in South Sudan, from 18 June - 1 December 2016

Cholera cases in South Sudan,18 June - 1 Dec 2016

Cholera Bentiu PoC - week 47, 2016 Most cases are <10 years [and in 2yrs) <10 yrs - 64% <2yrs - 36% Most cases in sectors Sect 3: 27% Sect 2: 24% Sect 1: 9% Oral cholera vaccination 41 (91%) did not receive OCV

Laboratory Updates as of 1 Dec 2016 State Culture results New positives in week 47 Cumulative Positive Cumulative Negative Total tested Eastern Nile  0 5 Jonglei 1 4 Jubek 73 126 199 Terekeka 2 Eastern Lakes 17 38 55 Imatong 7 8 Fangak 13 26 39 Wau 6 Boma Northern Liech 11 28 Southern Liech Eastern Nile (Pigi) 00 128 241 369 128 confirmed cases in 9 states 11 confirmed cases in Northern Liech

Measles New suspect measles cases reported in Aweil South (1); Wau (2); Gogrial West (6). Recent outbreak confirmed in Wau; and a cumulative of 13 counties with confirmed measles in 2016. Comprehensive response including reactive measles vaccination underway in Wau. Since the beginning of 2016, a total of 1,851 suspect measles cases including at least 19 deaths (CFR 1.03%) have been reported countrywide Continued vigilance - detect and test suspect measles cases as we head into the dry season during which transmission is expected to increase

HEV Mayom & Abyei Two clusters of acute jaundice syndrome suspected to be due to HEV have been reported in Mayom [involving 27 cases including 9 deaths since 29/05/2016] and Abyei [involving 8 cases including 4 deaths [since 25 Oct 2016]. Four of 16 samples were PCR positive for HEV. Further laboratory testing is to date negative for Ebola; Marburg; RVF; & CCHF by PCR. Arboviral testing is underway. Additionally, three of six samples tested in Geneva were HEV [PCR] and malaria positive. All six samples were positive for malaria

Preparedness and response actions Integrated approach for cholera response including targeted vaccination with OCV in areas with active transmission Cholera evaluation - updating EPR plan & guidelines Enhanced measles surveillance and case based investigation Enhanced surveillance for meningitis Timely and consistent submission of weekly reports Response to HEV cases in Abyei and Mayom

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