South Sudan IDP South Sudan IDP P Sur veillance P Sur veillance - - PowerPoint PPT Presentation

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South Sudan IDP South Sudan IDP P Sur veillance P Sur veillance - - PowerPoint PPT Presentation

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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

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SLIDE 1

South Sudan IDP South Sudan IDP

Epidemiology upd p gy p Weekly Disease Surveil as of 17th Ma

d b i li

Email: outbreak_ss_2007@

Prepared by Dr. Boris Pavlin, W

_ _ @

CSR - DD

P Sur veillance P Sur veillance

date based on lance System Report arch 2014 9pm

O S id i l i

@yahoo.com

HO Surge Team Epidemiologist

@y

DC AFRO

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SLIDE 2

Caveat about all following slides: Caveat about all following slides: Most sites have not reported on prev when HC Meeting Presentation is pre when HC Meeting Presentation is pre misleading suggestion that cases of a

Recommendation: If at all possib to send previous surveillance wee HC Meeting get HC Meeting get

vious week by Monday evening epared, hence they may give a epared, hence they may give a all diseases are decreasing.

le, health partners are requested ek reports by Monday evening, so ts accurate data ts accurate data

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SLIDE 3

Completeness and Timel Completeness and Timel week

  • Clinics are requested to repo

previous epidemiologic week p p g

  • Data By Camp
  • Camps reporting 7/21

p p g /

  • Reports received on time: 6/2
  • Data By Site/Clinic
  • Sites reporting: 8/44
  • Reports received on time: 8/4

iness Data for the past iness Data for the past

  • rt by Monday PM on data for

k (Monday‐Sunday) ( y y)

21 44

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SLIDE 4

Completeness Data Completeness Data

  • Most sites do not provide da

difficult to describe trends m

  • There has been a modest up
  • verall
  • verall
  • Faltering over last few week
  • Recommendation: to improv

from rarely‐reporting sites), y p g ), actively follow up with sites ata consistently, making it meaningfully g y ward trend in completeness

s

ve completeness (particularly , surveillance team should , s each Monday.

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SLIDE 5

1081 1200

Total Consultations by Camp, Week 11,2014

800 1000 575 60 600 800 400 600 200 92 UN House Tomping Bor Ben 1050 808 00 639 ntiu Melut Nasir Gorom

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SLIDE 6

3000

Trend of Priority Diseases, Week 51

2000 2500 1500 2000 Cases 1000 C 500 2013 ‐ 51 2013 ‐ 52 2014 ‐ 01 2014 ‐ 02 2014 ‐ 03 2014 ‐ 04 2014 ‐ 05 2014 ‐ 06 2014 ‐ 07 2014 ‐ 08

  • Proportional morbidity in Week 11 contribute
  • Malaria and watery diarrhoea remain by far t

Week Number

y y

1‐2013 to Week 11, 2014

Bloody Diarrhoea Malaria Suspected Measles Watery diarrhoea 2014 ‐ 09 2014 ‐ 10 2014 ‐ 11

ed by these four diseases together was 32% the greatest burden g

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SLIDE 7

300 350

Trend of Priority Diseases, Week 51

250 300 200 Cases 100 150 C 50 100 2013 ‐ 51 2013 ‐ 52 2014 ‐ 01 2014 ‐ 02 2014 ‐ 03 2014 ‐ 04 2014 ‐ 05 2014 ‐ 06 2014 ‐ 07 2014 ‐ 08

  • Cases of ABD are decreasing, but this is largely

Week Number

previously reported a high burden of ABD

1‐2013 to Week 11, 2014

l Cumulative Count 2102

Bloody Diarrhoea 2014 ‐ 09 2014 ‐ 10 2014 ‐ 11

y a reflection of non‐reporting by sites that had

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SLIDE 8

1800 2000

Trend of Priority Diseases, Week 51

1400 1600 1000 1200 Cases 600 800 C 200 400 600 200 2013 ‐ 51 2013 ‐ 52 2014 ‐ 01 2014 ‐ 02 2014 ‐ 03 2014 ‐ 04 2014 ‐ 05 2014 ‐ 06 2014 ‐ 07 2014 ‐ 08

  • AWD Cases remain steady

Week Number

Cumulative count 13501

1‐2013 to Week 11, 2014

Watery diarrhoea 2014 ‐ 09 2014 ‐ 10 2014 ‐ 11

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SLIDE 9

160 180

Trend of Priority Diseases, Week 51

120 140 100 120 Cases 60 80 C 20 40 20 2013 ‐ 51 2013 ‐ 52 2014 ‐ 01 2014 ‐ 02 2014 ‐ 03 2014 ‐ 04 2014 ‐ 05 2014 ‐ 06 2014 ‐ 07 2014 ‐ 08

  • Measles again on rise – let’s take a closer look

Week Number

Cumulative count 756

1‐2013 to Week 11, 2014

756

Suspected Measles 2014 ‐ 09 2014 ‐ 10 2014 ‐ 11

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SLIDE 10

Measles Epidemic Curve, Wee

350 250 300 350 100 150 200 Cases 50 51 52 01 02 03 04 2013 Epid 2013 51 52 01 02 03 04 Sum of Deaths 22 24 Sum of Cases 6 18 102 262 15 Sum of Cases 6 18 102 262 15

ek 51 2013 ‐ Week 10 2014 Where is this rise coming from?

05 06 07 08 09 10 2014 demiologic Week 2014 4 05 06 07 08 09 10 35 18 58 281 324 86 44 36 106 58 281 324 86 44 36 106

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SLIDE 11

120

Measles Epidemic Curv

80 100 60 80 Cases 40 20

Zooming in on the last few weeks, it is clear that

07 08 Epidemiologic W

g No reports received from Yida and Yuai for wee Recommendation: urgent vaccination needed h Vaccination done in Lankien ve, Week 7‐10 2014

Yuai Yida UN HOUSE Tomping Nasir Melut Malakal Lankien Gorom Bor Bor Bentiu Awerial

most cases now occurring in Yida and Yuai

09 10 Week

g k 11 ere

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SLIDE 12

3000

Trend of Priority Diseases, Week 51

2500 2000 1500 Cases 500 1000 500

  • Cases generally increasing, likely because of ra

2013 ‐ 51 2013 ‐ 52 2014 ‐ 01 2014 ‐ 02 2014 ‐ 03 2014 ‐ 04 2014 ‐ 05 2014 ‐ 06 2014 ‐ 07 2014 ‐ 08 Week Number

Recommendation: improve drainage; distribute m Cumulative count 26137

1‐2013 to Week 11, 2014

26137

Malaria

ains

2014 ‐ 09 2014 ‐ 10 2014 ‐ 11

mosquito nets

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SLIDE 13

Meningitis Meningitis

  • No cases reported in Week 11
  • 2 cases reported from IMC Malak
  • Two <5
  • No additional info at present
  • 2 cases reported in Juba 3 in week 10
  • 2 17yo F, both with clear CSF and negat

Recommendation: need to follow up with whether any samples taken for testing

kal in week 10 (from IDSR)

(from line list)

tive Pastorex (CSF referred to AMREF) IMC Malakal for more information – esp

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SLIDE 14

M i iti U d t Meningitis Update

  • Meningitis outbreak was confirmed

Northern Uganda. As of 10th March (6/57=10 5%) and Adjumani (23/60 (6/57=10.5%) and Adjumani (23/60

  • Seven suspected meningitis cases a

recorded in Kapoeta North and Bud CSF l t t AMREF CSF sample sent to AMREF was neg

  • Nine (9) suspected meningitis case

from Kajo Keji county between wee forwarded to AMREF were all negat

  • A total of 27 cases have been reporte

el ghazal between week 1 and 9 el ghazal between week 1 and 9

  • One suspected case reported from M
  • Abyei reported 1 death in week 9
  • Juba 3 reported 2 cases in week 10.

J M h 2014 e Jan‐March 2014

d in South Sudanese refugee camps in h cases reported among refugees in Arua 0=38 3%) 0=38.3%). and five deaths (CFR=71.4%) were di county between week 6 and 8. One ti

f N i i i itidi

gative for Neisseria meningitidis. s and 3 deaths (CFR= 37.5%) reported ek 7 and 11. Three CSF samples tive for Neisseria meningitidis.

ed from Aweil Civil Hospital, Northern Bahr Mingkaman PHCC, Lakes

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SLIDE 15

Other Diseases of Public Other Diseases of Public

  • No reported cases of cholera, NN
  • One case AFP in Awerial, testing o
  • ~150 cases of pruritic skin rash re

area) in Week 11 area) in Week 11

  • Whole‐body pruritic maculopapular ras
  • Both sexes, all ages

C hi h b i i f k i

  • Cases highest at beginning of week, virt
  • Hypothesized to be allergic reaction to

water?) R d ti T i h lth t Recommendations: Tomping health partne condition and notify outbreak_ss_2007 if o undertaken.

  • Measles, meningitis and hepatitis

Northern Uganda g

  • As of now, no reports of SSd refugees r
  • Nevertheless, must maintain vigilance f

Health Importance Health Importance

NT, AJS, VHF

  • ngoing

eported from Tomping (Rwanda

sh, no other symptoms ll b Th d tually none by Thursday food or environment (excessive chlorine in t i t i i il f t f thi ers to maintain vigilance for return of this

  • ccurs so that investigation can be

s E outbreaks reported from

eturning to SSd from there for these diseases

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SLIDE 16

Under 5 Mortality Rates in IDP camps, week

16 18 12 14 y 8 10 12 er 10,000 per day

Emergency threshold U5MR: ≥ 2 per 10,000 per day

6 8 Deaths pe 2 4 Wks 51 Wks 52 Wks 1 Wks 2 Wks 3 Wks 4 Tomping UN House Bor

A decline in Mortality rates is observed in all IDP cam below the emergency threshold in all camps.

k 51 2013 ‐ week 11 2014 (per 10,000 per day)

Wks 5 Wks 6 Week 7 Week 8 Week 9 Week 10 Week 11 r Bentiu Malakal Awerial

  • ps. By week 9, the under 5 mortality rates were
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SLIDE 17

Crude Mortality rates in IDP Camp (per 10 000

4 4.5

(per 10,000

3 3.5 day 2 2.5 s per 10,000 per d

Emergency threshold CMR: ≥ 1 per 10,000 per day

1 1.5 Deaths 0.5 1 Wks 51 Wks 52 Wks 1 Wks 2 Wks 3 Wks 4 Tomping UN House Bor

Crude Mortality rates are below the emergency thresho

ps, week 51 2013 ‐ week 11 2014 0 per day) 0 per day)

Wks 5 Wks 6 Week 7 Week 8 Week 9 Week 10 Week 11 Bentiu Malakal Awerial

  • ld in all camps reporting
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SLIDE 18

Location of death (week 51 Location of death (week 51

Place of Camp Death Camp Outs ide Clinic or Hospital Camp ide Hospital Bentiu 30 3 3 Bor 27 19 UN House 6 1 11 M l k l 72 1 9 Malakal 72 1 9 Awerial 34 2 9 Tomping 106 33 p g Grand Total 275 7 84

CSR - DD

2013 – week 11 2014) 2013 week 11 2014)

Total Deaths

  • 75% of the deaths
  • ccurred in the camps
  • 23% of the deaths

3 36 9 46

23% of the deaths

  • utside camps
  • 2% occurred in clinics or

hospitals

1 18 9 82

hospitals

9 82 9 45 3 139 4 366

DC AFRO

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SLIDE 19

Comments about m

  • It is critical to understand w

can intervene

  • Yet there are two main barri
  • There is a cultural taboo abou
  • Some deaths ma go n repor
  • Some deaths may go un‐repor
  • Cause of death is rarely known

Recommendation: we must wo

  • Most deaths have occurred

by clinicians, so cause difficu d i d Recommendation: we must do seeking

CSR - DD

  • rtality

hy people are dying so that we iers:

ut talking about dead people

rted rted n because no‐one wants to talk about it

  • rk to break the silence

in the camp rather than attended ult to ascertain d f l h l h more to advocate for early health

DC AFRO

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SLIDE 20

Thank you fo

CSR - DD

  • r Listening

DC AFRO