WEEKLY BULLETIN ON OUTBREAKS
AND OTHER EMERGENCIES
Week 33: 14 - 20 August 2023
Data as reported by: 17:00; 20 August 2023
...
South Sudan
Measles
5 722 Cases
140 Deaths
2.5 % CFR
EVENT DESCRIPTION
The measles outbreak in South Sudan, initially declared
by health authorities on 23 February 2022, remains active
and has further expanded to affect multiple counties
across all 10 States and three administrative areas. This
year, among the affected counties, some presented
an atypical situation. Indeed, during week 24 (ending
18 June 2023), a suspected viral haemorrhagic fever
outbreak was reported in Longechuk county, Upper Nile
State, and the conclusive findings were consistent with an
outbreak of measles and cases of malaria. Furthermore,
amidst the ongoing crisis in Sudan, counties that are
witnessing population movements due to refugees
and returnees from Sudan have observed a rise in the
incidence of measles cases.
Although there appears to be a declining trend with fewer
than 100 cases reported in the past two epi-weeks (32
and 33), precisely 73 and 50 suspected measles cases,
respectively, the risk factors associated with the outbreak
persist. A nationwide measles vaccination campaign,
implemented in April and May 2023, targeted 2 597 415
children aged 6-59 months, achieving coverage of 92%
(2 383 771 children). However, certain counties like Renk
and Duk experienced low coverage rates, necessitating
supplementary immunization efforts. Also, several
counties, including Renk, Ulang Rubkona, and Aweil
North, continue to report suspected measles cases
stemming from the returnees from the Sudan crisis.
Cumulative data for 2023 up to week 33 (ending on
August 20) reveals 5 722 suspected cases, 424 of which
were laboratory-confirmed, resulting in 140 related
deaths with the case fatality ratio (CFR) of 2.5%. Most
cases, 53.7% (n =3 073) are children under five and
13.7% (n=783) of cases are children under one. Among
the reported cases, about 45% are female and 55% are
male. Further analysis shows that 40.6% (n= 2 322) of the
reported cases this year were unvaccinated and 43.5%
(n=2489) with unknown measles vaccination status.
Overall, the recent epidemiological weeks (week 30-
33) indicate a significant reduction in new suspected
cases and related deaths, with 472 suspected cases
and 22 deaths, compared to the preceding four epiweeks
(weeks 26-29), which reported 1 571 suspected
cases and 85 deaths. This decline is likely attributed to
intensified response measures at the points of entry and
reactive campaigns conducted.
PUBLIC HEALTH ACTIONS
• With regard to the ongoing Sudan crisis, the country
is developing a one-country plan that includes measles
situation.
• A measles mop up and reactive campaign activities
plan has been developed and submitted to partners for
support. A total of 15 counties are targeted for the reactive
campaign, and 14 counties targeted for points of entry
and transit post-vaccination.
• Measles case management (including vitamin A
supplementation), surveillance, and risk communication
activities in locations with suspected and confirmed
outbreaks are ongoing. In collaboration with the Ministry of
Health and partners, WHO is prepositioning Interagency
Emergency Health Kits to support case management in
counties with active outbreaks.
• A robust system of enhanced surveillance is actively
underway in silent counties, this involves systematic
sample collection and regular reporting mechanisms.
To encourage measles vaccine acceptance and early
treatment-seeking behaviours, communities are being
engaged through tailored communication campaigns
emphasizing the safety and benefits of vaccination while
dispelling misconceptions around the disease.
SITUATION INTERPRETATION
South Sudan is one of countries with a fragile health system
and the ongoing protracted humanitarian situation further
complicate the ability to effectively respond to any declared
outbreak. The high proportions of unvaccinated (40.6%)
and individuals with unknown measles vaccination status
(43.5%) among suspected measles cases reported are
concerning and call to double efforts to improve routine
vaccination coverage against measles. The Ministry of health’s
partners should seize this opportunity to increase
support to the country in achieving the vaccination
objectives against the disease. Strengthening health
systems, sustaining vaccination efforts, improving data
management, and fostering community engagement are critical to
effectively curb the measles outbreak’s impact.
https://apps.who.int/iris/bitstream/handle/10665/372631/OEW33-1420082023.pdf
