South Sudan conducts a full-scale simulation exercise to test Bundibugyo virus disease (BVD) readiness

The Ministry of Health of South Sudan, together with the National Public Health Institute (NPHI), and with support from the World Health Organization (WHO), the African Centre for Disease Control and Prevention (Africa CDC), UNICEF, and other partners, conducted a five-day full-scale simulation exercise (SIMEX) from 19 to 24 October in Juba, Yei and Yambio to test the country’s readiness for Bundibugyo virus disease (BVD).

South Sudan has not reported any BVD case so far. South Sudan is effectively using this time to build her BVD readiness capabilities. In this preparedness and readiness period, South Sudan has set up surveillance systems that have to date detected 71 alerts, verified 23 credible alerts that met the BVD standard case definition, before testing them negative at the established national public health laboratory. The suspected alerts meeting the BVD case definitions were safely isolated in the designated holding Areas that have been established in the 15 high-risk counties that border DRC and Uganda. The prioritization of counties bordering DRC and Uganda is a strategic choice made by the National preparedness and readiness steering committee to focus the limited assets and resources. This area-based preparedness and readiness capacity building in the 15-priority counties focuses on early detection, timely notification, investigation, isolation, confirmation and containment (including contacts tracing) loop. There is no complacency among the government, health workers or partners. Everyone remains mobilized.

The full-scale simulation exercise is part of the country’s efforts to test country’s preparedness capacity to prevent, detect, and manage any suspected cases of Ebola. Its’s objective is to test and validate capabilities for early detection, timely notification and investigation, rapid response, and effective coordination at national, county and community levels, in view of the ongoing BVD outbreak in the Democratic Republic of Congo (DRC) and Kenya.

“As of October, South Sudan’s readiness level stands at 72.5 percent with varying levels of readiness in the11 different pillars. The simulation exercise is critical to test if these pillars can coherently work together at the right speed and technical accuracy to effectively contain any potential Ebola virus importation” Said Dr Ader Macar Aciek, Executive Director, National Public Health Institute (NPHI) “During the simulation exercise, the system will be activated including coordination, early detection, infection prevention and control, case management, risk communication and community engagement and safe/dignified burial.” This is the time to test our capabilities for BVD outbreak containment before we are confronted by the virus itself.”

The SIMEX involved 10 participating sites (3 in Yambio, 3 in Yei and 4 in Juba), all supported by 9 facilitators, 9 evaluators and 9 observers. The exercise was managed by at least 3 facilitators (one in each of the three preparedness hubs in the country’s adopted hub and spoke readiness and response structure). And all three test locations were coordinated by a command-and-control centre at the national level. In the field, over 100 participants from Ministry of Health, National Public Health Institute, and health implementing partners, facilitated by WHO, UNICEF, Africa CDC, UN/IOM and FHI/360 Strides Project. The exercise was designed to test the detection-to-containment loop in line with IHR/Emergency Committee temporary recommendations. Hypothetical scenarios of multiple suspected cases of Ebola virus disease (EVD) were used in the 10 simulation sites of three hubs. “A lot has been done BUT more needs be done to close the remaining gaps. This simulation exercise is critical to evaluate and find the remaining operational capacity gaps in our outbreaks management”, said Dr Moses Ongom, WHO Representative (OIC) for South Sudan. “Several drills and functional exercises have been conducted in high-risk areas leading up to this full-scale simulation.”

In this full-scale simulation exercise, we tested ability to recognize suspected Ebola, investigate cases, patient referral, isolate credible cases, including donning and doffing of personal protective equipment (PPE); preparation of chlorine solutions for disinfection; safe collection, packaging and transportation of blood samples (pre-analytic phase); terminal disinfection, vehicle disinfection; and waste management at healthcare centers; safe and dignified burials; data management, analysis and interpretation; reporting; contacts identification, listing/tracing and daily follow up; screening of travelers at a designated points of entry (POE) and testing the linkages and communication with the EVD hotlines responding to the scenario of a potential EVD outbreak in South Sudan.

The full scale simulation exercise also tested overall coordination and communication at national and sub-national levels and the linkages between the three levels of government; surveillance, and reporting of public health events; public health emergency operations Centre (PHEOC) activation, case management at designated isolation/treatment units; infection prevention and control practices; disinfection and waste management; risk communications; engagement of communities; finance and administration; operations support and logistics; movement of emergency supplies and equipment, Entry/exit screening of travelers, PHEOC ability to coordinate the multiple entities, collaboration of the various institutions among others.

Following the conclusion of the SIMEX, facilitators and participants reviewed and evaluated the performance of all involved actors in order to generate immediate and short term actions to close the identified gaps.

The Ministry of Health, the National Public Health Institute, the United Nations and partners have been working collectively on BVD preparedness since the onset of the outbreak in DRC, Uganda, and more recently Kenya and will continue to strengthen measures.

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Based on reporting by RELIEFWEB