Somalia Weekly Update Week-39 Ending 30 Sept 2018

cVDPV2 and cVDPV3 Highlights

• The total number of cVDPVs cases isolated from AFP cases is 10 (Four cVDPV2, Five cVDPV3 and one with both cVDPV2 & cVDPV3) • The dates of onset of most recent cVDPV2 is 30 July, 2018 and cVDPV3 is 27 July, 2018; both from Kismayu District of Lower Jubba Region

• One new cVDPV2 and one cVDPV3 positive environmental samples were reported this week from Hamar Weyn and Waberi Districts of Banadir province respectively. The two specimens were both collected on 23 August 2018

cVDPV2 and cVDPV3 isolated from AFP cases 2017-2018

5

cVDPV2 4 1 1

3 cVDPV3 cVDPV2/3 (n=1)

2 2 cVDPV2 and cVDPV3 3 1 2 1 0 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18 Oct-18

List of cVDPV Cases in Somalia

Date of Onset of OPV Doses EPID # Region Province District City/Village Gender Age Results Paralysis IPV OPV Date of last OPV

SOM/HRN/BBT/18/002 Central HIRAN BULO BURTI JAMECO MUBARAK Female 72 11/05/2018 0 0 - cVDPV3 & cVDPV3

SOM/MSH/WRS/18/001 Central MIDDLE SHABELLE WARSHEIKH MUNGAB Male 30 16/05/2018 0 6 06/05/2018 cVDPV3

SOM/MSH/WRS/18/003 Central MIDDLE SHABELLE WARSHEIKH BOHI Male 39 23/05/2018 0 0 - cVDPV3

SOM/GDO/DLO/18/002 South Gedo Dolo KABASA IDP Male 24 26/05/2018 0 6 08/05/2018 cVDPV2

SOM/LJB/KSM/18/005 South LOWER JUBA KISMAYO GULWADE Male 24 24/06/2018 0 4 05/05/2018 cVDPV3

SOM/MSH/MDY/18/002 Central MIDDLE SHABELLE MAHADAY SHAAN Male 42 29/06/2018 0 9 05/05/2018 cVDPV3 TABELHA- SH SOM/BAN/DYN/18/003 Cntral BANADIR DANYILE IBRAHIM Male 36 10/07/2018 0 1 05/05/2018 cVDPV2

SOM/LJB/KSM/18/006 South LOWER JUBA KISMAYO ALANLEY Male 156 27/07/2018 0 6 - cVDPV3

SOM/LJB/KSM/18/008 South LOWER JUBA KISMAYO FANOLE DP Female 24 29/07/2018 0 4 10/07/2018 cVDPV2

SOM/LJB/KSM/18/007 South LOWER JUBA KISMAYO FANOLE IDP Male 96 30/07/2018 0 10 - cVDPV2 Summary Environmental Samples and Lab Classification

Epidemiological Week-2017 Epidemiological Week-2018

Name of Date of District 39 40 41 42 43 44 45 46 47 48 49 50 51 52 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40

Site Establishment

5 6

Waberi 21-Oct 19 Sept. 2017 1 4

VDPV2

cVDPV2 cVDPV2 cVDPV3 cVDPV2 cVDPV3 cVDPV2 cVDPV3 cVDPV3

cVDPV2

5 5 3 3 3 3 3 3 Shangani Urobo 1 20 Sept. 2017 1 3

Shangani Urobo2 17 Aug. 2018

Hamerew

3 5 5 3 5 5 5 14

Kawma 21 Sept. 2017 1 14

cVDPV2 cVDPV3 cVDPV3 cVDPV3 cVDPV3 cVDPV3 cVDPV2 cVDPV2 cVDPV2 cVDPV2 cVDPV2 oini cVDPV2 Egyt. Hodan 23 Nov. 2017 3 5 3 5 5 3

Hosp cVDPV2

Legend 9 cVDPV3

1 Not scheduled 5 NPENT 10 Sent for sequencing

2 Pending 6 Sabin 11 Scheduled but not collected

3 Negative 7 NPENT + Sabin 12 Sabin 2

4 NEV 8 cVDPV2 13 Sabin + NPEV + NEV SIA Activity Calendar Apr – Dec. 2018 Activity Target area Date Status NID 1 bOPV Somaliland and Puntland 30 Apr- 03 May 2018 Campaign completed

NID 1 bOPV South and Central Except Banadir, Lower and Middle Shabelle 5-8 May 2018 Campaign completed

Third response round mOPV2 Campaign Banadir, Lowe Shabelle and Middle Shabelle 5-8 May 2018 Campaign completed

Synchronized mOPV2 Campaign (with South and Central regions without Banadir, Lower and Middle Shablle regions 9 - 12 Jul 2018 Campaign completed Kenya and Ethiopia), Round 1 synchronized with Kenya response campaign

Small scale bOPV Response Banadir, Lower and Middle Shablle regions 23-Jul 2018 Campaign completed

Synchronized mOPV2 Campaign (with South and Central regions with out Banadir, Lower and Middle Shabelle regions 4-8 Aug. 2018 Campaign completed Kenya and Ethiopia), Round 2 synchronized with Kenya response campaign mOPV2 Daynile district 19-22 Sept. 2018 Campaign completed Upcoming Campaigns

NID 1 bOPV synchronized with Kenya All 19 regions in Somalia (Target: 2,499,010 Children) 1-4 October 2018 Campaign in progress and Ethiopia

NID 2 bOPV synchronized with Kenya All 19 regions in Somalia (Target: 2,499,010 Children) 29 Oct-1 Nov 2018 Planned and Ethiopia

In 9 regions of South and Central zones sNID mOPV2 19-22 November 2018 Planned (Outbreak areas). To be synchronized with border regions of Kenya and Ethiopia Outbreak response Post Campaign IM Results: Daynile District Somalia – Mogadishu/Banadir region 22 to 25 Sept 2018 Post Campaign IM Results: Daynile mOPV Campaign, 19-22 Sept, 2018

# 12-59 % 12-59 % Total # of 0-59 % of 0-59 % HHs Aware # 0-11 children # 0-11 children % 0-11 children # 12-59 Province District DFA code # HHs Visited children children children (0-59) children children about the Visisted Vaccinated Vaccinated children seen Vaccinated Vaccinated Vaccinated missed missed Campaign BAN DRK SOM-0204006 120 118 104 88% 228 215 94% 92% 27 8% 71% BAN DRK SOM-0204007 190 269 248 92% 389 376 97% 95% 34 5% 88% BAN DRK SOM-0204015 120 97 85 88% 215 211 98% 95% 16 5% 90% BAN DRK SOM-0204018 152 149 148 99% 225 209 93% 95% 17 5% 97% BAN DRK SOM-0204021 30 37 35 95% 59 57 97% 96% 4 4% 100% BAN DRK SOM-0204022 120 76 75 99% 116 116 100% 99% 1 1% 67% BAN DRK Total 732 746 695 93% 1232 1184 96% 95% 99 5% 85% BAN DYN SOM-0203001 120 37 37 100% 311 304 98% 98% 7 2% 100% BAN DYN SOM-0203002 120 184 176 96% 207 202 98% 97% 13 3% 86% BAN DYN SOM-0203003 120 120 120 100% 260 233 90% 93% 27 7% 99% BAN DYN SOM-0203004 161 175 167 95% 198 175 88% 92% 31 8% 77% BAN DYN SOM-0203005 100 97 92 95% 153 147 96% 96% 11 4% 100% BAN DYN SOM-0203006 120 113 102 90% 180 176 98% 95% 15 5% 98% BAN DYN SOM-0203007 161 140 138 99% 341 334 98% 98% 9 2% 84% BAN DYN SOM-0203008 121 154 154 100% 212 211 100% 100% 1 0% 89% BAN DYN SOM-0203009 120 124 122 98% 147 130 88% 93% 19 7% 100% BAN DYN SOM-0203010 120 120 120 100% 216 206 95% 97% 10 3% 100% BAN DYN SOM-0203011 130 165 154 93% 221 203 92% 92% 29 8% 98% BAN DYN SOM-0203012 160 143 132 92% 307 264 86% 88% 54 12% 99% BAN DYN SOM-0203013 120 95 87 92% 161 149 93% 92% 20 8% 100% BAN DYN SOM-0203014 80 99 98 99% 142 140 99% 99% 3 1% 94% BAN DYN Total 1753 1766 1699 96% 3056 2874 94% 95% 249 5% 94% BAN Total 2485 2512 2394 95% 4288 4058 95% 95% 348 5% 91% LSH AFG SOM-1401020 80 36 35 97% 160 152 95% 95% 9 5% 93% LSH AFG SOM-1401021 80 37 35 95% 154 146 95% 95% 10 5% 95% LSH AFG SOM-1401022 80 34 32 94% 152 145 95% 95% 9 5% 95% LSH AFG SOM-1401023 72 34 33 97% 143 137 96% 96% 7 4% 97% LSH AFG SOM-1401025 80 33 31 94% 151 143 95% 95% 10 5% 96% LSH AFG SOM-1401039 71 33 31 94% 150 141 94% 94% 11 6% 97% LSH AFG Total 463 207 197 95% 910 864 95% 95% 56 5% 95% LSH Total 463 207 197 95% 910 864 95% 95% 56 5% 95% Grand Total 2948 2719 2591 95% 5198 4922 95% 95% 404 5% 92% SIAs Vaccines availability and mOPV2 vaccine management

• mOPV2 vaccine utilization report/July and Aug 2018rounds • Current mOPV2 balance in Mogadishu: 955 vials (2737 used in Danyle districts) out of the 3693 vials in the cold chain. • Recall and disposal of unusable unopened, empty and partially used vials: All used mOPV2 vials are now in Mogadishu for disposal within 2 weeks. • 48 mOPV2 vials were lost throughout the July and August mOPV2 rounds.

• bOPV vaccines for the next 2 rounds (Oct and Nov 2018) are available at country and regional level October bOPV outbreak response to cVDPV3

• SIAs started as planned in Puntland and Mogadishu • Somaliland will start on the 4th of October 2018 • C4D activities started on time: from 25 Sept 2018 for the general population and 30 Sept, a radio drama targeting nomadic communities was broadcasted and will continue during the SIA. Number of children U5 not vaccinated – as per target population/ performance per DFA (district field assistant), Daynile Campaign

404 children under 5 years were captured during the household survey as not having been vaccinated; This totals to an estimated 4,045 children overall.

The percentages of non-vaccinated children, as collated by the household survey, were applied to the target population of children U5 and used to approximate the total number of children missed per DFA Reasons for missed children, Daynile Campaign

“Children Not Available” was the main reason for “children missed” with 57%, followed by “Poor Team Performance” with 25% and “Refusal” with 18%.

The main reason for the child not being available in the Daynile District of Banadir was “Child in School or Madras”, followed by “Parent/ Caretaker Not Available” and “Child in Market, Street or Playground” as well as “Child Travelling”. Reasons for poor team performance, Daynile Campaign

“Child asleep”, “No Team Visit” and “Missed – Unknown” were the three indicators for poor team performance and accounted for 25% of “missed/ non- vaccinated children”. The distribution between the indicators “Child Asleep” and “Missed – Unknown” is almost equal with 46% and 48% respectively, whereas only 5% of households did not receive a team visit. Reasons for refusals, Daynile Campaign

The remaining causes such as “religious reasons” (5%), “no faith in vaccines” (4%), “demand for other services” (4%), “rumour” (3%) and “no response/ other” (3%) were all found to be below 10 percent

Graph.4: Reasons for “Parent / Caretaker Refusal” Daynile, Banadir. Awareness, Daynile Campaign

The campaign awareness rate seem to supersede the vaccination rate AFP Surveillance Week-39 Somalia Weekly EPI/POL Update

18 Epidemiological Curve 01 January 2014 – 05 Aug 2018

16

14

12

10

8

6

4

2

0

2014W01 2014W03 2014W05 2014W07 2014W09 2014W11 2014W13 2014W15 2014W17 2014W19 2014W21 2014W23 2014W25 2014W27 2014W29 2014W31 2014W33 2014W35 2014W37 2014W39 2014W41 2014W43 2014W45 2014W47 2014W49 2014W51 2015W01 2015W03 2015W05 2015W07 2015W09 2015W11 2015W13 2015W15 2015W17 2015W19 2015W21 2015W23 2015W25 2015W27 2015W29 2015W31 2015W33 2015W35 2015W37 2015W39 2015W41 2015W44 2015W46 2015W48 2015W50 2015W52 2016W02 2016W04 2016W06 2016W08 2016W10 2016W12 2016W14 2016W16 2016W18 2016W20 2016W22 2016W24 2016W26 2016W28 2016W30 2016W32 2016W34 2016W36 2016W38 2016W40 2016W42 2016W44 2016W46 2016W48 2016W50 2016W52 2017W02 2017W04 2017W06 2017W08 2017W10 2017W12 2017W14 2017W16 2017W18 2017W20 2017W22 2017W24 2017W26 2017W28 2017W31 2017W33 2017W35 2017W37 2017W39 2017W40 2017W42 2017W44 2017W46 2017W48 2017W50 2017W52 2018W02 2018W04 2018W06 2018W08 2018W10 2018W12 2018W14 2018W16 2018W18 2018W20 2018W22 2018W24 2018W26 2018W28 2018W30 2018W32 2018W34 2018W36 2018W38 Pending Lab Pending ERG Discarded Compatable WPV aVDPV cVDPV2 cVDPV3 cVDPV2 and cVDPV3 Week-39 Somalia Weekly EPI/POL Update

Weekly AFP cases reported by Provinces, 2016-2018 Somalia. (cases are distributed across weeks based on date of onset of paralysis).

PROVINCE

2017W31 2017W32 2017W33 2017W34 2017W35 2017W36 2017W37 2017W38 2017W39 2017W40 2017W41 2017W42 2017W43 2017W44 2017W45 2017W46 2017W47 2017W48 2017W49 2017W50 2017W51 2017W52 2018W01 2018W02 2018W03 2018W04 2018W05 2018W06 2018W07 2018W08 2018W09 2018W10 2018W11 2018W12 2018W13 2018W14 2018W15 2018W16 2018W17 2018W18 2018W19 2018W20 2018W21 2018W22 2018W23 2018W24 2018W25 2018W26 2018W27 2018W28 2018W29 2018W30 2018W31 2018W32 2018W33 2018W34 2018W35 2018W36 2018W37 2018W38 2018W39

Total 2016 Total

Total 2017 Total 2018 Total

BANADIR 30 2 2 1 2 1 1 1 33 2 1 1 1 1 1 1 1 1 1 2 2 2 2 1 1 1 22 GALGADUD 25 1 2 1 1 1 1 1 1 1 27 1 2 1 1 1 1 1 1 1 1 1 1 1 1 1 16 M. SHABELLE 19 1 1 2 1 1 1 1 1 1 24 1 1 1 1 1 1 3 1 1 1 1 1 1 2 17 L. SHABELLE 24 1 1 1 1 1 1 1 2 1 1 2 1 1 1 31 1 2 1 1 2 2 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 24 HIRAN 15 1 1 1 1 1 1 1 1 1 21 1 1 1 1 1 1 1 2 1 10 BARI 24 1 1 1 1 1 1 1 1 1 24 3 2 1 1 2 1 2 1 1 1 1 1 1 18 NUGAL 11 1 1 1 1 10 1 1 1 1 1 1 1 7 MUDUG 14 1 1 1 12 1 1 1 2 1 1 1 1 1 1 2 1 1 15 TOGDHER 11 1 1 1 9 1 1 1 1 1 1 1 1 1 9 GALBEED 19 2 1 2 1 2 20 1 1 1 1 1 2 1 1 1 1 1 3 15 SANAQ 7 1 1 6 1 1 1 1 4 AWDAL 18 1 1 1 17 1 2 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 19 SAHIL 8 1 1 8 1 1 1 1 4 SOOL 5 1 2 1 11 1 1 1 1 1 1 6

23 1

LOWER JUBA 26 1 1 1 1 1 1 1 1 29 2 1 2 1 1 1 1 1 1 1 1 1 1 1 1 2 2 1 1 - BAY 19 1 1 1 2 2 2 1 22 1 4 1 1 1 1 1 1 1 1 1 1 1 1 17 GEDO 21 2 1 1 1 20 1 1 1 1 1 1 1 3 2 1 1 1 2 1 18 MIDDLE JUBA 11 2 1 1 11 1 1 1 1 1 1 1 1 2 10

BAKOOL 9 1 1 1 1 1 10 1 1 1 1 1 1 1 1 8 no. Table Total Somalia 316 7 7 6 9 5 7 10 4 5 7 3 2 8 11 4 7 2 5 3 6 2 5 345 6 4 8 7 4 9 13 7 12 5 5 7 6 4 9 5 8 5 8 8 3 7 6 2 4 11 7 8 7 11 7 6 2 8 10 12 3 7 1 262 - Fourteen (14) new AFP cases were reported last week bringing the total AFP cases reported in 2018 to 262 from 19 Silent (not reporting) for > 8 weeks regions, compared to 280 AFP cases from 19 regions at the same time point in 2017. Reported AFP cases Community Samples collected in silent regions - Sanaq region from Somaliland and Nugal region from Puntland have not reported AFP case in the last 8 weeks Community Samples collected but regions not silent Week-39 Somalia Weekly EPI/POL Update

Classification of AFP cases by status (2017 & 2018) 2017 2018 ZONE PROVINCE Discard Pendin Discard Pendin Total VDPV Total ed g ed g 262 AFP cases BANADIR 33 0 33 20 1 1 22 reported in 2018 GALGADUD 27 0 27 16 0 16 CENTRAL HIRAN 21 0 21 9 1 10 L. SHABELLE 30 0 31 21 0 3 24 M. SHABELLE 24 0 24 13 3 16 BARI 24 0 24 18 0 18 0 1 Puntland MUDUG 11 0 12 13 0 2 15 235 0 17 4 5 cVDPV2 NUGAL 10 0 10 7 0 7 Compat Discarded WPV Pending cVDPV2 cVDPV3 & ible AWDAL 16 0 17 17 0 2 19 cVDPV3 GALBEED 20 0 20 12 0 3 15 SAHIL 8 0 8 4 0 4 Somaliland SANAQ 6 0 6 4 0 4 SOOL 11 0 11 5 0 1 6 TOGDHER 9 0 9 8 0 1 9

17 0 0 BAKOOL 10 0 10 8 0 8 2 2

In process Pending BAY 22 0 22 16 0 1 17 - (lab) Pending ITD ERG SOUTH GEDO 20 0 20 15 1 2 18 LOWER JUBA 29 0 29 19 4 1 24

Chart no. 1 MIDDLE JUBA 11 0 11 10 0 10 no. Table Note: The total number of cVDPV cases are 10 (two (5) cVDPV3, one (4) cVDPV2, one (1) had both cVDPV2 and cVDPV3). Grand Total 345 0 345 235 10 17 262 Week-39 Somalia Weekly EPI/POL Update

Surveillance Indicators by Zone and Region 2018

Annualized NP-AFP Rate by Zone, 2018 14.0 12.0 10.0 11.6 8.0 6.0 6.8 4.0 5.2 5.7 2.0 4.0 0.0 Central Puntland Somaliland South Total Somalia Graph no. 2

Annualized NP-AFP rate by accessibility status, 2018 10.0

8.0 Banadr region-Magnified Banadr region-Magnified 6.0 7.8 4.0 5.3 5.5 5.7 2.0 - In-accessible Partially Accessible Somalia Acceessible Map no. 1 Map no. 2 Graph no. 3 Week-39 Somalia Weekly EPI/POL Update

Surveillance Indicators (NP-AFP rate and Stool adequacy) by district, 2018

. 111/115 districts reported at least 1 AFP case since the first week of 2018

. Of the 111 districts reporting AFP cases in 2018, 107 have annualized NP-AFP rate above 2 per 100,000. In addition, 108 districts have stool adequacy rate of above 80%

Banadr region-Magnified . The remaining 4 districts have not reported any Banadr region-Magnified AFP case in 2018. However, no district in Somalia has been silent for more than 52 consecutive weeks

Map no. 3 Map no. 4 Week-39 Somalia Weekly EPI/POL Update

Number of NP-AFP cases reported across years during the same period (2013-2018) by zone 500

450 453 400

350

300 328

280 250 262 232 237 200

150 144 100 108 114 93 92 89 83 50 74 76 60 57 61 50 55 47 48 55 31 31 45 36 38 40 39 0 CENTRAL PUNTLAND SOMALILAND SOUTH SOMALIA 2013 2014 2015 2016 2017 2018

. Central and Somaliland have reported lower number of AFP cases compared to the number reported in 2017 during the same period. . A total of 426 additional community samples were collected from healthy children. Majority of these samples were collected from access compromised and silent districts of Central and South zones. Week-39 Somalia Weekly EPI/POL Update

Early case detection within 7 days from onset of paralysis at zonal and region levels-2018

Notification within 7 days, Zonal Notification within 7 days, Regional

100% 100% 88 40 55 66 249 22 16 10 24 18 15 7 15 4 6 9 8 90% 90% 16 18 17 249 9 80% 80% 14 18 70% 70% 3

60% 60% 50% 50% 40% 40% 30% 30% 20%

20% 10%

10% 0%

BAY

BARI

SOOL

SAHIL

GEDO

HIRAN

NUGAL

SANAQ

L. JUBA L.

AWDAL

MUDUG BAKOOL

0% M.JUBA

GALBEED

BANADIR TOGDHER

CENTRAL PUNTLAND SOMALILAND SOUTH SOMALIA GALGADUD

L. SHABELLE L. M.SHABELLE CENTRAL PUNTLAND SOMALILAND SOUTH TOTAL 95% (n=249/262) of cases reported in 2018 were notified within 7 days of onset of paralysis. Thirteen (13) AFP cases had delayed notification; [three (3) from Bay, five (5) from Lower Jubba and one (1) from Middle Jubba, Middle Shabelle , Sanaaq , Awdal and Gedo regions. Week-39 Somalia Weekly EPI/POL Update

Summary of AFP surveillance key indicators by Zone, 2018

EV

- NP NP EV %

% Stool % Inv. with NP Notification with

ZONE Adequacy within 48

AFP AFP Rate

cond. cond.

- within 7 Isolated

hours Isolated

Isolation Isolation

Specimen # # AFP cases

NP days

of samples of samples

% % Samples

Cases Cases with lab. result.

Cases Cases with stool in good

# Cases # Cases with Adequate

#

% of cases % of cases with VirusL S

Cases Cases pending lab results

% Cases % Cases with stool in good # cases # with cases virus Sabin like

Central 89 4.0 88 99% 99% 99% 4 85 85 100% 15 9% 7 8%

Puntland 40 11.6 40 100% 100% 100% 2 38 38 100% 3 4% 6 16%

Somaliland 57 5.2 56 98% 100% 96% 7 50 50 100% 5 5% 3 6%

South 76 6.8 73 96% 100% 87% 4 72 72 100% 9 6% 0 0%

Total 262 5.7 257 98% 100% 95% 17 245 245 100% 32 7% 16 7%

Table no.-4 Week-39 Somalia Weekly EPI/POL Update

Summary of AFP surveillance key indicators by Province, 2018 % Stool % Samples Expected # of AFP NP-AFP Rate % inv. within % Notif. % cases with Number of AFP % Stool Adq. condition with EV # Cases with late ZONE PROVINCE Regional U15 Pop. cases as of this (Target 48 hrs. within 7 days SL isolated cases reported (Target >80%) (Target isolated 60 days followup Week 2/100000) (Target >80%) (Target >80%) (Target >10) >80%) (Target >7) BANADIR 1110807 17 22 2.6 100% 100% 100% 100% 12% 14% 5 GALGADUD 267828 4 16 8.0 100% 100% 100% 100% 6% 13% 1 CENTRAL HIRAN 233838 4 10 5.7 100% 100% 100% 100% 5% 0% 0 LOWER SHABELLE 948112 14 24 3.4 100% 100% 100% 100% 12% 5% 2 MIDDLE SHABELLE 375400 6 17 6.0 94% 94% 94% 100% 6% 6% 2 BARI 182218 3 18 13.2 100% 100% 100% 100% 6% 11% 0 PUNTLAND MUDUG 186490 3 15 10.7 100% 100% 100% 100% 0% 23% 0 NUGAL 90921 1 7 10.3 100% 100% 100% 100% 7% 14% 1 AWDAL 244900 4 19 10.3 95% 95% 95% 100% 3% 12% 0 GALBEED 550148 8 15 3.6 100% 100% 100% 100% 4% 8% 0 SAHIL 85949 1 4 6.2 100% 100% 100% 100% 0% 0% 0 SOMALILAND SANAQ 150975 2 4 3.5 100% 100% 75% 100% 25% 0% 0 SOOL 120412 2 6 6.6 100% 100% 100% 100% 0% 0% 0 TOGDHER 317058 5 9 3.8 100% 100% 100% 100% 6% 0% 1 BAKOOL 183178 3 8 5.8 100% 100% 100% 100% 0% 0% 0 BAY 540491 8 17 4.2 94% 100% 82% 100% 19% 0% 1 SOUTH GEDO 312710 5 18 7.7 89% 100% 94% 100% 9% 0% 2 LOWER JUBA 300735 5 23 10.2 100% 100% 78% 100% 0% 0% 4 MIDDLE JUBA 162640 2 10 8.2 100% 100% 90% 100% 0% 0% 0 SOMALIA 636,4810 95 262 5.7 98% 100% 95% 100% 7% 7% 19 Week-39 Somalia Weekly EPI/POL Update

Summary of key AFP surveillance indicators for contacts, 2018

% Contact % Contact % Specimens # Contacts % contacts # Contact Average collected # Contact # Specimens # AFP # % contacts < 5 with stool in with NPEV with Sabin with Sabin ZONE samples with contacts per within 7 days pending lab with NPEV Good Isolated virus like virus Cases CONTACTS age of AFP results isolated Lab result cases Condition isolated Isolated notified Central 89 265 228 3 100% 100% 100% 37 36 16% 9 4% Puntland 40 120 105 3 100% 100% 100% 15 12 11% 9 9% Somaliland 57 168 150 3 100% 100% 100% 18 11 7% 8 5% South 76 228 206 3 100% 100% 100% 22 22 11% 5 2% Somalia 262 781 689 3 100% 100% 100% 92 81 12% 31 4%

Summary of Community Samples collected in 2018 from silent districts, Egyptian hospital and inaccessible districts

PV 1 Sabin & PV3 SUSPECT PV Zone Pending Negative NPENT PV 1 Sabin VPV3 PV 2 Sabin PV 3 Sabin Grand Total Sabin TYPE 2

CENTRAL 47 171 13 1 3 1 2 238 PUNLAND 5 52 11 1 1 70 SOMALILAND 10 32 3 45 SOUTH 31 33 2 2 5 73 Grand Total 93 288 29 1 3 2 1 6 3 426

Of the total 426 community samples collected from healthy children in 2018, 55% were collected from accessible and the rest (45% ) were from access-compromised areas Table no.-5 Week-39 Somalia Weekly EPI/POL Update

Distribution of AFP cases by source of case notification, 2018

Source of AFP cases notification 100% Number of Number of # of cases Notified Proportion of cases 6 Zone 90% 13 7 54 VPVs cases reported by VPV reported by VPV 80% 28 70% 35 60% 16 31 104 CENTRAL 190 89 41 46% 50% 22 40% PUNTLAND 105 40 17 43% 30% 20% 41 17 20 26 104 SOMALILAND 81 57 20 35%

Prop. cases notifed by notifed cases Prop. 10% 0% Central Puntland Somaliland South Somalia SOUTH 159 76 26 34% VPV HFs Other

Key: 1. VPVs: Village polio volunteers Total Somalia 535 262 104 40% 2. HFs: MCH, Hospitals and Private clinics 3. Others: community members, district field assistants, traditional healers Table no.-6 Week-39 Somalia Weekly EPI/POL Update

Proportion of AFP cases reported by different sources 2012-2018

100%

48 50 46 90% 64 138 80% 253 79 70% 104 105 74 60% 104

50% 131

40%

30% 268 191 67 143 163 20% 104 151

10%

25 0% 2 2012 2013 2014 2015 2016 2017 2018

Year of onset VPV HFs Other

The 7 years trend of AFP reporting source shows, the number of AFP cases notified by Health Facilities (HFs) has increased this year Week-39 Somalia Weekly EPI/POL Update

AFP cases by specific sources notification, 2012-2018

NOTIFIED BY VACCINATORS AND TRADITIONAL NOTIFIED BY COMMUNITY AND VOLUNTEERS NOTIFIED BY HEALTH FACILITIES 300 HEALERS 250 300

250 250 37 17 200 14 49 200 200

150 78

150 150 74 10 4 16 100 184 109 17 100 143 100 7 26 111 8 10 6 6 75 12 12 4 138 63 4 7 104 10 52 50 21 1 72 53 5 7 50 50 9 77 5 1 0 9 41 36 0 28 31 28 33 40 26 22 8 4 4 31 25 29 3 6 20 12 14 8 4 12 3 20 0 0 2 0 0 08 1 07 24 14 9 18 17 0 0 1 1 4 5 0 6 7 1 70 8 2012 2013 2014 2015 2016 2017 2018 0 20 3 2 0 0 0 0 2012 2013 2014 2015 2016 2017 2018 2012 2013 2014 2015 2016 2017 2018 CAMPAIGNS DISTRICT FIELD ASST DPO HEALTH POST HOSPITAL MCH CHW COMMUNITY HOUSEHOLD VOLUNTEERS NID VACCINATOR TRADITIONAL HEALER PRIVATE CLINIC PRIVATE PHARMACY Week-39 Somalia Weekly EPI/POL Update

Distribution of AFP cases by lifestyle, age group and sex, 2018

Distribution of AFP cases by Life style per Distribution of AFP cases by Age group Distribution AFP cases by Sex . Of the 262 AFP cases zone-2012-2018 2012-2018 2012-2018 100% 100% 100% reported in 2018, 46% 33 19 32 52 90% 90% 72 90% 73 (n=120) and 37% (n=97) 80% 112 80% 83 80% 65 181 129 152 120 152 129 came from urban and 281 189 70% 70% 70% 324 252 166 92 rural populations 60% 60% 60% respectively. Nomadic 50% 50% 50% 283 87 129 249 293 communities account for 40% 117 40% 348 40% 51 144 124 97 189 150 30% 30% 129 30% only 17% (n=45). 164 132 156 20% 20% 20% 56 221 167 115 . 72% (n=189) of cases are 80 31 91 70 10% 97 69 45 10% 10% aged less than 5 years. 0% 0% 0% . 2012 2013 2014 2015 2016 2017 2018 2012 2013 2014 2015 2016 2017 2018 2012 2013 2014 2015 2016 2017 2018 42% (n=132) AFP cases Nomadic Rural Urban <5 Yrs ≥ 5 Yrs Female Male are female. Graph no.-10 Graph no.- 11 Graph no.-12 Week-39 Somalia Weekly EPI/POL Update

AFP surveillance indicators by district accessibility status, 2018

# of AFP # of Cases % of Cases Number of % # of U-15 Pop in this NP AFP % of Stool % inv. Within % of Notif. % cases with Accessibility cases reported by reported by cases with Specimens districts area rate adequacy 48 hrs. within 7 days Sabin like virus Reported VPVs VPVs lab result with NPEV

Inaccessible 17 619,320 35 23 66% 7.8 34 100% 100% 94% 6% 3%

Partially accessible 23 1,720,826 67 19 28% 5.3 65 96% 100% 88% 6% 2%

Accessible 75 4,024,663 160 62 39% 5.5 146 99% 101% 98% 7% 10%

National 115 6,364,810 262 104 40% 5.7 245 98% 100% 95% 7% 7% Table no.

- 7 7 Despite accessibility challenges, majority of indicators are above global standards Week-39 Somalia Weekly EPI/POL Update

AFP surveillance indicators by population lifestyle, 2018

% of <15 # of AFP # of % of Number % of % of % inv. % of % % cases of cases cases Accessibility populati cases Cases Cases NP AFP Stool Within Notifie Specim with on in Reporte reported reported with lab with lab adequacy 48 hrs. d ens Sabin like rate result result the area d by VPVs by VPVs within with virus within 14 days 7 days NPEV

Nomadic 28.80% 45 23 51% 3.3 43 72% 96% 100% 91% 0% 12%

Rural 25.90% 97 47 48% 7.8 89 78% 100% 100% 99% 7% 6%

Urban 45.30% 120 34 28% 5.5 113 81% 98% 99% 93% 8% 5%

National 100% 262 104 40% 5.5 245 78% 98% 100% 95% 7% 7% Week-39 Somalia Weekly EPI/POL Update

Validation and zero dose investigation of AFP cases, 2018 AFP Cases Validation Zero Dose Investigation # of AFP cases # of AFP % of AFP # of Zero dose AFP # of Zero dose % of Zero dose Comment Zone Reported cases cases Zone cases Reported AFP cases AFP cases Validated Validated investigated investigated Central 89 31 35% 6 zero-dose Central 9 6 67% cases came from Somaliland 57 20 35% Somaliland 1 0 0% accessible areas, South Zone 76 37 49% South Zone 21 12 57% 9 from partially Puntland 40 25 63% Puntland 1 1 100% accessible and 17 from Grand Total 262 113 43% inaccessible areas Table no.-8 Table no.-9 . Of the 262 AFP cases reported in 2018, 43% (n=113) were validatedGrand by the Total RPOs. Of the 11332 AFP cases validated,18 81 were from accessible,56% 19 from partially accessible and 13 from inaccessible districts . There were 32 zero OPV dose AFP cases reported in 2018, out of which 56% (n=18/32) were investigated Week-39 Somalia Weekly EPI/POL Update

Total AFP cases Tracking lab results of AFP cases 262

Tracking AFP with stool specimens AFP cases with AFP cases without 1 5 stool specimens stool specimens cVDPV type 2 17 and 3 co- infection 38 cVDPV2 262 0

cVDPV3 With lab En route In the lab Other viruses results

neg st 245 17

197 in lab

cVDPV type 2 and cVDPV2 cVDPV3 SL EV -ve 3 coinfection 1 4 5 16 22 185 Week-39 Somalia Weekly EPI/POL Update

Lab performance indicators for AFP surveillance in Somalia, 2018 # # Specimen # Specimens # Specimen % of specimen Number of % of Number of Sample Specimen with culture pending lab with culture with culture specimen specimen cases with % of Cases source collected result result result within result within 14 with NPEV with Sabin with Sabin days 14 days NPEV isolation isolation

Cases 524 490 34 384 78% 32 7% 16 7%

Contacts 781 689 92 540 78% 81 12% 31 4%

Total 1305 1179 126 924 78% 113 10% 47 5%

Table no.-10 Week-39 Somalia Weekly EPI/POL Update

Median and average number of days from onset of paralysis to final lab results - 2018

Date of Date of Second stool Specimen reached Primary Culture ITD result onset Notification collected to Lab result

Median: 3.0 days Median: 2.0 days Median: 4.0 days Median: 11 days 8 day Average: 3.2 days Average: 2.1 days Average: 4.0 days Average: 12 days

Date second Date final stool Median: 28.0 days ITD results collected Average: 29.3 days Chart no. 2 Week-39 Somalia Weekly Polio Update

Routine immunization services, status of cold chain & vaccine stocks in AFP surveillance sites, 23 Sept 2018 Expected weekly Health facility with AFP sites with EPI service and Health facility have EPI Health facility with IPV vaccine available Region AFP sites visits routine EPI service functional cold chain vaccine available No No. % No. % No. % No. % Nugal 33 19 58% 19 100% 19 100% 17 89% Bari 116 34 29% 32 94% 34 100% 32 94% Mudug 58 39 67% 38 97% 38 97% 24 63% Galbeed 40 23 58% 23 100% 23 100% 23 100% Sahil 25 10 40% 10 100% 10 100% 8 80% Sanag 21 11 52% 11 100% 11 100% 11 100% Sool 30 10 33% 10 100% 10 100% 0 0% Awdal 52 23 44% 23 100% 23 100% 23 100% Togdher 47 21 45% 21 100% 21 100% 21 100% Middle Shabelle 38 19 50% 15 79% 19 100% 19 100% Hiran 27 22 81% 5 23% 22 100% 22 100% Galgadud 40 26 65% 15 58% 26 100% 25 96% Banadir 125 70 56% 25 36% 67 96% 64 96% Lower Shabelle 56 30 54% 16 53% 30 100% 24 80% Middle Juba 29 1 3% 0 0% 1 100% 0 0% Bakool 31 44 142% 47 107% 11 25% 10 91% Gedo 54 21 39% 20 95% 21 100% 19 90% Bay 74 30 41% 30 100% 30 100% 31 103% Lower Juba 59 30 51% 8 27% 30 100% 27 90% Somalia 955 483 51% 368 76% 446 92% 400 90% Week-39 Somalia Weekly Polio Update

Fever & Rush cases reported by AFP surveillance System 30/09/ 2018

Fever and Rash 2018

Total Total 2017

W01 W02 W03 W04 W05 W06 W07 W08 W09 W10 W11 W12 W13 W14 W15 W16 W17 W18 W19 W20 W21 W22 W23 W24 W25 W26 W27 W28 W29 W30 W31 W32 W33 W34 W35 W36 W37 W38 Regions Total 2018

CENTRAL 10472 132 136 145 161 161 142 166 171 151 129 128 86 77 84 109 62 141 114 94 84 83 93 73 79 51 57 65 85 109 103 98 95 84 71 98 67 56 54 3894 BANADIR 5559 72 73 79 70 70 68 56 66 59 54 48 36 26 20 40 32 58 62 47 53 40 42 25 18 16 21 32 31 48 63 36 48 30 35 33 28 19 21 1675 GALGADUD 651 5 7 4 6 6 8 16 11 8 6 4 7 6 4 8 5 7 4 11 7 5 7 3 2 4 3 4 2 4 3 4 2 4 2 3 5 2 5 204 HIRAN 1445 12 13 3 26 26 15 22 12 18 1 5 1 0 20 17 0 35 5 0 0 0 15 16 27 0 6 1 18 13 0 24 13 17 10 5 13 13 8 430 LOWER SHABELLE 2071 25 28 40 36 36 28 29 52 36 35 33 20 31 23 32 20 29 31 25 19 22 19 22 23 22 23 14 21 22 18 22 19 22 16 12 15 17 16 953 MIDDLE SHABELLE 746 18 15 19 23 23 23 43 30 30 33 38 22 14 17 12 5 12 12 11 5 16 10 7 9 9 4 14 13 22 19 12 13 11 8 45 6 5 4 632

PUNTLAND 6584 100 97 82 70 88 70 79 63 69 53 61 55 53 49 61 80 50 43 20 24 23 20 23 17 18 20 12 9 14 15 6 4 4 4 0 4 5 3 1468 BARI 1144 12 18 14 13 16 20 20 13 17 21 29 21 25 25 29 45 28 22 13 12 17 12 14 10 16 16 10 7 11 11 6 4 4 4 0 0 5 3 563 KARKAR 824 9 8 6 4 4 6 6 5 5 6 4 4 2 1 0 1 0 0 0 1 1 1 0 0 0 2 0 0 0 0 0 0 0 0 0 0 0 0 76 MUDUG 2566 47 45 36 27 44 25 23 24 30 15 21 20 16 10 13 14 7 17 0 8 1 0 3 5 0 1 0 0 1 4 0 0 0 0 0 4 0 0 461 NUGAAL 2050 32 26 26 26 24 19 30 21 17 11 7 10 10 13 19 20 15 4 7 3 4 7 6 2 2 1 2 2 2 0 0 0 0 0 0 0 0 0 368

SOMALILAND 4835 40 26 76 55 95 41 135 52 89 26 85 39 72 22 35 23 11 14 28 10 10 5 17 12 7 2 7 3 0 1 3 2 3 0 1 0 0 1 1048 GALBED 888 4 2 4 7 1 4 0 4 0 0 6 7 0 1 5 4 0 1 0 2 2 1 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 56 AWDAL 181 2 0 11 2 5 0 10 0 3 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 33 SAHIL 568 2 0 9 2 13 5 24 5 18 4 4 4 13 2 1 1 2 0 7 0 2 0 4 2 3 0 0 0 0 0 1 0 0 0 0 0 0 0 128 SANAG 273 4 6 5 11 0 5 7 5 5 2 0 0 12 0 6 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 70 SOOL 667 17 7 20 20 45 20 43 13 26 6 26 0 18 6 6 1 0 0 1 1 0 1 2 2 0 0 0 0 0 0 0 2 0 0 0 0 0 0 283 TOGDHER 2258 11 11 27 13 31 7 51 25 37 14 49 28 29 13 17 17 8 13 19 7 6 3 11 8 4 2 6 3 0 1 2 0 3 0 1 0 0 1 478

SOUTH 1503 40 27 14 60 50 73 81 124 103 62 40 44 22 43 87 54 36 20 39 8 37 11 35 34 29 19 15 10 9 7 6 6 5 2 9 6 9 13 1289 BAKOOL 100 4 2 2 0 4 0 0 4 2 0 0 4 0 4 4 0 2 0 0 2 3 0 2 0 2 0 4 2 0 0 4 2 3 0 3 0 0 2 61 BAY 658 17 17 2 0 9 4 11 11 9 0 0 0 0 0 5 5 5 5 5 0 0 1 0 2 0 0 0 0 3 0 1 0 0 0 0 2 0 3 117 GEDO 239 0 1 1 51 23 61 51 100 82 35 26 32 5 8 31 3 6 3 0 0 0 1 4 2 0 3 0 0 0 2 0 0 2 2 0 0 5 1 541 LOWER JUBA 446 19 4 6 9 12 6 17 6 10 27 12 5 14 28 43 43 19 9 30 0 31 5 26 22 25 11 8 4 4 2 1 2 0 0 4 4 2 7 477 MIDDLE JUBA 60 0 3 3 0 2 2 2 3 0 0 2 3 3 3 4 3 4 3 4 6 3 4 3 8 2 5 3 4 2 3 0 2 0 0 2 0 2 0 93

Somalia 23394 312 286 317 346 394 326 461 410 412 270 314 224 224 198 292 219 238 191 181 126 153 129 148 142 105 98 99 107 132 126 113 107 96 77 108 77 70 71 7699 Epid curve of suspected Measles cases by week, Somalia(2015 Week 13-2018 Week 38)

800 N=23,394 2015 2017 2016 700 N=5998 N=5521 2018 N=7699

600

500

400

300

200

100

0

2018W1 2018W4 2018W7

2015W13 2015W16 2015W19 2015W22 2015W25 2015W28 2015W31 2015W34 2015W37 2015W40 2015W43 2015W46 2015W49 2015W52 2016W03 2016W06 2016W09 2016W12 2016W15 2016W18 2016W21 2016W24 2016W27 2016W30 2016W33 2016W36 2016W39 2016W42 2016W45 2016W48 2016W51 2017W02 2017W05 2017W08 2017W11 2017W14 2017W17 2017W20 2017W23 2017W26 2017W29 2017W32 2017W35 2017W38 2017W41 2017W44 2017W47 2017W50 2018W10 2018W13 2018W16 2018W19 2018W22 2018W25 2018W28 2018W31 2018W34 2018W37 Week-39 Somalia Weekly EPI/POL Update

Transit Points Vaccination activities using bOPV - 23 Sept 2018

January February March April May June July August

Zones

Zero doses Zero

vaccinated vaccinated vaccinated vaccinated vaccinated vaccinated vaccinated vaccinated

Zero doses Zero doses Zero doses Zero doses Zero doses Zero doses Zero doses Zero doses Zero

Number of Number of Number of Number of Number of Number of Number of Number of

% Zero doses % Zero % doses % Zero doses % Zero doses % Zero doses % Zero doses % Zero doses % Zero

CENTRAL 99939 334 0.3% 106321 362 0.3% 134103 366 0.3% 104803 334 0.3% 103405 313 0.3% 128304 401 0.3% 102459 317 0.3% 50182 180 0.4%

PUNTLAND 25067 58 0.2% 24610 59 0.2% 31565 71 0.2% 25519 61 0.2% 25516 55 0.2% 30051 54 0.2% 24212 45 0.2% 12212 20 0.2% SOMALILAN 14705 350 2.4% 14490 377 2.6% 17807 430 2.4% 14898 343 2.3% 15809 337 2.1% 19051 481 2.5% 15911 4207 26.4% 8259 223 2.7% D SOUTH 32225 1073 3.3% 34364 1123 3.3% 46605 1589 3.4% 42947 1336 3.1% 34650 937 2.7% 54538 1287 2.4% 41390 1003 2.4% 22303 528 2.4% 1.0 SOMALIA 171936 1815 1.1% 179785 1921 1.1% 230080 2456 1.1% 188167 2074 1.1% 179380 1642 0.9% 231944 2223 1.0% 183972 5572 3.0% 92956 951 % . A total of 1,476,874< 10 years individuals were vaccinated week 32,2018. Among them 18,654 (1%) were vaccinated for the first time.

Table no.-16 Week-39 Somalia Weekly EPI/POL Update

Immunity Profile of NP-AFP cases and Contacts 2013-2018

Immunity Profile of NP-AFP Cases and Contacts combined Months, Immunity Profile of NP-AFP Cases Immunity Profile of NP-AFP cases Immunity Profile of NP-AFP cases 6- 2013-2018 6-23 Months, 2013-2018 6-59 Months by Zone, 2018 23 Months by Zone, 2018 100% 100% 100% 100% 2 90% 90% 9 90% 493 90% 25 35 16 18 31 80% 13 80% 5 8 80% 80% 80 30 8 650 465 4 812 635 70% 575 83 37 70% 70% 424 70% 28 18 26 60% 60% 60% 60% 50% 34 50% 21 50% 539 50% 5 28 27 40% 40% 7 61 6 9 230 243 16 14 40% 40% 34 178 245 271 30% 8 27 30% 17 30% 198 30% 20% 20% 13 21 8 252 34 9 16 0 4 20% 152 182 20 888 117 20% 20 10% 10% 2 6 8 4 2 5 22 1 5 341 29 1 10% 0% 1 01 0% 0 148 10% 155 172 112 21 9 10 11 7 0% 0% 2013 2014 2015 2016 2017 2018 2013 2014 2015 2016 2017 2018

0 Dose 1-3 doses 4-6 doses 7+ doses 0 dose 1-3 doses 4-6 doses 7+ doses 0 dose 1-3 doses 4-6 doses 7+ doses 0 Dose 1-3 Doses 4-6 Doses 7+ Doses Graph no.-22 Graph no.-19 Graph no.-20 1raph no.-21 . 32 zero dose AFP cases reported in 2018 from inaccessible and partially accessible areas of South (n=21), Central (n=8) and 1 from Puntland. (6 are from accessible, 9 from partially accessible and 17 from inaccessible districts) Week-39 Somalia Weekly EPI/POL Update

Immunity profile of NP-AFP cases and Contacts combined by Zone 2012-2018

SOMALILAND CENTRAL 100% 100% 230 80% 114 80% 234 430 294 166 156 178 268 273 60% 145 187 151 60% 306 66 40% 40% 81 82 119 59 27 76 20% 16 62 20% 51 78 58 52 52 484 53 48 36 25 127 51 23 27 58 69 29 0% 14 12 5 0 0 07 0% 29 2013 2014 2015 2016 2017 2018 2013 2014 2015 2016 2017 2018

0 dose 1-3 doses 4-6 doses 7+ doses 0 dose 1-3 doses 4-6 doses 7+ doses

Graph no.-24 Graph no.-25 SOUTH PUNTLAND 100% 100% 87 57 78 81 78 80% 100 80% 54 77 123 97 70 38 105 97 102 74 84 60% 36 81 60% 32 50 40% 68 77 85 40% 47 16 40 48 48 56 317 60 20% 101 20% 39 62 77 97 99 79 26 34 38 29 22 0% 0% 13 0 4 4 2013 2014 2015 2016 2017 2018 2013 2014 2015 2016 2017 2018

0 dose 1-3 doses 4-6 doses 7+ doses 0 dose 1-3 doses 4-6 doses 7+ doses

Graph no.-26 Graph no.-27 Routine Immunization coverage by zone, Somalia (2015-2018 Six months)

100 96 90 90 88.1 87 87.6 83.2 81 81 78.6 78.7 80 76 73.9 75 7372 72 73 73 73.5 71 69.871 71 71 69 67.6 70 66 66.8 64.1 64 62 63.1 63 60 59 585957.5 60 57 57 5755.8 57 57 54 55 54 5454.1 54 52 53 50 50 46.2 4646.5 47.3 43.3 43 43 39 40 38.4 40.5 35.233.8

30

20

10 5 0 0

0

P-1 P-3 P-1 P-3 P-1 P-3 P-1 P-3

IPV IPV IPV IPV

BCG BCG BCG BCG

OPV-3 OPV-3 OPV-3 OPV-3

Measles Measles Measles Measles PUNTLAND SOMALILAND SOUTH CENTERAL SOMALIA 2016 2017 2018 (6 months) END