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Situation Report for Acute Watery Diarrhoea/ Cholera Epidemiological Week 16 (17 – 23 April 2017)

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Situation Report for Acute Watery Diarrhoea/ Cholera Epidemiological Week 16 (17 – 23 April 2017) Situation report for acute watery diarrhoea/ cholera Epidemiological week 16 (17 – 23 April 2017) Cumulative key figures Highlights 17 – 23 April 2017 A total of 3,356 AWD/ cholera cases and 60 deaths (CFR– 3,356 new cases in week 16 1.8%) were reported during week 16 (17– 23 April 2017) in 50 districts in 13 regions. Of these, 780 cases were reported from 60 deaths (CFR–1.8%) in week 16 Buhodle district, Togdheer region, which represents 23.2% of 36.9 % cases female the total cases. 24.4% of cases are children under 5 There is a slight increase in the number of new AWD/ cholera years of age cases and deaths reported – 3356 cases/ 60 deaths were recorded in week 16 compared to 2984 cases/ 34 deaths in 50 districts reported AWD/ cholera week 15. cases New locations that have reported new AWD/ cholera cases 5,190 cases and 81 deaths (CFR 1.6%) and deaths are: Buhodle district, Togdheer region, Habal are from accessible areas Gedan Village, Mintane, Saydhalow and Landanbal Village 18,414 cases and 552 deaths (CFR Baidoa district in Bay region, Abudwak district, Galinsor 4.1%) are from inaccessible areas Village, Addado district Guriel Village, Dusmareb district in 31,764 cumulative cases since wk 1 to Galgadud region and Bulomarer Village district Kurtunwarey wk 16. in Lower Shebelle region. Additional alerts were recorded from other regions or districts; verification by surveillance 618 cumulative deaths (CFR–1.9%) officers is ongoing. since week 1 to week 16 Situation update A total of 3,356 AWD/ cholera cases and 60 deaths (CFR–1.8%) were reported during week 16 (17- to 23th April 2017) from 50 districts in 13 regions. Of these cases, 780 cases were reported from Buhodle district in region Togdheer which represents 23.2% of the total cases; Out of 10 stool samples collected from Bardere district, 6 have tested positive for Vibrio Cholerea. A total of 31,764 suspected AWD/ cholera cases and 618 deaths (CFR–1.9%) were recorded from 50 districts across 13 regions since the beginning of 2017. However, the trend of cholera cases recorded in the past 16 weeks has increased significantly compared to the cases reported during the same period last year (refer to epidemic curve below). It is important to note that the current cholera cases were a spill-over from last year’s major cholera outbreak, which recorded Page 1 of 7 15,619 cases and 548 deaths. Last year’s outbreak was one of the largest and longest in which the country has experienced in the last five years. Bay Region: a total of 926 AWD/ cholera cases and 12 deaths were recorded in week 16 and the trend has increased during this reporting period. Banadir Region: a total of 176 AWD/ cholera cases and 4 deaths were recorded across 17 districts in the region and the numbers of reported cases and deaths have slightly increased this week. Lower Shebelle Region: A total of 292 AWD/ cholera cases and 6 deaths were recorded in week 16, Middle Shebelle: a total of 71 AWD/ cholera cases and 1deaths were recorded during this reporting period. Lower Jubba: A total of 72 AWD/ cholera cases and 1 death were recorded in week 16 Bakool Region: 175 AWD/ cholera cases and 12 deaths were recorded in week 16. Gedo region: A total of 348 AWD/ cholera cases and 1 death were recorded in week 16 Hiran Region: A total of 6 AWD/ cholera cases were recorded in Beletweyne district this week. Galgadud Region: a total of 221 AWD/ cholera cases and 1 death were recorded during this week. Bari region: A total of 37 AWD/cholera cases and 4 deaths were reported this week 16 Mudug region AWD/Cholera cases 163 this week 16 Nugaal: A total of 89 AWD/cholera cases no death this week Togdheer region; A total of 780 AWD/Cholera cases and 18 deaths were reported at week 16 Page 2 of 7 The overall trend of the AWD/ cholera is not slowing down and the outbreak is spreading to new villages and districts. There are cholera alerts reported from Galgadud and Middle Juba, Togdheer region and other inaccessible areas, and the verification of these alerts is becoming a major challenge due to security. The severe draught and its consequence (water scarcity, food insecurity and malnutrition) are major contributing factors to the ongoing cholera outbreak which has spread to 13 regions across the country. More AWD/ cholera cases were recorded among displaced people due to drought living in IDP camps in Baidao, Banadir, Galkayo, Bossaso and other locations. The preparation of another upsurge of cholera outbreak along the main rivers are ongoing since the rainy season is about to begin and major floods are expected. Active transmission of AWD/ cholera is still going in all districts in Banadir region, but Hodan. Daynile, Dharkeynlay and Wadajir recorded the highest number of AWD/ cholera cases. Table 1. Summary of AWD/Cholera cases reported per Region in Somalia Cumulative as of Week 15(10th to 16th Apr - Week 16(17th to 23th Apr - 2017 2017 Epi-Week 1 to 16 Region Live Deaths CFR(%) Live Deaths CFR(%) Live Deaths CFR (%) Bay¥ 1094 13 1.2 926 12 1.3 12491 205 1.7 Bakol 215 3 1.4 175 12 6.9 3205 149 4.5 Lower Jubaα 61 1 1.6 72 1 1.4 847 8 0.9 Gedo¥ 460 3 0.7 348 1 0.3 3688 50 1.5 Galgaduud 285 0 0.0 221 1 0.5 674 6 1.1 Middle Shabelle 122 0 0.0 71 1 1.4 1496 16 1.1 Hiraanα 4 0 0.0 6 0 0.0 309 3 1.0 Lower Shebelle¥ 344 6 1.7 292 6 2.1 3451 48 1.3 Bari 26 0 0.0 37 4 10.8 356 8 1.3 Mudug 16 0 0.0 163 0 0.0 432 4 1.5 Nugaal 63 4 6.3 89 0 0.0 1171 29 2.7 Togdheer 134 2 1.5 780 18 18.0 1115 37 5.7 Banadirα 160 2 1.3 176 4 2.3 2529 55 2.2 Total 2984 34 1.1 3356 60 1.8 31764 618 1.9 αOral cholera Vaccination was introduced in 7 high risk districts in these regions. Alerts from Middle Juba have not be included because they could not be verified due to insecurity. ¥ Affected districts in these regions are hard to reach with the exception of town areas Page 3 of 7 Distribution of AWD/Cholera cases by Gender As shown in Fig 2, almost equal proportion of men and female are affected by WAD in all regions. Of the 31764 cumulative cases reported since the beginning of the outbreak, 49.5% are female while 50.5% are male as shown in figure below. Fig 2. Distribution of Cholera cases by gender, Somalia, 2017 3500 3000 2500 2000 1500 Noof cases Female 1000 Male 500 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 Week 2017 Distribution of cases by Age category As shown in Fig 3 below,18709(66%) of the cases are above 5 years, howver the case fatality rate in children under 5 years is 2.5 compared to 1.7 in children below 5 years Fig 3. Distribution of AWD/Cholera cases by age 20000 category 3.0 18000 2.5 16000 2.5 14000 2.0 12000 1.7 10000 1.5 8000 1.0 6000 4000 Fatality Case Rate(%) AWD AWD Cases deathsand 0.5 2000 0 0.0 <5 years 5 and above Cases Deaths CFR(%) Page 4 of 7 Cases in accessible areas in the South central The case fatality rates are higher in areas that are not accessible compared to accessible areas as shown in the chart below. Most of the inaccessible areas are in the South West state (Bay, Bakol and Lower Shabelle) as well as Middle Juba and Gedo regions. A total of 5,190 cases and 81 deaths (CFR 1.6%) are from accessible areas while 18,414 cases and 552 deaths (CFR 4.1%) are from inaccessible areas NB. Accessibility has been defined as areas where partners can reach to provide care for AWD/Cholera Page 5 of 7 Response activities Coordination Sub-national coordination mechanism for cholera response has been strengthened in Kismayo, Baidao, Hargeisa and Garowe; Health authorities and a national partner delivered medical supplies to Buuhodle hospital whereby patients affected AWD/ cholera are treated; Health, WASH and Nutrition clusters, in collaboration with MoH, developed operational guide for 34 IERTs which spells out key functions, services to deliver supplies and logistical support; IOM will provide support in the Gedweyn village and IDP camps in Dollow district through deployment of 2 Integrated Emergency Rapid Response Teams (IERTS). Released two DDK 14 Cartons of ORS (7 each) and 100 boxes/100 tablet of Zinc (50 each) to SAMA and BRH. Emergency Medical supplies were delivered to Wardi for Wanla-Weyne, MOH for El-berde in Lower shabelle and Bakol regions respectively by UNICEF. A national AWD/cholera Taskforce weekly meeting has been held in Mogadishu on 20 April, 2017, chaired by FMOH and participated by WHO, UNICEF, health, Wash Clusters and decisions on improving the AWD/cholera situation have been reached. Surveillance and laboratory Early warning surveillance has been scaled up in all high-risk districts across Puntland, Central and Southern regions; State and Regional RRTs and surveillance officers have been investigating cholera alerts in Lower Shebelle, Baidao and Bakool regions; Active case search has been extended to districts that reported AWD cases and death; Stool sample collection and testing from cholera affected districts were scaled and more CM media with swaps were distributed to all regional surveillance officers.
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