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Epidemiological Week 19 (Week Ending 13Th May, 2018)

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Epidemiological Week 19 (Week Ending 13Th May, 2018) Epidemiological Week 19 (Week ending 13th May, 2018) Highlights Cumulative figures as of week 19 • 217 health facilities across Somalia submitted • 1,077,571 consultations from week 1 weekly reports of epidemic-prone diseases in the to week 19. electronic early warning disease surveillance • 3,280 cumulative cases of (EWARN) system in week 19, compared to 192 health facilities reported in Week 18. AWD/Cholera and 21 deaths since • Total number of consultations increased from December 2017. 50,411 in week 18 to 57,498 in week 19. • 6,156 Accumulative alerts were • A total of 4,221 alerts were received. Of these, 199 received, 217 of these, were 1 were confirmed as true alerts . confirmed as true alerts from week 1 • The highest numbers of diseases reported in week to week 19, 2018. 19 were other acute diarrhoeas (2,816 cases), influenza like illness (1,729 cases) and severe acute • 5,398 cumulative cases of suspected respiratory illness (930 cases). measles cases since the beginning of 2018. • A total of 312 new cases of suspected AWD/cholera with 4 deaths were reported in week 19 compared • Of the 5,398 measles cases, 3,473 to 296 AWD cases with 4 deaths in week 18. (64%) are under 5 years while 1,925 • A cumulative total of 3,280 AWD/cholera cases2, (36%) are above 5 years. including 21 deaths have been reported since December 2017. • The number of reported measles cases decreased from 211 in week 18 to 126 cases in week 19. Table 1. Summary of Alerts for epidemic prone diseases Disease Wk16 Wk17 Wk18 Wk19 Cumulative cases (Wk 1 – 19, 2018 2018 2018 2018 2018) Total consultations 55,439 51,937 50,411 57,498 1,077,571 Other Acute Diarrheas 2285 2,142 2,421 2816 41192 Influenza Like Illness 1401 1502 1493 1729 33,468 Severe Acute Respiratory Illness 1106 874 855 930 17,415 Suspected Measles 104 160 211 126 5398 Confirmed Malaria 236 254 300 314 4446 Acute Watery Diarrhoea 66 15 11 14 1154 Bloody Diarrhea 53 162 111 114 1266 Whooping Cough 56 25 56 41 850 1 These alerts are alerts from specific diseases of SARI, ILI, AWD, OAD, WC, Measles, Malaria, Falciprium Positive &RDT examined as auto-calculated by the system. 2 The Cases of AWD/Cholera in the eWARN system are collected from sentinel sites. while the cases of AWD/cholera in Sitrep are collected from temporary CTC sites which doesn't include the Sentinel sites Page 1 of 14 Acute Jaundice 0 2 2 3 68 Disease Wk16 Wk17 Wk18 Wk19 Cumulative cases (Wk 1 – 19, 2018 2018 2018 2018 2018) Suspected Meningitis 6 1 2 6 55 Diphtheria 0 0 0 0 26 Neonatal Tetanus 0 0 1 1 19 Acute Flaccid Paralysis 0 0 0 0 2 Viral Hemorrhagic Fever 1 0 0 0 3 Total number of Consultations and Reporting sites Completeness of Reporting. Out of 265 health facilities expected to submit weekly reports of communicable diseases in the EWARN system across Somalia, 217 submitted reports in week 19, a completeness of reporting of 82%. A total of 57,498 consultations were recorded in week 19, 2018 (Fig 1). Fig 1: Consultations and reporting sites, week 1 to 19, 2018 70,000 250 60,000 200 50,000 40,000 150 30,000 100 20,000 Consultations 50 Reporting Sites 10,000 - 0 WK8 WK9 WK10 WK11 WK12 WK13 WK14 WK15 WK16 WK17 WK18 WK19 2018 2018 2018 2018 2018 2018 2018 2018 2018 2018 2018 2018 Totoal Consultations Reporting Sites Proportionate Morbidity As shown in figure 2; Other acute diarrhoeas (OAD), influenza like illness (ILI), severe acute respiratory illness (SARI), suspected measles and malaria are the commonest causes of morbidity across Somalia in 2018. In week 19, the highest numbers of diseases were other acute diarrhoeas (2,816 cases), influenza like illness (1,729 cases) and severe acute respiratory illness (930 cases). Fig. 2. Commonest Causes of Morbidity during Week 1 to 19 3000 2500 2000 1500 1000 500 0 Wk16 2018 Wk17 2018 Wk18 2018 Wk19 2018 other acute Diaria influence like illness Severe Acute Respiratory Illness Suspected Measles Confirmed Malaria Page 2 of 14 Situation Update of AWD/Cholera AWD/Cholera situation in different regions of Lower Jubba , Hiiran, Middle Shabelle and Banadir. Following the heavy rains that have led to the floods in Districts Reporting Cases in Week 19 the Juba land and Shabelle basins, there has been an observed increase in the number of new AWD/Cholera cases. The cholera outbreak that started in December 2017 in Beletweyne along river Shabelle has spread to Jowhar, Kismayo, Afgoye and Banadir. The cholera spread is expected to increase due to the floods that have led to contamination of water sources in the flood affected regions. Floods have also led to blockage of access of health services which will contribute to delayed health seeking by the affected populations with. Over the past 2 Weeks, there has been an increase in the number of AWD/Cholera cases reported in Lower Shabelle, Banadir and Lower Jubba; the regions that are affected by floods. In week ending 7th May, active transmission of AWD/cholera was reported in Kismayo district in Lower Jubba, Afgoye in Lower Shabelle as well as in 14 districts of Banadir region (Darkenly, Daynile, Hodan, Madina, Waberi, HamarWeine, Hamarjabjab, Heliwa, Waberi and Wardigley, Kaaran, Yaqshid, Howlwadag Shangani districts). In Kismayo, affected communities especially in Farjano IDP are reportedly using contaminated water from open water sources. The Oral Cholera Vaccination that was implemented in 11 high risk districts in 2017 of the central region has greatly contributed to the reduction in the number of new AWD/cholera cases. Page 3 of 14 Fig 3. AWD/Cholera cases in Somalia May 2017-May 2018 3500 4.0 3000 3.5 2500 3.0 2.5 2000 2.0 1500 1.5 1000 1.0 500 0.5 0 0.0 Numberof AWD/Cholera cases week 2 week 4 week 6 week 8 week week 16 week 18 week week 10 week 12 week 14 week Week 18 Week 20 Week 22 Week 24 Week 26 Week 28 Week 30 Week 32 Week 34 Week 36 Week 38 Week 40 Week 42 Week 44 Week 46 Week 48 Week 50 Week 52 Week weeks May.17 Jun.17 Jul.17 Aug.17 Sep.17 Oct.17 Nov.17 Dec.17 Jan-18 Feb-18 Mar.18April.18May.18 Cases Total Deaths CFR (%) Table 2. Summary of AWD/Cholera cases in different regions Week 18 Week 19 Cumulative as of Epi- Regions (30thApril -6thMay-2018) (07th -13thMay-2018) Week 49, 2017, Wk 19, States 2018 Cases Deaths CFR (%) Cases Deaths CFR (%) Cases Deaths CFR (%) Central Banadir 132 2 1.5 143 2 1.4 1,042 7 0.7 Jubba land L/ Jubba 127 2 1.6 149 2 1.3 1,186 11 0.9 South west L/ Shabelle 37 0 0.0 20 0 0.0 72 0 0.0 Hir-shabele M/Shabelle 0 0 0.0 0 0 0.0 4,15 2 0.5 Hiraan 0 0 0.0 0 0 0.0 565 1 0.2 Total 296 4 1.4 312 4 1.3 3,280 21 0.6 *The AWD/Deaths reported in this table have not been confirmed by stool analysis. Cholera Situation in Hiraan, Lower Jubba, Middle Shabelle and Banadir. • Banadir region which included Mogadishu city has one of the highest concentration of refugees where access to safe water and proper sanitation is limited. The AWD/Cholera outbreak in Banadir region started in January 2018 following reports of similar outbreak in Beletweyne district of Hiraan region. Of the 17 districts that make up Banadir region, 14 have so far reported cases which have been managed in Banadir CTC located in the capital Mogadishu. There has been an increase in the number of AWD/Cholera cases from 132 and 2 deaths to 143 cases and 2 deaths. More than 70% of the cholera cases reported in Banadir are children below 2 years of age. • In Lower Jubba, The current AWD/Cholera outbreak in Kismayo district started in week 5 of 2018 in the IDP communities of Farjano where access to safe water and sanitation is limited. The district is characterised by returnees from Kenya as well as those displaced by war in Middle Jubba. Currently Lower Jubba is one of the flood affected regions. The reported cases of AWD/Cholera did not receive OCV which was given in Kismayo in March 2017. The persons Page 4 of 14 may have been absent during the OCV campaign. Over the past week, the number of AWD/Cholera cases increased from 127 and 1 death to 149 and 2 deaths that have been reported in Farjano CTC and Kismayo General Hospital CTU. More than 68% of the cholera cases reported from Lower Jubba are children below 2 years. • The AWD/Cholera outbreak in Lower Shabelle region started in week 17 of 2018, as a result of displacement of people due to floods that have been reported in this regions. Afgoye is the most affected district and cases are being managed in Marka General hospital. More than 35% of the cases reported in Afgoye are children below 5 years. AWD/Cholera cases and floods Following heavy rains in Ethiopia and Somalia, flash floods have been reported in the basins of Juba and Shabelle in 4 states. An estimated 718,000 people have been affected of which 220,000 have been displaced3.
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