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Epidemiological Week 22 (Week Ending 3Rd June, 2018)

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Epidemiological Week 22 (Week ending 3rd June, 2018) Highlights Cumulative figures as of week 22 • 216 health facilities across Somalia submitted weekly • 1,250,869 consultations from week 1 reports of epidemic-prone diseases in the electronic to week 22. early warning disease surveillance (EWARN) system in • 4,300 cumulative cases of week 22. • Total number of consultations decreased from 62,876 AWD/Cholera and 28 deaths since in week 21 to 59,673 in week 22. December 2017. • A total of 4,231 alerts were received. 159 of these • 7,050 Accumulative alerts were alerts were confirmed as true alerts1. received, 251 of these, were • The highest numbers of diseases reported in week 22 confirmed as true alerts from week 1 were other acute diarrhoeas (3,161 cases), influenza to week 22, 2018. like illness (2,041 cases) and severe acute respiratory illness (981 cases). • 5,736 cumulative cases of suspected measles cases since the beginning of • A total of 396 new cases of suspected AWD/cholera including 1 death were reported in week 22 2018. compared to 357 AWD cases including 4 deaths in • Of the 5,736 measles cases, 3,729 week 21. (65%) are under 5 years while 2,007 • A cumulative total of 4,300 AWD/cholera cases2, (35%) are above 5 years. including 28 deaths have been reported since December 2017. • The number of reported measles cases decreased from 127 in week 21 to 113 cases in week 22. Table 1. Summary of Alerts for epidemic prone diseases Disease Wk19 Wk20 Wk21 Wk22 Cumulative cases (Wk 1 – 22, 2018 2018 2018 2018 2018) Total consultations 57,498 50749 62,876 59,673 1,250,869 Other Acute Diarrheas 2816 2470 3718 3161 50541 Influenza Like Illness 1729 1387 1611 2041 38,507 Severe Acute Respiratory 20,500 930 1353 981 Illness 751 Suspected Measles 126 98 127 113 5736 Confirmed Malaria 314 319 377 356 5498 Acute Watery Diarrhoea 14 43 227 82 1506 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 15 Bloody Diarrhea 114 112 133 123 1634 Whooping Cough 41 38 82 67 1037 Acute Jaundice 3 6 5 0 79 Suspected Meningitis 6 4 12 1 72 Diphtheria 0 16 1 0 43 Neonatal Tetanus 1 0 1 0 20 Acute Flaccid Paralysis 0 0 0 0 2 Viral Hemorrhagic Fever 0 0 0 0 3 Total number of Consultations and Reporting sites Completeness of Reporting. Out of 578 health facilities3 expected to submit weekly reports of communicable diseases in the EWARN system across Somalia, 216 submitted reports in week 22, a completeness of reporting of 37.4%. A total of 59,673 consultations were recorded in week 22, 2018 (Fig 1). Fig 1: Consultations and reporting sites, week 1 to 22, 2018 70000 250 60000 200 50000 40000 150 30000 100 Consultations 20000 50 Reporting Sites 10000 0 0 13 14 15 16 17 18 19 20 21 22 Epi-Week 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 22, the highest numbers of diseases were other acute diarrhoeas (3,161 cases), influenza like illness (2,041 cases) and severe acute respiratory illness (981 cases). Fig. 2. Commonest Causes of Morbidity during Week 1 to 22 3Some of the HFs are with no Network while some closed for a number of reasons Page 2 of 15 4000 3000 2000 1000 0 Wk19 Wk20 Wk21 Wk22 other acute Diaria influence like illness Severe Acute Respiratory Illness Suspected Measles Confirmed Malaria AWD/Cholera situation in Somalia Fig 3. Districts Reporting Cases in Week 22 Following the heavy rains that have led to the floods in the Juba land and Shabelle basins, there has been an observed increase in the number of new AWD/Cholera cases (fig 4) below. The cholera outbreak that started in December 2017 in Beletweyne along river Shabelle has spread to Jowhar, Kismayo, Afgoye Merka 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 LowerJubba; the regions that are affected by floods. In week ending 3rd June, active transmission of AWD/cholera was reported in Kismayo district in Lower Jubba, Afgoye and Merka in Lower Shabelle as well as in 11 districts of Banadir region (Darkenly, Daynile, Page 3 of 15 Hodan, Madina, Waberi, HamarWeine, Hamarjabjab, Heliwa, and Kaaran, Yaqshid, Howlwadag districts). In Kismayo, affected communities especially in Farjano IDP are reportedly using contaminated water due to floods. There was an increase in the number of cases reported from 357 in week 21 to 396 in week 22. 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 compared to the same time in 2017. Fig 4. AWD/Cholera cases in Somalia May 2017-June 2018 3500 4.0 3.5 3000 Cases Total Deaths CFR (%) 2500 3.0 2.5 2000 2.0 1500 1.5 1000 1.0 500 0.5 0 0.0 week 2 week 4 week 6 week 8 Numberof AWD/Cholera cases week 10 week 12 week 14 week 16 week 18 week 20 week 22 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 Jun.17 Jul.17 Aug.17 Sep.17 Oct.17 Nov.17 Dec.17 Jan-18 Feb-18 Mar.18April.18 May.18 weeks Table 2. Summary of AWD/Cholera cases in different regions States Week 21 Week 22 Cumulativeas of 3rd June 2018 Regions (21th -27thMay-2018) (28th May-3rdJune-2018) 2018 Cases Deaths CFR (%) Cases Deaths CFR (%) Case Deaths CFR s (%) Central Banadir 199 1 0.5 210 1 0.5 1,576 11 0.7 Jubba land L/ Jubba 142 3 2.1 146 0 0.0 1609 14 0.9 South west L/ Shabelle 16 0 0 40 0 0 135 0 0 Hir- M/Shabelle 0 0 0 0 0 0 415 2 0.5 shabele Hiraan 0 0 0 0 0 0 565 1 0.2 Total 357 4 1.1 396 1 0.3 4,300 28 0.7 *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 regions 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, 11 of them have so far reported cases which have been managed in Banadir CTC located in the Page 4 of 15 capital Mogadishu. There has been an increase in the number of AWD/Cholera cases from 199 and 1death to 210 cases and 1 death in the past 2 weeks. More than 64% of the AWD 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 may have been absent during the OCV campaign. Over the past week, the number of AWD/Cholera cases in Lower Jubba has increased from 142 and 3 deaths to 146 no deaths. More than 43% of the cholera cases reported from Lower Jubba are children below 2 years (Fig 2d). • The AWD/Cholera outbreak in Lower Shabelle region started in week 17 of 2018 and Merka destrict strated in week 22-2018 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 lower shabelle. More than 44% 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 displaced. Floods contribute to contamination of water sources as well as disruption of health services which are precursors of cholera outbreaks. Of the flood affected regions, cholera cases have been reported in Kismayo(146 cases) and Afgoye(24 cases) Merka (cases 16) as shown in table 5 below.
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