Epidemiological Week 22 (Week ending 3rd June, 2018)

Highlights Cumulative figures as of week 22 • 216 health facilities across 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 ReportingSites 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, , 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 , Banadir and LowerJubba; the regions that are affected by floods. In week ending 3rd June, active transmission of AWD/cholera was reported in 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

NumberofAWD/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, 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. Even when Jowhar and Beletweyne reported cases prior to the floods, no new cases have been reported from these districts following the floods.

Table 3. Number of AWD/Cholera cases in flood affected districts by age category Region District Week 22 Cumulative Week 49/17- Cases Live Deaths week 22/18 <2 yrs above ≥ 5 yrs <2 yrs above ≥ 5 Total Total CFR 2 yrs 2 yrs cases deaths (%) years Banadir Darkenley 14 10 14 0 0 0 250 1 0.4 Daynile 13 14 9 0 0 0 268 4 1.5 HamarJabja 15 8 6 0 0 0 103 1 1.0 Hawlwadag 3 5 6 0 0 0 72 0 0.0 Hodan 16 1 22 0 0 0 359 1 0.3

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Karaan 5 0 1 0 0 0 26 0 0.0 Madina 12 7 6 1 0 0 271 2 0.7 waberi 2 6 5 0 0 0 74 1 1.4 Shibis 0 0 0 0 0 0 6 0 0.0 Shingani 0 0 0 0 0 0 3 0 0.0 HamarWeine 2 0 1 0 0 0 29 0 0.0 Heliwaa 1 0 0 0 0 0 17 0 0.0 Wardigley 0 0 0 0 0 0 66 1 1.5 Yaqshid 0 0 5 0 0 0 32 0 0.0 Middle Jowhar 0 0 0 0 0 0 415 2 0.5 Shabelle Hiran Beletweyne 0 0 0 0 0 0 522 1 0.2 BuloBarde 0 0 0 0 0 43 0 0.0 Lower Afgoye 3 2 19 0 0 0 119 0 0.0 Shabelle Merka 0 4 12 0 0 0 16 0 0.0 Lower Kismayo 63 31 52 0 0 0 1,609 14 0.9 Jubba Total 149 88 158 1 0 0 4,300 28 0.7 × regions currently affected by floods. Cases include deaths.

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AWD/Cholera Response Activities Implemented During Week 21

Coordination and Leadership. • Coordination meetings were conducted in the flood affected districts. The coordination meetings are coordinated by Federal Ministry and State level MoH in coordination with health cluster partners

Case management • On job training was conducted for the health workers working in cholera treatment centres in Kismayo,Farjano and Banadir Merka(Ayuub Health Centre, and Afgoye Hospital CTCs • Management of cholera cases is being conducted in Banadir hospital CTC,Afgoye Hospital Merka(Ayuub Health Centre, CTCs,Kismayo hospitaland Farjano CTU Surveillance and Laboratory Investigations • Routine line listing of cases including data analysis and risk assessment for cholera hotspots • Investigation and verification of rumours has been conducted in flood affected regions. Alerts received from Baidoa and Elwak were negative for AWD. • Rapid Response Teams (RRT) have supported state level authorities to verify the rumors in flood affected districts

Water Sanitation, Hygiene and risk communication

• Distribution of hygienic kits in flood affected areas in Lower Jubba, Hiraan and regions • Community education is conducted by the C4D department using cholera preventive messages • Chlorination of water sources in cholera affected regions was conducted by WASH cluster • WHO has prepositioned 44.1 tons of medical supplies to flood affected regions

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Measles Situation

Fig5: Districts Reporting Measles Case: The number of suspected measles cases decreased Week 21 from 127 cases in week 21, to 113 cases in week 22. Cumulatively, 5,736 cases of suspected measles have been reported across Somalia since the beginning of 2018. Of the 5,736 measles cases, 3,729 (65%) are under 5 years while 2,007 (35%) are above 5 years. The most affected regions include Galgadud (1,072 cases), Bay (899 cases) Banadir (869 cases), (586 cases), and Sool (364 cases).

As shown in fig 6 below, the trends of measles have continued to decrease in all the regions following the successful implementation of measles vaccination campaign

Fig6: Measles Situation in Somalia from Week 1 to Week 22 2018

800

600

400 Cases 200

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 Epi-Week

Fig 7. Measles cases per region Across Somalia from Wk1 - Wk22, 2018 800 Awdal 700 600 500 Banadir 400 Bari 300 Bay 200 Galgadud 100 Gedo 0 Hiraan Cases<5 Cases >5

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Table 4: Summary of Suspected measles cases by region week 1 - 22, 2018

Cumulative cases (Wk 1 Region Wk19 2018 Wk20 2018 Wk21 2018 Wk22 2018 – 22)

Awdal 0 0 0 0 12 Bakool 0 0 0 0 117 Banadir 0 0 17 6 869 Bari - 0 - - 92 Bay 53 34 32 25 899 Galgaduud 0 9 0 0 1072 Gedo - - - - 18 Hiraan 1 2 6 12 121 33 - 18 14 232 Lower Shabelle 4 12 10 7 303 6 - 1 6 122 Middle Shabelle 0 1 9 5 145 Mudug 14 24 27 28 586 Nugaal - - - - 183 Sanaag 0 4 0 5 159 Sool 1 4 0 1 364 Togdher 7 6 4 - 206 Waqoyi Galbed 7 2 3 4 236 Grand Total 126 98 127 113 5736 Dash means there is no weekly Data/report submitted on the system during the specified reporting period.

Measles Outbreak Response Activities • The Federal Ministry of Health in collaboration with WHO, UNICEF and other partners launched the measles vaccination campaign in Mogadishu and Somaliland on 11th March 2018 to vaccinate 3.7 million children aged 6 months to 10 years in South Central and Somaliland. • The measles vaccination campaign was also conducted in Puntland in January 2018. 933,690 children aged 6 months to 10 years were vaccinated. • There has been a reduction in the number of measles cases reported from all the states following the vaccination campaign (fig 8&9)

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Fig8: Measles Trends after implementing Measles vaccination in Somaliland & South and Central

South & Central Zone Somaliland

500 Measles vaccination 400 implemented

300

Cases 200

100

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 Epi-Week

Fig9: Measles trends after implementing Measles vaccination in Puntland

Puntland

120

100 Measles vaccination implemented 80

60 Cases 40

20

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 Epi-Week

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Malaria Situation in Somalia The number of Malaria cases decreased from 377 cases in week 21 to 356 cases in week 22. Cumulatively, 5,498 cases of Malaria cases have been reported across Somalia since the beginning of 2018. Of the 5,498 malaria cases, 2,349 (42%) are under 5 years while 3,149 (58%) are above 5 years. The most affected regions include Bay (1,368 cases), Galgadud (806 cases), Banadir (651 cases) Lower Shabelle (572 cases), Bakol (574 cases), Bari (335 Cases) and Middle Shabelle (332 cases) Fig10: Malaria Situation in Somalia from Week 1 to Week 22, 2018

500 400 300

Cases 200 100 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 Epi-Week

Fig 11: Malaria Cases Per Region Across Somalia from Wk1-22, 2018 0 100 200 300 400 500 600 700 800 900 1000 Awdal Bakool Banadir Bari Bay Galgadud Gedo Hiraan Cases >5 Lower Juba Lower Shabelle Cases<5 Middle Juba Middle Shabelle Mudug Nugaal Sanaag Sool Togdher Waqoy Galbed

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Table 5. Cumulative Summary of Epidemic-prone Diseases in different Districts of Somalia as of Week 1-22, 2018

Regions District SARI ILI AWD BD OAD DIPH WC MEAS NNT AFP AJS VHF MAL MENG OC Total_cons

Awdal Total 0 7124 11 113 3187 0 0 12 0 0 0 0 20 2 27353 37851 Baki 0 892 0 53 219 0 0 0 0 0 0 0 0 0 2496 3660 Borama 0 4424 11 57 2234 0 0 8 0 0 0 0 12 0 17786 24560 Lughaya 0 156 0 2 173 0 0 0 0 0 0 0 0 0 1429 1760 Zeila 0 1652 0 1 561 0 0 4 0 0 0 0 8 2 5642 7871 Bakool Total 145 71 0 67 434 0 15 117 0 0 1 0 574 2 51690 53116 Elberde 0 13 0 0 105 0 0 0 0 0 0 0 0 0 8741 8859 Huddur 22 5 0 13 79 0 0 1 0 0 0 0 197 0 7553 7870 Tayeeglow 25 14 0 0 40 0 0 6 0 0 1 0 62 2 1171 1321 Waajid 98 39 0 54 210 0 15 110 0 0 0 0 315 0 34225 35066 Banadir Total 4762 7583 727 54 11800 0 9 869 0 1 0 0 651 12 313097 339565 Abdiaziz 0 89 0 0 93 0 0 0 0 0 0 0 0 0 7499 7681 Boondhere 0 0 18 0 226 0 0 24 0 0 0 0 0 0 6123 6391 Dayniile 19 144 0 0 218 0 0 7 0 0 0 0 1 0 11338 11727 Dharkinley 540 1051 0 0 1779 0 0 54 0 0 0 0 0 0 18444 21868 Hamar Jab Jab 193 534 0 2 492 0 1 7 0 0 0 0 1 0 11671 12901 Hamar Weyne 86 336 0 0 910 0 0 10 0 0 0 0 0 0 9658 11000 Hodan 3 22 5 0 63 0 0 0 0 0 0 0 6 0 8027 8126 Howl-wadaag 0 0 0 0 0 0 0 6 0 0 0 0 1 0 32256 32263 Huruwaa 1361 3195 15 6 3169 0 0 463 0 1 0 0 3 12 32992 41217 Kaaraan 10 69 0 0 47 0 0 1 0 0 0 0 0 0 16866 16993 Kahda 56 470 0 0 267 0 0 1 0 0 0 0 0 0 1451 2245 Shangani 82 68 0 0 56 0 0 0 0 0 0 0 0 0 195 401 Shibis 0 0 0 0 493 0 0 8 0 0 0 0 2 0 6478 6981 Waberi 0 0 0 0 33 0 0 0 0 0 0 0 0 0 15971 16004 Wadajir 1301 1516 689 5 2085 0 2 235 0 0 0 0 623 0 77631 84087 Wardhigley 18 0 0 24 1203 0 6 34 0 0 0 0 14 0 37920 39219 Yaqshid 1093 89 0 17 666 0 0 19 0 0 0 0 0 0 18577 20461 Bari Total 81 1020 5 10 586 0 0 92 0 0 0 0 335 0 36495 45843 Banderbayla 35 153 1 0 20 0 0 1 0 0 0 0 0 0 746 956 Bossaso 46 847 3 0 345 0 0 28 0 0 0 0 331 0 20973 29770 Carmo 0 6 0 0 4 0 0 0 0 0 0 0 2 0 634 668 Page 12 of 15

Hafun 0 0 0 0 24 0 0 0 0 0 0 0 0 0 1553 1577 Iskushuban 0 7 0 1 5 0 0 0 0 0 0 0 0 0 614 627 Qardho 0 0 0 9 127 0 0 45 0 0 0 0 2 0 6616 6799 Rakko 0 0 1 0 55 0 0 18 0 0 0 0 0 0 2311 2385 Ufeyn 0 7 0 0 2 0 0 0 0 0 0 0 0 0 374 383 Waciya 0 0 0 0 4 0 0 0 0 0 0 0 0 0 2674 2678 Bay Total 606 2491 62 576 1481 25 35 538 0 0 1 0 1368 0 78932 86201 Baidoa 560 1564 47 323 1031 25 17 312 0 0 1 0 1048 0 67399 72413 Berdale 0 213 6 36 42 0 18 49 0 0 0 0 262 0 3951 4577 Burhakaba 46 325 8 209 277 0 0 173 0 0 0 0 58 0 4781 5877 Qansahdere 0 389 1 8 131 0 0 4 0 0 0 0 0 0 2801 3334 Galgadud Total 3536 1330 191 5 982 0 166 1433 1 0 3 0 806 8 48854 57315 Abudwak 1270 380 0 0 258 0 28 709 1 0 0 0 184 4 11032 13866 Adado 764 407 3 1 253 0 53 279 0 0 3 0 280 1 9426 11470 Balanbale 257 156 0 1 52 0 11 129 0 0 0 0 85 0 2506 3197 Dhuusamarreeb 625 174 10 2 155 0 16 157 0 0 0 0 100 0 13560 14799 El Bur 24 6 178 0 38 0 0 34 0 0 0 0 17 0 533 830 El Dere 438 144 0 1 174 0 22 61 0 0 0 0 79 3 9367 10289 Gelinsor 158 63 0 0 52 0 36 64 0 0 0 0 61 0 2430 2864 Gedo Total 36 1011 0 0 207 0 0 18 0 0 0 0 222 0 13517 15011 B/hawo 22 237 0 0 48 0 0 9 0 0 0 0 59 0 3369 3744 Doolow 8 280 0 0 53 0 0 4 0 0 0 0 52 0 3164 3561 Garbahaarey 1 184 0 0 36 0 0 0 0 0 0 0 38 0 2775 3034 Luuq 5 310 0 0 70 0 0 5 0 0 0 0 73 0 4209 4672 Hiraan Total 6249 3603 242 6 5324 0 51 121 0 0 0 0 136 2 56934 72668 Belet Weyne 3573 2673 236 0 3291 0 5 91 0 0 0 0 135 1 32248 42253 Bulo Burto 1680 434 6 6 1343 0 0 24 0 0 0 0 1 1 11968 15463 Jalalaqsi 832 119 0 0 524 0 0 0 0 0 0 0 0 0 1933 3408 Matabaan 103 290 0 0 122 0 0 0 0 0 0 0 0 0 5963 6478 Maxaas 61 87 0 0 44 0 46 6 0 0 0 0 0 0 4822 5066 Lower Total 1184 15 51 134 1316 3 20 232 0 0 0 0 141 0 55637 58733 Juba Afmadow 398 0 28 52 279 0 0 0 0 0 0 0 4 0 7306 8067 Hagar 81 5 0 8 106 2 3 39 0 0 0 0 0 0 2758 3002 Jamaame 78 0 6 7 114 0 0 44 0 0 0 0 70 0 5863 6182 Kismayo 627 10 17 67 817 1 17 149 0 0 0 0 67 0 39710 41482

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Lower Total 559 502 107 10 5865 4 12 303 0 0 0 0 572 0 100236 108170 Shabelle Afgoi 38 95 0 1 237 0 0 34 0 0 0 0 8 0 17558 17971 Kurtunwarey 35 1 0 0 1109 0 0 29 0 0 0 0 38 0 11371 12583 Marka 222 3 79 6 3254 4 12 185 0 0 0 0 452 0 59528 63745 Qoryooley 58 0 28 0 727 0 0 49 0 0 0 0 60 0 10472 11394 Wanla Weyn 206 403 0 3 538 0 0 6 0 0 0 0 14 0 1307 2477 Middle Total 52 0 1 65 462 5 219 129 0 0 0 0 141 0 8517 9591 Juba Bu'ale 14 0 0 15 108 0 52 31 0 0 0 0 0 0 1729 1949 Jilib 29 0 1 31 277 5 124 75 0 0 0 0 141 0 5337 6020 Salagle 9 0 0 19 77 0 43 23 0 0 0 0 0 0 1451 1622 Middle Total 367 306 74 91 2579 0 1 138 0 0 0 0 332 0 78021 81909 Shabelle Adale 0 0 0 0 0 0 0 0 0 0 0 0 0 0 4669 4669 Bal'ad 319 278 19 28 600 0 1 107 0 0 0 0 226 0 32718 34296 Jowhar 38 0 52 53 1619 0 0 31 0 0 0 0 83 0 22037 23913 Mahaday 2 16 0 10 116 0 0 0 0 0 0 0 10 0 6255 6409 8 12 3 0 244 0 0 0 0 0 0 0 13 0 12342 12622 Mudug Total 387 37 12 36 3317 4 208 586 19 0 32 0 11 20 113370 118039 Galdogob 21 0 1 0 218 0 0 12 0 0 1 0 0 0 10118 10371 Galkacyo 266 1 11 30 2046 2 187 436 2 0 3 0 7 20 78582 81593 Harardere 28 36 0 1 146 0 12 29 0 0 0 0 4 0 3307 3563 Hobyo 72 0 0 0 848 2 8 99 17 0 27 0 0 0 10263 11336 Jariiban 0 0 0 5 59 0 1 10 0 0 1 0 0 0 11100 11176 Nugaal Total 72 771 6 0 428 1 6 183 0 0 0 0 0 0 11165 12632 Burtinle 1 148 0 0 108 0 0 29 0 0 0 0 0 0 2197 2483 Dangorayo 1 28 0 0 34 1 0 0 0 0 0 0 0 0 1333 1397 Eyl 12 213 0 0 84 0 0 44 0 0 0 0 0 0 3111 3464 Garoowe 58 382 6 0 202 0 6 110 0 0 0 0 0 0 4524 5288 Sanaag Total 1191 518 17 18 835 1 76 159 0 0 0 0 24 1 21677 24651 Badhan 458 151 10 0 317 0 1 136 0 0 0 0 22 0 5284 6386 Dhahar 353 1 2 17 104 0 3 3 0 0 0 0 2 0 2266 2751 Eil-afweine 301 184 5 1 278 1 0 12 0 0 0 0 0 0 7091 7917 Erigavo 79 182 0 0 136 0 72 8 0 0 0 0 0 1 7036 7597 Sool Total 38 3376 0 5 2693 0 32 364 0 0 0 0 41 0 30205 36754 Bocame 0 0 0 0 5 0 0 2 0 0 0 0 0 0 222 229 Hudun 0 567 0 0 345 0 1 14 0 0 0 0 0 0 2899 3826

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Lasacanod 38 2538 0 5 2208 0 31 346 0 0 0 0 41 0 24918 30125 Taleex 0 271 0 0 135 0 0 2 0 0 0 0 0 0 2166 2574 Togdher Total 230 1823 0 211 2562 0 34 199 0 0 5 0 2 13 22834 27925 Ainabo 1 85 0 40 131 0 0 3 0 0 0 0 0 0 1599 1859 Buhodle 23 111 0 70 162 0 0 13 0 0 0 0 0 0 2725 3104 Burao 180 1430 0 77 2073 0 34 183 0 0 5 0 2 13 16434 20443 Odwayne 26 197 0 24 196 0 0 0 0 0 0 0 0 0 2076 2519 Waqoy Total 1005 6926 0 233 6483 0 153 243 0 1 37 1 122 12 49679 64895 Galbed Ballayabane 155 212 0 21 217 0 24 9 0 0 0 0 0 1 2144 2783 Berbera 249 2391 0 2 1909 0 89 103 0 1 37 1 5 1 14118 18906 Gabiley 223 2062 0 89 1692 0 5 21 0 0 0 0 34 0 5582 9708 Hargeisa 224 1626 0 121 2143 0 32 97 0 0 0 0 83 10 23848 28184 Sheikh 154 635 0 0 522 0 3 13 0 0 0 0 0 0 3987 5314 Grand Total 20500 38507 1506 1634 50541 43 1037 5736 20 2 79 1 5498 72 1,118,213 1,250,869

SARI-Severe Acute respiratotyIllness,ILI-Influenza Like Illness, AWD-Acute Watery Diarrhoea,BD-Bloody Diarrhoea, Diph-Diptheria,WC-Whooping cough, Meas-Fever With Rash/Measles,NNT-Neonatal Tetanus,AJS-Acute Jaundice Syndrome, VHF-Viral Heamorrhagic Fever,Mal-Confirmed Malaria, Men-Bacterial Meningitis

For inquires please contact the Surveillance team, Ahmed Moalim Mohamed, Emergency Coordinator FMoH, [email protected] and WHO country office in Somalia or Dr Mutaawe Lubogo, Epidemiologist, [email protected]

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