Somalia Weekly Update Week-35 Ending 02 Sept 2018 2 Summary Highlight

Somalia Weekly Update Week-35 Ending 02 Sept 2018 2 Summary highlight

 PV-2 is isolated from 1 AFP case and 2 contacts from a different AFP case were sent to CDC for sequencing. Samples were collected on the from Kismayo district in VDPVs South. Detail investigation on progress. from No new cVDPV2 isolates from environmental samples. The date of collection of most recent positive environmental environm sample was on 17th May 2018  No new cVDPV3s isolated from environmental samples this New Suspected ental week. The date of collection of most recent positive PV-2; Kismayo samples environmental sample for cVDPV3 in Somalia was on 05 July 2018. In total, 10 cVDPV2 and Eight (8) cVDPV3 viruses have been isolated from environmental samples in 2018 compared to two (2) VDPV2s and 0 VDPV3 in 2017 There are five (5) environmental sites in Somalia, all of which are located in Banadir region (Mogadishu)

VDPVs from The total number of cVDPV cases remains 5 (two cVDPV2, two cVDPV3 and one had both cVDPV2 and cVDPV2/3 (n=1) human cVDPV3). The dates of onset of most recent cVDPV2 samples are on 10 July and cVDPV3 is on 23 May 2018

Summary Environmental Samples and Lab Classification

Epidemiological Week-2017 Epidemiological Week-2018

Date District Name 38 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 of of Ma Ma Ma Ma Ma Jun Jun Jun Jul Jul Jul Jul Au Au Au Au Au Au Establishm J. J. J. J. F. F. F. F. M. M. M. M. M. Ap. Ap. Ap. Ap. Jun SepSep y y y y y e e e y y y y g g g g g g Sites 04 11 18 25 01 08 15 22 01 08 15 22 29 05 12 19 26 e 7 . 05. 12 ent 03 10 17 24 31 14 21 28 05 12 19 26 02 02 09 16 23 30

19 Sept.

Waberi

vDPV2 vDPV2 cVDPV3 2017 cVDPV3

21October cVDPV2 cVDPV3 & cVDPV3

20 Sept. Shangani Urobo 2017

17 Aug. Urobo-2 Shangani 2018 21 Sept.

Hamere Kawma 2017

vDPV2 vDPV2

cVDPV3 cVDPV3 cVDPV3 cVDPV3 cVDPV3 cVDPV2 woini cVDPV2

Egyptian 23 Nov. sewage of flooding to due collected sample No Hodan Hospital 2017

Legend 9 cVDPV3 Sent to CDC for sequencing is a PV-2 from ES sample collected on 02 August 2018 1 Not scheduled 5 NPENT 10 Sent for sequencing from 21Oct. ES site. 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 Response activities-SIA summaries NID round 1 using bOPV summaries Somaliland Campaign date: 30 April-03 May 2018 Target: 638,062 Reached: 627,805 (98%) Missed: 2,206 IM coverage: 97%

South zone Campaign date: 08-11 May 2018 Target: 467,553 Reached: 457,167 (98%) Missed: 1,049 IM coverage: 95%

Central zone (Hiran and Galgaduud) Campaign date: 05-09 May 2018 Target: 213,865 Reached: 199,516 (93%) IM Coverage: 97% Missed: 579

Central zone( Banadir, L. Shabelle and M. Shabelle) Campaign date: 23-26 July 2018 Target: 774,622 Reached: 745,496 (96%) IM Coverage: 97% Missed: 16,024 LQAS: Of the 27, 23 have passed, 1 is satisfactory, 1 is fail and 2 is Incomplete.

Puntland Campaign date: 10-13 July 2018 Target: 484,523 Reached: 479,348 (99%) Missed: 499 IM Coverage: 99%

National Level: Target: 2,578,625 Reached: 2,509,332 (97%) IM coverage: 97% mOPV2 rounds summary  1st Round (10-13 Dec. 2017) • Target: 726,699 • Reached: 702,667 (97%) • Missed: 24,032 • IM coverage: 97% • LQAS= 98% FM  2nd Round ( 29 Jan-01 Feb 2018) • Target: 741,313 • Reached: 715,172 (96%) • Missed: 26,141 • IM coverage: 93% • LQAS= 98% FM  IPV • Target: 299,424 • Reached: 270,484 (90%)  3rd Round (05-08 May 2018) • Target: 790,837 • Reached: 763,471 (97%) • Missed: 27,366 • IM coverage: 98% FM • LQAS= 98% FM  1st Round Synchronized campaign (09-12 July 2018) • Target: 697,773 • Reached: 666,057 (97%) • Missed: 31,716 • IM coverage: 99% FM • LQAS= Of the total 27 Lots, 22 passed, 4 were satisfactory, 1 was incomplete and 0 lots failed  2nd Round Synchronized campaign (04-07 August 2018) • Target: 697,773 • Reached: 670,895 (96%) • Missed: 26,878 • IM coverage: 99% • Of the 26, 20 have passed, three are satisfactory, three are incomplete, and none of the lots fail SIA Activity Calendar Apr – Dec. 2018 Activity Target area Date Status NID 1 bOPV Somaliland and Puntland 30 Apr- 03 May 2018 Campaign completed South and Central Except Banadir, Lower and Middle NID 1 bOPV 5-8 May 2018 Campaign completed Shabelle Third response round mOPV2 Banadir, Lowe Shabelle and Middle Shabelle 5-8 May 2018 Campaign completed Campaign Synchronized South and Central regions without Banadir, Lower and mOPV2 Campaign (with Middle Shablle regions synchronized with Kenya 9 - 12 Jul 2018 Campaign completed Kenya and Ethiopia), Round 1 response campaign

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

Synchronized South and Central regions with out Banadir, Lower and mOPV2 Campaign (with Middle Shabelle regions synchronized with Kenya response 4-8 Aug. 2018 On going Kenya and Ethiopia), Round 2 campaign Upcoming Campaigns sNID mOPV2 Danyile district and IDPs in the area 15-18 September 2018 Planned NID 1 bOPV synchronized All 19 regions in Somalia (Target: 2,499,010 Children) 1-4 October 2018 Planned with Kenya and Ethiopia

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

AFP Surveillance Week-35 Somalia Weekly EPI/POL Update

Epidemiological Curve 01 January 2014 – 05 Aug 2018

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

Graph no. 1 Week-35 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

Total 2016Total

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 20 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 15 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 15 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 19 HIRAN 15 1 1 1 1 1 1 1 1 1 21 1 1 1 1 1 1 1 2 9 BARI 24 1 1 1 1 1 1 1 1 1 24 3 2 1 1 2 1 2 1 1 1 1 1 17 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 11 TOGDHER 11 1 1 1 9 1 1 1 1 1 1 1 7 GALBEED 19 2 1 2 1 2 20 1 1 1 1 1 2 1 1 1 1 11 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 15 SAHIL 8 1 1 8 1 1 1 1 4

SOOL 5 1 2 1 11 1 1 1 1 1 5 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 21 - BAY 19 1 1 1 2 2 2 1 22 1 4 1 1 1 1 1 1 1 1 1 1 15 GEDO 21 2 1 1 1 20 1 1 1 1 1 1 1 3 2 1 1 1 15 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 7 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 5 1 227

Silent (not reporting) for > 8 weeks - Seven (7) new AFP cases were reported last week bringing the total AFP cases reported in 2018 to 227 from 19 Reported AFP cases regions, compared to 254 AFP cases from 19 regions at the same time point in 2017. Community Samples collected in silent regions Community Samples collected but regions not silent Week-35 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 227 AFP cases BANADIR 33 0 33 17 1 2 20 reported in 2018 GALGADUD 27 0 27 15 0 15 CENTRAL HIRAN 21 0 21 6 1 2 9 L. SHABELLE 30 0 31 16 0 3 19 M. SHABELLE 24 0 24 13 1 1 15 BARI 24 0 24 17 0 17 1 Puntland MUDUG 11 0 12 10 0 1 11 0 cVDPV3 & 200 0 23 2 2 NUGAL 10 0 10 7 0 7 cVDPV3 Discarded WPV Pending Compat cVDPV2 cVDPV3 ible coinfectio AWDAL 16 0 17 12 0 3 15 n GALBEED 20 0 20 11 0 11 SAHIL 8 0 8 4 0 4 Somaliland SANAQ 6 0 6 4 0 4 SOOL 11 0 11 4 0 1 5 TOGDHER 9 0 9 7 0 7

23 0 0 BAKOOL 10 0 10 7 0 7 2 2

In process Pending BAY 22 0 22 13 0 2 15 - (lab) Pending ITD ERG SOUTH GEDO 20 0 20 10 1 4 15 LOWER JUBA 29 0 29 19 0 2 21

Chart no. 1 MIDDLE JUBA 11 0 11 8 0 2 10 no. Table Note: The total number of cVDPV cases are 5 (two (2) cVDPV3, one (2) cVDPV2 and one (1) Grand Total 345 0 345 200 4 23 227 had both cVDPV2 and cVDPV3). Week-35 Somalia Weekly EPI/POL Update

Surveillance Indicators by Zone and Region 2018

Annualized NP-AFP Rate by Zone, 2018 14.0 12.0 12.4 10.0 8.0 6.0 6.9 4.0 5.1 5.6 4.1 2.0 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 7.9 4.0 5.5 5.3 5.6 2.0 - In-accessible Partially Accessible Somalia Acceessible Map no. 1 Map no. 2 Graph no. 3 Week-35 Somalia Weekly EPI/POL Update

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

. 107/115 districts reported at least 1 AFP case since the first week of 2018

. Of the 107 districts reporting AFP cases in 2018, 103 have annualized NP-AFP rate above 2 per 100,000. In addition, 100 districts have stool adequacy rate of above 80%

Banadr region-Magnified . The remaining 8 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-35 Somalia Weekly EPI/POL Update

Distribution of NP-AFP cases and zero-dose cases vs accessibility of districts

. AFP cases were reported from all zones, regions, and accessible and inaccessible parts of the country

. Geo-code information was collected from 65.4% of AFP cases reported in 2018

. Of the twenty five (25) zero-dose AFP cases reported in 2018, thirteen (14) were reported from inaccessible districts, eight (8) from partially- accessible districts and three (3) from accessible districts (from Warshakh in M Shabelle and 1 from Jariban in Map no.6 Map no. 5 Mudug region Week-35 Somalia Weekly EPI/POL Update

Number of NP-AFP cases reported across years during the same period (2013-2018) by zone 450

400 400

350

300 305

250 254 227 200 212 214

150

133 100 96 97 86 84 78 77 50 65 68 57 54 47 42 45 44 44 46 48 24 24 30 36 35 38 0 CENTRAL PUNTLAND SOMALILAND SOUTH SOMALIA 2013 2014 2015 2016 2017 2018

. Except South zone, all the three 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-35 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% 77 35 45 59 216 20 15 9 19 17 11 7 15 11 4 5 7 7 90% 90% 14 14 216 9 80% 80% 12 17 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=216/227) cases reported in 2018 were notified within 7 days of onset of paralysis. Eleven (11) AFP cases [three (3) from Bay, four (4) from Lower Jubba, one (1) from Middle Jubba, Middle Shabelle, Sanaaq and Gedo regions had 1 AFP case from each with delayed notification. Week-35 Somalia Weekly EPI/POL Update

Summary of AFP surveillance key indicators by Zone, 2018

- 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 78 4.1 77 99% 99% 99% 8 70 70 100% 14 10% 6 9%

Puntland 35 12.4 35 100% 100% 100% 1 34 34 100% 3 4% 4 12%

Somaliland 46 5.1 46 100% 100% 98% 4 42 42 100% 4 5% 2 5%

South 68 6.9 65 96% 100% 87% 10 58 58 100% 7 6% 1 2%

Total 227 5.6 223 98% 100% 95% 23 204 204 100% 28 7% 13 6%

Table no.-4 Week-35 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 14 20 2.8 100% 100% 100% 100% 14% 17% 1 GALGADUD 267828 3 15 8.8 100% 100% 100% 100% 7% 13% 0 CENTRAL HIRAN 233838 3 9 5.9 100% 100% 100% 100% 7% 0% 1 LOWER SHABELLE 948112 12 19 3.1 100% 100% 100% 100% 13% 6% 3 MIDDLE SHABELLE 375400 5 15 6.1 93% 93% 93% 100% 7% 0% 2 BARI 182218 2 17 15.2 100% 100% 100% 100% 6% 12% 0 PUNTLAND MUDUG 186490 2 11 9.6 100% 100% 100% 100% 0% 10% 0 NUGAL 90921 1 7 12.5 100% 100% 100% 100% 7% 14% 0 AWDAL 244900 3 15 10.0 100% 100% 100% 100% 0% 8% 0 GALBEED 550148 7 11 3.2 100% 100% 100% 100% 5% 9% 0 SAHIL 85949 1 4 7.6 100% 100% 100% 100% 0% 0% 0 SOMALILAND SANAQ 150975 2 4 4.3 100% 100% 75% 100% 25% 0% 0 SOOL 120412 1 5 6.7 100% 100% 100% 100% 0% 0% 0 TOGDHER 317058 4 7 3.6 100% 100% 100% 100% 7% 0% 0 BAKOOL 183178 2 7 5.8 100% 100% 100% 100% 0% 0% 0 BAY 540491 7 15 4.2 93% 100% 80% 100% 15% 0% 1 SOUTH GEDO 312710 4 15 7.3 87% 100% 93% 100% 14% 0% 0 LOWER JUBA 300735 4 21 10.7 100% 100% 81% 100% 0% 5% 2 MIDDLE JUBA 162640 2 10 9.4 100% 100% 90% 100% 0% 0% 0 SOMALIA 636,4810 78 227 5.6 98% 100% 95% 100% 7% 6% 10 Week-35 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 78 235 186 3 100% 100% 100% 49 27 15% 10 5% Puntland 35 105 96 3 100% 100% 100% 9 12 13% 6 6% Somaliland 46 138 126 3 100% 100% 100% 12 9 7% 8 6% South 68 201 168 3 100% 100% 100% 33 19 11% 6 4% Somalia 227 679 576 3 100% 100% 100% 103 67 12% 30 5%

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-35 Somalia Weekly EPI/POL Update

Distribution of AFP cases by source of case notification, 2018

Source of AFP cases notification by Zone 2018 Number of Number of # of cases Notified Proportion of cases Zone 100% VPVs cases reported by VPV reported by VPV 4 90% 12 6 49 80% 27 70% 29 CENTRAL 190 78 37 47% 60% 14 26 86 50% 17 PUNTLAND 105 35 15 43% 40%

30% Prop. cases notifed notifed by Prop.cases 20% 37 15 SOMALILAND 16 24 92 81 46 16 35% 10%

0% Central Puntland Somaliland South Somalia SOUTH 159 68 24 35% VPV HFs Other Key: 1. VPVs: Village polio volunteers Total Somalia 535 227 92 41% 2. HFs: MCH, Hospitals and Private clinics 3. Others: community members, district field assistants, traditional healers Table no.-6 Week-35 Somalia Weekly EPI/POL Update

Proportion of AFP cases reported by different sources 2012-2018

100%

90%

80%

70%

60%

50%

40%

30%

20%

10%

0% 2012 2013 2014 2015 2016 2017 2018

VPV & Community HFs Vaccinators Traditional Healers

The 7 years trend of AFP reporting source shows, the number of AFP cases notified by HF has increased this year Week-35 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 16 100 184 100 109 17 143 100 7 8 26 111 6 75 12 10 12 4 4 138 63 4 7 10 21 1 53 50 50 92 9 72 5 15 07 50 42 77 9 41 36 0 28 31 28 33 40 25 22 8 4 4 31 25 3 6 20 26 12 14 8 2 12 3 20 0 2 8 1 6 14 0 0 0 0 0 9 18 24 17 0 1 1 4 5 0 6 4 1 70 70 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-35 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 227 AFP cases zone-2012-2018 2012-2018 2012-2018 100% 100% 100% reported in 2018, 44% 33 19 32 52 90% 90% 72 90% 64 (n=101) and 37% (n=85) 80% 112 80% 83 80% 65 181 129 152 101 152 113 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 85 163 150 30% 30% 129 30% only 18% (n=41). 164 113 156 20% 20% 20% 56 221 167 115 . 72% (n=163) of cases are 80 91 70 10% 31 97 69 41 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 50% (n=113) AFP cases Nomadic Rural Urban <5 Yrs ≥ 5 Yrs Female Male are female. Graph no.-10 Graph no.- 11 Graph no.-12 Week-35 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 31 19 61% 7.9 27 100% 100% 97% 7% 0%

Partially accessible 23 1,720,826 60 19 32% 5.5 53 95% 100% 87% 5% 4%

Accessible 75 4,024,663 136 54 40% 5.3 124 99% 101% 99% 8% 9%

National 115 6,364,810 227 92 41% 5.6 204 98% 100% 95% 7% 6% Table no.

- 7 7 Despite accessibility challenges, majority of indicators are above global standards Week-35 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% 41 21 51% 3.6 35 69% 95% 100% 93% 0% 3%

Rural 25.90% 85 43 51% 8.4 78 77% 100% 100% 99% 7% 8%

Urban 45.30% 101 28 28% 5.7 91 81% 98% 99% 93% 9% 7%

National 100% 227 92 41% 5.8 204 77% 98% 100% 95% 7% 6% Week-35 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 78 31 40% Central 7 6 86% 3 from accessible and Somaliland 46 20 43% Somaliland ------remaining from access- compromised South Zone 68 37 54% South Zone 17 12 71% areas Puntland 35 25 71% Puntland 1 1 100% Grand Total 227 113 50% Grand Total 25 18 72% Table no.-8 Table no.-9 . Of the 227 AFP cases reported in 2018, 50% (n=113) were validated by the RPOs. Of the 113 AFP cases validated, (n=81, n=19, n=13) were from accessible, partially accessible and inaccessible districts respectively . There were 25 zero OPV dose AFP cases reported in 2018, out of which 72% (n=18/25) were investigated Week-35 Somalia Weekly EPI/POL Update

Total AFP cases Tracking lab results of AFP cases 227

Tracking AFP with stool specimens AFP cases with AFP cases without stool specimens 1 2 stool specimens 23 32 cVDPV type 2 227 0 and 3 coinfection cVDPV2 With lab En route In the lab cVDPV3 results

Other viruses 204 23

167 neg st cVDPV type 2 and cVDPV2 cVDPV3 SL EV -ve 3 coinfection 1 2 2 13 19 167 Week-35 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 454 408 46 316 77% 28 7% 13 6%

Contacts 679 576 103 446 77% 67 12% 30 5%

Total 1133 984 149 762 77% 95 10% 43 6%

Table no.-10 Week-35 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-35 Somalia Weekly Polio Update

Village polio volunteers weekly house to house visit and number of AFP cases notified, 05 Aug 2018

January Feberuary March April May June July Aug Sept Oct Nov December

Central No. of No. of No. of AFP No. of AFP No. of AFP No. of AFP No. of No. of No. of No. of No. of AFP No. of AFP No. of AFP No. of AFP No. of No. of No. of HH No. of HH No. of HH No. of HH No. of HH No. of HH No. of HH No. of HH AFP AFP cases cases cases cases AFP cases HH AFP cases HH cases cases cases cases HH HH visited visited visited visited visited visited visited visited cases cases notified notified notified notified notified visited notified visited notified notified notified notified visited visited notified notified

38002 6 39361 8 48588 5 38442 3 38,481 2 4 39208 3 37957 6 ------Central 49,819

35756 2 35545 3 45593 4 36456 4 36,073 3 4 36012 1 36702 3 ------South 45,257

16237 3 16148 3 20107 2 16230 3 16,077 1 3 12047 0 12127 0 ------Puntland 19,967

32180 6 32370 1 39613 2 32532 1 32,325 2 2 32194 1 32136 1 ------Somaliland 40,207

Total 122175 17 123424 15 153901 13 123660 11 122956 8 155250 13 119461 5 118922 10 0 0 0 0 0 0 0 0 Week-35 Somalia Weekly Polio Update

Routine immunization services, status of cold chain & vaccine stocks in AFP surveillance sites, 02 Sept 2018

Expected weekly Health facility have a AFP sites with EPI service and functional Health facility have EPI Health facility have IPV vaccine available Region AFP sites visits routine EPI service 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% Part II

Fever and rash surveillance Week-35 Somalia Weekly Polio Update

Epi-curve on suspected measles cases by week, Somalia (2015-2018)

800 2015 2016 2017

(n=7498) (n=5657) (n=23,353) 2018

700

720

(n=7295)

703

699

696

693

686

685

670

663 657

600

584

560

554 538

500

507

496

488

487

463

461

444

441 441

440

436 436

400 426

416 416

410 410

408

407

406

401

400

399

393

389

383

373

362

352

351

349 346

300 330

325 325

320

317

315

314

309

292

290

286

277

269

255

239 228

200 227

224

222

219

214

210

208

199

198

196

191

182

180 180

175

174

173

172

170

163

161

158

156

155

154

153

151

149

145

144

142

141

140 140

134

133

132

128

127 127

100 126

125 125

124 124

122 122 122

117

116

115 115

113

112

111

109 109

107

105 105

97 103

96 102 102 102

95 95 101

100

93 93

90 90

88 88

87 87

86 86

85 85

84 84

76 76

74 74

72 72

66 60

0 202020202020202020202020202020202020202020202020202020202020202020202020202020202020202020202020202020202020202020202020202020202020202020202020202020202020202020202020202020202020202020202020202020202020202020202020202020202020202020202020202020202020202020202020202020202020202020202020202020202020202020202020202020202020202020202020 151515151515151515151515151515151515151515151515151515151515151515151515151515151616161616161616161616161616161616161616161616161616161616161616161616161616161616161616161616161616161617171717171717171717171717171717171717171717171717171717171717171717171717171717171717171717171717171717181818181818181818181818181818181818181818181818 W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W 131415161718192021222324252627282930313233343536373839404142434445464748495051520102030405060708091011121314151617181920212223242526272829303132333435363738394041424344454647484950515201020304050607080910111213141516171819202122232425262728293031323334353637383940414243444546474849505152010203040506070809101112131415161718192021222223 Series1 161414201817171921171415161813151112969585101286908472107289881110129711151087668610121195121087888310141310111114121414109812908274796091928176708476747167851017109393121112131512151719212222302540373938434467496965686669707268695856535546484440324333272935325044413841364448404240344135312831343932464140263122221929212319181215 Week-35 Somalia Weekly Polio Update

Fever and rash cases reported through the AFP surveillance system , 05 Aug 2018 Fever and Rash Cases by weekly 2018

Region

W1 W2 W3 W4 W5 W6 W7 W8 W9

Total 2017 Total 2018 Total

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

Nugal 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 0 368 Bari 1968 21 26 20 17 20 26 26 18 22 27 33 25 27 26 29 46 28 22 13 13 18 13 14 10 16 18 10 7 11 11 6 4 4 627 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 0 457 N/East Zone 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 0 1452 Galbeed 758 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 56 Sahil 576 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 0 128 Sanag 259 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 70 Sool 698 17 7 20 20 45 20 43 13 26 6 26 0 18 6 6 1 1 0 0 1 0 1 2 2 0 0 0 0 0 0 0 2 0 0 283 Awdal 105 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 33 Togdher 2324 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 0 476 N/West Zone 4720 40 26 76 55 95 41 135 52 89 26 85 39 72 22 35 23 12 14 27 10 10 5 17 12 7 2 7 3 0 1 3 2 3 0 1046 M/ Shabelle 716 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 8 572 Hiran 1461 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 10 391 Galgadud 625 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 2 189 Banadir 5617 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 1574 L/Shabelle 2106 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 16 893 Central Zone 10525 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 3619 Middle Juba 62 0 3 3 0 1 1 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 87 Bakool 99 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 56 Gedo 241 0 1 1 51 23 61 51 100 77 35 26 32 8 8 31 3 6 3 0 0 0 1 4 2 0 3 0 0 0 2 0 0 2 2 533 Bay 654 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 0 112 Lower Juba 468 22 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 0 463 South Zone 1524 43 27 14 60 49 72 81 124 98 62 40 44 25 43 87 54 36 20 39 8 37 11 35 34 29 19 15 10 9 7 6 6 5 2 1251 Grand Total 23353 315 286 317 346 393 325 461 410 407 270 314 224 227 198 292 219 239 191 180 126 153 129 148 142 105 98 99 107 132 126 113 107 96 73 7368 Week-35 Somalia Weekly Polio Update Trends of reported fever and rash cases by zone in, 2015 -2018 Source: AFP Surveillance Reporting System

Puntland 15 Somaliland

- 6Jan)

- 909 (11

1200 1000 861 March) (2

Campaign Campaign 823

Campaign Campaign 979 925 891 882 1000 800 667 800 634 503 510 600 600 491 349 323 300 282 400 269 275 400 214221 240 265 222 243 161 133 140 161197 202 194 71 115 7097 110119 627883 73 142 132 113 200 3639 30 48 2443 272939 1927 1133 1240 150 200 95 82 10492 61 93 72 99 8796 14 36 33 3541 1619 479 2942 47 2937 158 0 0 January February March April May June July AUG Sept. Oct. Nov. Dec

2015 2016 2017 2018 2015 2016 2017 2018 15 15

15 15 Central South

- -

1494 326

(11 (11 March)

1600 March) 350 Campaign Campaign Campaign Campaign 1340 1400 1205 300 1111 1200 250 220 925 916 207 1000 189 742 200 171 800 640 659 144 136 139 574 547 568 128 503 545 514 515 150 115 109 600 455 443 420441 450 451 104 367 401 348396 375 367 388 350383 401 82 83 315 324 296307 278 328 281310 100 77 75 64 400 265 271 50 142 4045 37 46 46 46 27 2729 30 22 27 2126 33 2632 200 30 50 9 9 19 147 13 18 18 0 0 January February March April May June July AUG Sept. Oct. Nov. Dec January February March April May June July AUG Sept. Oct. Nov. Dec

2015 2016 2017 2018 2015 2016 2017 2018

Data shows there is a steady decline of suspected measles reported after the measles mass immunization conducted in January in Puntland and March in central, south and Somaliland Week -21 Somalia Weekly Polio Update

Fever and rash cases reported, 02 Sept 2018 Source: AFP surveillance reporting system

Age-wise distribution of fever and rash cases reported Zone-wise cases of fever and rash reported by AFP surveillance by AFP surveivallance system during 2018 system in 2018

8000 7368 <1yr, 1223, 17% Yrs10+, 858, 7000 12% 6000 5_9yrs, 1121, 15% 5000 4000 3619 1_4 yrs, 4166, 3000 56% 2000 1452 1046 1251 1000 0 Central North East North West South Total Somalia Part III Population Immunity Week-35 Somalia Weekly EPI/POL Update

Maps showing accessibility and security/ risk level, Somalia

Source: UNDSS

Map no.10 Map no.11 Week-35 Somalia Weekly EPI/POL Update

Summary programmatic features and initiatives in Somalia by accessibility Number of Population AFP active Zone Accessibility VPV TPVP Settlement Under 15 Years Surveillance sites Accessible 2,475 2,419,077 127 251 150 CENTRAL Inaccessible 984 516,928 63 34 21 Total 3,459 2,936,005 190 285 171 Accessible 1,220 459,639 105 207 53 PUNTLAND Inaccessible 0 0 0 0 0 Total 1,220 459,639 105 207 53 Accessible 3,435 1,469,450 81 214 53 SOMALILAND Inaccessible 0 0 0 0 0 Total 3,435 1,469,450 81 214 53 Accessible 2,234 1,040,648 75 216 123 SOUTH Inaccessible 1,548 459,119 84 33 22 Total 3,782 1,499,767 159 249 145 Accessible 9,364 5,388,814 388 888 379 SOMALIA Inaccessible 2,532 976,047 147 67 43 Total 11,896 6,364,861 535 955 422

Note: the data are preliminary and U 15 population is estimated from Surveillance historical data and U5 SIA data and are being reviewed. Week-35 Somalia Weekly EPI/POL Update

Transit Points Vaccination activities using bOPV - 02 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-35 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 6-23 Immunity Profile of NP-AFP cases 6-59 Immunity Profile of NP-AFP cases 6-23 2013-2018 Months, 2013-2018 Months by Zone, 2018 Months by Zone, 2018 100% 100% 100% 100% 2 90% 9 90% 90% 493 90% 25 14 35 14 31 80% 80% 5 6 6 80% 80% 12 70 26 3 812 635 650 407 575 83 37 70% 70% 70% 424 70% 23 26 60% 17 60% 60% 60% 50% 50% 34 4 18 50% 539 50% 28 24 40% 7 40% 54 6 230 243 14 11 40% 40% 34 6 8 178 245 240 30% 27 30% 17 30% 30% 198 20% 12 20% 7 34 7 17 0 4 152 252 12 2 20% 182 20 10% 888 20% 20 7 10% 3 98 6 2 5 5 18 1 1 29 10% 341 0% 1 1 0% 0 148 10% 0 155 172 93 21 7 9 10 11 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 Graph no.-21 . 25 zero dose AFP cases reported in 2018 from inaccessible and partially accessible areas of South (n=17), Central (n=7) and 1 from Puntland. . 18 AFP cases with zero doses reported in 2018 are in the age group of 6-59 moths and the remaining 7 AFP cases with zero dose are out of the 5-59 months age group Week-35 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% 234 430 294 147 156 178 119 268 273 60% 145 187 60% 306 40% 66 40% 81 74 119 59 27 76 20% 16 52 62 48 20% 484 51 53 78 58 51 40 36 25 127 23 27 58 69 26 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 81 78 75 54 80% 77 100 80% 123 97 66 38 105 97 102 74 84 60% 36 60% 32 50 74 40% 68 77 85 40% 47 16 33 48 48 60 44 317 20% 101 20% 39 62 77 97 99 63 26 34 38 29 18 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 Part -IV Routine Immunization 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

10 5 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) Planning for the accessible underserved children for subsequent rounds (1st – 4th Oct and 29th Oct to 1st Nov 2018)

2nd Sept 2018 Planning for reaching accessible underserved children (1) 1. Planning to reach the accessible underserved children:

• A questionnaire (Slide 4) is administered to the nomadic elders, to collect information on risk perception, health seeking behavior and location of the community during the coming bOPV synchronized rounds.

• Nomadic elders listing is being updated, with designation of vaccinators/mobilizers from their community, and budgets developed to ensure their participation to microplanning before the next round starting 1st Oct 2018, to ensure reaching the nomad children in the accessible areas.

• So far the updated list of: 651 elders and leaders in SCZ, 303 in overall Puntland districts and 757 in all Somaliland districts. Work still in progress. To be extended to all districts hosting nomadic communities before the next round.

• OTPs (Outpatient nutritional centers) are being targeted for inclusion in the campaign micro plans, based on the list of service delivery points received from Nutrition team: the Geocoordinates are still to be collected. These centers although patronized by malnourished can provide opportunities to reach the inaccessible, through Polio pluses due to their locations nearby inaccessible areas.

• There is no planning to reach inaccessible areas, but an update on the situation of inaccessibility is being undertaken by WHO. Based on the information collected, a case by case solving approach will be conducted.

• The “inaccessibility” is very unclear: have we tried to involve them in microplanning; this is to be discussed with field people. Planning for reaching accessible underserved children (2) 2. Reaching the resistant groups to vaccination through the engagement of members of National Islamic Advisory Group (NIAG) and local religious leaders: • Inform them that there is no harm in immunizing a new born or a sick child (Major reasons for refusals) • Encourage their fellow believers/community members, through the public expression of their personal support; • Ensure regular campaign announcements in various mosques and other religious gatherings before and during the campaign; • Resolve Intra campaign persistent refusals ; • Participation to nomadic elders orientation meetings. Way forward/ support required: Involvement of religious leaders to address resistance between rounds.

3. C4D Recruitments: • Finalizing recruitments of C4D national consultant in Baidoa. • The recruitment for the NOA C4D position in Mogadishu is finalized (staff on board) and being finalized in Hargeisa. • Recruitment for International P3 C4D is being initiated.

4. Training of UNICEF Somalia supported MoH staff, contributing to outbreak response, with support of Country office C4D, Regional office and Head quarter: To improve social mobilization planning and implementation during outbreak response, applying evidence based programming, Review specific planning for special populations, collect specific data on missed children and address challenges.

• First session planned 10th to 13th Sept in Mogadishu: 6 regions • Second session planned 17th to 20th Sept in Mogadishu: 3 regions C4D (end process IM) and Vaccine management results (admin data) from previous SIAs in the 3 zones

The last SIA was a mOPV2 round in SCZ (Aug 2018) A bOPV round in Puntland (July 2018 due to delay) A bOPV round in Somaliland (April 2018) Source of information per last SIA in the 3 zones of Somalia

Somaliland bOPV NID1 April 2018

16% 6% Religi 16% Health R

Community mobilizer 91% Reasons for missed children per last SIA end process IM in the 3 zones of Somalia

SCZ End process IM Aug 2018 Synchronized mOPV2 round 2

No visit Refusals 1% 20% Parents / child unavailabl Child e asleep 28% 11% Travel Market / 1% street School 14% 25% Reasons for refusal per last SIA end process IM in the 3 zones of Somalia South Central Zone (SCZ) End process IM Aug 2018 Synchronized mOPV2 round 2 Other services 2%

Visitor Unknown 17% 15%

Sickness Newborn 26% 31%

Fatigue 7% Religious 2% SCZ: Preliminary mOPV2 Vaccine management report (Aug. 2018 mOPV2 second synchronized round)

All quantities are expressed in vials of 20 doses

Initial distribution Previous balance Total stock # Vials reported Balance post Unusable Lost (used Usable vials Balance in plan 8/1/2018 (per national July at the start Used (Admin Aug round vials partially or in stock at Mogadishu Form A - of SIAs report Aug.) returned or empty) regional central store Unopened and broken level (to be usable) recalled) 37,712 3,978 41,690 37,828 1,320 64 22 1,256 2,421

Challenges to accurate figures and timely recall, report and disposal of mOPV2 • Discrepancies between quantities received per Admin report and initial distribution plan: we are still reconciling the figures per regions; As of today 22 vials are lost and 3,776 vials (1256 to be recalled from the regions and 2421 confirmed vials remaining in the national cold store). • The recall of vaccine from Regions is late, and a system is being established for the recall after each round, as this was not the use in the past. • Form A supposed to be finalized at national level 15 days post SIAs is not yet available. Improvements: The number of lost vials has reduced compared to last round (206 in July), thanks to training and the implication of District Polio officers in vaccine management. The END