Epidemiological Week 25 (Week ending 24th June, 2018)

Highlights Cumulative figures as of week 25 • 219 health facilities across submitted weekly • 1,415,172 consultations from week 1 reports of epidemic-prone diseases in the electronic to week 25. early warning disease surveillance (EWARN) system in • 5,239 cumulative cases of week 25. • Total number of consultations increased from 44,883 AWD/Cholera and 39 deaths since in week 24 to 55,256 in week 25. December 2017. • A total of 341 alerts were received. 50 of these alerts • 8,032 Accumulative alerts were were confirmed as true alerts. received, 389 of these, were • The highest numbers of diseases reported in week 25 confirmed as true alerts from week 1 were other acute diarrhoeas (2,556 cases), influenza to week 25, 2018. like illness (1,678 cases) and severe acute respiratory

illness (1,279 cases). • 6,030 cumulative cases of suspected measles cases since the beginning of • A total of 304 new cases of suspected AWD/cholera including 3 deaths were reported in week 25 2018. Of the 6,030 measles cases, compared to 292 AWD cases including 4 deaths in 3,959 (66%) are under 5 years while week 24. 2,071 (34%) are above 5 years. • A cumulative total of 5,239 AWD/cholera cases1, • 6,778 cumulative cases of Malaria including 39 deaths have been reported since were reported since the beginning of December 2017. 2018, 2,956(44%) are under 5 years, • The number of reported measles cases increased from 72 in week 24 to 92 cases in week 25. while 3,822(56%) are above 5 years.

Table 1. Summary of Alerts for epidemic prone diseases Disease Cumulative Wk22 2018 Wk23 2018 Wk24 2018 Wk25 2018 cases (Wk 1 – 25, 2018)

Total consultations 59,673 64,164 44,883 55256 1,415,172 Other Acute Diarrheas 3161 3,402 2,411 2556 58910 Influenza Like Illness 2041 1,808 1,298 1678 43,291 Severe Acute Respiratory Illness 981 1,464 1,059 1279 24,302 Suspected Measles 113 130 72 92 6030 Confirmed Malaria 356 467 337 476 6778 Acute Watery Diarrhea 82 291 55 58 1910 Bloody Diarrhea 123 184 180 131 2129 Whooping Cough 67 65 45 34 1181

1 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 23

Acute Jaundice 0 8 2 5 94 Suspected Meningitis 1 0 1 0 73 Diphtheria 0 0 0 0 43 Neonatal Tetanus 0 0 1 2 23 Acute Flaccid Paralysis 0 9 2 0 13 Viral Hemorrhagic Fever 0 0 1 0 4

Completeness of Reporting & Reporting Rate Overall, a total of 219 (73%) health facilities submitted their weekly reports on time of the 302 active health facilities in Somalia. In Somaliland, 75 (99%) health facilities (HFs) of the 76 active health facilities submitted reports in week 25, while in Puntland, the completeness of reporting was very low for the past four weeks 25(43%) health facilities of the 58 active Health facilities submitted reports in week 25, while no reports were received from Nugal (12HFs) and Sool (4HFs) of Puntland as shown in Table 5. In South central, 119(71%) health facilities of 168 active health facilities submitted reports in week 25 as shown in Table5 and Fig1 below. Fig1: Completness of reporting

Somaliland Puntland SCZ

120

100

80

60

40

20

0 22 23 24 25 Percentage Percentage of submitted theHFs report Epi-week

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 25, the highest numbers of diseases were other acute diarrhoeas (2,556 cases), influenza like illness (1,678 cases), severe acute respiratory illness (1,279 cases), Suspected measles (92 cases) and Confirmed Malaria (476 cases). Fig. 2. Commonest Causes of Morbidity during Week 1 to 25

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other acute Diaria influence like illness Severe Acute Respiratory Illness Suspected Measles Confirmed Malaria

4000

3000

2000

1000

0 Wk22 Wk23 Wk24 Wk25

AWD/Cholera situation in Somalia

Following the heavy rains that have led to the floods Fig 3. Districts Reporting Cases in Week 25 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 , Banadir and Lower Jubba; the regions that are affected by floods. In week ending 24th June, active transmission of AWD/cholera was reported in in Lower Jubba, Afgoye Kurtunwarey Brava and Merka in Lower Shabelle as well as in 12 districts of Banadir region (Darkenly, Daynile, Hodan, Madina, Waberi, HamarWeine, Hamarjabjab, Wardhigley, Kaaran, Shingani Yaqshid,and Howlwadag districts) (fig 3). In Kismayo, affected communities especially in Farjano IDP are reportedly using contaminated water due to floods. As shown in table 2 below, there was an increase in the number of cases reported from 292 in week 24 to 304 in week 25. 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).

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Fig4: AWD cholera trends in Somalia 2017/18 2500 Cases Deaths CFR (%) 4.0 3.5 2000 3.0 1500 2.5 2.0 Cases 1000 1.5 1.0 500

0.5 Case Fatality Rate(%) 0 0.0 25 27 29 31 33 35 37 39 41 43 45 47 49 51 1 3 5 7 9 11 13 15 17 19 21 23 25 2018

Epi week

Table 2. Summary of AWD/Cholera cases in different regions

States Week 24 Week 25 Cumulative as of 24th June 2018 Regions Ending 17th June 18 Ending 24th June 18

Cases Death CFR (%) Case Deaths CFR (%) Cases Deaths CFR s s (%)

Banadir 137 2 1.5 155 2 1.3 2047 17 0.8

Jubba land L/ Jubba 120 0 0.0 99 0 0.0 1946 15 0.8

South west L/ Shabelle 35 2 5.7 50 1 2.0 266 4 1.5

Hir-shabele M/Shabelle 0 0 0 0 0 0.0 415 2 0.5

Hiraan 0 0 0 0 0 0.0 565 1 0.2

Total 292 4 1.4 304 3 1.0 5,239 39 0.7

NB. Deaths are included among cases. Banadir Region is not a state Cholera Situation in Lower Jubba, Lower 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, 13 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 137 including 4 deaths to 155 cases and 2 deaths in the past 2 weeks. More than 66% of the AWD cases reported in Banadir are children below 2 years of age.

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• 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 decreased from 120 cases with no deaths to 99 cases with no death. More than 39% 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 2018and Afgoye and Merka district started in week 25-2018, as a result of displacement of people due to floods that have been reported in this regions. Merka is the most affected district and cases are being managed in lower Shabelle. More than 68% of the cases reported in Merka 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. Even when Jowhar and Beletweyne reported cases prior to the floods, no new cases have been reported from these districts following the floods. Cholera cases have increased in Kismayo, Afgoye, Kurtunwarey Brava and Merka in Lower Shabelle (Table 3)

Table 3. AWD/Cholera cases in different districts

Region District Week 25 Cumulative Week 49/17- week 25/18 Cases Deaths

<2 yrs 2 -4 yrs ≥ 5 yrs <2 yrs 2-4yrs ≥ 5 yrs Cases Deaths CFR (%)

Banadir Darkenley 8 3 9 0 0 0 332 1 0.3

Daynile 10 8 15 0 0 0 357 6 1.7

HamarJabja 4 3 4 0 0 0 128 2 1.6

Hawlwadag 2 3 3 0 0 0 96 1 1.0

Hodan 14 12 7 0 0 0 440 1 0.2

Karaan 2 3 0 0 1 0 39 1 2.6

Madina 13 4 6 0 0 0 350 2 0.6

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Waberi 1 2 2 0 1 0 95 2 2.1

Shibis 0 0 0 0 0 0 7 0 0.0

Shingani 2 0 0 0 0 0 7 0 0.0

Abdilaziz 0 0 0 2 0 0.0

HamarWeine 1 4 1 0 0 0 40 0 0.0

Heliwaa 0 0 0 0 0 0 21 0 0.0

Wardigley 1 3 2 0 0 0 88 1 1.1

Yaqshid 1 1 1 0 0 0 45 0 0.0

Middle Shabelle× Jowhar 0 0 0 0 0 0 415 2 0.5

Hiran× Beletweyne 0 0 0 0 0 0 522 1 0.2

BuloBarde 0 0 0 0 0 43 0 0.0

Lower Shabelle× Afgoye 1 1 4 0 0 0 146 0 0.0

Kurtunwarey 0 0 6 0 0 1 31 4 12.9

Merka 3 9 14 0 0 0 77 0 0.0

Brava 4 7 1 0 0 0 12 0 0.0

Lower Jubba× Kismayo 39 25 35 0 0 0 1946 15 0.8

Total 106 88 110 0 2 1 5,239 39 0.7

× regions currently affected by floods. Cases include deaths.

Response activities implemented during the week

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 • Weekly coordination meeting for WASH cluster, MoH and Banadir hospital CTC was conducted in Banadir hospital

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 hospital and 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. • Rapid Response Teams (RRTs) have supported state level authorities to verify the rumours in flood affected districts. The teams have been deployed in Jowhar and Kismayo.

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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 increased Week 21 from 72 cases in week 24, to 92 cases in week 25. Cumulatively, 6,030 cases of suspected measles have been reported across Somalia since the beginning of 2018. Of the 6,030 measles cases, 3,959 (66%) are under 5 years while 2,071 (34%) are above 5 years. The most affected regions include; Galgadud (1,086 cases), Bay (959 cases) Banadir (887 cases), (610 cases), and Sool (367 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 25 2018

South & Central Zone Somaliland Puntland

500

450 Measles vaccination 400 in PL Measles vaccination 350 implemented in SL & 300 SCZ on Week 10

250 Cases 200 150 100 50 0 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 Epi-Week

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Fig 7. Measles cases per district Across Somalia from Wk1 - Wk25, 2018

Cases >5 Cases<5

450 400 350 300 250 200 150 100 50 0 Huruwaa Wadajir Abudwak Adado Galkacyo Burao Lasacanod Baidoa Marka Banadir Galmudug Somaliland Southwest

Table 4: Summary of Suspected measles cases by region week 1 - 25, 2018

Wk22 Wk23 Wk24 Wk25 Region Cumulative cases (Wk 1 – 25) 2018 2018 2018 2018

Awdal 0 0 0 0 12 0 0 1 1 119 Banadir 6 14 0 4 887 Bari - - 0 - 92 Bay 25 23 15 22 959 Galgaduud 0 14 0 0 1086 Gedo - 21 4 21 64 Hiraan 12 16 10 6 153 14 11 5 18 266 Lower Shabelle 7 5 5 4 317 6 6 4 5 137 5 3 2 2 152 Mudug 28 10 10 4 610 Nugaal - - 0 - 183 Sanaag 5 0 0 0 159 Sool 1 2 0 1 367 Togdher - 4 11 1 222 Waqoyi Galbed 4 1 5 3 245 Grand Total 113 130 72 92 6030 Dash means there is no weekly Data/report submitted on the system during the specified reporting period.

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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(Galmudug, Hirshabelle, Banadir, Southwest & Juballand) 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.

Malaria Situation in Somalia The number of Malaria cases decreased from 337 cases in week 24 to 476 cases in week 25. Cumulatively, 6,778 cases of Malaria cases have been reported across Somalia since the beginning of 2018. Of the 6,778 malaria cases, 2,956 (44%) are under 5 years while 3,822 (56%) are above 5 years. The most affected districts include; of Bay (1,290 cases), in Banadir (678 cases), Marka district of Lower Shabelle (490 cases), Berdale district of Bay(399 cases) of Bakol (385 cases), Adado district of Galgadud (553 cases), of Bari(331 cases), Bal’ad district of Middle Shabelle (301 cases) and of Bakol (247 Cases) . Fig8: Malaria Situation in Somalia from Week 1 to Week 25, 2018

500 SC Zone Somaliland Puntland 450 400 350 300

250 Cases 200 150 100 50 0 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 Epi-week

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Fig 9: Malaria Cases Per District Across Somalia from Wk1-25, 2018

Cases >5 Cases<5

900 800 700 600 500 400 300 200 100 0 Wadajir Adado Bal'ad Baidoa Berdale Huddur Marka Waajid Banadir Galmudug Hirshabelle SouthWest

Other Acute Diarrhea Situation in Somalia The number of OAD cases has been floatingly going up and down for the last four weeks, the cases in Week 24 were 2,411 compared to 2,556 cases in week 25. Cumulatively, 58,910 cases of OAD cases have been reported across Somalia since the beginning of 2018. Of the 58,910 OAD cases, 44,692 (76%) are under 5 years while 14,218 (24%) are above 5 years. The most affected districts include; Marka District of Lower Shabelle (3,772 cases), Beletweyn district of hiran (3,730 cases), Huruwa district of Banadir (3,254 cases), Wadajir district of Banadir (2,257 cases), Dharkinley of Banadir(1,946 cases), and Jowhar of Middle Shabelle (1,897 Cases) .

Fig10: Trends of Other Acute Diarrhoea cases in Puntland, Somaliland & South and Central (Banadir, Galmudug, Hirshabele Southwest, & Jubaland) from Week1-25, 2018

2500 SC Somaliland Puntland

2000

1500

Cases 1000

500

0 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 Epi-week

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Fig 11: OAD Cases Per District Across Somalia from Wk1-25, 2018

Cases >5 Cases<5 3500

3000

2500

2000

1500

1000

500

0 Dharkinley Huruwaa Wadajir Belet Weyne Bulo Burto Jowhar Baidoa Kurtunwarey Marka Banadir Hirshabelle Southwest

Bloody Diarrhea Situation in Somalia The number of BD cases has also been floatingly decreasing for the last four weeks, the cases in Week 24 were 180 compared to 131 cases in week 25. Cumulatively, 2,129 cases of BD cases have been reported across Somalia since the beginning of 2018. Of the 2,129 BD cases, 1,122 (53%) are under 5 years while 1,007 (47%) are above 5 years. The most affected districts include Baidoa of Bay (387 cases), Burhakaba of Bay (261 cases), Hargeisa of Waqoy Galbeed (137 cases), and Buhodle of Togdheer (112 cases). Fig12: Trends of Bloody Diarrhea cases in Puntland, Somaliland & South and Central (Banadir, Galmudug, Hirshabele Southwest,& Jubaland) from Week1-25, 2018.

140 SC Somaliland Puntland 120

100

80

Cases 60

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 23 24 25 Epi-week

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Fig 13: Bloody Diarrhea Cases Per District Across Somalia from Wk1-25, 2018

300 250 Cases >5 Cases<5 200 150 100 50 0 Afmadow Kismayo Luuq Buhodle Gabiley Hargeisa Baidoa Burhakaba Waajid Jubaland Somaliland SouthWest

Whooping Cough Situation in Somalia The number of WC cases has also been floatingly going up and down for the last four weeks, the cases in Week 24 were 45 compared to 34 cases in week 25. Cumulatively, 1,181 cases of WC cases have been reported across Somalia since the beginning of 2018. Of the 1,181 WC cases, 902 (76%) are under 5 years while 279 (24%) are above 5 years. The most affected districts include Galkacyo (253 cases), Jilib (144 cases), Berbera (91 cases),Erigavo (72 cases), Buale (61 cases) and Adaado (55 Cases) . Fig14: Trends of WC in Puntland, Somaliland & South and Central (Banadir, Galmudug, Hirshabele Southwest,& Jubaland) from Week1-25, 2018

SC Somaliland Puntland 90 80 70 60 50

Cases 40 30 20 10 0 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 Epi-week

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Fig15: Most affected districts of Whouping Cough in Somalia from Wk1-25, 2018

Cases <5 Cases >5

200 180 160 140 120 100 80 60 40 20 0 Adado Galkacyo Gelinsor Bu,aale Jilib Salagle Berbera Burao Erigavo Galmudug Jubaland Somaliland

Most Other affected diseases Across Somalia Severe Acute respiratory Illness (SARI)

Fig16: Trends of SARI cases in Puntland, Somaliland & South and Central (Banadir, Galmudug, Hirshabele Southwest,& Jubaland) from Week1-25, 2018

SC Somaliland Puntland 1400

1200

1000

800

Cases 600

400

200

0 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 Epi-week

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Fig17: Most SARI affected districts across Somalia from Wk1-25, 2018

Cases <5 Cases >5

2500 2000 1500 1000 500

0

Adado

Yaqshid

Wadajir

Jalalaqsi

Huruwaa

Abudwak

Bulo Burto

Belet Belet Weyne Dhuusamarreeb Banadir Galmudug Hirshabelle

Influenza like Illness (ILI): Fig18: Trends of ILI cases in Puntland, Somaliland & South and Central (Banadir, Galmudug, Hirshabele Southwest, & Jubaland) from Week1-25, 2018

SC Somaliland Puntland 1400 1200 1000 800

Cases 600 400 200 0 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 Epi-week

Fig19: Most ILI affected districts across Somalia from Wk1-25, 2018

Cases <5 Cases >5

3000 2500 2000 1500 1000 500 0 Dharkinley Huruwaa Wadajir Belet Weyne Berbera Borama Lasacanod Banadir Hirshabelle Somaliland

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Table 5. Completeness of reporting of the health facilities of Somalia as of Week 25, 2018

State Region District # of active HFs to submit report # of HFs submitted report in week25 Completeness of reporting (%) Abdiaziz 1 1 100 Boondhere 1 1 100 Dayniile 1 0 0 Dharkinley 4 2 50 Hamar Jab Jab 2 2 100 Hamar Weyne 1 1 100 Hodan 1 0 0 Howl-wadaag 2 1 50 Banadir Banadir Huruwaa 3 2 67 Kaaraan 1 0 0 Kahda 1 0 0 Shangani 1 1 100 Shibis 1 1 100 Waberi 1 1 100 Wadajir 9 2 22 Wardhigley 4 3 75 Yaqshid 4 4 100 Subtotal of Banadir 38 22 58 Awdal Baki 1 1 100 Borama 9 9 100 Lughaya 1 1 100 Zeila 2 2 100 Sanag Badhan 2 2 100 Eil-afweine 3 3 100 Erigavo 3 2 67 Somaliland Sool Hudun 1 1 100 Lasacanod 7 7 100 Taleex 1 1 100 Togdheer Ainabo 1 1 100 Buhodle 2 2 100 Burao 12 12 100 Odwayne 2 2 100 Ballayabane 2 2 100 Page 16 of 23

Waqoy Berbera 6 6 100 Galbed Gabiley 4 4 100 Hargeisa 14 14 100 Sheikh 3 3 100 Subtotal of Somaliland 76 75 99 Bari Banderbayla 1 0 0 Bossaso 7 3 43 Carmo 1 0 0 1 0 0 Iskushuban 1 0 0 Qardho 2 0 0 Rakko 2 0 0 Ufeyn 1 0 0 Waciya 2 0 0 Mudug Galdogob 6 5 83 Galkacyo 12 11 92 Puntland Jariiban 2 2 100 Nugal Burtinle 2 0 0 Dangorayo 1 0 0 Eyl 4 0 0 Garoowe 5 0 0 Sanag Badhan 2 2 100 Dhahar 2 2 100 Sool Bocame 1 0 0 Hudun 1 0 0 Lasacanod 1 0 0 Taleex 1 0 0 Subtotal of Puntland 58 25 43 Galgadud Abudwak 3 3 100 Adado 3 3 100 Balanbale 1 1 100 Galmudug Dhuusamarreeb 2 2 100 Guriel 1 1 100 El Bur 1 0 0 El Dere 2 2 100

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Gelinsor 1 1 100 Mudug Galkacyo 4 4 100 Hobyo 12 0 0 Subtotal of Galmudug 30 17 57 Hiraan Belet Weyne 9 7 78 Bulo Burto 3 3 100 Jalalaqsi 1 1 100 Matabaan 1 1 100 Maxaas 1 1 100 Hirshabelle Middle Adale 1 1 100 Shabelle Bal'ad 8 7 88 Jowhar 5 4 80 Mahaday 2 1 50 Warsheikh 3 2 67 Subtotal of Hirshabelle 34 28 82 Gedo B/hawo 2 2 100 Baardhere 1 1 100 Doolow 2 1 50 Garbahaarey 2 1 50 Gedweyne 1 1 100 Luuq 3 0 0 Jubaland Lower Afmadow 1 1 100 Juba Hagar 1 1 100 Jamaame 1 1 100 Kismayo 7 6 86 Middle Bu,aale 2 1 50 Juba Jilib 2 2 100 Salagle 1 1 100 Subtotal of Jubaland 26 19 73 Lower Afgoi 2 1 50 Shabelle Kurtunwarey 2 2 100 Marka 7 7 100 Southwest Qoryooley 2 1 50 Wanla Weyn 1 1 100 Bakool Elberde 3 1 33

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Huddur 1 1 100 Tayeeglow 1 0 0 Waajid 4 3 75 Bay Baidoa 12 11 92 Berdale 2 2 100 Burhakaba 2 2 100 Qansahdere 1 1 100 Subtotal of Southwest 40 33 83 Grand Total 302 219 73

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Table 6. Cumulative Summary of Epidemic-prone Diseases in different Districts of Somalia as of Week 1-25, 2018

Regions District SARI ILI AWD BD OAD DIPH WC MEAS NNT AFP AJS VHF MAL MENG OC Total_cons Awdal Total 0 7895 11 124 3637 0 0 12 0 0 0 0 24 2 30625 42359 Baki 0 993 0 59 256 0 0 0 0 0 0 0 0 0 2797 4105 Borama 0 4910 11 62 2526 0 0 8 0 0 0 0 15 0 20003 27563 Lughaya 0 178 0 2 208 0 0 0 0 0 0 0 0 0 1574 1962 Zeila 0 1814 0 1 647 0 0 4 0 0 0 0 9 2 6251 8729 Bakool Total 175 84 0 84 511 0 16 119 0 0 1 0 711 2 57741 59444 Elberde 0 13 0 0 128 0 0 0 0 0 0 0 0 0 9097 9238 Huddur 34 5 0 13 93 0 0 1 0 0 0 0 247 0 8340 8733 Tayeeglow 25 21 0 3 44 0 0 6 0 0 1 0 79 2 1446 1627 Waajid 116 45 0 68 246 0 16 112 0 0 0 0 385 0 38858 39846 Banadir Total 5297 8033 906 59 12867 0 9 887 0 1 0 0 706 12 336967 365744 Abdiaziz 0 91 0 0 108 0 0 0 0 0 0 0 0 0 8121 8320 Boondhere 0 0 18 0 250 0 0 24 0 0 0 0 0 0 6736 7028 Dayniile 30 180 0 0 280 0 0 7 0 0 0 0 1 0 12465 12963 Dharkinley 573 1130 0 0 1946 0 0 56 0 0 0 0 0 0 20384 24089 Hamar Jab Jab 211 578 0 2 547 0 1 7 0 0 0 0 1 0 12931 14278 Hamar Weyne 93 406 0 0 1017 0 0 10 0 0 0 0 0 0 10764 12290 Hodan 3 22 5 0 68 0 0 0 0 0 0 0 6 0 8661 8765 Howl-wadaag 0 0 0 0 0 0 0 6 0 0 0 0 1 0 34606 34613 Huruwaa 1416 3274 15 6 3254 0 0 468 0 1 0 0 3 12 33858 42307 Kaaraan 10 69 0 0 47 0 0 1 0 0 0 0 0 0 17534 17661 Kahda 56 470 0 0 273 0 0 1 0 0 0 0 0 0 1609 2409 Shangani 125 129 0 0 125 0 0 0 0 0 0 0 0 0 408 787 Shibis 0 0 0 0 578 0 0 11 0 0 0 0 2 0 7241 7832 Waberi 0 0 0 0 33 0 0 0 0 0 0 0 0 0 18046 18079 Wadajir 1464 1595 868 5 2257 0 2 243 0 0 0 0 678 0 81047 88159 Wardhigley 18 0 0 29 1339 0 6 34 0 0 0 0 14 0 41559 42999 Yaqshid 1298 89 0 17 745 0 0 19 0 0 0 0 0 0 20997 23165 Bari Total 81 1020 5 10 594 0 0 92 0 0 0 0 335 0 38837 48779 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 22675 32058

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Carmo 0 6 0 0 4 0 0 0 0 0 0 0 2 0 634 668 Hafun 0 0 0 0 32 0 0 0 0 0 0 0 0 0 1736 1768 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 2565 2639 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 2877 2881 Bay Total 920 3234 62 768 2004 25 45 598 1 0 1 0 1864 0 91724 101332 Baidoa 807 1821 47 387 1305 25 23 337 0 0 1 0 1290 0 76659 82788 Berdale 34 416 6 81 95 0 22 71 0 0 0 0 399 0 5305 6429 Burhakaba 60 376 8 261 348 0 0 185 1 0 0 0 63 0 5841 7143 Qansahdere 19 621 1 39 256 0 0 5 0 0 0 0 112 0 3919 4972 Galgadud Total 4144 1776 191 5 1158 0 174 1447 1 0 3 0 1080 8 57850 67837 Abudwak 1434 519 0 0 311 0 29 709 1 0 0 0 233 4 13094 16334 Adado 892 502 3 1 293 0 55 293 0 0 3 0 353 1 10698 13094 Balanbale 333 218 0 1 52 0 13 129 0 0 0 0 85 0 2862 3693 Dhuusamarreeb 745 274 10 2 208 0 19 157 0 0 0 0 174 0 16811 18400 El Bur 24 6 178 0 38 0 0 34 0 0 0 0 17 0 533 830 El Dere 544 194 0 1 198 0 22 61 0 0 0 0 131 3 11059 12213 Gelinsor 172 63 0 0 58 0 36 64 0 0 0 0 87 0 2793 3273 Gedo Total 267 1219 48 56 364 0 0 64 0 0 0 0 257 0 18161 20436 B/hawo 54 256 32 2 52 0 0 19 0 0 0 0 70 0 6087 6572 Baardheere 0 0 0 17 0 0 0 0 0 0 0 0 0 0 0 17 Doolow 85 419 0 0 53 0 0 35 0 0 0 0 52 0 3164 3808 Garbahaarey 5 189 11 0 140 0 0 4 0 0 0 0 46 0 2904 3299 Gedweyne 22 27 0 0 43 0 0 0 0 0 0 0 0 0 348 440 Luuq 101 328 5 37 76 0 0 6 0 0 0 0 89 0 5658 6300 Hiraan Total 7216 4030 284 6 6088 0 57 153 0 0 0 0 152 2 63901 81889 Belet Weyne 4079 3017 278 0 3730 0 7 115 0 0 0 0 150 1 35923 47300 Bulo Burto 2015 489 6 6 1520 0 1 26 0 0 0 0 2 1 14001 18067 Jalalaqsi 953 124 0 0 642 0 0 2 0 0 0 0 0 0 2185 3906 Matabaan 104 302 0 0 143 0 0 0 0 0 0 0 0 0 6499 7048 Maxaas 65 98 0 0 53 0 49 10 0 0 0 0 0 0 5293 5568 Lower Total 1550 15 51 169 1724 3 20 266 0 0 0 0 179 0 60936 64913 Juba Afmadow 585 0 28 67 366 0 0 0 0 0 0 0 4 0 7831 8881

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Hagar 99 5 0 11 134 2 3 46 0 0 0 0 0 0 3008 3308 Jamaame 92 0 6 7 126 0 0 44 0 0 0 0 97 0 6530 6902 Kismayo 774 10 17 84 1098 1 17 176 0 0 0 0 78 0 43567 45822 Lower Total 669 657 236 11 6935 4 15 317 0 0 0 0 620 0 112491 121955 Shabelle Afgoi 41 96 0 2 257 0 0 40 0 0 0 0 8 0 20519 20963 Kurtunwarey 37 3 41 0 1362 0 0 31 0 0 0 0 43 0 12670 14187 Marka 239 3 151 6 3772 4 15 191 0 0 0 0 490 0 66371 71242 Qoryooley 66 0 44 0 827 0 0 49 0 0 0 0 62 0 11408 12456 Wanla Weyn 286 555 0 3 717 0 0 6 0 0 0 0 17 0 1523 3107 Middle Total 96 0 1 77 522 5 255 144 0 0 0 0 163 0 9785 11048 Juba Bu,aale 19 0 0 17 118 0 61 33 0 0 0 0 0 0 1912 2160 Jilib 49 0 1 37 315 5 144 85 0 0 0 0 163 0 6170 6969 Salagle 28 0 0 23 89 0 50 26 0 0 0 0 0 0 1703 1919 Middle Total 492 307 77 100 3085 0 1 145 0 0 0 0 443 0 91823 96473 Shabelle Adale 0 0 0 0 0 0 0 0 0 0 0 0 1 0 5873 5874 Bal'ad 436 279 19 28 781 0 1 111 0 0 0 0 301 0 38162 40118 Jowhar 45 0 53 61 1897 0 0 34 0 0 0 0 101 0 25517 27708 Mahaday 3 16 0 11 142 0 0 0 0 0 0 0 10 0 7626 7808 Warsheikh 8 12 5 0 265 0 0 0 0 0 0 0 30 0 14645 14965 Mudug Total 552 43 14 42 3981 4 278 610 21 9 34 1 14 21 134019 139643 Galdogob 68 2 1 0 308 0 0 13 0 0 1 0 0 0 13471 13864 Galkacyo 337 5 13 36 2562 2 257 459 3 9 4 1 7 21 94310 98026 Harardere 28 36 0 1 146 0 12 29 0 0 0 0 4 0 3307 3563 Hobyo 115 0 0 0 893 2 8 99 18 0 28 0 3 0 10481 11647 Jariiban 4 0 0 5 72 0 1 10 0 0 1 0 0 0 12450 12543 Nugaal Total 76 829 6 0 474 1 6 183 0 0 0 0 0 0 12496 14071 Burtinle 1 166 0 0 120 0 0 29 0 0 0 0 0 0 2454 2770 Dangorayo 1 28 0 0 36 1 0 0 0 0 0 0 0 0 1435 1501 Eyl 12 227 0 0 97 0 0 44 0 0 0 0 0 0 3601 3981 Garoowe 62 408 6 0 221 0 6 110 0 0 0 0 0 0 5006 5819 Sanag Total 1392 668 18 51 1177 1 76 159 0 0 0 0 32 1 26861 30570 Badhan 516 181 10 0 392 0 1 136 0 0 0 0 28 0 6705 7976 Dhahar 411 1 2 49 199 0 3 3 0 0 0 0 2 0 3355 4025 Eil-afweine 362 215 5 2 364 1 0 12 0 0 0 0 0 0 8489 9494 Erigavo 103 271 1 0 222 0 72 8 0 0 0 0 2 1 8312 9075

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Sool Total 38 3847 0 6 3117 0 35 367 0 0 0 0 45 0 34300 41755 Bocame 0 0 0 0 5 0 0 2 0 0 0 0 0 0 222 229 Hudun 0 638 0 0 393 0 1 14 0 0 0 0 0 0 3222 4268 Lasacanod 38 2901 0 6 2560 0 34 349 0 0 0 0 45 0 28481 34414 Taleex 0 308 0 0 159 0 0 2 0 0 0 0 0 0 2375 2844 Togdheer Total 244 1978 0 283 3165 0 37 215 0 0 6 0 2 13 27899 33854 Ainabo 1 85 0 48 158 0 0 3 0 0 0 0 0 0 1856 2151 Buhodle 23 130 0 112 229 0 0 13 0 0 0 0 0 0 3738 4245 Burao 194 1538 0 94 2532 0 37 199 0 0 6 0 2 13 19388 24015 Odwayne 26 225 0 29 246 0 0 0 0 0 0 0 0 0 2917 3443 Waqoy Total 1093 7656 0 278 7507 0 157 252 0 1 51 1 151 12 55911 73070 Galbed Ballayabane 171 238 0 43 262 0 24 9 0 0 13 0 0 1 2481 3242 Berbera 282 2604 0 2 2186 0 91 106 0 1 38 1 5 1 15529 20846 Gabiley 229 2293 0 96 1900 0 6 21 0 0 0 0 36 0 6347 10928 Hargeisa 244 1829 0 137 2473 0 33 98 0 0 0 0 105 10 26861 31790 Sheikh 167 692 0 0 686 0 3 18 0 0 0 0 5 0 4693 6264

Grand Total 24302 43291 1910 2129 58910 43 1181 6030 23 11 96 2 6778 73 1,262,327 1,415,172

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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