Epidemiological Weekly Bulletin - From 17/AprTo 23/AprEarly Warning Alert and Response Network EPI Week 17-2016

Highlights = Preparations of the second quarterly meeting of DLOs in between 4-6 of May. = Training of NGOs health workers is ongoing in field in between 20-30 of April. = During EPI Week 17-2016 , 78.83% (432/548) of the health facilities across 12 Governorates provided surveillance data. 80.81% of reporting sites submitted the weekly reports on time. 6 sentinal sites have been added from Idelb = The total number of consultations reported during this week were 154312 (including 40% children under the age of five) compared to 163726 consultations during last week 2016. 6 sentinal sites have been added in Idleb. = In EPI Week 17-2016, 9 AFP (Acute Flaccid Paralysis) cases were reported: Deir-ez-Zor 3, Idleb 3, 2, Dar'a 1 For more details see weekly Acute Flaccid Paralysis Surveillance report. = 78 suspected measles cases reported in this week, the highest alerts reported in Ar- 15 Lab investigation for 14 suspected measles cases from (1) , Idleb (4) and Aleppo (9) , with positive results in one case in Idleb and all Aleppo cases. = The number of STF cases was 1652, the highest alerts were reported in Deir-ez-Zor 17 = 337 cases of SARI reported, the highest alert were reported in 9 = 10663 cases of Acute Diarrhea were reported and 16336 cases of Influenza Like Illness were reported to. while AD cases number were duplicated in the following sub district : Az-Zabdani = Common diseases reported under others were : acute bronchiolitis, chicken pox, Brucellosis, Pertussis, Scabies, lice, mumps, Tonsillitis, Impetigo and hand, foot and mouth disease. 7 new cases of T.B were reported this week . = 1782 new cutaneous leishmaniasis cases reported this week, with alerts Al Ma'ra 3 One case of visceral leishmaniasis (5 years male child) was reported from MENTOR in - . EWARN Coverage Number of Sentinel Sites and Total Number of Consultations

(Completiness) EWARN covers 130 Sub districts and 40 districts in 12 # of Governorate # of sentinels Reporting governorates. Percentage consultations Sentinels Aleppo 170 110 65% 33243 Al-Hasakeh 43 27 63% 3352 Ar-Raqqa 75 59 79% 5439 3 0 0% 0 Dar'a 27 23 85% 18085 Deir-ez-Zor 57 50 88% 15430 Hama 14 14 100% 6959 12 12 100% 5701 Idleb 122 122 100% 58152 Lattakia 3 0 0% 0 5 2 40% 651

17 13 76% 7300 Rural Damascus Grand total 548 432 79% 154312

Completeness and Timeliness

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Trends for essential priority diseases

Proportional Morbidity of suspected Measles

Please contact us: [email protected] 2 Syria EWARN - 2016 EPI Week 17-2016 Proportional Morbidity of AJS

Proportional Morbidity of STF

Number of cases that EWARN observes by age & geographical area

Governorate AD ABD AWD STF AJS ILISARI AFP MEA MEN UCE UXD FUO LEISH OTHER TOTAL < 5 1559 11 0 18 80 2013 12 2 17 6 11 0 14 86 8104 Aleppo 33243 ≥ 5 1466 14 0 66 110 1995 1 0 12 3 7 0 2 204 17430 < 5 495 22 0 24 34 667 25 0 0 15 0 1 21 67 471 Al- Hasakeh 3352 ≥ 5 411 13 0 21 37 502 19 0 0 12 0 0 15 85 395 < 5 241 1 0 4 63 73 5 0 7 12 0 0 0 42 2082 Ar-Raqqa 5439 ≥ 5 161 4 0 14 18 96 1 0 17 24 0 0 3 70 2501 < 5 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Damascus 0 ≥ 5 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 < 5 294 6 0 21 34 234 0 0 1 1 28 0 1 0 7012 Dar'a 18085 ≥ 5 221 11 0 152 34 308 4 1 0 2 44 0 1 7 9668 < 5 1212 80 0 128 122 1838 132 3 14 18 51 0 28 128 4613 Deir-ez-Zor 15430 ≥ 5 734 46 0 552 124 1376 30 0 3 7 63 0 40 204 3884 < 5 85 1 0 0 0 215 2 0 0 0 0 0 3 19 1666 Hama 6959 ≥ 5 103 2 0 16 3 302 14 0 1 0 0 0 13 50 4464 < 5 303 1 0 1 2 389 8 0 1 1 0 0 5 2 1690 Homs 5701 ≥ 5 262 1 0 36 12 393 10 0 0 3 0 0 9 7 2565 < 5 1527 10 0 73 56 2787 49 1 5 11 0 0 4 283 16908 Idleb 58152 ≥ 5 1357 16 0 387 89 2820 21 2 0 5 0 0 9 528 31204 < 5 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Lattakia 0 ≥ 5 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 < 5 21 2 0 10 2 10 0 0 0 0 0 0 0 0 220 Quneitra 651 ≥ 5 35 1 0 17 10 17 0 0 0 0 0 0 0 0 306 Rural < 5 108 0 0 15 19 146 2 0 0 1 133 0 6 0 1382 7300 Damascus ≥ 5 68 0 0 97 30 155 2 0 0 1 102 0 4 0 5029 < 5 5845 134 0 294 412 8372 235 6 45 65 223 1 82 627 44148 TOTAL ≥ 5 4818 108 01358 467 7964 102 3 33 57 216 0 96 1155 77446 154312 Grand total 10663 242 0 1652 879 16336 337 9 78 122 439 1 178 1782 121594

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Number and distribution of alerts reported

#HF reach Disease Alert threshold # Cases The most affected Communities-Districts threshold AFP 1 9 9 Deir-ez-Zor 3, Idleb 3, Aleppo 2, Dar'a 1

Ar-Raqqa 15,Menbij 11,Abu Kamal 5,Al 4,A'zaz 4,Ath-Thawrah 3,Jarablus 3,Deir-ez-Zor 2,Idleb 2, MEA 1 57 78 1,As-Suqaylabiyah 1,Harim 1,' 1,Jebel Saman (Aleppo) 1,Jisr-Ash-Shugur 1,Tadmor 1,Tell Abiad 1

Deir-ez-Zor 11,Menbij 10,Al Mayadin 9,Abu Kamal 5,Jebel Saman (Aleppo) 5,Idleb 3,Izra' 3,Duma 2,Jarablus AJS 5 62 879 2,Jisr-Ash-Shugur 2,Quneitra 2,Al-Hasakeh 1,Ariha 1,Ar-Rastan 1,Ath-Thawrah 1,Az-Zabdani 1,Dar'a 1,Harim 1,Rural Damascus 1

Deir-ez-Zor 17,Al Mayadin 13,Harim 11,Abu Kamal 10,Jisr-Ash-Shugur 7,Rural Damascus 6,Izra' 5,Dar'a 4,Idleb STF 5 94 1652 4,Al Ma'ra 3,Jebel Saman (Aleppo) 3,As-Salamiyeh 2,As-Sanamayn 2,Az-Zabdani 2,Quneitra 2,Ariha 1,Ar-Rastan 1,Duma 1

ABD 5 12 242 Deir-ez-Zor 7,Al Mayadin 3,Abu Kamal 1,Jebel Saman (Aleppo) 1

SARI 5 24 337 Abu Kamal 9,Al Mayadin 8,Idleb 2,Al Ma'ra 1,Al-Hasakeh 1,As-Salamiyeh 1,Jebel Saman (Aleppo) 1,Tell Abiad 1

MEN 5 1 122 Al Mayadin 1 LEISH 50 3 1782 Al Ma'ra 3

Response Activities

1. Training of NGOs health workers is ongoing in field in between 20-30 of April . The Titles are : • Case definition of EWARN surveillance list. • Alert notification , reporting mechanism and filling the weekly zero report. • Cholera : overview , surveillance , case management and WASH response.

2. Preparations of the second quarterly meeting of DLOs in between 4-6 of May.

3. Head Lice outbreak investigation in Tell Abiad – Ar Raqqa Governorate with coordination with the local education authorities . The total number of the cases was 660 cases in 3 schools , the proper response actions were taken (providing medication with education about the disease ) in the education institutes .

ABD=Acute Bloody SARI= Severe Acute AWD=Acute Watery Diarrhea AFP=Acute Flaccid Paralysis AJS=Acute Jaundice Syndrome Diarrhea Respiratory Illness FUO=Fever Of Unknown UCE=Unexplained Cluster Of UXD=Unexplained Death MEA=suspected Measles MEN= suspected Meningitis Origin Health Events

AD=Acute Diarrhea

ILI= Influenza-like Illness

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