Week-22 Ending 03 June 2018 Highlights

Somalia Weekly Update Week-22 Ending 03 June 2018 Highlights

• No cVDPV2 or cVDPV3 reported from any human stool sample in 2017 or 2018 • 3 PV3 isolated from 3 ES samples collected in week 18, 19 and 20 from KAWMA (n=2 samples) and 21 October (n=1 sample) ES sites with EPID number (ES/SOM/BAN/HDN/EGH/18/019, ES/SOM/BAN/HMW/KAWMA-1/18/018 and ES/SOM/BAN/HMW/KAWMA-1/18/020). Samples are undergoing sequencing • KAWMA ES site catchment area house-to-house survey completed. Further investigations ongoing in selected HH with suspected AFPs and sickly children reported. • An additional 25 community samples collected this week from healthy children from Sablale district (inaccessible area) in Lower Shabelle region (as per schedule to collect 25 stool samples from healthy children from access-compromised districts every week). • Microplan revised and budget finalized for the mOPV2 campaign in all accessible and partially accessible districts of South and Central zone. Banadir, Lower Shabelle and Middle Shabelle will be synchronized with Kenya. Summary Environmental Samples and Lab Classification

Epidemiological Week-2217 Epidemiological Week-2218

Region District Name Date 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 of of J. J. J. J. F. F. F. F. M. M. M. M. M. Ap. Ap. Ap. Ap. Ma Ma Ma Ma Sites Establishment y y y y 04 11 18 25 01 08 15 22 01 08 15 22 29 05 12 19 26 03 10 17 24

Banadir Waberi 21October 19 Sept. 2017

Banadir Shangani Urobo 20 Sept. 2017

21 Sept. 2017 Banadir Hamerewoini Kawma

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

Legend

1 Not scheduled 6 Sabin 11 WPV1+cVDPV2 16 aVDPV2

2 Pending 7 NPENT + Sabin 12 Sent for sequencing 17 cVDPV3

3 Negative 8 cVDPV2 13 Scheduled but not collected 18 cVDPV2+cVDPV3 4 NEV 9 WPV1 14 Sabin 2

5 NPENT 10 WPV3 15 Sabin + NPEV + NEV Summary of response activities using mOPV2 and bOPV

• 3 rounds of mOPV2 campaigns conducted targeting all mOPV2 3 rounds PCIM coverage <5 (Benadir, Middle and Lower Shabelle) 100% st 99% ➢ 1 Round (10-13 Dec. 2017) 98% 98% 97% 97% 97% • Target: 726,699 95% 96% 96%

• Reached: 702,667 (97%) 92% 90% • Missed: 24,032 • IM coverage: 97% 85% ➢ 2nd Round ( 29 Jan-01 Feb 2018)

• Target: 741,313 80% • Reached: 715,172 (96%) • Missed: 26,141 75% • IM coverage: 93% ➢ 3rd Round (05-08 May 2018) 70% • Target: 790,837 65% • Reached: 763,471 (97%) • Missed: 27,366 60% • IM coverage: 98%

• Target for the 3 rounds varied due to population moment and updated 55% and revised micro plan using mapping exercise output especially in 2 peripheral districts of Banadir. In these districts influx of new IDPs was 50% observed. ROUND I ROUND II ROUND III BANADIR LOWER SHABELLE MIDDLE SHABELLE Part I

AFP Surveillance Week-22 Somalia Weekly EPI/POL Update

Epidemiological Curve 01 January 2014 – 03 June 2018

2014W01 2014W04 2014W07 2014W10 2014W13 2014W16 2014W19 2014W22 2014W25 2014W28 2014W31 2014W34 2014W37 2014W40 2014W43 2014W46 2014W49 2014W52 2015W03 2015W06 2015W09 2015W12 2015W15 2015W18 2015W21 2015W24 2015W27 2015W30 2015W33 2015W36 2015W39 2015W42 2015W46 2015W49 2015W52 2016W03 2016W06 2016W09 2016W12 2016W15 2016W18 2016W21 2016W24 2016W27 2016W30 2016W33 2016W36 2016W39 2016W42 2016W45 2016W48 2016W51 2017W02 2017W05 2017W08 2017W11 2017W14 2017W17 2017W20 2017W23 2017W26 2017W30 2017W33 2017W36 2017W39 2017W41 2017W44 2017W47 2017W50 2018W01 2018W04 2018W07 2018W10 2018W13 2018W16 2018W19

Pending Lab Pending ERG Discarded Compatable WPV aVDPV Graph no. 1 Week-22 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

2017W23 2017W24 2017W25 2017W26 2017W27 2017W28 2017W29 2017W30 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

Total 2016Total

Total 2017 Total 2017 Total

BANADIR 30 2 1 1 2 2 2 1 2 1 1 1 33 2 1 1 1 1 1 1 1 1 1 2 13 GALGADUD 25 2 1 1 2 1 1 1 1 1 1 1 27 1 2 1 1 1 1 1 1 1 1 11 M. SHABELLE 19 1 1 1 1 1 1 2 1 1 1 1 1 1 24 1 1 1 1 1 1 3 1 10 L. SHABELLE 24 1 1 1 1 1 1 1 1 1 1 2 1 1 2 1 1 1 31 1 2 1 1 1 2 8 HIRAN 15 1 1 1 1 1 1 1 1 1 1 1 21 1 1 1 1 1 1 6 BARI 24 2 1 1 1 1 1 1 1 1 1 24 3 2 1 1 2 1 2 12 NUGAL 11 1 1 1 1 1 10 1 1 1 1 4 MUDUG 14 1 1 1 1 1 12 1 1 1 2 1 1 1 1 9 TOGDHER 11 1 1 1 1 9 1 1 1 1 4 GALBEED 19 1 2 1 2 1 2 20 1 1 1 1 1 2 1 1 9 SANAQ 7 1 1 1 6 1 1 2 AWDAL 18 1 1 1 1 1 1 17 1 2 1 1 1 1 1 1 1 10 SAHIL 8 1 1 1 1 8 1 1 2 SOOL 5 1 1 2 1 11 1 1 2

LOWER JUBA 26 1 1 2 2 1 1 1 1 1 1 1 1 1 29 2 1 2 1 1 1 1 1 1 11 1 BAY 19 1 1 1 1 1 2 2 2 1 22 1 4 1 1 1 1 1 1 1 1 13 - GEDO 21 1 1 1 2 2 1 1 1 20 1 1 1 1 1 1 6 MIDDLE JUBA 11 2 1 2 1 1 11 1 1 1 1 1 5

BAKOOL 9 1 1 1 1 1 1 1 10 1 1 1 1 1 5 no. Table Total Somalia 316 9 10 2 5 9 3 7 6 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 8 5 8 5 8 8 2 1 142

Silent (not reporting) for > 8 weeks - Seven new AFP cases were reported last week making the total AFP cases reported in 2018 to 142 from 19 regions as compared to 169 AFP cases Reported AFP cases from 19 regions as the same time point in 2017. Community Samples collected in silent regions Community Samples collected but regions not silent Week-22 Somalia Weekly EPI/POL Update

Classification of AFP cases by status (2017 & 2018)

2017 2018 ZONE PROVINCE Discarded Pending Total Discarded Pending Total 142 AFP Cases BANADIR 33 0 33 8 5 13 Reported in 2018 GALGADUD 27 0 27 9 2 11 CENTRAL HIRAN 21 0 21 4 2 6 LOWER SHABELLE 30 0 31 6 2 8 MIDDLE SHABELLE 24 0 24 5 5 10 BARI 24 0 24 11 1 12 0 Puntland MUDUG 11 0 12 7 2 9 112 0 30 0 NUGAL 10 0 10 3 1 4 Compatibl Discarded WPV Pending VDPV AWDAL 16 0 17 9 1 10 e GALBEED 20 0 20 8 1 9 SAHIL 8 0 8 2 0 2 Somaliland SANAQ 6 0 6 2 0 2 SOOL 11 0 11 2 0 2 TOGDHER 9 0 9 3 1 4 BAKOOL 10 0 10 4 1 5

30 0 0 BAY 22 0 22 10 3 13 2 2 In process (lab) Pending ERG Pending ITD SOUTH GEDO 20 0 20 6 0 6 - LOWER JUBA 29 0 29 9 2 11 MIDDLE JUBA 11 0 11 4 1 5 Grand Total

Chart no. 1 345 0 345 112 30 142 no. Table Week-22 Somalia Weekly EPI/POL Update

Surveillance Indicators by Zone and Region 2018

Annualized NP-AFP Rate by Zone, 2017 14.0

12.0 12.9 10.0 8.0 6.0 6.3 4.0 5.4 4.7 2.0 3.9 0.0 Central Puntland Somaliland South Total Somalia Graph no. 2

Annualized NP-AFP rate by accessibility status 10.0

8.0

6.0 6.7 4.0 5.2 5.3 5.4

2.0

- In-accessible Partially Accessible Somalia Acceessible Map no. 1 Map no. 2 Graph no. 3 Week-22 Somalia Weekly EPI/POL Update

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

▪ 94 out of 115 districts reported at least 1 AFP case since the first week of 2018. ▪ Out of the 94 districts reporting AFP cases in 2018, 89 have annualized NP-AFP rate above 2 per 100,000 . In addition, 92 districts have stool adequacy rate of above 80%. ▪ The remaining 21 districts have not reported any AFP case in 2018; However, no district in Somalia has been silent for more than 52 consecutive weeks. ▪ 17% (n=3/17) inaccessible districts, 4% (n=1/23) of partially accessible districts and 23%(n=17/75) of accessible districts did not report AFP cases in 2018. Map no. 3 Map no. 4 Week-22 Somalia Weekly EPI/POL Update

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

▪ AFP cases were reported from across

the country, from all zones, regions,

and accessible and inaccessible parts

of the country.

▪ Geo-code information was collected

from 64% of AFP cases reported in

2018.

▪ All the 14 zero-dose AFP cases

reported in 2018 were reported from

access-compromised districts of

central and south zones: 8 from

inaccessible and 6 from partially- Map no. 5 Map no.6 accessible districts. Week-22 Somalia Weekly EPI/POL Update

Number of NP-AFP cases reported across years during the same period (2013-2018) by zone 250

200 207

169 150 159

146 142 130

100

50 62 63 59 55 48 40 41 40 37 34 36 37 29 27 25 25 24 27 28 14 14 19 20 0 CENTRAL PUNTLAND SOMALILAND SOUTH SOMALIA 2013 2014 2015 2016 2017 2018

▪ All zones but Puntland have reported less number of AFP cases compared to the number of reported AFP cases in 2017 during the same period. Week-22 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 25 28 34 134 11 6 8 12 9 4 10 9 2 2 4 5 6 100% 100% 47 134 13 9 90% 90% 9 4 80% 80% 10

70% 70%

60% 60% 1 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=134/142) cases reported in 2018 were notified within 7 days of onset of paralysis. A total of 8 AFP cases (3 from Bay, 2 from Lower Jubba, 1 from Middle Jubba, 1 from Middle Shabelle and 1 from Sanaaq regions had delayed notification). Week-22 Somalia Weekly EPI/POL Update

Summary of AFP surveillance key indicators by Zone, 2018

. .

NP NP EV Adq

% Stool % Inv. % Notif. with NP

ZONE Adq. within 48 within 7 with

AFP AFP Rate

cond. -

hrs. days Isolated

Specimen

# # AFP cases

EVIsolated

good good cond.

virus virus Isolation

Virus Isolation

of samples of samples

# Cases # Cases with

% of cases % of cases with L S

% Cases % Cases with stool in

# cases # with cases Sabin like

% % Samples

Cases Cases with lab. result.

Cases Cases with stool in good Cases Cases pending lab results Central 48 3.9 47 98% 100% 98% 16 32 32 100% 4 6% 5 16%

Puntland 25 12.9 25 100% 100% 100% 4 21 21 100% 2 5% 4 19%

Somaliland 29 4.7 29 100% 100% 97% 3 26 26 100% 3 6% 0 0%

South 40 6.3 38 95% 100% 85% 7 33 33 100% 7 11% 0 0%

Total 142 5.4 139 98% 100% 94% 30 112 112 100% 16 7% 9 8%

Table no.-4 Week-22 Somalia Weekly EPI/POL Update

Summary of AFP surveillance key indicators by Province, 2018 Expected # of AFP % Samples Number of AFP % inv. within % Notif. % Stool % cases with # Cases with late ZONE PROVINCE Regional U15 Pop. cases as of this NP-AFP Rate % Stool Adq. with EV cases reported 48 hrs. within 7 days condition SL isolated 60 days followup Week isolated BANADIR 1110807 9 13 2.8 100% 100% 100% 100% 0% 38% 0 GALGADUD 267828 2 11 9.7 100% 100% 100% 100% 11% 11% 0 CENTRAL HIRAN 233838 2 6 6.1 100% 100% 100% 100% 0% 0% 0 LOWER SHABELLE 948112 8 8 2.0 100% 100% 100% 100% 17% 17% 0 MIDDLE SHABELLE 375400 3 10 6.3 90% 90% 90% 100% 0% 0% 0 BARI 182218 2 12 15.6 100% 100% 100% 100% 9% 18% 0 PUNTLAND MUDUG 186490 2 9 11.4 100% 100% 100% 100% 0% 14% 0 NUGAL 90921 1 4 10.4 100% 100% 100% 100% 0% 33% 0 AWDAL 244900 2 10 9.7 100% 100% 100% 100% 0% 0% 0 GALBEED 550148 5 9 3.9 100% 100% 100% 100% 6% 0% 0 SAHIL 85949 1 2 5.5 100% 100% 100% 100% 0% 0% 0 SOMALILAND SANAQ 150975 1 2 3.1 100% 100% 50% 100% 50% 0% 0 SOOL 120412 1 2 3.9 100% 100% 100% 100% 0% 0% 1 TOGDHER 317058 3 4 3.0 100% 100% 100% 100% 0% 0% 0 BAKOOL 183178 2 5 6.5 100% 100% 100% 100% 0% 0% 0 BAY 540491 5 13 5.7 92% 100% 77% 100% 20% 0% 0 SOUTH GEDO 312710 3 6 4.5 83% 100% 100% 100% 25% 0% 0 LOWER JUBA 300735 3 11 8.6 100% 100% 82% 100% 0% 0% 0 MIDDLE JUBA 162640 1 5 7.3 100% 100% 80% 100% 0% 0% 0 SOMALIA 6364810 54 142 5.4 98% 100% 94% 100% 7% 8% 1 Week-22 Somalia Weekly EPI/POL Update

Summary of key indicators for AFP surveillance 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 48 138 96 2.875 100% 100% 100% 42 6 6% 9 9% Puntland 25 75 63 3 100% 100% 100% 12 4 6% 6 10% Somaliland 29 87 78 3 100% 100% 100% 9 5 6% 5 6% South 40 120 99 3 100% 100% 100% 21 6 6% 2 2% Somalia 142 420 336 3 100% 100% 100% 84 21 6% 22 7%

Summary of Community Samples collected in 2018 from silent districts, Egyptian hospital and inaccessible districts Zone Pending for lab result Negative NP-EV Total Sample collected PUNLAND 5 24 1 30 SOMALILAND 0 19 1 20 CENTRAL 70 5 0 75 SOUTH 13 13 2 28 Total Sample collected 88 61 4 153 Table no.-5 Week-22 Somalia Weekly EPI/POL Update

Distribution of AFP cases by source of case notification, 2018

Source of AFP cases notification 2012-2018 100% Number of Number of # of cases Notified Proportion of cases 48 50 25 Zone 90% 64 VPVs cases reported by VPV reported by VPV 138 80% 253 79 70% 105 104 74 53 60% CENTRAL 190 48 23 48% 50% 131

40% PUNTLAND 105 25 11 44% 30% 268 143 163 191 67 64 20% 151 SOMALILAND 81 29 12 41% 10%

0% 2 25 2012 2013 2014 2015 2016 2017 2018

Year of onset SOUTH 159 40 16 40% VPV HFs Other Key: 1. VPVs: Village polio volunteers Total Somalia 535 142 62 44% 2. HFs: MCH, Hospitals and Private clinics 3. Others: community members, district field assistants, traditional healers Table no.-6 Week-22 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 12 4 138 63 4 7 10 50 21 1 72 53 5 7 50 50 9 4 77 5 1 0 41 3 36 28 31 28 62 33 26 40 7 22 8 4 4 0 31 25 3 6 15 20 12 14 8 12 3 20 17 0 2 8 1 12 14 0 0 0 0 0 9 18 24 17 0 1 1 4 5 0 6 3 1 70 2012 2013 2014 2015 2016 2017 2018 0 20 3 2 0 0 0 02 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-22 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 zone-2012-2018 2012-2018 2012-2018 ▪ Of the total 142 AFP 100% 100% 100% cases reported in 2018, 33 19 32 52 90% 90% 72 90% 38 42% (n=59) and 41% 80% 112 80% 83 80% 65 181 129 152 59 152 64 (n=58) are from urban 281 189 70% 70% 70% 92 324 252 166 and rural populations 60% 60% 60% respectively. Nomadic 50% 50% 50% 87 129 249 283 348 293 communities account for 40% 144 117 40% 40% 51 124 58 104 150 30% 30% 129 30% only 18% (n=25). 164 77 156 20% 20% 20% 56 221 167 115 ▪ 73% (n=104) of cases are 80 91 70 10% 31 97 69 25 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 ▪ 54% (n=77) AFP cases Nomadic Rural Urban <5 Yrs ≥ 5 Yrs Female Male are female. Graph no.-10 Graph no.- 11 Graph no.-12 Week-22 Somalia Weekly EPI/POL Update

AFP surveillance indicators by accessibility status of districts, 2018

% % of % of % of % cases # of AFP # of Cases NP AFP Number of % inv. Specim U-15 Pop in Cases Stool Notif. with # of districts cases reported rate cases with Within ens Accessibility this area reported adequac within Sabin Reported by VPVs lab result 48 hrs. with by VPVs y 7 days like virus NPEV

Inaccessible 17 619,320 17 10 59% 6.7 13 100% 100% 94% 8% 0%

Partially 23 1,720,826 37 14 38% 5.2 29 95% 100% 86% 9% 3% accessible

Accessible 75 4,024,663 88 38 43% 5.3 70 99% 100% 98% 6% 11%

National 115 6,364,810 142 62 44% 5.4 112 98% 100% 94% 7% 8% Table no.

- 7 7 ▪ Despite accessibility status of districts, majority of indicators are above global standards Week-22 Somalia Weekly EPI/POL Update

AFP surveillance indicators by lifestyle of population, 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 adequac 48 hrs. d ens Sabin like rate result result the area d by VPVs by VPVs y within with virus within 14 days 7 days NPEV

Nomadic 28.80% 25 13 52% 3.2 21 62% 96% 100% 92% 0% 5%

Rural 25.90% 58 29 50% 8.3 46 78% 100% 100% 98% 9% 7%

Urban 45.30% 59 20 34% 4.8 45 80% 97% 100% 92% 9% 11%

National 100% 142 62 44% 5.3 112 76% 98% 100% 94% 7% 8% Week-22 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 # of Zero dose % of Zero dose Comment Zone Reported cases cases Zone AFP cases AFP cases AFP cases Validated Validated Reported investigated investigated

Central 48 26 54% Central 7 4 57% 2 from accessible and Somaliland 29 20 69% Somaliland remaining from access- compromised South Zone 40 30 75% South Zone 10 9 90% areas

Puntland 25 20 80% Puntland

Grand Total 142 96 68% Grand Total 17 13 76% Table no.-8 Table no.-9

▪ Out of the total 142 AFP cases reported in 2018, 68% (n=86) were validated by the RPOs ▪ There were 17 zero OPV dose AFP cases reported in 2018, out of which 76% (n=13/17) were investigated Week-22 Somalia Weekly EPI/POL Update

Total AFP cases Tracking lab results of AFP cases 142

Tracking AFP with stool specimens Total AFP cases Total AFP cases with stool without stool specimens specimens 142 0 16 cVDPV2 30

Other viruses With lab En route In the lab

neg st results 112 0 30 in lab 96 en route cVDPV2 SL EV -ve 0 9 7 96 Week-22 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 284 224 60 170 76% 16 7% 9 8%

Contacts 420 336 84 255 76% 21 6% 22 7%

Total 704 560 144 425 76% 37 7% 31 7%

Table no.-10 Week-22 Somalia Weekly EPI/POL Update

Median and average number of days from onset of paralysis up to final lab result - 2018

Date of Date of Second stool Specimen reached Primary Culture ITD result onset Notification collected to Lab result

Median: 3 days Median: 2 days Median: 3 days Median: 11 days 1 day Average: 3.53 days Average: 1.89 days Average: 3.8 days Average: 11.7 days

Date second Date final stool Median: 20 days ITD results collected Average: 22 days Chart no. 2 Week-22 Somalia Weekly Polio Update

Village polio volunteers weekly house to house visit and AFP cases notified, 03 June 2018

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

No. of No. of No. of No. of No. of No. of No. of No. of No. of No. of No. of Central No. of No. of No. of No. of No. of No. of AFP No. of AFP No. of No. of No. of No. of No. of AFP No. of AFP AFP AFP AFP AFP AFP AFP AFP HH HH AFP cases HH HH HH cases HH cases HH HH HH HH HH cases HH cases cases cases cases cases cases cases cases visited visited notified visited visited visited notifie visited notifie visited visited visited visited visited notifie visited notifi notified notified notified notified notified notified notified d d d ed

38002 5 39361 8 48588 5 38442 3 ------Central 38,481 3 - - -

35756 1 35545 3 45593 5 36456 4 ------South 36,073 3 - - -

16237 2 16148 3 20107 2 16230 2 ------Puntland 16,077 2 - - -

32180 6 32370 1 39613 2 32532 1 ------Somaliland 32,325 1 - - - 122175 14 123424 15 153901 14 123660 10 122956 9 0 0 0 0 0 0 0 0 0 0 0 Total 0 0 0 Week-22 Somalia Weekly Polio Update

Routine Immunization Services, status of Cold Chain & Vaccine stocks in AFP Surveillance Sites. 003 June 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-22 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

(n=5892)

720

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

330 325

300 325

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

126 125

100 125

124 124

122 122 122

117

116

115 115

113

112

111

109 109

107

105 105

103

102 102 102

101

95 95

100

93 93

90 90

88 88

87 87

86 86

85 85

84 84

76 76

74 74

72 72

66 60

0 Week-22 Somalia Weekly Polio Update

Fever and rash cases reported by AFP surveillance system , 03 June 2018

Fever and Rash Cases by weekly 2018

Region

W1 W2 W3 W4 W5 W6 W7 W8 W9

Total Total 2017 Total 2018

W10 W11 W12 W13 W14 W15 W16 W17 W18 W19 W20 W21 Nugal 2050 32 26 26 26 24 19 30 21 17 10 7 10 10 13 19 20 15 4 7 3 4 343 Bari 1968 21 26 20 17 20 26 26 18 22 27 33 25 27 26 29 46 28 22 13 13 18 503 Mudug 2566 47 45 36 27 44 25 23 24 30 15 21 20 16 10 13 14 7 17 0 8 1 443 N/East Zone 6584 100 97 82 70 88 70 79 63 69 52 61 55 53 49 61 80 50 43 20 24 23 1289 Galbeed 758 4 2 4 7 1 4 0 4 0 0 6 7 0 1 5 4 0 1 0 2 2 54 Sahil 576 2 0 9 2 13 5 24 5 18 4 4 4 13 2 1 1 2 0 7 0 2 118 Sanag 259 4 6 5 11 0 5 7 5 5 2 0 0 12 0 6 0 1 0 1 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 0 276 Awdal 105 2 0 11 2 5 0 10 0 3 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 6 433 N/West Zone 4720 40 26 76 55 95 41 135 52 89 26 85 39 72 22 35 23 12 14 27 10 10 984 M/ Shabelle 716 18 15 19 23 23 23 43 30 30 33 38 22 14 17 12 5 12 12 11 5 16 421 Hiran 1461 12 13 3 26 26 15 22 12 18 1 5 1 0 20 17 0 35 5 0 0 0 231 Galgadud 625 5 7 4 6 6 8 16 11 8 6 4 7 6 4 8 5 7 4 11 7 5 145 Banadir 5617 72 73 79 70 70 68 56 66 59 54 48 36 26 20 40 32 58 62 47 53 40 1129 L/Shabelle 2106 25 28 40 36 36 28 29 52 36 35 33 20 31 23 32 20 29 31 25 19 22 630 Central Zone 10525 132 136 145 161 161 142 166 171 151 129 128 86 77 84 109 62 141 114 94 84 83 2556 Middle Juba 62 0 3 3 0 1 1 2 3 0 0 2 3 3 3 4 3 4 3 4 6 3 51 Bakool 99 4 2 2 0 4 0 0 4 2 0 0 4 0 4 4 0 2 0 0 2 3 37 Gedo 241 0 1 1 51 23 61 51 100 77 35 26 32 8 8 31 3 6 3 0 0 0 517 Bay 654 17 17 2 0 9 4 11 11 9 0 0 0 0 0 5 5 5 5 5 0 0 105 Lower Juba 468 22 4 6 9 12 6 17 6 10 27 12 5 14 28 43 43 19 9 30 0 31 353 South Zone 1524 43 27 14 60 49 72 81 124 98 62 40 44 25 43 87 54 36 20 39 8 37 1063 Grand Total 23353 315 286 317 346 393 325 461 410 407 269 314 224 227 198 292 219 239 191 180 126 153 5892 Week-22 Somalia Weekly Polio Update Trend of reported fever and rash cases by zone in, 2015 -2018 Source: AFP Surveillance

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 6283 142 132 113 200 3639 30 48 2443 2739 1927 1133 1240 150 200 95 82 10492 61 93 72 99 8796 14 36 33 35 16 479 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 189 742 200 171 800 640 659 144 574 568 136 128 139 503 545 514 547 515 150 115 600 455 443 420441 450 104 367 401 348396 375 388 350383 401 82 83 315 324 307 278 328 281310 100 77 75 64 400 265 271 50 142 4045 37 46 46 46 27 2729 30 22 27 21 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, 03 June 2018 Source: AFP surveillance system

Age-wise distribution of fever and rash cases reported by Cases of fever and rash reported by zone, AFP surveillance system, 2018 by AFP surveillance system, 2018

7000 5892 Yrs10+, 708, <1yr, 924, 16% 6000 12% 5000 5_9yrs, 951, 16% 4000

1_4 yrs, 3309, 3000 2556 56% 2000 1289 984 1063 1000

0 Central North East North West South Total Somalia Week-22 Somalia Weekly Polio Update

Measles mass immunization conducted in Somalia, 2018

• More than 23,000 suspected cases of measles 100% reported last year 90% 95% 92% 92% 94% 93% • Nationwide campaign planned to vaccinate 80% children from 6 months to 10 years of age; based on epidemiology, 83% of cases were under 10 70% years 60% • 4.7 million children targeted in all accessible and 50% partially accessible districts of the country 40%

• 4.4 million children vaccinated (94% coverage) 30%

• Independent monitoring data shows 94% of the 20% children reached with measles vaccination during 10% the campaign dates 0% centeral Puntland Somaliland South GrandNational Total Week-23 Somalia Weekly EPI/POL Update

Five-year Measles Strategic Plan

• Workshop conducted from 22-24 May 2018

• Stakeholders from Federal MHO, States, GAVI and other stakeholders attended the workshop

• The draft Strategic Plan was reviewed and will be finalized shortly

• Key Action Points from the Workshop: • Review of the EPI Policy • Development EPI Improvement plan for non-GAVI-supported districts • Development of measles outbreak response plans

• Standing committees were selected to work on it

Full story: http://www.emro.who.int/som/somalia-events/who-takes-strides-to-eliminate-measles-and-rubella-in-somalia.html Part III Population Immunity Week-22 Somalia Weekly EPI/POL Update

Maps showing accessibility and security/ risk level, Somalia

Source: UNDSS

Map no.10 Map no.11 Week-22 Somalia Weekly EPI/POL Update

Summary proramatic features and initiatives in Somalia by accessibility Number of Under 15- AFP active Zones Accessibility VPV TPVP Settlement POP. Surveillance sites Accessible 2475 2,419,077 127 251 150 CENTRAL Inaccessible 984 516928 63 34 21 Total 3459 2936005 190 285 171 Accessible 1220 459,639 105 207 53 PUNTLAND Inaccessible 0 0 0 0 0 Total 1220 459639 105 207 53 Accessible 3435 1,469,450 81 214 53 SOMALILAND Inaccessible 0 0 0 0 0 Total 3435 1469450 81 214 53 Accessible 2234 1,040,648.00 75 216 123 SOUTH Inaccessible 1548 459,119.00 84 33 22 Total 3782 1499767 159 249 145 Accessible 9364 5388814 388 888 379 Somalia Inaccessible 2532 976047 147 67 43 Total 11896 6364861 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-22 Somalia Weekly EPI/POL Update

Transit Points Vaccination activities using bOPV - 03 June 2018

January February March April May June

Zones

Zero doses Zero doses Zero

Zero doses Zero doses Zero doses Zero doses Zero doses Zero doses Zero

Number of of Number vaccinated of Number vaccinated of Number vaccinated of Number vaccinated of Number vaccinated of Number vaccinated

% % % 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% 78029 238 0.3%

PUNTLAND 25067 58 0.2% 24610 59 0.2% 31565 71 0.2% 25519 61 0.2% 19236 38 0.2%

SOMALILAND 14705 350 2.4% 14490 377 2.6% 17807 430 2.4% 14898 343 2.3% 11948 246 2.1%

SOUTH 32225 1073 3.3% 34364 1123 3.3% 46605 1589 3.4% 42947 1336 3.1% 24415 692 2.8%

SOMALIA 171936 1815 1.1% 179785 1921 1.1% 230080 2456 1.1% 188167 2074 1.1% 133628 1214 0.9%

▪ A total of 903,596 < 10 years individuals were vaccinated week 20,2018. Among them 9,480 (1%) were vaccinated for the first time.

Table no.-16 Week-22 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%

90% 90% 90% 5 90% 2 493 25 9 3 3 3 8 35 31 80% 13 8 38 80% 80% 80% 230 12 812 635 650 575 83 37 70% 70% 2 70% 424 70% 26 60% 10 60% 60% 60% 50% 15 34 50% 50% 21 6 6 3 539 50% 28 11 40 40% 40% 7 230 243 9 40% 169 40% 34 4 178 245 30% 27 30% 17 10 30% 30% 20% 198 20% 4 0 6 12 3 152 252 34 20% 182 20 7 10% 888 66 20% 20 6 10% 2 2 6 5 3 12 1 3 341 29 1 10% 10% 0% 0 0 0% 0 0 148 155 172 57 21 9 10 11 5 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 ▪ 17 zero dose AFP cases reported in 2018 from inaccessible and partially accessible areas of South (n=10) and Central (n=7) zones. ▪ 12 AFP cases with zero doses reported in 2018 are in the age group of 6-59 moths and the remaining 5 AFP cases with zero dose are out of the 5-59 months age group Week-22 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% 73 234 430 294 156 178 66 268 273 60% 145 187 60% 306 40% 66 40% 53 81 119 59 27 76 20% 16 52 62 40 20% 484 51 53 78 25 58 51 36 25 127 23 27 58 69 20 0% 14 12 5 0 0 04 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 78 81 50 80% 77 100 80% 54 123 41 38 105 97 97 102 74 84 60% 36 60% 32 50 40 40% 68 77 85 40% 47 16 36 19 48 48 317 60 20% 101 20% 39 62 77 97 99 37 26 34 38 29 18 0% 0% 13 0 4 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

Graph no.-26 Graph no.-27 Part -IV Routine Immunization Routine Immunization coverage by zone, Somalia 2016-2018(1st quarter)

2016 2017 2018 (1st Q) 100 96

89 90 90 87 85.7 81 81 80.6 80 76 75 73 7373.8 7374.3 72 72 71 71 71 71 71.8 69 70 66 67.4 67.3 64 62 63.1 6362.1 60.3 60 59 58.7 5859 60 5756.5 57 5755.7 57 57 54 54 54 54 54.6 52 53 50 50 46 4645.7 43.9 44.2 43 43 43.3 39 38.4 40.5 40 35.2 31.2 30

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 Somalia Monitoring chart 2016 350000 100%

90% 300000

80%

250000 70%

60% 200000

50%

150000 40%

30% 100000

20%

50000 10%

0 0% Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Sum of Pent1 24215 48781 73263 98229 124707 152394 181148 207148 235011 266781 299618 331481 Sum of Penta3 27543 48616 70816 91732 113674 136589 160723 181282 203464 229673 256554 283080 Sum of Measles 18379 39266 60502 81562 103608 127044 150435 174056 193371 209302 230710 249465 Sum of Montly target on surval% 8% 17% 25% 33% 42% 50% 58% 67% 75% 83% 92% 100% Sum of P-1% 5% 10% 15% 20% 25% 30% 36% 41% 47% 53% 60% 66% Sum of P-3% 5% 10% 14% 18% 23% 27% 32% 36% 41% 46% 51% 56% Sum of Measles% 4% 8% 12% 16% 21% 25% 30% 35% 39% 42% 46% 50% Somalia Monitoring Chart 2017 450000 100%

400000 90%

80% 350000

70% 300000

60% 250000

50%

200000 40%

150000 30%

100000 20%

50000 10%

0 0% Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Sum of Pent1 31367 61990 89840 119005 148901 178493 215415 247586 280838 316732 347716 390910 Sum of Penta3 26790 53670 77763 102433 127572 152696 178791 203443 232459 264569 291804 327981 Sum of Measles 20594 44105 64886 89207 115739 139255 166186 190981 216931 245101 272845 310220 Sum of Montly target on surval% 8% 17% 25% 33% 42% 50% 58% 67% 75% 83% 92% 100% Sum of P-1% 6% 12% 17% 23% 29% 34% 42% 48% 54% 61% 67% 75% Sum of P-3% 5% 10% 15% 20% 25% 29% 34% 39% 45% 51% 56% 63% Sum of Measles% 4% 8% 13% 17% 22% 27% 32% 37% 42% 47% 53% 60% Somalia Monitoring Chart 2018 120000 100%

90%

100000 80%

70% 80000

60%

60000 50%

40%

40000 30%

20% 20000

10%

0 0% Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Sum of BCG 26236 56728 77239 Sum of Pent1 37081 71460 96358 Sum of Penta3 31324 61096 83426 Sum of Measles 31908 63535 90555 Sum of Montly target on surval% 8% 17% 25% 33% 42% 50% 58% 67% 75% 83% 92% 100% Sum of P-1% 7% 13% 18% Sum of P-3% 6% 11% 16% Sum of Measles% 6% 12% 17% Week-23 Somalia Weekly EPI/POL Update

C4D and Cold Chain Management Week-23 Somalia Weekly EPI/POL Update C4D Updates (1) Synchronized response campaign: – Outbreak response materials and documents shared with Kenya, Ethiopia and Core group: • IEC materials Artworks translated in Somali language. • Storyboard of radio and TV spots. • Somali version of outbreak response training module. – Activities now going on in border districts in preparation of the synchronized campaign: • Mapping of entry/exit points. • Cross-border sensitization meetings (in all border districts). • Sessions in the school so that the teachers and students can take the message to their families / communities. Week-23 Somalia Weekly EPI/POL Update C4D Updates (2) Data activities currently going on # Sessions / Type of Meetings / Sessions # Participants # community meetings / sessions 11 Community / # Community leaders / influencers Involved 77 Advocacy meetings # community members participated in the 345 meetings Session with High # sessions with IDPs, Nomads, Pastoralists 12 Risk groups # IDPs, Nomads, pastoralist participated 138 Religious leaders # religious leaders involved 47 # Schools sessions 21 Schools sessions # Students & teachers sensitized 354 Sessions in Health # sessions at Health facilities 11 facilities # care givers participated 150 Week-23 Somalia Weekly EPI/POL Update C4D Updates (3) Synchronized response campaign: – Preparation of cross-border meeting in Nairobi; – Consensus with South Central polio team on: • Structure and dates of training of trainers and cascade training; • Production of IEC materials, monitoring and supervision and data collection tools; • Media engagement activities; • Monitoring and supervision of the campaign; • Joint operational planning meetings in border districts, with participation of Kenya and Ethiopia; • Involvement of NIAG; • Macro-budget of June response round. Week-23 Somalia Weekly EPI/POL Update C4D Next Steps on the Outbreak Response

• Federal Somalia – Radio spots for AFP surveillance – both accessible and inaccessible areas – Develop communication plan for cVDPV3 response – Implement mOPV2 management guide • Somaliland & Puntland preparedness – Outbreak response plans updated – IEC materials artworks & training modules available. • Ongoing – Complete the Global communication tool training – Complete the Media Broadcast LTAs C4D Trainings sessions conducted for the outbreak response campaigns

Campaigns Training 1st 2nd 3rd IPV participants round round round campaign mOPV2 mOPV2 mOPV2 No. of RSMCs 3 3 3 3 trained No. of DSMCs 30 30 33 32 trained No. of CMs 871 871 893 893 trained No. of NIAG members 0 12 12 12 trained No. of Post campaign Supervisors & 0 0 16 16 Monitors trained Campaigns performance: C4D indicators (Awareness, missed children and reasons, refusals and reasons)-per campaign

Awareness level- Post campaign IM Data

100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%

100%

99%

99% 99%

99%

99% 99%

99%

98%

98% 98%

98%

97%

96%

96% 96% 96% 96% 96%

100% 96%

96%

95%

94%

93%

91%

90%

89%

88% 77%

80% 76%

75%

74%

69% 60% 60%

40%

20% 7%

mOPV2 Dec campaign mOPV2 Jan campaign mOPV2 May campaign Graph no. 1 Week-23 Somalia Weekly EPI/POL Update Vaccines and Cold Chain Management

• 37,800 Vials of mOPV2 received on 28th May in Nairobi for the June synchronized Campaign. • Completed Form A for the concluded mOPV2 SIA in the three regions of Banadir, Lower & Middle Shabelle expected this week. • The CEEOP operational deployment plan was completed and shared with UNICEF supply division and GAVI. GAVI promised to share Somalia’s new decision letter were all cold chain equipment will be procured in year one. • Routine immunization vaccines required till year end estimated and procurement process to start this week. • Participated in the development of the joint UNICEF-WHO budget for the two synchronized mOPV2 campaigns with Kenya and Ethiopia • Participated in the three day’s five years measles strategy meeting NB: Vaccine wastage rate reduced from 7% in round one to 6% in round two as per admin data

55 The END