Early Warning Disease Surveillance and Response Bulletin, 2018 Epidemiological Week 26 (Week ending 1st July, 2018)

Highlights Cumulative figures as of week 26  217 health facilities across Somalia submitted weekly  1,470,515 consultations from week 1 reports of epidemic-prone diseases in the electronic to week 26. early warning disease surveillance (EWARN) system  5,582 cumulative cases of in week 26. AWD/Cholera and 40 deaths since  Total number of consultations increased from 55,256 in week 25 to 55,343 in week 26. December 2017.  A total of 284 alerts were received. 42 of these alerts  8,316 Accumulative alerts were were confirmed as true alerts in week 26. received, 431 of these, were  The highest numbers of diseases reported in week confirmed as true alerts from week 1 26 were other acute diarrhoeas (2,599 cases), to week 26, 2018. influenza like illness (1195 cases) and severe acute  6,088 cumulative cases of suspected respiratory illness (1,212 cases). measles cases since the beginning of  A total of 344 new cases of suspected AWD/cholera including 1 death were reported in week 26 2018. Of the 6,088 measles cases, compared to 304 AWD cases including 3 deaths in 4,011 (66%) are under 5 years while week 25. 2,077 (34%) are above 5 years. 1  A cumulative total of 5,582 AWD/cholera cases ,  7,004 cumulative cases of Malaria including 40 deaths have been reported since were reported since the beginning of December 2017. 2018, 3,056(44%) are under 5 years,  The number of reported measles cases decreased from 92 in week 25 to 58 cases in week 26. while 3,948(56%) are above 5 years.

Table 1. Summary of Alerts for epidemic prone diseases Disease Cumulative cases Wk23 2018 Wk24 2018 Wk25 2018 Wk26 2018 (Wk 1 – 26, 2018)

Total consultations 64,164 44,883 55,256 55,343 1,470,515 Other Acute Diarrheas 3,402 2,411 2,556 2,599 61509 Influenza Like Illness 1,808 1,298 1,678 1,195 44,486 Severe Acute 25,514 1,464 1,059 1,279 1,212 Respiratory Illness Suspected Measles 130 72 92 58 6,088 Confirmed Malaria 467 337 476 226 7,004 Acute Watery 291 55 58 76 1,986

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 22

Diarrhoea Bloody Diarrhea 184 180 131 107 2,236 Whooping Cough 65 45 34 58 1,239 Acute Jaundice 8 2 5 16 110 Suspected Meningitis 0 1 0 3 76 Diphtheria 0 0 0 2 45 Neonatal Tetanus 0 1 2 0 23 Acute Flaccid Paralysis 9 2 0 0 13 Viral Hemorrhagic Fever 0 1 0 0 4

Completeness of Reporting & Reporting Rate Overall, a total of 217 (64%) health facilities submitted their weekly reports on time of the 340 active health facilities in Somalia. In Somaliland, 76 (100%) health facilities (HFs) of the 76 active health facilities submitted reports in week 26, in Puntland, 37(61%) health facilities of the 61 active Health facilities submitted reports in week 26, while no reports were received from Nugal (12HFs) and Sool (4HFs) of Puntland as shown in Table 5. In South central, 104(51%) health facilities of 203 active health facilities submitted reports in week 26 as shown in Table5 and Fig1 below. Fig1: Completness of reporting

Somaliland Puntland SCZ 100 80 60 40 20

report 0 23 24 25 26 Epi-week

HFssubmitted the of Percentage

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 26, the highest numbers of diseases were other acute diarrhoeas (2,599 cases), influenza like illness (1,195 cases), severe acute respiratory illness (1,212 cases), Suspected measles (58 cases) and Confirmed Malaria (226 cases).

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Fig2: Commonest Causes of Morbidity during Week 1 to 26

4,000

3,000

2,000

1,000

0 Wk23 Wk24 Wk25 Wk26

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

AWD/Cholera situation in Somalia

Fig3: District reporting cases in week 26 Following the heavy rains that have led to the floods in the Juba land and Shabelle basins, there has been an observed increase in the number of new AWD/Cholera cases (fig 4). The cholera outbreak that started in December 2017 in Beletweyne along river Shabelle has spread to Jowhar, , Afgoye Merka and Banadir. The cholera spread is expected to increase due to the floods that have led to contamination of water sources in the flood affected regions. Floods have also led to blockage of access of health services which will contribute to delayed health seeking by the affected populations with. Over the past 2 weeks, there has been an increase in the number of AWD/Cholera cases reported in , Banadir and Lower Jubba; the regions that are affected by floods. In week ending 1st July, active transmission of AWD/cholera was reported in in Lower Jubba, Afgoye Kurtunwarey, Brava and Merka in Lower Shabelle as well as in 11 districts of Banadir region (Darkenly, Daynile, Hodan, Madina, Waberi, HamarWeine, Hamarjabjab, Wardhigley, Shibis,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 1, there was an increase in the number of cases reported from 304 in week 25 to 344 in week 26. 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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Fig 4: AWD cholera trends in Somalia 2017/18

2000 Cases Deaths CFR (%) 4.0 1800 3.5 1600 3.0 1400 1200 2.5 1000 2.0 Cases 800 1.5 600 1.0

400 Rate(%) Fatality Case 200 0.5 0 0.0 26 28 30 32 34 36 38 40 42 44 46 48 50 52 2 4 6 8 10 12 14 16 18 20 22 24 26 2018

epi week

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

States Week 25 Week 26 Cumulative as of 1st July 2018 Regions Ending 24th June 18 Ending 1st July 18

Cases Deaths CFR (%) Cases Deaths CFR (%) Cases Deaths CFR (%)

Banadir 155 2 1.3 124 1 0.8 2,171 18 0.8

Jubba land L/ Jubba 99 0 0.0 97 0 0.0 2,042 15 0.7

South west L/ Shabelle 50 1 2.0 18 0 0.0 284 4 1.4

Hir-shabele M/Shabelle 0 0 0.0 105 0 0.0 520 2 0.4

Hiraan 0 0 0 0 0 0.0 565 1 0.2

Total 304 3 1.0 344 1 0.3 5,582 40 0.7

NB.Deaths are included among cases. Banadir Region is not a state

Cholera Situation in Lower Jubba, Lower & and Banadir.  Banadir region which included city has one of the highest concentrations of refugees where access to safe water and proper sanitation is limited. The AWD/Cholera outbreak in Banadir region started in January 2018 following reports of similar outbreak in Beletweyne district of Hiraan region. Of the 17 districts that make up Banadir region, 11 have so far reported cases which have been managed in Banadir CTC located in the capital Mogadishu. There has been increase in the number of AWD/Cholera cases from 155 including 2 deaths to 124 cases and 1 death in the past 2 weeks. More than 68% of the AWD cases reported in Banadir are children below 2 years of age  In Lower Jubba, The AWD/Cholera outbreak started in week 5 of 2018 in the IDP communities of Farjano in Kismayo, where access to safe water and sanitation is limited. The Page 4 of 22

reported cases of AWD/Cholera did not receive OCV which was implemented 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 99 and no deaths to 97 no death. More than 43% 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 26-2018, 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 50% of the cases reported in Merka are children below 5 years.  In Middle shabelle, it has been reported a new outbreak of AWD/Cholera in the same villages that were affected before. During week 26, a total of 105 cases with no deaths were reported of which 60% of them are children below 5 years old. The affected villages include Hantiwadag, Kumis, Barey, Baraki, Bulo Seikh and Horseed.

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. Current information from OCHA shows that the floods are receding in all states, however new cholera cases have been reported in week 26, 2018 in Jowhar of Middle Shabelle (Table 3).

Table 3. AWD/Cholera cases in different districts Week 26 Cumulative Week 49/17- week 26/18 Region District Cases Deaths CFR <2 yrs 2 -4 yrs ≥ 5 yrs <2 yrs 2-4yrs ≥ 5 yrs Cases Deaths (%) Darkenley 7 4 8 0 0 0 351 1 0.3 Daynile 8 4 12 0 1 0 381 7 1.8

HamarJabja 6 5 3 0 0 0 142 2 1.4

Hawlwadag 2 2 3 0 0 0 103 1 1

Hodan 12 3 9 0 0 0 464 1 0.2 Karaan 0 0 0 0 0 0 39 1 2.6 Madina 7 2 3 0 0 0 362 2 0.6 Banadir Waberi 1 1 5 0 1 0 102 2 2 Shibis 1 0 2 0 0 0 10 0 0 Shingani 0 0 0 0 0 0 7 0 0 Abdilaziz 0 0 0 0 0 0 2 0 0

HamarWeine 0 2 1 0 0 0 43 0 0

Heliwaa 0 0 0 0 0 0 21 0 0 Wardigley 0 2 2 0 0 0 92 1 1.1 Yaqshid 3 0 3 0 0 0 51 0 0

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Middle Jowhar 41 22 42 0 0 0 520 2 0.4 Shabelle×

Beletweyne 0 0 0 0 0 0 522 1 0.2 Hiran× BuloBarde 0 0 0 0 0 43 0 0

Afgoye 1 1 3 0 0 0 151 0 0 Lower Kurtunwarey 0 0 0 0 0 1 31 4 12.9 Shabelle× Merka 5 2 6 0 0 0 90 0 0 Brava 0 0 0 0 0 0 12 0 0 Lower Kismayo 42 20 35 0 0 0 2043 15 0.7 Jubba× Total 136 71 137 0 0 1 5,582 40 0.7 × regions currently affected by floods. Cases include deaths.

Response activities implemented during week 26, 2018

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 were conducted in Banadir region as well as Middle Shebelle in Jowhar

Case management

 On job training was conducted for the health workers working in cholera treatment centres in Kismayo, Farjano and Banadir Merka (Ayuub Health Centre, and Afgoye Hospital CTCs  Management of cholera cases is being conducted in Banadir hospital CTC, Afgoye Hospital Merka(Ayuub Health Centre,CTCs,Kismayo hospitaland Farjano CTU

Surveillance and Laboratory Investigations

 Routine line listing of cases including data analysis and risk assessment for cholera hotspots  Investigation and verification of rumorshas been conducted in flood affected regions.  Rapid Response Teams (RRT) have supported state level authorities to verify the rumors in flood affected districts. The teams have been deployed in Jowhar and Kismayo.

Water Sanitation, Hygiene and risk communication

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

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Measles Situation

Fig5: Districts Reporting Measles Case: The number of suspected measles cases decreased Week 21 from 92 cases in week 25, to 58 cases in week 26. Cumulatively, 6,088 cases of suspected measles have been reported across Somalia since the beginning of 2018. Of the 6,088 measles cases, 4,011 (66%) are under 5 years while 2,077 (34%) are above 5 years. The most affected regions include; Galgadud (1,089 cases), Bay (959 cases) Banadir (887 cases), (613 cases), and Sool (368 cases). As shown in fig 6 below, the trends of measles cases 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 26, 2018

500 450 Measles vaccination Measles vaccination 400 in PL implemented in SL & 350 SCZ on Week 10 300

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 26 Epi-Week

South & Central Zone Somaliland Puntland

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Fig 7. Measles cases per district Across Somalia from Wk1 - Wk26, 2018 450 400 350 300 250 200 150 100 50 0 Huruwaa Wadajir Abudwak Adado Galkacyo Burao Lasacanod Marka Banadir Galmudug Somaliland Southwest Cases >5 Cases<5

Table 4: Summary of Suspected measles cases by region week 1 - 26, 2018

Cumulative cases Region Wk23 2018 Wk24 2018 Wk25 2018 Wk26 2018 (Wk 1 – 26)

Awdal 0 0 0 0 12 0 1 1 2 121 Banadir 14 0 4 0 887 Bari - 0 - 0 92 Bay 23 15 22 - 959 Galgaduud 14 0 0 3 1089 Gedo 21 4 21 1 65 Hiraan 16 10 6 9 162 11 5 18 18 284 Lower 5 5 4 3 320 Shabelle 6 4 5 10 147 Middle 3 2 2 1 153 Shabelle Mudug 10 10 4 3 613 Nugaal - 0 - - 183 Sanaag 0 0 0 0 159 Sool 2 0 1 1 368 Togdher 4 11 1 5 227 Waqoyi 1 5 3 2 247 Galbed Grand Total 130 72 92 58 6088 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 476 cases in week 25 to 226 cases in week 26. Cumulatively, 7,004 cases of Malaria cases have been reported across Somalia since the beginning of 2018. Of the 7,004 malaria cases, 3,056 (44%) are under 5 years while 3,948 (56%) are above 5 years. The most affected districts include; of Bay (1,290 cases), in Banadir (678 cases), Marka district of Lower Shabelle (518 cases), Berdale district of Bay(399 cases) of Bakol (397 cases), of Galgadud (375 cases), Bal’ad district of Middle Shabelle (309 cases) and district of Bakol (250 Cases) .

Fig8: Malaria Situation in Somalia from Week 1 to Week 26, 2018 500 400 300

Cases 200 100 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 Epi-week

SC Zone Somaliland Puntland

Fig 9: Malaria Cases Per District Across Somalia from Wk1-26, 2018 900 800 700 600 500 400 300 200 100 0 Wadajir Adado Bal'ad Baidoa Berdale Huddur Marka Waajid Banadir Galmudug Hirshabelle SouthWest Cases >5 Cases<5

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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 25 were 2,556 compared to 2,599 cases in week 26. Cumulatively, 61,509 cases of OAD cases have been reported across Somalia since the beginning of 2018. Of the 61,509 OAD cases, 46,531 (76%) are under 5 years while 14,978 (24%) are above 5 years. The most affected districts include; Marka District of Lower Shabelle (4,053 cases), Beletweyn district of hiran (3,891 cases), Huruwa district of Banadir (3,293 cases), Wadajir district of Banadir (2,285 cases), Jowhar of Middle Shabelle (1,953 Cases) and Dharkinley of Banadir(1,946 cases).

Fig10: Trends of Other Acute Diarrhoea cases in Somalia from Week1-26, 2018 2500

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 26 Epi-week

SC Somaliland Puntland

Fig 11: OAD Cases Per District Across Somalia from Wk1-26, 2018 3500

3000

2500

2000

1500

1000

500

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

Cases >5 Cases<5

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Bloody Diarrhea Situation in Somalia The number of BD cases has also been floatingly decreasing for the last four weeks, the cases in Week 25 were 131 compared to 107 cases in week 26. Cumulatively, 2,236 cases of BD cases have been reported across Somalia since the beginning of 2018. Of the 2,236 BD cases, 1,176 (53%) are under 5 years while 1,060 (47%) are above 5 years. The most affected districts include Baidoa of Bay (387 cases), Burhakaba of Bay (261 cases), Hargeisa of Waqoy Galbeed (148 cases), and Buhodle of Togdheer (127 cases).

Fig12: Trends of Bloody Diarrhea cases in Somalia from Week1-26, 2018. 140 120 100 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 26 Epi-week

SC Somaliland Puntland

Fig 13: Bloody Diarrhea Cases Per District Across Somalia from Wk1-26, 2018

300 Cases >5 Cases<5 250

200

150

100

50

0 Afmadow Kismayo Luuq Buhodle Gabiley Hargeisa Baidoa Burhakaba Waajid Jubaland Somaliland SouthWest

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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 25 were 34 compared to 58 cases in week 26. Cumulatively, 1,239 cases of WC cases have been reported across Somalia since the beginning of 2018. Of the 1,239 WC cases, 947 (76%) are under 5 years while 292 (24%) are above 5 years. The most affected districts include Galkacyo (282 cases), Jilib (153 cases), Berbera (93 cases),Erigavo (72 cases), Buale (66 cases) and Adaado (59 Cases) .

Fig14: Trends of Whooping Cough in Somalia from Week1-26, 2018 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 26 Epi-week

SC Somaliland Puntland

Fig15: Most affected districts of Whouping Cough in Somalia from Wk1-26, 2018 250

200

150

100

50

0 Adado Galkacyo Gelinsor Bu,aale Jilib Salagle Berbera Burao Erigavo Galmudug Jubaland Somaliland Cases <5 Cases >5

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Most Other affected diseases Across Somalia Severe Acute respiratory Illness (SARI) The number of SARI cases has also been floatingly going up and down for the last four weeks, the cases in Week 25 were 1,279 compared to 1,212 cases in week 26. Cumulatively, 25,514 cases of SARI cases have been reported across Somalia since the beginning of 2018. Of the 25,514 SARI cases, 15,430(60%) are under 5 years while 10,084 (40%) are above 5 years. The most affected districts include Beletweyne (4,234 cases), Buloburte (2,149 cases), Abudwak (1,519 cases),Wadajir (1,464 cases), Huruwa (1,437 cases) and Yaqshid (1,404 Cases) .

Fig16: Trends of SARI cases in Somalia from Week1-26, 2018 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 26 Epi-week

SC Somaliland Puntland

Fig17: Most SARI affected districts across Somalia from Wk1-26, 2018

Cases <5 Cases >5 3000

2500

2000

1500

1000

500

0 Huruwaa Wadajir Yaqshid Abudwak Adado Dhuusamarreeb Belet Weyne Bulo Burto Jalalaqsi Banadir Galmudug Hirshabelle

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Influenza like Illness (ILI): The number of ILI cases has also been floatingly going up and down for the last four weeks, the cases in Week 25 were 1,678 compared to 1,195 cases in week 26. Cumulatively, 44,486 cases of ILI cases have been reported across Somalia since the beginning of 2018. Of the 44,486 ILI cases, 26,405 (59%) are under 5 years while 18,081 (41%) are above 5 years. The most affected districts include Borama (4,998 cases), Huruwa (3,309 cases), Beletweyne (3,129 cases), Lascanod (3,068 cases), Berbera (2,692 cases) Wadajir (1,595 cases) and Dharkenley (1,130 cases).

Fig18: Trends of ILI cases in Somalia from Week1-26, 2018 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 26 Epi-week

SC Somaliland Puntland

Fig19: Most ILI affected districts across Somalia from Wk1-26, 2018 3000

2500

2000

1500

1000

500

0 Dharkinley Huruwaa Wadajir Belet Weyne Berbera Borama Lasacanod Banadir Hirshabelle Somaliland Cases <5 Cases >5

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Table 5. Completeness of reporting of the health facilities of Somalia as of Week 26, 2018

Completeness of reporting State Region District # of active HFs to submit report # of HFs submitted report in week26 (%) Abdiaziz 1 1 100 Boondhere 1 0 0 Dayniile 1 1 100 Dharkinley 4 0 0 Hamar Jab Jab 2 1 50 Hamar Weyne 1 1 100 Hodan 1 1 100 Howl-wadaag 2 1 50 Banadir Banadir Huruwaa 3 2 67 Kaaraan 1 0 0 Kahda 1 0 0 Shangani 1 0 0 Shibis 1 1 100 Waberi 1 1 100 Wadajir 9 1 11 Wardhigley 4 3 75 Yaqshid 4 3 75 Subtotal of Banadir 38 17 45 Baki 1 1 100 Borama 9 9 100 Awdal Lughaya 1 1 100 Zeila 2 2 100 Badhan 2 2 100 Sanag Eil-afweine 3 3 100 Erigavo 3 3 100 Somaliland Hudun 1 1 100 Sool Lasacanod 7 7 100 Taleex 1 1 100 Ainabo 1 1 100 Buhodle 2 2 100 Togdheer Burao 12 12 100 Odwayne 2 2 100 Page 15 of 22

Ballayabane 2 2 100 Berbera 6 6 100 Waqoy Gabiley 4 4 100 Galbed Hargeisa 14 14 100 Sheikh 3 3 100 Subtotal of Somaliland 76 76 100 Banderbayla 1 1 100 Bossaso 7 3 43 Carmo 1 0 0 1 1 100 Bari Iskushuban 1 0 0 Qardho 2 2 100 Rakko 2 2 100 Ufeyn 1 0 0 Waciya 2 2 100 Galdogob 8 8 100 Mudug Galkacyo 12 11 92 Puntland Jariiban 3 3 100 Burtinle 2 0 0 Dangorayo 1 0 0 Nugal Eyl 4 0 0 Garoowe 5 0 0 Badhan 2 2 100 Sanag Dhahar 2 2 100 Bocame 1 0 0 Hudun 1 0 0 Sool Lasacanod 1 0 0 Taleex 1 0 0 Subtotal of Puntland 61 37 61 Abudwak 3 2 67 Adado 3 3 100 Balanbale 1 1 100 Galmudug Galgadud Dhuusamarreeb 2 2 100 Guriel 1 1 100 El Bur 1 0 0

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El Dere 2 2 100 Gelinsor 1 1 100 Galkacyo 4 4 100 Mudug Hobyo 12 3 25 Subtotal of Galmudug 30 19 63 Belet Weyne 10 8 80 Bulo Burto 3 3 100 Hiraan Jalalaqsi 1 1 100 Matabaan 4 1 25 Maxaas 1 1 100 Hirshabelle Adale 1 1 100 Bal'ad 12 5 42 Middle Jowhar 6 1 17 Shabelle Mahaday 3 1 33 5 3 60 Subtotal of Hirshabelle 46 25 54 B/hawo 2 2 100 Baardhere 1 1 100 Doolow 2 0 0 Gedo Garbahaarey 2 1 50 Gedweyne 1 1 100 Luuq 3 2 67 Jubaland Afmadow 2 1 50 Lower Hagar 2 1 50 Juba Jamaame 2 1 50 Kismayo 11 8 73 Bu,aale 2 1 50 Middle Jilib 3 2 67 Juba Salagle 1 1 100 Subtotal of Jubaland 34 22 65 Afgoi 5 3 60 Kurtunwarey 3 2 67 Lower SouthWest Marka 12 8 67 Shabelle Qoryooley 2 1 50 Wanla Weyn 2 1 50

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Elberde 3 1 33 Huddur 2 1 50 Bakool Tayeeglow 1 1 100 Waajid 4 3 75 Baidoa 13 0 0 Berdale 3 0 0 Bay Burhakaba 3 0 0 Qansahdere 2 0 0 Subtotal of Southwest 55 21 38 Grand Total 340 217 64

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Table 6. Cumulative Summary of Epidemic-prone Diseases in different Districts of Somalia as of Week 1-26, 2018

Regions District SARI ILI AWD BD OAD DIPH WC MEAS NNT AFP AJS VHF MAL MENG OC Total_cons Awdal Total 0 8084 11 126 3778 0 0 12 0 0 0 0 24 2 31733 43799 Baki 0 1033 0 61 267 0 0 0 0 0 0 0 0 0 2898 4259 Borama 0 4998 11 62 2619 0 0 8 0 0 0 0 15 0 20716 28457 Lughaya 0 182 0 2 219 0 0 0 0 0 0 0 0 0 1659 2062 Zeila 0 1871 0 1 673 0 0 4 0 0 0 0 9 2 6460 9021 Bakool Total 191 102 0 91 526 0 16 121 0 0 1 0 732 2 59931 61713 Elberde 0 23 0 0 129 0 0 0 0 0 0 0 0 0 9208 9360 Huddur 34 5 0 13 96 0 0 1 0 0 0 0 250 0 8690 9089 Tayeeglow 33 29 0 3 44 0 0 6 0 0 1 0 85 2 1559 1762 Waajid 124 45 0 75 257 0 16 114 0 0 0 0 397 0 40474 41502 Banadir Total 5425 8100 906 60 13067 0 9 887 0 1 0 0 707 12 343145 372319 Abdiaziz 0 93 0 0 111 0 0 0 0 0 0 0 0 0 8267 8471 Boondhere 0 0 18 0 250 0 0 24 0 0 0 0 0 0 6736 7028 Dayniile 30 180 0 0 289 0 0 7 0 0 0 0 1 0 13020 13527 Dharkinley 573 1130 0 0 1946 0 0 56 0 0 0 0 0 0 20384 24089 Hamar Jab 211 578 0 2 547 0 1 7 0 0 0 0 1 0 13277 14624 Jab Hamar 94 435 0 0 1067 0 0 10 0 0 0 0 0 0 11185 12791 Weyne Hodan 3 22 5 0 76 0 0 0 0 0 0 0 6 0 9097 9209 Howl-wadaag 0 0 0 0 0 0 0 6 0 0 0 0 1 0 35444 35451 Huruwaa 1437 3309 15 6 3293 0 0 468 0 1 0 0 3 12 34175 42719 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 7551 8142 Waberi 0 0 0 0 33 0 0 0 0 0 0 0 0 0 18655 18688 Wadajir 1464 1595 868 5 2285 0 2 243 0 0 0 0 678 0 81588 88728 Wardhigley 18 1 0 30 1367 0 6 34 0 0 0 0 15 0 42610 44081 Yaqshid 1404 89 0 17 780 0 0 19 0 0 0 0 0 0 21605 23914 Bari Total 107 1020 5 10 627 0 0 92 0 0 0 0 336 0 43506 53879 Banderbayla 61 153 1 0 24 0 0 1 0 0 0 0 0 0 821 1061 Page 19 of 22

Bossaso 46 847 3 0 345 0 0 28 0 0 0 0 331 0 23929 33683 Carmo 0 6 0 0 4 0 0 0 0 0 0 0 2 0 634 668 Hafun 0 0 0 0 41 0 0 0 0 0 0 0 0 0 2044 2085 Iskushuban 0 7 0 1 5 0 0 0 0 0 0 0 0 0 614 627 Qardho 0 0 0 9 143 0 0 45 0 0 0 0 2 0 9007 9206 Rakko 0 0 1 0 59 0 0 18 0 0 0 0 1 0 2875 2954 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 3208 3212 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 4414 1852 191 5 1191 0 183 1450 1 0 3 0 1114 8 60988 71400 Abudwak 1519 542 0 0 318 0 30 709 1 0 0 0 233 4 13864 17220 Adado 946 518 3 1 301 0 59 293 0 0 3 0 375 1 11110 13610 Balanbale 366 218 0 1 52 0 15 129 0 0 0 0 85 0 2963 3829 Dhuusamarre 808 293 10 2 209 0 20 157 0 0 0 0 174 0 18060 19733 eb El Bur 24 6 178 0 38 0 0 34 0 0 0 0 17 0 533 830 El Dere 557 194 0 1 211 0 22 64 0 0 0 0 131 3 11543 12726 Gelinsor 194 81 0 0 62 0 37 64 0 0 0 0 99 0 2915 3452 Gedo Total 280 1262 52 82 389 0 0 65 0 0 0 0 279 0 20683 23092 B/hawo 54 256 35 2 52 0 0 19 0 0 0 0 83 0 7044 7545 Baardheere 0 0 0 35 3 0 0 0 0 0 0 0 4 0 0 42 Doolow 85 436 0 0 70 0 0 36 0 0 0 0 52 0 3347 4026 Garbahaarey 13 211 12 0 140 0 0 4 0 0 0 0 46 0 2971 3397 Gedweyne 22 27 0 0 43 0 0 0 0 0 0 0 0 0 348 440 Luuq 106 332 5 45 81 0 0 6 0 0 0 0 94 0 6973 7642 Hiraan Total 7548 4180 288 6 6363 0 57 162 0 0 0 0 158 2 66693 85497 Belet Weyne 4234 3129 282 0 3891 0 7 123 0 0 0 0 156 1 37566 49429 Bulo Burto 2149 514 6 6 1598 0 1 26 0 0 0 0 2 1 14692 18995 Jalalaqsi 991 126 0 0 673 0 0 2 0 0 0 0 0 0 2257 4049 Matabaan 109 309 0 0 148 0 0 0 0 0 0 0 0 0 6709 7275 Maxaas 65 102 0 0 53 0 49 11 0 0 0 0 0 0 5469 5749 Lower Total 1673 15 52 185 2016 3 20 284 0 0 0 0 187 0 62884 67319 Page 20 of 22

Juba Afmadow 622 0 28 80 395 0 0 0 0 0 0 0 4 0 8033 9162 Hagar 108 5 0 11 142 2 3 47 0 0 0 0 0 0 3130 3448 Jamaame 102 0 6 8 134 0 0 45 0 0 0 0 103 0 6732 7130 Kismayo 841 10 18 86 1345 1 17 192 0 0 0 0 80 0 44989 47579 Lower Total 757 673 274 11 7368 4 16 320 0 0 0 0 721 1 118083 128228 Shabelle Afgoi 81 96 23 2 274 0 0 41 0 0 0 0 76 0 21737 22330 Kurtunwarey 39 3 41 0 1397 0 0 33 0 0 0 0 43 0 13268 14824 Marka 246 3 166 6 4053 4 16 191 0 0 0 0 518 1 69643 74847 Qoryooley 68 0 44 0 887 0 0 49 0 0 0 0 63 0 11837 12948 Wanla Weyn 323 571 0 3 757 0 0 6 0 0 0 0 21 0 1598 3279 Middle Total 125 0 1 82 548 5 271 154 0 0 0 0 174 0 10246 11606 Juba Bu,aale 27 0 0 20 126 0 66 35 0 0 0 0 0 0 2005 2279 Jilib 63 0 1 39 328 5 153 92 0 0 0 0 174 0 6455 7310 Salagle 35 0 0 23 94 0 52 27 0 0 0 0 0 0 1786 2017 Middle Total 559 308 106 104 3206 0 1 146 0 0 0 0 456 0 95010 99896 Shabelle Adale 0 0 0 0 0 0 0 0 0 0 0 0 3 0 6340 6343 Bal'ad 502 279 19 30 830 0 1 111 0 0 0 0 309 0 39417 41498 Jowhar 45 0 82 62 1953 0 0 35 0 0 0 0 101 0 25817 28095 Mahaday 4 17 0 12 146 0 0 0 0 0 0 0 10 0 7768 7957 Warsheikh 8 12 5 0 277 0 0 0 0 0 0 0 33 0 15668 16003 Mudug Total 584 43 14 47 4239 6 307 613 21 9 37 1 19 22 142590 148552 Galdogob 76 2 1 5 339 0 0 13 0 0 1 0 0 0 15251 15688 Galkacyo 361 5 13 36 2754 4 286 462 3 9 4 1 11 22 100267 104238 Harardere 28 36 0 1 146 0 12 29 0 0 0 0 4 0 3307 3563 Hobyo 115 0 0 0 928 2 8 99 18 0 31 0 4 0 10570 11775 Jariiban 4 0 0 5 72 0 1 10 0 0 1 0 0 0 13195 13288 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 Total 1435 712 18 51 1242 1 76 159 0 0 0 0 32 1 28622 32483 Sanag Badhan 531 191 10 0 413 0 1 136 0 0 0 0 28 0 7028 8345 Dhahar 426 1 2 49 203 0 3 3 0 0 0 0 2 0 3732 4421 Eil-afweine 375 230 5 2 396 1 0 12 0 0 0 0 0 0 9000 10065

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Erigavo 103 290 1 0 230 0 72 8 0 0 0 0 2 1 8862 9652 Total 38 4056 0 6 3246 0 35 368 0 0 0 0 46 0 35523 43318 Sool Bocame 0 0 0 0 5 0 0 2 0 0 0 0 0 0 222 229 Hudun 0 667 0 0 410 0 1 14 0 0 0 0 0 0 3352 4444 Lasacanod 38 3068 0 6 2666 0 34 350 0 0 0 0 46 0 29484 35692 Taleex 0 321 0 0 165 0 0 2 0 0 0 0 0 0 2465 2953 Togdheer Total 249 2028 0 307 3410 0 38 220 0 0 6 0 2 13 29742 36027 Ainabo 1 85 0 50 170 0 0 3 0 0 0 0 0 0 1959 2268 Buhodle 23 136 0 127 255 0 0 13 0 0 0 0 0 0 4098 4652 Burao 199 1574 0 100 2715 0 38 204 0 0 6 0 2 13 20456 25319 Odwayne 26 233 0 30 270 0 0 0 0 0 0 0 0 0 3229 3788 Waqoy Total 1133 7988 0 295 7815 0 159 254 0 1 64 1 153 13 58108 75984 Galbed Ballayabane 175 241 0 44 271 0 24 9 0 0 25 0 0 1 2606 3396 Berbera 297 2692 0 2 2273 0 93 106 0 1 39 1 5 1 16039 21549 Gabiley 233 2384 0 101 1972 0 6 21 0 0 0 0 36 0 6638 11391 Hargeisa 259 1931 0 148 2583 0 33 100 0 0 0 0 107 11 27939 33111 Sheikh 169 740 0 0 716 0 3 18 0 0 0 0 5 0 4886 6537 Grand Total 25,514 44,486 1986 2,236 61,509 45 1,239 6,088 23 11 112 2 7,004 76 1,311,707 1,470,515

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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