Week-25 Ending 24 June 2018 Part -I Highlights Highlights

Somalia Weekly Update Week-25 Ending 24 June 2018 Part -I Highlights Highlights

• VDPV type 2 and type 3 were detected from 2 AFP cases, 3 Contacts and 3 Community samples collected from Bulloburti, Warshakeh and Jemmame West districts of Central and South Somalia.

• EPID no: SOM/HRN/BBT/18/002 and the 3 contacts have cVDPV3 The index: • Location of case: JAMECO MUBARAK village –BULO BURTI District-Hiran Region- Central zone • Date Stool collection 1st and 2nd: 13th and 14th May 2018 • Accessibility of the area: The village is inaccessible since 2015 and no SIA activity • Age and OPV dose status [if case]:72 months female, 0 Dose of • Sequencing results: PV-2 VDPV with 43nt difference and 17 nt difference from Sabin • Closest match: genetically linked to the VDPV3 sequence for ES/SOM/BAN/HMW/KAWMA-1/18/006 (Kawma ENV site, emergence group SOM-BAN- Warshaikh 2) • EPID no: SOM/MSH/WRS/18/003 and the contact SOM-MSH-WRS-18-001-C3 The index: • Location of case: Bohi village –Warsheikh District-Middle Shaballe-- Central zone • Date Stool collection 1st and 2nd: 30st and 31th May 2018 • Accessibility of the area: The village is accessible • Age and OPV dose status [if case]:39 months female, 0 Dose of • Sequencing results: PV-3 VDPV with 19nt difference from Sabin • Closest match: The PV3 VDPV is genetically linked to the VDPV3 sequence for ES/SOM/BAN/HMW/KAWMA-1/18/006 (Kawma ENV site, emergence group SOM- BAN-2). The new PV3 viruses are classified immediately are cVDPV3 • EPID no: SOM/LJB/JMW/18/CC1/001 and SOM/LJB/JMW/18/CC1/003 (Community samples) • Location of case: SANGUNI village –Jamamme west District- Lower Jubba Region- South zone • Date Stool collection 1st and 2nd: 24 April 2018 • Accessibility of the area: The district is completely inaccessible • Accessibility of the area: The village is inaccessible since 2015 and no SIA activity • Age and OPV dose status [if case]:18 &36 months females, 0 Dose • Sequencing results: PV-3 VDPV with 16nt difference from Sabin • Closest match: not genetically linked to any other previously sequenced VDPV3s; it is classified as VDPV3 and represents a VDPV3 event Summary Environmental Samples and Lab Classification

Epidemiological Week-2017 Epidemiological Week-2018

District Date Name 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 of of Ma Ma Ma Ma Ma Jun Establishmen J. J. J. J. F. F. F. F. M. M. M. M. M. Ap.Ap.Ap.Ap. Jun Sites y y y y y e t e 7 04 11 18 25 01 08 15 22 01 08 15 22 29 05 12 19 26 03 10 17 24 31 14

Waberi 21October 19 Sept. 2017 vDPV2

Urobo 20 Sept. 2017 Shangani

21 Sept. 2017 Hamerew Kawma oini

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

2 Pending 7 NPENT + Sabin 12 Sent for sequencing

3 Negative 8 cVDPV2 13 Scheduled but not collected

4 NEV 9 WPV1 14 Sabin 2

5 NPENT 10 WPV3 15 Sabin + NPEV + NEV Next steps

• Detailed case and field investigation ongoing. • Enhanced active surveillance to search for cases ongoing • Response planned - mOPV2 rounds synchronized with Kenya and Ethiopia: Round 1: 09-12 July and round 2: 04-08 August, 2018 • Identify hot cases through active case search in the community • Evaluate accessibility and security in Hiran Province to ensure good SIA coverage • Conduct high quality SIA using mOPV2 in the accessible settlements of the area • Revitalize social mobilization for polio vaccination and surveillance of paralysis through radio and TV • Review strategies to increase parental awareness prior to rounds and reduce child/parents absence Synchronized Campaign Dates Country Campaign Preparedness • Overall preparedness level: Somalia is ready for the campaigns scheduled for July 9-12, 2018 • Current status update # DFAs to % DFAs to Micro plan revision completed ready for use Region # District # DFAs  Monitors/supervisor training completed use ODK use ODK 2-day Master TOT training conducted in Mogadishu to DPOs and selected DFAs and team dispatched to 6 regional hubs Post Campaign IM and LQAS Training currently in progress Cascade training started in the districts and will be completed by June 28th, to be followed by team training Bakool 5 50 19 38% Budget: PO not yet received by zones but disbursement in Bay 5 148 50 34% progress  C4D activities: Key activities fully completed Gedo 8 120 43 36% Vaccine distribution: 416,000 doses mOPV2 now in Mogadishu, 340,000 expected this week. Vaccines and L Jubba 3 70 23 33% materials positioned in regional hubs of Baidoa, Gedo and Kismayo but not dispatched to parts of Bakool and Afmadow Galgad 9 86 29 34% districts MOH states/other partners informed and involved in the synchronized mOPV campaign preparation Grand Total 21 388 135 35% Summary of response activities using mOPV2

Three rounds of mOPV2 campaigns mOPV2 response areas mOPV2 rounds IM coverage conducted targeting all <5 (Benadir, Middle 100% and Lower Shabelle) 99% 98% 98%  st 97% 97% 97% 1 Round (10-13 Dec. 2017) 95% 96% 96% • Target: 726,699 • Reached: 702,667 (97%) 90% 92% • Missed: 24,032 85% • IM coverage: 97%

• LQAS= 98% FM 80%

 2nd Round ( 29 Jan-01 Feb 2018) 75% • Target: 741,313 70% • Reached: 715,172 (96%)

• Missed: 26,141 65% • IM coverage: 93% M. Shabelle • LQAS= 98% FM 60% Banadir L. Shabelle 55%  3rd Round (05-08 May 2018)

• Target: 790,837 50% ROUND I ROUND II ROUND III • Reached: 763,471 (97%) BANADIR 96% 92% 98% • Missed: 27,366 LOWER SHABELLE 97% 97% 96% MIDDLE SHABELLE 98% 97% 99% • IM coverage: 98% FM • LQAS= 98% FM BANADIR LOWER SHABELLE MIDDLE SHABELLE Province District % 0-11m Children Vaccinated Total Missed Children % 12-59-count Vaccinated % Total Under 5 Children vaccinated BAN ADA 98% 14 99% 98% BDB 99% 33 98% 98%

DRK 94% 204 95% 95%

DYN 98% 65 95% 96%

HDN 97% 61 98% 98% rd 3 round mOPV2 Post Campaign HJB 98% 35 98% 98% IM result by district HLW 99% 39 98% 98% HMW 100% 7 99% 100%

HWL 99% 38 97% 98%

KRN 100% 33 99% 99%

MDN 99% 78 97% 98%

SBS 97% 60 97% 97%

SHN 97% 17 99% 98%

WBR 98% 26 98% 98%

WDA 100% 26 98% 99%

YQA 98% 136 97% 97% BAN Total 98% 872 97% 98% LSH AFG 95% 139 96% 95% WLW 100% 100 96% 96%

QRO 99% 35 95% 96%

KRT 99% 32 95% 96%

BRV 99% 19 94% 95%

MAR 96% 72 95% 95% LSH Total 97% 397 95% 96% MSH ADL 100% 0 100% 100% BLD 99% 1 100% 100%

JOW 100% 1 100% 100%

MDY 100% 2 100% 100%

WRS 100% 2 100% 100% MSH Total Graph100% no. 1 6 100% 100% Grand Total 98% 1275 98% 98% 3rd round mOPV2 Post Campaign monitoring results LQAS Vaccination Status by finger marking

Finger Mark (FM) Region/Distric t NO FM FM Present Total HH Visited % Vaccinated Interpretation BANADIR 27 913 940 97% ADA 60 60 100% PASS BDB 60 60 100% PASS DRK 4 56 60 93% SATISFACTORY DYN 60 60 100% PASS HDN 5 55 60 92% SATISFACTORY HJB 50 50 100% PASS HLW 4 56 60 93% SATISFACTORY HMW 60 60 100% PASS HWL 3 57 60 95% PASS KRN 2 58 60 97% PASS MDN 2 58 60 97% PASS SBS 1 49 50 98% PASS SHN 1 59 60 98% PASS WBR 2 58 60 97% PASS • LQAS conducted in 24 districts in 24 WDA 1 59 60 98% PASS lots. YQA 2 58 60 97% PASS LSH 6 234 240 98% AFG 2 58 60 97% PASS • Of the 24, 21 have passed, 3 are WLW 60 60 100% PASS QRO 2 58 60 97% PASS satisfactory and non of the lots fail MAR 2 58 60 97% PASS MSH 3 237 240 99% • BLD 2 58 60 97% PASS All districts have coverage above JOW 60 60 100% PASS 90% MDY 1 59 60 98% PASS WRS 60 60 100% PASS Grand Total 36 1384 1420 97% Response activities using mOPV3 using bOPV

NIDs round 1 of bOPV campaign conducted targeting all <5 in Somaliland, South Zone and two Regions in Central Zone (Hiran and Galgadud). Somaliland Campaign date: 30 April-03 May 2018 Target: 638,062 Reached: 627,805 (98%) Missed: 2,206 IM coverage: 97% South zone Campaign date: 08-11 May 2018 Target: 467,553 Reached: 457,167 (98%) Missed: 1,049 IM coverage: 95% Central zone (Hiran and Galgaduud) Campaign date: 05-09 May 2018 Target: 213,865 Reached: 199,516 (93%) Missed: 579 National Level: Target: 1,319,480 Reached: 1,284,488 (97%) Missed: 3,824 IM coverage: 96% Summary results of IM result Summary results of LQAs conducted in South and Somaliland in South and Somaliland NID-1 IM Coverage by Region Regions Total Lots Lots Lots

100% lots Pass Satisfacto Fail

99%

96%

96% 96% 90% 95%

95% ry 94%

80% Awdal 5 4 1 0 70% Galbeed 7 4 1 2

60% Saaxil 2 2 0 0

50% Togdheer 7 7 0 0

40% Sool 4 4 0 0

30% Sanaag 4 3 0 1 Bakool 2 2 0 0 20% Bay 1 1 0 0

10%

No No NID

No NID No

No No NID

No No NID No NID No No IM No No IM Gedo 3 2 0 1

Bay

Bari

Sool

Sahil

Gedo

Hiran

Nugal Sanag

Awdal L/Juba 1 1 0 0

Bakool

Mudug

Banadir

Togther

L. Jubba L.

M. Jubba M.

Galgudud

Marodijeh

L. Shabelle L. M. Shabelle M. Central South Somaliland Puntland Somalia 36 30 2 4 Part II AFP Surveillance Week-25 Somalia Weekly EPI/POL Update

Epidemiological Curve 01 January 2014 – 24 June 2018

2014W01 2014W03 2014W05 2014W07 2014W09 2014W11 2014W13 2014W15 2014W17 2014W19 2014W21 2014W23 2014W25 2014W27 2014W29 2014W31 2014W33 2014W35 2014W37 2014W39 2014W41 2014W43 2014W45 2014W47 2014W49 2014W51 2015W01 2015W03 2015W05 2015W07 2015W09 2015W11 2015W13 2015W15 2015W17 2015W19 2015W21 2015W23 2015W25 2015W27 2015W29 2015W31 2015W33 2015W35 2015W37 2015W39 2015W41 2015W44 2015W46 2015W48 2015W50 2015W52 2016W02 2016W04 2016W06 2016W08 2016W10 2016W12 2016W14 2016W16 2016W18 2016W20 2016W22 2016W24 2016W26 2016W28 2016W30 2016W32 2016W34 2016W36 2016W38 2016W40 2016W42 2016W44 2016W46 2016W48 2016W50 2016W52 2017W02 2017W04 2017W06 2017W08 2017W10 2017W12 2017W14 2017W16 2017W18 2017W20 2017W22 2017W24 2017W26 2017W28 2017W31 2017W33 2017W35 2017W37 2017W39 2017W40 2017W42 2017W44 2017W46 2017W48 2017W50 2017W52 2018W02 2018W04 2018W06 2018W08 2018W10 2018W12 2018W14 2018W16 2018W18 2018W20 2018W22 2018W24

Pending Lab Pending ERG Discarded Compatable WPV aVDPV VDPV2 VDPV3

Graph no. 1 Week-25 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

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 2018W23 2018W24 2018W25

Total 2016 Total

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 2 1 1 1 1 1 1 24 1 1 1 1 1 1 3 1 1 11 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 2 2 1 1 11 HIRAN 15 1 1 1 1 1 1 1 1 1 1 21 1 1 1 1 1 1 1 7 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 12 1 1 1 2 1 1 1 1 1 10 TOGDHER 11 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 1 10 SANAQ 7 1 1 6 1 1 1 3 AWDAL 18 1 1 1 1 1 1 17 1 2 1 1 1 1 1 1 1 10 SAHIL 8 1 1 1 8 1 1 2 SOOL 5 1 1 2 1 11 1 1 1 3

LOWER JUBA 26 1 2 2 1 1 1 1 1 1 1 1 1 29 2 1 2 1 1 1 1 1 1 1 1 13 1 - BAY 19 1 1 1 1 1 2 2 2 1 22 1 4 1 1 1 1 1 1 1 1 1 14 GEDO 21 1 1 1 2 2 1 1 1 20 1 1 1 1 1 1 1 7 MIDDLE JUBA 11 1 2 1 1 11 1 1 1 1 1 1 1 7

BAKOOL 9 1 1 1 1 1 1 1 10 1 1 1 1 1 5 Table no. Table Total Somalia 316 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 9 5 8 5 8 8 3 7 6 0 1 157

Silent (not reporting) for > 8 weeks - Four new AFP cases were reported last week making the total AFP cases reported in 2018 to 157 from 19 regions Reported AFP cases as compared to 190 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-25 Somalia Weekly EPI/POL Update

Classification of AFP Cases by Status (2017 & 2018) 2017 2018 ZONE PROVINCE Discarde Discarde Pending Total VDPV Pending Total 157 AFP Cases d d BANADIR 33 0 33 10 0 0 10 Reported in 2018 GALGADUD 27 0 27 5 0 0 5 CENTRAL HIRAN 21 0 21 12 1 0 13 LOWER SHABELLE 30 0 31 12 0 0 12 MIDDLE SHABELLE 24 0 24 12 1 1 14 BARI 24 0 24 9 0 1 10 Puntland MUDUG 11 0 12 11 0 0 11 134 0 21 0 2 NUGAL 10 0 10 6 0 1 7 Discarded WPV Pending Compatible VDPV AWDAL 16 0 17 5 0 1 6 GALBEED 20 0 20 9 0 4 13 SAHIL 8 0 8 8 0 1 9 Somaliland SANAQ 6 0 6 5 0 2 7 SOOL 11 0 11 8 0 2 10 TOGDHER 9 0 9 9 0 1 10 BAKOOL 10 0 10 4 0 0 4

19 0 2 BAY 22 0 22 2 0 0 2 2 2 In process (lab) Pending ERG Pending ITD SOUTH GEDO 20 0 20 2 0 1 3 - LOWER JUBA 29 0 29 2 0 1 3 MIDDLE JUBA 11 0 11 3 0 1 4 Grand Total

345 0 345 134 2 17 153 no. Table Week-25 Somalia Weekly EPI/POL Update

Surveillance Indicators by Zone and Region 2018 Annualized NP-AFP Rate by Zone, 2017 14.0 12.0 12.3 10.0 8.0 6.0 6.6 4.0 6.0 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 8.3 6.0 4.0 5.9 5.7 6.0 2.0 - In-accessible Partially Accessible Somalia Acceessible Map no. 1 Map no. 2 Graph no. 3 Week-25 Somalia Weekly EPI/POL Update

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

. 98 out of 115 districts reported at least 1 AFP case since the first week of 2018. . Out of the 98 districts reporting AFP cases in 2018, 98 have annualized NP-AFP rate above 2 per 100,000 . In addition, 96 districts have stool adequacy rate of above 80%. . The remaining 17 districts have not reported any AFP case in 2018; However, no district in Somalia has been silent for more than 52 consecutive weeks. . 12% (n=2/17) inaccessible districts and 20%(n=15/75) of accessible districts did not report AFP cases in 2018. All the 17 partially accessible districts have reported at least 1 case. Map no. 3 Map no. 4 Week-25 Somalia Weekly EPI/POL Update

Distribution of NP-AFP cases and Zero-dose Cases by Accessibility

. 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 18 zero-dose AFP cases reported in 2018, 10 were reported from inaccessible districts, 6 from partially- accessible districts and 2 from accessible districts Map no. 5 Map no.6 Week-25 Somalia Weekly EPI/POL Update

Number of NP-AFP Cases Reported Across Years During the Same Period (2013-2018) by Zone 300

250

241 226 200

190 174 165 150 157

100 104

68 67 72 50 62 53 45 45 46 46 36 38 36 38 31 35 30 32 32 17 17 21 27 26 0 CENTRAL PUNTLAND SOMALILAND SOUTH SOMALIA 2013 2014 2015 2016 2017 2018

. All zones but South have reported less number of AFP cases compared to the number of reported AFP cases in 2017 during the same period. Week-25 Somalia Weekly EPI/POL Update

Early Case Detection Within 7 Days From Onset of Paralysis: Zonal and Region Levels, 2018

Notification within 7 days, Zonal Notification within 7 days, Regional 26 31 40 149 11 7 11 12 10 4 10 10 2 3 4 5 7 100% 100% 149 52 13 10 90% 90% 11 6 11 80% 80%

70% 2 70%

60% 60% 50% 50% 40% 40% 30% 30% 20%

20% 10%

10% 0%

BAY

BARI

SOOL

SAHIL

GEDO

HIRAN

NUGAL

SANAQ

L. JUBA L.

AWDAL

MUDUG BAKOOL

0% M.JUBA

GALBEED

BANADIR TOGDHER

CENTRAL PUNTLAND SOMALILAND SOUTH SOMALIA GALGADUD

L. SHABELLE L. M.SHABELLE CENTRAL PUNTLAND SOMALILAND SOUTH TOTAL

• 95% (n=149/157) cases reported in 2018 were notified within 7 days of onset of paralysis. Eight 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-25 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 53 3.9 52 98% 98% 98% 7 46 46 100% 5 5% 5 11%

Puntland 26 12.3 26 100% 100% 100% 1 25 25 100% 3 6% 4 16%

Somaliland 32 4.7 32 100% 100% 97% 4 28 28 100% 3 5% 1 4%

South 46 6.6 44 96% 100% 87% 9 37 37 100% 7 9% 0 0%

Total 157 6.0 154 98% 99% 95% 21 136 136 100% 18 7% 10 7%

Table no.-4 Week-25 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 10 13 2.5 100% 100% 100% 100% 0% 25% 0 GALGADUD 267828 2 11 8.9 100% 100% 100% 100% 9% 9% 1 CENTRAL HIRAN 233838 2 7 6.5 100% 100% 100% 100% 0% 0% 0 LOWER SHABELLE 948112 9 11 2.5 100% 100% 100% 100% 13% 13% 0 MIDDLE SHABELLE 375400 3 11 6.3 91% 91% 91% 100% 6% 0% 0 BARI 182218 2 12 14.3 100% 100% 100% 100% 8% 17% 0 PUNTLAND MUDUG 186490 2 10 11.6 100% 100% 100% 100% 0% 11% 1 NUGAL 90921 1 4 9.5 100% 100% 100% 100% 13% 25% 0 AWDAL 244900 2 10 8.8 100% 100% 100% 100% 0% 10% 0 GALBEED 550148 5 10 3.9 100% 100% 100% 100% 6% 0% 0 SAHIL 85949 1 2 5.0 100% 100% 100% 100% 0% 0% 0 SOMALILAND SANAQ 150975 1 3 4.3 100% 100% 67% 100% 50% 0% 1 SOOL 120412 1 3 5.4 100% 100% 100% 100% 0% 0% 1 TOGDHER 317058 3 4 2.7 100% 100% 100% 100% 0% 0% 0 BAKOOL 183178 2 5 5.9 100% 100% 100% 100% 0% 0% 0 BAY 540491 5 14 5.6 93% 100% 79% 100% 17% 0% 0 SOUTH GEDO 312710 3 7 4.9 86% 100% 100% 100% 25% 0% 0 LOWER JUBA 300735 3 13 9.4 100% 100% 85% 100% 0% 0% 1 MIDDLE JUBA 162640 2 7 9.3 100% 100% 86% 100% 0% 0% 0 SOMALIA 6364810 59 157 6.0 98% 99% 95% 100% 7% 7% 5 Week-25 Somalia Weekly EPI/POL Update

Summary of Key AFP surveillance Indicators for contacts, 2018 % Contact % Contact % Specimens # Contacts % contacts # Contact Average collected # Contact # Specimens # AFP # % contacts < 5 with stool in with NPEV with Sabin with Sabin ZONE samples with contacts per within 7 days pending lab with NPEV Good Isolated virus like virus Cases CONTACTS age of AFP results isolated Lab result cases Condition isolated Isolated notified Central 53 159 114 3 100% 100% 100% 45 6 5% 9 8% Puntland 26 78 66 3 100% 100% 100% 12 5 8% 6 9% Somaliland 32 96 84 3 100% 100% 100% 12 5 6% 5 6% South 46 138 106 3 100% 100% 100% 32 8 8% 4 4% Somalia 157 471 370 3 100% 100% 100% 101 24 6% 24 6%

Summary of Community Samples collected in 2018 from silent districts, Egyptian hospital and inaccessible districts PV 1 Sabin & suspect polio Zone Pending Negative NPENT PV 3 Sabin PV 1 Sabin VPV3 Grand Total PV3 Sabin viruse PUNLAND 5 28 1 1 35 SOMALILAND 10 19 1 30 CENTRAL 88 82 1 3 1 175 SOUTH 11 18 2 2 33 Grand Total 114 147 4 1 1 3 2 1 273 Table no.-5 Week-25 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 Zone 90% 64 28 VPVs cases reported by VPV reported by VPV 138 80% 253 79 70% 105 104 74 59 60% CENTRAL 190 53 25 47% 50% 131

40% PUNTLAND 105 26 12 46% 30% 268 143 163 191 67 67 20% 151 SOMALILAND 81 32 12 38% 10%

0% 2 25 2012 2013 2014 2015 2016 2017 2018

Year of onset SOUTH 159 46 18 39% VPV HFs Other Key: 1. VPVs: Village polio volunteers Total Somalia 535 157 67 43% 2. HFs: MCH, Hospitals and Private clinics 3. Others: community members, district field assistants, traditional healers Table no.-6 Week-25 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 6 5 7 50 50 9 3 77 5 1 0 41 36 28 28 67 29 31 7 33 40 0 22 8 4 4 31 25 3 6 17 20 12 14 8 12 3 20 18 0 2 8 1 2 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 03 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-25 Somalia Weekly EPI/POL Update

Distribution of AFP Cases by Lifestyle, Age and Sex, 2018

Distribution of AFP cases by Life style per Distribution of AFP cases by Age group Distribution AFP cases by Sex . Of the total 157 AFP zone-2012-2018 2012-2018 2012-2018 100% 100% 100% cases reported in 2018, 33 19 32 52 90% 90% 72 90% 44 43% (n=68) and 39% 80% 112 80% 83 80% 65 181 129 152 68 152 72 (n=61) are from urban 281 189 70% 70% 70% 324 252 166 92 and rural populations 60% 60% 60% respectively. Nomadic 50% 50% 50% 283 87 129 249 293 communities account for 40% 117 40% 348 40% 51 144 124 61 113 150 30% 30% 129 30% only 18% (n=28). 164 84 156 20% 20% 20% 56 221 167 115 . 72% (n=113) of cases are 80 91 70 10% 31 97 69 28 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=84) AFP cases Nomadic Rural Urban <5 Yrs ≥ 5 Yrs Female Male are female. Graph no.-10 Graph no.- 11 Graph no.-12 Week-25 Somalia Weekly EPI/POL Update

AFP Surveillance Indicators by District Accessibility Status, 2018

# of AFP # of % of Number % U-15 Pop % inv. % of Notif. % cases # of cases Cases Cases NP AFP of cases % of Stool Specimen Accessibility in this Within 48 within 7 with Sabin districts Reporte reported reported rate with lab adequacy s with area hrs. days like virus d by VPVs by VPVs result NPEV

Inaccessible 17 619,320 21 13 62% 8.3 16 100% 100% 95% 6% 0% Partially 23 1,720,826 42 15 36% 5.9 35 95% 100% 88% 7% 3% accessible

Accessible 75 4,024,663 94 39 41% 5.7 85 99% 101% 98% 6% 11%

National 115 6,364,810 157 67 43% 6.0 136 98% 99% 95% 7% 7% Table no.

- 7 7 . Despite accessibility status of districts, majority of indicators are above global standards Week-25 Somalia Weekly EPI/POL Update

AFP Surveillance Indicators by Population Lifestyle, 2018 % of <15 # of AFP # of % of Number % of % of % inv. % of % % cases of cases cases Accessibility populati cases Cases Cases NP AFP Stool Within Notifie Specim with on in Reporte reported reported with lab with lab 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% 28 14 50% 3.3 25 64% 93% 100% 89% 0% 4%

Rural 25.90% 61 32 52% 8.0 57 81% 100% 100% 98% 8% 5%

Urban 45.30% 68 21 31% 5.1 54 81% 99% 99% 94% 8% 11%

National 100% 157 67 43% 5.3 136 78% 98% 99% 95% 7% 7% Week-25 Somalia Weekly EPI/POL Update

AFP Case Validation and Zero Dose Investigation, 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 53 28 53% Central 7 6 86% 2 from accessible and Somaliland 32 22 69% Somaliland remaining from access- compromised South Zone 46 32 70% South Zone 11 10 91% areas

Puntland 26 22 85% Puntland

Grand Total 157 104 66% Grand Total 18 16 89% Table no.-8 Table no.-9 . Out of the total 157 AFP cases reported in 2018, 66% (n=104) were validated by the RPOs. Of the 104 AFP cases validated, (n=75, 15,11) were from accessible, partially accessible and inaccessible districts respectively . There were 17 zero OPV dose AFP cases reported in 2018, out of which 94% (n=16/17) were investigated Week-25 Somalia Weekly EPI/POL Update

Total AFP cases Tracking Lab Results of AFP Cases 157

Tracking AFP with stool specimens Total AFP cases Total AFP cases with stool without stool specimens specimens 157 0 21 18 cVDPV2

Other viruses With lab En route In the lab

neg st results 136 0 21 in lab 116 en route cVDPV3 cVDPV2 SL EV -ve 1 1 10 12 116 Week-25 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 314 272 42 212 78% 18 7% 10 7%

Contacts 471 370 101 288 78% 24 6% 24 6%

Total 785 642 143 500 78% 42 7% 34 7%

Table no.-10 Week-25 Somalia Weekly EPI/POL Update

Median and Average Number of Days from Onset of Paralysis 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 Median: 20 days stool ITD results collected Average: 22 days Chart no. 2 Week-25 Somalia Weekly Polio Update

Village Polio Volunteers Weekly House to House Visit and AFP Cases Notified, 24 June 2018

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

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

38002 6 39361 8 48588 5 38442 3 2 1 ------38,481 Central 29,439

35756 2 35545 3 45593 4 36456 4 3 2 ------36,073 South 27,124

16237 3 16148 3 20107 2 16230 3 1 0 ------16,077 Puntland 11,968

32180 6 32370 1 39613 2 32532 1 2 0 ------32,325 Somaliland 23,973

Total 122175 17 123424 15 153901 13 123660 11 122956 8 92504 3 0 0 0 0 0 0 0 0 0 0 0 0 Week-25 Somalia Weekly Polio Update

Routine Immunization Services, Status of Cold Chain & Vaccine Stocks in AFP Surveillance Sites, 24 June Expected weekly AFP Health facility have a AFP sites with EPI service and functional Health facility have EPI 2018 Health facility have IPV vaccine available Region 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 III Fever and rash surveillance Week-25 Somalia Weekly Polio Update

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

800 2015 2016 2017

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

700

720

(n=6169)

703

699

696

693

686

685

670

663 657

600

584

560

554 538

500

507

496

488

487

463

461

444

441 441

440

436 436

400 426

416 416

410 410

408

407

406

401

400

399

393

389

383

373

362

352

351

349 346

300 330

325 325

320

317

315

314

309

292

290

286

277

269

255

239 228

200 227

224

222

219

214

210

208

199

198

196

191

182

180 180

175

174

173

172

170

163

161

158

156

155

154

153

151

149

145

144

142

141

140 140

134

133

132

128

127 127

100 126

125 125

124 124

122 122 122

117

116

115 115

113

112

111

109 109

107

105 105

97 103

96 102 102 102

95 95 101

100

93 93

90 90

88 88

87 87

86 86

85 85

84 84

76 76

74 74

72 72

66 60

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Fever and rash cases reported by AFP surveillance system , 24 June 2018

Fever and Rash Cases by weekly 2018

Region

W1 W2 W3 W4 W5 W6 W7 W8 W9

W10 W11 W12 W13 W14 W15 W16 W17 W18 W19 W20 W21 W22 W23 W24

Total 2017 Total 2018 Nugal 2050 32 26 26 26 24 19 30 21 17 10 7 10 10 13 19 20 15 4 7 3 4 7 6 2 358 Bari 1968 21 26 20 17 20 26 26 18 22 27 33 25 27 26 29 46 28 22 13 13 18 13 14 10 540 Mudug 2566 47 45 36 27 44 25 23 24 30 15 21 20 16 10 13 14 7 17 0 8 1 0 3 5 451 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 20 23 17 1349 Galbeed 758 4 2 4 7 1 4 0 4 0 0 6 7 0 1 5 4 0 1 0 2 2 1 0 0 55 Sahil 576 2 0 9 2 13 5 24 5 18 4 4 4 13 2 1 1 2 0 7 0 2 0 4 2 124 Sanag 259 4 6 5 11 0 5 7 5 5 2 0 0 12 0 6 0 1 0 1 0 0 0 0 0 70 Sool 698 17 7 20 20 45 20 43 13 26 6 26 0 18 6 6 1 1 0 0 1 0 1 2 2 281 Awdal 105 2 0 11 2 5 0 10 0 3 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 33 Togdher 2324 11 11 27 13 31 7 51 25 37 14 49 28 29 13 17 17 8 13 19 7 6 3 11 8 455 N/West Zone 4720 40 26 76 55 95 41 135 52 89 26 85 39 72 22 35 23 12 14 27 10 10 5 17 12 1018 M/ Shabelle 716 18 15 19 23 23 23 43 30 30 33 38 22 14 17 12 5 12 12 11 5 16 10 7 9 447 Hiran 1461 12 13 3 26 26 15 22 12 18 1 5 1 0 20 17 0 35 5 0 0 0 15 16 27 289 Galgadud 625 5 7 4 6 6 8 16 11 8 6 4 7 6 4 8 5 7 4 11 7 5 7 3 2 157 Banadir 5617 72 73 79 70 70 68 56 66 59 54 48 36 26 20 40 32 58 62 47 53 40 42 25 18 1214 L/Shabelle 2106 25 28 40 36 36 28 29 52 36 35 33 20 31 23 32 20 29 31 25 19 22 19 22 23 694 Central Zone 10525 132 136 145 161 161 142 166 171 151 129 128 86 77 84 109 62 141 114 94 84 83 93 73 79 2801 Middle Juba 62 0 3 3 0 1 1 2 3 0 0 2 3 3 3 4 3 4 3 4 6 3 4 3 8 66 Bakool 99 4 2 2 0 4 0 0 4 2 0 0 4 0 4 4 0 2 0 0 2 3 0 2 0 39 Gedo 241 0 1 1 51 23 61 51 100 77 35 26 32 8 8 31 3 6 3 0 0 0 1 4 2 524 Bay 654 17 17 2 0 9 4 11 11 9 0 0 0 0 0 5 5 5 5 5 0 0 1 0 2 108 Lower Juba 468 22 4 6 9 12 6 17 6 10 27 12 5 14 28 43 43 19 9 30 0 31 5 26 22 406 South Zone 1524 43 27 14 60 49 72 81 124 98 62 40 44 25 43 87 54 36 20 39 8 37 11 35 34 1143 Grand Total 23353 315 286 317 346 393 325 461 410 407 269 314 224 227 198 292 219 239 191 180 126 153 129 148 142 6311 Week-25 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 130140 161197 202 194 71 115 7097 119 6283 142 132 113 200 3639 30 48 40 2443 2739 1927 1133 1240 150 200 95 82 10492 66 93 72 99 8796 14 36 33 2935 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 189 742 200 171 800 640 659 144 574 568 136 128 139 503 545 514 547 515 150 115 115 600 455 443 420441 468 450 367 401 348396 388 350383 401 82 83 315 324 307 278 328 281310 100 77 75 69 64 400 265 271 50 152 142 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 • Correction: there was a data error last week which causes Cases in Somaliland was inflated; Please disregard that figure and take this week corrected information on the trend of reported suspected cases Week -21 Somalia Weekly Polio Update Fever and Rash Cases Reported, 24 June 2018 Source: AFP Surveillance System

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

7000 6311 Yrs10+, 760, 6000 12% <1yr, 1016, 16% 5000 5_9yrs, 1006, 16% 4000 2801 3000

2000 1349 1018 1143 1_4 yrs, 3529, 1000 56% 0 Central North East North West South Total Somalia Week-25 Somalia Weekly Polio Update

Measles Mass Immunization in Somalia, 2018

• Nationwide campaign planned to vaccinate 100% 95% children from 6 months to 10 years of age; based 90% 94% 93% on epidemiology, 83% of cases were under 10 92% 92% years 80% • 4.7 million children targeted in all accessible and 70% partially accessible districts of the country 60% • 4.4 million children vaccinated (94% coverage) 50% • Independent monitoring data shows 94% of the 40% children reached with measles vaccination during 30% the campaign dates 20%

10%

0% centeral Puntland Somaliland South GrandNational Total Week-25 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 IV Population Immunity Week-25 Somalia Weekly EPI/POL Update

Maps showing accessibility and security/ risk level, Somalia

Source: UNDSS

Map no.10 Map no.11 Week-25 Somalia Weekly EPI/POL Update

Programmatic 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-25 Somalia Weekly EPI/POL Update

Transit Points Vaccination Activities using bOPV - 24 June 2018

January February March April May June

Zones

Zero doses Zero doses Zero

vaccinated vaccinated vaccinated vaccinated vaccinated vaccinated

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

Number of Number of Number of Number of Number of Number of

% % % doses % Zero doses % Zero doses % Zero doses % Zero

CENTRAL 99939 334 0.3% 106321 362 0.3% 134103 366 0.3% 104803 334 0.3% 103405 313 0.3% 76634 220 0.3% PUNTLAND 25067 58 0.2% 24610 59 0.2% 31565 71 0.2% 25519 61 0.2% 25516 55 0.2% 18096 32 0.2% SOMALILAND 14705 350 2.4% 14490 377 2.6% 17807 430 2.4% 14898 343 2.3% 15809 337 2.1% 11388 275 2.4% SOUTH 32225 1073 3.3% 34364 1123 3.3% 46605 1589 3.4% 42947 1336 3.1% 34650 937 2.7% 32935 789 2.4% SOMALIA 171936 1815 1.1% 179785 1921 1.1% 230080 2456 1.1% 188167 2074 1.1% 179380 1642 0.9% 139053 1316 0.9% . A total of 1,099,625< 10 years individuals were vaccinated week 24,2018. Among them 11,224(1%) were vaccinated for the first time.

Table no.-16 Week-25 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%

5 90% 493 90% 90% 90% 2 25 10 3 10 35 4 4 31 80% 8 44 80% 80% 80% 16 263 812 635 650 15 575 83 37 70% 70% 2 70% 424 70% 26 60% 12 60% 60% 60% 50% 34 50% 15 6 3 50% 539 50% 28 21 42 40% 6 40% 11 7 230 243 9 40% 183 40% 34 178 245 5 30% 27 30% 17 30% 10 198 30% 20% 20% 4 0 6 252 34 13 3 20% 152 182 20 7 888 20% 20 10% 10% 2 2 70 6 6 3 5 12 1 3 341 29 1 10% 10% 0% 0 0 0% 0 0 148 155 172 66 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-25 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% 88 234 430 294 156 178 78 268 273 60% 145 187 60% 306 40% 66 40% 56 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 26 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 53 80% 77 100 80% 54 123 44 38 105 97 97 102 74 84 60% 36 60% 32 50 51 40% 68 77 85 40% 47 16 48 48 36 317 23 60 20% 101 20% 39 62 77 97 99 26 40 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 V 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%

100000 30%

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% THE END