Epi update week 04/1/08 - 10/1/09
C4 Surveillance and lab group Toll free number for alert by district and province is 08089001 or 08089002 or 08089000 Mobile number for alerts is 0912 104 257
Email: [email protected]. New cholera cases, with case-fatality rates, by week. Zimbabwe, Nov 08 - Jan 09
• * For week 7-13 December, gaps in reporting of data • ** For week 28 December 08- 3 January 09, artefact (Christmas- New Years)
7,000 10.0
9.0 6,000
8.0
5,000 7.0
6.0 4,000 * * 5.0 Cases CFR
Cases * CFR 3,000 4.0
3.0 2,000
2.0
1,000 1.0
0 0.0 16-22 Nov 23-29 Nov 30 Nov - 6 Dec 7-13 Dec 14-20 Dec 21-27 Dec 28 Dec-3 Jan 4-10 Jan Global picture
The cholera outbreak is not yet under control with 9 of 10 provinces reported cases this week.
• Duration of the outbreak: 5 months • To date, cumulative total of 37 806 suspected cases and 1912 deaths have been reported • Number of cases have increased from last week as well as the number of deaths. • CFR increased markedly this week to 6 % similar to the week preceding the Christmas and New year’s holiday, • and CFR still much higher than expected for a cholera outbreak (normally <1%). • This week (4 Jan -10 Jan 2009), 656 cases per day reported and 39 persons are dying every day of cholera. • This week (4 Jan -10 Jan 2009) nearly half of the deaths (41%) are occurring outside treatments centre →unavailability of health care (especially human resources shortage) “Hot spots” this week
• Mashonaland West (increase cases and CFRs > 5% and high attack rates and 1/3 of the total weekly number of cases) • Midlands, (increase cases and CFRs > 5% and high attack rates) • Manicaland (CFRs > 5% and high attack rates) • Mathebeleland South (increase cases) • Chitungwiza (CFRs > 5%) • Masvingo (CFRs > 5%) • Mashonaland central (increase cases) Cumulative cholera cases, with cumulative case-fatality rates. Zimbabwe, Nov 08 - Jan 09
40000 6
35000 5
30000
4 25000
Cases 20000 3 CFR
15000 2
10000
1 5000
0 0 22-Nov 29-Nov 6-Dec 13-Dec 20-Dec 27-Dec 3-Jan 10-Jan CFR (proportion of cases that die of the disease )
• Case-fatality rates (CFR, the proportion of cases that die of the disease) increased markedly this week to 6 % (5.9% exactly) similar to the week preceding the Christmas and New year’s holiday,
• and is still far above the <1% target.
• The CFR for the week 04/10/09 - 10/1/09 is 5.9%, compared to 2.1 % last week CTC and CTU
• 172 CTC/CTU distributed over the country. • 74 of the 172 CTC/CTU so 43% run only by the MoHCW • the others 57 % are runed by MoHCW with support of NGOs/partners.
Table 1. Number of CTC/CTU per province, as of Jan 10th, Zimbabwe
Average catchment Province Population Number of CTC population per CTC Harare (Harare city+ Chitungwiza) 2,012,784 3 670928 Bulawayo 718,278 1 718278 Manicaland 1,665,451 36 46263 Mash Central 1,056,666 25 42267 Mash East 1,196,772 26 46030 Mash West 1,300,012 35 37143 Masvingo 1,401,672 31 45215 Mat North 748,317 0 - Mat South 693,230 7 99033 Midlands 1,554,058 8 194257 TOTAL 12347238 172 211046 CTC/CTU all over country CTC in Harare
Budiriro polyclinics
Beatrice hospital Cases and deaths per day, from week 16/11/08 - 22/11/08 to week 04/01/09 - 10/01/09, Zimbabwe
On average since November 16th 2008, 587 cases per day and 31 deaths per day are reported with a peak of 819 cases per day in 21-27 Dec 2008 and 52 per day in 14-20 Dec 2008
Week Cases Deaths CFR (%) Cases per day Deaths per day
16-22 Nov 2008 2863 99 3.5 409 14
23-29 Nov 2008 3254 136 4.2 465 19
30 Nov 6 Dec 2008 4499 159 3.5 643 23
7-13 Dec 2008 2841 257 9.0 406 37
14-20 Dec 2008 5379 367 6.8 768 52
21-27 Dec 2008 5730 358 6.2 819 51
28 Dec 08-3 Jan 09 3690 79 2.1 527 11
4-10 Jan 2009 4594 272 5.9 656 39
Total 587 31 Cumulative case-fatality rates, by district. Zimbabwe, as of 10 Jan 2008
Districts with cumulative CFRs over 1% are noted in the majority of the provinces (8 of the 10 provinces).
above 5 1.1 - 5.0 0 no cases/deaths Proportion of cases by provinces
This week, Mashonaland West is representing 1/3 of the total weekly number of cases, followed by Manicaland (17.0%) and Harare (10.9%). Since the beginning of the outbreak, most of the cases are coming from Harare (31.1%), then Mashonaland West (24.3%).
Proportion of Number cases cases (%) week (4 Cumulative week (4 Jan-10 number Jan-10 Jan Cumulative proportion of Provinces Jan 09) of cases 09) cases (%)
Harare (Harare city+ Chitungwiza) 501 11767 10.9 31.1 Bulawayo 8 383 0.2 1.0 Manicaland 783 4477 17.0 11.8
Mash Central 278 859 6.1 2.3 Mash East 401 3642 8.7 9.6 Mash West 1,565 9168 34.1 24.3 Masvingo 448 2565 9.8 6.8 Mat North 0 2 0.0 0.0 Mat South 438 4272 9.5 11.3 Midlands 172 671 3.7 1.8 TOTAL 4,594 37806 100.0 100.0 Attack rate (AR) per 100 000 inhabitants by provinces
The most affected provinces for this week in term of number of cases are from far Mashonaland West (AR= 120/100 000 inhabitants), then Mathebeleland South (AR= 63/100 000 inhabitants), Manicaland (AR= 47/100 000 inhabitants)
Number cases Cumulative number week (4 of cases (since Weekly AR Cumulative AR Jan-10 Jan beginning of (per 100 (per 100 Provinces Population 09) data collection) 000) 000
Harare (Harare city+ Chitungwiza) 2,012,784 501 11767 24.9 584.6
Bulawayo 718,278 8 383 1.1 53.3
Manicaland 1,665,451 783 4477 47.0 268.8
Mash Central 1,056,666 278 859 26.3 81.3
Mash East 1,196,772 401 3642 33.5 304.3
Mash West 1,300,012 1,565 9168 120.4 705.2
Masvingo 1,401,672 448 2565 32.0 183.0
Mat North 748,317 0 2 0.0 0.3
Mat South 693,230 438 4272 63.2 616.2
Midlands 1,554,058 172 671 11.1 43.2
TOTAL 12,347,240 4,594 37806 37.2 306.2 Cumulative attack rates, by district, as of 10 Jan 2009
Attack Rate (per 100,000) 1,000 and above 500.0 - 999.9 100.0 - 499.9 0.1 - 99.9 0 Proportion of deaths that occur outside CTC, week 04/01/08 - 10/01/09, selected* provinces
•* without taking into account Harare, where community deaths are irregularly (or even not) reported, •This week, more than 1/3 of the deaths (41%) are occurring outside treatments centre. In some districts (Mashonaland East) more deaths are recorded in the community than in the treatments centres.
Deaths within treatment Deaths outside treatment Proportion of deaths occuring outside Province centres centres treatment centres (%)
Bulawayo 0 0 0
Mashonaland West 117 67 36
Mashonaland Central 10 8 44
Mashonaland East 19 20 51
Manicaland 62 59 49
Masvingo 27 20 46
Matabeleland North 0 0 0
Matabeleland South 11 3 21
Midlands 16 11 41
Total 272 188 41 EPI UPDATE PER PROVINCE Chitungwiza
250 50.0
45.0
200 40.0
35.0
150 30.0
Number of Cases 25.0 CFR
100 20.0
15.0
50 10.0
5.0
0 0.0 2-8 Nov 2-8 5-11 Oct 5-11 4-10 Jan4-10 7-13 Dec 7-13 7-13 Sep 7-13 9-15 Nov Nov 9-15 12-18 Oct 12-18 Oct 19-25 16-22 Nov 16-22 Nov 23-29 14-20 Dec 14-20 Dec 21-27 17-23 Aug 17-23 Aug 24-30 Sep 14-20 Sep 21-27 26 Oct-1 Nov 28 Dec-3 Jan 28 Dec-3 28 Sep -4 Oct -4 28 Sep 31 Aug- 6 Sep 30 Nov - Dec 6 - 30 Nov Harare City
3000 25.0
2500 20.0
2000
15.0
Cases 1500 CFR
10.0
1000
5.0 500
0 0.0 16-22 Nov 23-29 Nov 30 Nov - 6 7-13 Dec 14-20 Dec 21-27 Dec 28 Dec-3 Jan 4-10 Jan Dec Harare City Distribution of Cholera Cases by place of residence, City of Harare, Oct - Dec 2008
N
W E Hatcliffe S Institute Of AgriculturalHogerty Hill Engineering
Philadelphia BorrowdaleHellensvale Brooke Umwindzidale Mount Pleasant Heights Quinnington New Marlborough Glen lo rne Northwood Marlborough Reylands VainonaPomona Greystone Park Glen Wood Borrowdale Adylin Kambanji Shawasha Hills AvonleaAshbrit tle Mount Pleasant Gl et wyn Borrowdale West The Grange Bluff Hill Little Norfolk Rolfe Valley Emerald Hill Gro ombridge Greencroft Colne ChisipiteValley North Avondale WestUniversity CampusBorrowdale Racecource Mabelreign New Alexandra ParkLewisam Mandara Dzivaresekwa Extension Mayfield Park Chisipite AshdownCotswold Park Hills Gu n H ill Dzivaresekwa SrathavenAvondale Chikurubi Tynwald Alexandra Park Highlands MeyrickMonovale Park Glaudina BelgraviaBorrowdale Road Government Block Merwede Haig Park Milton Park Greendale Avenues Belvedere North Eastlea Donnybrook Kuwadzana Warren Park City Centre Belvedere South Athlone MabvukuTafara Railway YardHillsideCoronation ParkGreen Grove Braeside Cleveland Ridgeview Msasa Amby Crowborough North Arcadia Beverly Westwood Workington Magaba Wilmington Park Chizanje Graniteside QueensdaleChadcombe KambuzumaRugare Cranborne Msasa Park Marimba Park Mbare St Mart ins Mukuvisi East Mufakose Southerton Zimre Park Lochinvar Sunningdale Aspindale Park Park Meadowlands Willowvale Ardbennie Ventersburg NewHoughton Ardbennie Park Logan Park Hatfield Budiriro Prospect Highfield Parkt own Epworth Mainway Meadows Midlands Glen Vie w Gl en No rah Kutsaga Village Gro bbi e Pa rk Uplands Airport Waterfalls Number of cases Hopley 1 - 100 Shortson 101 - 500 501 - 1000 1001 - 2000 Over 2000 No cases reported Bulawayo
140 12
120 10
100 8
80
6 Cases 60 CFR CFR Cases
4 40
2 20
0 0 16-22 Nov 23-29 Nov 30 Nov - 6 7-13 Dec 14-20 Dec 21-27 Dec 28 Dec-3 4-10 Jan Dec Jan Week Mashonaland West
3500 9
8 3000
7
2500 6
2000 5 Cases
CFR CFR Cases 1500 4
3 1000
2
500 1
0 0 16-22 Nov 23-29 Nov 30 Nov - 6 7-13 Dec 14-20 Dec 21-27 Dec 28 Dec-3 Jan 4-10 Jan Dec Week Mashonaland Central
350 25
300 20
250
15 200 Cases
CFR CFR Cases 150 10
100
5 50
0 0 16-22 Nov 23-29 Nov 30 Nov - 6 7-13 Dec 14-20 Dec 21-27 Dec 28 Dec-3 Jan 4-10 Jan Dec Week Mashonaland East
600 50.0
45.0
500 40.0
35.0 400
30.0
Cases 300 25.0
CFR CFR Cases
20.0
200 15.0
10.0 100
5.0
0 0.0 16-22 Nov 23-29 Nov 30 Nov - 6 7-13 Dec 14-20 Dec 21-27 Dec 28 Dec-3 Jan 4-10 Jan Dec Week Midlands
200 16.0
180 14.0
160 12.0 140
10.0 120
Cases 100 8.0
CFR CFR Cases
80 6.0
60 4.0 40
2.0 20
0 0.0 16-22 Nov 23-29 Nov 30 Nov - 6 7-13 Dec 14-20 Dec 21-27 Dec 28 Dec-3 Jan 4-10 Jan Dec Week Masvingo
1000 35.0
900 30.0 800
25.0 700
600 20.0 Cases 500
CFR CFR Cases 15.0 400
300 10.0
200 5.0 100
0 0.0 16-22 Nov 23-29 Nov 30 Nov - 6 Dec 7-13 Dec 14-20 Dec 21-27 Dec 28 Dec-3 Jan 4-10 Jan Week Manicaland
1600 40.0
1400 35.0
1200 30.0
1000 25.0
Cases 800 20.0
CFR CFR Cases
600 15.0
400 10.0
200 5.0
0 0.0 16-22 Nov 23-29 Nov 30 Nov - 6 Dec 7-13 Dec 14-20 Dec 21-27 Dec 28 Dec-3 Jan 4-10 Jan Week Matabeleland South
1400 25.0
1200 20.0
1000
15.0 800 Cases
CFR CFR Cases 600 10.0
400
5.0 200
0 0.0 16-22 Nov 23-29 Nov 30 Nov - 6 7-13 Dec 14-20 Dec 21-27 Dec 28 Dec-3 Jan 4-10 Jan Dec Week Matabeleland North
• No further cases or deaths were reported this week like the week before. Only 2 cases have been reported in week 21-27 Dec 08 for Matabeleland North.