Early Warning Disease Surveillance and Response Bulletin, Somalia 2017
Epidemiological week 45 (Week ending 12th November, 2017)
Cumulative figures as of week 45
Highlights
Reports were received from 226 out of 265 reporting facilities (85.2%) in week 45, a decrease in the reporting completeness compared to 251 (94.7%) in week 44. Total number of consultations increased from 69091 in week 44 to 71206 in week 45 The highest number of consultations in week 44were for other acute diarrhoeas (2,229 cases), influenza like illness (21,00 cases) followed by severe acute respiratory illness (834 cases) AWD cases increased from 77 in week 44 to 170 in week 45 No AWD/cholera deaths reported in all districts in the past 7 weeks The number of measles cases increased from in 323 in week 44 to 358 in week 45
1,363,590 total
consultations
78,596 cumulative cases of
AWD/cholera in 2017
1,159 cumulative deaths
of AWD/Cholera in 2017
55 districts in 19 regions
reported AWD/Cholera cases
20794 cumulative cases of
suspected measles cases
- Disease
- Week 44
- Week 45
- Cumulative cases (Wk 1 – 45)
- Total consultations
- 69367
2287 2240
71206
1801 2234
1363590
- 50517
- Influenza Like Illness
- Other Acute Diarrhoeas
- 60798
Severe Acute Respiratory Illness suspected measles [1]
890 323
911 358
16581 20436
Confirmed Malaria Acute Watery Diarrhoea [2]
269
77
289 170
11581 78596
Bloody diarrhea Whooping Cough
73 56
32 60
1983
687
Diphtheria Suspected Meningitis
82
11
2
221 225
Acute Jaundice
Neonatal Tetanus Viral Haemorrhagic Fever
000
420
166 173 130
[1] Source of data is CSR, [2] Source of data is Somalia Weekly Epi/POL Updates
The number of EWARN sites reporting decrease from 251 in week 44 to 226 in week 45. This is below the target of 400 health facilities that are targeted for reporting by the end of the year. The number of total consultations also increased from 69091 in week 44 to 71206 in week 45 in the 243 reporting sites (Chart 1 below). Overall, 1367245 consultations have been recorded since the beginning of the year.
Page 1 of 13
Total number of Consultations and number of reporting sites, week 34 to 45, 2017
800 700 600 500 400 300 200 100
0
80000 70000 60000 50000 40000 30000 20000 10000 0
WK 34 WK 35 WK 36 WK 37 WK 38 WK 39 WK 40 WK 41 WK 42 WK 43 WK 44 WK 45
- Consultations
- Reporting sites
Proportionate morbidity
The commonest causes of morbidity reported from the sentinel sites in week 45 are; Influenza like illness, other diarrhoeas, Severe Acute Respiratory infection, measles, malaria, AWD, Bloody diarrhoea and whooping cough and acute watery diarrhoea as shown in figure 2 below
Chart 2. Commonest Causes of Morbidty in Somalia, Week 44 and 45, 2017
2500 2000 1500 1000
500
0
Influenza Like
Illness
Other Acute Diarrhoeas
Severe Acute suspected measles Confirmed Malaria Acute Watery
- Respiratory Illness
- [1]
- Diarrhoea [2]
- Week 44
- Week 44
Page 2 of 13
Situation update of AWD/Cholera
Epidemic situation
The number of AWD cases declined from 77 in week 44 to 170 in week 45 in all regions (Table 1). No new cholera cases or deaths have been reported in the last 2months in all regions. In all, new cases reported from 7 district in 8 regions across the country.
ChCahratr3t.3M. Caupmouf lAaWtivDe CMaasepsoafsAoWf wDeCeakse4s4a, 2s0o1f7,
Week 45
This icludes; 13 from Baroma district in Awadal regoin, 12 cases from Barao district in Togdher region, 36 cases from Wadajir district in Banadir region, Marka (6) Wanla Weyn (1) in Lower shabelle, and 3 cases from Lasanood in Sool region and 4
Bossaso 4 in Bari region
A total of 78596 cases and 1,159 deaths (CFR 1.47%) have been reported in 55 districts in all the nineteen regions of Somalia. The most affected regions since the beginning of the outbreak include Bay, Banadir, Toghdeer, Bari and Mudug. Most of the affected populations live in IDP camps where access to safe water and sanitation is limited. Of the 55 affected districts, 34 of these have been classified as hard to reach or inaccessible. The Case
Fatality Rate in inaccessible districts is 4 times as in other districts. Overall, children below 5 years constitute more than 58% of the total number of AWD/cholera cases reported since the beginning of year.
Epi_curve showing AWD cases in Somalia, Week 1 - 45, 2017
6,000 5,000 4,000 3,000 2,000 1,000
-
5.00 4.50 4.00 3.50 3.00 2.50 2.00 1.50 1.00 0.50 -
- Jan
- Feb
- March
- April
- May
- June
Deaths
- July
- Aug
- Sept
- OctNovember
- Total Cases
- CFR
Page 3 of 13
Table 2. Activities implemented during the AWD/Cholera outbreak
Thematic area Activities implemented Surveillance and laboratory activities
265 health facilities were included in the EWARNs with plans to expand reporting sites to all districts
16 stool samples collected from Banadir hospital CTC during the week tested negative. A total of 282 stool samples were collected since week 1 for AWD/Cholera of which 111 were positive for V. Cholera, Ogawa.
57 IERT have been deployed in most affected districts during the drought response An alert about AWD/Cholera outbreak was investigated in Adado and was a false alert A review of the implementation of different activities was conducted by regional Surveillance officers and NPHL to identify gaps and lessons learnt so as to plan for the next expected outbreak during the rainy season.
Case Management and OCV
In addition to the 520 health workers so far trained in cholera case management, 30 additional health workers were trained in Banadir in cholera diagnosis Emergency planning meeting was held by the Banadir regional team for AWD/Cholera prevention in high risk districts Weekly coordination meetings between MoH and cluster partners A needs assessment for AWD/Cholera was conducted by the joint WHO and MoH team in Banadir hospital CTC
Coordination and Response
Water, Sanitation and Hygiene
Distribution of hygienic kits to IDP communities in AWD/Chigh risk districts Community education and mobilisation was done in all regions affected by AWD. The activities were implemented in Lower Jubba, Middle Jubba,Banadir and Middle Shabelle.
C4D conducted social mobilisation in hard to reach areas in all the districts affected by AWD/Cholera
Supplies and logistics
Over 167 tonnes of AWD/Cholera supplies and emergency kits were distributed to affected regions since January 2017
Page 4 of 13
Suspected measles cases
The number of suspected measles cases decreased from 323 cases in week 44 to 358 cases in week 45. A total of 20,078 cumulative
Chart 5. Map of Suspected Measles Cases in week 45
suspected measles cases have been reported from all the nineteen regions since the beginning of the year. 83% of the cases are children under 10 years. The most affected regions include Banadir (4,902 cases) Togdher (2,177 cases), Mudug (1,869) Lower Shabelle (1,731 cases), and Bari (1,624) (See Table 3).
Table 2: Summary of Suspected measles cases by region week 43 and 44, 2017
- Region
- Week 43
- Week 44
- Cumulative cases
Nugal Mudug Bari Banadir Lower Shabelle Bay Lower Juba M. Shabelle Galgadud Bakool
84 73 44 50 44 22 14 15
5
100
64 44 41 32 18 14 12
8
1414 2006 1712 4993 1807
515 357 638 584
- 76
- 6
- 8
Togdher Galbeed Hiran
27
23
7653
2211
735
1287
164
Gedo
9
Sool
- 2
- 1
- 611
Middle Juba Sahil
12
10
60
566
Sanag
- 5
- 0
- 244
Awdal
- 0
- 0
- 98
Grand Total
- 408
- 364
- 20078
Page 5 of 13
Measles outbreak response
WHO in collaboration of with the Federal Ministry of Health have started preparatory activities for the upcoming mass measles campaigns in November 2017 targeting 4,278,083 (6 months-10 years) children. Vaccines have been delivered to the state hubs.
Technical and coordinating structures set up, with weekly meetings at country office and zonal offices. Additionally, to micro planning and TOT trainings have been conducted in South-Central and Puntland.
Regional and district training will be conducted next week. Due to circumstance, a phase wise implementation strategy has been adopted as a best delivery option, to maintain good quality - one zone will be covered at a time.
Page 6 of 13
Table 3. Summary of epidemic prone diseases and syndromes in different districts of Somalia as of week 45
Region
Awdal
- District
- SARI
- ILI
- AWD
- BD
- OAD
- Diph
- WC
- Meas
- NNT
- AJS
- VHF
- Mal
- Men
- Total
consultations
- Baki
- 0
000
0
1
11
8
1222 6710
362
1702
9996
0
- 0
- 118
97 10 26
251
0
- 442
- 0
000
0
000
0
0000
0
- 6
- 0
000
0
000
0
0000
0
000
0000
0
000
0
8
62
0
35
105
0
112
93
205
736
5
741
280
3
0000
0
000
0
2311
Borama Lughaya Zeila
Subtotal
Elberde Hudur
1157
0
16
1173
0
3587
309
1020
5358
89
30
07
43
32
128
133
413 532
945
40
1
16132
1481 4794
24718
17096
4975
41824
63895
187518
36673
224191
27891
2080
- Bakool
- 0
- 8
- 0
0
00
- 0
- 60
- Waajid
- 28
28
121
4
125
32
0
207
356
5030 2113
7143
907
29
61
69
137
0
137
0
Subtotal
17 Districts Huruwaa
Subtotal
Bossaso Carmo
- 20
- 0
- 0
- 0
116
0
116
0
2372 1803
4175
44
0
2718 2849
5567
3293
35
798
21
819
73
1
123
0
123
3
169
0
169
0
128
0
128
0
128
2
130
1
Banadir
Bari
- 0
- 0
- 0
- 0
- 0
- 0
Iskushuban Ufeyn
08
12
00
01
41
00
00
00
00
00
00
00
00
1393 1347
Subtotal
Badale
52
0
3331
0
74
0
33
0
941
0
3
0
0
0
41
0
0
0
0
0
0
0
283
8
1
0
32711
1033
Bay
- Baidoa
- 329
000
188
0
235
000
55
0
2070
0
266
20
2
105
0
59
0
727
0
12
0
35
90007
14
080
19
00000000
188
0
20000000
00000000
00000000
896 130
8
38
0
00000000
95536
6196 3187 6762 2051 2718
11550
3967
Berdale Bur hakaba Qansahdere Bandarbayla Hafun Qardho Rakko Waciya
0100
0000
- 0
- 64
- 0
542
000
000
80 43
4
263 266
4
253
13
- 4
- 0
- 0
- 0
- 0
- 0
- 4064
- Subtotal
- 517
- 290
- 2485
- 164
- 1371
- 38
- 19
- 459
- 2
- 0
- 0
- 1091
- 0
- 137064
Page 7 of 13
- Region
- District
Abudwak
- SARI
- ILI
- AWD
- BD
- OAD
629
- Diph
- WC
- Meas
106
- NNT
- AJS
- VHF
- Mal
752
- Men
- Total
consultations
Galgadud
- 28
- 10
172
20 30 31
- 0
- 0
15
0000
15
1000000
1
5
10
003
18
4172
14
0
700030
10
0000000
0
00000
0
000200
2
0
44
9005
58
000000
13
13
40 23
000
63
3076
15
0
31
000000
0
0000000
0
00000
0
000000
0
020000
2
0000000
0
00000
0
000000
0
000000
0
0000000
0
00000
0
000000
0
260
16 15
0
39
0000000
0
30000
17726
- Adado
- 137
21
115
14
0
315
18
3
124
0
502 220 328 621
17
74
0
18 29
0
227
10
1
1468
0
1193
778
0
4191
74
2
49
5
32
6
55
223
592
14
0
30354
5298
27961 21890
5247
108476
5223
499
Balanbale Dhuusamarreeb El Dere Gelinsor
Subtotal
B/hawo Burdhubo Doolow
10
- 0
- 0
263
263
28
268
19
125
0
2317
78
Gedo
000000
0
7
67
9
34 10 71
10
0402
1000
4096
469
3742
821
Elbon Garbahaarey Gedweyne Luuq
176
63
243
1060
2000
392 135
60
112
2699
0
- 1
- 4274
19124
87971 26111
8260 3962 8034
134338
3862
58
- Subtotal
- 37
3079 1731
973
52
257
6092
2
276
5531 2459 1363
41
209
9603
79
3
60 81
388
2
13