Epidemiological Week 27 (Week ending 8th July, 2018)

Highlights Cumulative figures as of week 27 • A total of 224 health facilities submitted weekly • 1,522,140 consultations from week 1 reports of epidemic-prone diseases in week 27. to week 27. • Total number of consultations decreased from 55,343 • 5,733 cumulative cases of in week 26 to 51,625 in week 27. AWD/Cholera and 40 deaths since • A total of 257 alerts were received. 33 of these alerts were confirmed as true alerts in week 27. December 2017. • The highest numbers of diseases reported in week 27 • 8,573 total alerts were received, 464 were other acute diarrhoeas (2,486 cases), influenza of these, were confirmed as true like illness (1,342 cases) and severe acute respiratory alerts from week 1 to week 27, 2018. illness (1,173 cases). • 6,149 cumulative cases of suspected • A total of 151 new cases of suspected AWD/cholera measles cases since Jan 2018. Of the with no death were reported in week 27 compared to 344 AWD cases including 1 death in week 26. 4,068 (66%) are under 5 years while 2,081 (34%) are above 5 years. • A cumulative total of 5,733 AWD/cholera cases1, including 40 deaths have been reported since • 7,193 cumulative cases of Malaria December 2017. were reported since Jan 2018, 3,119 • The number of reported measles cases slightly (43%) are under 5 years, while increased from 58 in week 26 to 61 cases in week 27. 4,074(57%) are above 5 years.

Table 1. Summary of Alerts for epidemic prone diseases Disease Wk24 Wk25 Wk26 Wk27 Cumulative cases (Wk 1 – 27, 2018 2018 2018 2018 2018) Total consultations 44,883 55256 55343 51625 1,522,140 Other Acute Diarrheas 2,411 2556 2599 2486 63995 Influenza Like Illness 1,298 1678 1195 1342 45,828 Severe Acute Respiratory 26,687 1,059 1279 1212 1173 Illness Suspected Measles 72 92 58 61 6149 Confirmed Malaria 337 476 226 189 7193 Acute Watery Diarrhoea 55 58 76 13 1999 Bloody Diarrhea 180 131 107 62 2298 Whooping Cough 45 34 58 45 1284 Acute Jaundice 2 5 16 7 117 Suspected Meningitis 1 0 3 3 79 Diphtheria 0 0 2 0 45 Neonatal Tetanus 1 2 0 0 23

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

Acute Flaccid Paralysis 2 0 0 0 13 Viral Hemorrhagic Fever 1 0 0 1 5

Completeness of Reporting & Reporting Rate Overall, a total of 224 (62%) health facilities submitted their weekly reports on time of the 364 active health facilities in . In Somaliland, 76 (100%) health facilities (HFs) of the 76 active health facilities submitted reports in week 27. As shown in Table 5, in Puntland, 45(64%) health facilities of the 70 active Health facilities submitted reports in week 27, while no reports were received from Sool region (4HFs) of Puntland. As shown in Table5 and Fig1 below, In South central, 103(47%) health facilities of 218 active health facilities submitted reports in week 27, while no report were received from Bay region for the last two weeks. Fig1: Completness of reporting

Somaliland Puntland SCZ

100

80

60

40

20

Percentage of the HFs submitted report report submitted HFs the of Percentage 0 24 25 26 27 Epi-week

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 27, the highest numbers of diseases were other acute diarrhoeas (2,486 cases), influenza like illness (1,342 cases), severe acute respiratory illness (1,173 cases), Suspected measles (61 cases) and Confirmed Malaria (189 cases).

Fig2: Commonest Causes of Morbidity during Week 1 to 27

3,000

2,000

1,000

0 Wk24 Wk25 Wk26 Wk27

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

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AWD/Cholera situation in Somalia

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, Kismayo, Afgoye Merka and Banadir. The cholera spread is expected to increase due to the floods that have Fig3: District reporting cases in week 27 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 decrease in the number of AWD/Cholera cases reported in , Banadir and Lower Jubba; the regions that are affected by floods. In week ending 8th July, active transmission of AWD/cholera was reported in in Lower Jubba, Afgoye Kurtunwarey, Brava and Merka in Lower Shabelle as well as in 14 districts of Banadir region (Darkenly, Daynile, Hodan, Madina, Waberi, HamarWeine, Hamarjabjab, Wardhigley, Shibis,Yaqshid, Abdiaziz, Kaaran, Huruwa, 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 a decrease in the number of cases reported from 344 in week 26 to 151 in week 27. 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).

Fig4: AWD cholera trends in Somalia 2017/18 2000 Cases Deaths CFR (%) 4.0 1800 3.5 1600 1400 3.0 1200 2.5 1000 2.0

Cases 800 1.5 600 400 1.0 200 0.5 0 0.0 Case Fatality Rate(%) 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

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

States Week 26 Week 27 Cumulative as of 8th July 2018 Regions Ending 1st July 18 Ending 8th July 18

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

Banadir 124 1 0.8 75 0.0 0.0 2246 18 0.8

Jubba land L/ Jubba 97 0 0.0 59 0.0 0.0 2101 15 0.7

South west L/ Shabelle 18 0 0.0 5 0.0 0.0 289 4 1.4

Hir- M/Shabelle 105 0 0.0 12 0.0 0.0 532 2 0.4 shabele Hiraan 0 0 0.0 0 0 0.0 565 1 0.2

Total 344 1 0.3 151 0.0 0.0 5733 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 Mogadishu 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, 14 have so far reported cases which have been managed in Banadir CTC located in the capital Mogadishu. There has been decrease in the number of AWD/Cholera cases from 124 cases including 1 death to 75 cases with no death in the past 2 weeks. More than 52% of the AWD cases reported in Banadir are children below 5 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 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 97 cases with no deaths to 59 cases with no death. More than 51% 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 27-2018, as a result of displacement of people due to floods that have been reported in this regions. Brave is the most affected district and cases are being managed in lower Shabelle. More than 60% of the cases reported in Brave are children below 2years. • In Middle shabelle, it has been reported a new outbreak of AWD/Cholera in the same villages that were affected before. During week 27, a total of 12 cases with no deaths were reported of which 58% of them are children below 2 years old. The affected villages include Hantiwadag, Bulo Seikh and Horseed.

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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 27 Cumulative Week 49/17-week 27/18 STATE Region District Cases Deaths ≥ 5 CFR <2 yrs 2 -4 yrs ≥ 5 yrs <2 yrs 2-4yrs Cases Deaths yrs (%) Darkenley 5 5 9 0 0 0 370 1 0.3 Daynile 6 0 6 0 0 0 394 7 1.8

HamarJabja 0 1 1 0 0 0 144 2 1.4

Hawlwadag 1 0 2 0 0 0 106 1 0.9

Hodan 6 1 6 0 0 0 477 1 0.2 Karaan 0 0 1 0 0 0 40 1 2.5 Madina 5 1 6 0 0 0 374 2 0.5 Banadir Banadir Waberi 0 2 2 0 0 0 106 2 1.9 Shibis 1 0 0 0 0 0 11 0 0 Shingani 0 0 0 0 0 0 7 0 0 Abdilaziz 0 1 0 3 0 0

HamarWeine 1 0 1 0 0 0 45 0 0

Heliwaa 1 0 0 0 0 0 22 0 0 Wardigley 1 0 1 0 0 0 94 1 1.1 Yaqshid 1 0 1 0 0 0 53 0 0 Middle Jowhar 6 1 5 0 0 0 532 2 0.4 Shabelle×

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

Afgoye 0 1 1 0 0 0 153 0 0 Lower Kurtunwarey 0 0 0 0 0 0 31 4 12.9 South west Shabelle× Merka 0 0 1 0 0 0 91 0 0 Brava 0 2 0 0 0 0 14 0 0 Lower JUBBLAND Kismayo 30 12 17 0 0 0 2,101 15 0.7 Jubba× Grand Total 64 27 60 0 0 0 5,733 40 0.7 × regions currently affected by floods. Cases include deaths.

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Response activities implemented during week 27, 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 increased Week 21 from 58 cases in week 26, to 61 cases in week 27. Cumulatively, 6,149 cases of suspected measles have been reported across Somalia since the beginning of 2018. Of the 6,149 measles cases, 4,068 (66%) are under 5 years while 2,081 (34%) are above 5 years. The most affected districts include; Abudwak (709 cases), Huruwa (470 cases), Lascanod (350 cases), (337 cases), Adado (293 cases), Galkacyo (269 cases), Wadajir (244 cases), Burao (206 cases) and Marka (191 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 27, 2018

South & Central Zone Somaliland Puntland

500 450

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

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 27 Epi-Week

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Fig 7. Measles cases per district Across Somalia from Wk1 - Wk27, 2018 450 400 350 300 250 200 150 100 50 0 Huruwaa Wadajir Abudwak Adado Galkacyo Burao Lasacanod Baidoa Marka Banadir Galmudug Somaliland Southwest

Cases >5 Cases<5

Table 4: Summary of Suspected measles cases by region week 1 - 27, 2018

Cumulative cases Region Wk24 2018 Wk25 2018 Wk26 2018 Wk27 2018 (Wk 1 – 27)

Awdal 0 0 0 0 12 1 1 2 2 123 Banadir 0 4 0 7 894 Bari 0 - 0 0 92 Bay 15 22 - - 959 Galgaduud 0 0 3 0 1089 Gedo 4 21 1 0 65 Hiraan 10 6 9 14 176 5 18 18 18 302 Lower Shabelle 5 4 3 2 322 4 5 10 9 156 Middle Shabelle 2 2 1 0 153 10 4 3 7 620 Nugaal 0 - - 0 183 Sanaag 0 0 0 0 159 Sool 0 1 1 0 368 Togdher 11 1 5 2 229 Waqoyi Galbed 5 3 2 0 247 Grand Total 72 92 58 61 6149 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 226 cases in week 26 to 189 cases in week 27. Cumulatively, 7,193 cases of Malaria cases have been reported across Somalia since the beginning of 2018. Of the 7,193 malaria cases, 3,119 (43%) are under 5 years while 4,074 (57%) are above 5 years. The most affected districts include; of Bay (1,290 cases), in Banadir (678 cases), Marka district of Lower Shabelle (540 cases), of Bakol (409 cases), Berdale district of Bay(399 cases) of Galgadud (392 cases), Bal’ad district of Middle Shabelle (309 cases) and district of Bakol (270 Cases) .

Fig8: Malaria Situation in Somalia from Week 1 to Week 27, 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 27 Epi-week

SC Zone Somaliland Puntland

Fig 9: Malaria Cases Per District Across Somalia from Wk1-27, 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 26 were 2,599 compared to 2,486 cases in week 27. Cumulatively, 63,995 cases of OAD cases have been reported across Somalia since the beginning of 2018. Of the 63,995 OAD cases, 48,375 (76%) are under 5 years while 15,620 (24%) are above 5 years. The most affected districts include; Marka District of Lower Shabelle (4,291 cases), Beletweyn district of hiran (4,069 cases), Huruwa district of Banadir (3,320 cases), Wadajir district of Banadir (2,305 cases), Dharkinley of Banadir(2,006 cases) and Jowhar of Middle Shabelle (1,953 Cases).

Fig10: Trends of Other Acute Diarrhoea cases in Somalia from Week1-27, 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 27 Epi-week

SC Somaliland Puntland

Fig 11: OAD Cases Per District Across Somalia from Wk1-27, 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 26 were 107 compared to 62 cases in week 27. Cumulatively, 2,298 cases of BD cases have been reported across Somalia since the beginning of 2018. Of the 2,298 BD cases, 1,209 (53%) are under 5 years while 1,089 (47%) are above 5 years. The most affected districts include Baidoa of Bay (387 cases), Burhakaba of Bay (261 cases), Hargeisa of Waqoy Galbeed (155 cases), and Buhodle of Togdheer (142 cases).

Fig12: Trends of Bloody Diarrhea cases in Somalia from Week1-27, 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 27 Epi-week

SC Somaliland Puntland

Fig 13: Bloody Diarrhea Cases Per District Across Somalia from Wk1-27, 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 26 were 58 compared to 45 cases in week 27. Cumulatively, 1,284 cases of WC cases have been reported across Somalia since the beginning of 2018. Of the 1,284 WC cases, 974 (76%) are under 5 years while 310 (24%) are above 5 years. The most affected districts include Galkacyo (298 cases), Jilib (159 cases), Berbera (94 cases),Erigavo (72 cases), Buale (69 cases) and Adaado (69 Cases) .

Fig14: Trends of Whooping Cough in Somalia from Week1-27, 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 27 Epi-week

SC Somaliland Puntland

Fig15: Most affected districts of Whouping Cough in Somalia from Wk1-27, 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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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 26 were 1,212 compared to 1,173 cases in week 27. Cumulatively, 26,687 cases of SARI cases have been reported across Somalia since the beginning of 2018. Of the 26,687 SARI cases, 16,062(60%) are under 5 years while 10,625 (40%) are above 5 years. The most affected districts include Beletweyne (4,404 cases), Buloburte (2,283 cases), Abudwak (1,591 cases), Yaqshid (1,477 Cases), Wadajir (1,464 cases), and Huruwa (1,457 cases).

Fig16: Trends of SARI cases in Somalia from Week1-27, 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 27 Epi-week

SC Somaliland Puntland

Fig17: Most SARI affected districts across Somalia from Wk1-27, 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 26 were 1,195 compared to 1,342 cases in week 27. Cumulatively, 45,828 cases of ILI cases have been reported across Somalia since the beginning of 2018. Of the 45,828 ILI cases, 27,194 (59%) are under 5 years while 18,634 (41%) are above 5 years. The most affected districts include Borama (5,133 cases), Huruwa (3,345 cases), Beletweyne (3,241 cases), Lascanod (3,175 cases), Berbera (2,765 cases) Wadajir (1,595 cases) and Dharkenley (1,159 cases).

Fig18: Trends of ILI cases in Somalia from Week1-27, 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 27 Epi-week

SC Somaliland Puntland

Fig19: Most ILI affected districts across Somalia from Wk1-27, 2018 3500 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 27, 2018

Completeness of reporting State Region District # of active HFs to submit report # of HFs submitted report in week27 (%) Abdiaziz 1 1 100 Boondhere 1 0 0 Dayniile 4 0 0 Dharkinley 4 2 50 Hamar Jab Jab 2 2 100 Hamar Weyne 1 0 0 Hodan 2 1 50 Howl-wadaag 3 1 33 Banadir Banadir Huruwaa 3 2 67 Kaaraan 1 0 0 Kahda 4 2 50 Shangani 1 1 100 Shibis 1 0 0 Waberi 1 1 100 Wadajir 9 3 33 Wardhigley 4 3 75 Yaqshid 4 3 75 Subtotal of Banadir 46 22 48 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 2 2 100 Bossaso 8 3 38 Carmo 1 0 0 2 1 50 Bari Iskushuban 1 0 0 Qardho 2 1 50 Rakko 2 0 0 Ufeyn 1 0 0 Waciya 2 1 50 Galdogob 9 6 67 Mudug Galkacyo 16 12 75 Puntland Jariiban 4 4 100 Burtinle 2 2 100 Dangorayo 1 1 100 Nugal Eyl 4 4 100 Garoowe 5 4 80 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 70 45 64 Abudwak 4 2 50 Adado 3 3 100 Balanbale 1 1 100 Galmudug Galgadud Dhuusamarreeb 3 2 67 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 11 92 Harardhere 4 4 100 Subtotal of Galmudug 36 31 86 Belet Weyne 10 8 80 Bulo Burto 4 3 75 Hiraan Jalalaqsi 1 1 100 Matabaan 4 1 25 Maxaas 1 1 100 Hirshabelle Adale 1 0 0 Bal'ad 12 0 0 Middle Jowhar 6 1 17 Shabelle Mahaday 3 0 0 Warsheikh 5 0 0 Subtotal of Hirshabelle 47 15 32 B/hawo 2 1 50 Baardhere 1 0 0 Doolow 2 0 0 Gedo Garbahaarey 2 0 0 Gedweyne 1 0 0 Luuq 3 0 0 Jubaland Afmadow 2 1 50 Lower Hagar 2 2 100 Juba Jamaame 2 1 50 Kismayo 11 7 64 Bu,aale 2 1 50 Middle Jilib 3 2 67 Juba Salagle 1 1 100 Subtotal of Jubaland 34 16 47 Afgoi 5 2 40 South Lower Kurtunwarey 3 2 67 West Shabelle Marka 12 7 58 Qoryooley 2 1 50

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Wanla Weyn 2 1 50 Elberde 3 3 100 Huddur 2 1 50 Bakool Tayeeglow 1 0 0 Waajid 3 2 67 Baidoa 13 0 0 Berdale 3 0 0 Bay Burhakaba 3 0 0 Qansahdere 2 0 0 Subtotal of Southwest 55 19 35 Grand Total 364 224 62

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Table 6. Cumulative Summary of Epidemic-prone Diseases in different Districts of Somalia as of Week 1-27, 2018

Regions District SARI ILI AWD BD OAD DIPH WC MEAS NNT AFP AJS VHF MAL MENG OC Total_cons Total 0 8315 11 132 3928 0 0 12 0 0 0 0 40 2 33082 45551 Baki 0 1074 0 63 281 0 0 0 0 0 0 0 0 0 3027 4445 Awdal Borama 0 5133 11 66 2713 0 0 8 0 0 0 0 28 0 21623 29610 Lughaya 0 187 0 2 226 0 0 0 0 0 0 0 0 0 1716 2131 Zeila 0 1921 0 1 708 0 0 4 0 0 0 0 12 2 6716 9365 Total 195 112 0 91 540 0 16 123 0 0 1 0 764 2 61719 63563 Elberde 0 33 0 0 137 0 0 0 0 0 0 0 0 0 9677 9847 Bakool Huddur 34 5 0 13 96 0 0 1 0 0 0 0 270 0 8813 9232 Tayeeglow 33 29 0 3 44 0 0 6 0 0 1 0 85 2 1559 1762 Waajid 128 45 0 75 263 0 16 116 0 0 0 0 409 0 41670 42722 Total 5558 8286 906 62 13354 0 9 894 0 1 0 0 722 12 351504 381308 Abdiaziz 0 93 0 0 115 0 0 0 0 0 0 0 0 0 8424 8632 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 1159 0 0 2006 0 0 56 0 0 0 0 0 0 20822 24616 Hamar Jab Jab 222 624 0 2 585 0 1 8 0 0 0 0 1 0 13985 15428 Hamar Weyne 94 435 0 0 1067 0 0 10 0 0 0 0 0 0 11185 12791 Hodan 3 22 5 0 84 0 0 0 0 0 0 0 6 0 9532 9652 Howl-wadaag 0 0 0 0 0 0 0 6 0 0 0 0 1 0 36513 36520 Banadir Huruwaa 1457 3345 15 6 3320 0 0 470 0 1 0 0 3 12 34644 43273 Kaaraan 10 69 0 0 47 0 0 1 0 0 0 0 0 0 17534 17661 Kahda 61 529 0 0 316 0 0 1 0 0 0 0 6 0 2487 3400 Shangani 149 145 0 0 137 0 0 0 0 0 0 0 0 0 438 869 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 19172 19205 Wadajir 1464 1595 868 5 2305 0 2 244 0 0 0 0 687 0 83306 90476 Wardhigley 18 1 0 30 1425 0 6 34 0 0 0 0 15 0 44114 45643 Yaqshid 1477 89 0 19 797 0 0 22 0 0 0 0 0 0 22041 24445 Total 107 1020 5 10 645 0 0 92 0 0 0 0 338 0 44933 55621 Bari Banderbayla 61 153 1 0 30 0 0 1 0 0 0 0 0 0 993 1239 Page 19 of 22

Bossaso 46 847 3 0 345 0 0 28 0 0 0 0 331 0 24667 34716 Carmo 0 6 0 0 4 0 0 0 0 0 0 0 2 0 634 668 Hafun 0 0 0 0 45 0 0 0 0 0 0 0 0 0 2161 2206 Iskushuban 0 7 0 1 5 0 0 0 0 0 0 0 0 0 614 627 Qardho 0 0 0 9 151 0 0 45 0 0 0 0 4 0 9216 9425 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 3399 3403 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 Bay 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 Total 4659 1971 191 5 1214 0 198 1450 1 0 3 0 1131 9 64018 74920 Abudwak 1591 564 0 0 325 0 32 709 1 0 0 0 233 4 14543 18002 Adado 995 547 3 1 304 0 69 293 0 0 3 0 392 2 11523 14202 Balanbale 400 229 0 1 53 0 17 129 0 0 0 0 85 0 3058 3972 Galgadud Dhuusamarreeb 856 324 10 2 212 0 21 157 0 0 0 0 174 0 19285 21041 El Bur 24 6 178 0 38 0 0 34 0 0 0 0 17 0 533 830 El Dere 576 206 0 1 217 0 22 64 0 0 0 0 131 3 12008 13228 Gelinsor 217 95 0 0 65 0 37 64 0 0 0 0 99 0 3068 3645 Total 280 1262 52 82 389 0 0 65 0 0 0 0 279 0 20893 23302 B/hawo 54 256 35 2 52 0 0 19 0 0 0 0 83 0 7254 7755 Baardheere 0 0 0 35 3 0 0 0 0 0 0 0 4 0 0 42 Gedo 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 Total 7900 4336 294 6 6647 0 58 176 0 0 0 0 162 2 69526 89147 Belet Weyne 4404 3241 288 0 4069 0 7 131 0 0 0 0 160 1 39194 51535 Bulo Burto 2283 544 6 6 1656 0 2 29 0 0 0 0 2 1 15418 19947 Hiraan Jalalaqsi 1039 129 0 0 713 0 0 2 0 0 0 0 0 0 2350 4233 Matabaan 109 313 0 0 152 0 0 0 0 0 0 0 0 0 6890 7464 Maxaas 65 109 0 0 57 0 49 14 0 0 0 0 0 0 5674 5968 Total 1781 15 52 191 2205 3 20 302 0 0 0 0 193 0 64866 69628

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Afmadow 678 0 28 80 409 0 0 0 0 0 0 0 4 0 8296 9495 Lower Hagar 124 5 0 13 176 2 3 47 0 0 0 0 0 0 3248 3618 Juba Jamaame 102 0 6 8 137 0 0 48 0 0 0 0 108 0 6910 7319 Kismayo 877 10 18 90 1483 1 17 207 0 0 0 0 81 0 46412 49196 Total 825 717 281 11 7784 4 16 322 0 0 0 0 802 2 123543 134307 Afgoi 126 96 25 2 295 0 0 42 0 0 0 0 128 0 23133 23847 Lower Kurtunwarey 42 3 41 0 1452 0 0 34 0 0 0 0 45 0 13905 15522 Shabelle Marka 253 3 171 6 4291 4 16 191 0 0 0 0 540 2 72530 78007 Qoryooley 71 0 44 0 934 0 0 49 0 0 0 0 65 0 12275 13438 Wanla Weyn 333 615 0 3 812 0 0 6 0 0 0 0 24 0 1700 3493 Total 167 0 1 85 574 5 282 163 0 0 0 0 182 0 10756 12215 Middle Bu,aale 34 0 0 21 132 0 69 37 0 0 0 0 0 0 2098 2391 Juba Jilib 87 0 1 41 344 5 159 96 0 0 0 0 182 0 6789 7704 Salagle 46 0 0 23 98 0 54 30 0 0 0 0 0 0 1869 2120 Total 559 308 106 104 3206 0 1 146 0 0 0 0 456 0 95310 100257 Adale 0 0 0 0 0 0 0 0 0 0 0 0 3 0 6340 6343 Middle Bal'ad 502 279 19 30 830 0 1 111 0 0 0 0 309 0 39417 41498 Shabelle Jowhar 45 0 82 62 1953 0 0 35 0 0 0 0 101 0 26117 28456 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 Total 686 43 14 47 4529 6 323 620 21 9 38 2 22 23 152529 158912 Galdogob 92 2 1 5 385 0 0 14 0 0 1 0 0 0 16847 17347 Galkacyo 395 5 13 36 2910 4 302 468 3 9 5 1 13 23 106511 110698 Mudug Harardere 31 36 0 1 175 0 12 29 0 0 0 0 4 0 3984 4272 Hobyo 160 0 0 0 969 2 8 99 18 0 31 1 5 0 11055 12348 Jariiban 8 0 0 5 90 0 1 10 0 0 1 0 0 0 14132 14247 Total 77 866 6 0 515 1 6 183 0 0 0 0 0 0 13784 15438 Burtinle 1 175 0 0 127 0 0 29 0 0 0 0 0 0 2695 3027 Nugaal Dangorayo 1 33 0 0 40 1 0 0 0 0 0 0 0 0 1573 1648 Eyl 13 236 0 0 107 0 0 44 0 0 0 0 0 0 4032 4432 Garoowe 62 422 6 0 241 0 6 110 0 0 0 0 0 0 5484 6331 Total 1511 740 18 59 1321 1 76 159 0 0 0 0 34 1 30318 34372 Badhan 561 194 10 0 438 0 1 136 0 0 0 0 29 0 7377 8753 Sanag Dhahar 453 1 2 57 226 0 3 3 0 0 0 0 3 0 4214 4962 Eil-afweine 394 245 5 2 420 1 0 12 0 0 0 0 0 0 9456 10579

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Erigavo 103 300 1 0 237 0 72 8 0 0 0 0 2 1 9271 10078 Total 38 4213 0 6 3385 0 35 368 0 0 0 0 46 0 37107 45198 Bocame 0 0 0 0 5 0 0 2 0 0 0 0 0 0 222 229 Sool Hudun 0 702 0 0 430 0 1 14 0 0 0 0 0 0 3529 4676 Lasacanod 38 3175 0 6 2775 0 34 350 0 0 0 0 46 0 30777 37201 Taleex 0 336 0 0 175 0 0 2 0 0 0 0 0 0 2579 3092 Total 254 2083 0 331 3596 0 39 222 0 0 6 0 2 13 31645 38203 Ainabo 1 85 0 53 178 0 0 3 0 0 0 0 0 0 2060 2380 Togdheer Buhodle 23 140 0 142 280 0 0 13 0 0 0 0 0 0 4427 5025 Burao 204 1614 0 104 2847 0 39 206 0 0 6 0 2 13 21574 26621 Odwayne 26 244 0 32 291 0 0 0 0 0 0 0 0 0 3584 4177 Total 1170 8307 0 308 8159 0 160 254 0 1 70 1 156 13 60267 78866 Ballayabane 180 249 0 45 277 0 24 9 0 0 29 0 0 1 2720 3534 Waqoy Berbera 306 2765 0 2 2361 0 94 106 0 1 41 1 5 1 16550 22233 Galbed Gabiley 234 2489 0 106 2056 0 6 21 0 0 0 0 37 0 6928 11877 Hargeisa 276 2047 0 155 2707 0 33 100 0 0 0 0 109 11 28987 34425 Sheikh 174 757 0 0 758 0 3 18 0 0 0 0 5 0 5082 6797 Grand Total 26,687 45,828 1,999 2,298 63,995 45 1284 6,149 23 11 119 3 7,193 79 1,357,524 1,522,140

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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