Regional Humanitarian Health Update Eastern and Southern Africa (ESA) November 2009

Key Highlights 4842 cases and 131 deaths (CFR 2.7%) of cholera were recorded in 14 districts of Kenya in the last 1 month Zero cases of cholera reported in Zimbabwe in the last 2 weeks (epidemiological weeks 48 and 49)

1. Influenza A (H1N1) As of 7th December 2009, a cumulative of 15,193 cases and 106 deaths of H1N1 have been reported in the Eastern and Southern African sub‐region. Lesotho, Madagascar, South Africa, Uganda and Zambia reported 107 new cases and 1 death in epidemiological week 49 which ended on 6th December. In addition to the seven countries which have accredited laboratories for H1N1 diagnosis, Zimbabwe has completed all the necessary processes required for accreditation is currently awaiting final approval from WHO.

Table 1: Reported Cases and Deaths of Influenza A (H1N1) in Eastern and Southern Africa

Country Cumulative Newly Confirmed (30th Nov – 6th Dec) Cases Deaths Cases Deaths Botswana 23 0 0 0 Ethiopia 6 0 0 0 Kenya 417 0 0 0 Lesotho 65 0 11 0 Madagascar 827 3 61 1 Malawi 4 0 0 0 Mauritius* 69 8 0 0 Mozambique 101 2 0 0 Namibia 72 1 0 0 Seychelles 33 0 0 0 South Africa* 12631 91 5 0 Swaziland 2 0 0 0 Tanzania 561 1 0 0 Uganda* 251 0 24 0 Zambia 90 0 6 0 Zimbabwe 41 0 0 0 Total 15,193 106 107 1 * Due to high case loads, only laboratory confirmed cases are reported in these countries

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Dr. O. Walker, IST/ESA Coordinator, Harare Zimbabwe. Email: [email protected]; Cell no: +263 912433127 Dr. O. Olu, IST/ESA Emergency Focal Point, Harare Zimbabwe. Email: [email protected]; Cell no: +263 912104248 2. Cholera/Acute Watery Diarrhoea Acute Watery Diarrhoea (AWD) and cholera remain major health problems in the sub‐region with Kenya reporting an upsurge in the number of cholera cases during the month while Zimbabwe recorded a decreasing cholera trend in the last 2 epidemiological weeks (48 and 49). In Mozambique the cholera epidemic is currently limited to only one province with the epidemic curve showing a stabilized trend.

2.1 Zimbabwe So far 146 cholera cases and 5 deaths have been reported in Zimbabwe from the onset of the current outbreak in September 2009 to date. A breakdown of these cases and deaths by geographic areas shows that 5 provinces and 9 districts have been affected so far. Manicaland and Midlands Provinces have reported the highest number of cases of 58 each (39.7% each) followed by Mashonaland West with 22 cases (15.7%) and Harare with 6 cases (4.1%) (refer to table 2 below). No new cases have been reported in the country in the last 2 epidemiological weeks (48 and

49). The Cholera Command and Control Centre (C4), MOHCW and all partners are on high alert and ready to respond to any upsurge in cases.

Table 2: Distribution of Cholera Cases by Province and District in Zimbabwe

Province District Cumulative Cumulative Cases deaths Harare Harare 6 0 Mashonaland Central Rushinga 1 0 Bindura 1 0 Mashonaland West Kadoma 3 0 Chegutu 2 2 Makonde 17 1 Manicaland Chipinge 58 0

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2.2 Mozambique In Mozambique a cumulative of 19,522 cases and 155 deaths (CFR 0.8%) of cholera were reported between 1st January and 28th November 2009. It is important to note that the epidemic is currently restricted to only 3 districts (Montepuez, Mocimba da Praia and Ancuabe) of Cabo Delgado Province where 607 cases and 7 deaths (CFR 1.2%) have been reported in the last 12 weeks. The Figure 2: Weekly Cases of Cholera in Mozambique 2008 and epidemic curve of the outbreak 2009 (see figure 2) shows a stabilizing trend of the outbreak. Mozambique Cholera Incidence Week 47 2008 VS 2009 2.3 Kenya According to an update released by 2000 the Ministry of Public Health and 1500 Sanitation (MOPHS) of Kenya on 1000 4th December 2009, 4,842 cases 500 and 131 deaths of cholera (CFR 0 2.7%) have been reported in 14 districts of the country in the last Wk 1 Wk WK 3 WK 5 WK 7 WK 9 WK WK 11 WK 13 WK 15 WK 17 WK 19 WK 21 WK 23 WK 25 WK 27 WK 29 WK 31 WK 33 WK 35 WK 37 WK 39 WK 41 WK 43 WK 45 WK 47 WK one month. Efforts to obtain the 2009 Cases 2008 Cases detailed breakdown of the cases by week was not successful as at the time of filing this report but the break down by district and province is shown in table 3 below.

Table 3: Breakdown of Cholera Cases and Death in Kenya: September – December 2009

Province District AWD Lab Deaths Onset of Date last Cases Confirme current case was d outbreak reported Cholera

Nairobi Kasarani 105 28 10 23/9/09 24/11/09 Nairobi East 84 25 12 7/10/09 1/12/09 Starehe 42 12 0 24/10/09 1/12/09 Kamukunji 18 9 0 25/10/09 30/11/09

For Further Information please contact:

Dr. O. Walker, IST/ESA Coordinator, Harare Zimbabwe. Email: [email protected]; Cell no: +263 912433127 Dr. O. Olu, IST/ESA Emergency Focal Point, Harare Zimbabwe. Email: [email protected]; Cell no: +263 912104248 Eastern Laisamis 254 1 5 27/09/09 15/11/09 Kitui North 289 1 2 19/9/09 21/11/09 Chalbi 388 5 11 5/11/09 25/11/09 Rift Turkana 390 12 6 20/9/09 4/12/09 Valley North Turkana 1484 10 16 21/9/09 4/12/09 South Turkana 1255 32 34 08/8/09 2/12/09 Central Coast Lamu 255 8 6 19/9/09 3/12/09 Msambweni 80 2 0 16/10/09 2/12/09 Central Ruiru 47 4 5 10/11/09 4/12/09 RVP East Pokot 151 12 24 20/11/09 3/1209 Total 4842 161 131

2.4 Ethiopia (AWD) Increased numbers of AWD cases were reported in Southern Nations and Afar Regions of the country from week 47 to 48; however no official data to this effect have been provided by the Federal Ministry of Health (FMOH). Critical gaps in the response efforts include drugs for case management, water containers to support household level water treatment and funds for operation cost.

3. Upcoming Events Event Date Venue Contact

1st Regional 13th – 19th Harare, Dr. Custodia Mandlhate, WHO Conference on December, 2009 Zimbabwe Representative, Zimbabwe Immunization in (email: [email protected] Africa SPRINTRH Originally planned New dates and Ms. Jennifer Miquel (email: Coordination in for November venue to be [email protected]) Crisis Training 2009 but now announced postponed to 2010

4. Acknowledgments The production of this monthly update has been made possible by contributions from the health cluster and partners from Zimbabwe, Mozambique, Ethiopia and Kenya and the WHO Regional Office for Africa (AFRO)

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