EWARN: Early Warning Alert and Response Network : EWARN & Diseases Surveillance Bulletin

2018: Epidemiological Week: 04 Reporting Period: 22 January – 28 January 2018

Highlights

Number of reporting sites in week 04: One hundred and eighteen (116) submitted their weekly reports complete and in timely manner.

Total number of consultations in week 04: 40,678 marking an decrease of 2,570 to last week consultation of 43,248. The number of consultations for other disease this was week was 33,437.

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Leading causes of morbidity in week 04: Acute Upper Respiratory Infections (AURI) (n=4649; 11.54% of consultations number), Acute Lower Respiratory Infections (ALRI) (n=1282; 3.15%) and acute diarrhea (AD) (n=1048; 2.58%) remained the leading causes of morbidity this reporting week.

Number of alerts in week 04: Sixteen (16) alert were generated through EWARN. (details: see Alerts and Outbreaks Section). The health authorities of each municipality have the capacity to respond to outbreaks. The alerts were discussed with the focal person and respected surveillance officers of the municipalities. (Details: see Alert and Outbreak Section).

NOTE: In all the figures below that represent trends, numbers from week 4 in 2018 were compared to three different averages from 2017 representing the following:

 The average value for epidemiological weeks 01 – 52 in 2017, representing the entirety of 2017.  The average value for epidemiological weeks 39 – 52 in 2017, representing the period of reporting that followed the first EWARN training workshop in September of 2017.  The average value for epidemiological weeks 49 – 52 in 2017, representing the period of reporting that followed the second EWARN training workshop in December of 2017.

No of reporting sites in Libya comparing averages of weeks, week 1 - 52 2017, weeks 39 -52 2017, weeks 49 - 52 2017 and week 01 - 04 2018 140

120

100

80

60 119 121 118 104 40 86

20 40

0 Weeks 1 - 52 Weeks 39 - 52 Weeks 49 - 52 Week 01 2018 Week 02 2018 Week 03 2018 Week 04 2018 2017 2017 2017

Figure 1. Distribution of reporting health facilities

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Morbidity Patterns:

During week 04, the proportions of AURI , ALRI and AD decreased in comparison with the previous week as it can be seen in figure 2.

Comparing average cases of AURI, ALRI and AD of all of 2017, beyond 1st EWARN workshop, beyond 2nd EWARN workshop and week 01 - 04 2018 6000

5000

4000

3000

2000

1000

0 Weeks 1 - 52 Weeks 39 - 52 Weeks 49 - 52 Week 01 2018 Week 02 2018 Week 03 2018 Week 04 2018 2017 2017 2017

AURI ALRI AD

Figure 2. Distribution of AURI, AD and ALRI in week 1 – 52 2017 and 04 2018 2018 Epidemiological week 04:

Below is the distribution of the leading causes of morbidity by municipalities for the epidemiological week 04.

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Distribution of common disease by municipalities for week 04, 2018 100% 90% 80% 70% 60% 50% 40% ALRI 30% AD 20% AURI 10%

0%

Sert

JALO

GHAT

ZAWIA

Tobruk

ZWARA

ESBEAA

OUBARI

GARIAN

ZENTAN

MORZIG

ALBAIDA

ALKOFRA

SUBRATA

ALJEMAIL

TRAGHEN

DAWOON

ALAZIZIYA

REGDALIN

IMSALATA

BANIWALED

ASHATI EAST

SouqEljomaa HAYALANDALUS QasirGhashir Ben Figure 3. Distribution of common disease by municipalities for week 04, 2018

Trend of pertussis:

In total 109 cases of suspected pertussis have been reported from EWARN sites this year. The cases are distributed as follow: Imsalata (9), Bengazi (1), Subrata (8) and Albaida (1).

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Distribution of S. pertussis reported cases by week and by municipality up to week 04, 2018

ALABYAR ALAJILAT ALBAIDA Aljaghboub ALJEMAIL ALJOFRA ALKOBA ALKOFRA ALMARIJ ASHATI ASHATI EAST ASHATI West BANIWALED BENGAZI DARNAH ESBEAA GARIAN GHAT Ghdames IGDABYA IMSALATA JALO KHOMS MEZDAH MISURATA MORZIG MRADA OUBARI Qasir Ben Ghashir REGDALIN SABHA Sert SUBRATA SURMAN TARHUNA TAZIRBU TRAGHEN YEFRIN ZAWIA ZELTON ZENTAN ZLETIN ZWARA ALZAHRAA TRIPOLI central ALSWANI ALAZIZIYA Souq Eljomaa NESMAA

0 14 0 3 0 14 2 7 7 0 0 8 3 7 0 0 7 11 9 7 0 4 1 01 01 2 1 WEEK 01 2018 WEEK 02 2018 WEEK 03 2018 WEEK 04 2018 Figure 4. Distribution of suspected pertussis cases reported by week and by municipality week 04 2018.

Trend of Acute Upper Respiratory Infections

During week 04, a total of 4694 cases were reported (11.54% of total consultations) and are summed up in table 1 below:

Municipality AURI cases Municipality AURI cases

ALJEMAIL 11 SUBRATA 174

ALJOFRA 278 ALKOBA 194

ALKOFRA 72 ALBAIDA 96

ALMARIJ 25 ALAJILAT 175

BANIWALED 303 ALSWANI 25

BENGAZI 1026 ASHATI EAST 170

GARIAN 105 ASHATI West 29

IMSALATA 200 Tobruk 3

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KHOMS 33 SURMAN 52

MISURATA 30 Qasir Ben Ghashir 104

MORZIG 60 MEZDAH 19

MRADA 18 TRAGHEN 55

REGDALIN 44 ALABYAR 97

SABHA 64 ALZAHRAA 8

ZAWIA 173 JALO 59

ZLETIN 23 TAZIRBU 68

ZWARA 159 ZENTAN 90

TRIPOLI central 84 DARNAH 197

40 45 Souq Eljomaa ESBEAA 89 42 Ghdames ABOU SALEM 124 31 Sert HAY ALANDALUS Table 1. Summary of AURI cases by Municipality in week 04

Figure 5 below shows the trend of AURI cases in the period from week 01 2017 to week 04/2018 through the EWARN system. Moreover, Figure 6 shows the trend of AURI cases percentage from the total consultations in the period between week 39 and week 04/2018.

The cumulative AURI during this year reached 19244 cases. reported 18% of all cases (3394). Trend of the disease showed peaks of over the past two months.

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DISTRIBUTION OF AURI CASES BY WEEK, WEEK 1 - 52, 2017 AND WEEK 04, 2018 7000

6000

5000

4000

3000

2000

1000

0

Week 31 2017 Week 01 2017 Week 03 2017 Week 05 2017 Week 07 2017 Week 09 2017 Week 11 2017 Week 13 2017 Week 15 2017 Week 17 2017 Week 19 2017 Week 21 2017 Week 23 2017 Week 25 2017 Week 27 2017 Week 29 2017 Week 33 2017 Week 35 2017 Week 37 2017 Week 39 2017 Week 41 2017 Week 43 2017 Week 45 2017 Week 47 2017 Week 49 2017 Week 51 2017 WWeek 03 2018 WWeek 01 2018 Figure. 5 Distribution of AURI cases by week, week 1 – 52, 2017 and week 04, 2018.

Percentage of AURI cases from the total consultation number by week, week 39 - 52, 2017 and week 04, 2018 16.00

14.00

12.00

10.00

8.00

13.38 13.75 13.71 12.21 12.65 12.25 6.00 11.54 9.15 4.00 8.53 8.33 7.06 7.52 7.26 6.48 6.40 6.04 5.46 2.00 1.44 0.00 week week week week week week Week Week Week Week Week Week week week Week Week Week Week 39 40 41 42 43 44 45 46 47 48 49 50 51 52 01 02 03 04

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Figure.6 Distribution of AURI percentage by week, week 39 – 52, 2017 and 04, 2018

Trend of Acute Lower Respiratory Infection:

During week 04, a total of 1282 cases of acute lower respiratory infections were reported (3.15% of total consultations) and are summarised by municipality in Table 2 below:

Municipality ALRI cases Municipality ALRI cases

10 41 ALJEMAIL Ghdames ALJOFRA 66 34 Sert ALKOFRA 5 SUBRATA 155

ALMARIJ 4 ALKOBA 96

BANIWALED 96 ALBAIDA 15 BENGAZI 93 ALAJILAT 35 GARIAN 6 ASHATI EAST 32 IMSALATA 14 Tobruk 9 KHOMS 8 SURMAN 44 Qasir Ben MISURATA 43 Ghashir 90 REGDALIN 29 MEZDAH 8 SABHA 52 TRAGHEN 11 ZAWIA 61 ALABYAR 8 ZLETIN 26 JALO 21 ZWARA 3 TAZIRBU 29 TRIPOLI central 40 ZENTAN 16 Souq Eljomaa 32 DARNAH 9 HAY ESBEAA 40 ALANDALUS 1 Table 2. Summary of ALRI cases by Municipality in week 04

Figure 7 below shows the trend of ALRI cases in the period from week 01 2017 to week 04/2018 through the EWARN system. Moreover, Figure 8 shows the trend of ALRI cases percentage from the total consultations in the period between week 39 and week 04/2018.

The cumulative ALRI during this year reached 5398 cases. Baniwaled reported 15% of all cases (796). Trend of the disease showed peaks of cases reported over the past two months.

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DISTRIBUTION OF ALRI CASES BY WEEK, WEEK 1 - 52, 2017 AND WEEK 04, 2018 2000 1800 1600 1400 1200 1000 800 600 400 200

0

Week 31 2017 Week 01 2017 Week 03 2017 Week 05 2017 Week 07 2017 Week 09 2017 Week 11 2017 Week 13 2017 Week 15 2017 Week 17 2017 Week 19 2017 Week 21 2017 Week 23 2017 Week 25 2017 Week 27 2017 Week 29 2017 Week 33 2017 Week 35 2017 Week 37 2017 Week 39 2017 Week 41 2017 Week 43 2017 Week 45 2017 Week 47 2017 Week 49 2017 Week 51 2017 WWeek 03 2018 WWeek 01 2018 Figure. 7 Distribution of ALRI cases by week, week 1 – 52, 2017 and week 04, 2018.

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Percentage of ALRI cases from the total consultation number by week, week 39 - 52, 2017 and week 04, 2018 5.00

4.50

4.00

3.50

3.00

2.50 4.37 2.00 3.72 3.28 3.38 1.50 3.15 2.60 2.59 2.12 2.21 1.00 1.90 1.96 1.72 1.78 1.67 1.54 1.34 1.40 0.50 0.46 0.00 week week week week week week Week Week Week Week Week Week week week Week Week Week Week 39 40 41 42 43 44 45 46 47 48 49 50 51 52 01 02 03 04

Figure.8 Distribution of ALRI percentage by week, week 39 – 52, 2017 and week 04, 2018

Trend of Acute Diarrhea

During week 04, a total of 1048 (2.58% of total consultations) cases of Acute Diarrhea were reported and are summerised per municipality in Table 3 below:

Municipality AD cases Municipality AD cases

ALJEMAIL 11 SUBRATA 57

ALJOFRA 34 ALKOBA 78

ALMARIJ 10 ALBAIDA 31

BANIWALED 116 ALSWANI 7

BENGAZI 303 ASHATI EAST 18

GARIAN 4 Tobruk 3

100 22 IMSALATA SURMAN KHOMS 4 16 MEZDAH

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MISURATA 40 ALABYAR 8

REGDALIN 42 ALZAHRAA 2

SABHA 36 JALO 2

ZAWIA 23 15 TAZIRBU ZLETIN 14 12 ZENTAN TRIPOLI central 8 DARNAH 11

Souq Eljomaa 4 ABOU SALEM 5

HAY Ghdames 8 ALANDALUS 4

Table 3. Summary of AD cases by Municipality in week 04 Figure 5 below shows the trend of AD cases in the period from week 01 2017 to week 04/2018 through the EWARN system. Moreover, Figure 6 shows the trend of AD cases percentage from the total consultations in the period between week 39 and week 04/2018.

The cumulative AD during this year reached 4992 cases. Bengazi reported 25% of all cases (1265). Trend of the disease showed peaks of cases reported over the last two months.

DISTRIBUTION OF AD CASES BY WEEK, WEEK 1 - 52, 2017 AND WEEK 04, 2018 1600

1400

1200

1000

800

600

400

200

0

Week 31 2017 Week 01 2017 Week 03 2017 Week 05 2017 Week 07 2017 Week 09 2017 Week 11 2017 Week 13 2017 Week 15 2017 Week 17 2017 Week 19 2017 Week 21 2017 Week 23 2017 Week 25 2017 Week 27 2017 Week 29 2017 Week 33 2017 Week 35 2017 Week 37 2017 Week 39 2017 Week 41 2017 Week 43 2017 Week 45 2017 Week 47 2017 Week 49 2017 Week 51 2017 WWeek 03 2018 WWeek 01 2018 Figure 9. Distribution of AD cases by week, week 1 – 52, 2017 and week 04, 2018.

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Percentage of AD cases from the total consultation number by week, week 39 - 52, 2017 and week 04, 2018

4.50

4.00

3.50

3.00

2.50

2.00 4.17 3.68 3.36 3.19 1.50 3.16 3.00 2.76 2.58 2.59 2.61 2.63 2.58 2.21 2.23 1.00 2.19 2.17 2.16

0.50 0.59 0.00 week week week week week week Week Week Week Week Week Week week week Week Week Week Week 39 40 41 42 43 44 45 46 47 48 49 50 51 52 01 02 03 04

Figure 10. Distribution of AD percentage by week, week 39 – 52, 2017 and week 04, 2018

Trend of vaccine preventable diseases:

Durign week 04, 22 VPD cases was reported and they are summerised in the table below:

VPD No of Cases Municipality Age Sex Meningitis 1 Ghat under five Male (1) years Pertussis 19 Bengazi (1), Below 5 years Female (10) Male (9) Imsalata (9), (16) above Subrata (8) and five years (3) Albaida (1) Measles 2 Zawia (1) and Below 5 years Male (1) and females (1) Bengazi (1) (1) above five years (1)

Summary of all cases reported in week 04:

Disease No of cases Percentage from total consultations AURI 4694 11.54

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ALRI 1282 3.15 AD 1048 2.58 BD 14 0.03 AJS 23 0.06 Leishmania 63 0.15 Pertussis 19 0.05 Meningitis 1 0.00 Measles 2 0.00 Food Poisoning 42 0.10

Alerts & Outbreaks Sixteen (16) alerts were generated through EWARN following the case definition thresholds. All the alerts were notified to surveillance adminstration and local muncipality health offcials. No epidemic was resported during this period. (Details: see below table).

SN Alert Municipality No of Investigation Sample Alerts Public Health Cases and Taken Confirmed Interventions Response Yes/No True/False Conducted within 48-72 hrs DOH/ WHO/ NGO 1 AJS Tripoli 3 No No DK No central 2 AJS ASHATI east 3 No No DK No 3 AJS Surman 12 No No DK No 4 Pertussis Albaida 1 No No DK No 5 Pertussis Benghazi 1 No No DK No 6 Pertussis Subrata 8 No No DK No 7 Pertussis Imsalata 9 No No DK No 8 Leishmania Zletin 16 No No DK No 9 Leishmania Regdalin 12 No No DK No 10 Leishmania Khoms 27 No No DK No 11 Leishmania Bengazi 3 No No DK No 12 BD Albaida 3 No No DK No 13 BD Subrata 5 No No DK No 14 BD Bengazi 3 No No DK No 15 Measles Zawia 1 Yes Yes DK No 16 Measles Bengazi 1 Yes Yes DK No

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