Epidemiological Bulletin Week 13, 23 March–29 March 2020

Weekly

EPIEpidemiological Watch bulletin

OVERALL SITUATION Adverse climatic conditions shifting from severe drought to heavy Deyr rains (October-December, 2019) causing floods, continued across Somalia. This coupled with other drivers of humanitarian crisis, such as armed conflict and evictions have led to 643 000 internal displaced persons in 28 drought-affected districts.

Shortage of safe water, and poor hygiene and sanitation have left communities in drought-affected districts and IDP camps vulnerable to infectious disease outbreaks such as measles and diarrhoea.

DROUGHT KEY FACTS

Map showing drought affected areas in Somalia 2020 Djibouti Djibouti . Ethiopia Ethiopia

Drought Other districts Drought affected districts Legend Boundaries Drought Somalia_Major_Rivers Other districts Acute diarrhoea cases Drought affected districts No cases HEALTH SITUATION Boundries 1 - 250 HEALTH SITUATION Kenya Rivers 251 - 500 Acute diarrhoea cases 501 - 1000 No cases 23-29 March 2020 Banadir region 1001 - 8314

Kenya 1 - 500 cVDPV2 501 - 1000 cVDPV2 1001 - 2000 Suspected measles cases 1 2001 - 4573 1 - 30 111 cVDPV2 31 - 50 cVDPV2 51 - 279 New cholera cases Suspected measles cases 1 - 50 51 - 100

101 - 147

70 2 605 0 30 60 120 180 240 Suspected measles Miles Acute diarrhoea cases The designation employed and presentation of materials on the map do not imply the expression on any opinion whatsoever on the secretariat or the united nations concerning the cases legal status of any country, territory, city or any area of authority, or concerning determination of it’s frontiers or boundaries. 1 This data is from drought affected districts only

CHOLERA IN DROUGHT-AFFECTED DISTRICTS

SinceCHOLERA December IN 2017, THE cholera DRPOUGHT cases have AFFECTED continued to DISTRICTSbe reported in Somalia. A total of 1 817 cholera cases were reported from Beletweyne, Jowhar and ten districts of Banadir affected by drought between epidemiological weeks 1 to 13, 2020 (Table 1). During week 13, 2020, a total of 111 new cases were reported from drought-affected districts. Of the 1 408 stool samples tested since December 2017, 379 samples tested positive for serotype Ogawa and Inaba. Culture and sensitivity studies performed at the National Public Health Laboratory show that the V. cholerae serotype Ogawa isolated is sensitive to chloramphenicol and tetracycline but resistant to ampicillin and nalidixic acid.

Published by World Health Organization (WHO), Country Office, Mogadishu, Somalia For correspondence: Tel: +252616695096; Email address: [email protected]; URL: http://www.emro.who.int/countries/som/index.html 1 ACUTE DIARRHOEAL DISEASES Fig.1. Trends of acute diarrhoea cases in drought-affected districts of Somalia, 2017–2020 Cases of acute diarrhoea increased in the year 2020 compared with previous years. This is linked 23-29 March 2020 to the shortage of safe water, and poor hygiene 34 541 Acute diarrhoea and sanitation (Fig. 1) as a result of drought cases whichAcute occurred diarrhoeal towards thediseases end of 2019. Since epidemiological week 1 of 2020, a total of 34 541 3500 3000 Cases in 2018 cases of acute diarrhoea have been reported from Cases in 2019 2500 drought-affected districts through EWARN. The Cases in 2020 s e s

most affected districts were Lasanood, Baidoa a 2000 c

f o

and Beletweyne (See Table 1). . 1500 o N 1000

500

0 1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51 MEASLES Epidemiological weeks As a result of the mass measles vaccination campaign conducted in Somalia in 2018, the number of suspected cases of measles decreased in 2019 Fig. 2. Trends of measles cases reported in drought-affected compared with previous years (Fig. 2). Another districts of Somalia, 2018–2020 measles campaign conducted in November 2019 is expected to further contribute to the reduction 23-29 March 2020 of measles cases. Since epidemiological week 1, 869 2020, a total of 939 suspected cases of measles Suspected measles have been reported in drought-affected districts. cases

Adado and Madina are the most affected districts 450 (See Table 1). 400 Cases in 2018 Cases in 2019 A total of 18 824 (85%) children under 1 year of 350 Cases in 2020 300

age out of the targeted 22 068 received measles s e s

a 250 c

1 vaccine (MCV1) in drought-affected districts in f o

200 .

February 2020 (Fig. 3). During the drought moni- o toring period, March 2019 to February 2020 the N 150 vaccination coverage was ranging between 71% 100 and 93% per month against a monthly target of 50 0 22 068 children under 1 year of age. 1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51 Epidemiological weeks

Fig. 3. Number of children under 1 year of age vaccinated POLIO UPDATES against measles by month, 2019 and 2020 No new cVDPV2 reported from AFP case from week 1-14, 2020. Date of onset of the most recent Numbers Coverage cVDPV2 was on 08 May 2019. A total of three 25000 100%

) d % e (

cVDPV2 cases were reported in 2019. t

a 20000 80% e n g i c a c r a e

v 15000 60% No new cases of circulating vaccine-derived polio o v n c e

virus type 3 (cVDPV3) reported from acute flaccid r d l 10000 40% o n i � h a

paralysis cases from 2018 to date. The last case of c

n i c o f

cVDPV3 in Somalia was confirmed on 7 Septem- 5000 20% c o a N ber 2018. V Polio updates 0 0% No new cVDPV2 was Isolated from ES sample this Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb week. This brings to Four (4) cVDPV2 isolates Months(Mar 2019-Feb 2020) reported from ES samples in 2020. The total number of cVDPV2 isolates from ES samples in 2019 and 2020 is nine (9). Date of Sample collection of the last positive sample is 04 February, 2020.

State District Acute diarrhoea Suspected Suspected cases measles cases cholera cases

Banadirb Daynile 2050 70 273 Hawal Wadag 377 10 52 Hodan 61 10 227 Kahda 663 11 57 Karan 0 0 18 Madina/Wadajir 1052 279 283 Waberi 360 60 29 Yaqshid 265 6 21 Galmudug Adado 132 157 0 Dusamareeb 401 8 0 Abudwaq 47 0 0 Hirshabelle Balad 267 44 0 Jowhar 1295 51 438 Belet Weyne 2828 14 419 Jubaland Kismayo 994 69 0 Garbahare 442 0 0 Puntland Garowe 656 3 0 Bossaso 1575 26 0 Qardho 560 13 0 Galkayo 631 5 0 Somaliland Erigavo 904 0 0 Hargeisa 1080 8 0 Las Anod 8314 2 0 Burao 1763 5 0 South West State Wajid 37 0 0 Hudur 1686 0 0 Baidoa 3681 60 0 Marka 0 2420 28

Total 34 541 939 1 817

a The total number of cases reported on EWARN may change after verification by surveillance teams. b Banadir is a region not a state.

WHO is closely monitoring the respiratory infections including Severe Acute Respiratory Infection (SARI) and Influ- enza Like Illness (ILI) in Somalia through EWARN system. During epidemiological week 1 to 13, health facilities in the drought-affected districts reported an average of 1 788 cases of severe acute respiratory infection (SARI) per week , an average of 6 257 influenza like illnesses (ILI) cases as shown in (Fig.4.) and 56 suspected COVID-19 per week from week 12, 2020.

Fig. 4. Trend of SARI and ILI reported through EWARN during week COVID-19 response activities 1 to 13 in Somalia

State MoHs Somaliland, Puntland, Hirshabelle, 8000 Jubbaland and Southwest established task force 7000 committee for COVID 19 preparedness, and response 6000 have discussed infection prevention control (IPC) s e

s 5000 improving surveillance system at all levels focusing a c

f 4000 o

health facilities to give orientation on Covid-19 case .

o 3000 N definition, early detection and investigation and the 2000 community mobilization is continuing over all the 1000 0 districts. 1 2 3 4 5 6 7 8 9 10 11 12 13 Identified screening sites in Jubaland are Lower Epidemiological weeks Jubba region; Kismayo town and Kismayo Seaport, SARI ILI Suspected COVID_19 Dobley district, Gedo Region; Dolow district, Balad –Xaawo will start as they received PPE, Luuq district and Elwak district wait to PPE to start screening. Fig.5. SARI and ILI cases reported in the drought-a ected districts during week no 13, 2020 These are cross points of entry from Kenya and Ethiopian 100% 80% In response to COVID-19, WHO has prepositioned 60% specimen collection materials in the Sub offices . 40%

20% on 13 April 2020, Puntland Authorities deployed the

0% Rapid Response Team to investigation alerts of l i r r y a a a e o o d o o o d a g n a b d n e e e q o r o l a i r a s u e s a i k y v y a a n a e o a n d o a t d e h i w h l i r a h r r r r d a a y y a a d d h d o a d n e b s a o w a s d a i h u a r g k a e n u a T d a w o a g r i q

s COVID-19 in Garowe, Bossaso and Galkacyo districts. l m a d m a B a

a K a B s r a r K a H o a M A s a o H a B u d b W W i J a a W E w s D Q M

Y G r B G l b n L K t n H u a a a A e u l r D G t A search operation is ongoing to find a positive case w e r G a B u H K who was lost follow up recently. SARI ILI COVID-19

Table.2. Cases of SARI and ILI reported in states and Banadir region during epidemiological week no 13, 2020

AREAS SARI ILI COVID-19 Banadir 452 836 86 Galmudug 61 68 54 Hirshabele 253 618 54 Jubbaland 50 449 48 Puntland 133 1336 180 Somaliland 192 2056 200 SouthWest 479 556 74 TOTAL 1620 5919 696