Somalia Weekly Update Week-26 Ending 01 July 2018 Highlight: TROCAN

• A new VDPV2 isolated from a contact (EPID SOM/GDO/DLO/18/002-C1) from Dolo district in Gedo region of South zone. It has 38 nucleotide differences from Sabin2. The VP1 sequence shows it has no close genetic link to previously sequenced cVDPV2s; it is classified as VDPV2 and represents a VDPV2 event that has not previously been identified. Dolo • The contact sample is collected from an IDP camp called KABASA • Dolo is one of the 5 fully accessible districts in south from the total 29 districts in south zone. The districts borders both Ethiopia and Kenya characterized by high population moment in all directions and is around 40 km from Mandara town in Kenya. There is immunization activity in the district and the index case took 6 doses of OPV including 2 doses from routine EPI. The last SIA was conducted in May, 2018 during NID-1. - No reporting of a new positive environmental sample for cVDPV2 or cVDPV3 last week; the date of collection of most recent positive environmental sample for cVDPV2 or cVDPV3 was on 17th May 2018 from Waberi and Hamerewoini districts in Banadir.

A cVDPV3 and one co-infected (cVDPV2 & cVDPV3) cases reported from Bulloburti and Warhsakeh districts of Hiran and Middle Shabelle regions in Central zone - An index case with co-infection of cVDPV2 and cVDPV3 from Bulloburti district in Hiran region had date of onset on 11 May. In addition, cVDPV3 was isolated from three contacts of this case. - cVDPV3 case isolated from an AFP with dates of onset on 23 May is from Warsheikh district of Middle Shabelle region. Summary of cVDPV2 and cVDPV3 detected from 2 AFPs, 4 Contacts and 2 community samples

➢ EPID No: SOM/HRN/BBT/18/002 and the 3 contacts have cVDPV3 The index: ⁻ Location of case: JAMECO MUBARAK village –BULO BURTI District-Hiran Region- Central zone ⁻ Date of onset: 11 May 2018 ⁻ Date Stool collection 1st and 2nd: 13th and 14th May 2018 ⁻ Accessibility of the area: The village is inaccessible, the last SIA was 2009 activity ⁻ Age and OPV dose status [if case]:72 months female, 0 Dose of ⁻ Sequencing results: PV-2 VDPV with 43nt difference and 17 nt difference from Sabin ⁻ Closest match: genetically linked to the VDPV3 sequence for ES/SOM/BAN/HMW/KAWMA-1/18/006 (Kawma ENV site, emergence group SOM- BAN-2) ➢ EPID No: SOM/MSH/WRS/18/003 and its third contact (SOM-MSH-WRS-18- 001-C3) Warshaikh The index: ⁻ Location of case: Bohi village –Warsheikh District-Middle Shaballe-- Central zone ⁻ Date of onset: 23 May 2018 ⁻ Date Stool collection 1st and 2nd: 30st and 31th May 2018 ⁻ Accessibility of the area: The village is accessible ⁻ Age and OPV dose status [if case]:39 months female, 0 Dose of ⁻ Sequencing results: PV-3 VDPV with 19nt difference from Sabin ⁻ Closest match: The PV3 VDPV is genetically linked to the VDPV3 sequence for ES/SOM/BAN/HMW/KAWMA-1/18/006 (Kawma ENV site, emergence group SOM- BAN-2). The new PV3 viruses are classified immediately are cVDPV3

➢ EPID No: SOM/LJB/JMW/18/CC1/001 and SOM/LJB/JMW/18/CC1/003 (Community samples) ⁻ Location of case: SANGUNI village –Jamamme west District- Lower Jubba Region- South zone ⁻ Date Stool collection 1st and 2nd: 24 April 2018 ⁻ Accessibility of the area: The district is completely inaccessible ⁻ Accessibility of the area: The village is inaccessible since 2015 and no SIA activity ⁻ Age and OPV dose status [if case]:18 &36 months females, 0 Dose ⁻ Sequencing results: PV-3 VDPV with 16nt difference from Sabin ⁻ Closest match: not genetically linked to any other previously sequenced VDPV3s; it is classified as VDPV3 and represents a VDPV3 event Summary of VDPV2 and VDPV3 isolated from AFPs, Contacts and Community samaples SOM/MSH/WRS/18/0 SOM-MSH-WRS-18- SOM/HRN/BBT/18/002/SOM/HRN/BBT/18/002/ SOM/HRN/BBT/18/002/ SOM/LJB/JMW/18/CC1/ SOM/LJB/JMW/18/CC1/0 SOM/GDO/DLO/1 IDCODE SOM/HRN/BBT/18/002 03 001-C3 C1 C2 C3 001 03 8/002/C1 Type of Sample AFP case Contact-3 AFP case Contact-1 Contact-2 Contact-3 Community sample Community sample Contact cVDPV2 and cVDPV3 co- Final result cVDPV3 cVDPV3 cVDPV3 cVDPV4 cVDPV5 cVDPV3 cVDPV3 VDPV2 infection AXMED MOHAMED NAJMA MOHAMED SAMIRA MALUULANO NAME ABSHIR ALI MOALIM ABSHIR ALI MOALIM ISTAR ALI MOHAMED SAHAL OMAR AMIN SAREDO OMAR AMIN CUMAR ABDALA SIMBA AGE 39 39 72 48 26 64 36 18 24 SEX Male M Female Male Female Male Female Female Male Zone Cnetral Cnetral Central Central Central Central South South South

PROVINCE MIDDLE SHABELLE MIDDLE SHABELLE HIRAN HIRAN HIRAN HIRAN L/JUBBA L/JUBBA Gedo

DISTRICT WARSHEIKH WARSHEIKH BULO BURTI BULO BURTI BULO BURTI BULO BURTI JAMAMeE WEST JAMAMeE WEST Dolo VILLAGE BOHI BOHI JAMECO MUBARAK JAMECO MUBARAK JAMECO MUBARAK JAMECO MUBARAK SANGUNI SANGUNI KABASA IDP SIA in the area No No no SIA no SIA no SIA no SIA no SIA no SIA yes HOTCASE Yes Yes Contact-1 Contact-2 Contact-3 Community sample Community sample Contact Date of onset 5/23/2018 5/11/2018

Date of Notification 5/28/2018 5/13/2018

Date of investigation 5/28/2018 5/13/2018

Notified by BANADIR HOSPITAL WARDI MCH

DSTCOLL1 5/30/2018 5/30/2018 5/13/2018 5/13/2018 5/13/2018 5/13/2018 4/24/2018 4/24/2018 5/29/2018 DSTCOLL2 5/31/2018 5/14/2018 Accessibility of the Accessible Accessible Inaccessible Inaccessible Inaccessible Inaccessible Inaccessible Inaccessible Accessible village LIFESTYLE Nomadic Nomadic Nomadic Nomadic Nomadic Nomadic Nomadic Nomadic Urban EPIDOSES 0 0 0 0 0 0 0 0 2 NIDDOSES 0 0 0 0 0 0 0 0 4 DOSES 0 0 0 0 0 0 0 0 6 Date of last OPV no SIA no SIA no SIA no SIA no SIA no SIA no SIA no SIA 5/8/2018 IPV 0 0 0 0 0 0 0 0 0 Date of last result 6/15/2018 6/15/2018 6/15/2018 6/15/2018 6/15/2018 6/15/2018 6/15/2018 6/15/2018 6/30/2018 Summary Environmental Samples and Lab Classification

Epidemiological Week-2017 Epidemiological Week-2018

District Date Name 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 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 28 of of Ma Ma Ma Ma Ma Jun Establishmen J. J. J. J. F. F. F. F. M. M. M. M. M. Ap.Ap.Ap.Ap. Jun Sites y y y y y e t e 7 04 11 18 25 01 08 15 22 01 08 15 22 29 05 12 19 26 03 10 17 24 31 14

Waberi 21October 19 Sept. 2017 vDPV2

Urobo 20 Sept. 2017 Shangani

21 Sept. 2017 Hamerew Kawma oini

Hodan Egy. Hospital 23 Nov. 2017 No sample collected due to flooding of sewage of flooding to due collected sample No

Legend 1 Not scheduled 6 Sabin 11 WPV1+cVDPV2

2 Pending 7 NPENT + Sabin 12 Sent for sequencing

3 Negative 8 cVDPV2 13 Scheduled but not collected

4 NEV 9 WPV1 14 Sabin 2

5 NPENT 10 WPV3 15 Sabin + NPEV + NEV Next steps

• Detailed case and field investigation ongoing, reinforce active surveillance • Response planned - mOPV2 synchronized round starting on 9th -11th July 2018 • Identify hot cases through active case search in the community • Evaluate accessibility and security in Hiran Province to ensure good SIA coverage • Conduct high quality SIA using mOPV2 in the accessible settlements of the area • Revitalize social mobilization for polio vaccination and surveillance of paralysis, especially through radio and TV. • Review strategies to increase parents awareness prior to rounds and reduce child/parents absence SIA Activity Calendar Apr – Dec. 2018 Activity Target area Date NID 1 bOPV Somaliland and Puntland 30 Apr- 03 May 2018 South and Central Except Banadir, Lower and Middle NID 1 bOPV 5-8 May 2018 Shabelle Third response round mOPV2 Banadir, Lowe Shabelle and Middle Shabelle 5-8 May 2018 Campaign South and Central regions without Banadir, Lower and R 1 synchronized Middle Shablle regions synchronized with Kenya 9 - 12 Jul 2018 mOPV2 Campaign (with Ke, ET) response campaign

Small scale bOPV Response Banadir, Lower and Middle Shablle regions 23 Jul 2018

South and Central regions with out Banadir, Lower and R 2 synchronized OPV2 Campaign Middle Shabelle regions synchronized with Kenya 4 – 8 Aug. 2018 (with Ke, ET) response campaign

28 - 30 Aug. 2018 R 1 bOPV synchronized Ke & ET All 19 regions in Somalia (2,499,010) TBC

24 – 27 Sep. 2018 R 2 bOPV synchronized Ke & ET All 19 regions in Somalia (2,499,010) TBC Country Campaign Preparedness • Overall preparedness level: Somalia is ready for the campaign scheduled to kickoff on the 9th of July 2018 • Current status update # DFAs to % DFAs to Region # District # DFAs ➢ Team level micro plan done, revised is ready for use use ODK use ODK ➢ Monitors/supervisors training completed ➢ TOT training given for RPOs, DPOs, DFAs and IC& PC LQAS supervisors and monitors conducted in Mogadishu and 6 regional hubs ➢ Cascade training for DPOs and DFAs conducted in all Bakool 5 50 19 38% districts team training Bay 5 148 50 34% ➢ Budget: PO not yet received by zones ➢ C4D activities: on progress Gedo 8 120 43 36% ➢ Vaccine distribution: on progress L Jubba 3 70 23 33% • MOH states/other partners informed on the new campaign dates and involved the synchronized mOPV Galgad 9 86 29 34% campaign preparation Grand Total 21 388 135 35% Summary of response activities using mOPV2

Three rounds of mOPV2 campaigns mOPV2 response areas mOPV2 rounds IM coverage conducted targeting all <5 (Benadir, Middle 100% and Lower Shabelle) 99% 98% 98% ➢ st 97% 97% 97% 1 Round (10-13 Dec. 2017) 95% 96% 96% • Target: 726,699 • Reached: 702,667 (97%) 90% 92% • Missed: 24,032 85% • IM coverage: 97%

• LQAS= 98% FM 80%

➢ 2nd Round ( 29 Jan-01 Feb 2018) 75% • Target: 741,313 70% • Reached: 715,172 (96%)

• Missed: 26,141 65% • IM coverage: 93% M. Shabelle • LQAS= 98% FM 60% Banadir L. Shabelle 55% ➢ 3rd Round (05-08 May 2018)

• Target: 790,837 50% ROUND I ROUND II ROUND III • Reached: 763,471 (97%) BANADIR 96% 92% 98% • Missed: 27,366 LOWER SHABELLE 97% 97% 96% MIDDLE SHABELLE 98% 97% 99% • IM coverage: 98% FM • LQAS= 98% FM BANADIR LOWER SHABELLE MIDDLE SHABELLE Province District % 0-11m Children Vaccinated Total Missed Children % 12-59-count Vaccinated % Total Under 5 Children vaccinated BAN ADA 98% 14 99% 98% BDB 99% 33 98% 98%

DRK 94% 204 95% 95%

DYN 98% 65 95% 96%

HDN 97% 61 98% 98% rd 3 round mOPV2 Post Campaign HJB 98% 35 98% 98% IM result by district HLW 99% 39 98% 98% HMW 100% 7 99% 100%

HWL 99% 38 97% 98%

KRN 100% 33 99% 99%

MDN 99% 78 97% 98%

SBS 97% 60 97% 97%

SHN 97% 17 99% 98%

WBR 98% 26 98% 98%

WDA 100% 26 98% 99%

YQA 98% 136 97% 97% BAN Total 98% 872 97% 98% LSH AFG 95% 139 96% 95% WLW 100% 100 96% 96%

QRO 99% 35 95% 96%

KRT 99% 32 95% 96%

BRV 99% 19 94% 95%

MAR 96% 72 95% 95% LSH Total 97% 397 95% 96% MSH ADL 100% 0 100% 100% BLD 99% 1 100% 100%

JOW 100% 1 100% 100%

MDY 100% 2 100% 100%

WRS 100% 2 100% 100% MSH Total Graph100% no. 1 6 100% 100% Grand Total 98% 1275 98% 98% 3rd round mOPV2 Post Campaign monitoring results LQAS Vaccination Status by finger marking

Finger Mark (FM) Region/Distric t NO FM FM Present Total HH Visited % Vaccinated Interpretation BANADIR 27 913 940 97% ADA 60 60 100% PASS BDB 60 60 100% PASS DRK 4 56 60 93% SATISFACTORY DYN 60 60 100% PASS HDN 5 55 60 92% SATISFACTORY HJB 50 50 100% PASS HLW 4 56 60 93% SATISFACTORY HMW 60 60 100% PASS HWL 3 57 60 95% PASS KRN 2 58 60 97% PASS MDN 2 58 60 97% PASS SBS 1 49 50 98% PASS SHN 1 59 60 98% PASS WBR 2 58 60 97% PASS • LQAS conducted in 24 districts in 24 WDA 1 59 60 98% PASS lots. YQA 2 58 60 97% PASS LSH 6 234 240 98% AFG 2 58 60 97% PASS • Of the 24, 21 have passed, 3 are WLW 60 60 100% PASS QRO 2 58 60 97% PASS satisfactory and non of the lots fail MAR 2 58 60 97% PASS MSH 3 237 240 99% • BLD 2 58 60 97% PASS All districts have coverage above JOW 60 60 100% PASS 90% MDY 1 59 60 98% PASS WRS 60 60 100% PASS Grand Total 36 1384 1420 97% Response activities NID-1 using bOPV

NIDs round 1 of bOPV campaign conducted targeting all <5 in Somaliland, South Zone and two Regions in Central Zone (Hiran and Galgadud). ➢Somaliland Campaign date: 30 April-03 May 2018 Target: 638,062 Reached: 627,805 (98%) Missed: 2,206 IM coverage: 97% ➢South zone Campaign date: 08-11 May 2018 Target: 467,553 Reached: 457,167 (98%) Missed: 1,049 IM coverage: 95% ➢Central zone(Hiran and Galgaduud) Campaign date: 05-09 May 2018 Target: 213,865 Reached: 199,516 (93%) Missed: 579 ➢National Level: Target: 1,319,480 Reached: 1,284,488 (97%) Missed: 3,824 IM coverage: 96% Summary results of IM result Summary results of LQAs conducted in South and Somaliland in South and Somaliland NID-1 IM Coverage by Region Regions Total Lots Lots Lots

100% lots Pass Satisfacto Fail

99%

96%

96% 96% 90% 95%

95% ry 94%

80% Awdal 5 4 1 0 70% Galbeed 7 4 1 2

60% Saaxil 2 2 0 0

50% Togdheer 7 7 0 0

40% Sool 4 4 0 0

30% Sanaag 4 3 0 1 Bakool 2 2 0 0 20% Bay 1 1 0 0

10%

No No NID

No NID No

No No NID

No No NID No NID No No IM No No IM Gedo 3 2 0 1

Bay

Bari

Sool

Sahil

Gedo

Hiran

Nugal Sanag

Awdal L/Juba 1 1 0 0

Bakool

Mudug

Banadir

Togther

L. Jubba L.

M. Jubba M.

Galgudud

Marodijeh

L. Shabelle L. M. Shabelle M. Central South Somaliland Puntland Somalia 36 30 2 4 Part I

AFP Surveillance Week-26 Somalia Weekly EPI/POL Update

Epidemiological Curve 01 January 2014 – 01 July 2018

2014W01 2014W03 2014W05 2014W07 2014W09 2014W11 2014W13 2014W15 2014W17 2014W19 2014W21 2014W23 2014W25 2014W27 2014W29 2014W31 2014W33 2014W35 2014W37 2014W39 2014W41 2014W43 2014W45 2014W47 2014W49 2014W51 2015W01 2015W03 2015W05 2015W07 2015W09 2015W11 2015W13 2015W15 2015W17 2015W19 2015W21 2015W23 2015W25 2015W27 2015W29 2015W31 2015W33 2015W35 2015W37 2015W39 2015W41 2015W44 2015W46 2015W48 2015W50 2015W52 2016W02 2016W04 2016W06 2016W08 2016W10 2016W12 2016W14 2016W16 2016W18 2016W20 2016W22 2016W24 2016W26 2016W28 2016W30 2016W32 2016W34 2016W36 2016W38 2016W40 2016W42 2016W44 2016W46 2016W48 2016W50 2016W52 2017W02 2017W04 2017W06 2017W08 2017W10 2017W12 2017W14 2017W16 2017W18 2017W20 2017W22 2017W24 2017W26 2017W28 2017W31 2017W33 2017W35 2017W37 2017W39 2017W40 2017W42 2017W44 2017W46 2017W48 2017W50 2017W52 2018W02 2018W04 2018W06 2018W08 2018W10 2018W12 2018W14 2018W16 2018W18 2018W20 2018W22 2018W24

Pending Lab Pending ERG Discarded Compatable WPV aVDPV VDPV2 VDPV3

Graph no. 1 Week-26 Somalia Weekly EPI/POL Update

Weekly AFP cases reported by Provinces, 2016-2018 Somalia. (cases are distributed across weeks based on date of onset of paralysis).

PROVINCE

2017W24 2017W25 2017W26 2017W27 2017W28 2017W29 2017W30 2017W31 2017W32 2017W33 2017W34 2017W35 2017W36 2017W37 2017W38 2017W39 2017W40 2017W41 2017W42 2017W43 2017W44 2017W45 2017W46 2017W47 2017W48 2017W49 2017W50 2017W51 2017W52 2018W01 2018W02 2018W03 2018W04 2018W05 2018W06 2018W07 2018W08 2018W09 2018W10 2018W11 2018W12 2018W13 2018W14 2018W15 2018W16 2018W17 2018W18 2018W19 2018W20 2018W21 2018W22 2018W23 2018W24 2018W25 2018W26

Total 2016 Total

Total 2017 Total 2018 Total

BANADIR 30 2 1 1 2 2 2 1 2 1 1 1 33 2 1 1 1 1 1 1 1 1 1 2 13 GALGADUD 25 2 1 1 2 1 1 1 1 1 1 1 27 1 2 1 1 1 1 1 1 1 1 11 M. SHABELLE 19 1 1 1 1 1 2 1 1 1 1 1 1 24 1 1 1 1 1 1 3 1 1 11 L. SHABELLE 24 1 1 1 1 1 1 1 1 1 1 2 1 1 2 1 1 1 31 1 2 1 1 2 2 1 1 1 12 HIRAN 15 1 1 1 1 1 1 1 1 1 1 21 1 1 1 1 1 1 1 7

BARI 24 2 1 1 1 1 1 1 1 1 1 24 3 2 1 1 2 1 2 1 10 13 NUGAL 11 1 1 1 1 1 10 1 1 1 1 1 5 MUDUG 14 1 1 1 1 12 1 1 1 2 1 1 1 1 1 10 TOGDHER 11 1 1 1 9 1 1 1 1 4 GALBEED 19 1 2 1 2 1 2 20 1 1 1 1 1 2 1 1 1 10 SANAQ 7 1 1 6 1 1 1 3 AWDAL 18 1 1 1 1 1 1 17 1 2 1 1 1 1 1 1 1 1 11 SAHIL 8 1 1 1 8 1 1 2

SOOL 5 1 1 2 1 11 1 1 1 3 1

LOWER JUBA 26 1 2 2 1 1 1 1 1 1 1 1 1 29 2 1 2 1 1 1 1 1 1 1 1 1 14 - BAY 19 1 1 1 1 1 2 2 2 1 22 1 4 1 1 1 1 1 1 1 1 1 14 GEDO 21 1 1 1 2 2 1 1 1 20 1 1 1 1 1 1 1 7 MIDDLE JUBA 11 1 2 1 1 11 1 1 1 1 1 1 1 7

BAKOOL 9 1 1 1 1 1 1 1 10 1 1 1 1 1 1 6 no. Table Total Somalia 316 10 2 5 9 3 7 6 7 7 6 9 5 7 10 4 5 7 3 2 8 11 4 7 2 5 3 6 2 5 345 6 4 8 7 4 9 13 7 12 5 5 7 6 4 9 5 8 5 8 8 3 7 6 1 4 2 163 Silent (not reporting) for > 8 weeks - Six new AFP cases were reported last week making the total AFP cases reported in 2018 to 163 from 19 regions as Reported AFP cases compared to 195 AFP cases from 19 regions as the same time point in 2017. Community Samples collected in silent regions Community Samples collected but regions not silent Week-26 Somalia Weekly EPI/POL Update

Classification of AFP cases by status (2017 & 2018)

2017 2018 ZONE PROVINCE Discard Pendin Discard Pendin Total VDPV Total 163 AFP Cases ed g ed g BANADIR 33 0 33 12 0 1 13 Reported in 2018 GALGADUD 27 0 27 11 0 0 11 CENTRAL HIRAN 21 0 21 5 1 1 7 L. SHABELLE 30 0 31 9 0 3 12 M. SHABELLE 24 0 24 8 1 2 11 BARI 24 0 24 12 0 1 13 Puntland MUDUG 11 0 12 9 0 1 10 138 0 23 0 1 1 NUGAL 10 0 10 4 0 1 5 Compatibl Discarded WPV Pending cVDPV2 cVDPV3 AWDAL 16 0 17 10 0 1 11 e GALBEED 20 0 20 10 0 0 10 SAHIL 8 0 8 2 0 0 2 Somaliland SANAQ 6 0 6 3 0 0 3 SOOL 11 0 11 3 0 0 3 TOGDHER 9 0 9 3 0 1 4 BAKOOL 10 0 10 5 0 1 6

21 0 2 BAY 22 0 22 12 0 2 14 2 2

SOUTH GEDO 20 0 20 6 0 1 7 - In process (lab) Pending ERG Pending ITD LOWER JUBA 29 0 29 9 0 5 14 MIDDLE JUBA 11 0 11 5 0 2 7 Grand Total 345 0 345 138 2 23 163

Chart no. 1 no. Table Week-26 Somalia Weekly EPI/POL Update

Surveillance Indicators by Zone and Region 2018 Annualized NP-AFP Rate by Zone, 2017 14.0 12.0 12.2 10.0 8.0 6.0 6.4 6.2 4.0 4.5 2.0 3.7 0.0 Central Puntland Somaliland South Total Somalia

Graph no. 2

Annualized NP-AFP rate by accessibility status 10.0 8.0 8.3 6.0 6.2 6.2 4.0 5.9 2.0 - In-accessible Partially Accessible Somalia Acceessible Map no. 1 Map no. 2 Graph no. 3 Week-26 Somalia Weekly EPI/POL Update

Surveillance Indicators (NP-AFP rate and Stool adequacy) by district, 2018

▪ 99 out of 115 districts reported at least 1 AFP case since the first week of 2018. ▪ Out of the 99 districts reporting AFP cases in 2018, 94 have annualized NP-AFP rate above 2 per 100,000 . In addition, 97 districts have stool adequacy rate of above 80%. ▪ The remaining 16 districts have not reported any AFP case in 2018; However, no district in Somalia has been silent for more than 52 consecutive weeks. ▪ 12% (n=2/17) inaccessible districts and 19%(n=14/75) of accessible districts did not report AFP cases in 2018. All the 17 partially accessible districts have reported at least 1 case. Map no. 3 Map no. 4 Week-26 Somalia Weekly EPI/POL Update

Distribution of NP-AFP cases and zero-dose cases vs accessibility of districts

▪ AFP cases were reported from across the country, from all zones, regions, and accessible and inaccessible parts of the country.

▪ Geo-code information was collected from 64% of AFP cases reported in 2018

▪ All the 18 zero-dose AFP cases reported in 2018, 10 were reported from inaccessible districts, 6 from partially- accessible districts and 2 from accessible districts Map no. 5 Map no.6 Week-26 Somalia Weekly EPI/POL Update

Number of NP-AFP cases reported across years during the same period (2013-2018) by zone 300

250

241 226 200

190 174 150 165 163

100 104

68 67 72 50 62 54 45 45 46 48 36 38 35 36 38 28 31 30 32 33 17 17 21 27 0 CENTRAL PUNTLAND SOMALILAND SOUTH SOMALIA 2013 2014 2015 2016 2017 2018

▪ All zones but South have reported less number of AFP cases compared to the number of reported AFP cases in 2017 during the same period. ▪ A record low number AFP cases were reported from Central zone since 2014; However, over 215 community samples were collected from healthy children in this year to compensate the low AFP reporting and active cases search has continued in the community and HFs Week-26 Somalia Weekly EPI/POL Update

Early case detection within 7 days from onset of paralysis at zonal and region levels-2018

Notification within 7 days, Zonal Notification within 7 days, Regional 28 32 42 155 11 7 12 13 10 5 11 10 2 3 4 6 7 100% 100% 155 53 13 10 90% 90% 12 6 11 80% 80%

70% 2 70%

60% 60% 50% 50% 40% 40% 30% 30% 20%

20% 10%

10% 0%

BAY

BARI

SOOL

SAHIL

GEDO

HIRAN

NUGAL

SANAQ

L. JUBA L.

AWDAL

MUDUG BAKOOL

0% M.JUBA

GALBEED

BANADIR TOGDHER

CENTRAL PUNTLAND SOMALILAND SOUTH SOMALIA GALGADUD

L. SHABELLE L. M.SHABELLE CENTRAL PUNTLAND SOMALILAND SOUTH TOTAL

• 95% (n=155/163) cases reported in 2018 were notified within 7 days of onset of paralysis. Eight AFP cases (3 from Bay, 2 from Lower Jubba, 1 from Middle Jubba, 1 from Middle Shabelle and 1 from Sanaaq regions had delayed notification). Week-26 Somalia Weekly EPI/POL Update

Summary of AFP surveillance key indicators by Zone, 2018

. .

NP NP EV Adq

% Stool % Inv. % Notif. with NP

ZONE Adq. within 48 within 7 with

AFP AFP Rate

cond. -

hrs. days Isolated

Specimen

# # AFP cases

EVIsolated

good good cond.

virus virus Isolation

Virus Isolation

of samples of samples

# Cases # Cases with

% of cases % of cases with L S

% Cases % Cases with stool in

# cases # with cases Sabin like

% % Samples

Cases Cases with lab. result.

Cases Cases with stool in good Cases Cases pending lab results Central 54 3.7 53 98% 98% 98% 7 47 47 100% 5 5% 5 11%

Puntland 28 12.2 28 100% 100% 100% 3 25 25 100% 3 6% 4 16%

Somaliland 33 4.5 33 100% 100% 97% 2 31 31 100% 3 5% 1 3%

South 48 6.4 46 96% 100% 88% 11 37 37 100% 7 9% 0 0%

Total 163 6.2 160 98% 99% 95% 23 140 140 100% 18 6% 10 7%

Table no.-4 Week-26 Somalia Weekly EPI/POL Update

Summary of AFP surveillance key indicators by Province, 2018 Expected # of AFP % Samples Number of AFP % inv. within % Notif. % Stool % cases with # Cases with late ZONE PROVINCE Regional U15 Pop. cases as of this NP-AFP Rate % Stool Adq. with EV cases reported 48 hrs. within 7 days condition SL isolated 60 days followup Week isolated BANADIR 1110807 11 13 2.3 100% 100% 100% 100% 0% 25% 1 GALGADUD 267828 3 11 8.2 100% 100% 100% 100% 9% 9% 0 CENTRAL HIRAN 233838 2 7 6.0 100% 100% 100% 100% 0% 0% 0 LOWER SHABELLE 948112 9 12 2.5 100% 100% 100% 100% 11% 11% 0 MIDDLE SHABELLE 375400 4 11 5.9 91% 91% 91% 100% 6% 0% 0 BARI 182218 2 13 14.3 100% 100% 100% 100% 8% 17% 0 PUNTLAND MUDUG 186490 2 10 10.7 100% 100% 100% 100% 0% 11% 0 NUGAL 90921 1 5 11.0 100% 100% 100% 100% 13% 25% 0 AWDAL 244900 2 11 9.0 100% 100% 100% 100% 0% 10% 0 GALBEED 550148 6 10 3.6 100% 100% 100% 100% 5% 0% 0 SAHIL 85949 1 2 4.7 100% 100% 100% 100% 0% 0% 0 SOMALILAND SANAQ 150975 2 3 4.0 100% 100% 67% 100% 33% 0% 0 SOOL 120412 1 3 5.0 100% 100% 100% 100% 0% 0% 1 TOGDHER 317058 3 4 2.5 100% 100% 100% 100% 0% 0% 0 BAKOOL 183178 2 6 6.6 100% 100% 100% 100% 0% 0% 0 BAY 540491 5 14 5.2 93% 100% 79% 100% 17% 0% 0 SOUTH GEDO 312710 3 7 4.5 86% 100% 100% 100% 25% 0% 0 LOWER JUBA 300735 3 14 9.3 100% 100% 86% 100% 0% 0% 0 MIDDLE JUBA 162640 2 7 8.6 100% 100% 86% 100% 0% 0% 0 SOMALIA 6364810 64 163 6.2 98% 99% 95% 100% 6% 7% 2 Week-26 Somalia Weekly EPI/POL Update

Summary of key indicators for AFP surveillance for contacts, 2018

% Contact % Contact % Specimens # Contacts % contacts # Contact Average collected # Contact # Specimens # AFP # % contacts < 5 with stool in with NPEV with Sabin with Sabin ZONE samples with contacts per within 7 days pending lab with NPEV Good Isolated virus like virus Cases CONTACTS age of AFP results isolated Lab result cases Condition isolated Isolated notified Central 54 162 117 3 100% 100% 100% 45 6 5% 9 8% Puntland 28 84 66 3 100% 100% 100% 18 5 8% 6 9% Somaliland 33 99 93 3 100% 100% 100% 6 5 5% 5 5% South 48 144 106 3 100% 100% 100% 38 8 8% 4 4% Somalia 163 489 382 3 100% 100% 100% 107 24 6% 24 6% Summary of Community Samples collected in 2018 from silent districts, Egyptian hospital and inaccessible districts Zone Pending Negative NPENT VPV3 SL2 SL3 SL 1 & SL3 SL1 Grand Total PUNLAND 10 33 1 1 45 SOMALILAND 15 19 1 35 CENTRAL 88 102 5 1 1 3 200 SOUTH 16 18 2 2 38 Grand Total 129 172 9 2 1 1 1 3 318 • Of the total 318 samples collected from healthy children in 2018, 44% (n=140), 6% (n=18) and 50%(n=160) from accessible, Partially accessible and inaccessible districts respectively Table no.-5 Week-26 Somalia Weekly EPI/POL Update

Distribution of AFP cases by source of case notification, 2018

Source of AFP cases notification 2012-2018 100% Number of Number of # of cases Notified Proportion of cases 48 50 Zone 90% 64 29 VPVs cases reported by VPV reported by VPV 138 80% 253 79 70% 105 104 74 60% 62 CENTRAL 190 54 25 46% 50% 131

40% PUNTLAND 105 28 13 46% 30% 268 191 67 143 163 69 20% 151 SOMALILAND 81 10% 33 13 39%

0% 2 25 2012 2013 2014 2015 2016 2017 2018

Year of onset SOUTH 159 48 18 38% VPV HFs Other Key: 1. VPVs: Village polio volunteers Total Somalia 535 163 69 42% 2. HFs: MCH, Hospitals and Private clinics 3. Others: community members, district field assistants, traditional healers Table no.-6 Week-26 Somalia Weekly EPI/POL Update

AFP cases by specific sources notification, 2012-2018

NOTIFIED BY VACCINATORS AND TRADITIONAL NOTIFIED BY COMMUNITY AND VOLUNTEERS NOTIFIED BY HEALTH FACILITIES 300 HEALERS 250 300

250 250 37 17 200 14 49 200 200

150 78

150 150 74 10 4 16 100 184 100 109 17 143 100 7 8 26 111 6 75 12 12 4 138 63 4 21 17 10 6 50 72 53 4 5 7 50 50 9 77 5 1 0 41 36 28 69 30 31 28 7 33 40 0 22 8 4 4 31 25 3 6 17 20 12 14 8 12 3 20 19 0 2 8 1 32 14 0 0 0 0 0 9 18 24 17 0 1 1 4 5 0 6 3 1 70 2012 2013 2014 2015 2016 2017 2018 0 20 3 2 0 0 0 03 2012 2013 2014 2015 2016 2017 2018 2012 2013 2014 2015 2016 2017 2018 CAMPAIGNS DISTRICT FIELD ASST DPO HEALTH POST HOSPITAL MCH CHW COMMUNITY HOUSEHOLD VOLUNTEERS NID VACCINATOR TRADITIONAL HEALER PRIVATE CLINIC PRIVATE PHARMACY Week-26 Somalia Weekly EPI/POL Update

Distribution of AFP cases by lifestyle, age group and sex, 2018

Distribution of AFP cases by Life style per Distribution of AFP cases by Age group Distribution AFP cases by Sex zone-2012-2018 2012-2018 2012-2018 ▪ Of the total 163 AFP 100% 100% 100% cases reported in 2018, 33 19 32 52 90% 90% 72 90% 44 45% (n=73) and 37% 80% 112 80% 83 80% 65 181 129 152 73 152 75 (n=61) are from urban 281 189 70% 70% 70% 92 324 252 166 and rural populations 60% 60% 60% respectively. Nomadic 50% 50% 50% 87 129 249 283 117 348 293 communities account for 40% 51 144 40% 40% 124 61 119 150 30% 30% 129 30% only 18% (n=29). 164 87 156 20% 20% 20% 56 221 167 115 ▪ 73% (n=119) of cases are 80 91 70 10% 31 97 69 29 10% 10% aged less than 5 years.

0% 0% 0% 2012 2013 2014 2015 2016 2017 2018 2012 2013 2014 2015 2016 2017 2018 2012 2013 2014 2015 2016 2017 2018 ▪ 53% (n=87) AFP cases Nomadic Rural Urban <5 Yrs ≥ 5 Yrs Female Male are female. Graph no.-10 Graph no.- 11 Graph no.-12 Week-26 Somalia Weekly EPI/POL Update

AFP surveillance indicators by accessibility status of districts, 2018

# of AFP # of % of Number % U-15 Pop % inv. % of Notif. % cases # of cases Cases Cases NP AFP of cases % of Stool Specimen Accessibility in this Within 48 within 7 with Sabin districts Reporte reported reported rate with lab adequacy s with area hrs. days like virus d by VPVs by VPVs result NPEV

Inaccessible 17 619,320 21 13 62% 8.3 16 100% 100% 95% 6% 0% Partially 23 1,720,826 44 15 34% 6.2 36 95% 100% 89% 7% 3% accessible

Accessible 75 4,024,663 98 41 42% 5.9 88 99% 101% 98% 6% 10%

National 115 6,364,810 163 69 42% 6.2 140 98% 99% 95% 6% 7% Table no.

- 7 7 ▪ Despite accessibility status of districts, majority of indicators are above global standards Week-26 Somalia Weekly EPI/POL Update

AFP surveillance indicators by lifestyle of population, 2018

% of <15 # of AFP # of % of Number % of % of % inv. % of % % cases of cases cases Accessibility populati cases Cases Cases NP AFP Stool Within Notifie Specim with on in Reporte reported reported with lab with lab adequac 48 hrs. d ens Sabin like rate result result the area d by VPVs by VPVs y within with virus within 14 days 7 days NPEV

Nomadic 28.80% 29 14 48% 3.2 25 64% 93% 100% 90% 0% 4%

Rural 25.90% 61 32 52% 7.4 58 81% 100% 100% 98% 8% 5%

Urban 45.30% 73 23 32% 5.1 57 82% 99% 99% 95% 8% 11%

National 100% 163 69 42% 5.1 140 79% 98% 99% 95% 6% 7% Week-26 Somalia Weekly EPI/POL Update

Validation and zero dose investigation of AFP cases, 2018 AFP Cases Validation Zero Dose Investigation # of AFP cases # of AFP % of AFP # of Zero dose # of Zero dose % of Zero dose Comment Zone Reported cases cases Zone AFP cases AFP cases AFP cases Validated Validated Reported investigated investigated

Central 54 28 52% Central 7 6 86% 2 from accessible and Somaliland 33 22 67% Somaliland remaining from access- compromised South Zone 48 32 67% South Zone 11 10 91% areas

Puntland 28 22 79% Puntland

Grand Total 163 104 64% Grand Total 18 16 89% Table no.-8 Table no.-9 ▪ Out of the total 163 AFP cases reported in 2018, 64% (n=104) were validated by the RPOs. Of the 104 AFP cases validated, (n=75, 15,11) were from accessible, partially accessible and inaccessible districts respectively ▪ There were 18 zero OPV dose AFP cases reported in 2018, out of which 89% (n=16/18) were investigated Week-26 Somalia Weekly EPI/POL Update

Total AFP cases Tracking lab results of AFP cases 163

Tracking AFP with stool specimens Total AFP cases Total AFP cases with stool without stool specimens specimens 163 0 21 18 cVDPV2

Other viruses With lab En route In the lab

neg st results 140 0 23 in lab 116 en route cVDPV2 cVDPV3 SL EV -ve 1 1 10 12 120 Week-26 Somalia Weekly EPI/POL Update

Lab performance indicators for AFP surveillance in Somalia, 2018 # # Specimen # Specimens # Specimen % of specimen Number of % of Number of Sample Specimen with culture pending lab with culture with culture specimen specimen cases with % of Cases source collected result result result within result within 14 with NPEV with Sabin with Sabin days 14 days NPEV isolation isolation

Cases 326 280 46 220 79% 18 6% 10 7%

Contacts 489 382 107 300 79% 24 6% 24 6%

Total 815 662 153 520 79% 42 6% 34 7%

Table no.-10 Week-26 Somalia Weekly EPI/POL Update

Median and average number of days from onset of paralysis up to final lab result - 2018

Date of Date of Second stool Specimen reached Primary Culture ITD result onset Notification collected to Lab result

Median: 3 days Median: 2 days Median: 3 days Median: 11 days 1 day Average: 3.53 days Average: 1.89 days Average: 3.8 days Average: 11.7 days

Date second Date final stool Median: 20 days ITD results collected Average: 22 days Chart no. 2 Week-26 Somalia Weekly Polio Update

Village polio volunteers weekly house to house visit and AFP cases notified, 01 July 2018

January Feberuary March April May June July Aug Sept Oct Nov December

No. of No. of No. of No. of No. of No. of No. of No. of Central No. of No. of No. of AFP No. of No. of No. of No. of No. of No. of No. of No. of No. of No. of AFP No. of AFP No. of HH AFP AFP AFP AFP AFP AFP No. of HH HH AFP cases cases HH HH HH HH HH HH AFP cases HH AFP cases HH cases HH cases visited cases cases cases cases cases cases visited visited notified notified visited visited visited visited visited visited notified visited notified visited notifie visited notifie notified notified notified notified notified notified d d

38002 6 39361 8 48588 5 38442 3 2 1 ------Central 38,481 39,530

35756 2 35545 3 45593 4 36456 4 3 2 ------South 36,073 36,087

16237 3 16148 3 20107 2 16230 3 1 1 ------Puntland 16,077 15,987

32180 6 32370 1 39613 2 32532 1 2 1 ------Somaliland 32,325 32,202

Total 122175 17 123424 15 153901 13 123660 11 122956 8 123806 5 0 0 0 0 0 0 0 0 0 0 0 0 Week-26 Somalia Weekly Polio Update

Routine Immunization Services, status of Cold Chain & Vaccine stocks in AFP Surveillance Sites. 01 July 2018

Expected weekly AFP Health facility have a AFP sites with EPI service and functional Health facility have EPI Health facility have IPV vaccine available Region sites visits routine EPI service cold chain vaccine available No No. % No. % No. % No. % Nugal 33 19 58% 19 100% 19 100% 17 89% Bari 116 34 29% 32 94% 34 100% 32 94% Mudug 58 39 67% 38 97% 38 97% 24 63% Galbeed 40 23 58% 23 100% 23 100% 23 100% Sahil 25 10 40% 10 100% 10 100% 8 80% Sanag 21 11 52% 11 100% 11 100% 11 100% Sool 30 10 33% 10 100% 10 100% 0 0% Awdal 52 23 44% 23 100% 23 100% 23 100% Togdher 47 21 45% 21 100% 21 100% 21 100% Middle Shabelle 38 19 50% 15 79% 19 100% 19 100% Hiran 27 22 81% 5 23% 22 100% 22 100% Galgadud 40 26 65% 15 58% 26 100% 25 96% Banadir 125 70 56% 25 36% 67 96% 64 96% Lower Shabelle 56 30 54% 16 53% 30 100% 24 80% Middle Juba 29 1 3% 0 0% 1 100% 0 0% Bakool 31 44 142% 47 107% 11 25% 10 91% Gedo 54 21 39% 20 95% 21 100% 19 90% Bay 74 30 41% 30 100% 30 100% 31 103% Lower Juba 59 30 51% 8 27% 30 100% 27 90% Somalia 955 483 51% 368 76% 446 92% 400 90% Part II

Fever and rash surveillance Week-26 Somalia Weekly Polio Update

Epi-curve on suspected measles cases by week, Somalia (2015-2018)

800 2015 2016 2017

(n=7498) (n=5657) (n=23,353) 2018

700

720

(n=6416)

703

699

696

693

686

685

670

663 657

600

584

560

554 538

500

507

496

488

487

463

461

444

441 441

440

436 436

400 426

416 416

410 410

408

407

406

401

400

399

393

389

383

373

362

352

351

349 346

300 330

325 325

320

317

315

314

309

292

290

286

277

269

255

239 228

200 227

224

222

219

214

210

208

199

198

196

191

182

180 180

175

174

173

172

170

163

161

158

156

155

154

153

151

149

145

144

142

141

140 140

134

133

132

128

127 127

100 126

125 125

124 124

122 122 122

117

116

115 115

113

112

111

109 109

107

105 105

97 103

96 102 102 102

95 95 101

100

93 93

90 90

88 88

87 87

86 86

85 85

84 84

76 76

74 74

72 72

66 60

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Fever and rash cases reported by AFP surveillance system , 01 July 2018

Fever and Rash Cases by weekly 2018

Region

W1 W2 W3 W4 W5 W6 W7 W8 W9

W10 W11 W12 W13 W14 W15 W16 W17 W18 W19 W20 W21 W22 W23 W24 W25

Total Total 2017 Total 2018 Nugal 2050 32 26 26 26 24 19 30 21 17 10 7 10 10 13 19 20 15 4 7 3 4 7 6 2 2 360 Bari 1968 21 26 20 17 20 26 26 18 22 27 33 25 27 26 29 46 28 22 13 13 18 13 14 10 16 556 Mudug 2566 47 45 36 27 44 25 23 24 30 15 21 20 16 10 13 14 7 17 0 8 1 0 3 5 0 451 N/East Zone 6584 100 97 82 70 88 70 79 63 69 52 61 55 53 49 61 80 50 43 20 24 23 20 23 17 18 1367 Galbeed 758 4 2 4 7 1 4 0 4 0 0 6 7 0 1 5 4 0 1 0 2 2 1 0 0 0 55 Sahil 576 2 0 9 2 13 5 24 5 18 4 4 4 13 2 1 1 2 0 7 0 2 0 4 2 3 127 Sanag 259 4 6 5 11 0 5 7 5 5 2 0 0 12 0 6 0 1 0 1 0 0 0 0 0 0 70 Sool 698 17 7 20 20 45 20 43 13 26 6 26 0 18 6 6 1 1 0 0 1 0 1 2 2 0 281 Awdal 105 2 0 11 2 5 0 10 0 3 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 33 Togdher 2324 11 11 27 13 31 7 51 25 37 14 49 28 29 13 17 17 8 13 19 7 6 3 11 8 4 459 N/West Zone 4720 40 26 76 55 95 41 135 52 89 26 85 39 72 22 35 23 12 14 27 10 10 5 17 12 7 1025 M/ Shabelle 716 18 15 19 23 23 23 43 30 30 33 38 22 14 17 12 5 12 12 11 5 16 10 7 9 9 456 Hiran 1461 12 13 3 26 26 15 22 12 18 1 5 1 0 20 17 0 35 5 0 0 0 15 16 27 0 289 Galgadud 625 5 7 4 6 6 8 16 11 8 6 4 7 6 4 8 5 7 4 11 7 5 7 3 2 4 161 Banadir 5617 72 73 79 70 70 68 56 66 59 54 48 36 26 20 40 32 58 62 47 53 40 42 25 18 16 1230 L/Shabelle 2106 25 28 40 36 36 28 29 52 36 35 33 20 31 23 32 20 29 31 25 19 22 19 22 23 22 716 Central Zone 10525 132 136 145 161 161 142 166 171 151 129 128 86 77 84 109 62 141 114 94 84 83 93 73 79 51 2852 Middle Juba 62 0 3 3 0 1 1 2 3 0 0 2 3 3 3 4 3 4 3 4 6 3 4 3 8 2 68 Bakool 99 4 2 2 0 4 0 0 4 2 0 0 4 0 4 4 0 2 0 0 2 3 0 2 0 2 41 Gedo 241 0 1 1 51 23 61 51 100 77 35 26 32 8 8 31 3 6 3 0 0 0 1 4 2 0 524 Bay 654 17 17 2 0 9 4 11 11 9 0 0 0 0 0 5 5 5 5 5 0 0 1 0 2 0 108 Lower Juba 468 22 4 6 9 12 6 17 6 10 27 12 5 14 28 43 43 19 9 30 0 31 5 26 22 25 431 South Zone 1524 43 27 14 60 49 72 81 124 98 62 40 44 25 43 87 54 36 20 39 8 37 11 35 34 29 1172 Grand Total 23353 315 286 317 346 393 325 461 410 407 269 314 224 227 198 292 219 239 191 180 126 153 129 148 142 105 6416 Week-26 Somalia Weekly Polio Update Trend of reported fever and rash cases by zone in, 2015 -2018 Source: AFP Surveillance

Puntland 15 Somaliland

- 6Jan)

- 909 (11

1200 1000 861 March) (2

Campaign Campaign 823

Campaign Campaign 979 925 891 882 1000 800 667 800 634 503 510 600 600 491 349 323 300 282 400 269 275 400 214221 240 265 222 243 161 133 140 161197 202 194 71 115 7097 110119 627883 142 132 113 200 3639 30 48 2443 2739 1927 1133 1240 150 200 95 82 10492 61 93 72 99 8796 14 36 33 3541 16 479 2942 47 2937 158 0 0 January February March April May June July AUG Sept. Oct. Nov. Dec

2015 2016 2017 2018 2015 2016 2017 2018 15 15

15 15 Central South

- -

1494 326

(11 (11 March)

1600 March) 350 Campaign Campaign Campaign Campaign 1340 1400 1205 300 1111 1200 250 220 925 916 207 1000 189 742 200 171 800 640 659 144 136 139 574 547 568 128 503 545 514 515 150 115 109 600 455 443 420441 450 104 367 401 348396 375 388 350383 401 82 83 315 324 296307 278 328 281310 100 77 75 64 400 265 271 50 142 4045 37 46 46 46 27 2729 30 22 27 21 33 2632 200 30 50 9 9 19 147 13 18 18 0 0 January February March April May June July AUG Sept. Oct. Nov. Dec January February March April May June July AUG Sept. Oct. Nov. Dec

2015 2016 2017 2018 2015 2016 2017 2018

• Data shows there is a steady decline of suspected measles reported after the measles mass immunization conducted in January in Puntland and March in central, south and Somaliland • Correction: there was a data error last week which causes Cases in Somaliland was inflated; Please disregard that figure and take this week corrected information on the trend of reported suspected cases Week -21 Somalia Weekly Polio Update

Fever and rash cases reported, 01 July 2018 Source: AFP surveillance system

Age-wise distribution of fever and rash cases reported Zone-wise cases of fever and rash reported by AFP surveillance by AFP surveivallance system during 2018 system in 2018

Yrs10+, 770, 12%

<1yr, 1043, 7000 6416 16% 5_9yrs, 6000 1012, 16% 5000

1_4 yrs, 3591, 4000 56% 2852 3000

2000 1367 1025 1172 1000

0 Central North East North West South Total Somalia Week-26 Somalia Weekly Polio Update

Measles mass immunization conducted in Somalia, 2018

• Nationwide campaign planned to vaccinate 100% 95% children from 6 months to 10 years of age; based 90% 94% 93% on epidemiology, 83% of cases were under 10 92% 92% years 80% • 4.7 million children targeted in all accessible and 70% partially accessible districts of the country 60% • 4.4 million children vaccinated (94% coverage) 50% • Independent monitoring data shows 94% of the 40% children reached with measles vaccination during 30% the campaign dates 20%

10%

0% centeral Puntland Somaliland South GrandNational Total Week-26 Somalia Weekly EPI/POL Update

Five-year Measles Strategic Plan

• Workshop conducted from 22-24 May 2018

• Stakeholders from Federal MHO, States, GAVI and other stakeholders attended the workshop

• The draft Strategic Plan was reviewed and will be finalized shortly

• Key Action Points from the Workshop: • Review of the EPI Policy • Development EPI Improvement plan for non-GAVI-supported districts • Development of measles outbreak response plans

• Standing committees were selected to work on it

Full story: http://www.emro.who.int/som/somalia-events/who-takes-strides-to-eliminate-measles-and-rubella-in-somalia.html Part III Population Immunity Week-26 Somalia Weekly EPI/POL Update

Maps showing accessibility and security/ risk level, Somalia

Source: UNDSS

Map no.10 Map no.11 Week-26 Somalia Weekly EPI/POL Update

Summary programmatic features and initiatives in Somalia by accessibility Number of Under 15- AFP active Zones Accessibility VPV TPVP Settlement POP. Surveillance sites Accessible 2475 2,419,077 127 251 150 CENTRAL Inaccessible 984 516928 63 34 21 Total 3459 2936005 190 285 171 Accessible 1220 459,639 105 207 53 PUNTLAND Inaccessible 0 0 0 0 0 Total 1220 459639 105 207 53 Accessible 3435 1,469,450 81 214 53 SOMALILAND Inaccessible 0 0 0 0 0 Total 3435 1469450 81 214 53 Accessible 2234 1,040,648.00 75 216 123 SOUTH Inaccessible 1548 459,119.00 84 33 22 Total 3782 1499767 159 249 145 Accessible 9364 5388814 388 888 379 Somalia Inaccessible 2532 976047 147 67 43 Total 11896 6364861 535 955 422

Note: the data are preliminary and U 15 population is estimated from Surveillance historical data and U5 SIA data and are being reviewed. Week-26 Somalia Weekly EPI/POL Update

Transit Points Vaccination activities using bOPV - 01 July 2018

January February March April May June

Zones

Zero doses Zero doses Zero

vaccinated vaccinated vaccinated vaccinated vaccinated vaccinated

Zero doses Zero doses Zero doses Zero doses Zero doses Zero doses Zero

Number of Number of Number of Number of Number of Number of

% % % doses % Zero doses % Zero doses % Zero doses % Zero

CENTRAL 99939 334 0.3% 106321 362 0.3% 134103 366 0.3% 104803 334 0.3% 103405 313 0.3% 102347 301 0.3% PUNTLAND 25067 58 0.2% 24610 59 0.2% 31565 71 0.2% 25519 61 0.2% 25516 55 0.2% 24052 41 0.2% SOMALILAND 14705 350 2.4% 14490 377 2.6% 17807 430 2.4% 14898 343 2.3% 15809 337 2.1% 15188 396 2.6% SOUTH 32225 1073 3.3% 34364 1123 3.3% 46605 1589 3.4% 42947 1336 3.1% 34650 937 2.7% 43151 1030 2.4% SOMALIA 171936 1815 1.1% 179785 1921 1.1% 230080 2456 1.1% 188167 2074 1.1% 179380 1642 0.9% 184738 1768 1.0%

▪ A total of 1,145,762< 10 years individuals were vaccinated week 25,2018. Among them 11,676(1%) were vaccinated for the first time.

Table no.-16 Week-26 Somalia Weekly EPI/POL Update

Immunity Profile of NP-AFP cases and Contacts 2013-2018

Immunity Profile of NP-AFP Cases and Contacts combined Months, Immunity Profile of NP-AFP Cases 6-23 Immunity Profile of NP-AFP cases 6-59 Immunity Profile of NP-AFP cases 6-23 2013-2018 Months, 2013-2018 Months by Zone, 2018 Months by Zone, 2018 100% 100% 100% 100%

90% 6 90% 2 90% 493 90% 25 11 3 35 12 31 80% 49 80% 5 5 80% 80% 17 10 283 812 635 650 575 83 37 70% 16 70% 2 70% 424 70% 26 60% 13 60% 60% 60% 50% 34 50% 6 3 15 50% 539 50% 28 21 40% 11 43 40% 6 230 243 7 40% 40% 34 9 178 245 187 5 30% 27 30% 17 30% 10 198 30% 20% 20% 4 0 6 252 34 13 3 20% 152 182 20 888 20% 20 10% 7 10% 2 70 6 6 2 5 3 12 1 3 341 29 1 10% 10% 0% 0 0 0% 0 0 148 155 172 66 21 9 10 11 5 0% 0% 2013 2014 2015 2016 2017 2018 2013 2014 2015 2016 2017 2018

0 Dose 1-3 doses 4-6 doses 7+ doses 0 dose 1-3 doses 4-6 doses 7+ doses 0 dose 1-3 doses 4-6 doses 7+ doses 0 Dose 1-3 Doses 4-6 Doses 7+ Doses Graph no.-22 Graph no.-19 Graph no.-20 Graph no.-21 ▪ 17 zero dose AFP cases reported in 2018 from inaccessible and partially accessible areas of South (n=10) and Central (n=7) zones. ▪ 12 AFP cases with zero doses reported in 2018 are in the age group of 6-59 moths and the remaining 5 AFP cases with zero dose are out of the 5-59 months age group Week-26 Somalia Weekly EPI/POL Update

Immunity profile of NP-AFP cases and Contacts combined by Zone 2012-2018

SOMALILAND CENTRAL 100% 100% 230 80% 114 80% 92 234 430 294 156 178 82 268 273 60% 145 187 60% 306 40% 66 40% 81 56 119 59 27 76 20% 16 52 62 40 20% 484 51 53 78 25 58 51 36 25 127 23 27 58 69 26 0% 14 12 5 0 0 04 0% 29 2013 2014 2015 2016 2017 2018 2013 2014 2015 2016 2017 2018

0 dose 1-3 doses 4-6 doses 7+ doses 0 dose 1-3 doses 4-6 doses 7+ doses

Graph no.-24 Graph no.-25 SOUTH PUNTLAND 100% 100% 87 57 81 78 57 80% 77 100 80% 54 123 52 38 105 97 97 102 74 84 60% 36 60% 32 50 55 40% 68 77 85 40% 47 16 48 48 36 317 23 60 20% 101 20% 39 62 77 97 99 26 40 34 38 29 18 0% 0% 13 0 4 0 2013 2014 2015 2016 2017 2018 2013 2014 2015 2016 2017 2018

0 dose 1-3 doses 4-6 doses 7+ doses 0 dose 1-3 doses 4-6 doses 7+ doses

Graph no.-26 Graph no.-27 Part -IV Routine Immunization Routine Immunization coverage by zone, Somalia 2016-2018(1st quarter)

2016 2017 2018 (1st Q) 100 96

89 90 90 87 85.7 81 81 80.6 80 76 75 73 7373.8 7374.3 72 72 71 71 71 71 71.8 69 70 66 67.4 67.3 64 62 63.1 6362.1 60.3 60 59 58.7 5859 60 5756.5 57 5755.7 57 57 54 54 54 54 54.6 52 53 50 50 46 4645.7 43.9 44.2 43 43 43.3 39 38.4 40.5 40 35.2 31.2 30

10 5 0 0

P-1 P-3 P-1 P-3 P-1 P-3 P-1 P-3

IPV IPV IPV IPV

BCG BCG BCG BCG

OPV-3 OPV-3 OPV-3 OPV-3

Measles Measles Measles Measles PUNTLAND SOMALILAND SOUTH CENTERAL SOMALIA Somalia Monitoring chart 2016 350000 100%

90% 300000

80%

250000 70%

60% 200000

50%

150000 40%

30% 100000

20%

50000 10%

0 0% Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Sum of Pent1 24215 48781 73263 98229 124707 152394 181148 207148 235011 266781 299618 331481 Sum of Penta3 27543 48616 70816 91732 113674 136589 160723 181282 203464 229673 256554 283080 Sum of Measles 18379 39266 60502 81562 103608 127044 150435 174056 193371 209302 230710 249465 Sum of Montly target on surval% 8% 17% 25% 33% 42% 50% 58% 67% 75% 83% 92% 100% Sum of P-1% 5% 10% 15% 20% 25% 30% 36% 41% 47% 53% 60% 66% Sum of P-3% 5% 10% 14% 18% 23% 27% 32% 36% 41% 46% 51% 56% Sum of Measles% 4% 8% 12% 16% 21% 25% 30% 35% 39% 42% 46% 50% Somalia Monitoring Chart 2017 450000 100%

400000 90%

80% 350000

70% 300000

60% 250000

50%

200000 40%

150000 30%

100000 20%

50000 10%

0 0% Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Sum of Pent1 31367 61990 89840 119005 148901 178493 215415 247586 280838 316732 347716 390910 Sum of Penta3 26790 53670 77763 102433 127572 152696 178791 203443 232459 264569 291804 327981 Sum of Measles 20594 44105 64886 89207 115739 139255 166186 190981 216931 245101 272845 310220 Sum of Montly target on surval% 8% 17% 25% 33% 42% 50% 58% 67% 75% 83% 92% 100% Sum of P-1% 6% 12% 17% 23% 29% 34% 42% 48% 54% 61% 67% 75% Sum of P-3% 5% 10% 15% 20% 25% 29% 34% 39% 45% 51% 56% 63% Sum of Measles% 4% 8% 13% 17% 22% 27% 32% 37% 42% 47% 53% 60% Somalia Monitoring Chart 2018 120000 100%

90%

100000 80%

70% 80000

60%

60000 50%

40%

40000 30%

20% 20000

10%

0 0% Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Sum of BCG 26236 56728 77239 Sum of Pent1 37081 71460 96358 Sum of Penta3 31324 61096 83426 Sum of Measles 31908 63535 90555 Sum of Montly target on surval% 8% 17% 25% 33% 42% 50% 58% 67% 75% 83% 92% 100% Sum of P-1% 7% 13% 18% Sum of P-3% 6% 11% 16% Sum of Measles% 6% 12% 17% Week-24 Somalia Weekly EPI/POL Update

C4D and Cold Chain Management Week-26 Somalia Weekly EPI/POL Update C4D Updates (1) Timelines of major activities SN Activities Dates Participants Places 1 Training of trainers' sessions 18-19 June RSMCs and DSMCs Mogadishu 2 Cascade training sessions 23-25 June CMs Various Districts Orientation session for 3 20 June NIAG Members Mogadishu religious leaders Local leaders of 4 Local Cross Border meetings 24-26 June Border districts neighbour countries Radios & TV stations in 5 Radio and TV broadcasts 03-12 July Media Agency LTA all 6 regions 6-12July Joint CMs teams Border districts 6 House-to-house sensitization 5-12July CMs Other districts 7 Launching Ceremony 08 June MoH C4D Trainings sessions conducted for the outbreak response campaigns

Campaigns Synchroniz Training participants 1st round 2nd round 3rd round IPV ed mOPV2 mOPV2 mOPV2 mOPV2 campaign campaign # RSMCs 3 3 3 3 7 trained # DSMCs 30 30 33 32 31 trained # CMs trained 871 871 893 893 600 # NIAG members 0 12 12 12 18 trained # Post campaign Supervisors & 0 0 16 16 21 Monitors trained Families awareness Level SCZ (3 Regions)-mOPV-2 Campaigns

100% 98% 93% 90% 90%

80%

70%

60%

50%

40%

30%

20%

10%

Source: Post campaign IM Data Campaign-1 Campaign-2 Campaign-3 Missed Children per District (mOPV2 Campaigns)

35%

30% 30%

25%

20% 19% 17%

15%

12%

11% 11%

10%

8% 8%

7% 7%

6% 6% 6% 6%

5% 5% 5% 5% 5% 5%

4% 4% 4% 4% 4%

5% 4%

3% 3% 3% 3% 3% 3% 3%

2% 2% 2% 2% 2% 2% 2%

1% 1%

0% 0% 0% 0% 0%

Source: Post campaign IM Data Campaign-1 Campaign-2 Campaign-3

Parents’ Awareness per District

100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%

100%

99%

99% 99%

99%

98%

98% 98%

98%

97%

96%

96% 96% 96% 96% 96%

100% 96%

96%

95%

94%

93%

91%

90% 89%

90% 88% 77%

80% 76%

75% 74%

70% 69% 60% 60%

50%

40%

30%

20%

10% 7%

Source: Post campaign IM Data Campaign-1 Campaign-2 Campaign-3 Religious & Fatigue related refusals among total refusals per District Religious refusals Fatigue Refusals

WARSHEIKH WARSHEIKH MAHADAY MAHADAY BALAD BALAD JOWHAR JOWHAR WANLAWEIN 27% WANLAWEIN 12% AFGOI AFGOI MARKA MARKA Abdiaziz Abdiaziz Heliwa Heliwa Yaqshiid Yaqshiid Karaan Karaan Daynile Daynile Howlwadag Howlwadag War Dhigley War Dhigley Hodan Hodan Waberi Waberi H/Jajab H/Jajab H/weyne H/weyne Dharkenley Dharkenley Madiina Madiina 19.4% Shangaani Shangaani Bondhere Bondhere Shibis Shibis 0.0% 5.0% 10.0% 15.0% 20.0% 25.0% 0.0% 5.0% 10.0% 15.0% 20.0% 25.0% 30.0% Campaign-3 Campaign-2 Campaign-1 Campaign-3 Campaign-2 Campaign-1 Source: Post campaign IM Data Performance of C4D activities - NIDs 2017 (IM)

Parents’ Awareness Information Sources 100% 60% 96% 95% 80% 92% 40%

60% 20%

40%

Social… Social…

20% Social…

Radio (%) Radio (%) Radio (%) Radio

Other (%)* Other (%)* Other (%)* Other

Religious and… Religious and… Religious and… Religious

Television (%) Television (%) Television (%) Television

Health workers /… workers Health /… workers Health /… workers Health

Megaphone / PA… / Megaphone PA… / Megaphone 0% PA… / Megaphone Feb 17 Apr 17 Dec 17 Feb-17 Apr-17 Dec-17

Missed Children Reasons for Missed Children 6.00% 60% 57% 5.15% 50% 4.00% 4.40% 47% 4.00% 40% 44% 38% 34% 30% 32%

20% 24% 2.00% 10% 15% 9% 0% 0.00% N/Available Team Performance Refusal

Feb 17 Apr 17 Dec 17 Feb-17 Apr-17 Dec-17 Week-26 Somalia Weekly EPI/POL Update Vaccines and Cold Chain Management

• All mOPV2 for the June synchronized campaign received in Mogadishu. • The CEEOP operational deployment plan was completed and shared with UNICEF supply division and GAVI. GAVI promised to share Somalia’s new decision letter where all cold chain equipment will be procured in year one. • Routine immunization vaccines required till year end estimated and procurement process ongoing. NB: Vaccine wastage rate reduced from 7% in round one to 6% in round two as per admin data 64 The END