Libya: EWARN & Diseases Surveillance Bulletin

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

2018: Epidemiological Week: 09 Reporting Period: 26 February – 04 March 2018

Highlights

Number of reporting sites in week 09: One hundred and fourteen (114) submitted their weekly reports complete and in timely manner.

Total number of consultations in week 09: 42,878 marking a decrease of 3,596 to last week consultation of 46,474. The number of consultations for other disease this was week was 36,424.

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Leading causes of morbidity in week 09: Acute Upper Respiratory Infections (AURI) (n=4681; 10.92% of consultations number), Acute Lower Respiratory Infections (ALRI) (n=1254; 2.92%) and acute diarrhea (AD) (n=1168; 2.72%) remained the leading causes of morbidity this reporting week.

Number of alerts in week 09: Thirteen (13) 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 9 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 - 09 2018 140

120

100

60 119 121 118 104 40 86

20 40

0 Weeks 1 Weeks Weeks Week 01 Week 02 Week 03 Week 04 Week 05 Week 06 Week 07 Week 08 Week 09 - 52 2017 39 - 52 49 - 52 2018 2018 2018 2018 2018 2018 2018 2018 2018 2017 2017

Figure 1. Distribution of reporting health facilities

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Morbidity Patterns:

During week 09, the proportions of AURI and ALRI 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 - 09 2018 7000

6000

5000

4000

3000

2000

1000

0 Weeks 39 Weeks 49 Week 01 Week 02 Week 03 Week 04 Week 05 Week 06 Week 07 Week 08 - 52 2017 - 52 2017 2018 2018 2018 2018 2018 2018 2018 2018

AURI ALRI AD

Figure 2. Distribution of AURI, AD and ALRI in week 1 – 52 2017 and 09 2018 2018 Epidemiological week 09:

Below is the distribution of the leading causes of morbidity by municipalities for the epidemiological week 09.

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Distribution of common disease by municipalities for week 09, 2018 100% 90% 80% 70% 60%

50% ALRI 40% AD 30% AURI 20% 10%

Sert

JALO

GHAT

ZLETIN

ZAWIA

SABHA

Tobruk

YEFRIN

ZWARA

KHOMS

ESBEAA

MRADA

OUBARI

GARIAN

ALKOBA

ZENTAN

MORZIG

TAZIRBU

ALMARIJ

ALJOFRA

ALBAIDA

DARNAH

BENGAZI NESMAA

MEZDAH

ALAJILAT

IGDABYA

ALABYAR

ALKOFRA

ALSWANI

SUBRATA

Ghdames

ALJEMAIL

TRAGHEN

DAWOON

TARHUNA

REGDALIN

IMSALATA

ALZAHRAA

MISURATA

Aljaghboub

ALAZIZIYAH

BANIWALED

ASHATI EAST ASHATI

ASHATI West ASHATI

Souq Eljomaa Souq

ALQARABOULI TRIPOLI central TRIPOLI Qasir BenGhashir Qasir Figure 3. Distribution of common disease by municipalities for week 09, 2018

Trend of pertussis:

In total 313 cases of suspected pertussis have been reported from EWARN sites this year. This week 44 cases were reported and they are distributed as follow: Almarij (1), Imsalata (29), Bengazi (12) and Albaida (2).

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Distribution of S. pertussis reported cases by week and by municipality up to week 09, 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

0 0 33 0 14 0 29 30 0 14 2 01 7 0 24 17 7 0 30 8 12 7 0 0 7 12 12 0 11 9 3 9 7 0 8 0 4 0 3 0 1 1 01 01 2 10 10 2 2 3 2 WEEK 01 2018WEEK 02 2018WEEK 03 2018WEEK 04 2018WEEK 05 2018WEEK 06 2018WEEK 07 2018WEEK 08 2018WEEK 09 2018 Figure 4. Distribution of suspected pertussis cases reported by week and by municipality week 09 2018.

Trend of Acute Upper Respiratory Infections

During week 09, a total of 4681 cases were reported (10.92% of total consultations) and are summed up in table 1 below:

Municipality AURI cases Municipality AURI cases

ALJOFRA 71 ALAJILAT 158

ALKOFRA 79 ALSWANI 32

ALMARIJ 279 ASHATI EAST 74

BANIWALED 216 ASHATI West 24

BENGAZI 714 Tobruk 1

GARIAN 26 Qasir Ben Ghashir 92

IGDABYA 352 YEFRIN 100

IMSALATA 497 MEZDAH 18

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KHOMS 98 TRAGHEN 26

MISURATA 122 ALABYAR 57

MORZIG 27 ALZAHRAA 11

MRADA 10 JALO 13

REGDALIN 44 TAZIRBU 60

SABHA 30 ZENTAN 105

ZAWIA 194 ALQARABOULI 171

ZLETIN 47 DARNAH 111

ZWARA 142 ESBEAA 43

TRIPOLI central 47 2 Aljaghboub 55 105 Souq Eljomaa SUBRATA 81 Ghdames ALKOBA 192 94 Sert Table 1. Summary of AURI cases by Municipality in week 09

Figure 5 below shows the trend of AURI cases in the period from week 01 2017 to week 09/2018 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 09/2018.

The cumulative AURI during this year reached 45,631 cases. Benghazi reported 16% of all cases (7140). 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 09, 2018 7000

6000

5000

4000

3000

2000

1000

Week 01 Week2017 02 Week2017 03 Week2017 04 Week2017 05 Week2017 06 Week2017 07 Week2017 08 Week2017 09 Week2017 10 Week2017 11 Week2017 12 Week2017 13 Week2017 14 Week2017 15 Week2017 16 Week2017 17 Week2017 18 Week2017 19 Week2017 20 Week2017 21 Week2017 22 Week2017 23 Week2017 24 Week2017 25 Week2017 26 Week2017 27 Week2017 28 Week2017 29 Week2017 30 Week2017 31 Week2017 32 Week2017 33 Week2017 34 Week2017 35 Week2017 36 Week2017 37 Week2017 38 Week2017 39 Week2017 40 Week2017 41 Week2017 42 Week2017 43 Week2017 44 Week2017 45 Week2017 46 Week2017 47 Week2017 48 Week2017 49 Week2017 50 Week2017 51 Week2017 52 2017

WWeek 02WWeek 2018 03WWeek 2018 04WWeek 2018 05WWeek 2018 06WWeek 2018 07WWeek 2018 08WWeek 2018 09 2018 WWeek 01 2018 Figure. 5 Distribution of AURI cases by week, week 1 – 52, 2017 and week 09, 2018.

Percentage of AURI cases from the total consultation number by week, week 39 - 52, 2017 and week 09, 2018 16.00

14.00

12.00

10.00

8.00 14.79 13.38 13.7513.71 6.00 12.21 12.65 12.25 12.42 11.5411.33 10.92 10.21 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 Week Week Week Week Week 39 40 41 42 43 44 45 46 47 48 49 50 51 52 01 02 03 04 05 06 07 08 09

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Figure.6 Distribution of AURI percentage by week, week 39 – 52, 2017 and 09, 2018

Trend of Acute Lower Respiratory Infection:

During week 09, a total of 1254 cases of acute lower respiratory infections were reported (2.92% of total consultations) and are summarised by municipality in Table 2 below:

Municipality ALRI cases Municipality ALRI cases

21 98 ALJOFRA ALKOBA ALMARIJ 64 17 ALBAIDA BANIWALED 54 ALAJILAT 85

BENGAZI 92 ASHATI EAST 15

GARIAN 7 Tobruk 21 Qasir Ben IGDABYA 33 Ghashir 88 IMSALATA 23 YEFRIN 15 KHOMS 4 MEZDAH 19 MISURATA 98 TRAGHEN 37 MORZIG 7 ALABYAR 10 REGDALIN 44 JALO 3 SABHA 21 TAZIRBU 20 ZAWIA 38 ALKOBA 7 ZLETIN 28 ALBAIDA 41 TRIPOLI central 50 ZENTAN 51 Souq Eljomaa 23 DARNAH 11 Ghdames 8 ESBEAA 44 Sert 32 SUBRATA 73 Table 2. Summary of ALRI cases by Municipality in week 09

Figure 7 below shows the trend of ALRI cases in the period from week 01 2017 to week 09/2018 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 09/2018.

The cumulative ALRI during this year reached 11,853 cases. Baniwaled reported 10% of all cases (1168). 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 09, 2018 2000

1800

1600

1400

1200

1000

800

600

400

200

WWeek 02WWeek 2018 03WWeek 2018 04WWeek 2018 05WWeek 2018 06WWeek 2018 07WWeek 2018 08WWeek 2018 09 2018 WWeek 01 2018 Figure. 7 Distribution of ALRI cases by week, week 1 – 52, 2017 and week 09, 2018.

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Percentage of ALRI cases from the total consultation number by week, week 39 - 52, 2017 and week 09, 2018 5.00

4.50

4.00

3.50

3.00

2.50 4.37 2.00 3.72 3.38 3.28 3.15 1.50 3.05 3.11 2.93 2.92 2.60 2.59 2.64 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 Week Week Week Week Week 39 40 41 42 43 44 45 46 47 48 49 50 51 52 01 02 03 04 05 06 07 08 09

Figure.8 Distribution of ALRI percentage by week, week 39 – 52, 2017 and week 09, 2018

Trend of Acute Diarrhea

During week 09, a total of 1168 (2.72% of total consultations) cases of Acute Diarrhea were reported and are summerised per municipality in Table 3 below:

Municipality AD cases Municipality AD cases

ALJOFRA 20 ALKOBA 121

ALKOFRA 9 ALBAIDA 26

ALMARIJ 101 ALAJILAT 79

BANIWALED 90 ALSWANI 9

BENGAZI 228 Tobruk 12

GARIAN 2 TRAGHEN 14

55 9 IGDABYA ALABYAR IMSALATA 77 6 ALZAHRAA

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MISURATA 60 JALO 1

REGDALIN 40 TAZIRBU 16

SABHA 13 ZENTAN 20

ZAWIA 42 8 ALQARABOULI ZLETIN 32 4 DARNAH TRIPOLI central 20 Ghdames 9

Souq Eljomaa 17 SUBRATA 28

Table 3. Summary of AD cases by Municipality in week 09 Figure 5 below shows the trend of AD cases in the period from week 01 2017 to week 09/2018 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 09/2018.

The cumulative AD during this year reached 10,281 cases. Bengazi reported 22% of all cases (2228). 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 09, 2018 1600

1400

1200

1000

800

600

400

200

WWeek 02WWeek 2018 03WWeek 2018 04WWeek 2018 05WWeek 2018 06WWeek 2018 07WWeek 2018 08WWeek 2018 09 2018 WWeek 01 2018 Figure 9. Distribution of AD cases by week, week 1 – 52, 2017 and week 09, 2018.

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Percentage of AD cases from the total consultation number by week, week 39 - 52, 2017 and week 09, 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 2.72 2.58 2.59 2.61 2.63 2.58 2.50 2.50 2.21 2.23 1.00 2.19 2.17 2.16 2.10 2.18

0.50 0.59 0.00 week week week week week 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 05 06 07 08 09

Figure 10. Distribution of AD percentage by week, week 39 – 52, 2017 and week 09, 2018

Trend of vaccine preventable diseases:

Durign week 09, 53 VPD cases was reported and they are summerised in the table below:

VPD No of Cases Municipality Age Sex Pertussis 44 Bengazi (12), Below 5 years Female (22) Male (22) Almarij (1), (40) above Imsalata (29) five years (4) and Albaida (2) Measles 8 Albaida (1), Below 5 years Male (4) and females (4) Tripoli central (6) above five (1) and Bengazi years (2) (6) AFP 1 Misurata above 5 years male

Summary of all cases reported in week 09:

Disease No of cases Percentage from total consultations AURI 4681 10.92

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ALRI 1254 2.92 AD 1168 2.72 BD 7 0.02 AJS 11 0.03 Leishmania 32 0.07 Pertussis 44 0.10 Measles 8 0.02 AFP 1 0.00 Food Poisoning 16 0.04

Alerts & Outbreaks Thirteen (13) 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 Yes No DK No central 2 AJS Almarij 3 Yes No DK No 3 Pertussis Benghazi 12 No No DK No 4 Pertussis Albaida 2 No No DK No 5 Pertussis Imsalata 29 No No DK No 6 Pertussis Almarij 1 No No DK No 7 Leishmania Zletin 3 Yes Clinical Yes No Diagnosis 8 Leishmania Regdalin 7 Yes Clinical Yes No Diagnosis 9 Leishmania Khoms 22 Yes Clinical Yes No Diagnosis 10 measles Bengazi 6 Yes Yes DK No 11 measles Tripoli 1 Yes Yes DK No central 12 measles Albaida 1 Yes Yes DK No 13 AFP Misurata 1 Yes Yes DK No

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