Somalia Weekly Update Week-07 Ending 18 February 2018 cVDPV2 update

• 3 new VDPV2s are isolated Site name: 21October site Site name: Kawma from 2 environmental samples 3 VDPV2s isolated from 2 3 VDPLV2s isolated from 2 collected from an ES site called Samples-2017 samples-2018 ‘KAWMA' sewage site, in Hamerewoini- in Banadir region in Central zone • Samples were collected one week apart on 4th and 11th of January 2018 • Sequencing results were received from the CDC on February 10, 2018 • The VDPV2 from the first sample had 44 and 38 NT different from the parent Sabin and the second was 40 NT • 1 sample is pending for sequencing: (ES/SOM/BAN/HMW/KAWMA-1/18/004) • The 3 new viruses are genetically linked to previous ES viruses detected in 21October site. • These are classified as cVDPV2 as per guidelines

• Kawma sewage site was established on 20th September 2017 and a total of 16 samples were collected since establishment. • Kawma ES site is 3.9 km away from 21October ES site Somalia cVDPV2 update

List of ES samples sent for Sequencing in 2017 and 2018 and summary of final classification

Date sent Date of Date of Sample Final NT Deference Region District Site name Year Epid. Number for Sequencing Collection Classification from parent Sequencing result

Banadir Waberi 21October 2017 ES/SOM/BAN/WBR-TOO-17-002 22-Oct-17 cVDPV2 02-Nov-17 38 nt 09-Nov-17

Banadir Waberi 21October 2017 ES/SOM/BAN/WBR-TOO-17-003 2-Nov-17 cVDPV2 36 & 37 nt

Banadir Hamerewoini Kawma 2017 ES/SOM/BAN/HMW/KAWMA-1/17/009 21-Dec-17 SL-2 2-Feb-18 10-Feb-17

Banadir Hamerewoini Kawma 2017 ES/SOM/BAN/HMW/KAWMA-1/17/010 28-Dec-17 SL-2 2-Feb-18 10-Feb-17

Banadir Hamerewoini Kawma 2018 ES/SOM/BAN/HMW/KAWMA-1/18/001 4-Jan-18 cVDPV2 2-Feb-18 44 & 38 nt 10-Feb-17

Banadir Hamerewoini Kawma 2018 ES/SOM/BAN/HMW/KAWMA-1/18/002 11-Jan-18 cVDPV2 2-Feb-18 40 nt 10-Feb-17

Banadir Hamerewoini Kawma 2018 ES/SOM/BAN/HMW/KAWMA-1/18/003 18-Jan-18 SL-2 2-Feb-18 10-Feb-17

Banadir Hamerewoini Kawma 2018 ES/SOM/BAN/HMW/KAWMA-1/18/004 25-Jan-18 SL-2 2-Feb-18 10-Feb-17 Part –I

AFP-Surveillance Week-07 Somalia Weekly EPI/POL Update

Epidemiological Curve 01 January 2014 – 19 February 2018

18

16

14

12

10

8

6

4

2

0

Pending Lab Pending ERG Discarded Compatable WPV aVDPV Graph no. 1 Week-07 Somalia Weekly EPI/POL Update

Weekly AFP cases reported by Provinces, 2016-2017 Somalia. (cases are distributed across weeks based on date of onset of paralysis).

PROVINCE

2017W09 2017W10 2017W11 2017W12 2017W13 2017W14 2017W15 2017W16 2017W17 2017W18 2017W19 2017W20 2017W21 2017W22 2017W23 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

Total 2016 Total 2017 Total 2018 Total BANADIR 30 1 3 1 2 1 1 1 1 1 2 1 1 2 2 2 1 2 1 1 1 33 2 1 3 GALGADUD 25 1 1 2 1 1 1 1 1 2 1 1 2 1 1 1 1 1 1 1 27 1 2 1 1 5 M. SHABELLE 19 1 1 1 1 1 1 1 1 1 1 1 1 1 2 1 1 1 1 1 1 24 1 1 1 3 L. SHABELLE 24 1 2 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 2 1 1 2 1 1 1 31 1 1 HIRAN 15 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 21 1 1 2 BARI 24 1 1 2 1 1 1 1 1 2 1 1 1 1 1 1 1 1 1 24 3 3 NUGAL 11 1 1 1 1 1 1 1 1 10 1 1 14 1 1 1 1 1 1 1 1 12 1 1 2 TOGDHER 11 1 1 1 1 1 1 9 1 1 GALBEED 19 1 1 1 1 1 1 1 2 1 2 1 2 20 1 1 SANAQ 7 1 1 1 1 1 6 0 AWDAL 18 1 1 1 1 1 1 1 1 1 1 1 17 1 2 1 4 SAHIL 8 1 1 1 1 1 1 1 8 1 1 2 SOOL 5 2 1 1 1 1 1 2 1 11 1 1

LOWER JUBA 26 2 2 1 1 1 1 1 1 1 1 2 2 1 1 1 1 1 1 1 1 1 29 2 2 1 - BAY 19 3 1 1 1 1 1 1 1 1 2 2 2 1 22 0 21 1 1 1 1 1 1 1 1 1 1 2 2 1 1 1 20 1 1 11 1 1 1 2 1 2 1 1 11 1 1

BAKOOL 9 1 1 1 1 1 1 1 1 10 1 1 no. Table Total Somalia 316 7 12 8 6 9 8 8 4 10 8 6 9 8 5 9 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 3 4 2 34

Silent (not reporting) for > 8 weeks - 5 new AFP cases were reported last week making the total AFP cases reported in 2018 34 from 17 regions. Reported AFP cases - Sanaq region from Somaliland is silent and has not reported for more than 8 consecutive weeks - Only Nugal and Bay region are not reported AFP case in 2018 Community Samples collected in silent regions Community Samples collected but regions not silent Week-07 Somalia Weekly EPI/POL Update

Classification of AFP cases by status (2017 & 2018)

2017 2018 REGION Discarded Pending Total Discarded Pending Total Cases 34 AFP BANADIR 33 0 33 2 1 3 Reported in 2018 M. SHABELLE 27 0 27 3 2 5 HIRAN 21 0 21 2 0 2 BARI 30 1 31 1 0 1 NUGAL 24 0 24 1 2 3 GALGADUD 24 0 24 2 1 3 MUDUG 11 1 12 2 0 2 0 21 0 13 0 TOGDHER 10 0 10 0 1 1 Compatibl Discarded GALBEED 16 1 17 3 1 4 WPV Pending e VDPV SANAQ 20 0 20 1 0 1 AWDAL 8 0 8 2 0 2 SAHIL 6 0 6 0 0 SOOL 11 0 11 0 1 1 9 0 9 1 0 1 GEDO 10 0 10 0 1 1

0 0 21 1 22 0 0 2 13 MIDDLE JUBA - In process (lab) Pending ERG Pending ITD BAY 20 0 20 1 0 1 29 0 29 0 2 2 L. SHABELLE 11 0 11 0 1 1

Chart no. 1 no. Table Grand Total 341 4 345 21 13 34 Week-07 Somalia Weekly EPI/POL Update

Surveillance Indicators by Zone and Region 2018

Annualized NP-AFP Rate by Zone, 2017 12.0

10.0 11.3

8.0

6.0

4.0 5.3 4.8 4.1 2.0 2.9 0.0 Central Puntland Somaliland South Total Somalia Graph no. 2

Annualized NP-AFP rate by accessibility status 10.0

8.0

6.0 5.5 4.0 4.8 3.6 2.0 2.9 - In-accessible Partially Accessible Somalia Acceessible Map no. 1 Map no. 2 Graph no. 3 Week-07 Somalia Weekly EPI/POL Update

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

. 34 districts reported at least 1 AFP case each the first 5 weeks of 2018. . All districts (n=32) reporting AFP cases in 2018 have annualized NP-AFP rate above 2 per 100,00 and also Stool adequacy rate is above 80%. . The remaining 83 districts have not reported any AFP case in 2018; However, there is no district in Somalia which is silent for more than 52 consecutive weeks.

Map no. 3 Map no. 4 Week-07 Somalia Weekly EPI/POL Update

Number of NP-AFP cases reported across years during the same period (2012-2018) by zone 60

50 52 50

40 40

34 30 33

20 23

14 15 15 14 15 15 10 11 11 9 8 8 8 9 7 6 6 0 0 4 4 1 1 5 2 0 CENTRAL PUNTLAND SOMALILAND SOUTH SOMALIA 2013 2014 2015 2016 2017 2018

. Less number of AFPs reported in Somalia in general and also in all zones compared to number of reported AFP cases last year during the same period. Week-07 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

100% 100% 14 6 9 5 34 3 5 2 1 3 3 2 1 4 1 2 1 1 1 1 2 1 34 90% 90%

80% 80%

70% 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

• All the 34 AFP cases reported in 2018 were notified within 7 days of onset of paralysis. • Sanaq and Bay regions did not report AFP cases in 2018 Week-07 Somalia Weekly EPI/POL Update

Summary of AFP surveillance key indicators by Zone, 2018

-

. .

S L S

NP NP EV Adq

% Stool % Inv. % Notif. with NP with

ZONE Adq. within 48 within 7 with

AFP AFP Rate

cond. -

hrs. days Isolated

Specimen

# # AFP cases

EVIsolated

good good cond.

NP

virus virus Isolation

Virus Isolation

of samples of samples

# Cases # Cases with

% of cases % of cases

% 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 14 4.1 14 100% 100% 100% 5 9 9 100% 0 0% 0 0% Puntland 6 11.3 6 100% 100% 100% 2 4 4 100% 0 0% 1 25% Somaliland 9 5.3 9 100% 100% 100% 2 7 7 100% 0 0% 0 0% South 5 2.9 5 100% 100% 100% 4 1 1 100% 0 0% 1 100% Total 34 4.8 34 100% 100% 100% 13 21 21 100% 0 0% 2 10%

Table no.-4 Week-07 Somalia Weekly EPI/POL Update

Summary of AFP surveillance key indicators by Province, 2018

% Samples Number of AFP % Notif. within 7 % cases with # Cases with late 60 ZONE PROVINCE NP-AFP Rate % Stool Adq. % inv. within 48 hrs. % Stool condition with EV cases reported days SL isolated days follow-up isolated BANADIR 3 2.3 100% 100% 100% 100% 0% 0% GALGADUD 5 16.2 100% 100% 100% 100% 0% 0% CENTRAL HIRAN 2 7.4 100% 100% 100% 100% 0% 0% 1 0.9 100% 100% 100% 100% 0% 0% 3 6.9 100% 100% 100% 100% 0% 0% BARI 3 14.3 100% 100% 100% 100% 0% 33% PUNTLAND MUDUG 2 9.3 100% 100% 100% 100% 0% 0% NUGAL 1 9.5 100% 100% 100% 100% 0% 0% AWDAL 4 14.2 100% 100% 100% 100% 0% 0% GALBEED 1 1.6 100% 100% 100% 100% 0% 0% SAHIL 2 20.2 100% 100% 100% 100% 0% 0% SOMALILAND SANAQ 0 0.0 ------0% --- SOOL 1 7.2 100% 100% 100% 100% 0% 0% TOGDHER 1 2.7 100% 100% 100% 100% 0% 0% BAKOOL 1 4.7 100% 100% 100% 100% 0% 0% BAY 0 0.0 ------0% --- SOUTH GEDO 1 2.8 100% 100% 100% 100% 0% 100% LOWER JUBA 2 5.8 100% 100% 100% 100% 0% 0% MIDDLE JUBA 1 5.3 100% 100% 100% 100% 0% 0% 0% SOMALIA 34 4.8 100% 100% 100% 100% 10% Week-02 Somalia Weekly EPI/POL Update

Summary for Somalia Environmental Surveillance

Epidemiological week 2017 Epidemiological week 2018

Region District Name of Sites 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

Banadir Waberi 10 Twenty One October Oct Banadir Shangani 10 Urobo Oct Banadir Hamerewoini 10 Kawma Oct 10 Banadir Hodan Egyptian Hospital Oct

Legend

1 Not scheduled 6 Sabin 11 WPV1+cVDPV2

2 Pending 7 NPENT + Sabin 12 Sent for sequencing

3 Negative 8 VDPV2 13 Scheduled but not collected

4 NEV 9 WPV1 14 Sabin 2

5 NPENT 10 WPV3 15 Sabin + NPEV + NEV Week-07 Somalia Weekly EPI/POL Update

Summary of AFP surveillance key indicators for contacts, 2018

% Contact # Contact # Contact # Specimens % Specimens # Contacts % contacts collected with stool in pending lab with NPEV with NPEV with Sabin with Sabin within 7 days Good results isolated Isolated virus like virus # Contact Average of AFP Condition isolated Isolated # AFP # % contacts < 5 ZONE samples with contacts per notified Cases CONTACTS age Lab result cases

Central 14 42 27 3 100% 100% 27 15 0 0 0 0

Puntland 6 18 12 3 100% 100% 12 6 0 0 0 0

Somaliland 9 27 21 3 100% 100% 21 6 0 0 0 0

South 5 15 3 3 100% 100% 3 12 0 0 0 0

Somalia 34 102 63 3 100% 100% 63 39 0 0 0 0

Table no.-5 Week-07 Somalia Weekly EPI/POL Update

Distribution of AFP cases by source of case notification, 2017

Source of AFP cases notification 2012-2018 100% Number Number # of cases Proportion of 48 50 4 90% 64 Zone of VPVs of cases Notified by cases reported 138 80% 253 reported VPV by VPV 79 9 70% 105 104 74 60% CENTRAL 190 14 9 64% 50% 131 40% PUNTLAND 105 6 4 67% 30% 21 268 191 67 143 163 20% 151 SOMALILAND 10% 81 9 6 67%

0% 2 25 2012 2013 2014 2015 2016 2017 2018 Year of onset SOUTH 159 5 2 40% VPV HFs Other Key: 1. VPVs: Village polio volunteers 34 21 62% 2. HFs: MCH, Hospitals and Private clinics Somalia 535 3. Others: community members, district field assistants, traditional healers Table no.-6 Week-07 Somalia Weekly EPI/POL Update

AFP cases by specific sources notification 2012-2018

NOTIFIED BY COMMUNITY AND VOLUNTEERS NOTIFIED BY COMMUNITY AND VOLUNTEERS NOTIFIED BY HEALTH FACILITIES 300 250 300

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 7 10 50 21 1 72 53 5 7 50 50 9 77 5 1 0 41 36 28 31 28 33 40 22 8 4 4 31 25 3 6 20 12 14 8 12 3 20 0 2 8 1 301 14 40 0 0 0 0 0 9 18 24 17 21 0 1 1 4 5 0 6 05 1 70 2012 2013 2014 2015 2016 2017 2018 0 20 3 2 0 0 0 0 2012 2013 2014 2015 2016 2017 2018 2012 2013 2014 2015 2016 2017 2018 HEALTH POST HOSPITAL CAMPAIGNS DISTRICT FIELD ASST DPO MCH PRIVATE CLINIC CHW COMMUNITY HOUSEHOLD VOLUNTEERS NID VACCINATOR OTHER TRADITIONAL HEALER PRIVATE PHARMACY Week-07 Somalia Weekly EPI/POL Update

AFP surveillance indicators by accessibility status of districts

% % of % of % of % cases # of AFP # of Cases NP AFP Number of % inv. Specim U-15 Pop in Cases Stool Notif. with # of districts cases reported rate cases with Within ens Accessibility this area reported adequac within Sabin Reported by VPVs lab result 48 hrs. with by VPVs y 7 days like virus NPEV

Inaccessible 17 619,320 2 2 100% 2.9 0 100% 100% 100% 0% 0%

Partially 23 1,720,826 7 4 57% 3.6 3 100% 100% 100% 0% 0% accessible

Accessible 75 4,024,663 25 15 60% 5.5 16 100% 100% 100% 0% 13%

National 115 6,364,810 34 21 62% 4.8 13 100% 100% 100% 0% 10% Table no.

- 7 7 Week-07 Somalia Weekly EPI/POL Update

AFP surveillance indicators by Life Style of Population 2018

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

Nomadic 28.8% 7 6 86% 4.0 4 100% 100% 100% 100% 0% 0%

Rural 25.9% 16 9 56% 8.8 10 70% 100% 100% 100% 0% 20%

Urban 45.3% 11 6 55% 2.9 7 100% 100% 100% 100% 0% 0%

National 100% 34 21 62% 4.9 21 86% 100% 100% 100% 0% 10% Week-07 Somalia Weekly EPI/POL Update

Total AFP cases Tracking lab results of AFP cases 34

Tracking AFP with stool specimens Total AFP cases Total AFP cases with stool without stool specimens specimens 34 0 2 cVDPV2

13 Other viruses With lab En route In the lab

neg st results 21 0 13 19 in lab

en route cVDPV2 SL EV -ve 0 2 0 19 Note: Both SL and EV was found in 4 samples Week-07 Somalia Weekly EPI/POL Update

Lab performance indicators for AFP surveillance in Somalia, 2017 Sample # # Specimen # Specimens # Specimen % of specimen Number of % of Number of % of source Specimen with culture pending lab with culture with culture specimen specimen Specimens Specimen collected result result result within result within 14 with NPEV with with Sabin s with days 14 days NPEV isolation Sabin isolation

Cases 68 42 26 36 86% 0 0% 2 10%

Contacts 102 63 39 54 86% 0 0% 0 0%

Total 170 105 65 90 86% 0 0% 2 2%

Table no.-10 Week-07 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: no data Median: no data Median: no data Median: no data 1 day Average: 3.no data Average: no data Average: no data Average: no data

Date second Median: no data Date final stool ITD results collected Average: no data Chart no. 2 Week-07 Somalia Weekly Polio Update

Village polio volunteers weekly house to house visit and AFP cases notified , 19 February 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 No. of No. of No. of Central No. of No. of No. of No. of No. of No. of AFP No. of AFP No. of No. of No. of No. of AFP No. of AFP No. of AFP AFP AFP AFP AFP AFP AFP HH HH AFP cases HH HH HH cases HH cases HH HH HH HH cases HH cases HH cases cases cases cases cases cases cases visited visited notified visited visited visited notifie visited notifie visited visited visited visited notifie visited notifie visited notifie notified notified notified notified notified notified d d d d d

38002 5 19544 4 0 0 0 0 0 0 0 0 0 0 0 0 0 - 0 - 0 - 0 Central -

35756 1 18477 2 0 0 0 0 0 0 0 0 0 0 0 0 0 - 0 - 0 - 0 South -

16237 2 7953 1 0 0 0 0 0 0 0 0 0 0 0 0 0 - 0 - 0 - 0 Puntland -

32180 6 16235 0 0 0 0 0 0 0 0 0 0 0 0 0 0 - 0 - 0 - 0 Somaliland -

122175 14 62209 7 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Total 0 0 0 Week-07 Somalia Weekly Polio Update

Routine Immunization Services, status of Cold Chain & Vaccine stocks in AFP Surveillance Sites. 19 February 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 sites visits routine EPI service cold chain vaccine available Region No No. % No. % No. % No. %

Nugal 33 19 58% 19 100% 19 100% 18 95% Bari 116 34 29% 32 94% 34 100% 33 97% Mudug 58 39 67% 38 97% 38 97% 23 61% 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 28 10 36% 10 100% 10 100% 10 100% 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% 18 95% 19 106% Hiran 24 24 100% 5 21% 23 96% 23 100% Galgadud 38 25 66% 18 72% 24 96% 15 63% Banadir 122 63 52% 25 40% 59 94% 63 107% Lower Shabelle 56 28 50% 15 54% 27 96% 23 85% Middle Juba 29 1 3% 0 0% 1 100% 0 0% Bakool 26 10 38% 10 100% 10 100% 10 100% Gedo 53 21 40% 20 95% 20 95% 19 95% Bay 75 30 40% 30 100% 30 100% 30 100% Lower Juba 52 24 46% 24 100% 24 100% 20 83% Somalia 933 435 47% 349 80% 425 98% 392 92% Part -II

Fever and rash Surveillance Week-07 Somalia Weekly Polio Update

Epi-curve on suspected measles cases by week, Somalia (Week 20, 2015-Week 05, 2018) 800 2015 2016 2017 (n=7498) (n=5657) (n=23,353)

700 2018

720

703

699

696

693

686

685

670

663 657

600

584

560 554

500 538

507

496

488

487

463

444

441 441

440 436

400 436

426

416 416

410

408

406

401

400

399

393

389

383

373

362

352

351

349 346

300 330

325

320

317

315

309

290

286

277 255

200 228

222

214

210

208

199

196

182

180

175

174

173

172

170

163

161

158

156

155

154

151

149

145

144

142

141

140 140

134

133 132

100 128

127 127

125 125

124 124

122 122 122

117

116

115 115

113

112

111

109 109

107

105 105

98

97

103

96

102 102 102

95 95

101

100

93 93

92

91

90 90

89

88 88

87 87

86 86

85 85

84 84

83

82

81

79

76 76

74 74

72 72

71

70

67

66 60

0

- 272 Suspected cases reported since beginning of 2018 Week-07 Somalia Weekly Polio Update

Fever & Rush cases reported by AFP surveillance System 19 February 2018

Fever and Rash Cases by weekly 2018

Region

W1 W2 W3 W4 W5 W6

Total Total 2017 Total 2018

W30 W31 W32 W33 W34 W35 W36 W37 W38 W39 W40 W41 W42 W43 W44 W45 W46 W47 W48 W49 W50 W51 W52 Nugal 42 53 70 82 54 46 41 31 44 200 109 91 62 84 100 118 113 96 94 63 58 49 45 2050 32 26 26 26 24 19 153 Bari 47 62 44 34 56 39 26 50 35 38 36 35 22 44 44 33 33 24 42 35 34 27 28 1968 21 26 20 17 20 26 130 Mudug 73 51 42 51 37 32 56 61 49 64 77 85 72 73 64 61 115 63 65 61 67 65 63 2566 47 45 36 27 44 25 224 N/East Zone 162 166 156 167 147 117 123 142 128 302 222 211 156 201 208 212 261 183 201 159 159 141 136 6584 100 97 82 70 88 70 507 Galbeed 13 5 3 2 1 2 1 4 5 2 1 6 7 2 6 0 3 7 4 2 1 3 3 758 4 2 4 7 1 4 22 Sahil 2 3 0 5 0 4 0 2 1 1 0 1 0 2 0 0 0 3 1 4 0 2 0 576 2 0 9 2 13 5 31 Sanag 10 16 0 8 6 3 0 6 5 8 0 2 2 5 0 7 6 2 0 0 0 0 0 259 4 6 5 11 0 5 31 Sool 0 0 2 4 4 1 6 0 4 0 1 8 3 2 1 10 5 11 10 9 17 25 0 698 17 7 20 20 45 20 129 Awdal 0 4 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 3 2 0 0 1 105 2 0 11 2 5 0 20 Togdher 8 29 2 30 7 26 10 13 6 17 6 10 12 27 7 19 10 22 4 16 7 25 10 2324 11 11 27 13 31 7 100 N/West Zone 33 57 8 49 18 36 17 25 21 28 8 27 24 38 14 37 24 45 22 33 25 55 14 4720 40 26 76 55 95 41 333 M/ Shabelle 13 9 14 14 21 8 19 22 16 7 15 16 16 15 12 6 12 6 9 6 16 11 12 716 18 15 19 23 23 23 121 Hiran 21 14 3 3 13 8 7 4 10 4 6 3 5 5 3 7 13 15 22 49 10 30 28 1461 12 13 3 26 26 15 95 Galgadud 17 13 18 5 8 6 9 7 5 8 6 4 7 5 8 3 6 4 7 3 6 5 7 625 5 7 4 6 6 8 36 Banadir 134 93 71 140 76 62 58 69 68 75 98 58 81 50 41 71 106 76 79 74 82 69 67 5617 72 73 79 70 70 68 432 L/Shabelle 36 33 43 39 29 30 34 56 49 40 41 40 38 44 32 39 37 40 45 37 29 36 36 2106 25 28 40 36 36 28 193 Central Zone 221 162 149 201 147 114 127 158 148 134 166 121 147 119 96 126 174 141 162 169 143 151 150 10525 132 136 145 161 161 142 877 Middle Juba 3 0 3 3 0 0 0 0 2 0 4 4 1 1 1 0 0 0 2 0 0 0 0 62 0 3 3 0 1 1 8 Bakool 15 5 8 2 4 0 4 2 0 2 2 2 6 6 8 3 5 4 2 1 0 4 4 99 4 2 2 0 4 0 12 Gedo 0 1 0 0 0 0 2 8 8 24 12 24 9 9 3 35 16 12 6 8 0 0 0 241 0 1 1 51 23 61 137 Bay 6 7 1 10 6 7 12 9 3 4 8 5 14 22 18 19 7 9 22 12 9 36 25 654 17 17 2 0 9 4 49 Lower Juba 4 2 0 4 8 3 5 8 10 13 19 22 32 14 14 8 0 7 9 24 13 28 22 468 22 4 6 9 12 6 59 South Zone 28 15 12 19 18 10 23 27 23 43 45 57 62 52 44 65 28 32 41 45 22 68 51 1524 43 27 14 60 49 72 265 Grand Total 444 400 325 436 330 277 290 352 320 507 441 416 389 410 362 440 487 401 426 406 349 415 351 23353 315 286 317 346 393 325 1982 Week-07 Somalia Weekly Polio Update

Distribution of reported fever and rash cases in Somalia , 2014-2017

Fever Fever Fever Fever Fever & rash & rash & rash & rash & rash Region cases cases cases cases cases (2014) (2015) (2016) (2017) (2018)

Nugal 1110 82 112 2050 153

Bari 1284 226 202 1968 130

Mudug 542 561 270 2566 224

Galbeed 121 212 45 758 22

Sahil 30 60 226 576 31

Sanag 115 114 16 259 31

Sool 187 86 24 698 129

Awdal 1 15 56 105 20

Togdher 407 864 223 2324 100

M. Shab. 285 500 206 716 121

Hiran 63 663 107 1461 95

Galgadud 299 229 261 625 36

Banadir 2594 1974 2226 5617 432

L. Shab. 1978 1611 1217 2106 193

M. Juba 177 48 51 62 8

Bakool 3 26 37 99 12

Gedo 126 8 104 241 137

Bay 309 145 9 654 49

L.Juba 648 74 265 468 59 Map no.7 Map no.8 Map no.9 Total 10,279 7,498 5,657 23353 1982 . Data source: from the Polio surveillance system and CSR. Week -04 Somalia Weekly Polio Update

Fever & Rush cases reported by AFP surveillance System. 19 Feb 2018

Age-wise distribution of fever and rash cases reported by Zone-wise cases of fever and rash reported by AFP AFP surveivallance system during 2018 surveillance system in 2018 2500

Yrs10+, 198, 1982 10% 2000 <1yr, 342, 17% 1500 5_9yrs, 345, 18%

1000 877 1_4 yrs, 1097, 55% 507 500 333 265

0 Week-07 Somalia Weekly Polio Update

Trend of reported fever and rash cases by zone in 2015 /16/17/2018 Source AFP surveillance, Puntland Somaliland 909 1200 1000 861 979 823 925 891 1000 882 800 800 667 634 503 510 600 600 491 349 282 400 400 214 265 269 243 275 161 133158 115 119140 161197 202 194 71 48 7097 6283 136142 132 200 3639 30 2443 2739 1927 1133 1240 150 200 95 82 104 93 72 99 8796 113 14 36 33 35 16 479 2942 47 2937 15 0 8 0 January February March April May June July AUG Sept. Oct. Nov. Dec

2015 2016 2017 2018 2015 2016 2017 2018

Central South 1494 1600 250 1340 207 1400 1205 189 1111 200 1200 925 916 144 139 1000 136 128 742 150 121 115 800 659 574 545 514 547 568 515 82 83 455503 443 441 450 100 77 75 600 367 401 348 388 350383 401 64 303315 265 324 307 278 271328 281310 45 46 46 50 46 400 40 37 30 33 32 142 50 27 2729 22 27 1921 18 1826 200 30 9 9 147 13 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 Part -III Population Immunity Week-07 Somalia Weekly Polio Update

Coverage of measles mass vaccination

100% campaign by districts - Puntland

90%

47,787 47,787

15,272 15,272

21,958 21,958

49,678 49,678

16,841 16,841

9,704 9,704

15,713 15,713

9,192 9,192

10,573 10,573

9,026 9,026

72,851 72,851

9,757 9,757 933,406 933,406

80% 50,140

7,986 7,986

16,356 16,356

9,227 9,227

6,482 6,482

6,195 6,195

34,489 34,489

13,154 13,154

5,565 5,565

5,468 5,468

11,769 11,769

35,473 35,473

205,337 205,337

16,483 16,483 8,872 8,872

70% 8,009 5,902 5,902 60%

50%

40%

30%

20%

10%

0%

PL

Eyl

Rako

Alula

Taleh

Armo

Ufayn

Hafun

Gardo

Bargal Waiye

Hobyo

Hudun

Bosaso

Jariban

Dhahar

Bo'ame

Badhan

B/bayla

Garowe

Galkayo

Hingalol

Daadyar

Qandala

Burtinle Galshale

Lasqoray

Galdogob

Dangorayo

Iskushuban Quracyadher Bari Karkar Nugal Mudug Ayn Sanag Sool

Measles mass campaign conducted from January 02-06, 2018 targeting a total of 1,014,791 children aged from 6 months to 10 Years living in 30 districts of Puntland concluded vaccinating 933,406 children. Supplemental Immunization Activities Week-07 Somalia Weekly EPI/POL Update

Maps showing accessibility and security/ risk level, Somalia

Source: UNDSS

Map no.10 Map no.11 Week-07 Somalia Weekly EPI/POL Update

Summary Strategic features and initiatives in Somalia by accessibility Accessibility AFP active Zones VPV TPVP Settlement Under 15- POP. status Surveillance site Accessible 128 216 147 2354 2,297,618 CENTRAL Inaccessible 62 29 21 1042 638,368 Total 190 245 168 3396 2,935,985 Accessible 105 207 53 1076 459,628 PUNTLAND Inaccessible 0 0 0 0 - Total 105 208 53 1076 459,628 Accessible 81 206 53 3435 1,469,441 SOMALILAND Inaccessible 0 0 0 0 - Total 81 206 53 3435 1,469,441 Accessible 75 179 123 2234 1,040,636 SOUTH Inaccessible 84 33 22 1548 459,119 Total 159 212 145 3782 1,499,755 SomaliaAccessible Total 501389 869809 457 37611689 90996,179,4275,267,323 Somalia Inaccessible 146 62 43 2590 1,097,488 Somalia Total 535 933 419 11689 6,364,811 Week-07 Somalia Weekly EPI/POL Update 2018 SIA Calendar, Implementation status Summary Somalia SIA Callender for 2017

Target Age Zonal target Planned Date Campaign Type Geographic Areas to be covered Implementation date Vaccine LQAS Result Group Population # Reached/ Admin Coverage IM Coverage in Vaccinated in % % • 46 lots Passed, Districts of Banadir, Lower Shabelle 29 January - 01 29-Jan- 01 Feb. 2018 SNID (mOPV2) U-5 years 726,699 mOPV • 7 Failed, and Middle Shabelle February 2018 715,172 96% 93% • 15 Discarded Districts of Banadir, Lower Shabelle and 15-19 April 2018 SNID (IPV) U-2 years 290,691 IPV Middle Shabelle

All accessible areas of Central zone 931,588 Puntland all districts 546,107 bOPV 23-26 March -2018 NIDs R-1 Somaliland all districts Under 5 years 640,440 All accessible areas of South zone 397,122 2,515,256 75,650 33,787 Nomadic; Agro pastoral; Scattered, bOPV July-2018 HtR - R-1 remote, far settlements & Small Under 5 years 141,037 villages with difficult / no road access 150,359 400,834 All accessible areas of Central zone 931,585 Puntland all districts 545,490 bOPV 18-Oct-2018 NIDs R-2 Somaliland all districts Under 5 years 642,166

All accessible areas of South zone 410,380 14 14

2,529,620 - Jemame East and Jemame West in SIADs South Some areas in Galgadud region of SIADs

Central zone no. Table A) Target population: includes all accessible areas including the areas/districts that became and 3% population growth added 2018. B) Buffer stock: 1 million bOPV doses kept in country for: Transit/Cross Border Permanent Vaccination Teams and SIADs for new areas accessible. C) Country team strategy for newly accessible areas: conduct house to house bOPV vaccination, 4 Rounds at 10 days interval, R-1 target U<5 years, R-2 target U10 years, R-3 target all age groups; R-4 target U 5 years OPV + Measles. Week-07 Somalia Weekly EPI/POL Update

Transit Points Vaccination Activities as of 11 February 2018

January February March April May June

Zones

Zero doses Zero doses Zero

Number of of Number vaccinated doses Zero of Number vaccinated doses Zero of Number vaccinated doses Zero of Number vaccinated doses Zero of Number vaccinated doses Zero of Number vaccinated doses Zero

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

CENTRAL 99939 334 0.3% 52151 188 0.4%

PUNTLAND 25067 58 0.2% 11885 33 0.3%

SOMALILAND 14705 350 2.4% 7302 201 2.8%

SOUTH 32225 1073 3.3% 16945 576 3.4%

SOMALIA 171936 1815 1.1% 88283 998 1.1%

. A total of 260,219 < 10 years individuals were vaccinated week 6,2018. Among them 2,813 (1%) were vaccinated for the first time.

Table no.-16 Week-07 Somalia Weekly EPI/POL Update

Immunity Profile of NP-AFP cases (6-59 Months) and Contacts 2013-2018

Immunity Profile of NP-AFP Cases 6- Immunity Profile of NP-AFP Cases 6-23 Immunity Profile of NP-AFP cases 6-59 Immunity Profile of NP-AFP cases 6-23 Immunization Profile of contacts 59 Months, 2013-2018 Months, 2013-2018 Months by Zone, 2018 Months by Zone, 2017 (all-2017) 100% 100% 0 100% 0 100% 100% 1 90% 90% 90% 90% 25 409 90% 35 2 8 69 31 80% 80% 4 80% 80% 8 2 2 39 80% 630 515 37 70% 448 492 135 83 70% 70% 182 127 143 70% 2 4 344 70% 26 60% 60% 61 60% 60% 60% 4 50% 0 34 50% 1 1 50% 28 10 50% 439 50% 40% 3 3 40% 180 56 10 40% 34 40% 186 27 189 40% 63 50 27 30% 134 43 56 17 2 2 30% 30% 1 30% 30% 20% 164 33 34 3 20% 20 1 197 29 54 20% 20 1 10% 2 20% 123 144 20% 37 6 1 709 2 10% 1 15 76 3 29 10% 0% 0 0 0 10% 265 10% 73 21 1 38 37 40 9 10 11 0% 0 0 110 118 132 2 6 0% 0% 0% 2013 2014 2015 2016 2017 2018 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 0 Dose 1-3 doses 4-6 doses 7+ doses Graph no.-19 Graph no.-23 Graph no.-20 Graph no.-21 Graph no.-22

. 2 zero dose AFP cases and 6 contacts reported in 2018 from inaccessible and partially accessible areas of South zone. Week-07 Somalia Weekly EPI/POL Update

Immunity profile of 6-59 months age NP-AFP cases by Zone 2012-2018

SOMALILAND CENTRAL 100% 100%

2 13 31 80% 16 18 80% 4 64 33 34 98 61 66 60% 30 43 60% 29 18 15 40% 3 40% 3 13 24 18 6 26 19 14 14 20% 10 20% 10 8 18 9 3 10 12 11 4 1 26 28 2 4 4 6 5 13 15 0% 2 3 1 4 0 0% 8 0 2012 2013 2014 2015 2016 2017 2018 2012 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% 0 100% 9 15 3 22 12 15 80% 80% 1 11 11 10 19 2 2 29 24 22 7 9 17 20 15 60% 60% 9 4 8 0 11 17 17 40% 6 40% 10 4 12 15 37 11 20% 38 25 2 2 24 24 20% 13 6 7 5 5 4 5 0% 0% 4 4 1 0 2012 2013 2014 2015 2016 2017 2018 2012 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 120 Routine Immunization coverage by zone, Somalia (2014-2017

100 96

90 87

81 81 80 76 75 73 73 73 72 72 71 71 71 71 69 66 66 65 64 62 63 59 60 59 60 60 57 57 57 58 57 57 54 54 54 54 54 52 53 50 48 45 45 46 43 43 41 41 41 39 40 37 37 34 34 33 32 30 26 24 22 23 20

0 BCG P-1 P-3 Measles OPV-3 BCG P-1 P-3 Measles OPV-3 BCG P-1 P-3 Measles OPV-3 BCG P-1 P-3 Measles OPV-3 PUNTLAND SOMALILAND SOUTH CENTERAL SOMALIA 2014 2015 2016 2017 Source: HMIS/DHIS-2 data 2016 and 2017. Week-07 Somalia Weekly EPI/POL Update

Immuinzation monitoring chart, Somalia2016

350000 100% 450000 120%

90% 400000 300000 100% 80% 350000

250000 70% 300000 80%

60% 200000 250000

50% 60%

150000 200000 40%

150000 40% 100000 30%

100000 20% 20% 50000 10% 50000

0 0% 0 0% Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Pent1 24215 48781 73263 98229 124707 152394 181148 207148 235011 266781 299618 331481 Sum of Pent1 31367 61990 89840 119005 148901 178493 215415 247586 280838 316732 347716 381074 Penta3 27543 48616 70816 91732 113674 136589 160723 181282 203464 229673 256554 283080 Sum of Penta3 26790 53670 77763 102433 127572 152696 178791 203443 232459 264569 291804 320290 Measles 18379 39266 60502 81562 103608 127044 150435 174056 193371 209302 230710 249465 Sum of Measles 20594 44105 64886 89207 115739 139255 166186 190981 216931 245101 272845 301970 Target 7.50% 15.00% 22.50% 30.00% 37.50% 45.00% 52.50% 60.00% 67.50% 75.00% 82.50% 90.00% Sum of Montly target on surval% 8% 17% 25% 33% 42% 50% 58% 67% 75% 83% 92% 100% Penat1% 5% 11% 16% 22% 28% 34% 40% 46% 52% 59% 66% 73% Sum of P-1% 8% 16% 23% 31% 38% 46% 55% 64% 72% 81% 89% 98% Penta3% 6% 11% 16% 20% 25% 30% 36% 40% 45% 51% 57% 63% Sum of penta-3% 7% 14% 20% 26% 33% 39% 46% 52% 60% 68% 75% 82% measles% 4% 9% 13% 18% 23% 28% 33% 39% 43% 46% 51% 55% Sum of Measless% 5% 11% 17% 23% 30% 36% 43% 49% 56% 63% 70% 78% Part -IV Communication Week - 5 Somalia Weekly EPI/POL Update

Communication for development

885 social mobilizers were deployed mostly in high risk localities during the mOPV2 campaign. Below are the results of their work:

No. of No of people Number of No. of total No of total No. of total No. of total mosques reached Total SM HH reached Schools religious villages Regions announcing through No. SM reported by social and leaders reached by polio community Daily Data mobilizers madrasas reached sound truck messages meetings Banadir 607 607 193,522 105 103 171 524 206 Lower 150 150 46,429 72 61 83 321 114 Shabelle Middle 128 128 42,148 74 55 97 231 172 Shabelle Total 885 885 282,099 251 219 351 1,076 492 Week-34 Somalia Weekly EPI/POL Update Communication for development

Some photographs of the official And vaccination in launching ceremony households the end