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Zimbabwe Weekly Epidemiological Bulletin Number 102 Epidemiological week 10 (week ending 13 March) March 2011 Highlights Malaria outbreaks in Kadoma and Makoni Figure 1: Cumulative Cholera Cases since 1 January 2011 Cholera cases reported in Chiredzi Contents Chipinge 133 A. General context Mutare 86 B. Epidemic prone diseases C. Events of public health concern in the region Buhera 66 D. Preparedness Chiredzi E. Timeliness and completeness of data 42 F. Recommendations for action/follow up Bikita 42 Annex 1: National summary of cases/deaths by condition District Murewa 5 by week Annex 2: Standard case definitions and alert/action Chimanimani 4 epidemic thresholds Kadoma 2 Mutasa 1 A. General context 0 50 100 150 Cholera cases Cholera continues to be reported in week 10 of 2011, having spilled over from 2010. Since week 45 of Figure 2: Zimbabwe Cholera Epicurve, Week 5, 2010 to Week 10, 2011 2010, no new outbreaks of measles have been reported, although the situation is being closely 200 monitored. We are amidst the malaria season and 180 malaria outbreaks are now being reported. Within the C 160 region, suspected Rift Valley fever has been reported h 140C in South Africa. o 120a l 100s B. Epidemic prone diseases e e80 r 60s Cholera 40 a 20 Nine out of the 62 districts, namely: Bikita, Buhera, 0 17 33 5 9 13 21 25 29 37 41 45 49 1 5 9 Chimanimani, Chipinge, Chiredzi, Kadoma,Murewa, 1 Mutare and Mutasa have reported cases since the start of 2011. There were 381 cumulative cases: 324 2010 2011 suspected cases, 57 laboratory confirmed cases and 7 Epidemiological Week Number by year th deaths reported by the 13 March 2011. The crude case fatality rate is 1.6%. Malaria Week 10 (-7 -13 March 2011) The cumulative cases and deaths of malaria in 2011 are 47 453 and 86 respectively, giving a case fatality rate of . There were 7 new suspected cases, 8 confirmed 0.2%.The cases have been reported from all provinces. case reported from Chiredzi. 94.9% of these cases occurred in rural areas. Week 10 (-7 -13 March 2011) . Surveillance continued in all districts. Bikita, Buhera, Chimanimani, Kadoma, Mutasa and 8 894 malaria cases and 17 deaths were reported. 1244 Mutare districts have not reported cholera cases (14%) of the cases and 4 deaths were under the age of five for at least 2 weeks, hence the outbreak are over years. in those districts Malaria outbreaks have been reported in Kadoma, Makoni and Nyanga districts. This weekly Epidemiological Bulletin is published jointly by the Ministry of Health and Child Welfare, Zimbabwe and the World Health Organization. 1 For correspondence: Email: [email protected] and [email protected] or call: +263772104257 or +263772277893 Zimbabwe Weekly Epidemiological Bulletin Figure 3: Top 10 Districts reporting malaria cases in week 10 Cholera Nyanga 2358 Cholera emergency stocks were delivered to Mutasa 1005 Manicaland Makoni 795 Response actions this week Mt Darwin 480 Kariba 435 Cholera Mutare city 329 District Shamva 324 A joint MOHCW and WHO technical support Mutare 324 mission to Manicaland visited Manicaland. The Mazowe 313 highlights of the visit were: Kadoma 308 1. Recommended ways of containing risk factors 0 1000 2000 3000 2. Recommend ways of improvement of infection control at CTCs Malaria Cases Chiredzi ACF is currently repairing 3 water points and C. Events of public health concern within the conducting PHHP and NFI distribution in wards 1, region 3,3,4,5 and 25.The registration in the 6 wards is 1. Outbreaks complete and today Monday ACF has started the PHHP and NFI distribution inwards 2 and 25. South Africa Chipinge Rift Valley Fever ACF has started the bulk water treatment in Macdom States. The registration of beneficiaries in Ward 14 The first two cases are farmers from Free State and was done. The NFIs distribution will start on Eastern Cape provinces respectively, and Wednesday due to heavy rains during the weekend experienced onset of an uncomplicated, acute, febrile illness with “flu-like” symptoms during February that delay the process. 2011. Both cases reported direct contact with animal tissues/body fluids during animal husbandry, Malaria vaccination and/or slaughtering practices. These Civil protection unit convened a meeting to respond cases additionally noted mosquito bites and to malaria outbreak in Nyanga. The Nyanga DHE consumption of unpasteurised milk prior to their requested drugs and transport at the meeting. illness. The third of the most recent cases is a female patient, who is still being investigated. Preliminary E. Timeliness and completeness of data information received indicates that she is a resident of Bloemfontein, Free State Province, but recently The completeness of this week’s surveillance travelled to the Mossel Bay area (Western Cape data is 68% whilst timeliness is 63%. Province), where RVF outbreaks were reported earlier this year. This patient is currently hospitalised Acknowledgements and has numerous RVF associated complications We are very grateful to health workers from facility including: haemorrhage, encephalitis, hepatitis and to district and provincial level for sharing retinitis. surveillance data. In particular, we recognise those who share complete data on time. Zambia We acknowledge members of the Health and WASH Starting from week 45 of 2010, there has been a clusters who share their data with our team. MoHCW progressive increase in the weekly number of cholera recognizes the efforts made by NGOs and other cases reported from Zambia. So far, the country has partners that are providing support to them. reported a cumulative of 63 cases in 2011. Going by Information on health events occurring in the region experiences from the previous years, the epidemic is is consolidated from the WHO daily summary of expected to peak around week 13 to 15 of 2011. health events. D. Preparedness This weekly Epidemiological Bulletin is published jointly by the Ministry of Health and Child Welfare, Zimbabwe and the World Health Organization. 2 For correspondence: Email: [email protected] and [email protected] or call: +263772104257 or +263772277893 Zimbabwe Weekly Epidemiological Bulletin Annex 1: Table: Summary of cumulative current cholera outbreak cases by year as at week 10 District 2010 2011 Total Total Deaths Cases Cases Deaths Cases Deaths Beitbridge 17 0 0 0 17 0 Bikita 9 1 42 1 51 2 Bindura 2 0 0 0 2 0 Buhera 130 0 66 0 197 0 Chegutu 32 2 0 0 32 2 Chimanimani 66 0 4 1 70 1 Chipinge 39 2 133 0 130 2 Chiredzi 54 2 42 3 54 2 Chivi 13 0 0 0 13 0 Harare 4 0 0 0 4 0 Hurungwe 171 5 0 0 171 5 Kadoma 160 5 2 0 162 5 Makonde 3 0 0 0 3 0 Mangwe 1 0 0 0 1 0 Masvingo 10 1 0 0 10 1 Mt Darwin 11 1 0 0 11 1 Murewa 0 0 5 2 5 2 Mutare 206 2 86 0 292 2 Mutasa 0 0 1 0 1 0 Mwenezi 5 0 0 0 5 0 UMP 4 1 0 0 4 1 Total 937 22 381 7 1318 29 This weekly Epidemiological Bulletin is published jointly by the Ministry of Health and Child Welfare, Zimbabwe and the World Health Organization. 3 For correspondence: Email: [email protected] and [email protected] or call: +263772104257 or +263772277893 Zimbabwe Weekly Epidemiological Bulletin Annex 2: Standard case definitions and alert/action epidemic thresholds Unconfirmed severe malaria 1. Cholera Any patient living in area at risk of malaria or with a history of travel to a malaria prone area, hospitalised Standard Case Definition with severe febrile disease with accompanying vital Suspected case: organ dysfunction diagnosed clinically . In a patient age 5 years or more, severe dehydration or death from acute watery diarrhoea in an area where Confirmed Severe malaria there is no cholera. Any patient hospitalized with P. falciparum asexual . If there is a cholera epidemic, a suspected case is any parasitaemia as confirmed by laboratory tests with person age 2 years or more with acute watery accompanying symptoms and signs of severe disease diarrhoea, with or without vomiting. (vital organ dysfunction) diagnosed through laboratory. Confirmed case: . A suspected case in which Vibrio cholerae sero-groups Malaria with severe anaemia O1 or O139 has been isolated in the stool. Any child 2 months up to 5 yrs with malaria and, if NB: All suspected cases under the age of two years an outpatient with severe palmar pallor, or if an must be confirmed. inpatient, with a laboratory test confirming severe The inclusion of all ages in the case definition somewhat anaemia. (NOTE: young infants less than 2 months reduces specificity, that is, inclusion of more non-cholera are usually classified as serious bacterial infection childhood diarrhoea cases (mainly those below 5years). It and referred for further evaluation.) does not impede meaningful interpretation of trends. Teams should monitor any shift in the age distribution of F. Events of Public Health concern cases, which might indicate a changing proportion of non-cholera cases among patients seen. There are three main categories of events that are notified under the International Health Regulations (IHR), these include: 2. Malaria . Conditions that must be notified to WHO: smallpox, poliomyelitis due to wild-type Standard Case definition poliovirus, human influenza caused by a new subtype, SARS, cholera, plague, yellow fever, Uncomplicated malaria VHF, RVF and Meningococcal meningitis. Any person living in area at risk of malaria or with a . “Any event of potential international public health history of travel to a malaria prone area, with fever or history of fever within 24 hours; with headache, back concern including those of unknown cause or pain, chills sweats, myalgia, nauseas and vomiting, source, and those involving other events or without signs of severe disease (vital organ dysfunction) diseases” than those listed above- is diagnosed clinically as uncomplicated malaria.
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