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Early Warning Disease Surveillance and Response Bulletin, 2018 Epidemiological Week 24 (Week ending 17th June, 2018)

Highlights Cumulative figures as of week 24  227 health facilities across Somalia submitted weekly  1,359,916 consultations from week 1 reports of epidemic-prone diseases in the electronic to week 24. early warning disease surveillance (EWARN) system  4,935 cumulative cases of in week 24. AWD/Cholera and 36 deaths since  Total number of consultations decreased from 64,164 in week 23 to 44,883 in week 24. December 2017.  A total of 3,086 alerts were received. 469 of these  7,691 Accumulative alerts were alerts were confirmed as true alerts1. received, 339 of these, were  The highest numbers of diseases reported in week confirmed as true alerts from week 1 24 were other acute diarrhoeas (2,411 cases), to week 24, 2018. influenza like illness (1,298 cases) and severe acute  5,938 cumulative cases of suspected respiratory illness (1,059 cases). measles cases since the beginning of  A total of 292 new cases of suspected AWD/cholera including 4 death were reported in week 23 2018. Of the 5,938 measles cases, compared to 343 AWD cases including 4 death in 3,890 (66%) are under 5 years while week 23. 2,048 (34%) are above 5 years. 2  A cumulative total of 4,935 AWD/cholera cases ,  6,302 cumulative cases of Malaria including 36 deaths have been reported since were reported since the beginning of December 2017. 2018, 2,716(43%) are under 5 years,  The number of reported measles cases decreased from 130 in week 23 to 72 cases in week 24. while 3,586(57%) are above 5 years.

Table 1. Summary of Alerts for epidemic prone diseases Disease Cumulative cases Wk21 2018 Wk22 2018 Wk23 2018 Wk24 2018 (Wk 1 – 24, 2018)

Total consultations 62,876 59,673 64,164 44,883 1,359,916 Other Acute Diarrheas 3718 3161 3,402 2,411 56354 Influenza Like Illness 1611 2041 1,808 1,298 41,613 Severe Acute Respiratory 23,023 1353 981 1,464 1,059 Illness Suspected Measles 127 113 130 72 5938

1 These alerts are alerts from specific diseases of SARI, ILI, AWD, OAD, WC, Measles, Malaria, Falciprium Positive &RDT examined as auto-calculated by the system. 2 The Cases of AWD/Cholera in the eWARN system are collected from sentinel sites. while the cases of AWD/cholera in Sitrep are collected from temporary CTC sites which doesn't include the Sentinel sites Page 1 of 21

Confirmed Malaria 377 356 467 337 6302 Acute Watery Diarrhoea 227 82 291 55 1852 Bloody Diarrhea 133 123 184 180 1998 Whooping Cough 82 67 65 45 1147 Acute Jaundice 5 0 8 2 89 Suspected Meningitis 12 1 0 1 73 Diphtheria 1 0 0 0 43 Neonatal Tetanus 1 0 0 1 21 Acute Flaccid Paralysis 0 0 9 2 13 Viral Hemorrhagic Fever 0 0 0 1 4

Total number of Consultations and Reporting sites Completeness of Reporting. Out of 578 health facilities3 expected to submit weekly reports of communicable diseases in the EWARN system across Somalia, 227 submitted reports in week 24, a completeness of reporting of 39.3%. A total of 44,883 consultations were recorded in week 24, 2018 (Fig 1). Fig 1: Consultations and reporting sites, week 1 to 24, 2018 70,000 300 60,000 250 50,000 200 40,000 150 30,000 100

Consultations 20,000 Reporting Sites Reporting 10,000 50 0 0 15 16 17 18 19 20 21 22 23 24 Epi-Week

Totoal Consultations Reporting Sites

Proportionate Morbidity

As shown in figure 2; other acute diarrhoeas (OAD), influenza like illness (ILI), severe acute respiratory illness (SARI), suspected measles and malaria are the commonest causes of morbidity across Somalia in 2018. In week 24, the highest numbers of diseases were other acute diarrhoeas (2,411 cases), influenza like illness (1,298 cases) and severe acute respiratory illness (1,059 cases). Fig. 2. Commonest Causes of Morbidity during Week 1 to 24

3Some of the HFs are with no Network while some closed for a number of reasons Page 2 of 21

4000 3000 2000 1000 0 Wk21 Wk22 Wk23

other acute Diaria influence like illness Severe Acute Respiratory Illness Suspected Measles Confirmed Malaria

AWD/Cholera situation in Somalia

Fig 3. Districts Reporting Cases in Week 24 Following the heavy rains that have led to the floods in the Juba land and Shabelle basins, there has been an observed increase in the number of new AWD/Cholera cases (fig 4). The cholera outbreak that started in December 2017 in Beletweyne along river Shabelle has spread to Jowhar, Kismayo, Afgoye Merka and Banadir. The cholera spread is expected to increase due to the floods that have led to contamination of water sources in the flood affected regions. Floods have also led to blockage of access of health services which will contribute to delayed health seeking by the affected populations with. Over the past 2 Weeks, there has been an increase in the number of AWD/Cholera cases reported in , Banadir and LowerJubba; the regions that are affected by floods.

In week ending 17th June, active transmission of AWD/cholera was reported in in Lower Jubba, Afgoye Kurtunwarey and Merka in Lower Shabelle as well as in 13 districts of Banadir region (Darkenly, Daynile, Hodan, Madina, Waberi, HamarWeine,Hamarjabjab, Heliwa,Wardhigley,Kaaran, Shingani Yaqshid, and Howlwadagdistricts) (fig 2). In Kismayo, affected communities especially in Farjano IDP are reportedly using contaminated water due to floods. As shown in table 1, there was a decrease in the number of cases reported from 343 in week 23 to 292 in week 24. The Oral Cholera Vaccination that was implemented in 11 high risk districts in 2017 of the central region has greatly contributed to the reduction in the number of new AWD/cholera cases compared to the same time in 2017(fig 4).

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Fig4. AWD cholera trends in Somalia 2017/18 3500 Cases Deaths CFR (%) 4.0 3000 3.5 2500 3.0 2.5 2000 2.0

Cases 1500 1.5 1000 1.0

500 0.5 Rate(%) Fatality Case 0 0.0 24 26 28 30 32 34 36 38 40 42 44 46 48 50 52 2 4 6 8 10 12 14 16 18 20 22 24 2018

epi week

Table 2. Summary of AWD/Cholera cases in different regions Week 23 Week 24 Cumulative as of States Regions Ending 10th June 18 Ending 17th June 18 17th June 2018 Cases Deaths CFR (%) Cases Deaths CFR (%) Cases Deaths CFR (%) Banadir 179 2 1.1 137 2 1.5 1,892 15 0.8 Jubba land L/ Jubba 118 1 0.8 120 0 0 1,847 15 0.8 South west L/ Shabelle 46 1 2.2 35 2 5.7 216 3 1.4 M/Shabelle 0 0 0 0 0 0 415 2 0.5 Hir-shabele Hiraan 0 0 0 0 0 0 565 1 0.2 Total 343 4 1.2 292 4 1.4 4,935 36 0.7 NB. Deaths are included among cases. Banadir Region is not a state Cholera Situation in Lower Jubba, Lower Shabelle and Banadir.  Banadir region which included city has one of the highest concentrations of refugees where access to safe water and proper sanitation is limited. The AWD/Cholera outbreak in Banadir region started in January 2018 following reports of similar outbreak in Beletweyne district of Hiraan region. Of the 17 districts that make up Banadir region, 13 have so far reported cases which have been managed in Banadir CTC located in the capital Mogadishu. There has been decrease in the number of AWD/Cholera cases from 179 including 2 deaths to 137 cases and 4 deaths in the past 2 weeks. More than 65% of the AWD cases reported in Banadir are children below 2 years of age.  In Lower Jubba, The current AWD/Cholera outbreak in Kismayo district started in week 5 of 2018 in the IDP communities of Farjano where access to safe water and sanitation is limited. The district is characterised by returnees from as well as those displaced by war in Middle Jubba. Currently Lower Jubba is one of the flood affected regions. The reported cases of AWD/Cholera did not receive OCV which was given in Kismayo in March 2017. The Page 4 of 21

persons may have been absent during the OCV campaign. Over the past week, the number of AWD/Cholera cases in Lower Jubba has increased from 118 and 1 deaths to 120 no death. More than 64% of the cholera cases reported from Lower Jubba are children below 2 years.  The AWD/Cholera outbreak in Lower Shabelle region started in week 17 of 2018 and Afgoye district started in week 24-2018 as a result of displacement of people due to floods that have been reported in this regions. Afgoye is the most affected district and cases are being managed in lower Shabelle. There has been a reduction in the number of cholera cases reported as the floods are also decreasing in the region. More than 66% of the cases reported in Afgoye are children below 4 years.

AWD/Cholera cases and floods

Following heavy rains in Ethiopia and Somalia, flash floods have been reported in the basins of Juba and Shabelle in 4 states. An estimated 830,000 people have been affected of which 230,000 have been displaced4. Floods contribute to contamination of water sources as well as disruption of health services which are precursors of cholera outbreaks. Even when Jowhar and Beletweyne reported cases prior to the floods, no new cases have been reported from these districts following the floods. Cholera cases have increased in Kismayo, Afgoye,Kurtunwarey and Merka in Lower Shabelle (Table 3)

Table 3. AWD/Cholera cases in different districts Region District Week 24 Cumulative Week 49/17- Cases Deaths week 24/18

<2 yrs 2 -4 yrs ≥ 5 yrs <2 yrs 2-4yrs ≥ 5 yrs Cases Deaths CFR (%) Banadir Darkenley 10 6 9 0 0 0 312 1 0.3 Daynile 11 6 6 1 0 0 324 6 1.9 HamarJabja 1 1 1 0 0 0 117 2 1.7 Hawlwadag 4 0 3 1 0 0 88 1 1.1 Hodan 11 1 7 0 0 0 407 1 0.2 Karaan 3 0 0 0 0 0 34 0 0.0 Madina 16 6 11 0 0 0 327 2 0.6 Waberi 2 2 3 0 0 0 90 1 1.1 Shibis 0 0 0 0 0 0 7 0 0.0 Shingani 2 0 0 0 0 0 5 0 0.0 Abdilaziz 0 0 0 2 0 0.0 HamarWeine 3 0 0 0 0 0 34 0 0.0 Heliwaa 0 0 1 0 0 0 21 0 0.0

4 OCHA Flood Flash update #7 Page 5 of 21

Wardigley 1 2 4 0 0 0 82 1 1.2 Yaqshid 3 0 1 0 0 0 42 0 0.0 × Jowhar 0 0 0 0 0 0 415 2 0.5 Hiran× Beletweyne 0 0 0 0 0 0 522 1 0.2 BuloBarde 0 0 0 0 0 43 0 0.0 Lower Shabelle× Afgoye 0 3 5 0 0 0 140 0 0.0 Kurtunwarey 0 3 12 0 0 2 25 3 12.0 Merka 1 3 8 0 0 0 51 0 0.0 Lower Jubba× Kismayo 45 32 43 0 0 0 1,847 15 0.9 Total 113 65 114 2 0 2 4,935 36 0.7 × regions currently affected by floods. Cases include deaths.

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AWD/Cholera Response Activities Implemented During Week 24

Coordination and Leadership.  Coordination meetings were conducted in the flood affected districts. The coordination meetings are coordinated by Federal Ministry and State level MoH in coordination with health cluster partners  Weekly update meeting at Banadir HOSP-CTC was organized by 09-Jun-2018,CTC team, Surveillance team and Banadir HOSP-CTC.  Updates of Weekly meeting minutes  This week New AWD/Cholera Registers started from Banadir HOSP-CTC  Weekly supervision and case monitoring, at 1 districts of Banadir Region. Case management  On job training was conducted for the health workers working in cholera treatment centres in Kismayo, Farjano and Banadir, Merka (Ayuub Health Centre, and Afgoye Hospital CTCs  Management of cholera cases is being conducted in Banadir hospital CTC, Afgoye Hospital Merka(Ayuub Health Centre, CTCs, Kismayo hospital and Farjano CTU Surveillance and Laboratory Investigations  Routine line listing of cases including data analysis and risk assessment for cholera hotspots  Investigation and verification of rumours has been conducted in flood affected regions. Alerts received from Baidoa and Elwak were negative for AWD.  Rapid Response Teams (RRT) have supported state level authorities to verify the rumours in flood affected districts

Water Sanitation, Hygiene and risk communication

 Distribution of hygienic kits in flood affected areas in Lower Jubba, Hiraan and regions  Community education is conducted by the C4D department using cholera preventive messages  Chlorination of water sources in cholera affected regions was conducted by WASH cluster  WHO has prepositioned 44.1 tons of medical supplies to flood affected regions

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Measles Situation

Fig5: Districts Reporting Measles Case: The number of suspected measles cases decreased Week 21 from 130 cases in week 23, to 72 cases in week 24. Cumulatively, 5,938 cases of suspected measles have been reported across Somalia since the beginning of 2018. Of the 5,938 measles cases, 3,890 (66%) are under 5 years while 2,048 (34%) are above 5 years. The most affected regions include Galgadud (1,086 cases), Bay (937 cases) Banadir (883 cases), (606 cases), and Sool (366 cases).

As shown in fig 6 below, the trends of measles have continued to decrease in all the regions following the successful implementation of measles vaccination campaign

Fig6: Measles Situation in Somalia from Week 1 to Week 24 2018

700

600

500

400

Cases 300

200

100

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 Epi-Week

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Fig 7. Measles cases per State Across Somalia from Wk1 - Wk24, 2018

Cases >5 Cases<5 1000

800

600

Cases 400

200

0 Banadir Hirshabele Jubbaland Somaliland SouthWest State

Table 4: Summary of Suspected measles cases by region week 1 - 24, 2018

Cumulative cases Region Wk21 2018 Wk22 2018 Wk23 2018 Wk24 2018 (Wk 1 – 24)

Awdal 0 0 0 0 12 0 0 0 1 118 Banadir 17 6 14 0 883 Bari - - - 0 92 Bay 32 25 23 15 937 Galgaduud 0 0 14 0 1086 Gedo - - 21 4 43 Hiraan 6 12 16 10 147 18 14 11 5 248 Lower Shabelle 10 7 5 5 313 1 6 6 4 132 Middle Shabelle 9 5 3 2 150 Mudug 27 28 10 10 606 Nugaal - - - 0 183 Sanaag 0 5 0 0 159 Sool 0 1 2 0 366 Togdher 4 - 4 11 221 Waqoyi Galbed 3 4 1 5 242 Grand Total 127 113 130 72 5938 Dash means there is no weekly Data/report submitted on the system during the specified reporting period.

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Measles Outbreak Response Activities  The Federal Ministry of Health in collaboration with WHO, UNICEF and other partners launched the measles vaccination campaign in Mogadishu and Somaliland on 11th March 2018 to vaccinate 3.7 million children aged 6 months to 10 years in South Central(Galmudug, Hirshabelle, Banadir, Southwest & Juballand) and Somaliland.  The measles vaccination campaign was also conducted in Puntland in January 2018. 933,690 children aged 6 months to 10 years were vaccinated.  There has been a reduction in the number of measles cases reported from all the states following the vaccination campaign (fig 8&9)

Fig8: Measles Trends after implementing Measles vaccination in Somaliland & South and Central(Banadir, Galmudug, Hirshabele Southwest,& Jubaland)

South & Central Zone Somaliland 500 Measles vaccination 400 implemented 300

Cases 200

100

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 Epi-Week

Fig9: Measles trends after implementing Measles vaccination in Puntland

Puntland 120

100 Measles vaccination implemented 80

60 Cases 40

20

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 Epi-Week

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Malaria Situation in Somalia The number of Malaria cases decreased from 467 cases in week 23 to 337 cases in week 24. Cumulatively, 6,302 cases of Malaria cases have been reported across Somalia since the beginning of 2018. Of the 6,302 malaria cases, 2,716 (43%) are under 5 years while 3,586 (57%) are above 5 years. The most affected regions include Bay (1,625 cases), Galgadud (1,000 cases), Banadir (706 cases), Bakol (658 cases), Lower Shabelle (598 cases), Middle Shabelle (410 cases) and Bari (335 Cases) .

Fig10: Malaria Situation in Somalia from Week 1 to Week 24, 2018

500

400

300

Cases 200

100

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 Epi-Week

Fig 11: Malaria Cases Per Region Across Somalia from Wk1-24, 2018

Waqoy Galbed Togdheer Sool Sanaag Nugaal Mudug Middle Shabelle Middle Juba Lower Shabelle

Lower Juba Cases<5 Regions Hiraan Cases >5 Gedo Galgadud Bay Bari Banadir Bakool Awdal

0 200 400 600 800 1000 1200 Cases

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Fig 12: Malaria Cases Per Region Across Somalia from Wk1-24, 2018

SouthWest Somaliland Puntland Jubbaland

State Cases<5 Hirshabele Cases >5 Galmudug Banadir

0 200 400 600 800 1000 1200 1400 1600 1800 2000 Cases

Fig13: Malaria Trends in Somaliland & South and Central(Banadir, Galmudug, Hirshabele Southwest,& Jubaland) from Week1-24, 2018

SC Somaliland 500 400 300

Cases 200 100 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 Epi-week

Fig14: Malaria Trends in Puntland from Week1-24, 2018

Puntland

200

150

100 Cases 50

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 Epi-week

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Other Acute Diarrhea Situation in Somalia

The number of OAD cases has been floatingly going up and down for the last four weeks, the cases in Week 23 were 3,402 compared to 2,411 cases in week 24. Cumulatively, 6,302 cases of OAD cases have been reported across Somalia since the beginning of 2018. Of the 56,354 OAD cases, 42,763 (76%) are under 5 years while 13,591 (24%) are above 5 years. The most affected regions include Banadir (12,532 cases), Waqoy Galbeed (7,165 cases), Lower Shabelle (6,575 cases), Hiiran (5,832 cases), Mudug (3,913), Awdal (3,480 cases), Togdheer (2,985 cases), Sool (2,981 cases) and Middle Shabelle (2,915 Cases) .

Fig 15: OAD Cases Per State Across Somalia from Wk1-24, 2018

SouthWest Somaliland Puntland Jubbaland

State Cases<5 Hirshabele Cases >5 Galmudug Banadir

0 2000 4000 6000 8000 10000 12000 14000 Cases

Fig16: Trends of Other Acute Diarrhoea in Somaliland & South and Central (Banadir, Galmudug, Hirshabele Southwest,& Jubaland) from Week1-24, 2018

SC Somaliland 3000 2000

Cases 1000 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 Epi-week

Fig16: Trends of Other Acute Diarrhoea in Puntland from Week1-24, 2018

Puntland

300 200

Cases 100 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 Epi-week

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Bloody Diarrhea Situation in Somalia

The number of BD cases has also been floatingly decreasing for the last four weeks, the cases in Week 23 were 184 compared to 180 cases in week 24. Cumulatively, 1,998 cases of BD cases have been reported across Somalia since the beginning of 2018. Of the 1,998 BD cases, 1,039 (52%) are under 5 years while 959 (48%) are above 5 years. The most affected regions include Bay (721 cases), Waqoy Galbeed (271 cases), Togdheer (262 cases), Lower Juba (157 cases) and Awdal (119 Cases) .

Fig 17: Bloody Diarrhea Cases Per State Across Somalia from Wk1-24, 2018

Cases >5 Cases<5 500 400 300

Cases 200 100 0 SouthWest Somaliland Jubbaland Hirshabele Puntland Banadir Galmudug State

Fig18: Trends of Bloody Diarrhea in Somaliland & South and Central (Banadir, Galmudug, Hirshabele Southwest,& Jubaland) from Week1-24, 2018

SC Somaliland 150

100

Cases 50

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 Epi-week

Fig19: Trends of Bloody Diarrhea in Puntland from Week1-24, 2018

Puntland

15

10 Cases 5

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 Epi-week

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Whooping Cough Situation in Somalia

The number of WC cases has also been floatingly going up and down for the last four weeks, the cases in Week 23 were 65 compared to 45 cases in week 24. Cumulatively, 1,147 cases of WC cases have been reported across Somalia since the beginning of 2018. Of the 1,147 WC cases, 872 (76%) are under 5 years while 275 (24%) are above 5 years. The most affected district include Galkacyo (249 cases), Jilib (137 cases), Berbera (89 cases),Erigavo (72 cases), Buale (55 cases) and Adaado (53 Cases) .

fig20: Most affected district of Whouping Cough in Somalia from Wk1-24, 2018

Cases <5 Cases >5 200 150 100 50 0

District

Fig21: Trends of WC in Somaliland & South and Central (Banadir, Galmudug, Hirshabele Southwest,& Jubaland) from Week1-24, 2018

SC Somaliland 100 80 60

Cases 40 20 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 EPI-week

Fig22: Trends of WC in Puntland from Week1-24, 2018

5 4 Puntland 3

Cases 2 1 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 Epi-week

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Most Other affected diseases Across Somalia

Severe Acute respiratory Illness (SARI)

fig23: Most SARI affected districts across Somalia from Wk1-24, 2018

Cases <5 Cases >5 2500 2000 1500 1000 500 0

District

Fig24: Trends of SARI in Somaliland & South and Central (Banadir, Galmudug, Hirshabele Southwest,& Jubaland) from Week1-24, 2018

SC Somaliland 1400 1200 1000 800

Cases 600 400 200 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 Epi-week

Fig25: Trends of SARI in Puntland from Week1-24, 2018

Puntland 100 80 60

Cases 40 20 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 Epi-week

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Influenza like Illness (ILI):

fig26: Most ILI affected districts across Somalia from Wk1-24, 2018

Borama Huruwaa Belet Weyne Gabiley Lasacanod Berbera Cases >5

Wadajir District Baidoa Cases <5 Burao Hargeisa Zeila Dharkinley 0 500 1000 1500 2000 2500 3000

Fig27: Trends of ILI in Somaliland & South and Central (Banadir, Galmudug, Hirshabele Southwest,& Jubaland) from Week1-24, 2018

SC Puntland 1500

1000

Cases 500

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 Epi-week

Fig28: Trends of ILI in Puntland from Week1-24, 2018

Puntland 600 500 400

300 Cases 200 100 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 Epi-week

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Table 5. Cumulative Summary of Epidemic-prone Diseases in different Districts of Somalia as of Week 1-24, 2018

Regions District SARI ILI AWD BD OAD DIPH WC MEAS NNT AFP AJS VHF MAL MENG OC Total_cons Awdal Total 0 7582 11 119 3480 0 0 12 0 0 0 0 21 2 29575 40831 Baki 0 955 0 57 242 0 0 0 0 0 0 0 0 0 2709 3963 Borama 0 4681 11 59 2420 0 0 8 0 0 0 0 12 0 19279 26498 Lughaya 0 164 0 2 201 0 0 0 0 0 0 0 0 0 1540 1907 Zeila 0 1782 0 1 617 0 0 4 0 0 0 0 9 2 6047 8463 Bakool Total 166 78 0 77 493 0 16 118 0 0 1 0 658 2 55997 57606 Elberde 0 13 0 0 128 0 0 0 0 0 0 0 0 0 8978 9119 Huddur 34 5 0 13 88 0 0 1 0 0 0 0 222 0 7992 8355 Tayeeglow 25 21 0 3 44 0 0 6 0 0 1 0 79 2 1446 1627 Waajid 107 39 0 61 233 0 16 111 0 0 0 0 357 0 37581 38505 Banadir Total 5190 7868 906 59 12532 0 9 883 0 0 1 0 706 12 329523 357689 Abdiaziz 0 89 0 0 105 0 0 0 0 0 0 0 0 0 7975 8169 Boondhere 0 0 18 0 241 0 0 24 0 0 0 0 0 0 6466 6749 Dayniile 30 180 0 0 280 0 0 7 0 0 0 0 1 0 12465 12963 Dharkinley 573 1100 0 0 1901 0 0 56 0 0 0 0 0 0 19934 23564 Hamar Jab Jab 197 549 0 2 518 0 1 7 0 0 0 0 1 0 12237 13512 Hamar Weyne 92 379 0 0 973 0 0 10 0 0 0 0 0 0 10313 11767 Hodan 3 22 5 0 68 0 0 0 0 0 0 0 6 0 8661 8765 Howl-wadaag 0 0 0 0 0 0 0 6 0 0 0 0 1 0 33761 33768 Huruwaa 1388 3223 15 6 3220 0 0 465 0 0 1 0 3 12 33451 41784 Kaaraan 10 69 0 0 47 0 0 1 0 0 0 0 0 0 17534 17661 Kahda 56 470 0 0 273 0 0 1 0 0 0 0 0 0 1609 2409 Shangani 116 103 0 0 97 0 0 0 0 0 0 0 0 0 345 661 Shibis 0 0 0 0 535 0 0 10 0 0 0 0 2 0 6968 7515 Waberi 0 0 0 0 33 0 0 0 0 0 0 0 0 0 17296 17329 Wadajir 1464 1595 868 5 2227 0 2 243 0 0 0 0 678 0 80331 87413 Wardhigley 18 0 0 29 1286 0 6 34 0 0 0 0 14 0 40116 41503 Yaqshid 1243 89 0 17 728 0 0 19 0 0 0 0 0 0 20061 22157 Bari Total 81 1020 5 10 594 0 0 92 0 0 0 0 335 0 37894 47503 Banderbayla 35 153 1 0 20 0 0 1 0 0 0 0 0 0 746 956 Bossaso 46 847 3 0 345 0 0 28 0 0 0 0 331 0 21732 30782 Carmo 0 6 0 0 4 0 0 0 0 0 0 0 2 0 634 668 0 0 0 0 32 0 0 0 0 0 0 0 0 0 1736 1768 Page 18 of 21

Iskushuban 0 7 0 1 5 0 0 0 0 0 0 0 0 0 614 627 Qardho 0 0 0 9 127 0 0 45 0 0 0 0 2 0 6616 6799 Rakko 0 0 1 0 55 0 0 18 0 0 0 0 0 0 2565 2639 Ufeyn 0 7 0 0 2 0 0 0 0 0 0 0 0 0 374 383 Waciya 0 0 0 0 4 0 0 0 0 0 0 0 0 0 2877 2881 Bay Total 811 3040 62 721 1830 25 45 576 0 1 0 0 1625 0 87387 96209 Baidoa 712 1729 47 372 1205 25 23 329 0 1 0 0 1191 0 73397 79117 Berdale 20 399 6 71 73 0 22 64 0 0 0 0 373 0 4801 5829 Burhakaba 60 339 8 257 320 0 0 178 0 0 0 0 61 0 5578 6801 Qansahdere 19 573 1 21 232 0 0 5 0 0 0 0 0 0 3611 4462 Galgadud Total 3900 1604 191 5 1096 0 166 1447 1 3 0 0 1000 8 54401 63822 Abudwak 1368 466 0 0 297 0 28 709 1 0 0 0 220 4 12332 15425 Adado 846 471 3 1 281 0 53 293 0 3 0 0 326 1 10276 12554 Balanbale 309 200 0 1 52 0 11 129 0 0 0 0 85 0 2744 3531 Dhuusamarree 697 234 10 2 192 0 16 157 0 0 0 0 158 0 15507 16973 b El Bur 24 6 178 0 38 0 0 34 0 0 0 0 17 0 533 830 El Dere 498 164 0 1 184 0 22 61 0 0 0 0 115 3 10333 11381 Gelinsor 158 63 0 0 52 0 36 64 0 0 0 0 79 0 2676 3128 Gedo Total 197 1135 43 47 313 0 0 43 0 0 0 0 255 0 17021 19054 B/hawo 50 256 27 2 52 0 0 19 0 0 0 0 68 0 5148 5622 Baardheere 0 0 0 8 0 0 0 0 0 0 0 0 0 0 0 8 Doolow 42 335 0 0 53 0 0 14 0 0 0 0 52 0 3164 3660 Garbahaarey 4 189 11 0 107 0 0 4 0 0 0 0 46 0 2868 3229 Gedweyne 0 27 0 0 25 0 0 0 0 0 0 0 0 0 183 235 Luuq 101 328 5 37 76 0 0 6 0 0 0 0 89 0 5658 6300 Hiraan Total 6873 3868 275 6 5832 0 57 147 0 0 0 0 145 2 61390 78595 Belet Weyne 3911 2890 269 0 3581 0 7 110 0 0 0 0 144 1 34707 45620 Bulo Burto 1881 466 6 6 1461 0 1 26 0 0 0 0 1 1 13170 17019 Jalalaqsi 912 122 0 0 605 0 0 2 0 0 0 0 0 0 2103 3744 Matabaan 104 295 0 0 135 0 0 0 0 0 0 0 0 0 6297 6831 Maxaas 65 95 0 0 50 0 49 9 0 0 0 0 0 0 5113 5381 Lower Total 1415 15 51 157 1581 3 20 248 0 0 0 0 170 0 59122 62782 Juba Afmadow 523 0 28 61 339 0 0 0 0 0 0 0 4 0 7640 8595 Hagar 91 5 0 10 119 2 3 42 0 0 0 0 0 0 2924 3196 Jamaame 92 0 6 7 126 0 0 44 0 0 0 0 92 0 6287 6654 Page 19 of 21

Kismayo 709 10 17 79 997 1 17 162 0 0 0 0 74 0 42271 44337 Lower Total 630 605 195 11 6575 4 15 313 0 0 0 0 598 0 107779 116725 Shabelle Afgoi 41 96 0 2 252 0 0 38 0 0 0 0 8 0 19391 19828 Kurtunwarey 37 3 37 0 1274 0 0 31 0 0 0 0 42 0 12154 13578 Marka 233 3 118 6 3593 4 15 189 0 0 0 0 469 0 63675 68305 Qoryooley 63 0 40 0 802 0 0 49 0 0 0 0 62 0 11098 12114 Wanla Weyn 256 503 0 3 654 0 0 6 0 0 0 0 17 0 1461 2900 Middle Total 75 0 1 71 498 5 239 139 0 0 0 0 154 0 9320 10502 Juba Bu,aale 19 0 0 15 112 0 55 33 0 0 0 0 0 0 1815 2049 Jilib 36 0 1 34 301 5 137 82 0 0 0 0 154 0 5891 6641 Salagle 20 0 0 22 85 0 47 24 0 0 0 0 0 0 1614 1812 Middle Total 419 307 76 96 2915 0 1 143 0 0 0 0 410 0 87215 91582 Shabelle Adale 0 0 0 0 0 0 0 0 0 0 0 0 0 0 5465 5465 Bal'ad 365 279 19 28 722 0 1 111 0 0 0 0 288 0 35886 37699 Jowhar 43 0 52 58 1792 0 0 32 0 0 0 0 89 0 24280 26346 Mahaday 3 16 0 10 136 0 0 0 0 0 0 0 10 0 7472 7647 Warsheikh 8 12 5 0 265 0 0 0 0 0 0 0 23 0 14112 14425 Mudug Total 508 39 12 36 3913 4 270 606 20 29 14 1 14 21 126887 132374 Galdogob 51 0 1 0 285 0 0 13 0 1 0 0 0 0 12100 12451 Galkacyo 313 3 11 30 2525 2 249 455 2 2 11 1 7 21 88925 92557 Harardere 28 36 0 1 146 0 12 29 0 0 0 0 4 0 3307 3563 Hobyo 115 0 0 0 893 2 8 99 18 25 3 0 3 0 10481 11647 Jariiban 1 0 0 5 64 0 1 10 0 1 0 0 0 0 12074 12156 Nugaal Total 76 829 6 0 474 1 6 183 0 0 0 0 0 0 12496 14071 Burtinle 1 166 0 0 120 0 0 29 0 0 0 0 0 0 2454 2770 Dangorayo 1 28 0 0 36 1 0 0 0 0 0 0 0 0 1435 1501 Eyl 12 227 0 0 97 0 0 44 0 0 0 0 0 0 3601 3981 62 408 6 0 221 0 6 110 0 0 0 0 0 0 5006 5819 Sanaag Total 1341 630 18 44 1097 1 76 159 0 0 0 0 28 1 25240 28769 Badhan 500 177 10 0 377 0 1 136 0 0 0 0 24 0 6273 7505 Dhahar 395 1 2 42 181 0 3 3 0 0 0 0 2 0 2962 3591 Eil-afweine 343 208 5 2 335 1 0 12 0 0 0 0 0 0 7977 8927 Erigavo 103 244 1 0 204 0 72 8 0 0 0 0 2 1 8028 8746 Sool Total 38 3689 0 6 2981 0 35 366 0 0 0 0 45 0 33077 40237 Bocame 0 0 0 0 5 0 0 2 0 0 0 0 0 0 222 229

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Hudun 0 606 0 0 378 0 1 14 0 0 0 0 0 0 3102 4101 Lasacanod 38 2787 0 6 2445 0 34 348 0 0 0 0 45 0 27454 33157 Taleex 0 296 0 0 153 0 0 2 0 0 0 0 0 0 2299 2750 Togdheer Total 240 1930 0 262 2985 0 37 214 0 6 0 0 2 13 25845 31546 Ainabo 1 85 0 45 150 0 0 3 0 0 0 0 0 0 1763 2047 Buhodle 23 125 0 100 205 0 0 13 0 0 0 0 0 0 3394 3860 Burao 190 1506 0 90 2403 0 37 198 0 6 0 0 2 13 18072 22529 Odwayne 26 214 0 27 227 0 0 0 0 0 0 0 0 0 2616 3110 Waqoy Total 1063 7374 0 271 7165 0 155 249 0 8 39 1 136 12 53546 70019 Galbed Ballayabane 163 228 0 42 234 0 24 9 0 7 2 0 0 1 2320 3030 Berbera 274 2534 0 2 2115 0 89 106 0 1 37 1 5 1 15022 20187 Gabiley 228 2205 0 94 1837 0 6 21 0 0 0 0 34 0 6058 10483 Hargeisa 236 1738 0 133 2354 0 33 98 0 0 0 0 97 10 25739 30438 Sheikh 162 669 0 0 625 0 3 15 0 0 0 0 0 0 4407 5881 Grand Total 23023 41613 1852 1998 56354 43 1147 5938 21 47 55 2 6302 73 1,213,715 1,359,916 SARI-Severe Acute respiratotyIllness,ILI-Influenza Like Illness, AWD-Acute Watery Diarrhoea,BD-Bloody Diarrhoea, Diph-Diptheria,WC-Whooping cough, Meas-Fever With Rash/Measles,NNT-Neonatal Tetanus,AJS-Acute Jaundice Syndrome, VHF-Viral Heamorrhagic Fever,Mal-Confirmed Malaria, Men-Bacterial Meningitis

For inquires please contact the Surveillance team, Ahmed Moalim Mohamed, Emergency Coordinator FMoH, [email protected] and WHO country office in Somalia or Dr Mutaawe Lubogo, Epidemiologist, [email protected]

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