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Early Warning Disease Surveillance and Response Bulletin, Somalia 2018 Epidemiological Week 24 (Week Ending 17Th June, 2018)

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Early Warning Disease Surveillance and Response Bulletin, Somalia 2018 Epidemiological Week 24 (Week Ending 17Th June, 2018) Early Warning Disease Surveillance and Response Bulletin, Somalia 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 Lower Shabelle, Banadir and LowerJubba; the regions that are affected by floods. In week ending 17th June, active transmission of AWD/cholera was reported in Kismayo district 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). Page 3 of 21 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 Mogadishu 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 Kenya 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.
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