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

2018: Epidemiological Week: 14 Reporting Period: 02 April –08 April 2018

Highlights

Number of reporting sites in week 14: One hundred and five (105) submitted their weekly reports complete and in timely manner.

Total number of consultations in week 14: 43,707 marking an increase of 4,733 to last week consultation of 48,440. The number of consultations for other disease this was week was 36,557.

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Leading causes of morbidity in week 14: Acute Upper Respiratory Infections (AURI) (n=4389; 10.04% of consultations number), Acute Lower Respiratory Infections (ALRI) (n=1552; 3.55%) and acute diarrhea (AD) (n=1105; 2.53%) remained the leading causes of morbidity this reporting week.

Number of alerts in week 14: Twelve (12) 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 14 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 - 14 2018

140

120

100

80

60 119 121 118 104 40 86

20 40

0 Weeks Weeks Weeks Week Week Week Week Week Week Week Week Week Week Week Week Week Week 1 - 52 39 - 52 49 - 52 01 02 03 04 05 06 07 08 09 10 11 12 13 14 2017 2017 2017 2018 2018 2018 2018 2018 2018 2018 2018 2018 2018 2018 2018 2018 2018

Figure 1. Distribution of reporting health facilities

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Morbidity Patterns:

During week 14, the proportions of AD and ALRI increased 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 - 14 2018 7000

6000

5000

4000

3000

2000

1000

0 Weeks Week Week Week Week Week Week Week Week Week Week Week Week Week Week 49 - 52 01 02 03 04 05 06 07 08 09 10 11 12 13 14 2017 2018 2018 2018 2018 2018 2018 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 14 2018 2018 Epidemiological week 14:

Below is the distribution of the leading causes of morbidity by municipalities for the epidemiological week 14.

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Distribution of common disease by municipalities for week 14, 2018 100% 90% 80% 70% 60%

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

0%

Sert

JALO

GHAT

ZLETIN

ZAWIA

SABHA

Tobruk

ZWARA

KHOMS

ESBEAA

MRADA

OUBARI

GARIAN

ALKOBA

MORZIG

TAZIRBU

ALMARIJ

ALJOFRA

ALBAIDA

DARNAH

BENGAZI NESMAA

MEZDAH

ALAJILAT

IGDABYA

ALABYAR

ALKOFRA

SUBRATA

Ghdames

ALJEMAIL

TRAGHEN

DAWOON

TARHUNA

REGDALIN

IMSALATA

MISURATA

Aljaghboub

BANIWALED

ASHATI EAST ASHATI

ASHATI West ASHATI

ABOU ABOU SALEM

Souq Eljomaa Souq

TRIPOLI central TRIPOLI HAY HAY ALANDALUS Qasir BenGhashir Qasir Figure 3. Distribution of common disease by municipalities for week 14, 2018

Trend of pertussis:

In total 430 cases of suspected pertussis have been reported from EWARN sites this year. This week 26 cases were reported and they are distributed as follow: Albaida (3), Subrata (8), Imsalata (12) and Bengazi (3).

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Distribution of S. pertussis reported cases by week and by municipality up to week 14, 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 TAZIRBU Tobruk TRAGHEN Tripoli YEFRIN ZAWIA ZELTON ZENTAN ZLETIN ZWARA ALZAHRAA TRIPOLI central ALSWANI ALAZIZIYA Souq Eljomaa NESMAA

10 0

0 0 33 0 0 14 0 29 1 0 30 0 14 2 01 0 8 0 24 17 20 7 18 0 0 7 8 12 3 0 16 7 0 0 12 7 12 12 9 0 11 9 3 9 2 7 0 8 0 7 1 3 4 0 3 0 01 01 0 5 4 5 01 01 2 10 10 2 2 3 2 2 0 10 0 3 WEEK 01 WEEK 02 WEEK 03 WEEK 04 WEEK 05 WEEK 06 WEEK 07 WEEK 08 WEEK 09 WEEK 10 WEEK 11 WEEK 12 WEEK 13 WEEK 14 2018 2018 2018 2018 2018 2018 2018 2018 2018 2018 2018 2018 2018 2018 Figure 4. Distribution of suspected pertussis cases reported by week and by municipality week 14 2018.

Trend of Acute Upper Respiratory Infections

During week 14, a total of 4389 cases were reported (10.04 % of total consultations) and are summed up in table 1 below:

Municipality AURI cases Municipality AURI cases

ALJOFRA 249 Souq Eljomaa 300

ALKOFRA 113 Ghdames 92

ALMARIJ 192 Sert 77

BANIWALED 182 Aljaghboub 1

BENGAZI 554 SUBRATA 195

GARIAN 36 ALKOBA 111

IGDABYA 293 ALBAIDA 70

IMSALATA 255 ALAJILAT 235

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KHOMS 82 ASHATI EAST 89

MISURATA 186 Tobruk 5

MORZIG 73 Qasir Ben Ghashir 82

MRADA 17 MEZDAH 10

REGDALIN 49 TRAGHEN 5

SABHA 48 ALABYAR 24

ZAWIA 193 JALO 20

ZLETIN 38 TAZIRBU 61

ZWARA 157 ABOU SALEM 29

TRIPOLI central 117 37 HAY ALANDALUS DARNAH 101 8 OUBARI ESBEAA 12

Table 1. Summary of AURI cases by Municipality in week 14

Figure 5 below shows the trend of AURI cases in the period from week 01 2017 to week 14/2018 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 14/2018.

The cumulative AURI during this year reached 68658 cases. Benghazi reported 15% of all cases (10087). 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 14, 2018 7000

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0

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 09WWeek 2018 10WWeek 2018 11WWeek 2018 12WWeek 2018 13WWeek 2018 14 2018 WWeek 01 2018 Figure. 5 Distribution of AURI cases by week, week 1 – 52, 2017 and week 14, 2018.

Percentage of AURI cases from the total consultation number by week, week 39 - 52, 2017 and week 14, 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 10.9211.53 11.09 10.21 10.04 9.15 9.53 4.00 8.53 8.33 8.64 7.067.52 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 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 10 11 12 13 14

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Figure.6 Distribution of AURI percentage by week, week 39 – 52, 2017 and 14, 2018

Trend of Acute Lower Respiratory Infection:

During week 14, a total of 1552 cases of acute lower respiratory infections were reported (3.55% of total consultations) and are summarised by municipality in Table 2 below:

Municipality ALRI cases Municipality ALRI cases

51 21 ALJOFRA TRIPOLI central ALKOFRA 1 222 Souq Eljomaa ALMARIJ 63 Ghdames 25

BANIWALED 71 Sert 38

BENGAZI 148 SUBRATA 216 GARIAN 10 ALKOBA 53 IGDABYA 26 ALBAIDA 23 IMSALATA 30 ALAJILAT 65 KHOMS 4 ASHATI EAST 22 MISURATA 94 Tobruk 13 Qasir Ben MORZIG 11 Ghashir 91 REGDALIN 49 MEZDAH 7 SABHA 96 ALABYAR 3 ZAWIA 35 JALO 1 ZLETIN 28 TAZIRBU 3 HAY DARNAH 8 ALANDALUS 14 ESBEAA 10 Table 2. Summary of ALRI cases by Municipality in week 14

Figure 7 below shows the trend of ALRI cases in the period from week 01 2017 to week 14/2018 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 14/2018.

The cumulative ALRI during this year reached 19038 cases. Baniwaled reported 9% of all cases (1688). 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 14, 2018 2000

1800

1600

1400

1200

1000

800

600

400

200

0

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 09WWeek 2018 10WWeek 2018 11WWeek 2018 12WWeek 2018 13WWeek 2018 14 2018 WWeek 01 2018 Figure. 7 Distribution of ALRI cases by week, week 1 – 52, 2017 and week 14, 2018.

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Percentage of ALRI cases from the total consultation number by week, week 39 - 52, 2017 and week 14, 2018 5.00

4.50

4.00

3.50

3.00

2.50 4.37 2.00 3.72 3.82 3.38 3.55 3.28 3.15 1.50 3.053.11 2.932.92 3.00 2.60 2.59 2.64 2.77 2.73 1.00 2.12 2.21 1.78 1.901.96 1.541.72 1.67 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 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 10 11 12 13 14

Figure.8 Distribution of ALRI percentage by week, week 39 – 52, 2017 and week 14, 2018

Trend of Acute Diarrhea

During week 14, a total of 1105 (2.53% 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 98 TRIPOLI central 11

ALKOFRA 42 Souq Eljomaa 39

ALMARIJ 99 Ghdames 16

BANIWALED 115 Aljaghboub 5

BENGAZI 128 SUBRATA 23

GARIAN 5 ALKOBA 129

81 46 IMSALATA ALBAIDA KHOMS 2 17 ASHATI EAST

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MISURATA 60 TRAGHEN 1

REGDALIN 47 ALABYAR 4

SABHA 26 JALO 1

ZAWIA 26 40 TAZIRBU 18 4 ZLETIN OUBARI Tobruk 5 ABOU SALEM 5

HAY ALANDALUS 12

Table 3. Summary of AD cases by Municipality in week 14 Figure 5 below shows the trend of AD cases in the period from week 01 2017 to week 14/2018 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 14/2018.

The cumulative AD during this year reached 16195 cases. Bengazi reported 19% of all cases (3074). 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 14, 2018 1600

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1000

800

600

400

200

0

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 09WWeek 2018 10WWeek 2018 11WWeek 2018 12WWeek 2018 13WWeek 2018 14 2018 WWeek 01 2018 Figure 9. Distribution of AD cases by week, week 1 – 52, 2017 and week 14, 2018.

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Percentage of AD cases from the total consultation number by week, week 39 - 52, 2017 and week 14, 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 2.722.87 2.58 2.59 2.61 2.63 2.58 2.502.50 2.552.502.572.53 2.21 2.23 1.00 2.192.17 2.16 2.102.18

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 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 10 11 12 13 14

Figure 10. Distribution of AD percentage by week, week 39 – 52, 2017 and week 14, 2018

Trend of vaccine preventable diseases:

Durign week 14, 35 VPD cases was reported and they are summerised in the table below:

VPD No of Cases Municipality Age Sex Meningitis 4 Tripoli central Below 5 years Male (3) Female (1) (3) and Tobruk (1) above five (1) years (3) Pertussis 26 Albaida (3), Below 5 years male (15) female (11) Subrata (8), (21) above 5 Bengazi (3), years (5) Imsalata (12) Measles 4 Bengazi (1), Below 5 years males (4) Sabha (2) and (2) above five Regdalin (1) years (2) AFP 1 Bengazi (1) Below 5 years Male (1) (1)

Summary of all cases reported in week 14:

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Disease No of cases Percentage from total consultations AURI 4389 10.04 ALRI 1552 3.55 AD 1105 2.53 BD 22 0.05 AJS 4 0.01 Leishmania 15 0.03 Meningitis 4 0.01 Pertussis 26 0.06 Measles 4 0.01 AFP 1 0.00 Food Poisoning 4 0.01

Alerts & Outbreaks Twelve (12) 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 Pertussis Benghazi 3 No No DK No 2 Pertussis Imsalata 12 No No DK No 3 Pertussis Albaida 3 No No DK No 4 Pertussis Subrata 8 No No DK No 5 Leishmania Garian 3 Yes Clinical Yes No Diagnosis 6 Leishmania Khoms 11 Yes Clinical Yes No Diagnosis 7 Meningitis Tripoli 3 Yes Yes DK No central 8 AFP Bengazi 1 Yes Yes DK No 9 measles Sabha 2 Yes Yes DK No 10 measles Bengazi 1 Yes Yes DK No 11 measles Regdalin 1 Yes Yes DK No 12 BD Baniwaled 12 No No DK No

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