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Zimbabwe Weekly Epidemiological Bulletin

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Zimbabwe Weekly Epidemiological Bulletin Zimbabwe Weekly Epidemiological Bulletin Number 159 Epidemiological week 15 (week ending 15 April 2012) Highlights: Week 15 (9– 15 April 2012) cases, 322 from Zvimba and four cases from 46 typhoid cases reported Harare was done. The Zvimba cases were from Late reporting of 322 Zvimba typhoid cases November 2011 to February 2012. The number Malaria deaths double of cases reported weekly has been in general 13967 malaria cases and 14 deaths reported decline since week 52, 2011 as is shown in the epi-curve Contents Since the beginning of 2012, a total of 3331 A.General context cases have been reported. B.Epidemic prone diseases C.Events of public health importance in the region The distribution of cumulative cases, in D.Completeness and timeliness of the national data Harare City since the beginning of the E. Acknowledgments outbreak to date, by place of residence is F. Annexes shown in Figure 2. 1. Classification of events that may constitute a Public Event of International Concern Table 1: Distribution of typhoid cases by place of 2. Standard case definitions residence in Harare City, 9-15 Apr 2012 3. Alert/action epidemic thresholds Suburb Cases Frequency A. General Context (%) n=45 Kuwadzana 21(46.7%) Typhoid outbreak in Harare is still on-going Dzivaresekwa 17(37.8%) since October 10, 2011. The disease has spread to other provinces. However the weekly number Crowborough 2(4.4%) of cases has declined. Tynwald 2(4.4%) Snake park 1(2.2%) No reports of cholera, Influenza A and measles Unknown 1(2.2%) outbreaks countrywide. Whitecliffe 1(2.2%) B. Epidemic prone diseases Typhoid outbreak Figure 1: Harare and Bindura Typhoid Epidemic Curve, 10 October 2011 – 15 April 2012 Since 10 October 2011, Harare City has been experiencing an outbreak of Typhoid Fever. The disease has also spread to Chitungwiza City, 120 Mashonaland Central Province (Bindura district) and 100 Mashonaland West Province (Zvimba and Chegutu districts). As of 15 April 2012, a total of 4520 cases 80 were reported of which 4107 cases and 2 deaths 60 (CFR= 0.05%) were from Harare City, 325 from 40 Zvimba, 69 from Bindura , Chegutu 16 cases, Harare Cases Typhoid Central Hospitals 8 cases, Chitungwiza 2 cases and 20 Chirumanzu 1 case. Of the total samples collected 0 for laboratory confirmation from 26 October 2011 to date, 67 were confirmed S.typhi of which 63 were from Harare and 4 from Bindura. 2012/01/01 2011/09/18 2011/09/25 2011/10/02 2011/10/09 2011/10/16 2011/10/23 2011/10/30 2011/11/06 2011/11/13 2011/11/20 2011/11/27 2011/12/04 2011/12/11 2011/12/18 2011/12/25 2012/01/08 2012/01/15 2012/01/22 2012/01/29 2012/02/05 2012/02/12 2012/02/19 2012/02/26 2012/03/04 2012/03/11 2012/03/18 2012/03/25 2012/04/01 2012/04/08 2012/04/15 During week 15, a total of 46 cases were reported: 45 Date of Symptom Onset from Harare and one from Chegutu district. In the previous week 48 cases had been reported countrywide. In addition late reporting of 326 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 Since the beginning of 2012, a total of 137302 cases and 106 deaths (CFR = 0.08%) were Response activities reported. Weekly coordination meetings with the Figure 3: Comparison of national malaria cases thematic committees involving Harare 2012 vs. 2011 and epidemic threshold City Health authorities and Partners (WHO, UNICEF, CDC, NGOs) Social mobilization activities 2011 threshold 2012 Case Management, and investigation Active contact tracing 18000 Water quality monitoring 16000 14000 Bucket Chlorination at water points 12000 10000 8000 Figure 2: Map of the distribution of typhoid Cases cases by place of residence, Harare City, 10 6000 Oct 2011- 15 April 2012 4000 2000 0 1 4 7 10 13 16 19 22 25 28 31 34 37 40 43 46 49 52 Week Number C. Completeness and timeliness of the National data National data reported in week no 15 Completeness increased from 80% to 84% Timeliness increased from 75% to 82% D. Events of public health importance within SADC Anthrax No new events were reported. No cases of anthrax were reported this week: E. Acknowledgements The cumulative figure for anthrax is 17. All health workers, operating at different levels Malaria of the health system, providing information are greatly acknowledged. In addition, special This week, a total of 13967 cases and 13 deaths thanks to Health and WASH cluster members were reported compared with 11970 cases and 6 for sharing their data with our team. deaths in the previous week. The following districts are the most affected: Mutoko 2092 MOHCW is grateful to all Partners including (15.0%), Mt Darwin 1496 (10.7%), Nyanga UN family and NGOs for their support. 1054 (7.5%), Chipinge 764 (5.5%), Hurungwe Information on events of public health 757 (5.4%), Makoni 674 (4.8%), Makonde importance occurring within SADC is 589(4.2%), Chimanimani 562 (4.02%), Mudzi 539 (3.9%), Mutare 532 (3.8%) and Kariba 512 consolidated from the WHO daily summary of (3.7%). health events. 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: Classification of Events that may constitute a Public Health Emergency of International Concern There are three groups of events if detected by the national surveillance system should trigger the use of the IHR (2005) Decision Instrument to be notified as they may constitute Public Health Emergencies of International Concern. These are: 1. A case of unusual or unexpected diseases which may have serious public health impact: smallpox, poliomyelitis due to wild-type poliovirus, human influenza caused by a new subtype and SARS. 2. Any event of potential international public health concern including events of unknown causes or sources and those involving other events or diseases: environmental health emergencies (natural events, chemical and radio-nuclear events, technological incidents, complex emergencies and deliberate events) Food borne diseases Zoonotic diseases or other infectious diseases. 3. Any of following diseases that have demonstrated the ability to cause serious public health impact and spread rapidly and internationally: Cholera, pneumonic plague, yellow fever, viral haemorrhagic fevers, West Nile Fever, other diseases that are of special national or regional concern e.g. dengue, RVF and meningococcal disease. 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 Diseases Standard Case Definitions Cholera Suspected case In an area where there is no cholera outbreak, any person aged five years or more, presenting with severe dehydration or death from acute watery diarrhoea In an area where there is a cholera outbreak, any person aged two years or more presenting with acute watery diarrhoea, with or without vomiting Confirmed case A suspected case in which Vibrio cholerae sero-groups O1 or O139 has been isolated in the stool. Note All suspected cases under the age of two years must be confirmed. The inclusion of all ages in the case definition somewhat reduces specificity, that is, inclusion of more non-cholera childhood diarrhoea cases (mainly those below 5years). It does not impede meaningful interpretation of trends. Teams should monitor any shift in the age distribution of cases, which might indicate a changing proportion of non- cholera cases among patients seen. Malaria Suspected uncomplicated malaria Any person living in a malaria area or history of travelling in a malaria area within the last 6 weeks, presenting with fever, malaise, chills, and rigors, without signs of severe disease such as vital organ dysfunction Confirmed uncomplicated malaria Is suspected uncomplicated malaria with laboratory diagnosis by malaria blood slide or RDT for malaria parasites Confirmed severe malaria A patient hospitalized with P. falciparum asexual parasitaemia as confirmed by laboratory tests with accompanying symptoms of severe disease (vital organ dysfunction) Typhoid Suspected case Any person with gradual onset of steadily increasing and then persistently high fever, chills, malaise, headache, sore throat, cough, and, sometimes, abdominal pain and constipation or diarrhoea Confirmed case A suspected case confirmed by isolation of Salmonella typhi from blood, bone marrow, bowel fluid or stool Diarrhoea Suspected case Passage of 3 or more loose or watery stools in the past 24 hours with or without dehydration or some dehydration and two or more of the following signs: restlessness, irritability, sunken eyes, thirsty, skin pinch goes back slowly, or severe dehydration and two or more of the following signs: lethargy or unconsciousness; sunken eyes; not able to drink or drinking poorly; skin pinch goes back very slowly Confirmed case Suspected case confirmed with stool culture for a known enteric pathogen. Note: Laboratory confirmation of specific agent causing outbreak is not routinely
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