Weekly Cholera Situation Report Epidemiological Week 18 (28 - April -5-May 2019) HIGHLIGHTS KEY FIGURES • A total of 47 new cases of Cholera were • 47 new cases with no death reported in week 18 from Banadir CTC • 40% of the new cases were female • No death was reported in week 18 • 64% of the cases were ≤5 years • No cases of Cholera were reported from weeks 1 to 7 due to closure of CTCs • All Cases reported in week 18 had never received cholera vaccine • A cumulative total of 7,187 cases including 46 deaths were reported from December 2017 to • A total of 16 districts in Banadir region have 5 May 2019 in 5 regions reported cholera cases from February 5 May 2019 • Only Banadir region has active cases of cholera to date • 7,187 cumulative cases including 46 deaths from December 2017 till 5 May 2019 (CFR • Due to limited funding, response activities are constrained 0.6%)

Cholera situation in

The current cholera outbreak started in December 2017 following floods that affected the districts in the basins of rivers Shabelle and Jubba (fig 1). As of week 18, 2019, the outbreak has been contained in 5 regions with only Banadir reporting active transmission. Since the beginning of the outbreak a total of 7,187 including 46 deaths (CFR 0.6%) (Table 1). However; the drought affecting many parts of the country has led to limited access to safe water and food insecurity and this is expected to lead to increased spread of cholera cases to other regions.

Fig 1: Cholera trends in Somalia 2018/19 450 Cases Deaths 400 350 300 250 200

150 Cases 100 50 0 18 20 22 24 26 28 30 32 34 36 38 40 42 44 46 48 50 52 2 4 6 8 10 12 14 16 18 2018 2019 epi week

NB: Cholera Treatment Centre in Banadir hospital was closed between week 1-7 /2019

1

The cholera outbreak has been contained in districts of Jubaland, Hirshabelle and South West States following implementation of Oral Cholera Vaccination (OCV) Map: Districts affected with cholera in Banadir in these areas as well as other control interventions. However, region week 18 active transmission is still reported in Banadir region. As shown in Table 3, a total of 47 new cholera cases were reported in Banadir region in week 18 due to a high concentration of people living in Internally Displaced Persons (IDP) camps where access to safe water and proper sanitation is limited. Following the closure of the CTC, there was no data collected between weeks 1-7. Severe drought has led to drying up of water sources in South West, Puntland and Somaliland states of Somalia since January 2019 due to poor Dyer rain received in 2018. Over 1.5 million people have been classified under IPC3 by the health cluster with over 15% of children below 5 years at risk of malnutrition. Limited access to safe water coupled with Severe Mal nutrition among children is likely to lead to an increase to the spread of cholera to new locations

Table 1. Cholera cases per region Regions week 17/2019 week 18/2019 Cumulative Week 1- 52/2018-week 18/2019 Cases Deaths CFR(%) Cases Deaths CFR(%) Cases Deaths CFR(%) Banadir 36 0 0 47 0 0 3,440 24 0.7 Lower Jubba 0 0 0 0 0 0 2330 15 0.6 0 0 0 0 0 0 294 4 1.4 0 0 0 0 0 0 558 2 0.4 Hiraan 0 0 0 0 0 0 565 1 0.2 Total 36 0 0 47 0 0 7,187 46 0.6 NB. Deaths are included among cases. Banadir is not classified as a state.

2

Cholera situation in Banadir region

As of Epi week 18, only Banadir region is still reporting cholera cases in Somalia (fig 2a). A total of 47 new cholera cases and no death were reported from 11 of the 17 districts of Banadir region. Hodan and Deynile districts were the most affected. Of the 47 cases reported during week 18, 30 (64%) of them were children below 5 years. The protracted cholera outbreak in Banadir is attributed to high concentration of IDPs where access to safe water and sanitation is limited. All the 47 new cholera cases reported did not receive OCV in 2018/19 campaigns. As shown in fig 2a below, Banadir hospital CTC did not report any cholera cases between week 1-7 due to the closure of the Cholera Treatment Centre.

250 Fig 2a: Cholera trends in Banadir region 2018-2019

200

150

Cases Cases 100

50

0 18 20 22 24 26 28 30 32 34 36 38 40 42 44 46 48 50 52 2 4 6 8 10 12 14 16 18 2018 2019 Epi week

cases Deaths

Laboratory activities

Between weeks 8-18 a total of the 120 stool samples have been collected of which 10 tested positive for V. cholera on (Table 2). Of the 6 Stool samples tested in the National Public Health Laboratory in during the current week18 tested was Negative

Table 2. Stool culture results from cholera affected regions Region Culture Positive samples Culture negative Total Banadir 10 110 120 Total 10 110 120

3

Distribution of Cholera cases in different districts

As shown in table 3 below, 79% of the cholera cases reported from Banadir are from Hodan district, Madina Deynile and Darkenley district. These most affected districts have high concentration of IDPs. Table 3. /Cholera cases in different districts Week 18-2019 Cumulative Week 1/2018 – Week 18/2019 Cases Deaths Region District <2 yrs 2 -5 yrs ≥ 5 yrs <2 yrs 2-5yrs ≥ 5 yrs Cases Deaths CFR (%) Banadir Darkenley¥ 3 1 4 0 0 0 545 1 0.2 Daynile¥ 4 0 3 0 0 0 620 11 1.8 HamarJabja α 0 0 1 0 0 0 213 2 0.9 Hawlwadag 1 0 2 0 0 0 155 1 0.6 Hodan¥ 10 1 4 0 0 0 743 2 0.3 Bondere 0 0 1 0 0 0 5 0 0.0 Karaan 0 1 0 0 0 0 66 1 1.5 Kahda α 0 0 1 0 0 0 8 0 0.0 Madina 4 3 0 0 0 0 602 3 0.5 Waberi 0 0 2 0 0 0 138 2 1.4 Shibis 0 0 0 0 0 0 15 0 0.0 Shingani 0 0 0 0 0 0 24 0 0.0 Abdilaziz 0 0 0 0 0 0 8 0 0.0 HamarWeine 0 0 0 0 0 0 59 0 0.0 Heliwaa α 0 0 0 0 0 0 34 0 0.0 Warta nabada 0 0 0 0 0 0 138 1 0.7 Yaqshid 1 0 0 0 0 67 0 0.0 Total: others 0 0 0 0 0 0 3,747 22 0.6 Total 23 6 18 0 0 0 7,187 46 0.6 ¥ : α: OCV implemented in October 2017; Planned OCV implementation in 2019

Response activities implemented during the week

Coordination and Leadership • Weekly coordination and monitoring meeting was conducted by the emergency team of MoH, WASH team and staff of Banadir CTC to identify the gaps in response activities • Daily monitoring of Cholera cases in all Somalia continued during the week Case management • A total of 47 new cholera cases where treated using standard guidelines in Banadir CTC Surveillance and Laboratory Investigations • Routine line listing of cases and data analysis was done to identify most affected districts and vulnerable populations which will inform intervention measures • Monitoring of alerts was done through the Early Warning Alerts and Response Network (EWARN) Gaps in response • Limited medical supplies to manage confirmed cases using standard guidelines • Insecurity within Banadir region is limited movement of health workers to verify the alerts as well as implementation of other response activities

For enquiries, please contact Ahmed Moallim Mohamed Dr. Mutaawe Lubogo Emergency Coordinator Epidemiologist Federal Ministry of Health World Health Organization, Somalia [email protected] [email protected]

4