Somalia Weekly Update Week-48 Ending 03 October 2017 Part -I

VDPV2 Situation Update VDPV2 in • Background • VDPV2 was identified in 2 environmental samples collected 10 days apart from the same sewage site in of Banadir region in • The 1st sequencing results were received from the CDC on November 9th • The first VDPV2 was 38 NT different from the parent Sabin • Advisory Group discussion • The Somalia mOPV2 advisory group meeting was held on November 20th • The country program presented detailed risk assessment on the VDPV2 situation • mOPV2 request received by advisory group and was approved as per country program request • Risk Assessment • Virological risk: Medium to high • Contextual risk of further transmission= Medium • Risk for international spread= Medium

3 Preparation for mOPV Campaign

• Two rounds of mOPV2 and 1 IPV campaigns were approved by the advisory group • The mOPV2 campaign will target 726,699 under 5 years old children living in Badadir, and regions of Central zone • The proposed dates for the first round is from 10-14 December • There will be 2 weeks interval between the two mOPV2 rounds and also between the second mOPV2 and the IPV campaign • RPOs and DPOs from neighboring regions will be mobilized to support the intra campaign monitoring • Quality of SIA will be assessed by independent monitoring and LQAS • There will be daily and weekly coordination activities both at Nairobi and Mogadishu levels involving MoH, WHO and UNICEF • Orientation will be given for RPOs, DPOs, DFAs and Vaccinators in Mogadishu about the management of mOPV2

Preparation so far • Micro-plans prepared, revised and validated at DFA and district level • Training for RPOs, DPOs and DFs and data managers on how to use satellite maps to enhance their micro-plans and identify DFA and team areas • DFA level area maps prepared, validated by DPOs and DFAs, and printed • Vaccine arrived in Mogadishu on the 2nd December 2017 • Plans for C4D, Vaccine management and monitoring is being developed Other Activities Related to VDPV2 Response

• Heightened AFP surveillance with active case searches in the community and health facilities • Joint visit conducted in selected public and private HFs to see the AFP surveillance activity and also sensitize the health workers about the event • Quick surveillance review both internal and external was conducted to identify any gaps • Review of surveillance and immunization services among special population in Mogadishu (IDPs etc.) • Healthy children Stool samples were collected from randomly selected households in Waberi district (25) as well as from health facilities with pediatric outpatient (24) • Additional ES samples collected from the existing 3 sites and from a new temporary site in one of the busy hospitals. Frequency of sampling from the ES sites was increased from once monthly to once every two weeks. • Mapping the area to narrow our focus and identify upstream catchment population served by the Mogadishu sewage system drained to 21 October site. • Household survey was conducted to ascertain the coverage of the sewage site that yielded the VDPV2s • Collaborating with WHO Malaria team who were conducting malaria indicators survey. Immunization coverage survey was included into the exercise – currently ongoing Part -II

AFP-Surveillance Week-48 Somalia Weekly EPI/POL Update

Epidemiological Curve January 1, 2014 – December 03, 2017

18

16

14

12

10

aVDPV Cases 8 WPV

Compatable 6 Discarded

4 Pending ERG

Pending Lab 2

0

2015W13 2015W19 2015W25 2015W31 2015W37 2015W44 2015W50 2017W22 2017W28 2017W35 2017W40 2017W46 2017W52 2014W01 2014W03 2014W05 2014W07 2014W09 2014W11 2014W13 2014W15 2014W17 2014W19 2014W21 2014W23 2014W25 2014W27 2014W29 2014W31 2014W33 2014W35 2014W37 2014W39 2014W41 2014W43 2014W45 2014W47 2014W49 2014W51 2015W01 2015W03 2015W05 2015W07 2015W09 2015W11 2015W15 2015W17 2015W21 2015W23 2015W27 2015W29 2015W33 2015W35 2015W39 2015W41 2015W46 2015W48 2015W52 2016W02 2016W04 2016W06 2016W08 2016W10 2016W12 2016W14 2016W16 2016W18 2016W20 2016W22 2016W24 2016W26 2016W28 2016W30 2016W32 2016W34 2016W36 2016W38 2016W40 2016W42 2016W44 2016W46 2016W48 2016W50 2016W52 2017W02 2017W04 2017W06 2017W08 2017W10 2017W12 2017W14 2017W16 2017W18 2017W20 2017W24 2017W26 2017W31 2017W33 2017W37 2017W39 2017W42 2017W44 2017W48 2017W50 Week number of onset

Graph no. 1 Week-48 Somalia Weekly EPI/POL Update

Weekly AFP cases reported by Provinces, 2016-2017 Somalia. (cases are distributed across weeks based on date of onset of paralysis).

PROVINCE

2017W08 2017W10 2017W12 2017W14 2017W23 2017W25 2017W27 2017W29 2017W38 2017W40 2017W42 2017W01 2017W02 2017W03 2017W04 2017W05 2017W06 2017W07 2017W09 2017W11 2017W13 2017W15 2017W16 2017W17 2017W18 2017W19 2017W20 2017W21 2017W22 2017W24 2017W26 2017W28 2017W30 2017W31 2017W32 2017W33 2017W34 2017W35 2017W36 2017W37 2017W39 2017W41 2017W43 2017W44 2017W45 2017W46 2017W47 2017W48 2016W49 2016W50 2016W51 2016W52

Total 2017 Total Total2016 BANADIR 1 30 1 1 1 2 1 3 1 2 1 1 1 1 1 2 1 1 2 2 2 1 2 1 1 32 GALGADUD 25 1 1 1 1 1 1 1 2 1 1 1 1 1 2 1 1 2 1 1 1 1 1 25 M. SHABELLE 1 19 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 2 1 1 1 1 1 23 L. SHABELLE 1 24 1 1 1 1 1 2 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 2 1 1 2 1 29 HIRAN 1 15 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 20 BARI 1 1 24 1 2 1 1 1 2 1 1 1 1 1 2 1 1 1 1 1 1 21 NUGAL 1 1 11 2 1 1 1 1 1 1 1 9 1 1 14 1 2 1 1 1 1 1 1 1 1 1 12 TOGDHER 11 1 1 1 1 1 1 1 1 8 GALBEED 1 1 1 1 19 1 3 1 1 1 1 1 1 1 1 2 1 2 1 2 20 SANAQ 7 1 1 1 1 1 5 AWDAL 1 18 1 1 1 1 2 1 1 1 1 1 1 1 1 1 1 1 17 SAHIL 8 1 1 1 1 1 1 1 1 8 SOOL 5 1 2 1 1 1 1 1 2 10

LOWER JUBA 1 1 26 2 1 1 2 2 1 1 1 1 1 1 1 1 2 2 1 1 1 1 1 1 1 27 1 - BAY 19 3 1 3 1 1 1 1 1 1 1 1 2 2 19 1 21 1 2 1 1 1 1 1 1 1 1 1 1 2 2 1 18 11 1 1 1 1 2 1 2 1 10

BAKOOL 1 9 1 1 1 1 1 1 1 1 1 9 no. Table Total Somalia 7 3 5 4 316 6 8 10 6 3 8 9 11 7 12 8 6 9 8 8 4 10 8 6 9 8 5 9 10 2 5 9 3 7 6 7 7 6 9 5 7 10 4 5 7 3 2 8 11 4 5 1 1 322 Silent (not reporting) for > 8 weeks - 4 new AFP cases were reported this week making the total 322 AFP cases reported in 2017. Reported AFP cases - In addition 962 contact samples (3 contacts for each case) and 172 community samples were collected from 24 districts Community Samples collected in silent regions -- 3 regions ( Bay, Gedo and Middle Juba) are silent for not reporting for 8 weeks and are advised to collect community samples Community Samples collected but regions not silent Week-48 Somalia Weekly EPI/POL Update

Classification of AFP cases by status (2016 & 2017) 2016 2017 REGION Pending Discarded VDPV Total Discarded Pending Total 322 AFP Cases BANADIR 0 30 0 30 32 0 32 25 0 25 Reported in 2017 GALGADUD 0 25 0 25 HIRAN 0 15 0 15 19 1 20 L. SHABELLE 0 24 0 24 26 3 29 M. SHABELLE 0 19 0 19 22 1 23 BARI 0 24 0 24 20 1 21 MUDUG 0 14 0 14 11 1 12 0 0 NUGAL 0 11 0 11 9 0 9 310 12 0 AWDAL 0 18 0 18 16 1 17 Discarded Compatible WPV Pending VDPV GALBEED 0 19 0 19 20 0 20 SAHIL 0 8 0 8 8 0 8 SANAQ 0 7 0 7 5 0 5 SOOL 0 5 0 5 10 0 10 TOGDHER 0 10 1 11 8 0 8 0 9 0 9 8 1 9 19 0 19 3 0 BAY 0 19 0 19 2

9 - In process (lab) Pending ERG Pending ITD GEDO 0 21 0 21 18 0 18 0 26 0 26 24 3 27 10 0 10 Chart no. 1 MIDDLE JUBA 0 11 0 11 no. Table Grand Total 0 315 1 316 310 12 322 Week-48 Somalia Weekly EPI/POL Update

Surveillance Indicators by Zone and Region 2017

Annualized NP-AFP Rate by Zone, 2017 12.0

10.0 10.2 8.0

6.0 6.2 5.6 4.0 4.9 5.2 2.0

0.0 Central Puntland Somaliland South Total Somalia

Graph no. 2

Annualized NP-AFP rate by accessibility status 10.0

8.0

6.0 7.6

4.0 5.4 5.4 5.6

2.0

- In-accessible Partially Accessible Somalia Map no. 1 Acceessible Map no. 2 Graph no. 3 Week-48 Somalia Weekly EPI/POL Update

Surveillance Indicators (NP-AFP rate and Stool adequacy) by district, 2017

. All the 115 districts in Somalia have reported at least 1 AFP case since the beginning of 2017. . The NP-AFP rate for 112 districts is >2. The 2 districts that did not meet this indicator are; Badan and Gabile from Somaliland and Heliwa from Central. . 112 districts had stool adequacy above 80% while three districts (Badade, Kismayo and Bossaso) did not meet the required stool adequacy rate. Badade and kismayo are partially accessible from south while Bossaso is fully accessible district in Puntland. Map no. 3 Map no. 4 Week-48 Somalia Weekly EPI/POL Update

Distribution of NP-AFP cases and zero-dose cases Vs accessibility of districts

. AFP cases were reported from across

the country from all zones, all regions

and also from the accessible and the

inaccessible parts of the country.

. All but one of the total 41 zero dose

AFP cases reported in 2017 were

reported from access compromised

Map no. 5 districts. Map no.6 Week-48 Somalia Weekly EPI/POL Update

Number of NP-AFP cases reported across years during the same period (2013-2017) by zone

600

500 514

400 393

300 322 297 265

200

178

140 136 100 129 109 102 96 82 83 60 61 63 68 62 48 37 24 37 50 43 42 36 55 51 27 0 CENTRAL Puntland Somaliland SOUTH SOMALIA 2012 2013 2014 2015 2016 2017

. Overall number of AFP cases reported in 2017 exceeded the number of AFP cases reported in 2015 and 2016 in the zones except Puntland for the same period . Week-48 Somalia Weekly EPI/POL Update

CASES AND CONTACT SAMPLES WITH LAB RESULT OF Number of AFP Cases and Contact samples with 18.0% NP-EV AND SLV Entero virus and Sabin like Virus Isolation

16.0% NP-AFP Cases Contact Cases 15.3%

14.0% EV

14.3% -

EV - 13.3% 12.0% 12.5% 12.5%

12.0%11.9% result

11.2% # SLs # # SLVs 10.0% 10.4%

10.1% Zone

# Samples # Samples from # # Samples from # Samples from # Samples from

Contacts with lab

cases cases NPwith contacts with NP 8.0% 8.8% Cases lab with result 7.4% Central 248 38 8 375 38 21 6.0% 6.5% 5.6% 5.2% 5.0% Puntland 80 10 5 119 17 6 4.0% 3.8% 3.9%

2.0% 2.6% Somaliland 134 7 7 204 18 3

1.5% 0.0% South 158 19 3 233 31 6 % Specimens from cases with % Specimens from % SL from cases % SL from Contacts NPEV Contactswith NPEV Central Puntland Somaliland South Somalia Somalia 620 74 23 931 104 36 Table no.-3 Week-48 Somalia Weekly EPI/POL Update

Early case detection within 7 days from onset of paralysis at zonal and region levels

Notification within 7 days, Zonal Notification within 7 days, Regional 100% 100% 129 41 66 32 25 20 29 23 12 9 17 8 10 8 9 90% 304 20 19 304 17 9 80% 80% 15 68 4 70% 18 60% 60%

50% 40% 40%

30% 20% 20%

10% 0%

0%

CENTRAL NE NW SOUTH SOMALIA CENTRAL NE NW SOUTH SOMALIA

. 94% (n=304/322) of AFP cases reported in 2017 are notified within 7 days of onset. . 18 cases were notified more than seven days after the onset of paralysis from 7 regions {Lower Jubba (8), Gedo (3) , Middle Juba (1), Bari (1), Sanaq (1), Bay (2) and Galbeed (1)}. Week-48 Somalia Weekly EPI/POL Update

Summary of AFP surveillance key indicators by Zone, 2017

with with

EV EV -

ZONE % tool Adq. % inv. within % Notif.

AFP Rate AFP cond.

- 48 hrs. within 7 days

result.

. Specimen

of samples samples of

Isolated

S L Virus Virus S L

Isolation Isolation

lab results results lab

# cases AFP#

# Cases with with Cases # #

NP with cases #

% Cases with with Cases % with NP

stool good in stool

in good cond. good in

% of cases with with cases of %

Cases pending pending Cases

NP EV Isolated NP EV

Cases with lab. lab. with Cases stool with Cases Samples % like virus Sabin Adq

Central 129 4.9 119 100% 99% 100% 5 124 124 100% 38 15% 8 6%

Puntland 42 10.2 42 98% 100% 98% 2 40 40 100% 10 13% 5 13%

Somaliland 68 5.2 68 100% 100% 97% 1 67 67 100% 7 5% 7 10%

South 83 6.2 81 98% 99% 82% 4 79 79 100% 19 12% 3 4%

Total 322 5.6 319 99% 99% 94% 21 310 310 100% 74 12% 23 7% . Surveillance indicators at national and sub-national level perform above global standard . EV isolation is low in Somaliland and the zonal team are investigating this, with focus on the reverse cold-chain practices . Except 2 AFP cases; one from El-Waq district of Gedo region in South zone and one from Buloburti distrct of Hiran region in Central zone, all the other AFP cases were investigated within 48 hrs of notification . Three cases from Badade, Bosaso and Kismayo districts (one from each) had low stool adequacy levels. Table no.-4 Week-48 Somalia Weekly EPI/POL Update

Summary of AFP surveillance key indicators by Province, 2017

# Cases with Number of AFP cases % inv. within 48 % Notif. within % Stool % Samples with EV % cases with SL ZONE PROVINCE NP-AFP Rate % Stool Adq. late 60 days reported hrs. 7 days condition isolated isolated follow-up BANADIR 32 3.2 100% 100% 100% 100% 20% 6% 0 GALGADUD 25 10.4 100% 100% 100% 100% 16% 4% 2 CENTRAL HIRAN 20 9.5 100% 95% 100% 100% 3% 0% 3 LOWER SHABELLE 29 3.4 100% 100% 100% 100% 17% 19% 0 MIDDLE SHABELLE 23 6.8 100% 100% 100% 100% 16% 0% 0 BARI 21 12.9 95% 100% 95% 100% 5% 15% 0 PUNTLAND MUDUG 12 7.2 100% 100% 100% 100% 18% 18% 0 NUGAL 9 11.0 100% 100% 100% 100% 22% 0% 0 AWDAL 17 7.7 100% 100% 100% 100% 0% 13% 0 GALBEED 20 4.1 100% 100% 95% 100% 0% 5% 0 SAHIL 8 10.4 100% 100% 100% 100% 0% 25% 0 SOMALILAND SANAQ 5 3.7 100% 100% 80% 100% 10% 0% 1 SOOL 10 9.3 100% 100% 100% 100% 20% 20% 1 TOGDHER 8 2.8 100% 100% 100% 100% 13% 0% 0 BAKOOL 9 5.5 100% 100% 100% 100% 6% 0% 1 BAY 19 3.9 100% 100% 89% 100% 0% 0% 3 SOUTH GEDO 18 6.4 100% 94% 83% 100% 11% 17% 4 LOWER JUBA 27 10.0 93% 100% 67% 100% 25% 0% 1 MIDDLE JUBA 10 6.9 100% 100% 90% 100% 10% 0% 2 SOMALIA 322 5.6 99% 99% 94% 100% 12% 7% 18 Week-48 Somalia Weekly EPI/POL Update

Summary for Somalia Environmental Surveillance

Sites (Total=03) 2017 2018 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Mogadishu Region District Site name Banadir Waberi 21October Banadir Shangani Urobo Banadir Hamerewoini Kawma

New Province /Region Egyptian Hospital temporary site

WPV1 SL2 VDPV2 NPEV Under process

SL1 SL3 Mix SL1&SL3 Negtive PV2 Undergoing Sequencing Week-48 Somalia Weekly EPI/POL Update

Summary of AFP surveillance key indicators for contacts, 2017

% Contact # Contact # Contact # Specimens % Specimens # Contacts % contacts # Contact Average collected with stool in pending lab with NPEV with NPEV with Sabin with Sabin # AFP # % contacts < 5 ZONE samples with contacts per within 7 days Good results isolated Isolated virus like virus Cases CONTACTS age Lab result cases of AFP Condition isolated Isolated notified

Central 129 387 375 3 93% 99% 375 12 38 10% 21 6% Puntland 42 126 119 3 98% 97% 119 7 17 14% 6 5% Somaliland 68 204 204 3 94% 98% 204 0 18 9% 3 1% South 83 245 233 3 94% 97% 233 12 31 13% 6 3% Somalia 322 962 931 3 94% 98% 931 31 104 11% 36 4%

Note: Three specimen are collected for each contact

Community Samples collected from healthy children Zone Total Samples collected Discarded Pending for lab result NP-EV Sabin 3 Central 54 47 0 5 0 Putland 30 23 5 0 1 Somaliland 85 61 0 21 3 South 3 3 0 0 0 TOTAL 172 134 5 26 4 Table no.-5 Week-48 Somalia Weekly EPI/POL Update

Distribution of AFP cases by source of case notification, 2017

Source of AFP cases notification 100% Number Number # of cases Proportion of 12 10 90% 7 52 Zone of cases Notified by cases reported 23 of VPVs 80% 22 reported VPV by VPV

70% 96 16 CENTRAL 60% 36 22 190 129 95 74%

50% Prop. cases notifedcasesProp.by 40% PUNTLAND 95 105 42 19 45% 30% 174 38 20% 19 22 SOMALILAND 10% 81 68 22 32%

0% Central Puntland Somaliland South Somalia

VPV HFs Other SOUTH 159 83 38 46%

Key: 1. VPVs: Village polio volunteers 2. HFs: MCH, Hospitals and Private clinics Somalia 535 322 174 54% 3. Others: community members, district field assistants, traditional healers Table no.-6 Week-48 Somalia Weekly EPI/POL Update

Distribution of AFP cases by life style, age group and sex, 2017

Distribution of AFP cases by Life style Distribution of AFP cases by Age group Distribution AFP cases by Sex . Of the total 322 AFP 100% 100% 100% 19 32 33 43 cases reported in 2017, 90% 90% 72 90% 44% (n=141) and 36% 80% 112 80% 83 80% 65 181 129 141 152 281 176 (n=116) are from Urban 70% 70% 70% 92 324 252 166

60% 60% 60% and Rural population

50% 50% 50% respectively. Nomadic 87 129 249 283 279 40% 117 40% 348 40% 51 144 116 communities account for 150 30% 30% 129 30% only 20% (n=65). 164 146 20% 20% 20% 56 221 167 115 . 87% (n=279) of cases are 80 70 10% 31 97 91 65 10% 10% aged less than 5 years. 0% 0% 0% . 2012 2013 2014 2015 2016 2017 2012 2013 2014 2015 2016 2017 2012 2013 2014 2015 2016 2017 45% (n=146) AFP cases Nomadic Rural Urban <5 Yrs ≥ 5 Yrs Female Male are female. Graph no.-10 Graph no.- 11 Graph no.-12 Week-48 Somalia Weekly EPI/POL Update

AFP surveillance indicators by accessibility status of districts # of U-15 Pop # of AFP # of Cases % of Cases NP Number % of % inv. % of % % cases Accessibility districts in this cases reported reported AFP of cases Stool Within Notif. Specime with area Reported by VPVs by VPVs rate with lab adequacy 48 hrs. within 7 ns with Sabin like result days NPEV virus

Inaccessible 17 601,282 42 34 81% 41 100% 100% 90% 26% 0% 7.6

Partially 23 1,670,705 84 39 46% 79 98% 99% 91% 4% 8% accessible 5.4

Accessible 75 3.907,440 196 100 52% 190 99% 99% 96% 13% 9% 5.4

National 115 6,179,427 322 174 54% 310 99% 99% 94% 12% 7% Table no.

5.6 -

. VPVs continue to support AFP surveillance and have reported 81% (n=34/42) of cases from inaccessible and 46%(n=39/84) from partially accessible districts. 7 . Most of the surveillance indicators in the accessible and access compromised areas are above global standards; however, SL isolation is very low in the access compromised districts, there are challenges in providing immunization services in those districts Week-48 Somalia Weekly EPI/POL Update

AFP surveillance indicators by Life Style of Population 2017

% of <15 # of AFP # of Cases % of Cases Number % of cases % of % inv. % of % % cases Accessibility populatio cases reported reported of cases with lab Stool Within Notified Specime with Sabin n in the Reported by VPVs by VPVs with lab result adequacy 48 hrs. within 7 ns with like virus result within 14 area days NPEV days

Nomadic 28.8% 65 41 63% 63 83% 97% 98% 94% 10% 7%

Rural 25.9% 116 73 63% 111 88% 100% 99% 95% 14% 8%

Urban 45.3% 141 60 43% 136 91% 99% 100% 94% 12% 8%

National 100% 322 174 54% 310 88% 99% 99% 94% 12% 7%

All major AFP surveillance indicators have met global standard across all life styles Week-48 Somalia Weekly EPI/POL Update

Validation and zero dose investigation of AFP cases, 2017 AFP cases Validation Zero dose Investigation # of AFP cases # of AFP % of AFP # of Zero dose # of Zero dose % of Zero dose Zone Reported cases cases Zone AFP cases AFP cases AFP cases Validated Validated Reported investigated investigated

Central 129 73 57% Central 18 15 83%

Somaliland 68 49 72% Puntland 1 1 100%

South Zone 83 67 81% Somaliland 0 0 0

Puntland 42 25 60% South 22 19 86% Somalia 322 214 66% Somalia 41 35 85% Table no.-8 Table no.-9

. Of the total 322 cases, 66% (n=214) were validated by the RPOs . There were 41 zero OPV dose AFP cases reported in 2017, 85% (n=35/41) were investigated. Week-48 Somalia Weekly EPI/POL Update

Total AFP cases Tracking lab results of AFP cases 322

Tracking AFP with stool specimens Total AFP cases Total AFP cases with stool without stool specimens specimens 22 322 0 66 cVDPV2

Other viruses With lab En route In the lab

neg st results 310 0 22 in lab 234 en route cVSPV2 SL EV -ve 0 23 47 244 Week-48 Somalia Weekly EPI/POL Update

Lab performance indicators for AFP surveillance in Somalia, 2017 Sample # # Specimen # Specimens # Specimen % of specimen Number of % of Number of % of source Specimen with culture pending lab with culture with culture specimen specimen Specimens Specimen collected result result result within result within 14 with NPEV with with Sabin s with days 14 days NPEV isolation Sabin isolation

Cases 644 620 42 558 90% 74 12% 23 7%

Contacts 962 931 31 838 90% 104 11% 36 4%

Total 1606 1551 73 1396 90% 178 11% 59 5%

Table no.-10 Week-48 Somalia Weekly EPI/POL Update

Median and average number of days from onset of paralysis up to final lab result - 2017

Date of Date of Second stool Specimen reached Primary Culture ITD result onset Notification collected to Lab result

Median: 3 days Median: 2 days Median: 3 days Median: 11 days 1 day Average: 3.53 days Average: 1.89 days Average: 3.8 days Average: 11.7 days

Date second Median: 20 days Date final stool ITD results collected Average: 22 days Chart no. 2 Week-48 Somalia Weekly Polio Update

Village polio volunteers weekly house to house visit and AFP cases notified , December 03, 2017

January Feberuary March April May June July Aug Sept Oct Nov

No. of No. of No. of No. of No. of Central No. of No. of No. of No. of No. of No. of No. of No. of No. of No. of AFP No. of No. of No. of No. of AFP No. of HH AFP AFP AFP No. of HH No. of HH AFP HH HH AFP cases HH AFP cases HH HH HH AFP cases cases AFP cases HH HH AFP cases cases visited cases cases cases visited visited cases visited visited notified visited notified visited visited visited notified notified notified visited visited notified notified notified notified notified notified

31757 6 31780 6 39997 11 35672 12 37438 10 46730 10 38112 6 46205 10 11 4 9 37,881 37,599 39,134 Central

33599 5 32985 3 41237 5 34252 4 33505 4 43001 1 32761 6 41701 3 2 3 1 33,641 33,095 34,121 South

15237 3 15591 1 18903 3 15193 1 15291 2 14887 1 15175 1 19043 1 4 1 1 15,393 16,554 16,289 Puntland

36646 6 36882 4 45971 0 35634 3 35446 2 41710 1 33807 1 43648 2 1 0 3 34,710 32,547 31,561 Somaliland

117239 20 117238 14 146108 19 120751 20 121680 18 146328 13 119855 14 120535 16 151687 18 119795 8 121105 Total 14 Week-48 Somalia Weekly Polio Update

Routine Immunization Services, status of Cold Chain & Vaccine stocks in AFP Surveillance Sites as of December 03, 2017

Expected weekly Health facility have a AFP sites with EPI service and Health facility have EPI Health facility have IPV vaccine Region AFP sites visits routine EPI service functional cold chain vaccine available available No No. % No. % No. % No. % Nugal 33 19 58% 19 100% 19 100% 17 89% Bari 116 34 29% 32 94% 34 100% 31 91% Mudug 58 39 67% 38 97% 38 97% 32 84% Galbeed 40 23 58% 23 100% 23 100% 23 100% Sahil 24 10 42% 10 100% 10 100% 8 80% Sanag 19 11 58% 11 100% 11 100% 11 100% Sool 28 10 36% 10 100% 10 100% 10 100% Awdal 43 23 53% 23 100% 23 100% 23 100% Togdher 52 21 40% 21 100% 21 100% 21 100% Middle Shabelle 35 18 51% 15 83% 16 89% 15 94% Hiran 24 23 96% 6 26% 23 100% 23 100% Galgadud 36 23 64% 14 61% 23 100% 23 100% Banadir 101 51 50% 22 43% 51 100% 51 100% Lower Shabelle 49 27 55% 13 48% 25 93% 20 80% Middle Juba 15 1 7% 0 0% 1 100% 0 0% Bakool 26 10 38% 10 100% 10 100% 10 100% Gedo 51 20 39% 20 100% 20 100% 17 85% Bay 75 30 40% 30 100% 30 100% 30 100% Lower Juba 46 23 50% 8 35% 23 100% 20 87% Somalia 870 416 48% 325 78% 411 99% 385 94% Part -III

Fever and rash Surveillance Week-48 Somalia Weekly Polio Update

Epi-curve on suspected measles cases by week, Somalia (Week 20, 2015-Week 43, 2017) 800 2015 2016 2017 (n=7498) (n=5657) (n=21,210)

700

720

703

699

696

693

686

685

670

663 657

600

584

560 554

500 538

507

496

488

487

463

444

441 441

440 436

400 436

416

410

408

401

400

399

389

383

373

362 352

300 330

325

320

309

290

277 255

200 228

222

214

210

208

199

196

182

180

175

174

173

172

170

163

161

158

156

155

154

151

149

145

144

142

141

140 140

134

133 132

100 128

127 127

125 125

124 124

122 122 122

117

116

115 115

113

112

111

109 109

107

105 105

98

97

103

96

102 102 102

95 95

101

100

93 93

92

91

90 90

89

88 88

87 87

86 86

85 85

84 84

83

82

81

79

76 76

74 74

72 72

71

70

67

66 60

0

- After showing a steady decline for about 14 consecutive weeks starting from week 24, the numbers have started to go up in recent weeks. - The cumulative reported cases also still remain higher than the number of cases reported at the same period in the past 4 years. - All regions have reported suspected measles cases in 2017, however, the top 5 reporting regions are Banadir, Togdhere, Hiran, Lower shabelle and Glbeed. Week-48 Somalia Weekly Polio Update

Fever & Rush cases reported by AFP surveillance System, December 03, 2017 Fever and Rash Cases by weekly

Region

W4 W5 W8 W1 W2 W3 W6 W7 W9

W12 W18 W24 W25 W34 W37 W43 W10 W11 W13 W14 W15 W16 W17 W19 W20 W21 W22 W23 W26 W27 W28 W29 W30 W31 W32 W33 W35 W36 W38 W39 W40 W41 W42 W44 W45 W46 W47

Total 2016 Total 2017

Nugal 112 3 1 1 2 2 0 1 1 0 2 0 0 4 3 4 5 15 3 6 18 27 25 23 21 17 22 19 38 42 42 53 70 82 54 46 41 31 44 200 109 91 62 84 100 118 113 96 1738 Bari 202 1 7 5 3 7 0 1 4 4 12 0 11 23 21 31 26 22 47 74 73 74 81 114 85 44 90 98 67 75 47 62 44 34 56 39 26 50 35 38 36 35 22 44 44 33 33 24 1801 Mudug 270 1 3 7 2 1 21 18 15 29 28 16 35 50 24 53 51 27 26 26 45 72 82 78 77 93 73 44 52 70 73 51 42 51 37 32 56 61 49 64 77 85 72 73 64 61 115 63 2244 N/East Zone 584 5 11 13 7 10 21 20 20 33 42 16 46 77 48 88 82 64 76 106 136 173 188 215 183 154 185 161 157 187 162 166 156 167 147 117 123 142 128 302 222 211 156 201 208 212 261 183 5783 Galbeed 45 0 3 1 5 2 7 10 8 8 12 18 19 30 29 50 60 45 63 85 41 44 19 29 19 22 9 11 14 12 13 5 3 2 1 2 1 4 5 2 1 6 7 2 6 0 3 7 745 Sahil 226 12 18 37 25 22 17 28 17 28 18 31 20 27 16 24 10 27 11 11 10 13 17 15 9 39 2 17 7 17 2 3 0 5 0 4 0 2 1 1 0 1 0 2 0 0 0 3 557 Sanag 16 0 3 0 0 1 0 0 0 0 5 0 1 2 1 9 0 11 1 5 5 19 5 11 19 22 11 13 19 10 10 16 0 8 6 3 0 6 5 8 0 2 2 5 0 7 6 2 259 Sool 24 8 11 6 22 26 24 41 20 32 36 37 36 37 40 28 24 14 24 14 13 15 16 5 5 11 13 9 5 3 0 0 2 4 4 1 6 0 4 0 1 8 3 2 1 10 5 11 629 Awdal 56 0 1 4 1 6 0 0 0 0 0 0 0 0 1 0 0 3 0 11 1 2 0 6 4 23 2 24 0 4 0 4 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 99 Togdher 223 42 22 26 18 63 28 103 36 105 66 118 87 88 111 162 87 157 108 141 98 88 31 50 37 23 29 42 13 22 8 29 2 30 7 26 10 13 6 17 6 10 12 27 7 19 10 22 2220 N/West Zone 590 62 58 74 71 120 76 182 81 173 137 204 163 184 198 273 181 257 207 267 168 181 88 116 93 140 66 116 58 68 33 57 8 49 18 36 17 25 21 28 8 27 24 38 14 37 24 45 4509 M/ Shabelle 206 5 10 6 18 7 10 8 11 5 19 23 23 20 20 12 14 25 10 8 7 6 16 18 20 20 16 20 16 28 13 9 14 14 21 8 19 22 16 7 15 16 16 15 12 6 12 6 657 Hiran 107 0 4 9 3 19 15 23 66 28 29 28 37 45 63 78 75 74 76 78 84 57 52 69 24 48 58 15 21 0 21 14 3 3 13 8 7 4 10 4 6 3 5 5 3 7 13 15 1322 Galgadud 261 4 3 2 5 5 6 3 11 4 7 4 5 149 17 28 23 19 17 13 7 9 13 8 12 9 13 29 19 14 17 13 18 5 8 6 9 7 5 8 6 4 7 5 8 3 6 4 593 Banadir 2226 89 78 76 71 95 79 119 128 91 83 93 108 110 65 134 184 172 209 162 225 205 226 202 181 116 138 140 123 117 134 93 71 140 76 62 58 69 68 75 98 58 81 50 41 71 106 76 5157 L/Shabelle 1217 25 27 45 23 37 25 33 42 42 45 36 32 45 53 45 45 59 30 38 47 52 52 49 47 47 40 59 58 45 36 33 43 39 29 30 34 56 49 40 41 40 38 44 32 39 37 40 1898 Central Zone 4017 123 122 138 120 163 135 186 258 170 183 184 205 369 218 297 341 349 342 299 370 329 359 346 284 240 265 263 237 204 221 162 149 201 147 114 127 158 148 134 166 121 147 119 96 126 174 141 9627 Middle Juba 51 0 0 0 0 2 0 0 2 3 3 0 2 0 0 0 3 3 3 0 0 3 5 0 3 0 0 0 0 6 3 0 3 3 0 0 0 0 2 0 4 4 1 1 1 0 0 0 60 Bakool 37 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 10 15 5 8 2 4 0 4 2 0 2 2 2 6 6 8 3 5 4 88 Gedo 104 0 0 4 1 1 6 0 0 0 0 0 0 0 0 6 0 5 0 0 12 13 14 2 0 0 0 0 0 0 0 1 0 0 0 0 2 8 8 24 12 24 9 9 3 35 16 12 227 Bay 9 0 0 0 3 0 0 0 0 14 0 23 9 33 19 23 42 3 31 18 12 18 28 12 19 26 22 8 8 12 6 7 1 10 6 7 12 9 3 4 8 5 14 22 18 19 7 9 550 Lower Juba 265 6 19 0 12 15 17 20 14 6 7 1 7 7 8 12 8 4 4 6 5 3 4 2 2 0 0 6 3 1 4 2 0 4 8 3 5 8 10 13 19 22 32 14 14 8 0 7 366 South Zone 466 6 19 4 16 18 23 20 16 23 10 24 18 40 27 41 53 15 38 24 29 37 51 16 24 26 22 14 11 29 28 15 12 19 18 10 23 27 23 43 45 57 62 52 44 65 28 32 1291 Grand Total 5657 196 210 229 214 311 255 408 375 399 372 428 432 670 491 699 657 685 663 696 703 720 686 693 584 560 538 554 463 488 444 400 325 436 330 277 290 352 320 507 441 416 389 410 362 440 487 401 21210 Week-48 Somalia Weekly Polio Update

Distribution of reported fever and rash cases in Somalia , 2014-2017

Fever & Fever & Fever & Fever & rash rash rash rash Region cases cases cases cases (2014) (2015) (2016) (2017)

Nugal 1110 82 112 1738

Bari 1284 226 202 1801

Mudug 542 561 270 2244

Galbeed 121 212 45 745

Sahil 30 60 226 557

Sanag 115 114 16 259

Sool 187 86 24 629

Awdal 1 15 56 99

Togdher 407 864 223 2220

M. Shab. 285 500 206 657

Hiran 63 663 107 1322

Galgadud 299 229 261 593

Banadir 2594 1974 2226 5157

L. Shab. 1978 1611 1217 1898

M. Juba 177 48 51 60

Bakool 3 26 37 88

Gedo 126 8 104 227

Bay 309 145 9 550 L.Juba Map no.7 Map no.8 Map no.9 648 74 265 366 Total 10,279 7,498 5,657 21210 . Data source: from the Polio surveillance system and CSR. Week-48 Somalia Weekly Polio Update

Fever & Rush cases reported by AFP surveillance System- December 03, 2017

Age-wise distribution of fever and rash cases reported by AFP Zone-wise cases of fever and rash reported by AFP surveivallance system during 2017 surveillance system in 2017 25000

21210

20000

Yrs10+, 3370, 15000 16% <1yr, 3891, 18% 5_9yrs, 9627 3580, 17% 10000

5783 5000 4509 1_4 yrs, 1291 10565, 49% 0 Central North East North West South Total Somalia Week-48 Somalia Weekly Polio Update

Trend of reported fever and rash cases by zone in 2015 /16/17 Source AFP surveillance,

Puntland Somaliland 925 891 882 909

1000 1000 861 823 25 May)25

800 - 667 634 800

Measles Campaign 491 (21 510 28 April) 28 503

600 600 459 -

Measles Campaign 282 (24 400 214 400 265 269 243 275 161 140 183 202 133 115 97 119 83 161 142 132 200 3639 3071 48 70 62 2443 2739 27 33 40 82 104 93 72 99 8796 113 19 11 12 150 200 14 36 33 35 16 479 2942 47 2937 15458 0 0 January February March April May June July AUG Sept. Oct. Nov. Dec

2015 2016 2017 2015 2016 2017

Central South

2000 250 207 25 May)25

- 1494 189 Measles

1340Campaign 200 1500 1205 (21

1111 136 139 28 May)28 150 128 -

925 115 Measles Campaign 1000 742 659 (24 82 83 545 547 568 100 77 75 455503 443 441 450 514 515 64 367 401 348 388 350383 401 4045 46 46 50 46 500 315 265 324 307 278 271328 281310 2737 2729 30 27 33 32 142 141 50 22 1921 14 18 1826 30 9 9 7 13 0 0 January February March April May June July AUG Sept. Oct. Nov. Dec January February March April May June July AUG Sept. Oct. Nov. Dec

2015 2016 2017 2015 2016 2017

• Number of fever and rash cases reported has shown decline in recent months compared to the previous month; However, it is still very high/4 times higher than cases reported during the same period in 2015 or 2016. Part -IV Population Immunity Supplemental Immunization Activities Week-48 Somalia Weekly EPI/POL Update

Maps showing accessibility and security/ risk level, Somalia

Map no.10 Map no.11 Week-48 Somalia Weekly EPI/POL Update

Summary Strategic features and initiatives in Somalia by accessibility Accessibility AFP active Zones VPV TPVP Settlement Under 15- POP. status Surveillance site Accessible 128 216 147 2354 2,230,697 CENTRAL Inaccessible 62 29 21 1042 619,775 Total 190 245 168 3396 2,850,471 Accessible 105 207 53 1076 446,241 PUNTLAND Inaccessible 0 0 0 0 0 Total 105 207 53 1076 446,241 Accessible 81 206 53 3435 1,426,642 SOMALILAND Inaccessible 0 0 0 0 0 Total 81 206 53 3435 1,426,642 Accessible 75 179 123 2234 1,010,326 SOUTH Inaccessible 84 33 22 1548 445,747 Total 159 212 145 3782 1,456,073 SomaliaAccessible Total 501389 869808 457 37611689 90996,179,4275,113,906 Somalia Inaccessible 146 62 43 2590 1,065,522 Somalia Total 535 870 419 11689 6,179,428 Week-48 Somalia Weekly EPI/POL Update 2017 SIA Calendar, Implementation status and coverage Summary Somalia SIA Callender for 2017 Target Zonal Admin IM Campaign # Reached/ Planned Date Geographic Areas to be covered Age target Implementation date Vaccine Coverage Coverage in Type Vaccinated LQAS Result Group Population in % % All accessible areas of Central zone 904,454 26-29 Feb. 2017 848,340 94% 94% Of 11 lotes, 9=passed and 2=Satisfactory Puntland all districts Under 5 530,201 05-08 April 2017 b-OPV 546,302 103% 97% Of 31 lotes, 27=Passed, 3= Satisfactory and 1=Failed 26-Feb-17 NIDs R-1 Somaliland all districts years 621786 26-29 Feb. 2017 612,911 99% 97% Of 29 lotes, 19=Passed, 6=satisfactory, 3 =failed and 1 discarded All accessible areas of South zone 385,555 26-29 Feb. 2017 369,517 96% 91% Of 5 lotes, 4=Passed and 1=Failed 2,441,996 2,377,070 97% All accessible areas of Central zone 904,451 02-05 April 2017 850,772 94% 93% Of 11 lots, 9=passed, 2= Satisfactory and 0=failed

Puntland all districts Under 5 529602 6-9 May 2017 b-OPV 546,673 103% 98% 02-04, April-17 NIDs R-2 Somaliland all districts years 623462 02-05 April 2017 609,734 98% 97% Of 28 lotes, 25=Passed, 1= Satisfactory and 2=Failed All accessible areas of South zone 398427 02-05 April 2017 385,584 97% 95% Of 5 lotes, 3=Passed, 1= Satisfactory and 1=Failed 2,455,942 2,392,763 97% 73,447 C. Z: 23-26 July 2017 64,160 87% No IM No LQAS Nomadic; Agro pastoral; Scattered, 32,803 S.Z: 23-26 July 2017 31,095 95% No IM No LQAS Under 5 b-OPV 23-Jul-17 HtR - R-1 remote, far settlements & Small 136,929 P.L: 07-10 Sept 2017 122,321 89% No IM No LQAS years villages with difficult / no road access 145,980 SL: 23-26 July 2017 142,794 98% 92% No LQAS 389,159 360,370 93% 73,447 C. Z: 29 Aug-01 Sept. 2017 66,285 90% No IM No LQAS Nomadic; Agro pastoral; Scattered, Under 5 32,803 S.Z: 29- Aug-01 Sept. 2017 b-OPV 32,238 98% No IM No LQAS 14-Aug-17 HtR - R-2 remote, far settlements; & Small years 136,929 P.L:25-28 Nov. 2017 villages with difficult / no road access 145,980 SL: 11- 14 Sept. 2017 143,750 98% No IM No LQAS 252,230 242,273 96%

All accessible areas of Central zone 904,451 17-20 Dec.2017 14 - Puntland all districts Under 5 526636 03-Dec-2017 NIDs R-3 b-OPV Somaliland all districts years 623462 29 Nov. - 02 Dec. 2017 All accessible areas of South zone 398427 17-20 Dec.2017 2,452,976 0 0 no. Table A) Target population: includes all accessible areas including the areas/districts that became accessible in 2015 and 3% popul ation growth added 2016. B) Buffer stock: 1 million bOPV doses kept in country for: Transit/Cross Border Permanent Vaccination Teams and SIADs for new areas accessible. C) Country team strategy for newly accessible areas: conduct house to house bOPV vaccination, 4 Rounds at 10 days interval, R-1 target U<5 years, R-2 target U10 years, R-3 target all age groups; R-4 target U 5 years OPV + Measles. Week-48 Somalia Weekly EPI/POL Update NID-1, NID-2 2017 Summary

NID-1 NID-2 HtR-1

ZONE/REGION # U -5 IM # U -5 # U-5 IM # U -5 # U-5 IM # U-5 . Targete coverag NID1 & NID 2 was Targeted Reached coverage Targeted reached coverage reached d e conducted as scheduled in Banadir 424086 398999 96% 424083 399509 95% 19,323 18,056 March and April 2017. Galgadud 100060 91815 86% 100060 91077 86% 25,047 20,559

Hiran 77692 72736 97% 77692 70991 94% 8,025 6,699 No IM L. Shabelle 182368 167848 94% 182368 171852 94% 8,304 7,618 . HtR 1 also conducted in M. Shabelle 120248 116942 98% 120248 117343 98% 12,748 11,228 South, Central and Central Total 904454 848340 94% 904451 850772 93% 73447 64160 Somaliland, Puntland will Ayn 12662 12157 97% 12662 12375 conducted in August Bari 138029 167908 103% 138029 163261 99%

Karkar 48509 47142 99% 48509 47807 98%

Mudug 208301 201496 94% 208401 202736 100% . Cumulatively 5,336,012 Nugal 81659 77952 94% 80961 80267 94% under 5 children were Sanag 27755 26773 96% 27755 27068 96% targeted in the two NIDs Sool 13286 12874 97% 13286 13159 97% and 1 HTR rounds and Puntland Total 530201 546302 98% 529602 546673 99% 5,007,882 million doses Awdal 107324 104100 100% 107324 105201 98% 23,910 23,351 92%

Sanag 65777 62900 96% 205431 201208 95% 15,965 15,212 92% were administered.

Sool 59781 64651 98% 46202 44442 96% 14,510 15,843 70% Togder 138946 134347 99% 65777 61014 97% 30,519 29,294 97% . IM data showed overall

Marodijeh 203756 203756 93% 59781 63193 94% 49,862 48,407 74% national coverage of 95%,

Sahil 46202 43157 100% 138946 134676 100% 11,214 10,687 100% 96% and 92% respectively Somaliland Total 621786 612911 97% 623462 609734 96% 145,980 142,794 92% for NID-1 and NID 2. Bakool 36758 35575 90% 36758 34187 95% 2,088 1,938 Bay 162935 157910 93% 162935 158629 95% 7,275 6,678 . Regional summary and Middle Juba NO NID (Inaccessible Region) No IM Gedo 111491 106423 89% 111491 108737 93% 11,448 10,845 district level IM coverage

Lower Juba 74371 69609 93% 87243 84031 96% 11,992 11,634 is presented on the table South Total 385555 369517 92% 398427 385584 95% 32,803 31,095 and the maps on the left Grand Total 2,441,996 2,377,070 96% 1,926,340 1,846,090 95% 252,230 238,049 92% Week-48 Somalia Weekly EPI/POL Update

Transit Points Vaccination Activities as of December 03, 2017

January February March April May June July August September October November

Zones

vaccinated vaccinated vaccinated vaccinated vaccinated vaccinated vaccinated vaccinated vaccinated vaccinated vaccinated

Zero dosesZero Number of dosesZero Number of dosesZero Number of Number Number of dosesZero Number of Number of dosesZero dosesZero Number of Number of dosesZero Number of dosesZero dosesZero Number of Number of dosesZero dosesZero

% Zerodoses% Zerodoses% % Zero%doses Zero%doses Zero%doses Zero%doses Zero%doses Zero%doses Zero%doses Zero%doses Zero%doses

CENTRAL 102390 1208211.8%109859 7779 7.1%144262 7777 5.4% 11074839023.5% 10245525832.5% 13063717421.3% 102700 786 0.8% 127897 632 0.5% 104615 418 0.4% 102436 375 0.4% 100514 353 0.4%

PUNTLAND 22653 93 0.4% 21444 71 0.3% 27405 83 0.3% 21282 67 0.3% 20612 59 0.3% 28689 91 0.3% 23886 63 0.3% 27849 76 0.3% 22146 66 0.3% 23933 51 0.2% 23680 63 0.3%

SOMALILAN 14367 208 1.4% 15220 428 2.8% 18818 752 4.0% 14696 426 2.9% 15646 485 3.1% 18904 515 2.7% 15998 477 3.0% 19626 614 3.1% 15714 476 3.0% 15747 482 3.1% 15050 358 2.4% D

SOUTH 39301 1249831.8% 417101463235.1% 39045 2388 6.1% 29791 11253.8% 29842 11353.8% 38680 13323.4% 29127 929 3.2% 35148 11733.3% 28224 888 3.1% 27930 843 3.0% 28367 918 3.2%

SOMALIA 178711 2488113.9%1882332291012.2%229530110004.8%17651755203.1%16855542622.5%21691036801.7%17171122551.3%21052024951.2%17069918481.1%17004617511.0%167611 1692 1.0%

. A total of 2,049,043 < 10 years individuals were vaccinated week 47,2017. Among them,82,294 (4%) were vaccinated for the first time.

Table no.-16 Week-48 Somalia Weekly EPI/POL Update

Performance of Permanent Vaccination sites in inaccessible areas of S/C zone and distribution as of December 03, 2017

Number of U-10 Children vaccinated by Newly Established permanent vaccination sites in inaccessible areas of South and Central zones of Somalia. DISTRICT Number of Number of Zero Proportion of Zero ZONE REGION vaccinated kids doses vaccinated doses (%)

Elbur 2,928 2,315 79% GALGADU D Galhareri Data not received CENTRAL Elgaras 7,273 6,305 87% Awdegle 38,500 12,068 31% L.Shabelle Sablale 39,205 11,482 29% Hagar 5,397 3,226 60% Jamame East 4,137 3,950 95% L. Jubba Jamame West 3,071 2,857 93% South Kismayo 11,379 2,705 24% Buale 7,800 6,714 86% M. Jubba Sakaw 5,814 4,865 84% TOTAL 125,504 56,487 45%

Since the first weeks of 2017, a total of 125,504 <10 years children were reached through the newly established permanent vaccination sites in fully inaccessible area in South and Central zones. 45% (n=56,487) of the children are vaccinated for the first time. Week-48 Somalia Weekly EPI/POL Update

Immunity Profile of NP-AFP cases (6-59 Months) and Contacts 2013-2017

Immunity Profile of NP-AFP Cases 6-59 Immunity Profile of NP-AFP cases 6- Immunity Profile of NP-AFP Cases 6-23 Immunity Profile of NP-AFP cases 6-23 Immunization Profile of contacts Months, 2013-2017 59 Months by Zone, 2017 Months, 2013-2017 Months by Zone, 2017 (all-2017) 100% 100% 100% 100% 100% 1 27 90% 409 90% 84 90% 14 90% 90% 5 35 12 35 80% 80% 80% 31 80% 129 80% 630 477 129 19 36 10 448 492 143 62 17 70% 80 182 127 70% 83 37 344 70% 34 20 70% 70% 60% 2 60% 60% 60% 60% 50% 34 50% 100 57 34 50% 439 50% 4 50% 11 56 28 40% 16 40% 180 180 56 18 40% 9 134 189 40% 50 40% 44 56 30% 27 17 30% 30% 10 11 164 30% 14 52 30% 34 20% 17 14 123 182 31 20% 709 144 29 52 21 21 31 20% 8 20% 179 38 20% 79 21 10% 6 265 15 37 6 10% 5 10% 110 76 118 123 10% 0% 1 0 10% 4 38 37 37 22 9 3 9 0% 10 9 0% 0 0 0% 0% 2013 2014 2015 2016 2017 2013 2014 2015 2016 2017 2013 2014 2015 2016 2017

0 dose 1-3 doses 4-6 doses 7+ doses 0 dose 1-3 doses 4-6 doses 7+ doses 0 dose 1-3 doses 4-6 doses 7+ doses 0 Dose 1-3 Doses 4-6 Doses 7+ Doses 0 Dose 1-3 doses

Graph no.-19 Graph no.-20 Graph no.-21 . In 2017, 41 zero-dose NP-AFP cases were reported; 22 from South, 18 from Central and 1 from Puntland. 3 cases are off the age group 6-59 months. . Review of five years data reveals, the proportion of zero dose AFP cases is declining progressively, however, there are significant proportion (32%) of children are under immunized. Week-48 Somalia Weekly EPI/POL Update

Immunity profile of 6-59 months age NP-AFP cases by Zone 2012-2017 CENTRAL

100% 13 31 80% 61 98 61 66 60% 29 18 40% 24 18 26 19 14 10 20% 8 11 17 26 12 5 28 13 15 0% 8 2012 2013 2014 2015 2016 2017

0 dose 1-3 doses 4-6 doses 7+ doses Graph no.-22 Graph no.-23

Graph no.-24 Graph no.-25 Part -V Routine Immunization Trend of routine EPI coverage by zone, 2014-2017 100

(N.B. 2017 is annualized from 9 months data ) 90

80

70

60

50

40

30

20

10

0 BCG P-1 P-3 Measles OPV-3 BCG P-1 P-3 Measles OPV-3 BCG P-1 P-3 Measles OPV-3 BCG P-1 P-3 Measles OPV-3 PUNTLAND SOMALILAND SOUTH CENTERAL SOMALIA

2014 2015 2016 2017 Nine month

Source: HMIS/DHIS-2 data 2016 and 2017. Week-48 Somalia Weekly EPI/POL Update

Immuinzation monitoring chart, Somalia2016 Somalia Monitoring Chart, 2017 350000 100% 300000 120%

90% 300000 250000 100% 80%

250000 70% 200000 80%

60% 200000 150000 60%

50% Axis Title Axis 150000 40% 100000 40%

100000 30% 50000 20% 20% 50000 10% 0 0% Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 0 0% Sum of Pent1 31367 61990 89840 119005148901178493215415247586272579 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Pent1 24215 48781 73263 98229 124707 152394 181148 207148 235011 266781 299618 331481 Sum of Penta3 26790 53670 77763 102433127572152696178791203443225161 Penta3 27543 48616 70816 91732 113674 136589 160723 181282 203464 229673 256554 283080 Sum of Measles 20594 44105 64886 89207 115739139255166186190981210074 Measles 18379 39266 60502 81562 103608 127044 150435 174056 193371 209302 230710 249465 Sum of Montly target on surval% 8% 17% 25% 33% 42% 50% 58% 67% 75% 83% 92% 100% Target 7.50% 15.00% 22.50% 30.00% 37.50% 45.00% 52.50% 60.00% 67.50% 75.00% 82.50% 90.00% Sum of P-1% 8% 16% 23% 31% 38% 46% 55% 64% 70% Penat1% 5% 11% 16% 22% 28% 34% 40% 46% 52% 59% 66% 73% Sum of penta-3% 7% 14% 20% 26% 33% 39% 46% 52% 58% Penta3% 6% 11% 16% 20% 25% 30% 36% 40% 45% 51% 57% 63% measles% 4% 9% 13% 18% 23% 28% 33% 39% 43% 46% 51% 55% Sum of Measless% 5% 11% 17% 23% 30% 36% 43% 49% 54% Part -VI Vaccines and Cold Chain Management Week-48 Somalia Weekly EPI/POL Update

Vaccines and Cold Chain Management

USSC (Country Office) • Received 57,000 vials of bOPV at the National vaccine store (Nairobi) • mOPV cold chain and logistics training to be conducted on 5th Dec and participants will involve UNICEF, WHO and MoH cold chain critical staff. • First shipment of mOPV arrived in Mogadishu over weekend second and last shipment to be delivered on 5th Dec • Joint EPI task force meeting to be held in Mogadishu on 6th Dec • Dhusamareb cold room installation finally complete and ready to be hand over to government. Part -VII Communication Week-48 Somalia Weekly EPI/POL Update

Communication for Development

• C4D technical support now present on the field for the forthcoming polio response campaign. • Additional technical support expected this week. • Consensus on cascade training plan and budget of frontline workers. • Meeting with MoH and WHO for adoption of IEC materials for the response campaign. the end