Eiectronic Integrated Disease Early Warning and Response System Volume 07,Lssue47,Epi Week 47,(18-24 November,2019)

Ministary Of Public Health Papulation Epidemiological Bulletin Primary Heath Care Sector Weekly DG for Diseases Control & Surveillance Eiectronic Integrated Disease Early Warning and Response System Volume 07,lssue47,Epi week 47,(18-24 November,2019)

Highlights eDEWS Reporting Rates vs Consultations in Govemorates,Epi Weeks 1-47,2019

% %

% % % % % % % % % % % % %

% % % % % % % % % % % % % % % % %

% % % % % %

97 97

96 96 96 96 96 96 96 96 96 96 96 96 96

95 95 95 95 95 95 95 95 95 95 95 95 95 95 95 95 95

94 94 94 94 94 94

100% % 450000

96 93 90% 93 400000 •During week no.47,2019, %95(1991/1883) health facilites from 23 80% 350000 70% 300000 Governorates provided valid surveillance data. 60% 250000 50% 200000

Percentage 40%

150000 Consulttaions 30% 20% 100000 10% 50000

•The total number of consultation reported during the week in 23 0% 0

Wk 1 Wk 4 Wk 7 Wk Wk 2 Wk 3 Wk 5 Wk 6 Wk 8 Wk 9 Wk

Wk20 Wk23 Wk26 Wk29 Wk32 Wk35 Wk38 Wk41 Wk44 Wk 11 Wk 12 Wk 13 Wk 14 Wk 15 Wk 16 Wk 17 Wk 18 Wk 19 Wk 21 Wk 22 Wk 24 Wk 25 Wk 27 Wk 28 Wk 30 Wk 31 Wk 33 Wk 34 Wk 36 Wk 37 Wk 39 Wk 40 Wk 42 Wk 43 Wk 45 Wk 46 Wk 47 Governorates was 397352 compared to 387266 the previous reporting week Wk 10

47. Acute respiratory tract infections lower Respiratory Infections (LRTI), Upper Reporting Rate Consultations Respiratory Infections (URTI), Other acute diarrhea (OAD) and Malaria (Mal)

Distribution of Reporting Rates by Governoraes (Epi-Week 47,2019)

% %

were the leading cause of morbidity this week. 100% %

100

92 100

90% 100

% 100 97

100

93 90

80% 91

% 95

70% 83 60% 50% 40% 30% 20% ● A total of 2008 alerts were generated by eDEWS system in week47, 2019, Of No. HF Reports 10% these 2000 alerts were verified as true for further investigations with 0% appropriate response

Reporting Rate Target

Leading causes of morbidity mortality in Epi-Week 47,2019 Proportional morbidity of leading priority diseases, Epi week 47,2019

Guinea Worm ● (URTI) 16%, suspected Malaria (6.7%),(DD) (11.2%) and (LRTI) (6.1%)Remain the Scabies Chicken Pox leading causes of morbidity representing a total of (40%) Brucellosis HIV/ AIDS Tuberculosis RB CL ● Acute viral hepatitis, acute watery diarrhea and Schistosomiasis represented less than Sch VHF 1% of total morbidity in reporting period Bloody diarrhea represented 0.3% Of this DF Meng morbidity Mal Mumps AFP NNT AVH_B&C ● All diarrheal disease comprised 11.2% and LRTI 6.1% of total morbidity in pilot Governorates AVH_A&E Meas this week . Typhoid F OAD BD Pert SARI ILI ● All diarrheal disease comprised 11.2% and OAD 7.7% of total morbidity in all age group . LRTI URTI

0.0% 2.0% 4.0% 6.0% 8.0% 10.0% 12.0% 14.0% 16.0% 18.0%

التهاب تنفسي حاد وخيم:SARI التهاب الكبد :AVH الحصبة :Meas داء الكلب :RB التهاب السحايا :Men حمى الضنك :DF مالريا :Mal بلهارسيا :Sch اسهال مائي حاد :AWD التهاب الجهاز التنفسي السفلي:LRTI اسهال حاد اخرى :OAD اسهال مدمم :BD عدوى الجهاز التنفسي العلوي :URTI االيذز :HIV الجذري:CHICKEN دودة غينية:GUINEA حمى مالطيه:BRUCELLOSIS السل:TUPERCULOSIS النكاف :Mumps التيفوئيد أخرى :Typh أمراض أخرى :Others أنفلونزا على شكل وباء :ILI

This weekly epidemiological leaflet is issued by the National Early Warning and Response Program of the Ministry of Public Health and Population. For Correspondence: Dr. Rema Al-Yousfi, Mobile (713228999, e-mail: [email protected]), Yahya Amer-Mobile (777553779, e-mail [email protected]) 1 Weekly Bulletin: Electornic Integrated Disease Early Warinig & Response System, Yemen - Epidemiological Week Number 47 (18-24 November,2019) Epidemiological Situation of Cholera

GOV

Distribution of suspected cholera cases by age group ( 01 Jan- 07 December 2019) Distribution of associated deaths by age group ( 01 Jan- 07 December 2019)

Maps Officer / Fawaz Al-Khalidi - Mobile (771422601)

This weekly epidemiological leaflet is issued by the National Early Warning and Response Program of the Ministry of Public Health and Population. For Correspondence: Dr. Rema Al-Yousfi, Mobile (713228999, e-mail: [email protected]), Yahya Amer-Mobile (777553779, e-mail [email protected]) 2 Weekly Bulletin: Electornic Integrated Disease Early Warinig & Response System, Yemen - Epidemiological Week Number 47 (18-24 November,2019) Epidemiological Situation of Dengue Fever and Influenza

Maps Officer / Fawaz Al-Khalidi - Mobile (771422601) Email ([email protected])

Deaths

This weekly epidemiological leaflet is issued by the National Early Warning and Response Program of the Ministry of Public Health and Population. For Correspondence: Dr. Rema Al-Yousfi, Mobile (713228999, e-mail: [email protected]), Yahya Amer-Mobile (777553779, e-mail [email protected]) 3 Weekly Bulletin: Electornic Integrated Disease Early Warinig & Response System, Yemen - Epidemiological Week Number 47 (18-24 November,2019)

weekly trends of Upper Respiratory infections ,Lower Respiratory and mararia tested cases & confirmed (Epi weeks 1-47 ,2019)

URTI LRTI mararia tested cases & confirmed Epi weeks 1-47,2019 20.0% 8.0% 4500

18.0% 4000 7.0%

16.0% 3500 6.0%

14.0% 3000

5.0% 12.0% 2500

10.0% 4.0% 2000

8.0% 3.0% 1500

6.0%

2.0% 1000

4.0%

1.0% 500 2.0%

0.0%

wk2 wk7 wk3 wk4 wk5 wk6 wk8 wk9

0.0% wk1

wk12 wk17 wk22 wk27 wk32 wk37 wk40 wk42 wk45 wk47 wk10 wk11 wk13 wk14 wk15 wk16 wk18 wk19 wk20 wk21 wk23 wk24 wk25 wk26 wk28 wk29 wk30 wk31 wk33 wk34 wk35 wk36 wk38 wk39 wk41 wk43 wk44 wk46

WK1 WK2 WK3 WK4 WK5 WK6 WK7 WK8 WK9

WK2 WK5 WK7 WK1 WK3 WK4 WK6 WK8 WK9

WK17 WK18 WK19 WK20 WK21 WK22 WK23 WK24 WK25 WK26 WK27 WK28 WK29 WK30 WK31 WK10 WK11 WK12 WK13 WK14 WK15 WK16 WK32 WK33 WK34 WK35 WK36 WK37 WK38 WK39 WK40 WK41 WK42 WK43 WK44 WK45 WK46 WK47

WK10 WK12 WK14 WK15 WK17 WK19 WK20 WK22 WK24 WK25 WK27 WK29 WK30 WK32 WK34 WK35 WK37 WK39 WK40 WK42 WK44 WK47 WK13 WK16 WK18 WK21 WK23 WK26 WK28 WK31 WK33 WK36 WK38 WK41 WK43 WK45 WK46 WK11 Rapid Test(Postive) Microscope(Postive)

Age and Sex distribution of total consultations of leading diseases (Epi week 47,2019) Number of Alerts Received and Responded (Epi Weeks 44-47,2019)

90000 83558 URTI LRTI Pert BD OAD Typhoid F 80000 AFP Meas AVH_A&E AVH_B&C DF Meng

70000 Sch CL Chicken Pox Mal 250 60000 56227

50000 200

40000 38572 38941 35939 34942 150 31865 30000 28917 24683

23746 100 No.of Alerts 20000

50 10000

0 0 <1yr 1-4yr 5-14yr 15-44yr >45yr Male 23746 35939 38572 56227 28917 Female 24683 34942 38941 83558 31865 Distribution of consultations of leading diseases by Governorates,Epi week 47-2019

Hadramout Sanaa Suspected Disease Abyan Aden Al-Baidha Al-Dhale AlHodaidah Al-Jawf Al-Mahra Al-Mahweet Amana Amran Dhamar Hadramout Hajjah Ibb Lahj Mareb Rayma Sa'adah Shabwah Socotra Taiz Total wady Governorate URTI 3163 4832 1338 1090 6954 1149 841 1619 5795 2568 3462 1936 2620 3855 2603 4605 1106 648 3720 3709 1496 124 4361 63594 LRTI 374 518 814 199 5071 195 109 749 2267 1223 1706 460 359 1637 1460 1334 448 169 658 1594 270 80 2434 24128 ILI 192 0 125 0 105 125 0 0 18 57 170 11 0 109 71 0 196 3 85 214 242 17 536 2276 SARI 0 0 2 0 0 0 0 0 2 9 118 0 0 0 1 0 1 0 23 7 0 0 1 164 Pert 8 3 0 0 1 2 0 0 0 1 15 6 1 0 1 5 0 0 3 8 8 0 16 78 BD 42 9 51 9 77 83 3 75 96 93 95 4 7 3 58 19 39 7 91 122 28 0 166 1177 OAD 1483 2163 880 646 1916 739 404 812 3321 1455 2496 800 554 1753 1469 1723 702 360 1678 2127 1022 19 1959 30481 Typhoid F 42 54 272 5 397 159 17 155 590 244 1010 33 4 10 489 51 76 56 128 380 51 50 539 4812 Meas 0 11 1 3 6 1 2 0 13 5 5 2 2 7 5 4 1 0 8 0 2 0 10 88 AVH_A&E 9 13 4 1 0 8 1 7 107 11 46 28 2 4 18 23 8 0 17 12 15 0 48 382 AVH_B&C 1 2 1 0 3 4 1 0 100 14 11 1 0 2 24 0 2 0 1 2 5 0 14 188 NNT 0 0 0 0 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 AFP 0 0 1 0 1 0 0 0 0 0 2 0 0 0 1 0 1 0 0 1 0 0 0 7 312 9 0 6 17 14 2 11 18 19 19 9 9األمراض المشتبهة Mumps 5 16 2 12 2 19 1 14 53 33 22 Mal 32 230 1 2 15068 54 72 684 200 585 687 2 2 5409 374 91 21 214 711 323 7 0 1816 26585 Meng 0 9 0 0 10 0 0 0 16 2 5 0 2 0 1 1 1 1 0 0 0 0 24 72 DF 21 157 1 6 3947 2 2 141 24 7 4 50 3 1243 18 195 273 11 4 9 28 0 1818 7964 VHF 2 2 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 5 Sch 0 0 1 11 1 15 0 21 62 73 37 13 0 118 22 13 2 18 42 76 1 0 25 551 CL 0 0 0 4 0 2 0 0 8 13 14 0 3 12 2 6 3 4 10 6 1 0 3 91 RB 0 1 34 0 0 0 0 15 61 10 93 0 1 12 89 0 0 0 2 7 0 0 0 325 Tuberculosis 2 8 0 0 6 2 3 0 9 3 32 0 0 11 5 1 1 1 0 6 0 0 6 96 HIV/ AIDS 0 0 0 0 0 0 0 0 5 0 2 0 0 0 0 0 0 0 0 0 0 0 0 7 Brucellosis 2 0 59 0 0 91 0 5 145 30 412 0 6 142 59 0 11 3 5 15 14 0 9 1008 Chicken Pox 1 10 4 0 11 17 0 7 51 16 16 6 3 17 26 18 16 36 37 30 5 0 2 329 Scabies 7 2 11 0 38 0 0 5 16 6 23 2 0 27 0 0 0 6 9 26 0 0 4 182 Guinea Worm 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 othr_disease 4445 10337 4754 7624 14869 4313 2260 4863 44743 10871 22336 8610 4317 12116 10950 11052 5622 1006 6441 8544 4627 295 10819 215814 total_cons_disease 10146 18887 9244 9617 50496 7163 3721 9688 59290 18109 34464 12367 8338 27426 19026 19284 8583 2754 14549 19119 7913 585 26583 397352 This weekly epidemiological leaflet is issued by the National Early Warning and Response Program of the Ministry of Public Health and Population. For Correspondence: Dr. Rema Al-Yousfi, Mobile (713228999, e-mail: [email protected]), Yahya Amer-Mobile (777553779, e-mail [email protected]) 4 Weekly Bulletin: Electornic Integrated Disease Early Warinig & Response System, Yemen - Epidemiological Week Number 47 (18-24 November,2019)

Alert Responded in Epi - Week 47,2019

Suspected Governorate District HFs Actions Taken / Notes Cases Deaths Disease

Eidews coordinator visited the health facility, the cases of suspected whooping cough were diagenosed Pert Lahj Tuban,Yaffa Alsharif Health Center,Tebah Dispensary clinicaly according to case definition. 5 0 Cases added to the line list , treated symptomaticaly and left the health facility.

Radfan,Halimayn,Yaffa,Al Alhlal HC, Tur Sena'a Dispensary ,Halimeen rural Milah,Tuban,Al Madaribah and Ras Eidews coordinator visited the health facility, the cases of suspected Dengue fever were diagenosed DF Lahj H,Tebah Dispensary, AL jamaheer Dispensary,AL Amal clinicaly according to case definition. 195 0 Alara,Tur Al Bahah,Habil Jabr,Al Center,Tour Albaha Hospital,Almusaimeer H,Other Cases added to the line list , treated symptomaticaly and improved. Musaymir Contact with the focal points , the cases of suspected cholera were diagenosed clinicaly according to case definition. Radfan,Halimayn,AlMaqatirah,AlMusaymi Radfan Public H,Halimeen rural H,Ibn Khaldoon 57 RDT Chol Lahj r,AlQabbaytah, Tur Al Bahah,Al Had,Al Hospital,October public H,Tour Albaha positive. 118 1 Hawtah,Al Milah,Yaffa Hospital,Almusaimeer H Cases reported immediatly to the operation room , recorded in the line list. Cases treated by iv fluid, ors and antibiotic Cases finaly left the health facility,one case was dead

Contact with the focal points,the cases of suspected measles were diagenosed clinicaly according to case definition. Meas Lahj Radfan,Al Had Radfan Public H,Other 4 0 Cases reported immediatly to the operation room, recorded in the line list, cases treated symptomaticaly and left the health facility.

Contact with the focal points, the cases of suspected Diphtheria were diagenosed clinicaly according to case definition. Diph Lahj Yaffa,Al Had October public H,Alhaid rural H,Other Cases reported immediatly to the operation room, added to the line list. 7 0 Cases treated by penicillin and improved. RRT visited contact and supplyed them by erythromycin.

DarSad,AlMansura, AlBuraiqeh,Khur Alburaihi H,Masafi Aden H,Alwahda educational H,Al-Wali eIDEWS team were contacted fp: the cases were different area, diagnosis clinically,most samples were DF Aden 157 1 Maksar, AshShaikhOuthman, Hosp.,Hwailat Dispensar,Al-Salam Hosp.,Saber H collected, treatment were given, investigation form were done,one case was dead

Almua'ala health complex,Albasateen medical eiDEWS team were contacted fp,the cases were diagnoses clinically, ,treatment were given,investigation Chol Aden Al Mualla,Dar Sad,Ash Shaikh Outhman 70 0 center,Alwahda educational H form were done

Alkalloa'a Complex.,Alwahda educational H,Al-Memdara eidews team were contacted fp:the cases were diagnoses clinically, the cases were vaccination except 2 Meas Aden Attawahi,Ash Shaikh Outhman,Dar Sad Complex.,Al Basateen Al Tahri Center,Alkahera health cases were vaccination unknown , samples were collacted, treatment were given, investigation form 11 0 complex,Altwahi Health Complex were done

Ash Shaikh Outhman,Dar Sad,Al Alwahda educational H,Durrat Aldar specialized eIDEWS team were contacted fh :The cases were diagnosis clinically,treatment were given, Pert Aden 3 0 Mansura H,Alnakib H investigation from were done,the cases were vaccination unknown except one case was vaccination

eIDEWS team were contacted fh: The cases were diagnosis clinically, unknown vaccination and Diph Aden Ash Shaikh Outhman Alwahda educational H 8 2 samples, treatment were given, investigation from were done,2 cases were dead

eIDEWS team were contacted fp: the dead cases were 1-maroan ali tabet ,22y from darsad/2-salsabeel VHF Aden Al Mansura Aden German Hosp. ameen abdulmaged9y from darsad, diagnosis clinically,3 samples were collected, investigation form 2 2 were done

RRT visited the reported cases in districts ,the patients didn't receive any dose of pertussis vaccine,The suspected cases diagnosed clinically according to the standard case definition. He received antibiotics & Pert Abyan Mudiyah,Lawder Mudiya Hosp.,Mahnf-Lwdr H 8 0 regular interest . investigation form done , RRT in districts investigated the region for quick research on other new cases

RRT in districts visited FP. in H and the suspected cases in district villages to investigate the new Mudiyah,Jayshan,Lawder, Sarar,Al cases of AWD there, the cases diagnosed clinically, RDT'S were positive for 5 cases , stool culture Chol Abyan Mudiya Hosp.,Alrazi .H,Al Mahfad Hospital,Mahnf-Lwdr H didn't done, treatment were given, investigation forms were done , the cases and their families received 57 0 Mahfd,khanfir complete advices about the ways of prevention and management of cholera infection. the cases included in Cholera line list

eIDEWS team contacted the FP. In Hospital,all the patients came from different villages of district. the DF Abyan Mudiyah,Al Mahfd,Ahwar Mudiya Hosp.,Al Mahfad Hospital,Ekhlas Clinic cases diagnosed clinically (standard dengue case definition), samples were not collected, treatment 21 0 were given, investigation forms were done

RRT in district level visited the Family house in Jaar city. The case was 1 male (Omar Ali Naser Awbsl) 13 years old .He unvaccinated. The doctor in Alrazi H.diagnosed him clinicaly and reffered the case to Diph Abyan khanfir Alrazi .H 1 0 Aden (Alsadakka H.) oral swab didn't collected, and there he recieved antibiotics only and not receive anti toxoid

IDEWS team visited the reported cases in Lawdar city,Mahnf H . the propable case were 1 male 12 years old, (Abdu Faisal Alqabli),from Zarah village . He complained from high grade fever, headache, VHF Abyan Lawder Rowais Dispensary muscles and joints pain and lastly epistaxis This case diagnosed clinically according to the standard 2 0 case definition. . investigation form done , RRT in Lawdar district investigated the region for quick research on other new cases Sharab Ar Rawnah,Al Misrakh,Khadir,AlQahirah Al Aroos Hospital,22 May HC,Ar Romah Rapid response team contacted also focal points by eIDEWS coordinator,cases diagnosed clinically AlMaafer,Mawiyah,Salh center,Almodafar Hospital,Aljoumhri H,Khalifa according to case definition.Stool samples(C/S & serotyping) collected from cases & sent to lab (Central Chol Taiz Sama,AlMudhaffar,Sabir labs)for confirmation. Supplements & antibiotics treatment were given(case management) rapid test : 1961 2 Hospital,Al Loqiah Hospital,22 May Almodafar HC,Mawih AlMawadim,Maqbanah, case positive for some cases &the results of stool C/s still pending. .There were collection & cluster of Hospital,Alnshmh H,MSF Hospital,Other AtTaiziyah,AshShamayataynHayfan,Jabal cases in the same Place,2 cases were dead Habashy, Sharab As Salam

AlMudhaffar,AlQahirah, Alhikma Hospital,Al wahdah HC,22 May H,Althwrh Rapid response team were contacted, information shared, facilities has been visited ,, the suspected DF cases had a history of high fever , retro- bulbar pain ,myalgia and arthralgia, cases were diagnosed DF Taiz SharabArRawnah,Salh, AlMukha,Al H,Almkha Hospital,Almodafar Hospital,Yemeni - Suidi 1818 0 clinically.and by blatelets counting, ,rapid test of dengue virus were done for some of cases ,,which were Waziyah,Sabir Al Mawadim H,Altawn H,26 September Hospital,Other positive,, Medications have been given,,,there are cluster of cases in some areas, All data in the line list..

Pert Taiz Sama,At Taiziyah Al Qatab HU,MSF Hospital 16 0

Mashraa Wa Hadnan,Al eIDEWS coordinator contacted focal points and the coordinator of the directorate ,information's Alshifaa Hadnan HC,MSF Hospital,Almsrakh shared.Blood samples were collected from the cases and sent for lab confirmation &5 cases were Meas Taiz Mawasit,Mawza,AlMisrakh, 10 0 Hospital,Other vaccinated and 3 cases were vaccination unknown but 3 cases other un vaccination,All data in the line AshShamayatayn,AtTaiziyah list

they receiving an immediate report from the coordinator of edews in the facility about these cases of suspicion of diphtheria , the cases were diagnosed clinically as a suspected cases of diphtheria,,they deid in the hospital after admission in few days ,,..we write all data about the case in the line list .. action Diph Taiz Al Qahirah,Mawiyah Yemeni - Suidi H,Other :we inform the Rapid response teams to visit the facility which receive the cases and they found data 3 3 recorded in the hospital and the cases were complained of fever and membrane in the throat and difficulty of swallowing,,after that the teams have been visit the houses of the patients and they take all data about the cases and their contacts..all that's in the line lis,3 cases were dead

The DRRT investigated the living area. the cases were diagnosed clinically by case definition, the cases Pert Hadramout Ad Dis,Ghail Ba Wazir,Ash Shahr Alghurifatain HU,Ghail Bawazeer H were un vaccinated except one case was vaccination, all cases treated by antibiotic and supportive 6 0 treatment.

The EDEWS coordinator contacted the focal persons, one case was vaccinated and one case other was Meas Hadramout Adh Dhlia'ah,Ar Raidah and Qosaiar Aldhulaia'a HC 2 0 un vaccination, blood samples were collected,symptomatic treatment were given

The district RRT investigated the living area. The cases were diagnosed clinically by case definition, 9 blood samples were collected and tested for df by using df NS1 RDT.ALLos the tested sampmes were DF Hadramout Ar Raidah and Qosaiar,Ash Shahr Ar Raydah General Hospital,Alshahr public H,Other 50 1 positive for df antigen. the area were targeted by indoor spray conducted by MNCP. health education were performed,one case was dead

the DRRT investigated the area. the cases were diagnosed clinically by case definition, RDT were Alsadara HC,Hajar aljoul rural H,Maternity and Childhood positive in 6 samples and negative. in 5 stool samples. 4 stool culture were collected and sent to central Chol Hadramout Hajr,Al Mukalla City lab by Carry _Blair media. 2 samples were positive by culture . The WASH RRT informed. chlorin was 12 0 H - Mukalla added to the main water supplay in the area. all cases were treated by iv fluids ORS and antibiotic. all cases improved.

The EDEWS coordinator visited the health facility. The case was 6 years old female from Shabowa gov . the case was diagnosed clinically. pseudomembrane was present. 2 pharyngeal swaps were collected Diph Hadramout Al Mukalla City Maternity and Childhood H - Mukalla and sent to the central lab. the result was positive for diphitheria bacilli. the case was not vaccinated. the 1 0 case was admitted to the isolation department. DAT with. iv penicillin was given. the case was still admitted. the EDEWS coordinator of Shabowa gov was informed.

This weekly epidemiological leaflet is issued by the National Early Warning and Response Program of the Ministry of Public Health and Population. For Correspondence: Dr. Rema Al-Yousfi, Mobile (713228999, e-mail: [email protected]), Yahya Amer-Mobile (777553779, e-mail [email protected]) 5 Weekly Bulletin: Electornic Integrated Disease Early Warinig & Response System, Yemen - Epidemiological Week Number 47 (18-24 November,2019)

Alert Responded in Epi - Week 47,2019

Suspected Governorate District HFs Actions Taken / Notes Cases Deaths Disease

ArRadmah,Mudhaykhirah Badan,HazmAlUdayn, Yarim Hospital,al-Hazm Hospital,Alshaheed Albadani AsSabrah,AlQafr,AsSaddah,AlMakhadir, Immediate notification. eDEWS Coordinator visited hospital, stool samples were collected and positive Hospital,Alradhmah H,Almakhader HC,Alqaidah H,AL by rapid test for 34 cases Chol Ibb AsSayyani, 1256 0 Mzahan H,Yahsub Hospital,Aladin H,Mother and Child AshShair,AnNadirah,Jiblah,AlDhihar,AlUd H,Other All cases were improved ayn,Yarim ,AlMashannah Hubaysh, FarAlUdayn,Ibb,DhiAsSufal

eDEWS focal points contacted.Information shared, Samples were Meas Ibb Al Udayn,Jiblah Aladin H,Jplh .H 5 0 collected,the cases were vaccination

Immediate notification by focal point. Case was diagnosed clinically and treated accordingly.case was Pert Ibb Al Dhihar ALhamd Hospital 1 0 Vaccinated

Immediate notification by focal points. Cases were diagnosed clinically and treated accordingly and Diph Ibb Al Mashannah Alnassr H 5 0 recieved anti-toxin . 4 cases were unknown Vaccinated .Cases from different area. 2 cases from Taiz

eDEWS Coordinnator Contacted focal points .Information shared.Cases have been diagnosed Clinically. DF Ibb Al Dhihar Alameen H According to the Standard definition. 18 0 Cases from AlHudaydah _Aljrahi . All cases have been taken rapid test. and All cases were only positive.

Immediate notification.Patient name Abdullah Omer Ahmed Mohammed . 23 AFP Ibb Al Mashannah Mother and Child H months ,old male.From Alqafr_ -Nakhlah - Date of notification 17/11/2019.Date onset of symptoms 1 0 15/11/2019. samples 2 from case ,and send to sanaa,number of vaccinated 4 doses

Bura,AlMansuriyah AzZaydiyah,Bayt AlFaqiah Alsalakhana H,Alkanawes HC,Aldhahi Rural AlQanawis,AdDahi,AzZuhrah,AlHawak,Al H,Almansouria rural H,Bait Alfakih H,Alzaydia Rural Hali,AsSalif, AlMunirah,AlMighlaf, Chol AlHodaidah H,Aljarrahi rural H,Alluheyah HU,Alhshm 1996 0 AlGarrahi,Alluheyah, Center,Althawra public H,Almekhlaf HC,Alzaydia Rural AlHajjaylah,JabalRas, H,Other AsSukhnah,Zabid,AlMina, AlMarawiah,Kamaran

Alluheyah,AlQanawis,Hays, Bait Alfakih H,Alzuhra Rural Hospital,Alkanawes Private AdDahiBaytAlFaqiah,AlHali, Bajil H,Tihama Hospital,ALNoor Hospital,Aljarrahi rural ,AlHawak,Zabid,AlMina DF AlHodaidah H,Alesra'a Specialized H,Bajil Rural Hospital,Althawra 3947 1 AzZuhrah,AzZaydiyahAsSalif,JabalRas,Al public H,Zabid rural Hospital,Alhshm Center,Alsalif Munirah AtTuhayat,AlMansuriyah Hospital,Alkahra'a HC,Almuneera H,Altuhaita HC,Other AsSukhnah,Al Garrahi

AFP AlHodaidah Al Marawiah New Katee'e HC 1 0

Meas AlHodaidah Al Mina, Al Hawak Altahrir HC,Alrabsa HC,Althawra public H 6 0

Pert AlHodaidah As Salif Alkarya HC 1 0

Diph AlHodaidah Al Hawak Althawra public H 7 0

Najrah,AshShahil,AlMiftah QaflShamer,BaniQais,Qarah Public Republican Hospital,Khatwah HC,Qafl Shamer Aslem,AlJamimah,Mabyan, Kufl-Shamar Rural H,Bani Chamakh HC,Bani Qais AflahAshShawm,HajjahCity,Abs,Hajjah,K eIDEWS Coordinator contacted the Coordinator of Surveillance in Districts, Information shared .It have Chol Hajjah Health Center,Mabyan Hospital,Kuhlan Afar been reported cases of suspected cholera , The cases were diagnosed clinically (Acute watery diarrhea) 905 0 uaydinah, AlMahabishah,KuhlanAffar, HC,Almahabesha Public H,Alshahel Rural the cases from different area, It were given the appropriate treatment Mustaba,Bani AlAwam, Kuhlan Hospital,Almaghraba HC,Other AshSharaf, AlMaghrabah,Khayran AlMuharraq,AshShaghadirah

Qafl Shamer,Khayran Al Al ghfaliah HU,Public Republican Hospital,Abs Rural Diph Hajjah 15 0 Muharraq,Hajjah City Hospital

Khayran Al Muharraq,Hajjah City,Kuhlan Almuharak HC,Public Republican Hospital,Kuhlan Ash Meas Hajjah Ash Sharaf,Aslem,Abs,Ash 7 0 Sharaf HC,Other Shahil,Mabyan

Mabyan,AlMahabishah,Abs,Mustaba,Was Martyr d. Yasser w Thab Hospital,Public Republican hhah,Aflah Al Yaman,Aslem,Kuaydinah, Hospital,Sauid Hospital in Hajja,Abs Rural eDEWS coordinator contacted focal points, information shared, cases have been diagnosed clinically DF Hajjah .According to the standard definition DF ,the Cases from different areas , Some cases have been rapid 1243 1 HajjahCity,KuhlanAshSharaf,Khayran Al Hospital,Kuaidena HC,Jabal Aslam HU,Aslam test work the result were positive, Appropriate treatment were given Muharraq HC,Tihama region center,Mabyan Hospital,Other

eIDEWS coordinator contacted focal points,information's shared.Blood samples were collected from the AtTahrir,Assafi'yah,Az'zal, Alulfi HC,Jabr Bn Hyan HC,Altwhid HC,Al Mithaq cases and sent for lab confirmation & the onset of fever,skin rash, the were unvaccinated against Meas Amana 13 0 Aththaorah,Maain,AsSabain, Shu'Aub Complex,Alkher and Alslam Complex,As Sabin Hospital measles, Vit-A were given to the cases in order to support his immunity against complications of measles.

Rapid response team contacted focal points,cases diagnosed clinically according to case definition.Stool Bni - Hwath HC,Alwahda Health Center,Arwdhah H,As Aththaorah,Shu'Aub, AsSabain, samples(C/S & serotyping) collected from cases & sent to lab (Central labs)for confirmation. Sabin Hospital,22 May Hospital,Jabr Bn Hyan Supplements & antibiotics treatment were given,Most of them were from Amana governorate & a few of Chol Amana Assafi'yah,Bani AlHarith,Maain,Az'zal, 965 0 Complex,Al Jraf Complex,Ibn Khaldon HC,Omar Al them from other governorates from different districts of that governorates,the results of stool C/s still AtTahrir,Sana'a Old,AlWahda Mokhtar Complex,Other pending. .Rapid tests of cholera were negative for most collected specimens, so stool C/s not done for that samples.There were no collection or cluster of cases in the same Place.

contacted the focal points & visited the HF.She told us that suspected dengue cases ,the cases had a history of high fever, back pain, muscular pain, and arthralgia. The samples were collected at the DF Amana Maain,At Tahrir Alamanh H,Alkwit educational H,Aljomhwri H 24 0 hospital's laboratory for serological testing (NS1). This test measures the presence of dengue protein (high sensitivity and quality test) which detects the virus antigen that confirmed.

eIDEWS coordinator contacted focal points,informations shared,after that HF visited by eIDEWS coordinator.The case diagnosed clinically according to the case definition as suspected diphtheria.Symptoms & signs of a case were,fever,sore throat,grey-whitish pseudo-membrane,swelling Diph Amana Maain,As Sabain 22 May Hospital,As Sabin Hospital 4 0 of neck lymph-nodes(Bull neck) & difficulty of swallowing & breathing. Antibiotic treatment was given & case management done.Throat swab & fixed slides were taken into Central Lab for confirmation(Albert stain,Gram stain & Diphtheria C/S)the cases were vaccination

As Safra,Majz,Qatabir,Sa'da Qatabir Health Center,Al Jumhoori Hospital,Ghamer elDEWS team contacted focal points,information shared, blood samples were not collected from the Meas Sa'adah 8 0 ,Baqim,Ghamir Health Center,Other cases and the onset of fever,skin rash ,the cases were un vaccination

Pert Sa'adah Majz,Shada Dhian HC,Thaher Hamdan Health Unit 3 0

Sahar,Qatabir,Majz,Sa'da , Al Ghamer Health Center,Monabbih Rural Hospital,Qatabir Hishuah,Baqim,Razih, Kitaf wa Chol Sa'adah Health Center,Al Ghabir Health Unit,Al Jumhoori 398 0 AlBoqee,AdhDhahir, Hospital,Other Ghamir,Munabbih,Shada

Diph Sa'adah Majz,Sa'da ,Baqim Majz Health hospital ,Al Jumhoori Hospital,Other 8 0

This weekly epidemiological leaflet is issued by the National Early Warning and Response Program of the Ministry of Public Health and Population. For Correspondence: Dr. Rema Al-Yousfi, Mobile (713228999, e-mail: [email protected]), Yahya Amer-Mobile (777553779, e-mail [email protected]) 6 Weekly Bulletin: Electornic Integrated Disease Early Warinig & Response System, Yemen - Epidemiological Week Number 47 (18-24 November,2019) Alert Responded in Epi - Week 47,2019

Suspected Governorate District HFs Actions Taken / Notes Cases Deaths Disease

AsSudah,Huth,Suwayr,Khammer Al Qaflah Rural Hospital,As Sawd Health Shaharah,HarfSufyan,DhiBin hospital,Raydah Health hos.,Al Ashah Health hospital, HaburZulaymah,AlAshah,Amran Harf Sufyan H,Al Salam Khamir Eidews Coordinator Contacted The Coordinator of Surveillance in Districts The cases were diagnosed Chol Amran clinically as suspected cholera. According to case Definition Rapid Test were done for some cases 500 0 Raydah,Thula,BaniSuraim,Kharif, Hospital,HuthHealth,hospital ,Kharif Rural the Result were positive, All The cases improved After Taking The Treatments proper AlMadan,AlQaflah,AsSawd,MaswarJabal Hospital,Amran General Hospital,Thula Health Iyal Yazid hospital,Habur Health hospital,Al Abraq Health Unit,Other

eidews Coordinator Contacted The Coordinator of Surveillance in District and visit amran health center,the Case Were diagnosed clinically as suspected Measles. According to Case definition, Blood Meas Amran Kharif,As Sawd,Thula,Bani Suraim,Huth Al-Damana,Amran Healthcenter,Other 5 0 Samples Were Collected Of case and Sent To Central Lab in Sanaa for confirmation, the Cases were Vaccinated Against Measles

Eidews Coordinator contacted focal point . And RRT district visit Health Hospital and Visit the contacts and gives antibiotics case were diagnosed Diph Amran Amran,Raydah 22 May hospital,Raydah Health hos. 2 0 clinically probable diphtheria . case Treated with antibiotics and antitoxin case from district iyal surayh

eidews coordinator was contacted focal point and visit 22 may health hospital. the cases suspected cases of dengue DF Amran Amran 22 May hospital 7 0 fevere . one case were positive by rapid test The cases were diagnosed clinically according to case definition. All cases were Received the treatment and improvement . the cases different areas

Pert Amran Khammer Al Salam Khamir Hospital 1 0

BaniHushaysh,Attyal,SanhanAlHaymahAl 22 May Hospital,Alar rural H,Awmara H,Alshaeed Kharijiyah, AlHusn,Nahm,Bani Dhabyan Mohamed Aldurra Hospital,Alhanak HU,Bait Alsaid Khwlan,Manakhah,Hamdan eDEWS coordinator contacted focal points, The cases were diagnosed suspected cholera(AWD) cases Chol Sanaa Governorate HC,Almarbak HC,Hamdan Hospital, Bani Mansour tested by rapid test 185 cases positive and cases were treated at the health facility and received 1881 0 BaniMatar,AlHaymahAd HC,Bait Alhenami HC,QaaAlSook Hu,Alshe'eb Alaswad treatment Dakhiliyah,Jahanh,Bilad ARus, HC,Walan Hospital,Other Arhab,Sa'fan

The EDEWS coordinator contacted the focal persons, The cases were diagnosed clinically by case Pert Sanaa Governorate Arhab,Bani Hushaysh Alhayfa HC,alrona HU 8 0 definition,the cases were vaccination unknown,The cases were treated with antibiotic.

The district RRT visited the health facility. The case was 19 months male The case was diagnosed AFP Sanaa Governorate Hamdan 22 May Hospital clinically by case definition. paralysis started in 18_11_2019. The case vaccinated 5 dose stool sample 1 0 was collected and sent to central lab

The EDEWS coordinator contacted the focal persons, The cases were diagnosed clinically by case Diph Sanaa Governorate Khwlan,Manakhah Alfadhaya HC,Alqadam center definition,2 cases were vaccination unknown and one case was vaccination,The cases were treated with 3 0 antibiotic.

The focal points of the health facility were contacted information shared cases of suspected Dengue DF Sanaa Governorate Manakhah Alqadam center fever,the cases were diagneosed cilinicaly acoording to case definiation,the cases were treated and 9 0 improved

eIDEWS team were contacted with health facilities found the cases suspected of pertussis,the cases Pert Shabwah Ataq,Markhah Assufla Teab Al Atfal Clinic were diagnosed clinically accord to case definition,the cases were un vaccination except one case was 8 0 vaccination,the cases were treated and improved

eIDEWS team were contacted with health facilities found the cases suspected cases of dengue feve,the DF Shabwah Baihan,Osailan,Ataq Bayhan Hospital,Usaylan Hospital casesr from different areas, the cases rapid test positive for one case only ,the cases were received their 28 1 best treated and improve,one case was dead

eIDEWS coordinator was contacted with health facilities found the suspected case of measlesthe cases Meas Shabwah Ar-rawdah,Arma Al Redha Clinic,Arma Hospital were diagnosed clinically accord to case definition one case was vaccination and one case other was un 2 0 vaccination, samples were collected ,the cases were received their best treatment and improvement.

Habban Hospital,Emergency/Ataq Hospital,Rudum Rural eIDEWS team were contacted with health facilities found the cases suspected case of cholera,the cases Chol Shabwah Habban,Ataq,Rodhoom were diagnosed clinically accord to case definition, rapid test were positive for 4 cases,the cases 10 1 Hospital received their best treatment and improvement.

Diph Shabwah Rodhoom Al Wafa Clinic 1 0

AsSawadiyah,AtTaffah, Naman,Mukayras,Sabah, DhiNa'im,ALSharyah, Alshriah Sare H,Qaea Rada Center,Mother and child eIDEWS team contacted focal points, the cases were diagnosed clinically as suspected cholera using case definition , the rapid test 72 positive and the main saing watery diarrhea &vomting some Chol Al-Baidha AlMalagim,RadmanAlAwad, HC,Mukayras Hospital,Althwrh Hospital,Al-Taffah 887 1 dehydration the paitnts ademittedt in Hospital and with ORS and IV fluid in good condation,one case AlQuraishyah,ArRyashyyah,AlBaydaCity, Center,Other was dead Rada' ,Wald Rabi',AlA'rsh,AsSawma'ah ,Nati

IDEWS team contacted points information shared blood saeIDEWS team contacted focal point the cases diagnosed clinically according to case the number of cases were and one femal less than 5 VHF Al-Baidha Sabah Zkhm HC 1 0 years he ages 24 months the and bleeding from muthe and nose there are non was collction of cases their are was from sabah

eIDEWS team contacted and visit focal points information shared field investgation done stool sample were collected from the case and close contactes in samples were sent for confirmation the date of AFP Al-Baidha Mukayras Mukayras Hospital 1 0 onset of AFP in 24/11/2019 the case was one male his name was Ahmed Mostfa Abdullah Baawad this age 84 Monthes he was from Mukayras and from aAnaab villages he was vaccinated

IDEWS team contacted points information shared blood saeIDEWS team contacted focal point the cases diagnosed clinically according to case definition Antibiotics treatment were given the number of Meas Al-Baidha Naman Araa health center cases were and one male less than 5 years he ages 36 months and Apear skin rash in 20/11/2019 and 1 0 the fever in 18/11/2019 in respectively the case from Naman from Alkawl villsges and there are was collction of cases samples was cases and their are non was vaccination against measls

EDEWS team contact Edews focal points in Health Centre, ,the cases were diagnosis according to Chol Al-Mahra Huswain,Al Ghaydah Saqar Health Centre,Al Ghaydah Center Hospital case defination , susspected Cholera ,,Cholera rapid test was -ve except one case was positive 5 0 ,treatment were given

EDEWS team contact Edews focal points in `AlAis Health Centre . cases from AlMasilah District Meas Al-Mahra Al Masilah Al Ais Health Centre ,cases diagnosis according to case defination , susspected Measles case was 1 males (21 ) years 2 0 ageand female 3 years ,treatment was given , and serum sample was teken and send to central level ,

edews team contact focal points , the case was diagnosed clinically as suspected (cholera) using case definition , (1) name : Salama Awad Balghith, age 90y the case admitted in tareem H Chol Hadramout wady Tarim Tarim H main sign : sever dehydration , vomiting , 1 0 Lab : Rapid test negative Invtstigation done by RRT Address: tareem - damoon Treatment : ORS, iv fluid , anti biotic.

edews team contact focal points , the cases were diagnosed clinically as suspected (meas) using case definition , the cases were vaccination Meas Hadramout wady Shibam,Amd Shibam District H , blood samples collected 2 0 vit A provided . symptomatic treatment were prescribed

Pert Hadramout wady Al Qatn Other 1 0

This weekly epidemiological leaflet is issued by the National Early Warning and Response Program of the Ministry of Public Health and Population. For Correspondence: Dr. Rema Al-Yousfi, Mobile (713228999, e-mail: [email protected]), Yahya Amer-Mobile (777553779, e-mail [email protected]) 7 Weekly Bulletin: Electornic Integrated Disease Early Warinig & Response System, Yemen - Epidemiological Week Number 47 (18-24 November,2019) Alert Responded in Epi - Week 47,2019 Suspected Governorate District HFs Actions Taken / Notes Cases Deaths Disease

Alhumyat HC,Dhamar public H,A Unity Centre Utmah,DhamarCity Dawran (residential),Zeraja rural H,Meshrafa HC,Alrabo'o Aness,Wusab AlAli,Wusab AsSafil EideWS coordinator contacted focal points he found cases diagnosed suspected Chol(Acut watery Chol Dhamar banighulais HC,Althalouth HC,Rsabh Hospital ,Alkharba diarrhoea and dyhadretion )37 cases tested by rapid test And result were postive ,all cases received 807 0 Mayfa'at Anss,Jabal Ashsharq,AlManar, rural H,Aljarf HC,Kharbah Abuyabes HC,Alwahda treatment Jahran, Anss Maghirib Ans, AlHada university H,Dawran Hospital,Other

Alwahda university H,Hadhran HU,Aljma'a HC,Bin Eidewds coordinator contacted of the coordinator districts and he founds that cases were diagnosed Pert Dhamar Jahran,Jabal Ash sharq,Dawran Aness according to the standard definition of pert, the cases were un Vaccination , treatment and education 15 0 alakwa'a Dispensary health given

Eidewds coordinator contacted of the focal points and he found that the cases were diagnosed according Dawran Aness,Al Hada,Al to the Meas Dhamar Zeraja rural H,Hamam Ali Hospital, AlMasli Hospital 5 0 Manar,Dhamar City standard definition of Meas( fever -rash )2 cases were un vaccination and one case other was vaccination but the last case was vaccination unknown

Diph Dhamar Dhamar City Dhamar public H 2 0

EideWS team contacted focal point and he found the case diagnosed according to case definition as suspected AFP Flaccid Paralysis- Weakness - ) -Patient data is Mhmed Ahmed ALmsaady (12 years AFP Dhamar Dhamar City,Jahran AlMasli Hospital,Alwahda university H 2 0 old - From ALBETHAH governort - Kefh - Thearaan area - The beginning of the symptoms 16 /11/2019- Reporting date 23/11/2019. samples from the patient delivered to the coordinatori of paralyss

Harib,Mahliyah,Al Jubah,Al wadi,Marib the contacted the contact and told us that suspected dengue cases had a history of high fever, back ( al Wahdah ) Hospital,May 22 Hospital,September 26 pain, muscular pain, and arthralgia. The samples were collected at the hospital's laboratory for DF Mareb City,Rahabah,Al Abdiyah,Sirwah,Jabal 273 0 Hospital,Bid Bidah Hospital,Rahabah hospital,Other serological testing (NS1). This test measures the presence of dengue protein (high sensitivity and quality Murad,Bid Bidah,Majzar test) which detects the virus antigen .that confirms the result

Rapid response team contacted focal point by eIDEWS coordinator & HF visited,cases diagnosed Al Kari Hospital,Bid Bidah Hospital,ALShahud Ali Abdul clinically according to case definition.Stool samples collected from cases for screening test only . Chol Mareb Al wadi,Bid Bidah,Al Abdiyah 42 0 Hospital,( al Wahdah ) Hospital Supplements & antibiotics treatment were given(case management) ,the results of stool Rapid tests of cholera 9 positive .There were a no collection or cluster of cases seen in the same Place

eIDEWS coordinator contacted focal point,then HF visited(kara hospital). Information shared.Stool sample collected from the case in 24/11/2019 & the sample sent for lab confirmation.The date of onset of AFP Mareb Al wadi Al Kari Hospital AFP was in 18/11/2019.The case was one female,her name Hamass Raeed Ahmed Alabadi ,her age 1 1 0 years,from Mareb governorate,Jabal Morad district, Alsen area,she was vaccinated against polio(4 doses)

Meas Mareb Al wadi Other 1 0

Al Hamidat,AlGhayl Al Hazm Hospital,Bart Al Anan Rural Hospital,Al AlMatun,AlHazm,AlMaslob Humaydat Health Center,Bart Rajuzah Hospital,Al The EDEWS Coordinator received a report from the control officer that there were cases of the doctor's Chol Al-Jawf 158 0 AlMatammah,Bi'rat AlAnan Kharab Al Masloob Health Center,Al Shifa Center,Al Khalq Health diagnosis. It were cholera, 2 cases were positive by rapid test ,Treatments were treated Marashi Center,Al Marashi Health Center,Other

EDEWS team contacted focal points, the Cases diagnosed clinically as suspected pert.treatments were Pert Al-Jawf Al Matun Al Qasabah Health Unit 2 0 given,the cases were un vaccines

The EDEWS coordinator has contacted the coordinator. The condition was diagnosed clinically by definition of the condition. The number of cases was 1 from different districts and villages. Number 1 Meas Al-Jawf Az Zahir Al Mabna Health Unit 1 0 female case vaccination number of cases . Blood sample was not collected. Symptom therapy and antibiotic giving were given and vitamin A

Shibam Kawkaban Hufash,BaniSa'd Swaq Alahd HU,Mlhan Health Center,BaniSa`dHospital, eIDEWS coordinator contacted focal points, information was shared. all cases were diagnosed clinically according to case definition,some cases were investigated by rapid test for vibrio cholera and results Chol Al-Mahweet AlMahwait,alKhabt ArRujum,AtTawilah Aljoumhwri H,AlArkobHC,HufashH,BniAlhmadiHU, 523 0 positive for 19 cases, appropriate treatment were given according to severity of symptoms and AlMahwaitCity ,Milhan Alrujm Hospital,Other dehydration

eIDEWS coordinator contacted focal points,information was shared. all cases were diagnosed clinically DF Al-Mahweet AlMahwait,Milhan,BaniSa'd, Al Khabt Alahjoul asfl HU,Bani Sa`d Hospital,Other according to case definition,some cases were investigated by RDT for dengue fever and results 141 0 positive,appropriate treatment were given, according to severity of symptom

As Salafiyah,Bilad At Ta'am,Al 6 eIDEWS Coordination contact focal points in health centre , cases diagnosed according to case Chol Rayma Az Zilh HC,Almithaq H,Wadi Alarid HC,Althulaia H,Other 214 0 Jafariyah,Al Jabin,Kusmah,Mazhar definition , most cases treatment at home

eIDEWS coordinator contacted focal points,information was shared. all cases were diagnosed clinically DF Rayma Al Jafariyah Alhadiah HC according to case definition,some cases were investigated by RDT for dengue fever and results 11 0 positive,appropriate treatment were given

AlAzariq,AlHusha,Damt eDEWS team contacted FP ,all cases diagnosed according to case definition, all included in updated Chol Al-Dhale Damt HC,Daglal Health Center,Alnassr H,Other 81 0 ,Qa'atabah,AdDhale'e Ash Shu'ayb daily line listing

eIDEWS team were contacted fp: The cases were diagnoses clinically, vaccination were done, samples Meas Al-Dhale Al Husha,Jahaf Dhwran HC,Alazlh HC 3 0 were collected , treatment were given, investigation form were done.

eIDEWS team were contacted fp: the cases were diagnoses clinically , vaccination were done, samples Diph Al-Dhale Al Hussein Al Kharbh Health Unit 2 0 were collacted , treatment were given, investigation form were done.