Bulletin: Cholera and AWD Outbreaks in Eastern and Southern Africa Regional Update for 2018 - as of 18 May 2018 Highlights In 2018; More than 17,479 cholera / AWD cases and 268 deaths (Case Fatality Rate, 1.5%) have been reported in Eritrea 10 of 21 countries of Eastern and Southern Africa Region (ESAR) since the beginning of 2018. These 17,479 268 countries include; Angola, Kenya, , Mozambique, Rwanda, Somalia, , Uganda, 10 1.5% and Zimbabwe. Zambia accounts for 23.4% of the total case load reported this year followed by Kenya at Countries Cases deaths CFR 22.5%.

Currently, 7 out of the 21 countries in ESAR are reporting active transmission of cholera / AWD (Kenya, Somalia Tanzania, Angola, Uganda, Somalia, Zambia and Zimbambwe). During the week under review, Kenya Ethiopia reported the highest number of new cases (302 cases), followed by Somalia (296 cases). Apart from South Sudan Somalia, all countries with active transmission have recorded CFR above 1% in 2018, with Zimbabwe (CFR, 4.2%) and Uganda (CFR, 2.1%) recording the highest CFR. 296 Kenya: An increase in the epidemic trend has been noted. During week 19 (week ending 13 May 2018), 4 / 16 302 new cases were reported compared to 58 cases reported in week 18 (week ending 6 May 2018). 2,654 These new cases emerged from the following counties; Garissa (202), Nairobi (29), Isiolo (24), Elgeyo 42 Uganda Marakwet (17), Turkana (14), Kiambu (8), West Pokot (7) and Meru (1). Cumulatively a total of 24,741 0 / 71 / 49 cases including 414 deaths have been reported, as from December 2014. Of these, a total of 3,931 cases 2,376 0 and 71 deaths have been reported since the beginning of 2018. Kenya 3 Rwanda Somalia: An increase in the epidemic trend has been noted. During week 18, 296 new cases including 4 30219 deaths (CFR, 1.4%) were reported compared to 212 cases including 2 deaths (CFR, 0.9%) reported in Burundi week 17 (week ending 29th April 2018). New cases emerged from Banadir (132 cases and 2 deaths), 0 / 36 3,931 Lower Jubba (127 cases and 2 deaths) and Lower Shabelle (37) regions. Cumulatively a total of 2,967 cases including 17 deaths have been reported, as from December 2017. Tanzania

Tanzania: A decline in the epidemic trend has been noted. During week 19, 44 new cases were reported 44 compared to 89 cases including 3 deaths (CFR, 3.4%) reported in week 18. New cases emerged from 1,837 District region (33) and Songwe region (11). Cumulatively a total of 30,468 cases 16 including 502 deaths have been reported, as from August 2015. Of these, a total of 1,837 cases and 36 7 Malawi deaths have been reported since the beginning of 2018. Comoros 839 0 / 22 4,097 Uganda: A decline in the epidemic trend has been noted. During week 17, 42 new cases were reported Angola Zambia 774 compared to 110 cases including 2 deaths (CFR, 1.8%) reported in week 16 (week ending 22 April 2018). These new cases are concentrated in the following districts Kagadi (19), Amudat (12), Hoima (9) and 0 / 9 0 / 55 Kyegegwa (2). Cumulatively a total of 2,376 cases including 49 deaths have been reported since the Mozambique outbreak started in February 2018. 9 0 / 7 167 801 Zambia: The country has been reporting an average 2 cases per day, mainly from Chelston sub-district of Zimbabwe Madagascar Lusaka district. During epidemiological week 19, the country reported 16 cholera cases and no deaths. Botswana Cumulatively a total of 5,905 cases including 115 deaths have been reported since the outbreak started Namibia 0 / 3 on 6 October 2017. Lusaka district accounts for 92% (4,768) of the cumulative reported cholera cases countrywide. Legend

Zimbabwe: Sporadic cases continue to be reported, mainly from Chitungwiza and Stoneridge (an informal Swaziland settlement in Harare right next to Chitungwiza). Both places have extremely erratic access to tap water New cholera cases (last 1 week) (from Harare city) and largely depend on well water. During week 19, 9 new cases were reported 2018 Cumulative cases compared to 4 cases reported in week 18. Cumulatively, 167 cases including 7 deaths have been Lesotho Cholera Deaths reported, as from January 2018, when the outbreak started. Number of new cholera deaths (Week 17, 18 or 19) / 2018 Cumulative South Africa deaths Angola: 7 new cases were reported in week 19 compared to 6 cases reported in week 18. These new cases are concentrated in Uige district. Cumulatively, 944 cases including 15 deaths have been reported, Distribution of new cases: Week 17, 18 or 19, 2018 as from 15 December 2017. Of these, 839 cases and 9 deaths have been reported since the beginning of No data No outbreak reported in 2018 2018. No new cases reported in Week 17, 18 or 19 1 to 500 cases > 500 cases Creation date: 18th May 2018 Sources: Ministries of Health and WHO Country Priorities and Response Interventions

Country Priorities Response Interventions

- With an estimate 630,000 people affected by heavy rains and floods, • 112,905 new beneficiaries reached with temporary water supply services through trucking, voucher and water source chlorination in Bay, more resources need to be mobilized in order to respond to emerging Banadir, Middle Shabelle, Gedo, Sanaag, Sool, Mudug and Nugaal regions. needs and prevent possible new outbreaks of infectious diseases • An additional 131,349 people accessed sustained water supply services through the construction and rehabilitation of water systems in including cholera Nugaal; Bakool, Bay and Sanaag regions Somalia - Support provision of emergency and sustained WASH serviced through • 19,908 people benefitted from adequate sanitation in Nuugal, Bakool, and Sanaag regions. different water supply option, appropriate sanitation and hygiene promotion • 6,939 school children got access to sanitation facilities in Nuugal, Bakool, and Sanaag regions activities at the community and institutional level • Hygiene kits and means for water disinfection were provided to about 185,000 people in emergency situation. These include 168,000 - Provide people with hygiene kits enabling them to prevent cholera people affected by floods in the district of Belet Weyne, Hiraan region. -Proper case tracing and management through early detection mechanisms, • Hygiene promotion messages reached 109,313 people based in different IDP settlements laboratory surveillance and timely referral to different CTCs/CTUs established - Continue oral cholera vaccinations campaigns in hotspot areas

-Need for continuous capacity building in counties on IDSR, IPC and RRT • The Ministry of Health with UNICEF continues to sensitize Health Care Workers in affected counties on case management and Infection -Ensure the availability of safe water (HWTS, HH water treatment and safe Prevention and Control Measures storage, and targeted investment in water supply) and safe human waste • National MOH and UNICEF designed and printed IEC materials for cholera. The Materials were prepositions and distributed to the affected disposal (CLTS and ODF) counties and those deemed to be at risk of Cholera outbreak. Kenya -Strengthen cholera prevention (hand washing) and health promotion in high • The Ministry designed Radio spots which were aired in English and Kiswahili across the country risk areas • Cholera treatment centers have been set up in areas where cholera cases are reported -For Nairobi County, key priority areas include: Strengthening coordination at • Hygiene promotion, health education activities are being carried out in the affected counties the county level; engaging the unit committees, food vendors as well as the • Prepositioning and distribution of water treatment and storage commodities as well as medical supplies informal sector workers; sensitization of hospitality and other institutions; • The affected counties have enhanced surveillance activities, case finding and contact tracing with targeted provision of chemoprophylaxis for supporting rapid response teams and intensifying risk communication and the members of affected families public health education using the local FM radio stations • UNICEF partnering with MOH and Kenya Red Cross to support effort to respond to outbreak

• Uganda police has started sensitizing people on cholera at border points with Kenya targeting traders, boda - boda riders - Additional water sources required to improve on current 8 litres per • Orientation of school teachers and health workers about cholera outbreak is ongoing person per day to 20 litres per person per day • UNICEF is partnering with Amudat district to strengthen inter personal communication in addition to printing of IEC materials; and Uganda dissemination of messages through radio - Construction of communal and household latrines required • Cholera Treatment Centre (CTC) has been established at Amudat hospital. Government of Uganda has provided initial medical supplies - Training of health workers in case management and Village Health to support case management. Teams (VHTs) in community based surveillance • UNICEF Zonal office is supporting Amudat district to conduct WASH assessment including quantification of key WASH supplies

- Point of use water treatment - Rehabilitation of communal latrines • 1,200 Non-Food Items (NFI’s) kits i.e. soap, aquatabs and IEC were distributed to affected households in Stoneridge Zimbabwe - Continue to intensify hygiene promotion • Installation of inline chlorinators on 3 piped water schemes - Water treatment chemicals • Training of 55 health promotion volunteers resulting in door to door health and hygiene awareness campaign • Mass media campaigns in high risk areas • Water trucking (20,000L) to the Cholera Treatment Unit set up in the affected area • Repair of boreholes in Chitungwiza Country Priorities and Response Interventions Country Priorities Response Interventions

Interventions by the Ministry of Health Include; - Provide Point of Use water treatment products Angola • Dissemination of educational and informative messages on the prevention of Cholera and Malaria in the Provincial Radio - Enhance sustainable water distribution Broadcaster, 6 times per day • Mass integration of 60 new ADECOS, in the joint activities of Social Mobilization in the municipality of Uíge • 1,260 Tablets of Aquatab were distributed in the districts of Cacole (760 tablets) and Popular (500 tablets)

- District wide water chlorination especially in Urban/Peri Urban Lilongwe • CTCs operational in all affected sites were erected - Sinking of Waterwells in Rural Lilongwe • Robust Community Cholera prevention activities, including pot-pot chlorination, enhancing access to clean potable water by sinking - Promote construction and use of community latrines through CLTS boreholes, community wide 1% chlorine stock solution distribution in all affected villages Malawi - Extending Coverage of OCV in rural Lilongwe district • Reactive OCV immunization in Karonga, Lilongwe, and preemptive OCV in Salima and Dowa - Continue with promoting good hygiene practices • Dissemination of key health messages through media, public gatherings, road shows, community cinemas, and community dialogue - Continue advocating with government and WASH cluster to increase safe • Branded multimedia campaign and social movement involving entertainment approaches and social mobilization -targeting behavior water coverage in the hotspots change at multiple levels - Water trucking in some Lilongwe rural and peri urban hotspot areas • Rehabilitation of boreholes and drilling of new boreholes - Social accountability for WASH: Demanding duty bearers to provide safe water • Water Trucking and sanitation facilities Raising awareness and knowledge regarding community • Water quality surveillance case management and early reporting to avert community deaths - Rehabilitation of boreholes and drilling of new boreholes - Water quality surveillance

- Training and continuous mentorship of CTC staff • Water trucking to refill central supply and collection points • Establishment, staffing and supplying commodities to CTCs for case management Zambia - Strengthening lab confirmation and epi-linkage of all cases - Co-ordinated GPS tracing of cases and ensure safe water availability at • Procurement of cholera supplies including chlorine and pharmaceutical commodities patient’s homes • Water quality testing in water tanks and at domestic level - Maintenance of residual chlorine level of 0.5mg/L in all supplied water • WHO facilitated procurement of the Oral Cholera Vaccine (OCV). During round one of the OCV campaign which ran from - Continued engagement and sensitization of communities on hygiene 10th to 20th January 2018, 1,317,925 people were vaccinated, with a coverage of 109%. This included 1,407 inmates at Lusaka practice and prevention of cholera Central Prison were vaccinated • Behaviour change communication/hygiene promotion

- Follow up closely with communities on construction of toilets in the affected • Community education and awareness raising regarding the prevention and control of Cholera through villages and Schools meeting and local media outlets is ongoing in all cholera hotspots areas Tanzania areas and ensure by-laws are adhered to - Capacity building of medical personnel on proper handling of cholera cases • Public health law enforcements has been strengthened through environmental health officers (EHOs) with temporary closure of the when under their supervision food vending restaurants not abiding with the regulations - Increase the number of health personnel • Training and mentorship of health workers in case management, infection prevention and control is ongoing mainly done by the RRT that visits the outbreak areas

• Disease surveillance and laboratory surveillance is on-going. From January to March a total of 40 Multimedia Mobile Unit Sessions were conducted in the priority districts of Memba, Erati, Nacaroa and Nacala Velha, and reached a total of 48,100 people with key - Sustain hygiene promotion messages on prevention and treatment of cholera as well as on key hygiene and wash good practices. All interventions were followed Mozambique - Laboratory surveillance by debates with the community members, local community leaders, local authorities and health professionals - Mapping and identification of cholera hotspots • In Cabo Delgado province, a total of 24,407 people have been reached out through house-to-house distribution of 7,821 bottles of Certeza, point-of-use water treatment products, and delivery of hygiene messages by Red Cross Mozambique in Pemba, Chiure, Meluco and Ancuabe districts since March, 2018. In addition, a total of 328 community workshops on the prevention and control of cholera were held and 11,669 people from those districts participated in the workshops during the same period Annex 1: Distribution of Cholera and AWD Outbreaks in the Horn of Africa and Challenges in Response - as from 1st January 2018

Uganda: Challenges

- Currently the district is experiencing challenges to conduct community based surveillance and active case finding Tigray - Inadequate human resources for health especially at the district level - High risk of cross border transmission of the cholera outbreak between Kenya and Uganda. For instance the index case had a history of visiting Kenya - Mobility of the population across border between the two countries - Sub-optimal coordination of the local leadership Afar Amhara

Beneshangul Gumuz Awdal Sanaag South Sudan Bari Dire Dawa Sool Northern Upper Nile Hareri Bahr el Warrap Addis Ababa Togdheer Somalia Challenges Ghazal Unity Nugaal - An estimated 630,000 people have been affected Oromia Western Bahr el Ghazal Jonglei Gambela Somali Mudug by heavy rains and floods, and this is a risk factor Lakes to new outbreaks of infectious diseases including cholera SNNPR Ethiopia

Central Somalia Western Equatoria Eastern Equatoria Galgaduud Equatoria Hiraan Bakool Turkana 252

Kenya: Challenges 14 Karamoja Gedo Bay Middle Shabelle 415 -Weak coordination between MOH national level and counties on cholera response 771 -Weak disease outbreak response capacity at the county level and shortage of cholera 12 46 West Pokot RDTs in some counties Kenya Banadir 132 -Limited funding at county level for prompt response Uganda 7 899 -Weak enforcement of the Public Health Act Western Region 512 24 Lower Shabelle TransNzoia 89 37 -Zero vaccination coverage against cholera in Kenya 30 69 Isiolo Lower Juba 52 -Limited capacity of some county laboratories to carry out confirmatory tests and hence 2,329 Busia 143 1 Meru Legend have to ship specimens to the National Public Health laboratory and KEMRI Siaya 258 127 Tharaka Nithi Garissa CFR: XX%: Calculated based on new deaths reported Nakuru 1,036 -Water supplies in rural areas and informal settlements exhibit low levels of functionality. 161 Kirinyaga Across Kenya almost one-quarter (23%) of the population lack access to a water supply Murang’a Status of outbreak 10 Kiambu 202 system, and depend on open water sources (rivers, ponds, irrigation canals) for their 29 Nairobi 259 975 Outbreak active Outbreak contained drinking water e.g. in Turkana County, 34% of rural households depend on open water sources. Machakos -Nationally, 12% of the population practice open defecation (15% in rural areas, 3% in urban areas). Tana River No data No outbreak reported In the ASAL counties the problem of open defecation is even more serious e.g. in Turkana County, 90% of the rural population practice open defecation. Cholera / AWD Cases -Across Kenya only 30% of the population have access to basic sanitation. Kiambu 8 -Inadequate utilization of IEC materials and slow adaptation and sustaining of new behaviors. 39 New cases (last 1 week) 29 Mombasa 11 XX 40 3 Cumulative cases 2018 Nairobi 133 308 Murang’a ** Cases from Uganda emerged from Hoima, Kyegegwa and Kagadi districts (in Western region), and Amudat district in Karamoja Kirinyaga Tharaka Nithi Creation date: 18 May 2018 Sources: Ministries of Health and WHO Annex 2: Distribution of Cholera / AWD outbreaks in Southern Africa and Challenges in Response - as from 1st of January 2018

Challenges: Angola 52 Burundi - Poor sanitation of the environment Rwanda - Inadequate supply of drinking water, both from the public Cistern Trucks - Insufficient water reservoirs to meet the demand for water - Inadequate means of transport to support response teams in the Field Tanzania - Demotivation of Personnel (CTC Health workers, social mobilizers and data managers) Mara 3 Rwanda 33 Challenges: Zambia 190 Arusha Dodoma Western Province - Inadequate water supply from Lusaka Water and Sewerage 163 Manyara Company network Cabinda 51 Kigoma 9 -The quality of the supplied water is not optimum. 42% of Tabora Tanga sampled water have high levels of contamination with Dodoma Unguja fecal coliforms Katavi Singida Uige 593 Dar es Salam - Due to inadequate water supply, people resorted to using Zaire 270 Iringa 7 Rukwa Pwani alternative water sources including shallow wells that are 788 Mbeya 88 Morogoro contaminated by surface or ground run-off water 56 Njombe -The general state of sanitation in affected areas is poor Northern Luapula -The urban water supply infrastructure is old and prone to province 361 contamination as the infrastructure often runs through dirty Zambia Ruvuma Karonga contaminated ground water. Cabo Delgado 213 -People in some sections of affected areas use pit latrines for 13 36 2 642 human waste disposal, which are often shallow and prone to Copperbelt fecal matter wash off when it rains. North-Western EasternMalawi Rumphi 13 Angola Central 123 Nampula 4 Lusaka Tete Challenges: Tanzania 5,688 159 Nkhata Bay Western Southern - Access to improved and safe water a major Malawi 4 problem in most of the hotspots areas as well 39 Mashonaland West Likoma 13 Harare as low coverage of improved sanitation 107 9 60 Kasungu Mozambique 1 Zimbabwe Challenges: Malawi Dowa Namibia 3 Salima - Misconceptions and risky beliefs regarding cholera treatment Lilongwe 99 and OCV in some parts of the affected communities Botswana - CTC staff demotivation owing to lack of incentives 386 Dedza - Fatigue observed in health workers owing to long and sustained 31 outbreak especially in Karonga and Lilongwe Legend 1 - Within Lilongwe City, in some cholera affected locations, piped water CFR: Calculated based on new cases supply is intermittent, therefore people resort to unsafe dug wells Swaziland and deaths reported Mwanza Blantyre - In the cholera hotspots in Lilongwe Rural, some people drink water from Status of outbreak rivers and unsafe dug wells without treating or boiling it. 1 Mulanje Chikwawa 4 - Suboptimal coordination at District level Lesotho Outbreak active Outbreak contained Challenges:Zimbabwe Nsanje 6 No outbreak reported - Stoneridge is a 'peri-urban' surbub on the outskirts of Harare. The area is South Africa not serviced and rely mainly on shallow unprotected well. The area is also Cholera / AWD Cases not connected to sewer network and uses pit latrines - St Mary's is the oldest surbub in Chitungwiza with delapidated sewer network. New cases Residents disconnected the sewer and opted for septic tanks due to sewer bursts XX Cumulative cases 2018

Creation date: 18 May 2018 *Cases presented for Zambia refer to cumulative cases since the beginning of the outbreak on 6th October 2017 Sources: Ministries of Health and WHO Annex 3: Epi Curves of Countries with Reported Outbreaks Since 2017

700 Zambia Somalia 3,000 600

2,500 500

2,000 400

1,500 300

1,000 200

500 100

0 0 1 2 3 4 5 6 7 9 8 7 6 5 4 3 2 1 k k k k k k k 2 3 2 4 2 5 2 6 2 7 2 8 2 9 3 0 3 1 3 2 3 3 4 3 5 3 6 3 7 3 8 3 9 4 0 4 1 4 3 4 4 5 4 6 4 7 4 8 4 9 1 1 2 1 4 1 5 1 9 k k k k k k k k k 1 8 1 7 1 6 1 5 1 4 1 3 1 2 1 1 0 4 9 4 8 4 7 4 6 4 5 4 4 3 4 2 4 1 4 0 3 9 3 8 3 7 3 6 3 5 3 4 3 3 2 3 1 3 0 2 9 2 8 2 7 2 6 2 5 2 4 2 3 k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W 2017 2018 2017 2018

600 Uganda South Sudan 600 500 500 400 400 300 300 200 200 100 100 0 9 8 7 6 5 4 3 2 1 0 k k k k k k k k k 1 9 1 8 1 7 1 6 1 5 1 4 1 3 1 2 1 1 0 4 9 4 8 4 7 4 6 4 5 4 4 3 4 2 4 1 4 0 3 9 3 8 3 7 3 6 3 5 3 4 3 3 2 3 1 3 0 2 8 2 7 2 6 2 5 2 3 1 2 3 4 5 6 7 8 9 k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k W W W W W W W W W 2 3 2 4 2 5 2 6 2 7 2 8 2 9 3 0 3 1 3 2 3 3 4 3 5 3 6 3 7 3 8 3 9 4 0 4 1 4 2 4 3 4 4 5 4 6 4 7 4 8 1 0 1 1 2 1 3 1 4 1 5 1 6 1 7 W W W W W W W k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W 2017 2018 2017 2018

350 Tanzania 350 Kenya 300 300

250 250

200 200

150 150

100 100 50 50 0 0 9 8 7 6 5 4 3 2 1 1 9 1 8 1 7 1 6 1 5 k k k k k k k k k 1 4 1 3 1 2 1 1 0 4 8 4 7 4 6 4 5 4 4 3 4 2 4 1 4 0 3 9 3 8 3 7 3 6 3 5 3 4 3 3 2 3 1 2 7 2 6 2 5 2 4 2 3 1 2 3 4 5 6 7 8 9 k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k 2 4 2 6 2 7 2 8 3 1 3 2 3 3 4 3 5 3 6 3 7 3 8 4 0 4 1 4 2 4 3 4 5 4 6 4 8 4 9 1 2 1 3 1 4 1 5 1 6 1 7 1 8 1 9 W W W W W W W W W W W W W W k k k k k k k k k k k k k k k k k k k k k k k k k k k k W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W 2017 2018 2017 2018 Annex 3: Epi Curves of Countries with Reported Outbreaks Since 2017

Angola 200 250 Mozambique 180 160 200 140 150 120 100 100 80 60 50 40 20 0 0 1 2 3 4 5 6 7 8 9 k k k k k k k k k 2 3 2 4 2 5 2 6 2 7 2 8 2 9 3 0 3 1 3 2 3 3 4 3 5 3 6 3 7 3 8 3 9 4 0 4 1 4 2 4 3 4 4 5 4 6 4 7 4 8 4 9 1 0 1 1 2 1 3 1 4 1 5 1 6 1 7 1 8 1 9 1 2 3 4 5 6 7 8 9 k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k 2 3 2 4 2 5 2 6 2 7 2 8 2 9 3 0 3 1 3 2 3 3 4 3 5 3 6 3 7 3 8 3 9 4 0 4 1 4 2 4 3 4 4 5 4 6 4 7 4 8 1 0 1 1 2 1 3 1 4 1 5 1 6 1 7 1 8 1 9 W W W W W W W W W k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W 2017 2018 2017 2018

Zimbabwe

120 Malawi 60

100 50

80 40

60 30

40 20

20 10

0 0 1 2 3 4 5 6 7 8 9 1 2 3 4 5 6 7 8 9 k k k k k k k k k 2 3 2 4 2 5 2 6 2 7 2 8 2 9 3 0 3 1 3 2 3 3 4 3 5 3 6 3 7 3 8 3 9 4 0 4 1 4 2 4 3 4 4 5 4 6 4 7 4 8 4 9 1 0 1 1 2 1 3 1 4 1 5 1 6 1 7 1 8 1 9 k k k k k k k k k 2 3 2 4 2 5 2 6 2 7 2 8 2 9 3 0 3 1 3 2 3 3 4 3 5 3 6 3 7 3 8 3 9 4 0 4 1 4 2 4 3 4 4 5 4 6 4 7 4 8 1 0 1 1 2 1 3 1 4 1 5 1 6 1 7 1 8 1 9 k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W 2017 2018 2017 2018

Burundi Rwanda 45 1.2 40 1 35 30 0.8 25 0.6 20 15 0.4 10 0.2 5 0 0 1 2 3 4 5 6 7 8 9 1 2 3 4 5 6 7 8 9 k k k k k k k k k 2 3 2 4 2 5 2 6 2 7 2 8 2 9 3 0 3 1 3 2 3 3 4 3 5 3 6 3 7 3 8 3 9 4 0 4 1 4 2 4 3 4 4 5 4 6 4 7 4 8 4 9 1 0 1 1 2 1 3 1 4 1 5 1 6 1 7 1 8 k k k k k k k k k 2 3 2 4 2 5 2 6 2 7 2 8 2 9 3 0 3 1 3 2 3 3 4 3 5 3 6 3 7 3 8 3 9 4 0 4 1 4 2 4 3 4 4 5 4 6 4 7 4 8 4 9 1 0 1 1 2 1 3 1 4 1 5 1 6 1 7 1 8 k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k k W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W 2017 2018 2017 2018 Annex 4: Weekly Reported Cholera / AWD Cases and Deaths for Countries in Eastern and Southern

Africa Country Week 14 Week 15 Week 16 Week 17 Week 18 Week 19 2018 Cumulative Cumulative since the Beginning of beginning of the outbreak Outbreaks Cases Deaths Cases Deaths Cases Deaths Cases Deaths Cases Deaths Cases Deaths Cases Deaths CFR Cases Deaths CFR (%) (%) Somalia 214 0 178 0 192 0 212 2 296 4 2,654 16 0.6 2,967 17 0.6 Dec-17 Kenya 24 0 63 0 87 0 24 0 58 0 302 0 3,931 71 1.8 24,741 414 1.7 Dec-14 Tanzania 5 0 148 1 115 5 12 0 89 3 44 0 1,837 36 2.0 30,468 502 1.6 Aug-15 Malawi 15 3 15 0 14 0 11 0 0 0 0 0 774 22 2.8 929 30 3.2 Nov-17 Mozambique 16 0 0 0 0 0 0 0 0 0 0 0 801 3 0.4 2,373 3 0.1 Aug-17 Angola 13 0 17 0 11 0 4 0 6 0 7 0 839 9 1.1 944 15 1.6 Dec-17 Zambia 168 3 184 3 16 0 4,097 55 1.3 5,905 115 1.9 Oct-17 Uganda 60 4 33 0 110 2 42 0 2,376 49 2.1 2,376 49 2.1 Feb-18 Zimbabwe 2 2 22 1 12 0 13 0 4 0 9 0 167 7 4.2 167 7 4.2 Jan-18 Rwanda 0 0 0 0 3 0 0.0 3 0 0.0 Jan-18 Namibia Burundi South Sudan Madagascar Comoros Swaziland Botswana

Eritrea Lesotho South Africa

TOTAL 17,479 268 1.5 70,873 1,152 1.6

For further information Contact:

Georges Tabbal Ida Marie Ameda Maureen Khambira WASH Emergencies Specialist Health Emergencies Specialist Information Management Specialist UNICEF Eastern and Southern Africa Region UNICEF Eastern and Southern Africa Region UNICEF Eastern and Southern Africa Region Email: [email protected] Email: [email protected] Email: [email protected]