Early Warning Disease Surveillance and Response Bulletin, Somalia 2018 Epidemiological Week 30 (Week ending 29th July, 2018) Highlights Cumulative figures as of week 30 286 (73%) health facilities across Somalia 1,704,713 consultations from submitted weekly reports of epidemic-prone week 1 to week 30. diseases in the electronic early warning alert 6,018 cumulative cases of and response network (EWARN) system in AWD/Cholera and 41 deaths week 30. Total number of consultations increased from (CFR 0.7%) since December 58,449 in week 29 to 69,519 in week 30. 2017. A total of 432 alerts were received. 21 of these 9,715 cumulative alerts were alerts were confirmed as true alerts in week received, 553 of these, were 30. confirmed as true alerts from The highest numbers of diseases reported in week 1 to week 30, 2018. week 30 were other acute diarrhoeas (2,083 6,326 cumulative cases of cases), influenza like illness (1,656 cases) and severe acute respiratory illness (689 cases). suspected measles cases since the beginning of 2018. Of the A total of 50 new cases of suspected AWD/cholera with no deaths were reported 6,326 measles cases, 4,203 in week 30 compared to 88 AWD cases with 1 (66%) were under 5 years while death in week 29. 2,123 (34%) were above 5 years. A cumulative total of 6,018 AWD/cholera 8,260 cumulative cases of 1 cases , including 41 deaths have been Malaria were reported since the reported since December 2017. beginning of 2018, 3,574 (43%) The number of reported measles cases increased from 54 in week 29 to 71 cases in were under 5 years, while 4,686 week 30. (57%) were above 5 years. 1 The Cases of AWD/Cholera in the eEWARN system are collected from sentinel sites. While the cases of AWD/cholera in Sitrep are collected from temporary CTC sites which doesn't include the Sentinel sites Page 1 of 23 Table 1. Summary of Alerts for epidemic prone diseases Disease Wk27 2018 Wk28 2018 Wk29 2018 Wk30 2018 Cumulative cases (Wk 1 – 30, 2018) Total consultations 51625 54605 58449 69519 1,704,713 Other Acute Diarrheas 2486 2306 2045 2083 70429 Influenza Like Illness 1342 1245 1151 1656 49,880 Severe Acute Respiratory Illness 1173 1559 912 689 29,847 Confirmed Malaria 189 431 296 340 8260 Suspected Measles 61 52 54 71 6326 Bloody Diarrhea 62 144 83 94 2619 Acute Watery Diarrhoea 13 24 37 2 2062 Whooping Cough 45 74 53 64 1475 Acute Jaundice 7 5 5 3 130 Suspected Meningitis 3 2 6 1 88 Diphtheria 0 3 9 6 63 Neonatal Tetanus 0 0 0 0 23 Viral Hemorrhagic Fever 1 0 0 15 20 Acute Flaccid Paralysis 0 0 1 1 15 Completeness of Reporting & Reporting Rate Of the 392 health facilities in the EWARN system, 286 health facilities submitted their weekly reports on time in week 30 across the country. The national surveillance completeness rate Fig. 1a: Completeness of Reporting of EWARN Facilities was 73% in the week which is below the Caluula Qandala Bossaso Zeylac minimum requirement (80%). Apart from Lughaye Laasqoray Berbera ± Iskushuban Baki Ceerigaabo Borama Ceel Afweyn Sheikh Gebiley Somaliland which exceeded the minimum Hargeysa Qardho Caynabo Owdweyne Bandarbeyla Burco Xudun Taleex target, none of the other states including Garoowe Buuhoodle Laas Caanood Eyl Burtinle Banadir region have reached the 80% Jariiban Galdogob Gaalkacyo minimum requirement (fig. 1a & 1b). Cadaado Hobyo Cabudwaaq Dhuusamarreeb All the 77 active health facilities in Somaliland Xarardheere Ceel Buur Belet Weyne Ceel Barde Legend Rab Dhuure Xudur Somalia_Coastline_Extended Ceel Dheer Doolow Bulo Burto Waajid Tayeeglow Somalia_Neighbouring_Countries_Polygon Luuq have submitted reports in week 30. In Adan Yabaal Somalia_Sea_Cover Belet Xaawo Jalalaqsi Baydhaba Garbahaarey Completeness of reporting (%) Cadale Jowhar 0/No Data Qansax Dheere Wanla Weyn Ceel Waaq Puntland, 72(79%) health facilities of the 91 1 - 58.3 Buur Hakaba Balcad 58.4 - 81.8 Afgooye Baardheere Banadir Diinsoor 81 - 100 Qoryooley Marka Kurtunwaarey Saakow active health facilities submitted reports in Sablaale Bu'aale Baraawe Heliwa Dayniile Afmadow Jilib Yaaqshid Karaan Wardhigley week 30, whilst in South central, 137 (61%) Hawl Wadaag Shibis Hodan BondhereCabdulasiis Jamaame Hamar Weyne Hamar Jabjab Waaberi Wadajir (Medina) Dharkenley Kismaayo health facilities of 224 active health facilities Badhaadhe 0 45 90 180 270 360 submitted reports in week 30. Challenges to Miles completeness of the reporting include; lack of training at the health facility level (see fig 1b and 1c). Cascade EWARN training is currently being conducted in health facilities in Puntland and South Central. Somaliland has already completed the cascade training. Page 2 of 23 Fig 1b: Completeness of reporting from EWARN sites, week 30, 2018 100 90 80 70 60 50 40 30 20 10 0 Bay Bari Sool Sool Gedo Hiran Bakol Sanag Sanag Awdal Nugal Mudug Mudug Banadir Togdher Jubaland Puntland Galgadud Galmudug Southwest Somaliland Hirshabelle Lower Jubba MiddleJubba WaqoyGalbed Lower Shabelle MiddleShabelle Banadir Somaliland Puntland Galmudug SouthWest Jubaland Hirshabelle Received (%) Target(%) Fig 1c: Completness of reporting Somaliland Puntland SCZ 100 80 60 40 20 0 27 28 29 30 Percentage Percentage of the submitted HFs report Epi-week Proportionate Morbidity As shown in figure 2; other acute diarrhoeas (OAD), influenza like illness (ILI), severe acute respiratory illness (SARI), suspected measles and malaria are the commonest causes of morbidity across Somalia in 2018. In week 30, the highest numbers of diseases were other acute diarrhoeas (2,083 cases), influenza like illness (1,656 cases), severe acute respiratory illness (689 cases), Confirmed Malaria (340 cases), bloody diarrhoea (94) and Suspected measles (71 cases). Page 3 of 23 Fig 2: Commonest Causes of Morbidity during Week 1 to 30 2,500 2,000 1,500 1,000 500 0 Wk27 Wk28 Wk29 Wk30 other acute Diaria influence like illness Severe Acute Respiratory Illness Suspected Measles Confirmed Malaria AWD/Cholera situation in Somalia Generally, the AWD/cholera cases have been on the decline for the past four weeks (fig 3b) and cases are Fig 2. 3a Districts: Districts Reporting reporting Cases in Week 29, 2018 localized in Lower Juba and Banadir regions. The cholera spread is expected to increase due to the floods that have led to contamination Somaliland of water sources in the flood affected regions. Floods have also led to Puntland blockage of access of health services which contribute to delayed health seeking by the affected populations with. Over the past 2 Legend Districts Galmudug State AWD/Cholera Cases_WK29 weeks, there has been decrease in the number of AWD/Cholera cases No Case 1 - 10 Cases 11 - 25 Cases Hir-Shabelle State reported in Middle Shabelle, Banadir and Lower Jubba; the regions 26 - 47 Districts Affected by Floods South West State Floods th Major_Rivers that are affected by floods. In week ending 29 July, active Banadir Heliwa Dayniile Coastline Yaaqshid Jubaland State Karaan HodanWardhigley .! Shibis Hawl WadaagCabdulasiis transmission of AWD/cholera was reported in Kismayo district in Wadajir (Medina)Waaberi Dharkenley µ Lower Jubba, as well in 9 districts of Banadir region (Darkenly, 0 45 90 180 270 360 Miles Daynile, Hodan, Madina, Abdiazis, Hamarjabjab, Wardhigley, Heliwa, The designation employed and presentation of material on the map do not imply the expression on any opinion whatsoever on the part of the Secretariat or the United Nations concerning the legal status of any country, territory, city or any any area of authority, or concerning determination of its fronteers or boundaries. Karaan districts) (fig 3a). In Kismayo, affected communities especially in Farjano IDP are reportedly using contaminated water due to floods. As shown in table 2, there was a decrease in the number of cases reported from 88 in week 29 to 50 in week 30. The Oral Cholera Vaccination that was implemented in 11 high risk districts in 2017 of the central region has greatly contributed to the reduction in the number of new AWD/cholera cases compared to the same time in 2017(fig3b). Page 4 of 23 Fig 3b. AWD/Cholera cases in Somalia July 2017-July 2018 450 4.0 400 Cases Total Deaths CFR (%) 3.5 350 3.0 300 2.5 250 2.0 200 150 1.5 100 1.0 50 0.5 0 0.0 week 2 week 4 week 6 week 8 week week 16 week week 10 week 12 week 14 week 18 week 20 week 22 week 24 week 26 week 28 week 30 week Week 32 Week 50 Week Week 30 Week 34 Week 36 Week 38 Week 40 Week 42 Week 44 Week 46 Week 48 Week 52 Week Numberof AWD/Cholera cases Aug.17 Sep.17 Oct.17 Nov.17 Dec.17 Jan-18 Feb-18 Mar.18 April.18 May.18 June.18 Jul.18 Epi-week Table 2. Summary of AWD/Cholera cases in different regions Week 29 Week 30 Cumulative as of th States Regions Ending 22th July 18 Ending 29th July 18 29 July 2018 Cases Deaths CFR (%) Cases Deaths CFR (%) Cases Deaths CFR (%) Banadir 33 1 3 23 0 0 2,351 19 0.8 Jubba land L. Jubba 47 0 0 27 0 0 2,250 15 0.7 South west L. Shabelle 0 0 0 0 0 0 294 4 1.4 M. Shabelle 8 0 0 0 0 0 558 2 0.4 Hir-shabele Hiraan 0 0 0 0 0 0 565 1 0.2 Total 88 1 3 50 0 0 6,018 41 0.7 NB. Deaths are included among cases. Banadir Region is not a state Cholera Situation in Lower Jubba, Lower & Middle Shabelle and Banadir.