Early Warning Disease Surveillance and Response Bulletin, 2017

Epidemiological week 52 (Week ending 31 December, 2017)

Highlights Cumulative figures as of week 52  Reports were received from 268 facilities  1,851,018 total consultations reported in week 50, compared to 265  79,121 cumulative cases of reporting completeness in week 48. AWD/cholera in 2017.  Total number of consultations decreased from  Of the 78,842, 32,768 (41%) are 60,746 in week 52 to 53,631 in week 52. children less than 5 years while  The highest number of consultations in week 52 46,397 (59%) are 5 years above. were for Other Acute Diarrhoea (OAD-1,645  1,159 cumulative deaths of cases), Influenza Like Illness (ILI-1,458 cases) AWD/Cholera in 2017 followed by Severe Acute Respiratory Illness  55 districts in 19 regions have (SARI-573 cases) reported AWD/Cholera cases  AWD cases increased from 55 in week 51 to 108  22,657 cumulative cases of in week 52. suspected measles cases

 Most of the AWD Cases were reported from  Of the 22,657 measles cases, Beletweyne district of Hirshabelle state where 11,753 (51%) are under 5 years there an active outbreak of cholera. while 10,933 (49%) are above 5  No AWD/cholera deaths reported in all districts years in the past 14 weeks  The number of measles cases decreased from 415 in week 51 to 351 cases reported in week 52.

Table 1. Summary of A Table 1. Summary of Alerts for epidemic prone diseases diseases Disease Week 51, 2017 Wk52 2017 Cumulative cases (Week 1 – 52) Total consultations 60746 53,631 1851018 Other Acute Diarrheas 2172 1645 77424 Influenza Like Illness 2004 1458 65264 Severe Acute Respiratory Illness 634 573 22669 Confirmed Malaria 328 254 14070 Suspected Measles 415 351 22657 Acute Watery Diarrhoea 55 108 79121 Bloody Diarrhea 42 26 2360 Whooping Cough 39 35 975 Suspected Meningitis 6 4 237 Viral Hemorrhagic Fever 5 8 149 Acute Jaundice 2 8 205

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Neonatal Tetanus 2 4 181 Diphtheria 0 4 242 Acute Flaccid Paralysis 0 4 141

Total number of Consultations and number of reporting sites, week 34 to 52, 2017.

Total number of Consultations and number of reporting sites, week 34 to 52, 2017

800 90000 700 80000 600 70000 60000 500 50000 400 40000 300

30000

Consultations Reportingsites 200 20000 100 10000 0 0 WK WK WK WK WK WK WK WK WK WK WK WK WK WK WK WK WK WK WK 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 Consultations Reporting sites

Proportionate morbidity The commonest causes of morbidity during week 52

The commonest causes of morbidity during week 52 2500

2000

1500

1000

500

0 Other Acute Influenza Like Severe Acute Confirmed Suspected Acute Watery Diarrheas Illness Respiratory Malaria Measles Diarrhoea Illness

Week 51, 2017 Week 52, 2017

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Situation update of AWD/Cholera

Epidemic situation

The number of AWD cases increased from 55 in week 51 to 108 in week 52 across Somalia (Table 1). However, in Beletweyene district of Hiraan region where new cholera cases have been reported, 8 cases tested positive for V. Cholerae, Ogawa, O1. No deaths have been reported. All new cases reported from 6 district 5 regions across the country.

A total of 79,121 cases and 1,159 deaths (CFR 1.47%) have been reported in 55 districts in all the nineteen regions of Somalia. The most affected regions since the beginning of the outbreak include Bay, Banadir, Toghdeer, Bari and . Most of the affected populations live in IDP camps where access to safe water and sanitation is limited. Of the 55 affected districts, 34 of these have been classified as hard to reach or inaccessible. The Case Fatality Rate in inaccessible districts is 4 times as in other districts. Overall, children below 5 years constitute more than 58% of the total number of AWD/cholera cases reported since the beginning of year.

AWD/Cholera Cases in Somali: Week 1-52 Epi_curve showing AWD cases in Somalia between week 1 - 52 (January and December), 2017 6,000 5.00 5,000 4.00 4,000 3.00 3,000 2.00 2,000 1,000 1.00

- -

Week1 Week3 Week5 Week7 Week9

Week19 Week11 Week13 Week15 Week17 Week21 Week23 Week25 Week27 Week29 Week31 Week33 Week35 Week37 Week39 Week41 Week43 Week45 Week47 Week49 Week51 Jan Feb March April May June July Aug Sept Oct Nov Dec

Total Cases Deaths CFR

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Response activities implemented during the week Coordination and Leadership  The Federal Ministry of Health, with the support of WHO, conducted weekly coordination meetings with Health and WASH cluster partners at national and sub-national levels.  The Cholera treatment centre in Beletweyne was opened to manage AWD/Cholera cases with support from local NGOS  Surveillance and Laboratory activities  A total of 265 sentinel health facilities submitted reports to the electronic disease surveillance systems in all regions. This is in addition to AWD/cholera reports received from cholera treatment facilities.  The 8 stool samples collected from Banadir region were all negative for cholera  AWD/Cholera alerts were received from Balad district in in the EWARN system and were confirmed as negative alerts for cholera.  Water Sanitation and Hygiene  Community education and mobilisation has been conducted in AWD/Cholera affected communities in Beletweyne and Balad district of Middle Shabelle  400 hygienic kits were distributed to affected communities in Beletweyne district  Mobile vans have been deployed to sensitise communities on hygienic behaviour in Beletweyne  Mobile teams have been deployed in high risk villages of Beletweyne district  Community education and mobilisation was done in all regions affected by AWD.  Essential Medicines and supplies  Medical supplies and Integrated Health Kits were prepositioned in Baidoa,Hudur,Beletweyne,Kismayo and Banadir hospital .

Suspected Measles Cases

The number of suspected measles cases decreased from 415 cases in week 51 to 351 cases in week 52. A total of 23,353 cumulative cases of suspected measles have been reported from all the nineteen regions since the beginning of the year. Of the 23,353 measles cases, 15,846 (51%) are under 5 years while 7,507 (67%) are above 5 years. The most affected regions include Banadir (5,617 cases) Togdher (2,787 cases), Mudug (2566 cases) Lower Shebelle (2,050 cases), and Bari (1,968) (See Table 2).

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Suspected Measles Cases in 2017: Week 1-52

Somalia, Suspected Measles Cases as of Week 1 - 25 800 700 600 500 400 300

Measles Measles Cases 200 100 0 W1 W3 W5 W7 W9 W11 W13 W15 W17 W19 W21 W23 W25 W27 W29 W31 W33 W35 W37 W39 W41 W43 W45 W47 W49 W51 Week

Measles outbreak response

Table 2: Summary of Suspected measles cases by region week 50, 51 and 52, 2017 Cumulative cases Region Week 50 Week 51 Week 52 (Wk 1 – 52) Awdal 0 0 1 105 0 4 4 99 Banadir 82 69 67 5617 Bari 34 27 28 1968 Bay 9 36 25 654 W/Galbeed 1 3 3 758 Galgadud 6 5 7 625 0 0 0 241 Hiraan 10 30 28 1461 13 28 22 468 29 36 36 2106 Middle Shabelle 16 11 12 716 0 0 0 62 Mudug 67 65 63 2566 Nugal 58 49 45 2050 Sanag 0 0 0 259 Sool 17 25 0 698 Togdher 7 27 10 2900 Grand Total 349 415 351 23,353

WHO in collaboration with the Federal Ministry of Health have started preparatory activities for the upcoming mass nationwide measles campaigns in November 2017 targeting 4,278,083 (6 months- 10 years) children. Vaccines have been delivered to the state hubs.

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Technical and coordinating structures set up, with weekly meetings at country office and zonal offices. Additionally, to micro planning and TOT trainings have been conducted in South-Central and Puntland. Puntland completed their district microplanning exercise and planning to implement campaign in first week of January 2018, targeting around one million children from 6 months to 10 years of age. Trainings for district microplans are planned in January 2018 in south central zone. Somaliland started preparation for measles campaign. ToT for microplanning is planned in January 2018.

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Table 4. Summary of epidemic prone diseases and syndromes in different districts of Somalia as of week 52 Region/District SARI ILI AWD BD OAD Diph WC Meas NNT AFP AJS VFS MAL Men total_cons Baki 0 1468 0 130 533 0 0 6 0 0 0 0 8 0 3346 Borama 0 8343 1190 108 4112 0 0 33 0 0 0 0 69 0 23791 Lughaya 0 411 0 10 356 0 0 0 0 0 0 0 0 0 1896 Zeila 0 2030 16 26 1217 0 0 7 0 0 0 0 36 0 6962 Awdal 0 12252 1206 274 6218 0 0 46 0 0 0 0 113 0 35995 Elberde 1 0 0 0 124 0 0 3 0 0 0 0 0 0 21566 Huddur 12 0 0 2 91 0 16 16 0 0 0 0 134 0 8009 Tayeeglow 0 0 0 0 0 0 0 0 1 0 0 0 10 0 163 Wajid 20 0 0 38 266 0 100 237 0 0 0 0 135 0 52200 Bakool 33 0 0 40 481 0 116 256 1 0 0 0 279 0 81938 Abdiaziz 464 291 260 123 208 124 131 121 172 132 120 132 127 132 7488 Boondhere 0 0 0 0 274 0 0 43 0 0 0 0 0 0 5883 Dayniile 0 0 9 0 156 0 0 7 0 0 0 0 0 0 10719 Dharkinley 659 1729 0 0 1879 0 0 80 0 0 0 0 3 0 23045 Hamar Jab Jab 276 718 0 0 478 0 1 21 0 0 0 0 3 0 14265 Hamar Weyne 204 231 20 0 793 3 1 46 0 0 0 0 1 0 10085 Hodan 8 0 0 0 93 0 0 1 0 0 0 0 2 0 8390 Howl-wadaag 0 0 0 0 12 0 0 5 0 0 0 0 1 0 18435 Huruwaa 2631 4572 21 4 3757 0 1 871 0 0 0 0 8 2 58416 Kaaraan 1 0 0 0 14 0 0 0 0 0 0 0 5 0 16456 Kahda 13 144 0 0 104 0 0 0 0 0 0 0 0 0 3914 Shibis 75 0 0 1 541 0 0 25 0 0 0 0 17 0 8589 Waberi 0 0 0 0 88 0 0 7 0 0 0 0 1 0 15900 Wadajir 1128 1026 761 1 1843 0 18 182 3 0 0 0 845 0 86886 Wardhiigley 0 0 0 0 146 0 0 3 0 0 0 0 3 0 8052 Warta-nabadda 7 0 51 0 673 0 0 38 0 0 0 0 10 0 28430 Yaqshid 680 205 0 0 650 0 0 17 0 0 0 0 2 0 27648 Banadir 6146 8916 1122 129 11709 127 152 1467 175 132 120 132 1028 134 352601 Banderbayla 209 151 2 0 57 7 0 1 0 0 0 0 2 0 2818 Bossaso 45 3883 83 43 1100 3 1 63 0 0 0 0 777 1 34161 Carmo 0 70 1 1 43 0 0 1 0 0 0 0 4 0 3035 0 0 0 0 110 14 0 0 0 0 0 0 0 0 4045 Iskushuban 0 19 0 0 15 0 0 0 0 0 0 0 0 0 2120 Qardho 0 0 80 10 334 0 0 304 0 0 0 0 5 0 15907 Rakko 0 0 43 6 328 8 0 19 0 0 0 0 4 0 5343

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Region/District SARI ILI AWD BD OAD Diph WC Meas nnt afp ajs vfs mal men total_cons Ufeyn 8 2 0 1 1 0 0 0 0 0 0 0 0 0 1451 Waciya 0 0 4 0 4 0 0 4 0 0 0 0 2 0 5523 Bari 262 4125 213 61 1992 32 1 392 0 0 0 0 794 1 74403 Baidoa 527 345 2070 133 913 13 19 283 2 0 0 0 1192 0 120770 Berdale 0 0 0 0 0 0 0 0 0 0 0 0 138 0 7229 Burhakaba 0 0 266 63 12 0 0 0 0 0 0 0 24 0 4120 Qasax dhere 0 0 20 0 0 0 0 1 0 0 0 0 38 0 7437 Bay 527 345 2356 196 925 13 19 284 2 0 0 0 1392 0 139556 Abudwak 39 15 0 0 678 7 3 154 0 0 0 0 782 2 20704 Adado 145 172 136 15 527 0 76 74 0 0 2 0 1543 6 33191 Balanbale 21 20 0 0 248 0 10 3 0 0 0 0 0 0 5966 Dhuusamarreeb 126 30 1 0 366 0 4 21 0 0 0 0 1204 16 30991 El Dere 34 31 0 0 664 3 0 32 0 0 0 0 835 15 24811 Gelinsor 0 0 3 0 20 0 9 0 0 0 0 0 0 0 5973 Galgadud 365 268 140 15 2503 10 102 284 0 0 2 0 4364 39 121636 B/hawo 28 440 0 1 127 0 0 15 0 0 0 0 125 0 8202 Burdhubo 3 28 0 0 7 0 0 1 0 0 0 0 2 0 499 Doolow 18 467 0 0 112 0 0 5 0 0 0 0 87 0 6885 Elbon 0 19 0 0 9 0 0 0 0 0 0 0 5 0 469 Garbahaarey 6 326 0 0 69 0 0 0 0 0 0 0 59 0 6216 Gedweyne 0 63 0 0 10 0 0 0 0 0 0 0 6 0 821 Luuq 4 479 0 0 130 0 18 13 0 0 0 0 107 0 7653 Gedo 59 1822 0 1 464 0 18 34 0 0 0 0 391 0 30745 Belet Weyne 3920 2637 425 5 6700 0 40 171 0 0 0 0 629 3 103715 Bulo Burto 2104 496 10 12 2991 0 25 35 0 0 0 0 14 0 30053 Jalalaqsi 1181 178 16 0 1558 0 0 0 0 0 0 0 0 0 9556 Matabaan 79 97 0 0 57 0 0 0 0 0 0 0 0 0 5081 Maxaas 298 132 0 3 232 0 0 0 0 0 0 0 0 0 9856 Hiraan 7582 3540 451 20 11538 0 65 206 0 0 0 0 643 3 158261 Afmadow 16 0 3 9 117 0 6 94 0 0 0 0 54 0 6184 Badhaadhe 0 0 0 1 3 0 0 1 0 0 0 0 3 0 58 Hagar 6 0 0 9 91 0 7 44 0 0 0 0 0 0 2002 Jamaame 12 0 10 2 140 2 8 52 0 0 0 0 70 0 6368 Kismayo 151 3 15 33 576 0 20 86 0 0 0 0 197 0 36757 Muganbow 0 0 0 0 2 0 0 0 0 0 0 0 9 0 118 Lower Juba 185 3 28 54 929 2 41 277 0 0 0 0 333 0 51487

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Region/District SARI ILI AWD BD OAD Diph WC Meas nnt afp ajs vfs mal men total_cons Afgoi 627 540 291 0 974 0 6 203 0 0 0 0 799 0 56536 Awdhegle 0 0 0 0 0 0 0 5 0 0 0 0 7 0 1491 Baraawe 0 0 0 0 56 0 4 19 0 0 0 0 51 0 3940 Kurtunwarey 40 9 187 0 1123 0 0 42 0 0 0 0 75 0 24920 Marka 813 63 851 42 4499 3 2 428 0 1 0 0 2153 5 161890 Qoryooley 93 4 108 0 1022 14 8 16 0 0 0 0 86 0 28419 Wanla Weyn 856 1386 188 10 1857 1 11 120 0 0 0 0 184 0 14049 Lower Shabelle 2429 2002 1625 52 9531 18 31 833 0 1 0 0 3355 5 291245 Baligubadle 12 525 0 27 566 0 8 23 0 0 0 0 0 0 157 Ballayabane 75 334 0 0 147 0 3 25 0 0 0 0 0 0 2506 Gabiley 311 3915 0 112 1632 0 10 38 0 0 0 0 29 1 9265 Hargeisa 246 4465 37 200 2415 0 41 664 0 4 0 0 104 22 23005 M.Jeex 644 9239 37 339 4760 0 62 750 0 4 0 0 133 23 34933 Bu'ale 0 0 12 9 129 1 28 25 0 0 0 0 0 0 1880 Jilib 0 0 0 23 224 0 82 46 0 0 0 0 138 0 5638 Salagle 0 0 0 7 108 0 39 24 0 0 0 0 0 0 1893 Middle Juba 0 0 12 39 461 1 149 95 0 0 0 0 138 0 9411 Adale 0 0 0 0 4 0 0 0 0 0 0 0 0 0 6205 Bal'ad 683 815 27 34 989 0 1 125 1 0 0 0 266 0 48672 Jowhar 250 324 141 178 1483 0 4 158 0 0 0 0 72 0 33118 Mahaday 71 237 27 44 355 0 0 4 0 0 0 0 33 0 8654 Warsheikh 10 34 3 37 245 0 8 2 0 0 0 0 5 0 12287 Middle Shabelle 1014 1410 198 293 3076 0 13 289 1 0 0 0 376 0 108936 Galdogob 6 2 7 11 193 9 0 23 0 0 9 2 0 0 15383 Galkacyo 132 25 46 5 754 13 8 593 1 0 1 0 0 2 85083 Jariiban 9 0 1 6 118 0 11 130 0 0 0 0 0 0 19391 Mudug 147 27 54 22 1065 22 19 746 1 0 10 2 0 2 119857 Burtinle 1 370 0 0 348 0 0 165 0 0 0 0 0 0 6481 Dangorayo 0 76 0 0 118 0 0 0 0 0 0 0 0 0 3011 Eyl 2 413 10 0 326 1 1 122 0 0 0 0 0 0 10696 Garoowe 36 1226 2 0 638 0 9 343 0 0 0 0 2 0 15459 Nugaal 39 2085 12 0 1430 1 10 630 0 0 0 0 2 0 35647 Badhan 256 257 239 1 887 1 0 137 0 0 0 0 364 0 8545 Baran 1 36 0 2 110 0 3 19 0 0 0 0 237 0 4337 Dhahar 0 10 2 0 51 0 3 25 0 0 0 0 0 0 2362 Eil-afweine 820 164 0 17 1415 3 0 69 1 0 0 0 0 0 13704

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Region/District SARI ILI AWD BD OAD Diph WC Meas nnt afp ajs vfs mal men total_cons Erigavo 164 316 0 2 305 0 0 47 0 0 0 0 0 3 11988 Xingalol 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1017 Sanaag 1241 783 241 22 2768 4 6 297 1 0 0 0 601 3 41953 Bocame 0 13 2 0 35 0 2 9 0 0 0 0 0 0 1730 Hudun 1 506 0 0 370 0 0 40 0 0 0 0 0 0 1714 Hudur 0 466 0 0 328 0 0 22 0 0 0 0 0 0 3695 Lasacanod 0 9 2 1 54 0 0 0 0 0 0 0 0 0 3544 Lasanod 30 4745 115 15 3853 1 45 318 0 3 0 0 70 1 25672 Taleex 0 11 0 1 19 0 1 10 0 0 0 0 0 0 1592 Taleh 0 547 139 4 310 0 0 2 0 0 0 0 3 0 2152 Sool 31 6297 258 21 4969 1 48 401 0 3 0 0 73 1 40099 Galkayo 147 2 0 9 356 0 15 210 0 0 0 0 28 1 10959 Harardere 93 88 0 0 194 0 0 0 0 0 0 0 0 0 3519 Hobyo 364 263 0 16 648 10 14 100 0 0 26 0 0 0 16838 South Galkacyo 35 0 0 0 31 0 0 34 0 0 0 0 0 0 526 South Mudug 639 353 0 25 1229 10 29 344 0 0 26 0 28 1 31842 Ainabo 3 169 0 96 246 0 0 28 0 0 0 0 0 0 5031 Berbera 385 4437 1 2 3866 1 66 378 0 1 39 0 24 4 16101 Buhodle 79 670 264 196 756 0 0 74 0 0 0 0 0 0 8475 Burao 449 4790 4284 410 5083 0 11 1074 0 0 8 0 2 21 49689 Odwaine 78 792 0 53 509 0 0 21 0 0 0 0 0 0 4584 Sheikh 331 926 0 0 911 0 17 30 0 0 0 0 0 0 5743 Bossaso 0 0 2 0 4 0 0 0 0 0 0 0 0 0 237 Eyl 1 13 0 0 1 0 0 0 0 0 0 0 0 0 158 Waciya 0 0 0 0 0 0 0 1 0 0 0 0 1 0 455 Togdher 1326 11797 4551 757 11376 1 94 1606 0 1 47 0 27 25 90473 Grand Total 22669 65264 12504 2360 77424 242 975 9237 181 141 205 134 14070 237 1851018

SARI-Severe Acute respiratoty Illness, ILI-Influenza Like Illness, AWD-Acute Watery Diarrhoea, BD-Bloody Diarrhoea, Diph-Diptheria, WC-Whooping cough, Meas-Fever With Rash/Measles, NNT-Neonatal Tetanus, AJS-Acute Jaundice Syndrome, VHF-Viral Heamorrhagic Fever, Mal-Confirmed Malaria, Men-Bacterial Meningi

For inquires please contact the Surveillance team, WHO country office in Somalia on address below: Dr. Mutaawe Lubogo, Epidemiologist, [email protected]

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