Epi update week 04/1/08 - 10/1/09 C4 Surveillance and lab group Toll free number for alert by district and province is 08089001 or 08089002 or 08089000 Mobile number for alerts is 0912 104 257 Email: [email protected]. New cholera cases, with case-fatality rates, by week. Zimbabwe, Nov 08 - Jan 09 • * For week 7-13 December, gaps in reporting of data • ** For week 28 December 08- 3 January 09, artefact (Christmas- New Years) 7,000 10.0 9.0 6,000 8.0 5,000 7.0 6.0 4,000 * * 5.0 Cases CFR Cases * CFR 3,000 4.0 3.0 2,000 2.0 1,000 1.0 0 0.0 16-22 Nov 23-29 Nov 30 Nov - 6 Dec 7-13 Dec 14-20 Dec 21-27 Dec 28 Dec-3 Jan 4-10 Jan Global picture The cholera outbreak is not yet under control with 9 of 10 provinces reported cases this week. • Duration of the outbreak: 5 months • To date, cumulative total of 37 806 suspected cases and 1912 deaths have been reported • Number of cases have increased from last week as well as the number of deaths. • CFR increased markedly this week to 6 % similar to the week preceding the Christmas and New year’s holiday, • and CFR still much higher than expected for a cholera outbreak (normally <1%). • This week (4 Jan -10 Jan 2009), 656 cases per day reported and 39 persons are dying every day of cholera. • This week (4 Jan -10 Jan 2009) nearly half of the deaths (41%) are occurring outside treatments centre →unavailability of health care (especially human resources shortage) “Hot spots” this week • Mashonaland West (increase cases and CFRs > 5% and high attack rates and 1/3 of the total weekly number of cases) • Midlands, (increase cases and CFRs > 5% and high attack rates) • Manicaland (CFRs > 5% and high attack rates) • Mathebeleland South (increase cases) • Chitungwiza (CFRs > 5%) • Masvingo (CFRs > 5%) • Mashonaland central (increase cases) Cumulative cholera cases, with cumulative case-fatality rates. Zimbabwe, Nov 08 - Jan 09 40000 6 35000 5 30000 4 25000 Cases 20000 3 CFR 15000 2 10000 1 5000 0 0 22-Nov 29-Nov 6-Dec 13-Dec 20-Dec 27-Dec 3-Jan 10-Jan CFR (proportion of cases that die of the disease ) • Case-fatality rates (CFR, the proportion of cases that die of the disease) increased markedly this week to 6 % (5.9% exactly) similar to the week preceding the Christmas and New year’s holiday, • and is still far above the <1% target. • The CFR for the week 04/10/09 - 10/1/09 is 5.9%, compared to 2.1 % last week CTC and CTU • 172 CTC/CTU distributed over the country. • 74 of the 172 CTC/CTU so 43% run only by the MoHCW • the others 57 % are runed by MoHCW with support of NGOs/partners. Table 1. Number of CTC/CTU per province, as of Jan 10th, Zimbabwe Average catchment Province Population Number of CTC population per CTC Harare (Harare city+ Chitungwiza) 2,012,784 3 670928 Bulawayo 718,278 1 718278 Manicaland 1,665,451 36 46263 Mash Central 1,056,666 25 42267 Mash East 1,196,772 26 46030 Mash West 1,300,012 35 37143 Masvingo 1,401,672 31 45215 Mat North 748,317 0 - Mat South 693,230 7 99033 Midlands 1,554,058 8 194257 TOTAL 12347238 172 211046 CTC/CTU all over country CTC in Harare Budiriro polyclinics Beatrice hospital Cases and deaths per day, from week 16/11/08 - 22/11/08 to week 04/01/09 - 10/01/09, Zimbabwe On average since November 16th 2008, 587 cases per day and 31 deaths per day are reported with a peak of 819 cases per day in 21-27 Dec 2008 and 52 per day in 14-20 Dec 2008 Week Cases Deaths CFR (%) Cases per day Deaths per day 16-22 Nov 2008 2863 99 3.5 409 14 23-29 Nov 2008 3254 136 4.2 465 19 30 Nov 6 Dec 2008 4499 159 3.5 643 23 7-13 Dec 2008 2841 257 9.0 406 37 14-20 Dec 2008 5379 367 6.8 768 52 21-27 Dec 2008 5730 358 6.2 819 51 28 Dec 08-3 Jan 09 3690 79 2.1 527 11 4-10 Jan 2009 4594 272 5.9 656 39 Total 587 31 Cumulative case-fatality rates, by district. Zimbabwe, as of 10 Jan 2008 Districts with cumulative CFRs over 1% are noted in the majority of the provinces (8 of the 10 provinces). above 5 1.1 - 5.0 0 no cases/deaths Proportion of cases by provinces This week, Mashonaland West is representing 1/3 of the total weekly number of cases, followed by Manicaland (17.0%) and Harare (10.9%). Since the beginning of the outbreak, most of the cases are coming from Harare (31.1%), then Mashonaland West (24.3%). Proportion of Number cases cases (%) week (4 Cumulative week (4 Jan-10 number Jan-10 Jan Cumulative proportion of Provinces Jan 09) of cases 09) cases (%) Harare (Harare city+ Chitungwiza) 501 11767 10.9 31.1 Bulawayo 8 383 0.2 1.0 Manicaland 783 4477 17.0 11.8 Mash Central 278 859 6.1 2.3 Mash East 401 3642 8.7 9.6 Mash West 1,565 9168 34.1 24.3 Masvingo 448 2565 9.8 6.8 Mat North 0 2 0.0 0.0 Mat South 438 4272 9.5 11.3 Midlands 172 671 3.7 1.8 TOTAL 4,594 37806 100.0 100.0 Attack rate (AR) per 100 000 inhabitants by provinces The most affected provinces for this week in term of number of cases are from far Mashonaland West (AR= 120/100 000 inhabitants), then Mathebeleland South (AR= 63/100 000 inhabitants), Manicaland (AR= 47/100 000 inhabitants) Number cases Cumulative number week (4 of cases (since Weekly AR Cumulative AR Jan-10 Jan beginning of (per 100 (per 100 Provinces Population 09) data collection) 000) 000 Harare (Harare city+ Chitungwiza) 2,012,784 501 11767 24.9 584.6 Bulawayo 718,278 8 383 1.1 53.3 Manicaland 1,665,451 783 4477 47.0 268.8 Mash Central 1,056,666 278 859 26.3 81.3 Mash East 1,196,772 401 3642 33.5 304.3 Mash West 1,300,012 1,565 9168 120.4 705.2 Masvingo 1,401,672 448 2565 32.0 183.0 Mat North 748,317 0 2 0.0 0.3 Mat South 693,230 438 4272 63.2 616.2 Midlands 1,554,058 172 671 11.1 43.2 TOTAL 12,347,240 4,594 37806 37.2 306.2 Cumulative attack rates, by district, as of 10 Jan 2009 Attack Rate (per 100,000) 1,000 and above 500.0 - 999.9 100.0 - 499.9 0.1 - 99.9 0 Proportion of deaths that occur outside CTC, week 04/01/08 - 10/01/09, selected* provinces •* without taking into account Harare, where community deaths are irregularly (or even not) reported, •This week, more than 1/3 of the deaths (41%) are occurring outside treatments centre. In some districts (Mashonaland East) more deaths are recorded in the community than in the treatments centres. Deaths within treatment Deaths outside treatment Proportion of deaths occuring outside Province centres centres treatment centres (%) Bulawayo 0 0 0 Mashonaland West 117 67 36 Mashonaland Central 10 8 44 Mashonaland East 19 20 51 Manicaland 62 59 49 Masvingo 27 20 46 Matabeleland North 0 0 0 Matabeleland South 11 3 21 Midlands 16 11 41 Total 272 188 41 EPI UPDATE PER PROVINCE 100 150 200 250 50 0 17-23 Aug 24-30 Aug 31 Aug- 6 Sep 7-13 Sep 14-20 Sep 21-27 Sep Chitungwiza 28 Sep -4 Oct 5-11 Oct 12-18 Oct 19-25 Oct 26 Oct-1 Nov 2-8 Nov 9-15 Nov 16-22 Nov 23-29 Nov 30 Nov - 6 Dec 7-13 Dec 14-20 Dec 21-27 Dec 28 Dec-3 Jan 4-10 Jan 0.0 5.0 10.0 15.0 20.0 25.0 30.0 35.0 40.0 45.0 50.0 CFR Cases of Number Harare City 3000 25.0 2500 20.0 2000 15.0 Cases 1500 CFR 10.0 1000 5.0 500 0 0.0 16-22 Nov 23-29 Nov 30 Nov - 6 7-13 Dec 14-20 Dec 21-27 Dec 28 Dec-3 Jan 4-10 Jan Dec Harare City Distribution of Cholera Cases by place of residence, City of Harare, Oct - Dec 2008 N W E Hatcliffe S Institute Of AgriculturalHogerty Hill Engineering Philadelphia BorrowdaleHellensvale Brooke Umwindzidale Mount Pleasant Heights Quinnington New Marlborough Glen lo rne Northwood Reylands Marlborough VainonaPomona Greystone Park Glen Wood Borrowdale Adylin Kambanji Shawasha Hills AvonleaAshbrit tle Mount PleasantBorrowdale West Gl et wyn Rolfe ValleyThe Grange Bluff Hill Little Norfolk Emerald Hill Gro ombridge Chisipite North Greencroft Colne Valley Avondale WestUniversity CampusBorrowdale Racecource Dzivaresekwa Extension Mabelreign New Alexandra ParkLewisam Mandara Mayfield Park Chisipite AshdownCotswold Park Hills Gu n H ill Dzivaresekwa SrathavenAvondale Chikurubi Tynwald Alexandra Park Highlands MeyrickMonovale Park Glaudina BelgraviaBorrowdale Road Government Block Merwede Haig Park Milton Park Greendale Avenues Belvedere North Eastlea Donnybrook Kuwadzana Warren Park City Centre Belvedere South Athlone MabvukuTafara Railway YardHillsideCoronation ParkGreen Grove Braeside Cleveland Ridgeview Msasa Amby Crowborough North Arcadia Beverly Westwood Workington Magaba Wilmington Park Chizanje Graniteside QueensdaleChadcombe KambuzumaRugare Cranborne Msasa Park Marimba Park Mbare St Mart ins Mukuvisi East Mufakose Southerton Zimre Park Sunningdale Aspindale ParkLochinvar Park Meadowlands Willowvale Ardbennie Ventersburg Houghton Park New Ardbennie Logan Park Hatfield Budiriro Prospect Highfield Parkt own Epworth Mainway Meadows Midlands Glen Vie w Gl en No rah Kutsaga Village Gro bbi e Pa rk Uplands Airport Waterfalls Number of cases Hopley 1 - 100 Shortson 101 - 500 501 - 1000 1001 - 2000 Over 2000 No cases reported Bulawayo 140 12 120 10 100 8 80 Cases 6 CFR CFR Cases 60 4 40 2 20 0 0 16-22 Nov 23-29 Nov 30 Nov - 6 7-13 Dec 14-20 Dec 21-27 Dec 28 Dec-3 4-10 Jan Dec Jan Week Mashonaland West 3500 9 8 3000 7 2500 6 2000 5 Cases CFR CFR Cases 1500 4 3 1000 2 500 1 0 0 16-22 Nov 23-29 Nov 30 Nov - 6 7-13 Dec 14-20 Dec 21-27 Dec 28 Dec-3 Jan 4-10 Jan Dec Week Mashonaland Central 350 25 300 20 250 15 200 Cases CFR CFR Cases 150 10 100 5 50 0 0 16-22 Nov 23-29 Nov 30 Nov - 6 7-13 Dec 14-20 Dec 21-27 Dec 28 Dec-3 Jan 4-10 Jan Dec Week Mashonaland East 600 50.0 45.0 500 40.0 35.0 400 30.0 Cases 300 25.0 CFR CFR Cases 20.0 200 15.0 10.0 100 5.0 0 0.0 16-22 Nov 23-29 Nov 30 Nov - 6 7-13 Dec 14-20 Dec 21-27 Dec 28 Dec-3 Jan 4-10 Jan Dec Week Midlands 200 16.0 180 14.0 160 12.0 140 10.0 120 Cases 100 8.0 CFR CFR Cases 80 6.0 60 4.0 40