Epidemiological Week 6 (Week ending 11th February, 2018) Highlights Cumulative figures as of week 6 Total of 198 Health Facilities across Somalia have 383,907 cumulative week1 to week 6 submitted weekly report of communicable diseases in cases of all diseases the electronic early warning disease surveillance system 846 cumulative cases of AWD in 2018. in week 6, 2018. Total number of consultations decreased from 57,359 in Of the 846 cases, 310 were (58%) are week 5 to 51,959 in week 6. children less than 5 years while 225 The highest number of diseases in week 6 were: other (42%) are 5 years above. acute diarrhoeas (1,944 cases), influenza like illness 1 AWD death in Week6 (1,980 cases) followed by severe acute respiratory 2,167 cumulative cases of suspected illness (1,048 cases) measles cases since the beginning of A total of 98 new cases of AWD/Cholera and 1 death 2018. were reported in week 6 compared to 103 AWD cases in Of the 2,167 measles cases, 1,458 week 5 with no deaths. (67%) are under 5 years while 709 Cumulatively, 846 AWD/Cholera cases including 3 deaths (33%) are above 5 years (CFR 1.4) since the beginning of the outbreak in December. However, since January 2018, 533 cases including 2 deaths have been reported. Most of the AWD/Cholera cases were reported from Kismayo in Lower Juba region, Beletweyne in Hiran region and 10 districts in Banadir Region where cholera case have been confirmed since December, 2017. The number of measles cases increased from 277 in week 5 to 343 cases reported in week 6. Table 1. Summary of Alerts for epidemic prone diseases Disease Wk1 Wk2 Wk3 Wk4 2018 Wk5 Wk6 Cumulative cases 2018 2018 2018 2018 2018 (Wk 1 – 6, 2018) Total consultations 67,500 68,923 72,052 66,114 57359 51959 383,907 Other Acute Diarrheas 2382 2573 2455 2402 2182 1944 13938 Influenza Like Illness 2340 2252 2065 2,436 2109 1980 13,182 Severe Acute Respiratory Illness 786 889 873 926 701 1048 5,223 Suspected Measles 430 283 424 410 277 343 2167 Confirmed Malaria 337 291 315 406 214 205 1768 Acute Watery Diarrhoea 92 95 97 59 70 64 477 Bloody Diarrhea 49 37 56 59 42 23 266 Whooping Cough 34 39 21 33 32 49 208 Acute Jaundice 13 6 6 1 1 2 29 Page 1 of 11 Suspected Meningitis 2 3 4 3 2 2 16 Diphtheria 2 0 0 0 0 1 3 Neonatal Tetanus 1 16 0 0 0 0 17 Acute Flaccid Paralysis 1 0 0 0 0 0 1 Viral Hemorrhagic Fever 0 0 0 0 0 2 2 Total number of Consultations and number of reporting sites, week 1 to Week 6, 2018 800 80000 700 70000 600 60000 500 50000 400 40000 300 30000 Consultations Reporting sites 200 20000 100 10000 0 0 WK 1 WK 2 WK 3 WK 4 WK 5 WK 6 Consultations Reporting sites Proportionate morbidity The commonest causes of morbidity during week 3 to 6 3,000 2,500 2,000 1,500 1,000 500 0 Other Acute Diarrheas Influenza Like Illness Severe Acute Suspected Measles Confirmed Malaria Respiratory Illness Wk1 2018 Wk2 2018 Wk3 2018 Wk4 2018 Wk5 2018 Wk6 2018 of AWD/Cholera Page 2 of 11 Epidemic situation Over the past 10 Weeks, there has been a slight increase in the reported number of cases of AWD/Cholera in Somalia. Laboratory confirmed cholera cases have been reported from Beletweyne in the Hiran Region, Kismayo in Lower Juba, and Districts Reporting Cases in Week 6 13 districts in Banadir region. In week 6, active transmission of AWD/cholera was reported in Beletweyne district of Hiraan region and Lower jubba district Kismayo as well as in 10 districts of Banadir region. The recent outbreaks began in week 49 (December 2017) in Beletweyne district of Hiraan region. Additional confirmed cases were reported in 13 districts of Banadir region since week 1 (January 2018) and in February, 2018, cases were confirmed from Kismayo in the Lower Jubba region. Since the beginning of the outbreak in December 2017 up to date (week 6, 2018), 846 cumulative cases of AWD/Cholera including 3 deaths (CFR 0.4) were reported. However, since January 2018, 533 cases including 2 deaths have been reported. The affected communities in Hiraan are located along the Shabelle and inhabitants reportedly use contaminated water from Shabelle River since safe water sources are reported to have dried up. The AWD cases reported in 10 districts of Banadir may be linked to Beletweyne due to uncontrolled movement of people in both regions. The Oral Cholera Vaccination that was implemented in 11 high risk districts of the central region has greatly contributed to the reduction in the number of new AWD/cholera cases according to last year. Table 2. Summary of AWD/Cholera cases in different regions Week 5 Week 6 Cumulative cases th th th th Region (29 -Jan-4 Feb 2018) (5 -11 Feb 2018) Epi-Week 1-6-2018 Live Deaths CFR(%) Live Deaths CFR(%) Live Deaths CFR (%) Hiraan 11 0 0 7 0 0 176 0 0 Banadir 45 0 0 48 0 0 269 1 0.4 Lower jubba 47 0 0 43 1 2.3 90 1 1.1 Total 103 0 0 98 0 0 535 2 0.4 Page 3 of 11 Cholera Situation in Hiraan, Lower Jubba and Banadir. The AWD/cholera outbreak in Beletweyne started in December 2017 (2a) followed by the outbreak in Banadir in at the beginning of January 2018 (fig 2b). At the beginning of February 2018, new cholera cases were confirmed in Kismayo (2c). All these towns are connected by River Shabelle and Kismayo started in Feb-2017(2c) . Communities in these districts are reported to use contaminated water from the river and open water sources As shown in figure 3,most of the cases in Hiraan are reported from Beletweyne district and lower Jubba reported cases from district Kismayo while in Banadir, cases are reported from Daynile,Hodan and Madina districts. AWD Cases in Somali: Week 1 2018 – Week 6, 2018 6000 5.00 4.50 5000 4.00 4000 3.50 3.00 3000 2.50 2.00 2000 1.50 1000 1.00 0.50 0 - WKWKWKWKWKWKWKWKWKWKWKWKWKWKWKWKWKWKWKWKWKWKWKWKWKWKWKWKWKWKWKWKWKWKWKWKWKWKWKWKWKWKWKWKWKWKWKWKWKWKWKWKWKWKWKWKWKWK 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 1 2 3 4 5 6 Jan Feb Mar Apr May Jun Jul Aug Sept Oct Nov Dec Jan Feb 2007 2018 Cases Deaths CFR Table 3. Distribution of AWD/cholera cases per district in Somalia (Feb. 2018) Week 6 (5th- 11th Feb - 2018 Cumulative (week 1-6-2018) Region District cases <5yrs cases Deaths CFR (%) Live Deaths CFR (%) >5yrs Heliwaa 0 0 0 0 2 0 0 Banadir Daynile 4 1 0 0 41 1 2.4 Hamar Weine 0 0 0 0 2 0 0 HamarJabjab 1 0 0 0 5 0 0 Dharkenley 2 3 0 0 30 0 0 Hodan 6 10 0 0 84 0 0 Howlwadag 0 0 0 0 10 0 0 Karan 1 0 0 0 4 0 0 Madina 10 7 0 0 67 0 0 Shibis 0 1 0 0 3 0 0 waberi 1 1 0 0 12 0 0 Wardigley 0 0 0 0 4 0 0 Yaqshid 0 0 0 0 5 0 0 Hiiran Beletweyne 1 6 0 0 176 0 0 Lower Jubba Kismayo 29 13 1 0 90 1 1.1 Total 55 42 0 0 535 2 0.4 Page 4 of 11 Response activities implemented during the week Coordination and Leadership Weekly meetings were held in Banadir hospital CTC between Ministry of Health, Health and WASH cluster partners to plan for the implementation of response activities. Case management and Oral Cholera Vaccination The Cholera treatment centres in Banadir hospital and Beletweyne hospital have been opened to support the management of new cases. Rapid Response Teams and community health workers that were trained in Banadir region have been deployed to refer and manage cases in the communities. Surveillance and Laboratory Investigations Mobile teams and community health workers have been deployed to support the investigation and verification of rumours in Banadir and Beletweyne. AWD/Cholera alerts are being received from different regions using the newly activated EWARN system. Water Sanitation and Hygiene Community education was conducted in crowded areas of Banadir and Beletweyne district. Hygienic kits were distributed by WASH cluster partners in Beletweyne district. Suspected Measles Cases The number of suspected measles cases increased Districts Reporting Cases During Week 3 from 277cases in week5 to 343 cases in week 6. Cumulatively, 2,167 cases of suspected measles have been reported across Somalia since the beginning of the year, 2018. Of the 2,167 measles cases, 1,458(67%) are under 5 years while 709 (33%) are above 5 years. The most affected regions include Galgadud (358cases) Banadir (372cases), and Mudug(313 Cases) (See Table 4). Somalia, Suspected Measles Cases as of Week 1- 6 2018 Page 5 of 11 500 450 400 350 300 250 430 424 200 410 Measles Cases 343 150 283 277 100 50 0 Wk1 2018 Wk2 2018 Wk3 2018 Wk4 2018 Wk5 2018 Wk6 2018 Table 4: Summary of Suspected measles cases by region week 1 - 6, 2018 Region Wk1 Wk2 Wk3 Wk4 Wk5 Wk6 Cumulative cases 2018 2018 2018 2018 2018 2018 (Wk 1 – 6) Awdal 2 0 0 0 5 0 7 Bakool 11 21 17 21 6 9 85 Banadir 75 66 57 68 49 57 372 Bari 29 9 5 14 6 5 68 Bay 29 42 29 12 0 0 112 Galgaduud 0 0 78 65 54 161 358 Gedo 3 1 3 1 3 0 11 Hiraan 1 0 0 1 1 8 11 Lower Juba 8 9 10 7 8 12 54 Lower Shabelle 26 13 42 13 14 9 117 Middle Juba 6 4 5 6 10 5 36 Middle Shabelle 6 9 4 4 4 0 27 Mudug 131 31 87 46 12 6 313 Nugaal 31 27 24 19 20 0 121 Sanaag 18 5 8 70 11 13 125 Sool 40 16 29 35 50 31 201 Togdher 7 19 15 11 13 17 82 Waqoyi Galbed 7 11 11 17 11 10 67 Grand Total 430 283 424 410 277 343 2167 Measles Outbreak response Page 6 of 11 Page 7 of 11 Table 3.