Early Warning Disease Surveillance and Response Bulletin, Somalia 2017 Epidemiological week 45 (Week ending 12th November, 2017) Highlights Cumulative figures as of week 45 Reports were received from 226 out of 265 reporting 1,363,590 total facilities (85.2%) in week 45, a decrease in the reporting consultations completeness compared to 251 (94.7%) in week 44. 78,596 cumulative cases of Total number of consultations increased from 69091 in week 44 to 71206 in week 45 AWD/cholera in 2017 The highest number of consultations in week 44were for 1,159 cumulative deaths other acute diarrhoeas (2,229 cases), influenza like illness of AWD/Cholera in 2017 (21,00 cases) followed by severe acute respiratory illness 55 districts in 19 regions (834 cases) reported AWD/Cholera AWD cases increased from 77 in week 44 to 170 in week 45 cases No AWD/cholera deaths reported in all districts in the past 7 20794 weeks cumulative cases of The number of measles cases increased from in 323 in week suspected measles cases 44 to 358 in week 45 Disease Week 44 Week 45 Cumulative cases (Wk 1 – 45) Total consultations 69367 71206 1363590 Influenza Like Illness 2287 1801 50517 Other Acute Diarrhoeas 2240 2234 60798 Severe Acute Respiratory Illness 890 911 16581 suspected measles [1] 323 358 20436 Confirmed Malaria 269 289 11581 Acute Watery Diarrhoea [2] 77 170 78596 Bloody diarrhea 73 32 1983 Whooping Cough 56 60 687 Diphtheria 8 11 221 Suspected Meningitis 2 2 225 Acute Jaundice 0 4 166 Neonatal Tetanus 0 2 173 Viral Haemorrhagic Fever 0 0 130 [1] Source of data is CSR, [2] Source of data is Somalia Weekly Epi/POL Updates The number of EWARN sites reporting decrease from 251 in week 44 to 226 in week 45. This is below the target of 400 health facilities that are targeted for reporting by the end of the year. The number of total consultations also increased from 69091 in week 44 to 71206 in week 45 in the 243 reporting sites (Chart 1 below). Overall, 1367245 consultations have been recorded since the beginning of the year. Page 1 of 13 Total number of Consultations and number of reporting sites, week 34 to 45, 2017 800 80000 700 70000 600 60000 500 50000 400 40000 300 30000 Consultations Reporting sites 200 20000 100 10000 0 0 WK 34 WK 35 WK 36 WK 37 WK 38 WK 39 WK 40 WK 41 WK 42 WK 43 WK 44 WK 45 Consultations Reporting sites Proportionate morbidity The commonest causes of morbidity reported from the sentinel sites in week 45 are; Influenza like illness, other diarrhoeas, Severe Acute Respiratory infection, measles, malaria, AWD, Bloody diarrhoea and whooping cough and acute watery diarrhoea as shown in figure 2 below Chart 2. Commonest Causes of Morbidty in Somalia, Week 44 and 45, 2017 2500 2000 1500 1000 500 0 Influenza Like Other Acute Severe Acute suspected measles Confirmed Malaria Acute Watery Illness Diarrhoeas Respiratory Illness [1] Diarrhoea [2] Week 44 Week 44 Page 2 of 13 Situation update of AWD/Cholera Epidemic situation ChChartart 3 .3 Map. Cumulative of AWD CasesMap of as AWD of week Cases 44, as 2017, of The number of AWD cases declined from 77 in week Week 45 44 to 170 in week 45 in all regions (Table 1). No new cholera cases or deaths have been reported in the last 2months in all regions. In all, new cases reported from 7 district in 8 regions across the country. This icludes; 13 from Baroma district in Awadal regoin, 12 cases from Barao district in Togdher region, 36 cases from Wadajir district in Banadir region, Marka (6) Wanla Weyn (1) in Lower shabelle, and 3 cases from Lasanood in Sool region and 4 Bossaso 4 in Bari region A total of 78596 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 Mudug. 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. Epi_curve showing AWD cases in Somalia, Week 1 - 45, 2017 6,000 5.00 4.50 5,000 4.00 4,000 3.50 3.00 3,000 2.50 2.00 2,000 1.50 1,000 1.00 0.50 - - Week 1 Week 3 Week 5 Week 7 Week 9 Week Week 13 Week 41 Week Week 11 Week 15 Week 17 Week 19 Week 21 Week 23 Week 25 Week 27 Week 29 Week 31 Week 33 Week 35 Week 37 Week 39 Week 43 Week 45 Week Jan Feb March April May June July Aug Sept Oct November Total Cases Deaths CFR Page 3 of 13 Table 2. Activities implemented during the AWD/Cholera outbreak Thematic area Activities implemented Surveillance and 265 health facilities were included in the EWARNs with plans to laboratory activities expand reporting sites to all districts 16 stool samples collected from Banadir hospital CTC during the week tested negative. A total of 282 stool samples were collected since week 1 for AWD/Cholera of which 111 were positive for V. Cholera, Ogawa. 57 IERT have been deployed in most affected districts during the drought response An alert about AWD/Cholera outbreak was investigated in Adado and was a false alert Case Management and A review of the implementation of different activities was conducted OCV by regional Surveillance officers and NPHL to identify gaps and lessons learnt so as to plan for the next expected outbreak during the rainy season. In addition to the 520 health workers so far trained in cholera case management, 30 additional health workers were trained in Banadir in cholera diagnosis Coordination and Emergency planning meeting was held by the Banadir regional team Response for AWD/Cholera prevention in high risk districts Weekly coordination meetings between MoH and cluster partners A needs assessment for AWD/Cholera was conducted by the joint WHO and MoH team in Banadir hospital CTC Water, Sanitation and Distribution of hygienic kits to IDP communities in AWD/Chigh risk Hygiene districts Community education and mobilisation was done in all regions affected by AWD. The activities were implemented in Lower Jubba, Middle Jubba,Banadir and Middle Shabelle. C4D conducted social mobilisation in hard to reach areas in all the districts affected by AWD/Cholera Supplies and logistics Over 167 tonnes of AWD/Cholera supplies and emergency kits were distributed to affected regions since January 2017 Page 4 of 13 Suspected measles cases The number of suspected measles cases decreased from 323 cases in week 44 to 358 cases in week 45. A total of 20,078 cumulative Chart 5. Map of Suspected Measles Cases in week 45 suspected measles cases have been reported from all the nineteen regions since the beginning of the year. 83% of the cases are children under 10 years. The most affected regions include Banadir (4,902 cases) Togdher (2,177 cases), Mudug (1,869) Lower Shabelle (1,731 cases), and Bari (1,624) (See Table 3). Table 2: Summary of Suspected measles cases by region week 43 and 44, 2017 Region Week 43 Week 44 Cumulative cases Nugal 84 100 1414 Mudug 73 64 2006 Bari 44 44 1712 Banadir 50 41 4993 Lower Shabelle 44 32 1807 Bay 22 18 515 Lower Juba 14 14 357 M. Shabelle 15 12 638 Galgadud 5 8 584 Bakool 6 8 76 Togdher 27 7 2211 Galbeed 2 6 735 Hiran 3 5 1287 Gedo 9 3 164 Sool 2 1 611 Middle Juba 1 1 60 Sahil 2 0 566 Sanag 5 0 244 Awdal 0 0 98 Grand Total 408 364 20078 Page 5 of 13 Measles outbreak response WHO in collaboration of with the Federal Ministry of Health have started preparatory activities for the upcoming mass measles campaigns in November 2017 targeting 4,278,083 (6 months-10 years) children. Vaccines have been delivered to the state hubs. 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. Regional and district training will be conducted next week. Due to circumstance, a phase wise implementation strategy has been adopted as a best delivery option, to maintain good quality - one zone will be covered at a time. Page 6 of 13 Table 3. Summary of epidemic prone diseases and syndromes in different districts of Somalia as of week 45 Region District SARI ILI AWD BD OAD Diph WC Meas NNT AJS VHF Mal Men Total consultations Awdal Baki 0 1222 0 118 442 0 0 6 0 0 0 8 0 2311 Borama 0 6710 1157 97 3587 0 0 30 0 0 0 62 0 16132 Lughaya 0 362 0 10 309 0 0 0 0 0 0 0 0 1481 Zeila 0 1702 16 26 1020 0 0 7 0 0 0 35 0 4794 Subtotal 0 9996 1173 251 5358 0 0 43 0 0 0 105 0 24718 Bakool Elberde 1 0 0 0 89 0 0 3 0 0 0 0 0 17096 Hudur 11 0 0 0 60 0 8 2 0 0 0 112 0 4975 Waajid 8 0 0 28 207 0 61 128 0 0 0 93 0 41824 Subtotal 20 0 0 28 356 0 69 133 0 0 0 205 0 63895 17 Districts 2372 2718 798 121 5030 123 137 413 169 116 128 736 128 187518 Huruwaa 1803 2849 21 4 2113 0 0 532 0 0 0 5 2 36673 Banadir Subtotal 4175 5567 819 125 7143 123 137 945 169 116 128 741 130 224191 Bari Bossaso 44 3293 73 32 907 3 0 40 0 0 0 280 1 27891 Carmo 0 35 1 0 29 0 0 1 0 0 0 3 0 2080 Iskushuban 0 1 0 0 4 0 0 0 0 0 0 0 0 1393 Ufeyn 8 2 0 1 1 0 0 0 0 0 0 0 0 1347 Subtotal 52 3331 74 33 941 3 0 41 0 0 0 283 1 32711 Bay Badale 0 0 0 0 0 0 0 0 0 0 0 8 0 1033 Baidoa 329 235 2070 105 727 9 19 188 2 0 0 896 0 95536 Berdale 0 0 0 0 0 0 0 0 0 0 0 130 0 6196 Bur hakaba 0 0 266 59 12 0 0 0 0 0 0 8 0 3187 Qansahdere 0 0 20 0 0 0 0 1 0 0 0 38 0 6762 Bandarbayla 188 55 2 0 35 7 0 0 0 0 0 0 0 2051 Hafun 0 0 0 0 64