Epidemiological Week 45 (Week Ending 12Th November, 2017)

Early Warning Disease Surveillance and Response Bulletin, Somalia 2017 Epidemiological week 45 (Week ending 12th November, 2017) Cumulative figures as of week 45 Highlights Reports were received from 226 out of 265 reporting facilities (85.2%) in week 45, a decrease in the reporting completeness compared to 251 (94.7%) in week 44. Total number of consultations increased from 69091 in week 44 to 71206 in week 45 The highest number of consultations in week 44were for other acute diarrhoeas (2,229 cases), influenza like illness (21,00 cases) followed by severe acute respiratory illness (834 cases) AWD cases increased from 77 in week 44 to 170 in week 45 No AWD/cholera deaths reported in all districts in the past 7 weeks The number of measles cases increased from in 323 in week 44 to 358 in week 45 1,363,590 total consultations  78,596 cumulative cases of AWD/cholera in 2017  1,159 cumulative deaths of AWD/Cholera in 2017  55 districts in 19 regions reported AWD/Cholera cases 20794 cumulative cases of suspected measles cases <ul style="display: flex;"><li style="flex:1">Disease </li><li style="flex:1">Week 44 </li><li style="flex:1">Week 45 </li><li style="flex:1">Cumulative cases (Wk 1 – 45) </li></ul><ul style="display: flex;"><li style="flex:1">Total consultations </li><li style="flex:1">69367 </li></ul>2287 2240 71206 1801 2234 1363590 <ul style="display: flex;"><li style="flex:1">50517 </li><li style="flex:1">Influenza Like Illness </li></ul><ul style="display: flex;"><li style="flex:1">Other Acute Diarrhoeas </li><li style="flex:1">60798 </li></ul>Severe Acute Respiratory Illness suspected measles [1] 890 323 911 358 16581 20436 Confirmed Malaria Acute Watery Diarrhoea [2] 269 77 289 170 11581 78596 Bloody diarrhea Whooping Cough 73 56 32 60 1983 687 Diphtheria Suspected Meningitis 82 11 2 221 225 Acute Jaundice Neonatal Tetanus Viral Haemorrhagic Fever 000 420 166 173 130 [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 800 700 600 500 400 300 200 100 0 80000 70000 60000 50000 40000 30000 20000 10000 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 <ul style="display: flex;"><li style="flex:1">Consultations </li><li style="flex:1">Reporting sites </li></ul>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 Illness Other Acute Diarrhoeas Severe Acute suspected measles Confirmed Malaria Acute Watery <ul style="display: flex;"><li style="flex:1">Respiratory Illness </li><li style="flex:1">[1] </li><li style="flex:1">Diarrhoea [2] </li></ul><ul style="display: flex;"><li style="flex:1">Week 44 </li><li style="flex:1">Week 44 </li></ul>Page 2 of 13 Situation update of AWD/Cholera Epidemic situation The number of AWD cases declined from 77 in week 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. ChCahratr3t.3M. Caupmouf lAaWtivDe CMaasepsoafsAoWf wDeCeakse4s4a, 2s0o1f7, Week 45 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 5,000 4,000 3,000 2,000 1,000 - 5.00 4.50 4.00 3.50 3.00 2.50 2.00 1.50 1.00 0.50 -<ul style="display: flex;"><li style="flex:1">Jan </li><li style="flex:1">Feb </li><li style="flex:1">March </li><li style="flex:1">April </li><li style="flex:1">May </li><li style="flex:1">June </li></ul>Deaths <ul style="display: flex;"><li style="flex:1">July </li><li style="flex:1">Aug </li><li style="flex:1">Sept </li><li style="flex:1">OctNovember </li></ul><ul style="display: flex;"><li style="flex:1">Total Cases </li><li style="flex:1">CFR </li></ul>Page 3 of 13 Table 2. Activities implemented during the AWD/Cholera outbreak Thematic area Activities implemented Surveillance and laboratory activities 265 health facilities were included in the EWARNs with plans to 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 A review of the implementation of different activities was conducted 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. Case Management and OCV 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 Emergency planning meeting was held by the Banadir regional team 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 Coordination and Response Water, Sanitation and Hygiene Distribution of hygienic kits to IDP communities in AWD/Chigh risk 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 <ul style="display: flex;"><li style="flex:1">Region </li><li style="flex:1">Week 43 </li><li style="flex:1">Week 44 </li><li style="flex:1">Cumulative cases </li></ul>Nugal Mudug Bari Banadir Lower Shabelle Bay Lower Juba M. Shabelle Galgadud Bakool 84 73 44 50 44 22 14 15 5 100 64 44 41 32 18 14 12 8 1414 2006 1712 4993 1807 515 357 638 584 <ul style="display: flex;"><li style="flex:1">76 </li><li style="flex:1">6</li><li style="flex:1">8</li></ul>Togdher Galbeed Hiran 27 23 7653 2211 735 1287 164 Gedo 9Sool <ul style="display: flex;"><li style="flex:1">2</li><li style="flex:1">1</li><li style="flex:1">611 </li></ul>Middle Juba Sahil 12 10 60 566 Sanag <ul style="display: flex;"><li style="flex:1">5</li><li style="flex:1">0</li><li style="flex:1">244 </li></ul>Awdal <ul style="display: flex;"><li style="flex:1">0</li><li style="flex:1">0</li><li style="flex:1">98 </li></ul>Grand Total <ul style="display: flex;"><li style="flex:1">408 </li><li style="flex:1">364 </li><li style="flex:1">20078 </li></ul>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 Awdal <ul style="display: flex;"><li style="flex:1">District </li><li style="flex:1">SARI </li><li style="flex:1">ILI </li><li style="flex:1">AWD </li><li style="flex:1">BD </li><li style="flex:1">OAD </li><li style="flex:1">Diph </li><li style="flex:1">WC </li><li style="flex:1">Meas </li><li style="flex:1">NNT </li><li style="flex:1">AJS </li><li style="flex:1">VHF </li><li style="flex:1">Mal </li><li style="flex:1">Men </li><li style="flex:1">Total </li></ul>consultations <ul style="display: flex;"><li style="flex:1">Baki </li><li style="flex:1">0</li></ul>00001 11 8 1222 6710 362 1702 9996 0<ul style="display: flex;"><li style="flex:1">0</li><li style="flex:1">118 </li></ul>97 10 26 251 0<ul style="display: flex;"><li style="flex:1">442 </li><li style="flex:1">0</li></ul>0000000000000<ul style="display: flex;"><li style="flex:1">6</li><li style="flex:1">0</li></ul>0000000000000000 0000000008 62 0 35 105 0 112 93 205 736 5741 280 3 0000000002311 Borama Lughaya Zeila Subtotal Elberde Hudur 1157 0 16 1173 0 3587 309 1020 5358 89 30 0743 32 128 133 413 532 945 40 1 16132 1481 4794 24718 17096 4975 41824 63895 187518 36673 224191 27891 2080 <ul style="display: flex;"><li style="flex:1">Bakool </li><li style="flex:1">0</li></ul><ul style="display: flex;"><li style="flex:1">8</li><li style="flex:1">0</li></ul>0 00<ul style="display: flex;"><li style="flex:1">0</li><li style="flex:1">60 </li></ul><ul style="display: flex;"><li style="flex:1">Waajid </li><li style="flex:1">28 </li></ul>28 121 4125 32 0 207 356 5030 2113 7143 907 29 61 69 137 0137 0Subtotal 17 Districts Huruwaa Subtotal Bossaso Carmo <ul style="display: flex;"><li style="flex:1">20 </li><li style="flex:1">0</li><li style="flex:1">0</li><li style="flex:1">0</li></ul>116 0116 0 2372 1803 4175 44 0 2718 2849 5567 3293 35 798 21 819 73 1 123 0123 3 169 0169 0 128 0128 0 128 2130 1Banadir Bari <ul style="display: flex;"><li style="flex:1">0</li><li style="flex:1">0</li><li style="flex:1">0</li><li style="flex:1">0</li><li style="flex:1">0</li><li style="flex:1">0</li></ul>Iskushuban Ufeyn 08 12 00 01 41 00 00 00 00 00 00 00 00 1393 1347 Subtotal Badale 52 03331 074 033 0941 0300041 0000000283 81032711 1033 Bay <ul style="display: flex;"><li style="flex:1">Baidoa </li><li style="flex:1">329 </li></ul>000 188 0 235 000 55 0 2070 0 266 20 2 105 0 59 0 727 0 12 0 35 90007 14 080 19 00000000 188 0 20000000 00000000 00000000 896 130 8 38 0 00000000 95536 6196 3187 6762 2051 2718 11550 3967 Berdale Bur hakaba Qansahdere Bandarbayla Hafun Qardho Rakko Waciya 0100 0000<ul style="display: flex;"><li style="flex:1">0</li><li style="flex:1">64 </li><li style="flex:1">0</li></ul>542 000 000 80 43 4 263 266 4 253 13 <ul style="display: flex;"><li style="flex:1">4</li><li style="flex:1">0</li><li style="flex:1">0</li><li style="flex:1">0</li><li style="flex:1">0</li><li style="flex:1">0</li><li style="flex:1">4064 </li></ul><ul style="display: flex;"><li style="flex:1">Subtotal </li><li style="flex:1">517 </li><li style="flex:1">290 </li><li style="flex:1">2485 </li><li style="flex:1">164 </li><li style="flex:1">1371 </li><li style="flex:1">38 </li><li style="flex:1">19 </li><li style="flex:1">459 </li><li style="flex:1">2</li><li style="flex:1">0</li><li style="flex:1">0</li><li style="flex:1">1091 </li><li style="flex:1">0</li><li style="flex:1">137064 </li></ul>Page 7 of 13 <ul style="display: flex;"><li style="flex:1">Region </li><li style="flex:1">District </li></ul>Abudwak <ul style="display: flex;"><li style="flex:1">SARI </li><li style="flex:1">ILI </li><li style="flex:1">AWD </li><li style="flex:1">BD </li><li style="flex:1">OAD </li></ul>629 <ul style="display: flex;"><li style="flex:1">Diph </li><li style="flex:1">WC </li><li style="flex:1">Meas </li></ul>106 <ul style="display: flex;"><li style="flex:1">NNT </li><li style="flex:1">AJS </li><li style="flex:1">VHF </li><li style="flex:1">Mal </li></ul>752 <ul style="display: flex;"><li style="flex:1">Men </li><li style="flex:1">Total </li></ul>consultations Galgadud <ul style="display: flex;"><li style="flex:1">28 </li><li style="flex:1">10 </li></ul>172 20 30 31 <ul style="display: flex;"><li style="flex:1">0</li><li style="flex:1">0</li></ul>15 000015 100000015 10 00318 4172 14 0 70003010 0000000000000000020020 44 900558 000000 13 13 40 23 00063 3076 15 031 000000000000000000000000000002000020000000000000000000000000000000000000000000000000260 16 15 039 0000000030000 17726 <ul style="display: flex;"><li style="flex:1">Adado </li><li style="flex:1">137 </li></ul>21 115 14 0315 18 3 124 0 502 220 328 621 17 74 0 18 29 0227 10 1 1468 0 1193 778 04191 74 2 49 5 32 6 55 223 592 14 0 30354 5298 27961 21890 5247 108476 5223 499 Balanbale Dhuusamarreeb El Dere Gelinsor Subtotal B/hawo Burdhubo Doolow 10<ul style="display: flex;"><li style="flex:1">0</li><li style="flex:1">0</li></ul>263 263 28 268 19 125 02317 78 Gedo 00000007 67 9 34 10 71 10 0402 1000 4096 469 3742 821 Elbon Garbahaarey Gedweyne Luuq 176 63 243 1060 2000 392 135 60 112 2699 0<ul style="display: flex;"><li style="flex:1">1</li><li style="flex:1">4274 </li></ul>19124 87971 26111 8260 3962 8034 134338 3862 58 <ul style="display: flex;"><li style="flex:1">Subtotal </li><li style="flex:1">37 </li></ul>3079 1731 973 52 257 6092 2276 5531 2459 1363 41 209 9603 79 3 60 81 388 213

Epidemiological Week 45 (Week Ending 12Th November, 2017)

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