Epidemiological Week 28 (Week ending 15th July, 2018) Highlights Cumulative figures as of week 28 • 232 health facilities across Somalia submitted weekly • 1,576,745 consultations from week 1 reports of epidemic-prone diseases in the electronic to week 28. early warning disease surveillance (EWARN) system in • 5,880 cumulative cases of week 28. • Total number of consultations increased from 51,625 AWD/Cholera and 40 deaths since in week 27 to 54,605 in week 28. December 2017. • A total of 307 alerts were received. 35 of these alerts • 8,880 Accumulative alerts were were confirmed as true alerts in week 28. received, 499 of these, were • The highest numbers of diseases reported in week 28 confirmed as true alerts from week 1 were other acute diarrhoeas (2,306 cases), influenza to week 28, 2018. like illness (1,245 cases) and severe acute respiratory illness (1,559 cases). • 6,201 cumulative cases of suspected measles cases since the beginning of • A total of 146 new cases of suspected AWD/cholera with no death were reported in week 28 compared to 2018. Of the 6,201 measles cases, 151 AWD cases with no death in week 27. 4,112 (66%) are under 5 years while • A cumulative total of 5,880 AWD/cholera cases1, 2,089 (34%) are above 5 years. including 40 deaths have been reported since • 7,624 cumulative cases of Malaria December 2017. were reported since the beginning of • The number of reported measles cases decreased 2018, 3,302(43%) are under 5 years, from 61 in week 27 to 52 cases in week 28. while 4,322(57%) are above 5 years. Table 1. Summary of Alerts for epidemic prone diseases Disease Wk25 Wk26 Wk27 Wk28 Cumulative cases (Wk 2018 2018 2018 2018 1 – 28, 2018) Total consultations 55256 55343 51625 54605 1,576,745 Other Acute Diarrheas 2556 2599 2486 2306 66301 Influenza Like Illness 1678 1195 1342 1245 47,073 Severe Acute Respiratory Illness 1279 1212 1173 1559 28,246 Suspected Measles 92 58 61 52 6201 Confirmed Malaria 476 226 189 431 7624 Acute Watery Diarrhoea 58 76 13 24 2023 Bloody Diarrhea 131 107 62 144 2442 Whooping Cough 34 58 45 74 1358 1 The Cases of AWD/Cholera in the eWARN system are collected from sentinel sites. while the cases of AWD/cholera in Sitrep are collected from temporary CTC sites which doesn't include the Sentinel sites Page 1 of 22 Acute Jaundice 5 16 7 5 122 Suspected Meningitis 0 3 3 2 81 Diphtheria 0 2 0 3 48 Neonatal Tetanus 2 0 0 0 23 Acute Flaccid Paralysis 0 0 0 0 13 Viral Hemorrhagic Fever 0 0 1 0 5 Completeness of Reporting & Reporting Rate Overall, a total of 232 (63%) health facilities submitted their weekly reports on time of the 371 active health facilities in Somalia. In Somaliland, 77 (100%) health facilities (HFs) of the 77 active health facilities submitted reports in week 28. As shown in Table 5, in Puntland, 22(30%) health facilities of the 73 active Health facilities submitted reports in week 28, while no reports were received from Sool region (4HFs) of Puntland. As shown in Table5 and Fig1 below, In South central, 133(60%) health facilities of 221 active health facilities submitted reports in week 28, while 80% of Banadir districts did not submit report due to technical issues of the eWARN mobile system. Fig1: Completness of reporting Somaliland Puntland SCZ 100 80 60 40 20 0 25 26 27 28 Percentage Percentage of the submitted HFs report Epi-week Proportionate Morbidity As shown in figure 2; other acute diarrhoeas (OAD), influenza like illness (ILI), severe acute respiratory illness (SARI), suspected measles and malaria are the commonest causes of morbidity across Somalia in 2018. In week 28, the highest numbers of diseases were other acute diarrhoeas (2,306 cases), influenza like illness (1,245 cases), severe acute respiratory illness (1,559 cases), Suspected measles (52 cases) and Confirmed Malaria (431 cases). Fig2: Commonest Causes of Morbidity during Week 1 to 28 3,000 2,000 1,000 0 Wk25 Wk26 Wk27 Wk28 other acute Diaria influence like illness Severe Acute Respiratory Illness Suspected Measles Confirmed Malaria Page 2 of 22 AWD/Cholera situation in Somalia Fig3: District reporting cases in week 28 Following the heavy rains that have led to the floods in the Juba land and Shabelle basins, there has been an observed increase in the number of new AWD/Cholera cases (fig 4). The cholera outbreak that started in December 2017 in Beletweyne along river Shabelle has spread to Jowhar, Kismayo, Afgoye Merka and Banadir. The cholera spread is expected to increase due to the floods that have led to contamination of water sources in the flood affected regions. Floods have also led to blockage of access of health services which will contribute to delayed health seeking by the affected populations with. Over the past 2 weeks, there has been decrease in the number of AWD/Cholera cases reported in Lower Shabelle, Banadir and Lower Jubba; the regions that are affected by floods. In week ending 15th July, active transmission of AWD/cholera was reported in Kismayo district in Lower Jubba, Afgoye Kurtunwarey, Brava and Merka in Lower Shabelle as well as in 11 districts of Banadir region (Darkenly, Daynile, Hodan, Madina, Waberi, HamarWeine, Hamarjabjab, Shingani, Wardhigley, Yaqshid, and Howlwadag districts) (fig 3). In Kismayo, affected communities especially in Farjano IDP are reportedly using contaminated water due to floods. As shown in table 1, there was a decrease in the number of cases reported from 151 in week 27 to 146 in week 28. The Oral Cholera Vaccination that was implemented in 11 high risk districts in 2017 of the central region has greatly contributed to the reduction in the number of new AWD/cholera cases compared to the same time in 2017(fig 4). Fig 4. AWD/Cholera cases in Somalia July 2017-July 2018 1200 4.0 Cases Total Deaths CFR (%) 3.5 1000 3.0 800 2.5 600 2.0 1.5 400 1.0 200 0.5 0 0.0 Numberof AWD/Cholera cases week 2 week 4 week 6 week 8 week 14 week 10 week 12 week 16 week 18 week 20 week 22 week 24 week 26 week 28 Week Week 52 Week 30 Week 32 Week 34 Week 36 Week 38 Week 40 Week 42 Week 44 Week 46 Week 48 Week 50 weeks Week 28 Aug.17 Sep.17 Oct.17 Nov.17 Dec.17 Jan-18 Feb-18 Mar.18April.18May.18June.18Jul.18 Page 3 of 22 Table 2. Summary of AWD/Cholera cases in different regions States Week 27 Week 28 Cumulative as of 15th July 2018 Regions Ending 8th July 18 Ending 15th July 18 Cases Deaths CFR (%) Cases Deaths CFR (%) Cases Deaths CFR (%) Banadir 75 0.0 0.0 49 0 0.0 2295 18 0.8 Jubba land L/ Jubba 59 0.0 0.0 74 0 0.0 2176 15 0.7 South west L/ Shabelle 5 0.0 0.0 5 0 0.0 294 4 1.4 Hir-shabele M/Shabelle 12 0.0 0.0 18 0 0.0 550 2 0.4 Hiraan 0 0 0.0 0 0 0.0 565 1 0.2 Total 151 0.0 0.0 146 0 0.0 5880 40 0.7 NB.Deaths are included among cases. Banadir Region is not a state Cholera Situation in Lower Jubba, Lower & Middle Shabelle and Banadir. • Banadir region which included Mogadishu city has one of the highest concentrations of refugees where access to safe water and proper sanitation is limited. The AWD/Cholera outbreak in Banadir region started in January 2018 following reports of similar outbreak in Beletweyne district of Hiraan region. Of the 17 districts that make up Banadir region, 11 have so far reported cases which have been managed in Banadir CTC located in the capital Mogadishu. There has been decrease in the number of AWD/Cholera cases from 75 cases with no death to 49 cases with no death in the past 2 weeks. More than 45% of the AWD cases reported in Banadir are children below 2 years of age. • In Lower Jubba, The AWD/Cholera outbreak started in week 5 of 2018 in the IDP communities of Farjano in Kismayo, where access to safe water and sanitation is limited. The reported cases of AWD/Cholera did not receive OCV which was implemented in Kismayo in March 2017. The persons may have been absent during the OCV campaign. Over the past week, the number of AWD/Cholera cases in Lower Jubba has increased from 59 cases with no deaths to 74 cases with no death. More than 59% of the cholera cases reported from Lower Jubba are children below 2 years. • The AWD/Cholera outbreak in Lower Shabelle region started in week 17 of 2018and Afgoye and Merka district started in week 28-2018, as a result of displacement of people due to floods that have been reported in this regions. Brave is the most affected district and cases are being managed in lower Shabelle. More than 60% of the cases reported in Brave are children below 5 years. • In Middle shabelle, it has been reported a new outbreak of AWD/Cholera in the same villages that were affected before. During week 28, a total of 18 cases with no deaths were reported of which 58% of them are children below 2 years old. The affected villages include Hantiwadag, Bulo Seikh and Kulmis.