Somalia Weekly Update Week-26 Ending 01 July 2018 Highlight: TROCAN • A new VDPV2 isolated from a contact (EPID SOM/GDO/DLO/18/002-C1) from Dolo district in Gedo region of South zone. It has 38 nucleotide differences from Sabin2. The VP1 sequence shows it has no close genetic link to previously sequenced cVDPV2s; it is classified as VDPV2 and represents a VDPV2 event that has not previously been identified. Dolo • The contact sample is collected from an IDP camp called KABASA • Dolo is one of the 5 fully accessible districts in south from the total 29 districts in south zone. The districts borders both Ethiopia and Kenya characterized by high population moment in all directions and is around 40 km from Mandara town in Kenya. There is immunization activity in the district and the index case took 6 doses of OPV including 2 doses from routine EPI. The last SIA was conducted in May, 2018 during NID-1. - No reporting of a new positive environmental sample for cVDPV2 or cVDPV3 last week; the date of collection of most recent positive environmental sample for cVDPV2 or cVDPV3 was on 17th May 2018 from Waberi and Hamerewoini districts in Banadir. A cVDPV3 and one co-infected (cVDPV2 & cVDPV3) cases reported from Bulloburti and Warhsakeh districts of Hiran and Middle Shabelle regions in Central zone - An index case with co-infection of cVDPV2 and cVDPV3 from Bulloburti district in Hiran region had date of onset on 11 May. In addition, cVDPV3 was isolated from three contacts of this case. - cVDPV3 case isolated from an AFP with dates of onset on 23 May is from Warsheikh district of Middle Shabelle region. Summary of cVDPV2 and cVDPV3 detected from 2 AFPs, 4 Contacts and 2 community samples ➢ EPID No: SOM/HRN/BBT/18/002 and the 3 contacts have cVDPV3 The index: ⁻ Location of case: JAMECO MUBARAK village –BULO BURTI District-Hiran Region- Central zone ⁻ Date of onset: 11 May 2018 ⁻ Date Stool collection 1st and 2nd: 13th and 14th May 2018 ⁻ Accessibility of the area: The village is inaccessible, the last SIA was 2009 activity ⁻ Age and OPV dose status [if case]:72 months female, 0 Dose of ⁻ Sequencing results: PV-2 VDPV with 43nt difference and 17 nt difference from Sabin ⁻ Closest match: genetically linked to the VDPV3 sequence for ES/SOM/BAN/HMW/KAWMA-1/18/006 (Kawma ENV site, emergence group SOM- BAN-2) ➢ EPID No: SOM/MSH/WRS/18/003 and its third contact (SOM-MSH-WRS-18- 001-C3) Warshaikh The index: ⁻ Location of case: Bohi village –Warsheikh District-Middle Shaballe-- Central zone ⁻ Date of onset: 23 May 2018 ⁻ Date Stool collection 1st and 2nd: 30st and 31th May 2018 ⁻ Accessibility of the area: The village is accessible ⁻ Age and OPV dose status [if case]:39 months female, 0 Dose of ⁻ Sequencing results: PV-3 VDPV with 19nt difference from Sabin ⁻ Closest match: The PV3 VDPV is genetically linked to the VDPV3 sequence for ES/SOM/BAN/HMW/KAWMA-1/18/006 (Kawma ENV site, emergence group SOM- BAN-2). The new PV3 viruses are classified immediately are cVDPV3 ➢ EPID No: SOM/LJB/JMW/18/CC1/001 and SOM/LJB/JMW/18/CC1/003 (Community samples) ⁻ Location of case: SANGUNI village –Jamamme west District- Lower Jubba Region- South zone ⁻ Date Stool collection 1st and 2nd: 24 April 2018 ⁻ Accessibility of the area: The district is completely inaccessible ⁻ Accessibility of the area: The village is inaccessible since 2015 and no SIA activity ⁻ Age and OPV dose status [if case]:18 &36 months females, 0 Dose ⁻ Sequencing results: PV-3 VDPV with 16nt difference from Sabin ⁻ Closest match: not genetically linked to any other previously sequenced VDPV3s; it is classified as VDPV3 and represents a VDPV3 event Summary of VDPV2 and VDPV3 isolated from AFPs, Contacts and Community samaples SOM/MSH/WRS/18/0 SOM-MSH-WRS-18- SOM/HRN/BBT/18/002/SOM/HRN/BBT/18/002/ SOM/HRN/BBT/18/002/ SOM/LJB/JMW/18/CC1/ SOM/LJB/JMW/18/CC1/0 SOM/GDO/DLO/1 IDCODE SOM/HRN/BBT/18/002 03 001-C3 C1 C2 C3 001 03 8/002/C1 Type of Sample AFP case Contact-3 AFP case Contact-1 Contact-2 Contact-3 Community sample Community sample Contact cVDPV2 and cVDPV3 co- Final result cVDPV3 cVDPV3 cVDPV3 cVDPV4 cVDPV5 cVDPV3 cVDPV3 VDPV2 infection AXMED MOHAMED NAJMA MOHAMED SAMIRA MALUULANO NAME ABSHIR ALI MOALIM ABSHIR ALI MOALIM ISTAR ALI MOHAMED SAHAL OMAR AMIN SAREDO OMAR AMIN CUMAR ABDALA SIMBA AGE 39 39 72 48 26 64 36 18 24 SEX Male M Female Male Female Male Female Female Male Zone Cnetral Cnetral Central Central Central Central South South South PROVINCE MIDDLE SHABELLE MIDDLE SHABELLE HIRAN HIRAN HIRAN HIRAN L/JUBBA L/JUBBA Gedo DISTRICT WARSHEIKH WARSHEIKH BULO BURTI BULO BURTI BULO BURTI BULO BURTI JAMAMeE WEST JAMAMeE WEST Dolo VILLAGE BOHI BOHI JAMECO MUBARAK JAMECO MUBARAK JAMECO MUBARAK JAMECO MUBARAK SANGUNI SANGUNI KABASA IDP SIA in the area No No no SIA no SIA no SIA no SIA no SIA no SIA yes HOTCASE Yes Yes Contact-1 Contact-2 Contact-3 Community sample Community sample Contact Date of onset 5/23/2018 5/11/2018 Date of Notification 5/28/2018 5/13/2018 Date of investigation 5/28/2018 5/13/2018 Notified by BANADIR HOSPITAL WARDI MCH DSTCOLL1 5/30/2018 5/30/2018 5/13/2018 5/13/2018 5/13/2018 5/13/2018 4/24/2018 4/24/2018 5/29/2018 DSTCOLL2 5/31/2018 5/14/2018 Accessibility of the Accessible Accessible Inaccessible Inaccessible Inaccessible Inaccessible Inaccessible Inaccessible Accessible village LIFESTYLE Nomadic Nomadic Nomadic Nomadic Nomadic Nomadic Nomadic Nomadic Urban EPIDOSES 0 0 0 0 0 0 0 0 2 NIDDOSES 0 0 0 0 0 0 0 0 4 DOSES 0 0 0 0 0 0 0 0 6 Date of last OPV no SIA no SIA no SIA no SIA no SIA no SIA no SIA no SIA 5/8/2018 IPV 0 0 0 0 0 0 0 0 0 Date of last result 6/15/2018 6/15/2018 6/15/2018 6/15/2018 6/15/2018 6/15/2018 6/15/2018 6/15/2018 6/30/2018 Summary Environmental Samples and Lab Classification Epidemiological Week-2017 Epidemiological Week-2018 District Date Name 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 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 of of Ma Ma Ma Ma Ma Jun Establishmen J. J. J. J. F. F. F. F. M. M. M. M. M. Ap.Ap.Ap.Ap. Jun Sites y y y y y e t e 7 04 11 18 25 01 08 15 22 01 08 15 22 29 05 12 19 26 03 10 17 24 31 14 Waberi 21October 19 Sept. 2017 vDPV2 Urobo 20 Sept. 2017 Shangani 21 Sept. 2017 Hamerew Kawma oini Hodan Egy. Hospital 23 Nov. 2017 No sample collected due to flooding of sewage of flooding to due collected sample No Legend 1 Not scheduled 6 Sabin 11 WPV1+cVDPV2 2 Pending 7 NPENT + Sabin 12 Sent for sequencing 3 Negative 8 cVDPV2 13 Scheduled but not collected 4 NEV 9 WPV1 14 Sabin 2 5 NPENT 10 WPV3 15 Sabin + NPEV + NEV Next steps • Detailed case and field investigation ongoing, reinforce active surveillance • Response planned - mOPV2 synchronized round starting on 9th -11th July 2018 • Identify hot cases through active case search in the community • Evaluate accessibility and security in Hiran Province to ensure good SIA coverage • Conduct high quality SIA using mOPV2 in the accessible settlements of the area • Revitalize social mobilization for polio vaccination and surveillance of paralysis, especially through radio and TV. • Review strategies to increase parents awareness prior to rounds and reduce child/parents absence SIA Activity Calendar Apr – Dec. 2018 Activity Target area Date NID 1 bOPV Somaliland and Puntland 30 Apr- 03 May 2018 South and Central Except Banadir, Lower and Middle NID 1 bOPV 5-8 May 2018 Shabelle Third response round mOPV2 Banadir, Lowe Shabelle and Middle Shabelle 5-8 May 2018 Campaign South and Central regions without Banadir, Lower and R 1 synchronized Middle Shablle regions synchronized with Kenya 9 - 12 Jul 2018 mOPV2 Campaign (with Ke, ET) response campaign Small scale bOPV Response Banadir, Lower and Middle Shablle regions 23 Jul 2018 South and Central regions with out Banadir, Lower and R 2 synchronized OPV2 Campaign Middle Shabelle regions synchronized with Kenya 4 – 8 Aug. 2018 (with Ke, ET) response campaign 28 - 30 Aug. 2018 R 1 bOPV synchronized Ke & ET All 19 regions in Somalia (2,499,010) TBC 24 – 27 Sep. 2018 R 2 bOPV synchronized Ke & ET All 19 regions in Somalia (2,499,010) TBC Country Campaign Preparedness • Overall preparedness level: Somalia is ready for the campaign scheduled to kickoff on the 9th of July 2018 • Current status update # DFAs to % DFAs to Region # District # DFAs ➢ Team level micro plan done, revised is ready for use use ODK use ODK ➢ Monitors/supervisors training completed ➢ TOT training given for RPOs, DPOs, DFAs and IC& PC LQAS supervisors and monitors conducted in Mogadishu and 6 regional hubs ➢ Cascade training for DPOs and DFAs conducted in all Bakool 5 50 19 38% districts team training Bay 5 148 50 34% ➢ Budget: PO not yet received by zones ➢ C4D activities: on progress Gedo 8 120 43 36% ➢ Vaccine distribution: on progress L Jubba 3 70 23 33% • MOH states/other partners informed on the new campaign dates and involved the synchronized mOPV Galgad 9 86 29 34% campaign preparation Grand Total 21 388 135 35% Summary of response activities using mOPV2 Three rounds of mOPV2 campaigns mOPV2 response areas mOPV2 rounds IM coverage conducted targeting all <5 (Benadir, Middle 100% and Lower Shabelle) 99% 98% 98% ➢ st 97% 97% 97% 1 Round (10-13 Dec.