Zimbabwe Weekly Epidemiological Bulletin Number 168 Epidemiological week 24 (week ending 17 June 2012) Highlights: Week 24:11 -17 June 2012) Typhoid outbreak 1 cholera death reported in Chiredzi district 1 typhoid case reported in Chegutu district Since 10 October 2011, Harare City has been 5205 malaria cases and 4 deaths reported experiencing an outbreak of typhoid fever. The disease also spread to Chitungwiza City, Mashonaland Central Province (Bindura Contents district), Mashonaland West Province (Zvimba A. General context and Chegutu districts) and Midlands Province B. Epidemic prone diseases (Chirumanzu district). This week one new case was reported from Chegutu district. The last C. Events of public health importance in the region case was in Chegutu was reported on the 15th D. Completeness and timeliness of the national data April 2012. As of 17 June 2012, a total of 4781 E.Acknowledgments cases and 2 deaths (CFR= 0.04%) have been F.Annexes reported of which 68 were laboratory confirmed. 1. Classification of events that may constitute a The typhoid fever epidemic curve is shown in Public Health Emergency of International Figure 1. Concern Figure 1: Harare and Bindura Typhoid fever A. General Context Epidemic Curve, 10 October 2011–17 June 2012 120 On 3 May 2012, an outbreak of cholera was reported in Chiredzi district. 100 80 Since 10 October 2011, an outbreak of typhoid 60 fever has been reported in Harare City. The disease spread to other provinces. 40 20 Number ases of Number Suspected outbreaks of malaria have been 0 2011/10/02 2011/10/16 2011/10/30 2011/11/13 2011/11/27 2011/12/11 2011/12/25 2012/01/08 2012/01/22 2012/02/05 2012/02/19 2012/03/04 2012/03/18 2012/04/01 2012/04/15 2012/04/29 2012/05/13 2012/05/27 reported in the following districts: Mudzi, Seke, 2011/09/18 Hurungwe, Makonde, Zvimba, Mt Darwin and Beitbridge. Seasonal increases in the number of Date of onset cases have been reported in other districts. One suspected/confirmed typhoid case reported Figure 2: Map of the distribution of typhoid cases in Chegutu. by place of residence, Harare City, 10 Oct 2011- 17 June 2012 No reports of influenza A and measles outbreaks countrywide. B. Epidemic prone diseases Cholera outbreak On 3 May 2012, Chiredzi district reported an outbreak of cholera. As of 17 June 2012, a total of 22 cases including 1 death (CRF= 4.54%) were reported of which 11 were found positive by laboratory test. One cholera death reported th from Old Boli Clinic on the 19 of June 2012. Anthrax This weekly Epidemiological Bulletin is published jointly by the Ministry of Health and Child Welfare, Zimbabwe and the World Health Organization. 1 For correspondence: Email: [email protected] and [email protected] or call: +263772104257 or +263772277893 Zimbabwe Weekly Epidemiological Bulletin Kariba 183 (3.52) This week, no anthrax case was reported. Since the beginning of 2012, a total of 18 anthrax cases in human have been reported. C. Completeness and timeliness of the Malaria National data This week, a total of 5205 malaria cases and 4 National data reported in week no 24 deaths (CFR= 0.08%) have been reported while Completeness decreased from 83% to 80% 6232 cases and 3 deaths (CFR= 0.05%) were Timeliness decreased from 87% to 86% reported in week 23. Since the beginning of 2012, 215 903 cases and 167 deaths (CFR= D. Events of public health importance within 0.08%) have been reported through the weekly SADC surveillance system. Table 3 shows the 10 most affected districts. No new events reported. Table 3: The top 10 malaria affected districts E. Acknowledgements in week 24, Zimbabwe, 2012 All health workers, operating at different levels District Frequency of the health system, providing information are n= 5205 (%) greatly acknowledged. In addition, special Mutoko 613 (11.78) thanks to Health and WASH cluster members Mt Darwin 540 (10.37) for sharing their data with our team. Chimanimani 380 (7.3) Chipinge 330 (6.34) MOHCW is grateful to all Partners including Nyanga 327 (6.28) UN family and NGOs for their support. Information on events of public health Mudzi 318 (6.11) importance occurring within SADC is Mutare 278 (5.34) consolidated from WHO daily summary of Makonde 271 (5.21) health events. Zaka 254 (4.88) This weekly Epidemiological Bulletin is published jointly by the Ministry of Health and Child Welfare, Zimbabwe and the World Health Organization. 2 For correspondence: Email: [email protected] and [email protected] or call: +263772104257 or +263772277893 Zimbabwe Weekly Epidemiological Bulletin Annex 1: Classification of Events that may constitute a Public Health Emergency of International Concern There are three groups of events if detected by the national surveillance system should trigger the use of the IHR (2005) Decision Instrument to be notified as they may constitute Public Health Emergencies of International Concern. These are: 1. A case of unusual or unexpected diseases which may have serious public health impact: smallpox, poliomyelitis due to wild-type poliovirus, human influenza caused by a new subtype and SARS. 2. Any event of potential international public health concern including events of unknown causes or sources and those involving other events or diseases: environmental health emergencies (natural events, chemical and radio-nuclear events, technological incidents, complex emergencies and deliberate events) Food borne diseases Zoonotic diseases or other infectious diseases. 3. Any of following diseases that have demonstrated the ability to cause serious public health impact and spread rapidly and internationally: Cholera, pneumonic plague, yellow fever, viral haemorrhagic fevers, West Nile Fever, other diseases that are of special national or regional concern e.g. dengue, RVF and meningococcal disease. This weekly Epidemiological Bulletin is published jointly by the Ministry of Health and Child Welfare, Zimbabwe and the World Health Organization. 3 For correspondence: Email: [email protected] and [email protected] or call: +263772104257 or +263772277893 Zimbabwe Weekly Epidemiological Bulletin Annex 2: Standard Case Definitions Diseases Standard Case Definitions Cholera Suspected case In an area where there is no cholera outbreak, any person aged five years or more, presenting with severe dehydration or death from acute watery diarrhoea In an area where there is a cholera outbreak, any person aged two years or more presenting with acute watery diarrhoea, with or without vomiting Confirmed case A suspected case in which Vibrio cholerae sero-groups O1 or O139 has been isolated in the stool. Note All suspected cases under the age of two years must be confirmed. The inclusion of all ages in the case definition somewhat reduces specificity, that is, inclusion of more non-cholera childhood diarrhoea cases (mainly those below 5years). It does not impede meaningful interpretation of trends. Teams should monitor any shift in the age distribution of cases, which might indicate a changing proportion of non- cholera cases among patients seen. Malaria Suspected uncomplicated malaria Any person living in a malaria area or history of travelling in a malaria area within the last 6 weeks, presenting with fever, malaise, chills, and rigors, without signs of severe disease such as vital organ dysfunction Confirmed uncomplicated malaria Is suspected uncomplicated malaria with laboratory diagnosis by malaria blood slide or RDT for malaria parasites Confirmed severe malaria A patient hospitalized with P. falciparum asexual parasitaemia as confirmed by laboratory tests with accompanying symptoms of severe disease (vital organ dysfunction) Typhoid Suspected case Any person with gradual onset of steadily increasing and then persistently high fever, chills, malaise, headache, sore throat, cough, and, sometimes, abdominal pain and constipation or diarrhoea Confirmed case A suspected case confirmed by isolation of Salmonella typhi from blood, bone marrow, bowel fluid or stool Diarrhoea Suspected case Passage of 3 or more loose or watery stools in the past 24 hours with or without dehydration or some dehydration and two or more of the following signs: restlessness, irritability, sunken eyes, thirsty, skin pinch goes back slowly, or severe dehydration and two or more of the following signs: lethargy or unconsciousness; sunken eyes; not able to drink or drinking poorly; skin pinch goes back very slowly Confirmed case Suspected case confirmed with stool culture for a known enteric pathogen. Note: Laboratory confirmation of specific agent causing outbreak is not routinely recommended for surveillance purposes. This weekly Epidemiological Bulletin is published jointly by the Ministry of Health and Child Welfare, Zimbabwe and the World Health Organization. 4 For correspondence: Email: [email protected] and [email protected] or call: +263772104257 or +263772277893 Zimbabwe Weekly Epidemiological Bulletin Annex 3: Alert/Action Epidemic Thresholds for selected epidemic prone diseases and other diseases of public health importance in Zimbabwe Disease or condition Alert Threshold Action Threshold Measles 5 suspected cases within a district in a 1 measles IgM confirmed case month Note: This also applies to closed settings like Refugee camps, schools, or health facilities Meningococcal meningitis 1 suspected case 1 confirmed case Plague 1 suspected case 1 confirmed case Rabies 1 case of a bite from 1 case of a bite from suspected rabid animal (Suspected rabid bites) suspected rabid animal Trypanosomiasis 1 suspected case 1 case in an area that is not endemic or For endemic areas 3 cases per 100,000 Typhoid fever 1 case 5 suspected cases per 50,000 population or 20 suspected cases per District’s catchment area or any 1 confirmed case by blood culture Viral Haemorrhagic Fever 1 suspected case 1 confirmed case Outbreak of unknown 3-5 cases or deaths with Any cluster of cases or deaths that had similar cause similar symptoms that symptoms over a short period of time and fail to don’t fit most case respond to treatment for the usual causes of the definitions symptoms Acute Flaccid paralysis 1 AFP case 1 confirmed case of polio (virus isolated).