Epidemiological Week 9(Week ending 5thMarch, 2018) Highlights Cumulative figures as of week 9 • Total of 196 Health Facilities across Somalia have submitted weekly report of communicable diseases in the electronic early • 547,303 cumulative week 1 to week 9 warning disease surveillance system in week 9, 2018. cases of all diseases • Total number of consultations decreased from 55,775 in week 8 • 1,313 cumulative cases of AWD and 8 to 51,174 in week 9. • The highest number of diseases in week 9 were: other acute deaths since December 2017. diarrhoeas (2,061 cases), influenza like illness (1,697 cases) followed by severe acute respiratory illness (1,038 cases) • 3,555 cumulative cases of suspected • A total of 174 new cases of AWD with no deaths were reported in measles cases since the beginning of week9 compared to 148 AWD cases no deaths death in week 8. 2018. • A cumulative total of 1,3131 cases including 8 deaths have been • Of the 3,555 measles cases, 2,220 (62%) reported since December 2017. are under 5 years while 1,335 (38%) are • The new AWD/cholera cases reported in Beletweyne started in above 5 years December 2017. All the new outbreaks in Banadir, Kismayo and Jowhar started in 2018 • The number of measles cases decreased from 586 in week 8 to 447 cases reported in week 9. Disease Wk7 2018 Wk8 2018 Wk9 2018 Cumulative cases (Wk 1 – 9, 2018) Total consultations 56447 55775 51,174 547,303 Other Acute Diarrheas 2006 2068 2061 20073 Influenza Like Illness 1890 1787 1697 18,556 Severe Acute Respiratory Illness 963 1112 1038 8,336 Suspected Measles 355 586 447 3555 Confirmed Malaria 205 142 108 2223 Acute Watery Diarrhoea 60 62 74 673 Bloody Diarrhea 61 38 56 421 Whooping Cough 81 104 23 416 Acute Jaundice 0 5 2 36 Suspected Meningitis 1 3 3 23 Diphtheria 13 6 1 23 Neonatal Tetanus 0 0 0 17 Acute Flaccid Paralysis 0 0 0 1 Viral Hemorrhagic Fever 0 0 0 2 Total number of Consultations and number of reporting sites 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 Completeness of Reporting Out of 265 Health Facilities expected to submit weekly report of communicable diseases in the electronic early warning disease surveillance system across Somalia, 196 reported data in week 9. Thus the completeness of reporting about 74%. A total of 51,174 consultations were recorded in week 9, 2018. (See fig1) Chat 1: Consultations and reporting sites, week 1 to 8, 2018 800 80,000 700 70,000 600 60,000 500 50,000 400 40,000 Consultations Reporting sites 300 30,000 200 20,000 100 10,000 0 0 WK 1 WK 2 WK 3 WK 4 WK 5 WK 6 WK 7 WK 8 WK 9 Consultations Reporting sites Proportionate morbidity Other acute diarrhoeas, influenza like illness Severe Acute respiratory illness, suspected measles and Malaria are the commonest causes of morbidity across Somalia in 2018. In week 9, the highest number of diseases: other acute diarrhoeas (2,061 cases), influenza like illness (1,697 cases) followed by severe acute respiratory illness (1,038 cases) Chart 1. Commonest causes of morbidity during week 1 to 9 3000 2500 2000 1500 1000 500 0 Wk1 2018 Wk2 2018 Wk3 2018 Wk4 2018 Wk5 2018 Wk6 2018 Wk7 2018 Wk8 2018 Wk9 2018 other acute Diaria influence like illness Severe Acute Respiratory Illness Suspected Measles Confirmed Malaria Situation update of AWD/Cholera AWD/Cholera situation in different regions of Lower Jubba ,Hiiran,Middle Shabelle and Banadir Over the past 13 Weeks, there has been a significant increase in the number of AWD/Cholera cases reported Districts Reporting Cases in Week 9 in four regions (Banadir, Lower jubba Middle Shabelle and Hiiran). In week 9, active transmission of AWD/cholera was reported in Beletweyne district of Hiraan region, Jowhar district Middle Shabelle and Lower jubba district Kismayo as well as in 10 districts of Banadir region. In Hiraan, Kismayo and Jowhar affected communities are reportedly using contaminated water from open water sources. The AWD outbreak that was reported in Beletweyne in December 2017 is responsible for the spread to other regions that are all located at the banks of river shabelle. The Oral Cholera Vaccination that was implemented in 11 high risk districts of the central region has greatly contributed to the reduction in the number of new AWD/cholera cases according to last year. Fig 1. AWD/Cholera cases in Somalia Feb 2017-Feb 2018 5000 5.00 4500 4.50 4000 4.00 3500 3.50 3000 3.00 2500 2.50 CFR 2000 2.00 Number of AWD/Cholera casesAWD/Cholera of Number 1500 1.50 1000 1.00 500 0.50 0 - WK 1 WK 2 WK 3 WK 4 WK 5 WK 6 WK 7 WK 8 WK 9 WK 1 WK 2 WK 3 WK 4 WK 5 WK 6 WK 7 WK 8 WK 9 WK WK 10 WK 11 WK 12 WK 13 WK 14 WK 15 WK 16 WK 17 WK 18 WK 19 WK 20 WK 21 WK 22 WK 23 WK 24 WK 25 WK 26 WK 27 WK 28 WK 29 WK 30 WK 31 WK 32 WK 33 WK 34 WK 35 WK 36 WK 37 WK 38 WK 39 WK 40 WK 41 WK 42 WK 43 WK 44 WK 45 WK 46 WK 47 WK 48 WK 49 WK 50 WK 51 WK 52 WK Jan Feb Mar Apr May Jun Jul Aug Sept Oct Nov Dec Jan Feb 2007 2018 weeks Total Total CFR Table 2. Summary of AWD/Cholera cases in different regions Week 8 Week 9 Cumulative as of Epi- Week 49, 2017, Wk Region (19th -25th Feb 2018) (26th Feb to 4th Mar 9. 2018) 2018 Cases Deaths CFR (%) Cases Deaths CFR (%) Cases Deaths CFR (%) Hiraan 8 0 0 10 0 0 515 1 0.2 Banadir 51 0 0 48 0 0 405 2 0.5 Lower Jubba 29 0 0 33 0 0 193 3 1.6 Middle Shabelle 60 0 0 83 0 0 200 2 1.0 Total 148 0 0 174 0 0 1313 8 0.6 The AWD/Deaths reported in this table have not been confirmed by stool analysis. Cholera Situation in Hiraan, Lower Jubba, Middle Shabelle and Banadir. • The current AWD/Cholera event started in Beletweyne districts in December 2017 and continued in 2018. There has been an observed reduction in the number of new AWD/Cholera cases in Beletweyne over the past weeks with only 10 cases and no deaths reported in week 9. 90% of all the affected cases in Beletweyne are children below 5 years. Only 4% of the AWD/Cholera cases reported in Hiraan received OCV vaccination during the campaign that was conducted in Xaawo Taako and Koshin in March 2017 • The AWD/Cholera outbreak in Banadir region started in week 1 of 2018 following reports of similar outbreak in Hiraan. Banadir region is one of the regions with the highest concentration of IDPs where access to safe water and sanitation facilities are limited. Of the 15 districts that make up Banadir region, 10 have so far reported cases and these are managed in Banadir CTC located in the capital Mogadishu. • Lower Jubba is one of the cholera hotspots in Somalia located at the border with Kenya in the South. The current AWD/Cholera outbreak in Kismayo district started in week 5 of 2018 in the IDP communities of Farjano where access to safe water and sanitation is also limited. The district is characterised by returnees from Kenya as well as those displaced by war in Middle Jubba. Even when OCV was implemented in Kismayo in March 2017, the reported cases of AWD/Cholera did not receive OCV. This may be attributed to these being new cases who were absent during the time of the vaccination • Middle shabelle region is one of the cholera hot spots for the past decade with limited access to safe water and sanitation. The new AWD/Cholera outbreak in Middle Shabelle started in week 7 of 2018 and the most affected villages of Hantiwadag, Kumis , Bulo Sheik and Horseed. of the 200 cases so far reported, 51% are children below 5 years. Table 3. Distribution of AWD/cholera cases per district in Somalia (Dec.2017 - March. 2018) Week 9 26th Feb- 4th Mar - 2018 Cumulative (week 1-9- 2018) Region District cases <5yrs cases Deaths CFR (%) Live Deaths CFR (%) >5yrs Heliwaa 0 0 0 0 3 0 0 Banadir Daynile 5 4 0 0 64 2 3.1 Hamar Weine 0 0 0 0 4 0 0 HamarJabjab 1 1 0 0 12 0 0 Dharkenley 3 2 0 0 56 0 0 Hodan 5 4 0 0 111 0 0 Howlwadag 2 0 0 0 14 0 0 Karan 5 0 0 0 10 0 0 Madina 8 0 0 0 92 0 0 Shibis 0 0 0 0 3 0 0 waberi 3 1 0 0 17 0 0 Wardigley 1 2 0 0 11 0 0 Yaqshid 1 0 0 0 8 0 0 Hiiran Beletweyne 3 7 0 0 515 1 0.2 Lower Jubba Kismayo 19 14 0 0 193 3 1.6 Middle Shabelle Jowhar 34 49 0 0 200 2 1.0 Total 90 84 0 0 1313 8 0.6 Response activities implemented during the week Coordination and Leadership • Weekly meetings were held in Banadir hospital CTC between Ministry of Health, Health and WASHcluster partnersto plan for the implementation of response activities.