Weekly Epidemiological Bulletin Ministary of public Health Papulation Electronic Disease Early Warning and Response System Primary Health Care Sector DG for Disease Contraol Surveillance Volume 04, Issue 29, Epi week 29, 18 - 24 July 2016 H i g h l i g h t s eDEWS Reporting Rates vs Consultations in All Governorates, Epi weeks 1 to 29, 2016 96% 96% 96% 100% 96% 95%94 %94 %93 %95 %95 %95 % 95% 92%92 %93 %94 % 140,000 94%94 %96 %92 %94 95% % 95%95 % 90%87 % 90% 84% • During week no. 29, 2016; 87% (893/775) health facilities from 22 governorates provided 79%81 % 120,000 80% valid surveillance data. 70% 100,000 60% 80,000 50% 40% 60,000 30% P e r c e n t a g e g a t n e c r e P 40,000 • The total number of consultations reported during the week in 22 governorates was 20% C a i o n s u l t o n s t 20,000 130914 compared to 122028 the previous reporting week. Acute respiratory tract infections 10% 0% - Lower Respiratory Infections (LRTI), Upper Respiratory Infections (URTI), Other acute diarrhea (OAD) and Malaria (Mal) were the leading cause of morbidity this week. Reporting Rate Consultations Distribution of Reporting Rates by Governorates (Epi-week 29 , 2016) • A total of 1040 alerts were generated by eDEWS system in week 29, 2016; Of these 771 100% alerts were verified as true for further investigations with appropriate response. 80% % % % % % 60% % % % % % % % % % % % % % % 99 97 96 96 96 % 100 100 100 100 100 100 92 40% 92 88 84 84 % 80 80 75 70 % • Altogether 122 alerts for Upper Respiratory Infections, 120 Other acute diarrhea, 110 20% 56 35 0% Lower Respiratory Infections, 87 Typhoid and Paratyphoid Fever, 81 Pertussis, 62 Malaria, et N o. F p H Ro r s 51 Bloody diarrhea, 39 Measles, 30 Influeza Like Illness, 28 Dengue Fever, 9 Schistosomiasis, 8 Meningitis, 6 each for Mumps and Acute Flaccid Paralysis, 5 Severe Acute Respiratory Infection, 2 each for Cut.Leishmaniasis, Acute viral hepatitis and Neonatal Tetanus, 1 Reporting Rate Target Diphtheria were received and responded in system generated. • Online disease surveillance and response system was launched in 4 governorates (Aden, Abyan, Lahj and Taiz) in March 2013 and the expansion phase has stared in 6 Governorates (Sana'a City, Hodaidah, Hajjah, Ibb,Al-Mukalla and Sa'da ) in November 2013. The next expansion phase has 6 Governorates (Amran, Shabwah, Al-Mahrah, Sana'a Gov., HadramoutAl- wady and Dhamar).The last eDEWS expand in new 6 Governorates (Al- Baidha, Mareb, Al-Jawf, Al-Mahweet,Rayma and Al-Dhale). Leading causes of morbidity and mortality in Epi-week 29, 2016 Suspected dengue outbreak in Al-Hodaidah, Lahj,Shabwah & Aden Gov., Epi weeks 1 to a). Suspected dengue outbreak 29, 2016 Suspected Dengue fever cases • 475 suspected dengue cases were reported in 15 governorates, out of these 98 cases 600 reported from Shabwah, 78 Cases from Al-Hodidah, 38 Cases from Aden and 21 Cases from Lahj, No cases with hemorrhagic manifestations were reported governorate 500 through the eDEWS system. 400 300 NO. of cases 200 • Surveillance is being intensified to ensure that the ongoing dengue outbreak is 100 effectively monitored and other priority communicable disease are reported through alternative sources including private health facilities, mobile clinics, NGO partners on 0 the ground, health workers in the community, and the general public Aden Lahj AlHodaidah Shabwah Leading causes of morbidity and mortality in Epi-week 29, 2016 Proportional morbidity of leading priority diseases, Epi weeks 1 to 29, 2016 b. Other leading priority diseases 20.0% 18.0% • URTI (13.6%), suspected malaria (3.1%), OAD (8.4%) and LRTI (5.9%) remain the leading 16.0% 14.0% causes of morbidity representing a total of 31%. 12.0% 10.0% 8.0% 6.0% 4.0% 2.0% • Acute viral hepatitis, acute watery diarrhea and Schistosomiasis represented less than 1% 0.0% Wk 1 Wk 2 Wk 5 Wk 6 Wk 9 Wk Wk 4 Wk 7 Wk 8 of total morbidity in reporting period. Bloody diarrhea represented 0.4% of this morbidity. Wk 3 Wk 10 Wk 13 Wk 14 Wk 17 Wk 18 Wk 21 Wk 22 Wk 25 Wk 26 Wk 29 Wk 11 Wk 12 Wk 15 Wk 16 Wk 19 Wk 20 Wk 23 Wk 24 Wk 27 Wk 28 DD URTI S.Malaria LRTI LRTI 6.2% OAD 8.8% • All diarrheal disease comprised 8.8% and LRTI 5.9% of total morbidity in Pilot URTI 14.3% BD 0.5% Sch 0.1% Governorates this week. Mal 3.2% Rb 0.1% AVH 0.2% Other_Disease Tuberculosis 0.0% 63.8% Mumps 0.1% • All diarrheal disease comprised 8.8% and LRTI 5.9% of total morbidity in all age group. HIV/ AIDS 0.0% Brucellosis 0.2% Guinea Worm 0.0% Chicken Pox 0.1% URTI=Upper respiratory infections; LRTI=Lower Respiratory Infections; ILI=Influeza Like Illness; OAD=Other acute diarrhea; BD=Bloody diarrhea; Susp. Cholera; SARI=Severe Acute Respiratory Infection; Typh=Typhoid and Paratyphoid Fever; Mumps; Sch=Schistosomiasis; Mal=Malaria; Rb=Rabies; AVH=Acute viral hepatitis; Meng=Meningitis; DF=Dengue fever; VHF=Viral hemorrhagic fever; Meas=Measles; CL=Cutaneous Leishmaniasis; Pert=Pertussis; Diph=Diphtheria; NNT=Neonatal Tetanus This weekly Epidemiological bulletin is published jointly by the Ministry of Public Health & Polupation and World Health Organization (WHO), WHO/EHA office, Sana'a, Yemen. For Correspondence: Mobile:+967 713228999;MOPH;[email protected]: +967 772924388 WHO/EHA Office; Email: [email protected] 1 Weekly Bulletin:Electronic Disease Early Warning & Response System, Yemen - Epidemiological Week Number 29 ( 18 - 24 July 2016 ) Weekly trends of Diarrheal Diseases, Upper Respiratory infections, Suspected Malaria and Lower Respiratory infections ( Epi week 1 to 29, 2015 & 2016) DD 2015 URTI 2015 S.MAL 2015 LRTI 2015 Diarrheal Diseases DD 2016 URTI Sus.Malaria LRTI URTI 2016 S.MAL 2016 LRTI 2016 25.0% 20.0% 8.0% 7.0% 18.0% 7.0% 6.0% 20.0% 16.0% 6.0% 14.0% 5.0% 5.0% 15.0% 12.0% 4.0% 10.0% 4.0% 3.0% 10.0% 8.0% 3.0% 6.0% 2.0% 2.0% 5.0% 4.0% 1.0% 2.0% 1.0% 0.0% 0.0% 0.0% 0.0% Wk Wk 1 Wk 7 Wk 4 Wk Wk 1 Wk 3 Wk 5 Wk 7 Wk 9 Wk Wk 1 Wk 7 Wk 4 Wk 4 Wk Wk1 Wk7 Wk 10 Wk 13 Wk 19 Wk 22 Wk 25 Wk 28 Wk 34 Wk 37 Wk 40 Wk 46 Wk 49 Wk 52 Wk 16 Wk 31 Wk 43 Wk Wk 11 Wk 13 Wk 15 Wk 19 Wk 21 Wk 23 Wk 27 Wk 29 Wk 31 Wk 35 Wk 37 Wk 39 Wk 41 Wk 43 Wk 45 Wk 47 Wk 49 Wk 53 Wk 17 Wk 25 Wk 33 Wk 51 Wk 10 Wk 13 Wk 19 Wk 22 Wk 25 Wk 31 Wk 34 Wk 37 Wk 43 Wk 46 Wk 49 Wk 16 Wk 28 Wk 40 Wk 52 Wk 10 Wk 13 Wk 19 Wk 22 Wk 28 Wk 34 Wk 37 Wk 43 Wk 46 Wk 52 Wk Wk16 Wk25 Wk31 Wk40 Wk49 Age and Sex distribution of total consultations of leading diseases (Epi week 29, 2016) Vaccine preventable diseases in Epi-weeks 1 to 29, 2016 (28th Dec 2015 to 24th July 2016) No.# of Cases Total No.# of Greater Than Total No.# of Diseases Less Than Five 30000 Wk-29 Cases Five Alerts Measles 80 1422 882 540 921 25000 20000 Diphtheria 1 6 6 0 3 15000 Pertussis 345 4154 2689 1465 1180 10000 Number of Consultations of Number Acute Viral Hepatitis 191 5574 2574 3000 216 (A & E) 5000 Acute Flaccid 7 338 174 164 196 Paralysis 0 <1yr 1-4yr 5-14yr 15-44yr >45yr Meningitis 61 1371 857 514 157 Male 7980 10625 12368 19107 9858 Female 7582 10336 12866 26561 14600 Mumps 88 1586 737 849 124 Distribution of consultations of leading diseases by Governorates, Epi week 29 Sana'a Al- Hadramout Al- Al- Suspected Disease Lahj Aden Abyan Taiz Hadramout Ibb Hodidah Hajjah Amana Sa'da Amran Shabwah Dhamar Mareb Al-Jawf Rayma Al-Dhale Total Gov. Mahrah wady Baidha Mahweet Upper Respiratory Infections 612 1997 746 1678 809 999 1792 395 897 992 387 676 615 354 763 1462 508 431 176 454 313 700 17756 Lower Respiratory Infections 271 301 348 1228 282 370 1033 129 522 236 396 209 272 108 135 570 256 242 138 193 159 382 7780 Other Acute Diarrhea 248 863 300 860 360 787 1318 216 663 661 624 572 363 186 272 771 317 302 244 335 228 481 10971 Bloody Diarrhea 4 2 3 3 5 60 52 6 4 15 27 8 23 1 4 16 49 66 51 79 33 76 587 Susp. Cholera 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Schistosomiasis 3 0 0 1 0 7 4 13 15 2 21 5 0 0 0 5 2 7 22 40 22 9 178 Malaria 3 61 3 8 0 170 1964 898 7 60 140 18 47 2 0 190 10 148 58 145 102 14 4048 Meningitis 0 4 0 12 1 2 7 1 6 0 5 0 0 0 0 10 2 7 0 0 0 4 61 Dengue Fever 38 21 29 112 13 0 78 34 3 0 0 0 98 1 6 1 0 35 0 0 1 5 475 Viral Hemorrhagic Fever 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Rabies 0 0 0 7 0 4 1 26 20 0 19 0 0 0 0 24 0 0 1 1 0 6 109 Measles 1 4 0 3 0 6 0 3 23 11 5 4 0 0 2 1 0 8 2 3 3 1 80 Acute Viral Hepatitis (A & E) 4 6 0 68 6 14 1 0 38 6 5 0 2 0 8 20 1 1 0 4 1 6 191 Neonatal Tetanus 0 0 0 19 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 20 Acute Flaccid Paralysis 1 0 0 0 0 0 0 1 2 0 1 0 0 0 0 1 0 0 0 1 0 0 7 Cutaneous Leishmaniasis 3 0 0 0 1 1 0 6 2 1 5 5 0 1 2 8 0 3 2 0 9 4 53 Diphtheria 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 Pertussis 4 6 0 68 6 14 1 0 38 6 5 0 2 0 8 20 1 1 0 4 1 6 191 Influeza Like Illness 0 0 0 19 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 20 Severe Acute Respiratory Infection 0 0 9 10 0 0 0 0 0 0 10 0 0 0 0 50 17 0 0 0 2 1 99 Typhoid and Paratyphoid Fever 11 15 1 30 29 247 259 198 47 59 95 162 48 13 9 504 163 36 222 114 68 14 2344 Mumps 0 6 0 0 7 1 8 1 15 3 1 0 1 0 2 3 1 16 3 2 7 11 88 Tuberculosis 0 3 1 0 2 1 2 2 6 0 0 3 0 0 0 0 7 1 1 0 0 0 29 HIV/ AIDS 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Brucellosis 0 0 2 3 0 9 8 1 4 0 5 0 0 0 0 12 34 38 81 18 1 0 216 Chicken Pox 0 0 12 1 2 2 27 0 4 0 6 7 2 0 0 12 0 9 0 7 15 12 118 Guinea Worm 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Other_Disease 1781 5193 1595 7315 4567 4332 9360 1846 15869 2910 2548 1418 2038 883 2024 7389 734 1561 883 1560 461 3267 79534 Total_Consultations 3011 8508 3204 11486 6111 7043 15502 3787 18154 5003 4355 3132 3596 1552 3235 16450 2312 3058 1886 2993 1488 5048 130914 Number of alerts & outbreaks reported and investigated with appropriate response Number of Alerts Received and Responded (Epi weeks 26 and 29, 2016) 2016 Current week 29, 2016 System Gen.