SITUATION REPORT FOR ACUTE WATERY DIARRHEA/CHOLERAEPIDEMIOLOGICAL WEEK 4 (23RD – 29TH JANUARY 2017)

HighlightsAs of epidemiological week 4, the reported number of AWD/Cholera cases has slightly decreased as compared to the previous week but the outbreak has spread to new districts in Puntland (refer table 1 below)

A total of 877 new suspected AWD/cholera cases and 15 deaths (CFR: 1.7%) were reported from 37 districts during epidemiological week 4 (23rd -29th January).

Almost 51% of all new cases were recorded in Baidao district, and 12% were reported from 4 districts in Puntland.

New districts and villages in Lower Shebelle and two regions in Puntland have reported new cholera cases, and the surveillance o�cers are planning to conduct field investigation and collect specimens

Situation update

A total of 877 suspected AWD/cholera cases and 15 deaths (CFR: 1.7%) were recorded from 37 districts across six regions during this reporting period. However, the trend of cholera cases recorded this week has slightly decreased as compared to the cases reported in previous week (Refer to below table 1). Of these cases, 107 of were reported from 4 districts in Puntland for the first time in five years.

Total cumulative cases of 3 113 with 47 deaths (CFR; 1.5%) were recorded across the country in the first four weeks of 2017. However, the trend of cholera cases and deaths recorded in the first four weeks is significantly higher as compared to the cases recorded the same period in 2016 (refer to below epicurve graph). The current cholera outbreak is spill-over from last year’s major cholera outbreak, which recorded 15,619 cases and 548 deaths. The current outbreak a�ected six regions in south central and Puntland:

Bay Region: A total of 392 cholera cases and 11 deaths were recorded in Baidao, Bayhow and Aliyow Munim districts as of week 4 and the trend has been increasing in the last four weeks.

Banadir Region: a total of 130 cholera cases 4 deaths were recorded across 17 districts across the region and the number of reported cases and deaths have decreases slightly in week 4.

Hiiran Region: a total of 28 AWD/cholera cases and 0 deaths were recorded in Beletweyn, Jalalaqsi and Buuloburte, and the trend of cases and deaths declined in the last two weeks.

Lower Shebelle Region: a total of 125 cholera cases and 0 deaths were recorded in Marka, Shalanbod, Waagaade, Janaale and Qoryoley districts, and the trend has decreased on week 4.

877 new cases reported this week

15 deaths reported this week

3 113 cumulative cases

47 cumulative deaths

1.5% case fatality rate

49% of cases are females

39% of cases are children under 5 years of age

33 districts in south central regions

4 new districts in Puntland regions

Highlight of Cumulative data from Epi-week 1-4, 2017

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Map of Somaliashowing location of AWD/Cholera cases and alerts January 2017

N

0 100 200 km

Legend

Non Cholera alerts received

Cholera hot spot, no active cases

active Cholera cases reported

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Considering the available surveillance data, even with the reduction in the number of cases reported this week there is strong evidence that the cholera outbreak is spreading to new villages and districts, and the ongoing draught and subsequent water shortage and malnutrition are exacerbating the spread of the outbreak.

Most of the districts reporting the cholera cases are along the Shebelle River and there is a severe water shortage due to dryness of the river.

Active transmission of cholera is still going in all districts in Banadir region, but Hodan, Daynile, Dharkeynlay and Wadajir recorded the highest number of cholera cases.

Middle Shebelle: a total of 95 cholera cases and 0 death were recorded in Jowhar, Mahaday, Balad and other villages, and the outbreak has spread to new communities during this reporting period.

Bari: A total of 31 cases and no death were reported in in Bosasso district, and this is the first cholera is reported in the last five years.

Mudug: A total of 76 cases and 0 deaths were recorded in Galdogob, Galkayo and Jariiban, and the most likely reason is the water shortage due to the draught.

Table 1. Distribution and summary of AWD/Cholera cases and deathsreported from Somalia (1-4 weeks), 2017

MiddleShabelle

(%)Live Dead Live Dead Live Dead CFR

Bay 248 3 1.2 234 5 2.1

121 1 0.8 47 2 4.3

94 0 0.0 111 4 3.6

35 0 0.0 50 0 0.0

8 0 0.0 11 0 0.0

34 1 2.9 20 0 0.0

11 0 0.0 14 0 0.0

Hiraan 35 0 0.0 24 0 0.0

2 0 0.0 4 0 0.0

0 0 0.0 0 0 0.0

58 0 0.0 45 0 0.0

25 0 0.0 26 0 0.0

3 0 0.0 0 0 0.0

5 0 0.0 3 0 0.0

Qoryoley 0 0 0.0 9 0 0.0

0 0 0.0 0 0 0.0

9 0 0.0 10 0 0.0

0 0 4.8 15 0 0.0

930 6 0.6 877 15 1.7 3113 47 1.5

Lower Shebelle

Baioda

144 1 0.7 130 4 3.1

960 16 1.7

168 3 1.8

315 4 1.3

166 1 0.6

49 1 2.0

54 1 1.9

48 0 0.0

210 2 1.0

7 0 0.0

3 0 0.0

103 0 0.0

99 0 0.0

24 0 0.0

11 1 9.1

9 0 0.0

10 0 0.0

32 0 0.0

15 1 0.7

574 18 3.117 districts

Aliyow Munim

Bayhow

Jowhar

Mahadaay

Balad

Hawaadley

Beletweyne

Buluborte

Jalaqsi

Ajogoye

Janale

Busley

Waagaade

Marka hosp

Galdogob

0 0 4.8 48 0 0.0 48 1 0.7Galkayo

0 0 4.8 13 0 0.0 13 1 0.7Jariiban

Madulow

12 0 0.0 8 0 0.0

86 0 0.0 24 0 0.0

28 0 0.0

136 0 0.0Hantiwadag

Shalanbond

Total

Week 423rd to 29th January 2017

Cumulative CasesWeek 1-4

Region District Week 316th to 22nd January 2017

Mudug

0 0 4.8 31 0 0.0 31 1 0.7GaldogobMudug

**CFR stands for case fatality rate, × The most a�ected districts in Banadir include Afgoye (28), Baydhabo (23), Boondheere(21), C/Casis (19) and Celesha (10)

(%)CFR

(%)CFR

Banadir

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Response activities

Coordination:

Multisectorial coordination mechanism at central and regional levels have been improved under the umbrella of Health and WASH clusters;

Multi-sectorial response interventions have been implemented in most of the districts reporting cholera cases including active case search, intensive household chlorination campaign, and community awareness;

Surveillance and laboratory services:

Health partners operating in cholera a�ected districts have scaled up the response activities including early warning surveillance, case management and WASH activities

Strengthened early warning surveillance especially at community level to ensure that case and deaths at community level are identified and reported;

Zonal and regional surveillance o�cers have conducted field investigation to verify reported alerts on suspected cholera cases and deaths in di�erent locations

Active case search and referral of the cases were initiate in most of the a�ected communities

WASH and Social mobilization:

In January, 17 WASH cluster partners responded through distribution of hygiene kits and chlorination of shallow wells in Bay (Baidoa), Hiraan (Beletweyne, Jalalaqsi), Middle Shabelle (Balad, Jowhar), Lower Juba (Dhobley, Badhadhe, Kismayo), Galgadud (Adado), Gedo (Belethawa, Ceel waq), Banadir (Deynile, Banadir hospital), Lower Shabelle (Merka and qoryole) reaching 18,071HH

Patients care:

New CTCs to manage cholera cases were established in a�ected districts in Bay, Lower Shabelle , Bari and Mudug regions;

Refresher trainings were given to health workers managing the cases in di�erent CTCs

Fig 1. AWD/Cholera cases by Epi-week in Somalia; April 2016 - Jan 2017

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Drought begins

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The weekly situation report is prepared by WHO and the health cluster team. For any queries kindly contact

Mutaawe Lubogo mutaawea@who.int; Iliana Mouradi mouradil@who.int; Abdihamid Ibrahim

Abdihamid.Ibrahim@savethechildren.org

Logistics and supplies:

FMOH and WHO have delivered the following Emergency supplies to Muslim Aid for Wanla-weyn district outbreak, 600 litres of Ringer Lactate , 2 cartons of ORS , 2 boxes of Aqua Tab, and 1DDK to Qadar Red crescent for Afgoi and Balad districts.

FMOH and UNICEF have dispatched one DDK to SWISS Kalmo for Janale, Shalambot, Marka and Qoryoley districts AWD/Cholera response and one DDK to Ayuub NGO for Mushani, Marka, Gaywarrow AWD/Cholera response.

Security concerns have remained a major impediment to the implementation of sustained and comprehensive cholera investigation and response activities in some of the cholera a�ected villages;

OCV

The planning for the Oral Cholera Vaccination campaigns targeting seven hotspot locations in three regions continued this week;

Urgent NeedsShortage of funds is hampering the implementation of response activities to contain the ongoing cholera outbreak in Somalia, and its important to raise funds to sustain the cholera response

Additional medical and non-medical supplies to be prepositioned in high risk districts

Building local capacities among health workers and partners on managing cholera cases and related areas

Engagement of the local health authorities in monitoring the response activities in all a�ected districts