Week-26 Ending 01 July 2018

Transcription

1 Somalia eekly Update eek-26 Ending 01 July 18

2 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. 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, 18 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 th May 18 from aberi and Hamerewoini districts in Banadir. Dolo A cvdpv3 and one co-infected (cvdpv2 & cvdpv3) cases reported from Bulloburti and arhsakeh 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 arsheikh district of Middle Shabelle region.

3 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 18 Date Stool collection 1 st and 2 nd : 13 th and 14 th May 18 Accessibility of the area: The village is inaccessible, the last SIA was 09 activity Age and OPV dose status [if case]:72 months female, 0 Dose of Sequencing results: PV-2 VDPV with 43nt difference and nt difference from Sabin Closest match: genetically linked to the VDPV3 sequence for ES/SOM/BAN/HM/KAMA-1/18/006 (Kawma ENV site, emergence group SOM- BAN-2) EPID No: SOM/MSH/RS/18/003 and its third contact (SOM-MSH-RS C3) The index: Location of case: Bohi village arsheikh District-Middle Shaballe-- Central zone Date of onset: 23 May 18 Date Stool collection 1 st and 2 nd : 30 st and 31 th May 18 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/HM/KAMA-1/18/006 (Kawma ENV site, emergence group SOM- BAN-2). The new PV3 viruses are classified immediately are cvdpv3 arshaikh EPID No: SOM/LJB/JM/18/CC1/001 and SOM/LJB/JM/18/CC1/003 (Community samples) Location of case: SANGUNI village Jamamme west District- Lower Jubba Region- South zone Date Stool collection 1 st and 2 nd : 24 April 18 Accessibility of the area: The district is completely inaccessible Accessibility of the area: The village is inaccessible since and no SIA activity Age and OPV dose status [if case]:18 &36 months females, 0 Dose Sequencing results: PV-3 VDPV with nt difference from Sabin Closest match: not genetically linked to any other previously sequenced VDPV3s; it is classified as VDPV3 and represents a VDPV3 event

4 Summary of VDPV2 and VDPV3 isolated from AFPs, Contacts and Community samaples IDCODE SOM/MSH/RS/18/0 03 SOM-MSH-RS C3 SOM/HRN/BBT/18/002 SOM/HRN/BBT/18/002/ SOM/HRN/BBT/18/002/ SOM/HRN/BBT/18/002/ C1 C2 C3 SOM/LJB/JM/18/CC1/ 001 SOM/LJB/JM/18/CC1/0 03 Type of Sample AFP case Contact-3 AFP case Contact-1 Contact-2 Contact-3 Community sample Community sample Contact Final result cvdpv3 cvdpv3 cvdpv2 and cvdpv3 coinfection NAME ABSHIR ALI MOALIM ABSHIR ALI MOALIM ISTAR ALI MOHAMED SAHAL OMAR AMIN SAREDO OMAR AMIN cvdpv3 cvdpv4 cvdpv5 cvdpv3 cvdpv3 VDPV2 AXMED MOHAMED CUMAR NAJMA MOHAMED ABDALA SAMIRA MALUULANO SIMBA AGE 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 ARSHEIKH ARSHEIKH BULO BURTI BULO BURTI BULO BURTI BULO BURTI JAMAMeE EST JAMAMeE EST 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 5/23/18 5/11/18 Date of Notification 5/28/18 5/13/18 SOM/GDO/DLO/1 8/002/C1 Date of investigation 5/28/18 5/13/18 Notified by BANADIR HOSPITAL ARDI MCH DSTCOLL1 5/30/18 5/30/18 5/13/18 5/13/18 5/13/18 5/13/18 4/24/18 4/24/18 5/29/18 DSTCOLL2 5/31/18 5/14/18 Accessibility of the village Accessible Accessible Inaccessible Inaccessible Inaccessible Inaccessible Inaccessible Inaccessible Accessible LIFESTYLE Nomadic Nomadic Nomadic Nomadic Nomadic Nomadic Nomadic Nomadic Urban EPIDOSES NIDDOSES DOSES Date of last OPV no SIA no SIA no SIA no SIA no SIA no SIA no SIA no SIA 5/8/18 IPV Date of last result 6//18 6//18 6//18 6//18 6//18 6//18 6//18 6//18 6/30/18

5 No sample collected due to flooding of sewage vdpv2 Summary Environmental Samples and Lab Classification Epidemiological eek- Epidemiological eek-18 District Name of Sites Date of Establishmen t J. 04 J. 11 J. 18 J. 25 F. 01 F. 08 F. F. M. M. M. M. M Ap. 05 Ap. Ap. Ap Ma y 03 Ma y 10 Ma y Ma y 24 Ma y 31 Jun Jun e e 7 14 aberi 21October 19 Sept. Shangani Urobo Sept. Hamerew oini Kawma 21 Sept. Hodan Egy. Hospital 23 Nov. Legend 1 Not scheduled 6 Sabin 11 PV1+cVDPV2 2 Pending 7 NPENT + Sabin 12 Sent for sequencing 3 Negative 8 cvdpv2 13 Scheduled but not collected 4 NEV 9 PV1 14 Sabin 2 5 NPENT 10 PV3 Sabin + NPEV + NEV

6 Next steps Detailed case and field investigation ongoing, reinforce active surveillance Response planned - mopv2 synchronized round starting on 9th -11th July 18 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

7 SIA Activity Calendar Apr Dec. 18 Activity Target area Date NID 1 bopv Somaliland and Puntland 30 Apr- 03 May 18 NID 1 bopv South and Central Except Banadir, Lower and Middle Shabelle 5-8 May 18 Third response round mopv2 Campaign R 1 synchronized mopv2 Campaign (with Ke, ET) Banadir, Lowe Shabelle and Middle Shabelle 5-8 May 18 South and Central regions without Banadir, Lower and Middle Shablle regions synchronized with Kenya response campaign 9-12 Jul 18 Small scale bopv Response Banadir, Lower and Middle Shablle regions 23 Jul 18 R 2 synchronized OPV2 Campaign (with Ke, ET) South and Central regions with out Banadir, Lower and Middle Shabelle regions synchronized with Kenya response campaign 4 8 Aug. 18 R 1 bopv synchronized Ke & ET All 19 regions in Somalia (2,499,010) R 2 bopv synchronized Ke & ET All 19 regions in Somalia (2,499,010) Aug. 18 TBC Sep. 18 TBC

8 Country Campaign Preparedness Overall preparedness level: Somalia is ready for the campaign scheduled to kickoff on the 9 th of July 18 Current status update Team level micro plan done, revised is ready for use 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 districts team training Budget: PO not yet received by zones C4D activities: on progress Vaccine distribution: on progress MOH states/other partners informed on the new campaign dates and involved the synchronized mopv campaign preparation Region # District # DFAs # DFAs to use ODK % DFAs to use ODK Bakool % Bay % Gedo % L Jubba % Galgad % Grand Total %

9 Summary of response activities using mopv2 Three rounds of mopv2 campaigns conducted targeting all <5 (Benadir, Middle and Lower Shabelle) 1 st Round (10-13 Dec. ) Target: 726,699 Reached: 702,667 (97%) Missed: 24,032 IM coverage: 97% LQAS= 98% FM mopv2 response areas 95% 9 85% 8 mopv2 rounds IM coverage 98% 97% 97% 97% 96% 92% 98% 96% 99% 2 nd Round ( 29 Jan-01 Feb 18) Target: 741,313 Reached: 7,2 (96%) Missed: 26,141 IM coverage: 93% LQAS= 98% FM 3 rd Round (05-08 May 18) Target: 790,837 Reached: 763,471 (97%) Missed: 27,366 IM coverage: 98% FM LQAS= 98% FM L. Shabelle M. Shabelle Banadir 75% 7 65% 6 55% 5 ROUND I ROUND II ROUND III BANADIR 96% 92% 98% LOER SHABELLE 97% 97% 96% MIDDLE SHABELLE 98% 97% 99% BANADIR LOER SHABELLE MIDDLE SHABELLE

10 Province District % 0-11m Children Vaccinated Total Missed Children % count Vaccinated % Total Under 5 Children vaccinated BAN ADA 98% 14 99% 98% BDB 99% 33 98% 98% DRK 94% 4 95% 95% DYN 98% 65 95% 96% 3 rd round mopv2 Post Campaign IM result by district HDN 97% 61 98% 98% HJB 98% 35 98% 98% HL 99% 39 98% 98% HM 7 99% HL 99% 38 97% 98% KRN 33 99% 99% MDN 99% 78 97% 98% SBS 97% 60 97% 97% SHN 97% 99% 98% BR 98% 26 98% 98% DA 26 98% 99% YQA 98% % 97% BAN Total 98% % 98% LSH AFG 95% % 95% L % 96% QRO 99% 35 95% 96% KRT 99% 32 95% 96% BRV 99% 19 94% 95% MAR 96% 72 95% 95% LSH Total 97% % 96% MSH ADL 0 BLD 99% 1 JO 1 MDY 2 RS 2 MSH Total 6 Graph no. 1 Grand Total 98% % 98%

11 3 rd round mopv2 Post Campaign monitoring results LQAS Vaccination Status by finger marking Finger Mark (FM) Region/Distric t NO FM FM Present Total HH Visited % Vaccinated Interpretation BANADIR % ADA PASS BDB PASS DRK % SATISFACTORY DYN PASS HDN % SATISFACTORY HJB PASS HL % SATISFACTORY HM PASS HL % PASS KRN % PASS MDN % PASS SBS % PASS SHN % PASS BR % PASS DA % PASS YQA % PASS LSH % AFG % PASS L PASS QRO % PASS MAR % PASS MSH % BLD % PASS JO PASS MDY % PASS RS PASS Grand Total % LQAS conducted in 24 districts in 24 lots. Of the 24, 21 have passed, 3 are satisfactory and non of the lots fail All districts have coverage above 9

12 Response activities NID-1 using bopv NIDs round 1 of bopv campaign conducted targeting all <5 in Somaliland, South Zone and two Regions in Central Zone (Hiran and Galgadud). Somaliland Campaign date: 30 April-03 May 18 Target: 638,062 Reached: 627,805 (98%) Missed: 2,6 IM coverage: 97% South zone Campaign date: May 18 Target: 467,553 Reached: 457,7 (98%) Missed: 1,049 IM coverage: 95% Central zone(hiran and Galgaduud) Campaign date: May 18 Target: 213,865 Reached: 199,5 (93%) Missed: 579 National Level: Target: 1,319,480 Reached: 1,284,488 (97%) Missed: 3,824 IM coverage: 96%

13 Banadir L. Shabelle M. Shabelle Galgudud Hiran M. Jubba L. Jubba Bay Gedo Bakool Marodijeh Togther Awdal Sahil Sool Sanag Mudug Nugal Bari No IM No IM No NID No NID No NID No NID No NID No NID No NID 95% 96% 95% 96% 94% 96% 96% 99% 99% 99% Summary results of IM result in South and Somaliland Summary results of LQAs conducted in South and Somaliland 9 NID-1 IM Coverage by Region Regions Total lots Lots Pass Lots Satisfacto ry Lots Fail 8 Awdal Galbeed Saaxil Togdheer Sool % 1 Sanaag Bakool Bay Gedo L/Juba Central South Somaliland Puntland Somalia

14 Part I AFP Surveillance

15 eek-26 Somalia eekly EPI/POL Update Epidemiological Curve 01 January July Pending Lab Pending ERG Discarded Compatable PV avdpv VDPV2 VDPV3 Graph no. 1

16 Table no.-1 Total Total Total 18 eek-26 Somalia eekly EPI/POL Update eekly AFP cases reported by Provinces, -18 Somalia. (cases are distributed across weeks based on date of onset of paralysis). PROVINCE BANADIR GALGADUD M. SHABELLE L. SHABELLE HIRAN BARI NUGAL MUDUG TOGDHER GALBEED SANAQ ADAL SAHIL SOOL LOER JUBA BAY GEDO MIDDLE JUBA BAKOOL Total Somalia Six new AFP cases were reported last week making the total AFP cases reported in 18 to 3 from 19 regions as compared to 195 AFP cases from 19 regions as the same time point in. Silent (not reporting) for > 8 weeks Reported AFP cases Community Samples collected in silent regions Community Samples collected but regions not silent

17 Table no.-2 eek-26 Somalia eekly EPI/POL Update Classification of AFP cases by status ( & 18) Chart no Discarded 21 In process (lab) 0 PV 3 AFP Cases Reported in Pending 0 Pending ERG 0 Compatibl e 1 cvdpv2 2 Pending ITD 1 cvdpv3 ZONE PROVINCE Discard Pendin ed g 18 Total Discard ed VDPV Pendin g Total BANADIR GALGADUD CENTRAL HIRAN L. SHABELLE M. SHABELLE BARI Puntland MUDUG NUGAL ADAL GALBEED Somaliland SAHIL SANAQ SOOL TOGDHER BAKOOL BAY SOUTH GEDO LOER JUBA MIDDLE JUBA Grand Total

18 eek-26 Somalia eekly EPI/POL Update Annualized NP-AFP Rate by Zone, Surveillance Indicators by Zone and Region Central Puntland Somaliland South Total Somalia Annualized NP-AFP rate by accessibility status Graph no In-accessible Partially Acceessible Accessible Somalia Graph no. 3 Map no. 1 Map no. 2

19 eek-26 Somalia eekly EPI/POL Update Surveillance Indicators (NP-AFP rate and Stool adequacy) by district, 18 Map no out of 1 districts reported at least 1 AFP case since the first week of 18. Out of the 99 districts reporting AFP cases in 18, 94 have annualized NP-AFP rate above 2 per 100,000. In addition, 97 districts have stool adequacy rate of above 8. The remaining districts have not reported any AFP case in 18; However, no district in Somalia has been silent for more than 52 consecutive weeks. 12% (n=2/) inaccessible districts and 19%(n=14/75) of accessible districts did not report AFP cases in 18. All the partially accessible districts have reported at least 1 case. Map no. 4

20 eek-26 Somalia eekly EPI/POL Update Distribution of NP-AFP cases and zero-dose cases vs accessibility of districts AFP cases were reported from across the country, from all zones, regions, and accessible and inaccessible parts of the country. Geo-code information was collected from 64% of AFP cases reported in 18 Map no. 5 All the 18 zero-dose AFP cases reported in 18, 10 were reported from inaccessible districts, 6 from partially- accessible districts and 2 from accessible districts Map no.6

21 eek-26 Somalia eekly EPI/POL Update 300 Number of NP-AFP cases reported across years during the same period (13-18) by zone CENTRAL PUNTLAND SOMALILAND SOUTH SOMALIA All zones but South have reported less number of AFP cases compared to the number of reported AFP cases in during the same period. A record low number AFP cases were reported from Central zone since 14; However, over 2 community samples were collected from healthy children in this year to compensate the low AFP reporting and active cases search has continued in the community and HFs

22 BANADIR GALGADUD HIRAN L. SHABELLE M. SHABELLE BARI MUDUG NUGAL ADAL GALBEED SAHIL SANAQ SOOL TOGDHER BAKOOL BAY GEDO L. JUBA M. JUBA eek-26 Somalia eekly EPI/POL Update Early case detection within 7 days from onset of paralysis at zonal and region levels Notification within 7 days, Zonal Notification within 7 days, Regional % % 1 1 CENTRAL PUNTLAND SOMALILAND SOUTH SOMALIA CENTRAL PUNTLAND SOMALILAND SOUTH TOTAL 95% (n=5/3) cases reported in 18 were notified within 7 days of onset of paralysis. Eight AFP cases (3 from Bay, 2 from Lower Jubba, 1 from Middle Jubba, 1 from Middle Shabelle and 1 from Sanaaq regions had delayed notification).

23 # AFP cases NP-AFP Rate # Cases with Adq. Specimen Cases pending lab results Cases with lab. result. Cases with stool in good cond. % Cases with stool in good cond. # of samples with NP- EV Isolated % Samples with NP EV Isolated # cases with Sabin like virus Isolation % of cases with S L Virus Isolation eek-26 Somalia eekly EPI/POL Update Summary of AFP surveillance key indicators by Zone, 18 ZONE % Stool Adq. % Inv. within 48 hrs. % Notif. within 7 days Central % 98% 98% % 5 11% Puntland % 4 % Somaliland % % 1 3% South % 88% % 0 Total % 99% 95% % 10 7% Table no.-4

24 eek-26 Somalia eekly EPI/POL Update ZONE PROVINCE Regional U Pop. CENTRAL Summary of AFP surveillance key indicators by Province, 18 Expected # of AFP cases as of this eek Number of AFP cases reported NP-AFP Rate % Stool Adq. % inv. within 48 hrs. % Notif. within 7 days % Stool condition % Samples with EV isolated % cases with SL isolated # Cases with late 60 days followup BANADIR % 1 GALGADUD % 9% 0 HIRAN LOER SHABELLE % 11% 0 MIDDLE SHABELLE % 91% 91% 6% 0 BARI % % 0 MUDUG % 0 NUGAL % 25% 0 ADAL GALBEED % 0 SAHIL SANAQ % 33% 0 SOOL TOGDHER BAKOOL BAY % 79% % 0 GEDO % 25% 0 LOER JUBA % 0 MIDDLE JUBA % 0 SOMALIA % 99% 95% 6% 7% 2 PUNTLAND SOMALILAND SOUTH

25 eek-26 Somalia eekly EPI/POL Update ZONE # AFP Cases # CONTACTS Summary of key indicators for AFP surveillance for contacts, 18 # Contact samples with Lab result Average contacts per cases % contacts < 5 age % Contact collected within 7 days of AFP notified % Contact with stool in Good Condition # Contact pending lab results # Specimens with NPEV isolated % Specimens with NPEV Isolated # Contacts with Sabin virus isolated Central % 9 8% Puntland % 6 9% Somaliland % 5 5% South % 4 4% Somalia % 24 6% Summary of Community Samples collected in 18 from silent districts, Egyptian hospital and inaccessible districts Zone Pending Negative NPENT VPV3 SL2 SL3 SL 1 & SL3 SL1 Grand Total PUNLAND SOMALILAND CENTRAL SOUTH Grand Total Of the total 318 samples collected from healthy children in 18, 44% (n=140), 6% (n=18) and 5(n=0) from accessible, Partially accessible and inaccessible districts respectively Table no.-5 % contacts with Sabin like virus Isolated

26 eek-26 Somalia eekly EPI/POL Update Distribution of AFP cases by source of case notification, 18 Source of AFP cases notification Zone Number of VPVs Number of # of cases Notified cases reported by VPV Proportion of cases reported by VPV CENTRAL % 4 3 % Year of onset VPV HFs Other PUNTLAND % SOMALILAND % SOUTH % Key: 1. VPVs: Village polio volunteers 2. HFs: MCH, Hospitals and Private clinics 3. Others: community members, district field assistants, traditional healers Total Somalia % Table no.-6

27 eek-26 Somalia eekly EPI/POL Update AFP cases by specific sources notification, NOTIFIED BY VACCINATORS AND TRADITIONAL HEALERS 250 NOTIFIED BY COMMUNITY AND VOLUNTEERS 300 NOTIFIED BY HEALTH FACILITIES CAMPAIGNS DISTRICT FIELD ASST DPO NID VACCINATOR TRADITIONAL HEALER CH COMMUNITY HOUSEHOLD VOLUNTEERS HEALTH POST HOSPITAL MCH PRIVATE CLINIC PRIVATE PHARMACY

28 eek-26 Somalia eekly EPI/POL Update Distribution of AFP cases by lifestyle, age group and sex, % 1 Distribution of AFP cases by Life style per zone Nomadic Rural Urban % 1 Distribution of AFP cases by Age group Graph no.-10 Graph no.- 11 Graph no <5 Yrs 5 Yrs % 1 Distribution AFP cases by Sex Female Male Of the total 3 AFP cases reported in 18, 45% (n=73) and 37% (n=61) are from urban and rural populations respectively. Nomadic communities account for only 18% (n=29). 73% (n=119) of cases are aged less than 5 years. 53% (n=87) AFP cases are female.

29 eek-26 Somalia eekly EPI/POL Update AFP surveillance indicators by accessibility status of districts, 18 Accessibility # of districts U- Pop in this area # of AFP cases Reporte d # of Cases reported by VPVs % of Cases reported by VPVs NP AFP rate Number of cases with lab result % of Stool adequacy % inv. ithin 48 hrs. % of Notif. within 7 days % Specimen s with NPEV % cases with Sabin like virus Inaccessible 619, % % 6% Partially accessible 23 1,7, % % 89% 7% 3% Accessible 75 4,024, % % 101% 98% 6% 1 National 1 6,364, % % 99% 95% 6% 7% Despite accessibility status of districts, majority of indicators are above global standards Table no.-7

30 eek-26 Somalia eekly EPI/POL Update AFP surveillance indicators by lifestyle of population, 18 Accessibility % of < populati on in the area # of AFP cases Reporte d # of Cases reported by VPVs % of Cases reported by VPVs NP AFP rate Number of cases with lab result % of cases with lab result within 14 days % of Stool adequac y % inv. ithin 48 hrs. % of Notifie d within 7 days % Specim ens with NPEV % cases with Sabin like virus Nomadic % % 93% 9 4% Rural % % 98% 8% 5% Urban % % 99% 99% 95% 8% 11% National % % 98% 99% 95% 6% 7%

31 eek-26 Somalia eekly EPI/POL Update Validation and zero dose investigation of AFP cases, 18 AFP Cases Validation Zero Dose Investigation Zone # of AFP cases Reported # of AFP cases Validated % of AFP cases Validated Zone # of Zero dose AFP cases Reported # of Zero dose AFP cases investigated % of Zero dose AFP cases investigated Comment Central % Somaliland % South Zone % Puntland % Central % 2 from accessible and Somaliland remaining from accesscompromised South Zone % areas Puntland Grand Total % Table no.-8 Grand Total 18 89% Out of the total 3 AFP cases reported in 18, 64% (n=104) were validated by the RPOs. Of the 104 AFP cases validated, (n=75,,11) were from accessible, partially accessible and inaccessible districts respectively There were 18 zero OPV dose AFP cases reported in 18, out of which 89% (n=/18) were investigated Table no.-9

32 eek-26 Somalia eekly EPI/POL Update Tracking lab results of AFP cases Total AFP cases 3 Tracking AFP with stool specimens cvdpv2 Total AFP cases with stool specimens Total AFP cases without stool specimens Other viruses neg st in lab en route ith lab results En route In the lab cvdpv2 cvdpv3 SL EV -ve

33 eek-26 Somalia eekly EPI/POL Update Sample source # Specimen collected Lab performance indicators for AFP surveillance in Somalia, 18 # Specimen with culture result # Specimens pending lab result # Specimen with culture result within 14 days % of specimen with culture result within 14 days Number of specimen with NPEV % of specimen with NPEV Number of cases with Sabin isolation % of Cases with Sabin isolation Cases % 18 6% 10 7% Contacts % 24 6% 24 6% Total % 42 6% 34 7% Table no.-10

34 eek-26 Somalia eekly EPI/POL Update Median and average number of days from onset of paralysis up to final lab result - 18 Date of onset Date of Notification Second stool collected Specimen reached to Lab Primary Culture result ITD result Median: 3 days Average: 3.53 days Median: 2 days Average: 1.89 days Median: 3 days Average: 3.8 days Median: 11 days Average: 11.7 days 1 day Date second stool collected Median: days Average: 22 days Date final ITD results Chart no. 2

35 eek-26 Somalia eekly Polio Update Village polio volunteers weekly house to house visit and AFP cases notified, 01 July 18 January Feberuary March April May June July Aug Sept Oct Nov December Central No. of HH visited No. of AFP cases notified No. of HH visited No. of AFP cases notified No. of HH visited No. of AFP cases notified No. of HH visited No. of AFP cases notified No. of HH visited No. of AFP cases notified No. of HH visited No. of AFP cases notified No. of HH visited No. of AFP cases notified No. of HH visited No. of AFP cases notified No. of HH visited No. of AFP cases notified No. of HH visited No. of AFP cases notified No. of HH visited No. of AFP cases notifie d No. of HH visited No. of AFP cases notifie d Central , , South , , Puntland ,077 1, Somaliland , , Total

36 eek-26 Somalia eekly Polio Update Routine Immunization Services, status of Cold Chain & Vaccine stocks in AFP Surveillance Sites. 01 July 18 Region Expected weekly AFP sites visits Health facility have a routine EPI service AFP sites with EPI service and functional cold chain Health facility have EPI vaccine available Health facility have IPV vaccine available No No. % No. % No. % No. % Nugal % % Bari % 32 94% % Mudug % 38 97% 38 97% 24 63% Galbeed % Sahil Sanag % Sool % Awdal % Togdher % Middle Shabelle % Hiran % 5 23% Galgadud % 58% % Banadir % 25 36% 67 96% 64 96% Lower Shabelle % 53% Middle Juba % Bakool % % 11 25% 10 91% Gedo % 95% Bay % % Lower Juba % 8 27% Somalia % % % 400 9

37 Part II Fever and rash surveillance

38 eek-26 Somalia eekly Polio Update Epi-curve on suspected measles cases by week, Somalia (-18) (n=7498) (n=5657) Series (n=23,353) 18 (n=64)

39 Total Total 18 eek-26 Somalia eekly Polio Update Fever and rash cases reported by AFP surveillance system, 01 July 18 Region Fever and Rash Cases by weekly 18 Nugal Bari Mudug N/East Zone Galbeed Sahil Sanag Sool Awdal Togdher N/est Zone M/ Shabelle Hiran Galgadud Banadir L/Shabelle Central Zone Middle Juba Bakool Gedo Bay Lower Juba South Zone Grand Total

40 Campaign (2-6 Jan) Campaign (11- March) eek-26 Somalia eekly Polio Update Campaign (11- March) Campaign (11- March) Trend of reported fever and rash cases by zone in, -18 Source: AFP Surveillance Puntland Somaliland January February March April May June July AUG Sept. Oct. Nov. Dec Central January February March April May June July AUG Sept. Oct. Nov. Dec South January February March April May June July AUG Sept. Oct. Nov. Dec Data shows there is a steady decline of suspected measles reported after the measles mass immunization conducted in January in Puntland and March in central, south and Somaliland Correction: there was a data error last week which causes Cases in Somaliland was inflated; Please disregard that figure and take this week corrected information on the trend of reported suspected cases

41 eek -21 Somalia eekly Polio Update Fever and rash cases reported, 01 July 18 Source: AFP surveillance system Age-wise distribution of fever and rash cases reported by AFP surveivallance system during 18 Zone-wise cases of fever and rash reported by AFP surveillance system in 18 Yrs10+, 770, 12% 5_9yrs, 1012, % <1yr, 1043, % _4 yrs, 3591, 56% Central North East North est South Total Somalia

42 eek-26 Somalia eekly Polio Update Measles mass immunization conducted in Somalia, 18 Nationwide campaign planned to vaccinate children from 6 months to 10 years of age; based on epidemiology, 83% of cases were under 10 years % 92% 95% 94% 93% 4.7 million children targeted in all accessible and partially accessible districts of the country million children vaccinated (94% coverage) 5 Independent monitoring data shows 94% of the children reached with measles vaccination during the campaign dates 4 3 % 1 centeral Puntland Somaliland South Grand National Total

43 eek-26 Somalia eekly EPI/POL Update orkshop conducted from May 18 Five-year Measles Strategic Plan Stakeholders from Federal MHO, States, GAVI and other stakeholders attended the workshop The draft Strategic Plan was reviewed and will be finalized shortly Key Action Points from the orkshop: Review of the EPI Policy Development EPI Improvement plan for non-gavi-supported districts Development of measles outbreak response plans Standing committees were selected to work on it Full story:

44 Part III Population Immunity

45 eek-26 Somalia eekly EPI/POL Update Maps showing accessibility and security/ risk level, Somalia Source: UNDSS Map no.10 Map no.11

46 eek-26 Somalia eekly EPI/POL Update Zones CENTRAL PUNTLAND SOMALILAND SOUTH Somalia Summary programmatic features and initiatives in Somalia by accessibility Accessibility Number of Under - AFP active VPV Settlement POP. Surveillance sites TPVP Accessible ,419, Inaccessible Total Accessible , Inaccessible Total Accessible ,469, Inaccessible Total Accessible ,040, Inaccessible , Total Accessible Inaccessible Total Note: the data are preliminary and U population is estimated from Surveillance historical data and U5 SIA data and are being reviewed.

47 Number of vaccinated Zero doses % Zero doses Number of vaccinated Zero doses % Zero doses Number of vaccinated Zero doses % Zero doses Number of vaccinated Zero doses % Zero doses Number of vaccinated Zero doses % Zero doses Number of vaccinated Zero doses % Zero doses Table no.- eek-26 Somalia eekly EPI/POL Update Transit Points Vaccination activities using bopv - 01 July 18 January February March April May June Zones CENTRAL % % % % % % PUNTLAND % % % % % % SOMALILAND % % % % % % SOUTH % % % % % % SOMALIA % % % % % A total of 1,145,762< 10 years individuals were vaccinated week 25,18. Among them 11,676(1%) were vaccinated for the first time.

48 eek-26 Somalia eekly EPI/POL Update Immunity Profile of NP-AFP cases and Contacts Immunity Profile of NP-AFP Cases and Contacts combined Months, Immunity Profile of NP-AFP Cases 6-23 Months, Immunity Profile of NP-AFP cases 6-59 Months by Zone, 18 Immunity Profile of NP-AFP cases 6-23 Months by Zone, % Graph no Dose 1-3 doses 4-6 doses 7+ doses % Graph no.-22 zero dose AFP cases reported in 18 from inaccessible and partially accessible areas of South (n=10) and Central (n=7) zones. 12 AFP cases with zero doses reported in 18 are in the age group of 6-59 moths and the remaining 5 AFP cases with zero dose are out of the 5-59 months age group dose 1-3 doses 4-6 doses 7+ doses Graph no % dose 1-3 doses 4-6 doses 7+ doses Graph no % Dose 1-3 Doses 4-6 Doses 7+ Doses 6 3

49 eek-26 Somalia eekly EPI/POL Update Immunity profile of NP-AFP cases and Contacts combined by Zone SOMALILAND CENTRAL % % dose 1-3 doses 4-6 doses 7+ doses 0 dose 1-3 doses 4-6 doses 7+ doses SOUTH Graph no.-24 PUNTLAND Graph no % % dose 1-3 doses 4-6 doses 7+ doses 0 dose 1-3 doses 4-6 doses 7+ doses Graph no.-26 Graph no.-27

50 Part -IV Routine Immunization

51 BCG P-1 P-3 Measles OPV-3 IPV BCG P-1 P-3 Measles OPV-3 IPV BCG P-1 P-3 Measles OPV-3 IPV BCG P-1 P-3 Measles OPV-3 IPV Routine Immunization coverage by zone, Somalia -18(1st quarter) (1st Q) PUNTLAND SOMALILAND SOUTH CENTERAL SOMALIA

52 Somalia Monitoring chart % Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Sum of Pent Sum of Penta Sum of Measles Sum of Montly target on surval% 8% % 25% 33% 42% 5 58% 67% 75% 83% 92% Sum of P-1% 5% 1 % % 25% 3 36% 41% 47% 53% 6 66% Sum of P-3% 5% 1 14% 18% 23% 27% 32% 36% 41% 46% 51% 56% Sum of Measles% 4% 8% 12% % 21% 25% 3 35% 39% 42% 46% 5

53 Somalia Monitoring Chart % Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Sum of Pent Sum of Penta Sum of Measles Sum of Montly target on surval% 8% % 25% 33% 42% 5 58% 67% 75% 83% 92% Sum of P-1% 6% 12% % 23% 29% 34% 42% 48% 54% 61% 67% 75% Sum of P-3% 5% 1 % % 25% 29% 34% 39% 45% 51% 56% 63% Sum of Measles% 4% 8% 13% % 22% 27% 32% 37% 42% 47% 53% 6

54 Somalia Monitoring Chart % 1 0 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Sum of BCG Sum of Pent Sum of Penta Sum of Measles Sum of Montly target on surval% 8% % 25% 33% 42% 5 58% 67% 75% 83% 92% Sum of P-1% 7% 13% 18% Sum of P-3% 6% 11% % Sum of Measles% 6% 12% %

55 eek-24 Somalia eekly EPI/POL Update C4D and Cold Chain Management

56 eek-26 Somalia eekly EPI/POL Update C4D Updates (1) Timelines of major activities SN Activities Dates Participants Places 1 Training of trainers' sessions June RSMCs and DSMCs Mogadishu 2 Cascade training sessions June CMs Various Districts Orientation session for 3 religious leaders June NIAG Members Mogadishu 4 Local Cross Border meetings June Local leaders of Border districts neighbour countries 5 Radio and TV broadcasts July Media Agency LTA Radios & TV stations in all 6 regions 6 House-to-house sensitization 6-12July Joint CMs teams Border districts 5-12July CMs Other districts 7 Launching Ceremony 08 June MoH

57 C4D Trainings sessions conducted for the outbreak response campaigns Training participants 1 st round mopv2 2 nd round mopv2 Campaigns 3 rd round mopv2 IPV campaign Synchroniz ed mopv2 campaign # RSMCs trained # DSMCs trained # CMs trained # NIAG members trained # Post campaign Supervisors & Monitors trained

58 Families awareness Level SCZ (3 Regions)-mOPV-2 Campaigns 9 98% 9 93% % 1 Source: Post campaign IM Data Campaign-1 Campaign-2 Campaign-3

59 1% 1% 2% 2% 2% 2% 2% 2% 2% 2% 2% 2% 3% 2% 2% 1% 1% 2% 2% 2% 3% 3% 3% 3% 3% 3% 3% 3% 4% 4% 4% 4% 5% 5% 5% 5% 6% 6% 6% 5% 5% 5% 4% 5% 4% 3% 4% 4% 6% 7% 7% 8% 8% 11% 11% 12% % 19% 3 Missed Children per District (mopv2 Campaigns) 35% 3 25% % % 1 5% Source: Post campaign IM Data Campaign-1 Campaign-2 Campaign-3

60 7% 6 69% 74% 77% 76% 75% 99% 95% 99% 91% 96% 94% 99% 88% 94% 96% 94% 9 97% 95% 98% 93% 97% 98% 97% 93% 89% 91% 96% 96% 96% 96% 99% 98% 96% 97% 96% 98% 95% 98% 99% 96% 99% 95% 99% Parents Awareness per District % 1 Source: Post campaign IM Data Campaign-1 Campaign-2 Campaign-3

61 Religious & Fatigue related refusals among total refusals per District Religious refusals Fatigue Refusals ARSHEIKH MAHADAY BALAD JOHAR ANLAEIN AFGOI MARKA Abdiaziz Heliwa Yaqshiid Karaan Daynile Howlwadag ar Dhigley Hodan aberi H/Jajab H/weyne Dharkenley Madiina Shangaani Bondhere Shibis 12% 19.4% Source: Post campaign IM Data Campaign-3 Campaign-2 Campaign-1 ARSHEIKH MAHADAY BALAD JOHAR ANLAEIN AFGOI MARKA Abdiaziz Heliwa Yaqshiid Karaan Daynile Howlwadag ar Dhigley Hodan aberi H/Jajab H/weyne Dharkenley Madiina Shangaani Bondhere Shibis 27% Campaign-3 Campaign-2 Campaign-1

62 Social Health workers / Radio (%) Television (%) Religious and Megaphone / PA Other (%)* Social Health workers / Radio (%) Television (%) Religious and Megaphone / PA Other (%)* Social Health workers / Radio (%) Television (%) Religious and Megaphone / PA Other (%)* 8 6 Performance of C4D activities - NIDs (IM) Parents Awareness Information Sources 96% 95% 92% 6 4 % 4 % Feb Apr Dec Feb- Apr- Dec- 6.0 Missed Children 6 Reasons for Missed Children 5.% 5 57% % 44% 34% 38% 32% 2.0 % 24% 0.0 Feb Apr Dec 1 % 9% N/Available Team Performance Refusal Feb- Apr- Dec-

63 eek-26 Somalia eekly EPI/POL Update Vaccines and Cold Chain Management All mopv2 for the June synchronized campaign received in Mogadishu. The CEEOP operational deployment plan was completed and shared with UNICEF supply division and GAVI. GAVI promised to share Somalia s new decision letter where all cold chain equipment will be procured in year one. Routine immunization vaccines required till year end estimated and procurement process ongoing.

64 NB: Vaccine wastage rate reduced from 7% in round one to 6% in round two as per admin data 64

65 The END