Ethiopia Emergency Response. A. Situation update. B. Epidemiological situation I. AWD ZIKA VIRUS

Transcription

1 ZIKA VIRUS Ethiopia Emergency Response Situation Report # 28 May - 3 June M IN NEED OF ASSISTANCE >200,000 DISPLACED BY FLOODING 458,000 SEVERELY MALNOURISHED 1.2M FUNDING A WHO staff member from Afar region setting off to conduct a field monitoring visit. Credit: WHO Ethiopia HIGHLIGHTS The Acute watery diarrhoea (AWD) outbreak is still on going in 11 woredas, six zones of Oromia and Somali regions. By week 21, a total of 1, 935 AWD cases and 19 deaths (CFR 1%, AR 0.05%) had been reported. Harena woreda in Oromia region reported its first case, increasing the number of affected woredas from 10 to 11. No new cases of suspected yellow fever have been reported since the 22 reported during week 20/2016 in South Omo. Active surveillance continues in the area. A typhoid outbreak is on going in Benatsenay and Malie woredas in South Omo zone. As of 31 May, 4,395 measles cases had been reported, with 3,597 confirmed in total. Nutrition: No new information was available at the time of reporting. A. Situation update As of 30 May, at least 19,557 households had been affected by flooding and flash flooding caused by Belg rains. This includes 9,885 in Somali region, Oromia (5,322), SNNP (2,972), Afar (671), Amhara (420) and Harari (287) (OCHA, May 2016). The health impacts of floods include: death, injury, and an increase in diarrhoeal and vector borne diseases. Crop destruction causes food insecurity that can lead to an increase in malnutrition; additionally, displacement can have a serious impact on mental health (Abaya et al, 2009; Ahern et al, 2005; and WHO (2005). B. Epidemiological situation I. AWD Eleven (11) woredas in six zones of Oromia and Somali regions reported AWD cases during week 21/2016 (23 29 May 2016). This number includes Harena woreda, Bale zone, Oromia region that reported its first case during the same week. Figures 1 and 2 show the epicurve and distribution by age. A total of 27 woredas in eight zones in three regions have been affected since epidemiological week 45 in Sixteen (16) AWD affected woredas have reported zero cases for 30 or more days. Woredas of Guji and Borena zones, Oromia region and Liben zone, Somali region are experiencing a prolonged outbreak. The outbreak in Moyale Oromia and Moyale Somali woredas has been on going since 6 November 2015.

2 Map showing areas affected by AWD Figure 1: Epicurve of AWD cases in Oromia, Somali & SNNP Regions by onset of Illness as of Week 21, 2016 Number of cases Epi Week Figure 2: Distribution of AWD cases Oromia, Somali & SNNP Regions by age as of Week 21, Percent <1Y 1-4Y 5-14Y 15-44Y above 45Y Age group WHO Ethiopia Situation report 28 May 3 June

3 Table 1: Distribution of AWD cases and deaths by zone, woreda/district and region as of week 20/2016, Ethiopia Reporting Zone Woreda Population Cases Death CFR AR region Oromia Bale Meda Wolabu 122, Harena 102, Bale Total 2 122, Borena Arero 59, Abaya 129, Dhas 28, Gelana 89, Moyale 38, Yabello Town 132, Borena Total 6 478, Guji Adola Rede 136, Goro dola 78, Liben 165, Negele Town 59, Seba boru 264, Wadera 64, Guji Total 6 632, West Arsi Adaba 176, Dodola 251, Shalla 188, Shashemene Town 154, West Arsi Total 4 770, Oromia Total ,004, SNNPR Gamo Gofa Arbaminch Town 151, Arbaminch Zuria 192, Bonke 191, Kutcha 178, Gamo Gofa Total 4 713, Segen Amaro 181, Segen Total 1 181, SNNPR Total , Somali Liban Hudet 54, Moyale Somali 318, Dolo ado 141, Liban Total 3 514, Afder Dolo bay 105, Afder Total 1 105, Somali Total , Country total ,520,162 1, II. Typhoid fever A field team comprising FMoH and WHO staff visiting South Omo zone, SNNP region reported suspected typhoid in two woredas on 26 May All five samples that were taken tested positive for Salmonella typhi by culture at the SNNP Regional Health Bureau laboratory. Following a review of the line list, 433 cases have been reported in; Benatsenay woreda 185 cases and 4 deaths; and Malie woreda cases and zero deaths. Figure 3 shows the epicurve of the outbreak in Benatsenay and Malie woredas. WHO Ethiopia Situation report 28 May 3 June

4 The onset of illness for the first case was 23 April All age groups were affected, however, age group years (45%) were most affected. The main risk factor for the outbreak is believed to be a contaminated river which transverses villages in both woredas - it is the main source of water for drinking and other household uses. That said, these are still preliminary findings; the field investigation is not yet complete. Figure 3: Epicurve of typhoid fever outbreak in South Omo zone, Benatsemay and male woredas, SNNP region, Ethiopia, May/2016 Number /04/16 24/04/16 25/04/16 26/04/16 27/04/16 28/04/16 29/04/16 30/04/16 01/05/16 02/05/16 03/05/16 04/05/16 05/05/16 06/05/16 07/05/16 08/05/16 09/05/16 10/05/16 11/05/16 12/05/16 13/05/16 14/05/16 15/05/16 16/05/16 17/05/16 18/05/16 19/05/16 20/05/16 21/05/16 22/05/16 23/05/16 24/05/16 25/05/16 Date of admission III. Measles As of 31 May 2016, 4,395 measles cases had been reported, including 3,597 confirmed cases (469 Lab confirmed, 2,889 epi- linked and 239 clinically compatible). A total of five active outbreaks are on going in: Addis Ababa (Gulele zone, Gulele woreda), Afar (Afar 5 zone, Semu Robi woreda), Amhara (East Gojjam zone, Debre Markos town; and Wag Himra zone, Sekota woreda) and Oromia (North Shewa zone and Dera woreda). All regions are affected by the outbreak; the top three are SNNPR (49%), Oromia (29%) and Somali region (8%). Children under five (53% of all cases) are the most affected age group, followed by children 5-14 years (34%). It is anticipated that measles outbreaks will affect all parts of the country based on surveillance data, seasonal patterns, areas affected and also the low population immunity due to sub- optimal immunization coverage (<95% coverage) of routine immunization and Supplementary Immunization Activities. The El- Niño drought effects resulted further increase the risk of measles outbreaks in high- risk areas. IV. Suspected yellow fever A total of 22 suspected yellow fever cases and 5 deaths (CFR = 22.7%) were reported from South Ari woreda, South Omo Zone, SNNP region in week 20. History of yellow fever outbreaks in Ethiopia Of the total cases, 12 (50%) have history of The first reported yellow fever outbreak was in vaccination for yellow fever. All cases have no in Omo and and Dedesa valleys, history of travel. claiming 30,000 lives from nearly 100,000 Only one of the 19 samples turned positive by ELISA suspected cases. at the national laboratory; for PCR confirmatory The next outbreak was reported in May 2013: it testing, samples will be sent to one of the WHO affected 4 Woredas in South Omo with a total of 141 laboratory confirmed cases and 43 deaths collaboration laboratories in the African Region, (CFR: 30%). possibly Institut Pastuer in Dakar, Senegal. In response, a mass vaccination campaign for Observed risk factors for yellow fever transmission in Yellow Fever was conducted in South Omo Zone the area include: existence of Aedes mosquito in the in 2014 for age group 6 months to 65 years, with area, presence of mosquito breeding sites in the coverage of 89% for the Zone and 96% for South area, and low availability of mosquito treated nets. Ari Woreda. No new cases have been reported from South Ari woreda or neighbouring woredas since week 20/2016; the zonal health department remain on high alert. WHO Ethiopia Situation report 28 May 3 June

5 Response activities are still required to continue to prevent, detect and respond early for similar outbreaks among which include: enhancing surveillance, community mobilization and dissemination of key messages, environmental and household vector control activities, coordination, and preparedness for outbreak response. In addition, strengthening the national laboratory capacity to conduct testing for notifiable (epidemic prone) diseases is a priority for WHO. This capacity will enable the country to rapidly initiate a guided outbreak response that will also quickly stop its spread. The rapid response to this outbreak was hampered by the stock out of PCR test kits at the national laboratory. V. Scabies In response to the scabies outbreak reported in Amhara, WHO supported two trainings: (i) July to October 2015 training 600 health workers on scabies case management and control and (ii) 58 woreda Nutrition and Public Health Emergency surveillance officers on scabies surveillance. In addition to the training, a scabies campaign was conducted and WHO recommended treatments and national guidelines were provided. Outbreaks in neighbouring countries Chikungunya: Both South Sudan and Kenya (Mandera town, on the border of Ethiopia and Somalia) have reported confirmed cases of Chikungunya. Samples from cases reported in Mandera (7/10) were confirmed by KEMRI on May Cholera: Mandera, Kenya is also reporting a cholera outbreak. As of 29 May 2016, 894 cumulative cases with 14 deaths (CFR 1.6%) had been reported since 16 April 2016 when the outbreak was confirmed. The majority of the cases are from Mandera East, with others from Mandera North and Banisa counties. ONNV: Three samples taken from patients who presented with unexplained bleeding, fever, fatigue and jaundice from the northern region of South Sudan tested positive (PCR, PRNT, ELISA) for O Nyong Nyong virus (ONNV) at Uganda Virus Research Institute, NICD/South Africa and Institut Pastuer/Senegal during week 21. VI. Malnutrition The nutrition data for week 20 was not available at the time of reporting. The information shall be reflected in the next situation report. C. Strategic response Area Public health risk communication and community engagement activities Activities This week, the WHO emergency response team at national and Regional Health Bureaus: Provided technical support at the command post level in the MOH. The support included: analysis of health and nutrition data for public health action and; support for the preparation and review of the weekly Public Health Emergency Management Bulletin. Supported FMoH in the preparation for the Multi- agency 2016 Belg season assessment to be led by the National Disaster Risk Management Commission (NDRMC). The support included: (i) coordination of the development and finalisation of the health and nutrition checklist; (ii) advocacy with partners to support the assessment; (iii) support to the methodology and logistic group. WHO s direct support to the assessment includes USD 30,000, 16 vehicles and 16 staff. Continued supporting the outbreak investigation of the suspected yellow fever outbreak in South Omo Zone of SNNP region being with the team from MoH, Regional Health Bureau, and Zonal Health Department. Coordinated the development of the SNNP region flood response and preparedness plan being with health partners and the Regional Health Bureau. Continued support to the AWD response in Somali of Ethiopia and Oromia regions through its experts deployed in the outbreak sites. WHO Ethiopia Situation report 28 May 3 June

6 Area Emergency Outbreak Response Activities Represented and supported the upcoming Meher season flood contingency Plan Preparation being with MoH. The exercise was initiated based on the upcoming Meher season rain forecast by the National Meteorology Agency (NMA). In response to floods in SNNP, WHO supported the following response activities alongside partners and government sector offices: Establishment of coordination mechanisms (Emergency command post, Zonal and District emergency task forces, five emergency technical subcommittee) which now hold daily meetings at zonal and district levels; Supported the development of the Regional, zonal and district Emergency Response Plan; Mapped partners and shared responsibilities; Active surveillance of flood related communicable diseases; and Supported the delivery of health services (including distribution of long lasting insecticide impregnated nets, set up of clinics, screening for malnutrition). In Tigray region, WHO: Supported compilation and analysis of nutrition and surveillance data compilation; and response activities through the technical working groups. Provided public health support to one woreda (Tselemti priority 1) and 4 health facilities (Maitsebri primary hospital, Dima, Ambamadre and chercher health centres) with TFU and OTP services. The support included: - On job training for health care providers at the TFU/SC and OTP centres - Assessed the availability of F 75 and F100, feeding equipment, medicines and recording and reporting formats. The health facilities visited had no stock outs. - Assessed presence of separate and well- arranged rooms for management of SAM cases in each health facility. Maitsebri primary hospital and Dima health centres have separate rooms. - Checked availability and usage of inter facility referral slips. - Advised the health bureau to conduct regular supportive supervisions to health facilities with feeding centres using standardized checklists. - Nutrition focal persons in the visited health facilities were advised to properly record and report data from the TFU and OTP sites. The major gaps identified included: some staff that were not trained on TFP services; lack of updated tools and poor recording of services (due to high case loads at some centres). These have been communicated with relevant people or follow up. In Afar region: Supportive supervision for flood affected areas in Amibar woreda of Afar region was conducted. Supportive supervision was also made to Kasagita health center in Adaar woreda, Dewe health center in Wederagie woreda, Kumame health center Semarabu woreda and Dalifageh hospital in Afar region. The major gaps identified included: lack of tools, provision of an incomplete package of services at some OTPs (not taking vital signs, physical exam or provision of SAM medications. The WHO pediatrician and public health specialist supporting the region gave appropriate technical support and on job training. Feedback was also given to the woreda health office and regional health bureau for further follow up and support. Health promotion Conducted a health promotion session in Wadera town, specifically focussing on the central market. Monitoring carried out over the following days with short interviews about AWD knowledge from randomly selected WHO Ethiopia Situation report 28 May 3 June

7 Area Measles Activities market attendants revealed an increase in knowledge of AWD. Reached an agreement with Wadera woreda Govt communications affair bureau to run media coverage (using mini- media) at lunchtime, during weekends and after work till 8:00pm. Participated in a two day health review for 103 Woreda representative and communicated AWD response priorities and areas that require strengthening. The measles campaign was conducted from April 2016 (not 3 May as previously reported). The highlights of the report are listed below. o The campaign was conducted in 505 woredas, targeting 25,815,226 children of 6 months to 14 years, with a target of at least 95%. This required 28,654,901 doses of measles vaccine. o The strategy was to use fixed post (permanent and temporary). The measles SIAs was combined with a polio campaign. o It was coordinated through three technical working groups - Training, planning, and monitoring and evaluation; logistics; and communications. o A total of 24,954,638 received measles vaccination (97%) and 15, 276, 482 polio vaccination (101%). o The campaign was hampered by: heavy rain and flood in some places affected both the house to house and fixed post team performance; shortage of vaccines and; late delivery of vaccines and logistics WHO supported a response to measles in Samarobi woreda. Eight cases of measles were detected at Kumane HC; (3 from Fantida and 5 from Hari ama Kebele). Four of the five specimens from Hari amo Kebele tested positive. - WHO established a rapid response team that conducted an assessment. - All children with suspected measles were isolated and treated. - EPI vaccinators were deployed in the district to conduct vaccination of all the children in the area, including villages that were not covered during the previous campaign and nomadic pastoralists. Funding This response is made possible by funding from DFID and WHO s Contingency Fund for Emergencies. As its resources are getting depleted, WHO Ethiopia requires funds to work with FMoH to continue to strengthen surveillance for, and response to emerging outbreaks; as well as to continue to reinforce integrated disease surveillance and response and health security. Contact list For more information on the response, please contact the following: CFE Dr Akpaka Kalu WHO Representative WHO Ethiopia Country Office Office Tel.: kalua@who.int Dr James Teprey Incident manager WHO Emergency Response Team WHO Ethiopia Country Office Mobile: +251(0) tepreyj@who.int WHO Ethiopia Situation report 28 May 3 June