Somalia: Cholera Outbreak - Apr 2016Ongoing
Humanitarian partners have stepped up response to the outbreak...Projections of 15,000 severe and 60,000 moderate cases over the coming months have led to plans for a significant and rapid scale up of the response. To help stabilize and contain the outbreak, the CERF rapid response grant of $2 million will strengthen and complement response activities already underway by WASH and Health partners. (OCHA, 30 May 2016)
Since the beginning of , a total of 14165 case of AWD and 497 deaths have been reported in different parts of Somalia. Of these 47.7% are female while 57.9% are children below 5 years. [...] there has been a gradual reduction in number of cases from the peak 1,853 cases and 187 deaths (CFR 10.0%) in week 15 to 194 cases and 0 death in week 46. (WHO, 20 Nov 2016)
Drought conditions have increased the spread of epidemic-prone diseases such as acute watery diarrhoea, cholera and measles. In the first 7 weeks of 2017, more than 6000 cases and 65 deaths by acute watery diarrhoea/ cholera were reported. (WHO, 27 Feb 2017)
The AWD/cholera epidemic in Hiraan, Nugal, Mudug and Bari and Banadir region has been controlled and the cholera treatment centre in Beletweyne has been closed. 2016's outbreak was one of the worst and longest in which the country has experienced in the last five years. (WHO, 5 Mar 2017)
On 15 March 2017, the Government of Somalia, together with humanitarian partners, launched an Oral Cholera Vaccination campaign, the first of its kind in Somalia, targeting over 450,000 people in seven high-risk areas around the country...WASH partners have furthermore scaled up response to AWD/Cholera, reaching 316,000 people in southern and central Somalia through distribution of hygiene kits, chlorination of water points and hygiene promotion campaigns as of end of February. In total, some 568,600 people were assisted with temporary and/or sustainable access to safe water, 36,000 people with safe sanitation and 498,000 people with hygiene promotion activities. (OCHA, 24 Mar 2017)
In 2017, a total of 53,015 AWD/Cholera cases have been reported across 52 districts in 16 regions, including 795 deaths (CFR 1.5 per cent). This represents the worst case scenario with an attack rate (AR) of 5.5 per 1,000 people. 41 per cent of the cases are among children below five years with a slightly higher CFR (1.8%) compared to children above five years (1.4 per cent). The number of AWD/Cholera cases in 2017 is more than three times the 2016 caseload, and 10 times the 2015 caseload. Whilst the cumulative CFR is declining from 2.3 per cent at the beginning of the outbreak to 1.5 per cent as of last week, the reported CFR from inaccessible areas is still four times higher. (UNICEF, 30 Jun 2017)
The month of August has seen a sustained decline in the number of cases of cholera reported from across Somalia. The 917 cases recorded in August 2017 now approximate to the averaged monthly figures recorded in 2015 of 440 cases and during 2016 of 1,300 cases/month. (Health Cluster, 29 Sep 2017)
Over the past two months there has been a significant reduction in the number of new AWD/Cholera cases in all regions of Somalia. No AWD/cholera related deaths have been reported since August in any region across Somalia. (Health Cluster, 31 Oct 2017)
Cholera cases and deaths have declined significantly during the month of November 2017 with less districts reporting cases as compared to previous months. (WHO, 30 Nov 2017)
Since the start of the year, a total of 78,560 cumulative cases of AWD/cholera recorded from health facilities across the country and 1,160 deaths have been reported in 55 districts of 16 regions across Somalia. [...] Whilst an overall decline is being reported, new AWD/cholera cases have been reported from Beletweyne district of Hiran region during December. (Health Cluster, 31 Dec 2017)
As of 18 March 2018, a total of 1613 cholera cases, including nine deaths (case fatality rate = 0.6%), have been reported from four regions: Hiraan, Banadir, Lower Juba and Middle Shabelle. The outbreak started in Beletweyne, Hiraan Region; it spread to Banadir Region in early January 2018, to Lower Juba in early February 2018, and to Middle Shabelle in early February 2018... Banadir Region is one of the regions with the highest concentration of internally displaced persons (IDPs). (WHO, 29 Mar 2018)
Following the heavy rains that have led to the floods in the Juba land and Shabelle basins, there has been an observed increase in the number of new AWD/Cholera cases. The cholera outbreak that started in December 2017 in Beletweyne along river Shabelle has spread to Jowhar, Kismayo, Afgoye and Banadir. The cholera spread is expected to increase due to the floods that have led to contamination of water sources in the flood affected regions. Floods have also led to blockage of access of health services which will contribute to delayed health seeking by the affected populations with... A cumulative total of 3,280 cases including 21 deaths have been reported since December 2017. (WHO, 13 May 2018)
The cholera spread is expected to increase due to the floods that have led to contamination of water sources in the flood affected regions...Over the past 2 weeks, there has been decrease in the number of AWD/Cholera cases reported in Lower Shabelle, Banadir and Lower Jubba; the regions that are affected by floods. In week ending 8th July, active transmission of AWD/cholera was reported in Kismayo district in Lower Jubba, Afgoye Kurtunwarey, Brava and Merka in Lower Shabelle as well as in 14 districts of Banadir region (Darkenly, Daynile, Hodan, Madina, Waberi, HamarWeine, Hamarjabjab, Wardhigley, Shibis,Yaqshid, Abdiaziz, Kaaran, Huruwa, and Howlwadag districts). In Kismayo, affected communities especially in Farjano IDP are reportedly using contaminated water due to floods. There was a decrease in the number of cases reported from 344 in week 26 to 151 in week 27. (WHO/Gov't, 8 Jul 2018)
The Ministry of Health of Somalia has announced 30 new cases of cholera and no deaths for week 38 (17 to 23 September) of 2018. Since week 28, there has been a decreasing trend in the number of cholera cases reported. The cumulative total of cases is 6394, including 42 associated deaths (case-fatality rate 0.7%) since the beginning of the current outbreak in December 2017...Over the past five weeks, there has been a decrease in the number of cases reported in Banadir and Lower Jubba, while during week 38 active transmission was reported in Kismayo district of Lower Jubba, and 7 districts of Banadir region (Darkenly, Daynile, Hodan, Madina, Waberi, Hamarjabjab, and Heliwa districts). (WHO, 4 Oct 2018)
There has been a consecutive weekly downward trend of suspected cases reported since week 28. The peak was 296 cases in epidemiological week 23, dropping to 18 cases in this reporting period. In week 45, active transmission of Acute Watery Diarrhoea (AWD)/cholera was reported in six districts in the Banadir region: Darkenley, Daynile, Hodan, Madina, Shibis, and Yaqsid. All cases reported this week are among the internally displaced people (IDPs). None of the reported cases had previously received the oral cholera vaccine (OCV). OCV campaigns have contributed significantly to the reduction of reported cases in the country. (WHO, 07 Dec 2018)
The Ministry of Health of Somalia has announced 32 new suspected cases of cholera (last week: 18 cases), with no deaths, for epidemiological week 48 (26 November to 2 December) of 2018. Of these new cases, 38% (12) are females while 69% (22) are children below five years of age. The cumulative total of cases is 6637, including 45 associated deaths (case-fatality rate 0.7%), since the beginning of the current outbreak in December 2017. Of the 334 stool samples collected since the beginning of the year, 103 tested positive for Vibrio cholerae. (WHO, 12 Dec 2018)
Most read reports
- Humanitarian Bulletin Somalia, 4 October - 5 November 2018 [EN/SO]
- CERF results as reported by CERF recipients in 2017
- Bulletin: Cholera and AWD Outbreaks in Eastern and Southern Africa, Regional Update for 2018 - as of 10 December 2018
- Greater Horn of Africa Region: Humanitarian Snapshot (September - October 2018)
- Outbreak update – Cholera in Somalia, 12 December 2018
12 December 2018 – The Ministry of Health of Somalia has announced 32 new suspected cases of cholera (last week: 18 cases), with no deaths, for epidemiological week 48 (26 November to 2 December) of 2018. Of these new cases, 38% (12) are females while 69% (22) are children below five years of age. The cumulative total of cases is 6637, including 45 associated deaths (case-fatality rate 0.7%), since the beginning of the current outbreak in December 2017.
• There was a decrease in the number of AWD/Cholera cases reported from 27 in week 46 to 18 in week 47.
• No new death was reported in week 47.
• A cumulative total of 6,605 cases including 45 deaths have been reported since December 2017
• The cholera outbreak has been contained in 4 regions, however active transmission is still reported in Banadir region
• A total of 2101 people aged 1 year and above received 1st dose of OCV in 4 IDPs in Banadir and Afgoye
The Contingency Fund for Emergencies (CFE) has been a gamechanger for WHO. It allows WHO to respond rapidly to disease outbreaks and health emergencies - often in 24 hours or less. This saves lives and helps prevent unnecessary suffering. Furthermore, a quick response dramatically reduces the costs of controlling outbreaks and emergencies, as well as the wider social and economic impacts.
10 out of the 21 countries in Eastern and Southern Africa Region (ESAR) have reported more than 36,820 cholera / AWD cases and 433 deaths (Case Fatality Rate, 1.2%), since the beginning of 2018.
These countries include; Angola, Kenya, Malawi, Mozambique, Rwanda, Somalia, Tanzania, Uganda, Zambia and Zimbabwe. Zimbabwe accounts for 28.6 % (10,529) of the total case load reported this year, followed by Somalia at 17% (6,273).
7 December 2018 – The Ministry of Health of Somalia has announced 18 new suspected cases of cholera, with no deaths, for epidemiological week 47 (19 to 25 November) of 2018. Of these new cases, 61% (11) are females while 50% (9) are children below five years of age. The cumulative total of cases is 6605, including 45 associated deaths (case-fatality rate 0.7%), since the beginning of the current outbreak in December 2017.
The humanitarian crisis in Somalia continues to be driven by conflict, recurrent climatic shocks, and political and socioeconomic challenges. Access to basic services remains restricted and protection risks high. An estimated 2.6 million people are displaced. One third of Somalis (4.2 million) will require humanitarian assistance and protection in 2019. Some 1.5 million people are acutely food insecure in Emergency (IPC4) or Crisis (IPC Phase 3); and some 2 million in Stress (IPC 2).
Current major event
Transition from EWARN to routine surveillance
A three days workshop was conducted in Damascus, Syria from 8-10 August 2018 to disseminate findings of Early Warning Alert and Response Network (EWARN) evaluation in Syria. Participants included Ministry of Health (MOH) staff and technical EWARN officers. During this workshop the question of how and when to transition from EWARN to routine surveillance was examined.
• A total of 390 (87%) health facilities across Somalia submitted weekly report in week 47.
• A total of 9,674 alerts of which 62 were confirmed as true were received in week 47.
• Cholera alerts were received in Banadir regions in IDPs were confirmed as positive for cholera.
• Health cluster partners provided consultation services to 997,637 individuals in 379 health facilities (including 15 mobile health units). Of this, 463,342 were reached through funds received from the humanitarian appeal process.
• Twelve (12) cases of circulating vaccine-derived poliovirus (cVDPV) has been confirmed amongst children in Somalia; with five (5) new cases in September and October.
• 7,3654 suspected cases of measles were reported during 2018 up until 28 October. Overall, partners are reporting fewer cases of measles.
• An estimated 177,174 children with life threatening severe acute malnutrition (SAM) were treated from January to October 2018. The children reached represent 102 per cent of the overall UNICEF 2018 planning target of 173,000 SAM children.
• A UNICEF-supported inter-agency assessment found 102 children, all boys, reported to be associated with the Puntland forces in Tukaraq military base, in need of further screening and separation from the military.
29 November 2018 – The Ministry of Health of Somalia has announced 27 new suspected cases of cholera, with one death, reported in Banadir region for epidemiological week 46 (12 to 18 November) of 2018. Of these new cases, 44% (12) are female while 44% (12) are children below five years of age. During this reporting period, of the seven stool samples collected from suspected cholera cases and tested in the National Public Health Laboratory (NPHL), six samples were positive for Vibrio cholerae, serotype O1 Ogawa.
- A total of 390 (88%) health facilities across Somalia submitted weekly report in week 44.
- A total of 9,154 alerts of which 50 were confirmed as true were received in week 44.
- Cholera alerts were received in Banadir regions in IDPs were confirmed as positive for cholera.
- Food poisoning affecting 2 families in Jowhar town of middle Shabelle region was reported and under investigation.
Completeness of reporting
Current major event
Chikungunya update: Sudan
Sudan has had a major outbreak of Chikungunya since July 2018. A total of 20,110 cases have been reported since the outbreak began. No new cases of the disease were reported during the week ending 11th November 2018.
Humanitarian partners estimate that 4.2 million people will require assistance in 2019. This reduction in needs, in comparison to 2018, reflects an improvement in the overall humanitarian situation and a more focused approach to defining needs that now includes, in addition to people in Crisis (IPC3) and Emergency (IPC4), only those in the most vulnerable circumstances of Stress (IPC2).
22 November 2018 – The Ministry of Health of Somalia has announced 21 new suspected cases of cholera, with no deaths, for epidemiological week 45 (5 to 11 November) of 2018. Of these new cases, 67% (14) are females while 43% (9) are children below five years of age. The cumulative total of cases is 6560, including 44 associated deaths (case-fatality rate 0.6%), since the beginning of the current outbreak in December 2017 along the Shabelle River.
10 out of the 21 countries in Eastern and Southern Africa Region (ESAR) have reported more than 36,257 cholera / AWD cases and 425 deaths (Case Fatality Rate, 1.2%), since the beginning of 2018. These countries include; Angola, Kenya, Malawi, Mozambique, Rwanda, Somalia, Tanzania, Uganda, Zambia and Zimbabwe. Zimbabwe accounts for 28.5 % (10,318) of the total case load reported this year, followed by Somalia at 17.2% (6,225).
• A total of 384 (87%) health facilities across Somalia submitted weekly report in week 46.
• A total of 8,846 alerts of which 174 were confirmed as true were received in week 46.
• Cholera alerts were received in Banadir regions in IDPs were confirmed as positive for cholera
Completeness of reporting
• A total of 384 (87%) of 442 active health facilities in in all regions submitted reports