Outbreak Update – Cholera in Somalia, 14 November 2018

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14 November 2018 – The Ministry of Health of Somalia has announced 19 new suspected cases of cholera, with one death, for epidemiological week 44 (29 October to 4 November) of 2018. Of these new cases, 68% (13) are females while 58% (11) are children below five years of age. The cumulative total of cases is 6539, including 44 associated deaths (case-fatality rate 0.7%), since the beginning of the current outbreak in December 2017 along the Shabelle River.

Stool samples have been collected from six cholera treatment units in four regions (Banadir, Hiraan, Lower Jubba and Middle Shabelle) and tested in the National Public Heatlh Laboratory (NPHL) in Mogadishu. During this reporting period, 15 stool samples were collected from Banadir hospital and six samples were positive for Vibrio cholerae, serotype O1 Ogawa. In total, of the 315 stool samples that have been tested since the beginning of this year, 98 tested positive. Routine collection and analysis of stool samples have continued at NPHL.

The outbreak has spread to 28 districts in four states so far; the affected districts include Jowhar, Kismayo, Bulobarde, Afgoye, Merka and Banadir. Over the past 16 weeks, the trend of cases has been declining and the newly reported cases have been localized only in the Banadir region for five consecutive weeks. Lower Jubba has reported zero cases for the last six weeks. In week 44, active transmission of AWD/cholera was reported in five districts in the Banadir region: Darkenley, Daynile, Hodan, Madina, and Hamarjabab. In particular, Darkenley, Daynile, Hodan, and Medina have reported more than 450 cases cumulatively. To date, 2792 cases, with 22 deaths, have been reported only in Banadir, which represents 42% of the total cumulative number of cases in the country since the outbreak started. The Banadir region, which includes Mogadishu City, has one of the highest concentrations of internal displaced persons (IDPs), and access to safe water and proper sanitation is limited for this vulnerable population. None of the cases reported in week 44 had received oral cholera vaccinations in a campaign that was conducted in 2017.

WHO and the Ministry of Health continue to monitor outbreak trends through the early warning alert and response network (EWARN) system and promptly investigate and respond to all alerts. WHO also provides leadership and support to health authorities and partners in activities to mitigate the outbreak, including case management, surveillance and laboratory investigations, as well as water, sanitation and hygiene (WASH) and risk communication. This week, refresher training sessions on case management for health care workers in Banadir hospital were conducted.