EPIDEMIOLOGICAL BULLETIN: Abyot Bekele, MPH Ethiopian ... · EPIDEMIOLOGICAL BULLETIN: Weekly/Volume 2/Number 22/ Page 1-8 /May30-Jun 5/2016 Abyot Bekele, MPH1 1. Ethiopian Public

Weekly/Volume 2/No. 22 Detect, Prepare, Response and Recover Page 1`

Ethiopian Public Health Institute Center for Public Health Emergency

Management

የኢትዮጵያ የሕብረተሰብ ጤና ኢንስቲትዩት

የህብረተሰብ ጤና አደጋ ቁጥጥር ማዕከል

EPIDEMIOLOGICAL BULLETIN: Weekly/Volume 2/Number 22/ Page 1-8 /May30-Jun 5/2016 Abyot Bekele, MPH1

1Ethiopian Public Health Institute, Center for Public Health Emergency Management, Telephone 0112765340/0112758631 Tall Free 8335/8665, Fax 0112758634, Email: [email protected], Website:

www.ephi.gov.et, PO. Box 1242, Swaziland Street, Addis Ababa

Highlights of the Week: The national Surveillance report completeness and

timeliness rate is 91.9%; The new weekly Severe Acute Malnutrition (SAM)

cases are increasing in Amhara region, while East and West Hararge zone still reporting high cases;

Malaria cases are up surging in 33 malaria hotspot woredas which needs close follow up and investigation.

Measles crosses the normal threshold (five suspected cases per month) in 24 woredas;

AWD cases identified and reported in Addis Ababa; The suspected Yellow Fever samples sent to CDC

reference laboratory at KEMRI turned negative for Yellow Fever and further testing is undertaking

The died worm from Guinea worm suspected case was sent to Atlanta for confirmation and further characterization

I. Introduction This Epidemiological Weekly Bulletin serves to provide key information on public health emergency management activities, and summarizes surveillance data and performance on epidemic prone diseases and other public health emergencies. The bulletin mainly includes surveillance data of week 22 of 2016 and daily phone communication, line list reports of outbreaks for week 23 of 2016. It highlights the surveillance completeness and timeliness across the regions, trends of diseases under surveillance, cluster of cases and events, ongoing outbreaks and responses undertaken at all levels in Ethiopia. The number of disease specific cases indicated in this issue of bulletin are subject to change due to on-going receiving late surveillance data and retrospective verification and investigation of data from outbreak areas.

II. Surveillance report completeness and timeliness

Completeness: The national completeness rate of reports from government health facilities was 91.9% . Except for Gambella and Afar regions all the regions has fulfilled the expected minimum completeness rate for the week. Among the nine regional states and two city administrations seven

of them achieved more than 90% surveillance completeness rate (Figure 1).

Figure 1: Regional Surveillance Report Completeness, Week 19-22/2016

Timeliness: In week 22, the national surveillance timeliness rate was 91.9% which is above minimum requirement. From all regional states and city administrations nine of them achieved more than 80% surveillance report timeliness. Afar region kept reporting lately (Figure 2).

Figure 2: Regional Surveillance Report timeliness, Week 19-22/2016

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Weekly Epidemiological Bulletin

Weekly/Volume 2/No. 22 Page 2

III. Diseases and conditions 1) Severe Acute Malnutrition (SAM)

National SAM Trend: A total of 4,661 SAM cases were reported in week 22 of 2016 which is decreased compared with week 19 of 2016. The decrement of the cases might be associated with not reported Afar region surveillance data (Figure 3).

Figure 3: National SAM cases trend,2224-2016

Regional SAM Trend: In week 22 Oromia region has accounted for 48 % of the national cases followed by SNNPR (21%) and Somali (14 %) of the national cases. relatively the trend is showing increasing in Amhara region within the last three weeks (Figure 4).

Figure 4: SAM trend by region by week 19-22/2016

The inpatient rate for SAM cases in week 22 was 9% at national level. When further analysis was done at regional level most regions have an inpatient rate of more than 10%, which is the highest acceptable rate. However the high inpatient rate as detailed in table 1 should be further evaluated.

Table 1: New OTP and SC SAM cases and deaths in week 22, 2016 Region Total SAM OTP Inpatient Death Inpatient%

AA 45 39 6 0 13 Amh 657 621 36 0 5 BG 21 19 2 0 10 DD 55 53 2 0 4 Gam 17 8 9 0 53 Harari 11 0 11 0 100 Oromia 2236 2037 199 0 9 SNNPR 1001 879 122 7 12 Somali 475 449 26 0 5 Tigray 143 129 14 0 10 Total 4661 4234 427 7 9 Percent 90.8 9.2 1.6

Zonal SAM Trend: In week 22 the top 15 zones with the highest number of SAM cases contributed for 61% of all cases at national level. The highest number of SAM cases was reported from East Hararge contributing to 11% followed by West Hararge contributing 8% of the national cases. The two zones have been contributing to the highest SAM case for the last several weeks (Table 2). The contributing factors and intervention status should be further evaluated.

Table 2: Top 15 zones reported highest number of new SAM cases in week 22 of 2016 Region Zone w19 w20 w21 w22

Amh N/Gondar 71 50 96 148 Amh N/Wollo 75 40 104 119 Amh S/Gonder 33 65 80 104 Oro E/Hararge 624 535 421 508 Oro W/Hararge 405 429 495 368 Oro Bale 230 216 0 191 Oro W/Arsi 355 260 224 183 Oro Arsi 95 79 124 163 Oro Guji 125 161 131 152 Oro N/Shewa 50 51 67 140 Oro Jimma 100 62 110 128 Oro Borena 88 158 189 109 Oro E/Shewa 58 102 107 104 SNNP Sidama 232 250 238 277 SNNP Hadiya 149 0 55 129 Sum Top 15 zones 2690 2458 2441 2823 Sum National 4825 4836 4772 4661 Percent top 15 zones 56 51 51 61

Woreda SAM Trend: The top 15 woredas with the highest number of SAM cases in week 22 contributed to 22% of the national SAM cases. majority of the top 15 woredas are from Oromia regional state (table 3).

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Table 3: Top 15 woredas reported highest number of new SAM cases in week 22 of 2016 Region Zone Woreda 19 20 21 22 Amh S/Gonder Ebinat 15 35 27 49 Amh Waghimra Dehena 27 1 12 45 Oro E/Hararge Fedis 81 106 80 72 Oro E/Hararge Girawa 75 26 37 62 Oro E/Hararge Bedeno 81 28 42 53 Oro E/Hararge Haromaya R 25 30 16 43 Oro N/Shewa Y/Gulele 1 4 3 43 Oro W/Arsi Shashemene 147 131 60 94 Oro W/Arsi Shala 50 86 55 49 Oro W/Hararge Chiro Z 54 54 54 64 Oro W/Hararge Meiso 57 70 46 57 Oro W/Hararge Gemechis 37 63 116 43 SNNP Hadiya E/Badawocho 40 0 10 43 SNNP Sidama Dara 32 21 36 48 Som Deghabur Dagahbur Hos 26 39 24 47 Total 4825 4836 4772 4661

2) Malaria National Malaria Trend: A total of 39, 355 malaria cases were reported in week 22. This is the highest number of report in 2016. The Malaria cases have been increasing starting from week 19 of 2016 and crosses the 2014 and 2015 trends. It is also expected the number of malaria cases could increase in the coming weeks except adequate and appropriate intervention will taken (Figure 5).

Figure 5: National Malaria cases trend, 2224-2016

Regional Malaria Trend: From Amhara region 13,941 malaria cases were reported in week 22, accounting for 35% of all cases. Compared with week 21, this week malaria cases increased in Amhara, Benishangul Gumuz, Oromia, Tigray and Gambella regions (Figure 6).

Figure 6: Regional Malaria trend, Week 19-22/2016

In week 22, a total of 151,896 cases suspected for malaria are tested either by microscopy or RDT. Of which 37,540 (25%) are ended positive for malaria parasites. The positivity rate is increasing from week to week. PF contributes 25,704 (65%) while 11836 (30%) were PV and the rest 1,815 (4.6%) are clinically diagnosed malaria cases. There are only 226(0.6%) inpatient cases with no death reported in the week. When looking at regional level, Somali has reported treating 61% of the cases clinically in week 22. High proportion of clinical malaria case treatment has been observed in the region throughout 2016. Compared with other regions and nationally the Somali pattern is quite different. The reason behind treating high number of patients should be further investigated and the regional health bureau is expected to decrease clinical malaria treatment since there is no shortage of resources(Table 4).

Table 4: Regional Malaria cases by type and region, Week 22, 2016

Region Tested Malaria PF PV Cli. Inp Death MPR Amh 54052 13941 8670 5264 7 60 0 26 BG 13812 7466 5788 824 854 94 2 48 SNNP 36878 6018 3519 2417 82 30 0 16 Oro 27627 4586 2874 1712 0 19 0 17 Tigr 13898 3873 2687 1163 23 11 0 28 Gam 3477 2028 1573 199 256 33 1 51 Som 653 978 304 81 593 1 0 59 Har 609 318 237 81 0 3 0 52 AA 513 124 37 87 0 124 0 24 DD 377 23 15 8 0 3 0 6 Total 151896 39355 25704 11836 1815 378 3 25 % 65.3 30.1 4.6 1.0 0.8

Note: Tested-Suspected malaria fever cases examined by microscopy or RDT, PF-Plasmodium falciparum, PV-Plasmodium vivax,Cli-Clinical Malaria, Inp-Inpatient malaria cases, MPR, Malaria positivity rate

Zonal Malaria Trend: Up on disaggregating the data to the zonal level, the total malaria cases have been increased

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in 23 zones. Among them malaria is increasing in South Gonder, North Gonder, Awi, East Gojjem, Asossa, Kemashi, Agnuak, Etang, East Wollega, Central Tigray and North West Tigray zones (Figure 7.1).

Figure 7.1: Zones in which malaria cases are increased compared with previous week, Week 19-22/2016

Woreda Malaria Trend: Up on disaggregating the data to the woreda level, malaria cases have been increased in 33 woredas (Figure 8.1, 8.2 & 8.3).

Figure 8.1: Woredas in which malaria cases increased compared with previous week, Week 19-22/2016



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Management



3) Rabies: Nationally, a total of 73 rabies exposure cases with zero death are reported in week 22 of 2016. Among them 15 (21%) are reported from Gonder Town and 13 (18%) were reported from Hewi Gudina woreda of West Hararge zone. (Table 5). Table 5: Regional rabies Exposure cases , Week 22, 2016 Region Zone Woreda E-Cases % Deaths Amh Gonder T Gonder T 15 21 0 Amh N/Shewa Debrebrehan Hos 3 4 0 Amh W/Gojjam Mecha 1 1 0 BG Maokomo Maokomo 6 8 0 Oro Arsi L/Bilbilo 2 3 0 Oro Shashamane T Shashamane T 3 4 0 Oro W/Hararge H/Gudina 13 18 0 Oro W/Hararge Mesela 3 4 0 SNNP Basketo T Basketo T 1 1 0 Tig C/Tigray Akisum T 4 5 0 Tig C/Tigray T/Abergele 3 4 0 Tig C/Tigray Abiyi Adi T 2 3 0 Tig E/Tigray Adi Girat T 4 5 0 Tig E/Tigray Hawzen 3 4 0 Tig E/Tigray Wekero T 2 3 0 Tig Mekele Mekele 6 8 0 Tig S/East H/Wajirat 2 3 0 Total 73 100 0

4) Meningitis In week 22 of 2016, a total of 30 suspected meningitis cases are reported to the national level through weekly routine surveillance. Majority of the cases reported from Hospitals. Up on disaggregating the hospital cases to woreda level, the cases were reported from different woredas (table 6). The Meningitis threshold was not crossed in all reported woredas .

Table 6: Suspected Meningitis Cases in week 22, 2016 Region Zone Woreda Total MM OP IP Death SNNP G/Gofa Bonke 4 4 0 0 SNNP Gedeo Dila Hos 4 0 4 0 Oro Bale Goba T 3 3 SNNP Siliti Werabie Hos 3 0 3 0 Oro Borena Yabelo Hos 2 0 2 0 Oro W/Hararge Gelemso Hos 2 2 0 0 SNNP Hawassa T Hawassa Hos 2 0 0 2 SNNP K/Tembaro Durame T 2 0 2 0 AA A/Kaliti A/Kaliti 1 1 0 0 Oro Borena B/Hora Hos 1 0 1 0 Oro Guji H/Wamena 1 0 1 0 Oro Guji Negele Hos 1 0 1 0 Oro Jimma T Jimma T 1 1 0 0 Oro W/Wellega Begi hos 1 0 1 0 SNNP Dawuro Gesa Hos 1 1 0 0 SNNP Sheka Yeki 1 1 0 0 Total 30 10 18 2

5) Measles National measles trend: The national trend of reported measles cases is below the reports received in 2015 and 2014 of the same time. The number of cases reported has steadly declined since week 12 (Figure 9).

Figure 9: National suspected Measles Trend ,2224-2016

Table 7: Suspected Measles cases, week 22, 2016 Region 20 Percent Death Addis Ababa 5 3.7 0 Amhara 43 32.1 0 Benishangul-Gumuz 0 0.0 0 Dire Dawa 1 0.7 0 Gambella 0 0.0 0 Harari 0 0.0 0 Oromia 78 58.2 0 SNNPR 0 0.0 0 Somali 7 5.2 0 Tigray 0 0.0 0 Total 134 100.0 0

Woreda Measles trend: Up on disaggregating suspected measles cases to woreda level, 24 woredas reported five and more suspected cases in the last one month (Week 16-22 of 2016). This shows the woredas are in measles outbreak as per our technical guideline. The suspected measles cases reported from woredas in the outbreak contributed 47 % of the national cases reported in week 22 (Table 8).

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Table 8: Suspected measles cases from Wk 16-22/2016 Region Zone Woreda w19 w20 w21 w22 Total AA Bole Bole 1 2 1 1 5 AA K/Keraniyo K/Keraniyo 0 1 2 2 5 Amh Gonder T Gonder T 6 2 7 8 23 Amh N/Gondar Dabat 0 0 0 11 11 Amh N/Gondar E/Belesa 6 0 1 3 10 Amh N/Gondar Qaura 5 0 0 0 5 Amh S/Gonder Estea 0 0 15 0 15 Amh Waghimra Zikwala 0 1 4 0 5 Amh W/Gojjam N/Achefer 2 2 5 2 11 Amh W/Gojjam Bahirdar Z 0 2 2 4 8 Oro Arsi Guna 9 1 0 0 10 Oro Arsi L/Bilbilo 0 1 0 5 6 Oro E/Hararge Babile 0 2 4 1 7 Oro Finfine Z Sebeta 0 0 0 5 5 Oro Guji H/Wamena 0 13 0 10 23 Oro Jimma Limu Seka 0 6 12 5 23 Oro Jimma Agaro 4 0 4 0 8 Oro Jimma T JimmaT 2 3 0 0 5 Oro N/Shewa Dera 0 13 0 0 13 Oro S/W/Shewa Woliso R 0 0 8 4 12 Oro S/W/Shewa Ameya 0 0 6 0 6 Oro W/Shewa G/Beret 0 0 10 10 Oro W/Shewa Ambo 3 2 0 5 Som Afder Jarati 5 0 0 0 5 Sub-total 43 51 71 71 236 Total cases per week 110 119 138 134 501 Percent 39 43 51 53 47

6) Anthrax In week 22, a total of 11 suspected Anthrax cases with zero death reported from Amhara and Tigray regions only (Figure 9).

Table 9: Suspected Anthrax cases reported in Week 22, 2016) Region Zone Woreda Cases Deaths Amh N/Gondar Tselemet 2 0 Amh N/Wollo Woldia 1 0 Amh Waghimra Zikwala 2 0 Tig C/Tigray Wereilehi 2 0 Tig C/Tigray Abiyi Adi Town 1 0 Tig N/W/Tigray Laelay Adiabo 1 0 Tig S/East Hintalo Wajirat 2 0 Total 11 0

7) Maternal Death Since maternal death is integrated in PHEM surveillance system a number of deaths were reported to national level both through weekly report and MDRF. This week a total of 18 maternal deaths were reported to national level through rutine surveillance from Addis Ababa, Amhara, Dire Dawa, Oromia, Gambelaa, SNNP and

Tigray regions. The other regions reported zero maternal death in the week (Table 10).

Table 10: Maternal Deaths report by Woreda, Week 22, 2016) Region Zone Woreda Deaths AA Nefas Silk Lafto Nefas Silk Lafto 1 Amhara South Gonder Estea 1 Amhara South Gonder Farta 1 Dire Dawa Dredewa Dilchora Hos 1 Gambella Mejenger Godere 1 Oromia East Hararge Fedis 1 Oromia East Wellega Boneya Bushe 1 Oromia West Wellega Nejo Hospital 1 SNNPR Bench Maji M/Aman Hos 1 SNNPR Kembata Tembaro Anigacha 1 Tigray Central Tigray L/Mayichewu 1 Tigray N/W/ Tigray A/Tsimbila 1 Grand Total 12 In 2016, Week 1-22, a total of 275 maternal deaths were notified through weekly surveillance system. All regions reported at least one maternal death within the last 22 weeks. Oromia region reported the highest deaths (125 Deaths) comparing with other regions. All woredas are started reporting maternal deaths (at least zero report). Majority of the woredas kept reporting zero maternal death which needs furher evaluation (Map 1).

Map 1: AWD Affected Woredas, Week 1-22, 2016

8) Suspected AWD Cases: The Moyale AWD outbreak is further expanding to other woredas. So far, 39 woredas were reported suspected AWD cases in three regions and one city administration (Oromia, Somali and SNNP regions, Addis Ababa)



Management



(Map 2). Nationally as of 12 June 2016, about 2145 suspected AWD cases were reported (table 11). The Gode Town suspected AWD outbreak was investigated and verified as not AWD cases. Hence we excluded the AWD cases reported from Gode for detail information see suciquent figures below.

One June 07/2016 Addis Ababa regional health bureau also identfied the first AWD cases from Kolfe Subcity (Woreda 06). As of 12 June 2016 (Mid Day) a total of 25 AWD Cases were reported. Nine of the 10 subcities were reported at least one suspected case. Majority of the cases were reported from Kolfe (Six cases) followed by Akaki Kaliti (five cases) and Gullele (four cases). No death reported. All the cases are isolated and treated in CTC.

Table 11: AWD cases by Woreda, Week 22, 2016 Region Zone Woreda Onset of

First case Onset of last case

Zero case for # days

Cases

AA A/Kaliti A/Kaliti 6/7/16 6/11/16 1 5 AA A/Ketema A/Ketema 6/10/16 6/11/16 1 2 AA Arada Arada 6/11/16 6/11/16 1 1 AA Gullele Gullele 6/8/16 6/11/16 1 4 AA K/Keraniyo K/Keraniy 6/7/16 6/8/16 4 6 AA Kirkos Kirkos 6/9/16 6/10/16 2 2 AA Lideta Lideta 6/10/16 6/10/16 2 2 AA N/Lafto N/Lafto 6/9/16 6/9/16 3 1 AA Yeka Yeka 6/9/16 6/10/16 2 2 Oro Bale M/wolabu 5/7/16 6/5/16 7 44 Oro Bale D/Mana NA NA 6 Oro Bale Robe NA NA 1 Oro Bale H/Bulluk 5/25/16 5/25/16 17 1 Oro Borena Muyale 6/19/16 5/20/16 22 320 Oro Borena Gelana 3/3/16 4/25/16 47 53 Oro Borena Arero 2/25/16 3/29/16 73 13 Oro Borena Dehas 3/19/16 3/24/16 78 9 Oro Borena Yaebello 1/22/16 NA 6 Oro Borena Abeya 3/31/16 3/31/16 72 1 Oro Guji Liban 3/23/16 5/31/16 12 115 Oro Guji Negele T 3/27/16 6/1/16 11 114 Oro Guji Wadera 4/14/16 5/24/16 18 35 Oro Guji Goro Dola 4/6/16 5/22/16 20 15 Oro Guji Seba Boru 4/28/16 4/28/16 44 4 Oro Guji A/Rede 4/22/16 4/22/16 50 1 Oro W/Arsi Shalla 4/22/16 6/7/16 5 17 Oro W/Arsi Shashemen 4/1/16 5/11/16 31 5 SNN Amaro Amaro 3/16/16 4/6/16 66 9 SNN G/Gofa A/minch T 3/5/16 4/7/16 65 303 SNN G/Gofa A/minch R 3/5/16 3/30/16 72 65 SNN G/Gofa Kucha 3/22/16 NA 28 SNN G/Gofa Bonke 3/19/16 3/20/16 82 3 Som Afder Kersadul 5/11/16 6/9/16 3 46 Som Afder Dolobay 5/13/16 NA 34 Som Afder D/suftu NA NA 22 Som Liben Muyale 19/21/16 6/4/16 8 305 Som Liben Hudet 2/23/16 3/26/16 76 276 Som Liben D/Ado 5/2/16 6/10/16 2 269 2145

Map 2: AWD Affected Woredas, 12 June 2016

Figure 15.1: AWD Outbreak trend by date of onset, Moyale (Oromia and Somali) 2016, N=618

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Figure 15.2: AWD Outbreak trend by date of onset, Dollo Ado, Liben, Somali, 2016, N=269

Figure 15.3: AWD Outbreak trend by date of onset, Kersa Dula, Liben, Somali, 2016, N=46

Figure 154: AWD Outbreak trend by date of onset, West Arsi, Oromia, 2016, N=27

Guji:

Figure 15.5: AWD Outbreak trend by date of onset, Guji zone, Oromia, 2016, N=284

Figure 15.1: AWD Outbreak trend by date of onset, Mada Walabu, Bale, Oromia, 2016, N=44

9) Guinea Worm (GW) The last Confirmed case was reported on October 21/2015 almost seven months ago. The died worm from Guinea worm suspected case was sent to Atlanta for confirmation and further characterization. The National Guinea Worm Eradication Program provided two days training for national and regional PHEM, EPI and other officers from all regions by the Financial and Technical support of The Carter Center Ethiopia.

10) Influenza Sentinel Surveillance In week 22 of 2016, a total of 12 samples were collected from patients with Influenza like illness or SARI at predesignated influenza sentinel sites. Among them only one sample is tested positive for influenza B (Figure 11).

Figure 11: Influenza cases by suptype, Sentinel Surveillance, 2015-2016

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1) Suspected Yellow fever: The 19 samples we sent to CDC laboratory at KEMRI tested negative by RT-PCR for Yellow Fever. Further testing by ELISA is undertaking and tasting for other AFI and or VHF will also conducted.

IV. Response

Addis Ababa AWD Outbreak: a. Addis Ababa Regional health bureau together

with EPHI and Partners quickly established CTC and equipped with required medical and infection prevention supplies.

b. Command post was established by Addis Ababa city Municipality and evaluation of daily AWD prevention and response activity was started.

c. UNICEF provide four additional CTC kits with supplies

d. First cohort FETP Urban track residents (22) rapidly oriented and have been investigating each AWD suspected cases and support the response activities.

e. Active case searching and Contact Tracing, Health Education and Social mobilization are started in all the 10 Addis Ababa sub cities involving Urban HEWs.

Oromia (West Arsi, Guji, Bale and Borena) AWD Outbreak: a. Unicef provided a total of 1,200,000 water

treatment chemicals Sachets (600,000 Sachets to

Guji, 200,000 Sachets to Bale, 200,000 Sachets to Borena and 200,000 Sachets to West Arsi) with 4,829,481 ETB financial support.

b. Investigation, active case searching, social moblization and community awerness is continioued in all the three zones

Somali (Libe and Afder) AWD Outbreak: a. The two teams sent to the region from EPHI

continued investigating and responding to the outbreak.

b. Supplies is continiousely refilled c. Patient isolation and treatment in designated CTC

(Case Treatment Center), Contact trasing, infection prevention, health education and social moblization activities, distributing of water treatment chemicals at household level, treatment of water at the source and detail case investigation is undertaking in all AWD affected woredas.

d. Latrine construction is massively undertaking by community through the clossfollow up and inspection of woreda and kebele cabinets.

e. Dailly activities are being evaluated by zonal and woreda emergency preparedness and response committees

EPIDEMIOLOGICAL BULLETIN: Abyot Bekele, MPH Ethiopian ... · EPIDEMIOLOGICAL BULLETIN: Weekly/Volume 2/Number 22/ Page 1-8 /May30-Jun 5/2016 Abyot Bekele, MPH1 1. Ethiopian Public

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