Ethiopian Public Health Institute Center for Public …...6 Ethiopian Public Health Institute Center for Public Health Emergency Management A total of 968 cases (3.6%) of malaria were

Ethiopian Weekly Epidemiological Bulletin

Ethiopia Wkly Epi Bulletin/Vol. 3/No. 32 Epidemiological Week 32 Week Ending 13th August/2017

Highlights of the week

Surveillance Completeness Rate: Nationally, the

proportion of health facilities that reported surveillance

data was 93.6% which is above the minimum

requirement (80%).

Surveillance Timeliness Rate: Nationwide, the

proportion of health facilities that reported the

surveillance data timely were above the minimum

requirement i.e. 88.9%.

Malaria: A total of 115,878 febrile cases were suspected

for malaria and tested either by microscopy or RDT in

the week. Of these cases, 23.0% (26,678) were treated

for malaria. As compared to week 31, there was 12.8%

(3,910 cases) decrement.

Severe Acute Malnutrition: A total of 3,900 cases with

five deaths were reported with decrement of 6.4% (268

cases) as compared to last week.

Measles: Measles suspected outbreak threshold was

surpassed in about ten woredas during the week and the

national non measles febrile rash rate was 2.8.

Meningitis: A total of 48 suspected meningococcal

meningitis cases were reported without deaths. As

compared to last week there was 65.5% (19 cases)

increment. Alert threshold was reached at Robe Town of

Oromia Region (AR=8.4/100,0000 populations).

Anthrax: A total of 14 suspected anthrax cases without

death were reported during the week.

Rabies Exposure: A total of 51 exposure cases without

death were reported which was 12.1% (7 exposure cases)

lower than the last week.

Maternal Death: A total of 21 maternal deaths were

reported from 19 reporting sites.

Zero Reports: Zero suspected cases of avian human

influenza, drancunculiasis, pandemic influenza, small

pox, hemorrhagic fever, SARS and yellow fever were

reported during the week.

Acute Watery Diarrhea Outbreak: Acute watery

diarrhea outbreak is ongoing in some woredas of Somali,

Amhara, Tigray Afar and Oromia Regions and a total of

316 suspected AWD cases without deaths were reported

during the week.

National Public Health Emergency Operation Center

incident management system is coordinating the

response to the outbreak.

Influenza Sentinel Surveillance: A total of ten samples

were tested of which one tested positive for Influenza A

(H3).

Frontline FETP Workshop: In order to build the

capacity of the PHEM officers’ frontline FETP

workshop was conducted in Bahir Dar Town.

Epidemiologic Approach for Malaria Control

Training: In order to strengthen malaria surveillance

system training was conducted in SNNPR.

Maternal and Prenatal Death Surveillance and

Response TOT Training: First round Maternal and

perinatal death surveillance and response (MPDSR)

Training of trainers (TOT) for National and regional

Surveillance and Maternal and child health officers were

conducted.

One Health Approach Rabies Training: Rabies training organized by Zoonotic Research Directorate

aimed to create awareness on One Health Approach

towards rabies control and prevention strategies was

conducted.

Training on Diseases Mapping: Training on disease

mapping and GIS were carried out by CDC-Atlanta

experts for seven participants at EPHI Training Center.

The training was organized by EPHI/cPHEM in

collaboration with CDC.

Workshop on Medical Counter Measure

guideline/plan: A workshop on medical countermeasure

guideline/plan development is being conducted.

Ethiopian Public Health Institute Center for Public Health Emergency Management

2

Ethiopian Public Health Institute

Center for Public Health Emergency Management

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 32 of 2017 and

daily phone communication, line list reports of outbreaks for week 33 of 2017. 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 numbers of

disease specific cases indicated in this issue of bulletin are subject to change due to on-going receiving late

weekly surveillance data and retrospective verification and investigation of data from outbreak areas.

II. National Surveillance Data Summary Table 1: Comparison of surveillance data by week, week 31 and 32, 2017, Ethiopia. Indicators 2017

Week 31 Week 32 % Change

Percent of Health Facility reported 93.04% 93.61% 0.6

Percent of Health Facility reported timely 84.62% 88.91% 5.1

Total Malaria Confirmed and Clinical 30,588 26,678 -12.8 Typhoid fever 22,477 21,947 -2.4

Epidemic Typhus 7,882 7,740 -1.8

Dysentery 6,720 6,782 0.9

Severe Acute Malnutrition 4168 3900 -6.4

Acute Watery Diarrhea 462 316 -31.6

Rabies exposure 58 51 -12.1

Measles 40 30 -25.0

Meningococcal Meningitis 29 48 65.5

Relapsing fever 46 32 -30.4

Maternal Death 21 21 0.0

Acute Flaccid Paralysis 7 10 42.9

Anthrax 8 14 75.0

Neonatal Tetanus 1 1 0.0

Avian Human Influenza 0 0 0.0

Polio 0 0 0.0

Drancunculiasis/Guinea worm 0 0 0.0

Pandemic Influenza 0 0 0.0

SARS 0 0 0.0

Small pox 0 0 0.0

Yellow Fever 0 0 0.0

Viral hemorrhagic fever 0 0 0.0

Ethiopian Weekly Epidemiological Bulletin Vol. 3/No. 32

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3 PREDICT, PREVENT, DETECT, PREPARE FOR, RESPOND TO AND RECOVER FROM

III. Public Health Surveillance Reporting Completeness and Timeliness Rates

A. Public Health Surveillance Reporting Completeness Rate

The national surveillance completeness rate was 93.6% in the week which is above the minimum

requirement (80%) and all regions except Somali (72.1%), Gambella (73.2%) and Afar (79.2%) had

achieved above the minimum requirement (Fig 1).

Figure 1: Surveillance data completeness rate by regions, week 29-32, 2017, Ethiopia.

B. Public Health Surveillance Reporting Timeliness Rate

During the week the national surveillance data reporting timeliness rate was 88.9% and all the rest regions

except Afar (0.0%), Somali (0.0%) and Gambella (73.2%) had achieved above the minimum requirement,

80%.

Figure 2: Surveillance data completeness rate by regions, week 29-32, 2017, Ethiopia.

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IV. Diseases/Conditions under Surveillance Updates 1. Malaria

During the week a total of 115,878 health facilities visitors were suspected and examined for malaria of

which 23% (26,678) cases were treated as malaria which was 12.8% (3,910 cases) lower than the last

week. There was no death reported during the week. Plasmodium falciparum contributes the highest

portion of the cases reported during the week, 74.2% (19,074 cases) of the cases nationally and 94.6%,

86.0% and 85.3% in Gambella, Afar and Harari Regions respectively. The number of cases reported in

2017 is still lower than the number of cases reported in the last two years with significant decrement in the

last three weeks.

Figure 3: National malaria (clinical and laboratory confirmed) trend by week from 2015-2017,

Ethiopia.

The malaria attack rate per 100,000 populations is highest in Gambella (359.9) followed by B/Gumuz

Region (270.7) during the week and it was 20.8 nationwide.

Cascading the malaria cases to regions, 20.7% (5,544 cases), 17.01% (4,540 cases) and 12.8% (3,438

cases) were reported from SNNP, Amhara and Oromia Regions respectively during the week.


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Figure 4: Regional malaria cases distribution by week, week 28-32, 2017, Ethiopia.

Note: AR- Malaria attack rate per 100,000 populations

Map 1: Malaria attack rate per 100,000 populations by woredas, week 32, 2017, Ethiopia.

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A total of 968 cases (3.6%) of malaria were treated clinically nationwide while 69.8%, 13.5% and 10.2%

were treated clinically in Somali Region, Harari and Gambella Regions respectively. The clinically treated

malaria cases during the week were below the national recommendation nationally but higher than in

Somali, Harari and Gambella Regions. The malaria slide positivity rate nationwide during the week was

22.2%. The national positivity rate for plasmodium falciparum was 16.5% while 60.5% and 47.7% in

Gambella and Harari Regions respectively during the week.

Table 2: Regional Malaria cases by type and indicators, week 32, 2017, Ethiopia

Region Cases InP Deaths IpR CFR Tested PF PV Conf Cli MPR (%)

PF-PR (%)

Clinical (%)

A/Ababa 114 0 0 0.0 0.0 489 38 76 114 0.0 23.3 7.8 0.0

Afar 1061 2 0 0.2 0.0 2609 921 150 1071 -10.0 41.1 35.3 -0.9

Amhara 4540 15 0 0.3 0.0 25838 2982 1557 4539 1.0 17.6 11.5 0.0

B/Gumuz 3847 28 0 0.7 0.0 11072 3183 548 3731 116.0 33.7 28.7 3.0

D/Dawa 20 1 0 5.0 0.0 849 15 5 20 0.0 2.4 1.8 0.0

Gambella 2092 52 0 2.5 0.0 3799 1777 101 1878 214.0 49.4 46.8 10.2

Harari 393 2 0 0.5 0.0 661 264 76 340 53.0 51.4 39.9 13.5

Oromia 3438 12 0 0.3 0.0 21077 2328 1057 3385 53.0 16.1 11.0 1.5

SNNPR 5544 34 1 0.6 2.9 29871 3790 1662 5452 92.0 18.3 12.7 1.7

Somali 640 0 0 0.0 0.0 522 161 32 193 447.0 37.0 30.8 69.8

Tigray 4989 19 0 0.4 0.0 19091 3615 1372 4987 2.0 26.1 18.9 0.0

G/ Total 26678 165 1 0.6 0.6 115878 19074 6636 25710 968.0 22.2 16.5 3.6

Note: Tested-Suspected malaria fever cases examined by microscopy or RDT, PF-Plasmodium falciparum,

PV-Plasmodium vivax, Cli-Clinical Malaria, Conf-confirmed malaria, MPR, Malaria positivity rate, IpC-

In patient cases, IpR- In patient rate, CFR- case fatality rate

2. Meningitis

During week 32 of 2017 a total of 48 suspected meningococcal meningitis cases were reported

from Oromia (17 cases), SNNP (13 cases), Somali (10 cases), Addis Ababa (5 cases), Amhara (1 case),

B/Gumuz (1 case) and Gambella (1 case). There was no death reported during the week. Alert threshold

was reached at Robe Town (AR=8.4/100,000 populations) of Oromia Region. The suspected cases reported

during the week were higher than the suspected cases during the same week of the 2015 but lower than the

same week of 2016.


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Figure 5: Trend of suspected meningococcal meningitis cases over week, 2015-2017, Ethiopia.

Map 2: Suspected meningococcal meningitis thresholds status by woreda, week 32, 2017, Ethiopia.

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3. Dysentery

During week 32, a total of 6,782 dysentery cases with two deaths (from Oromia Region) were reported

showing 0.9% (62 cases) increment as compared to week 31 of 2017. The number of cases reported during

the week was lower than the same week of the last year cases.

Figure 6: Dysentery cases trend by week, 2016-2017, Ethiopia.

The national attack rate per 100,000 populations during the week was 7.04 and B/Gumuz Region was with

highest attack rate (21.3/100,000) followed by Tigray Region (AR=20.5/100,000) and Gambella Region

(AR=14.2/100,000).

4. Tyhoid Fever

During week 32, a total of 21,947 cases of typhoid fever with one death (from Tigray Region) were

reported which was 2.4% (530 cases) lower than the last week of the same year. The typhoid fever cases

reported in 2017 is continued to be higher than the cases of the same weeks in 2016.

Figure 7: Typhoid fever cases trend by week, 2016-2017, Ethiopia.


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B/Gumuz Region has highest affected population (AR= 113.7/100,000) followed by Addis Ababa (AR=

102.5/100,000) and SNNPR (AR=37/100,000) during the week while nationwide 228 persons per a

million populations were affected by typhoid fever.

5. Relapsing Fever

A total of 32 cases of relapasing fever with one death (from Oromia Region) were reported during week 32

which was 30.4% (14 cases) lower than the last week. Nationally, about three persons per ten million

populations were affected while 40 and four persons per ten million populations were affected in Addis

Ababa and SNNP Region respectively during the week.

6. Epidemic Typhus

A total of 7,740 cases of epidemic typhus without death were reported during week 32, which was 1.8%

(142 cases) lower than the week 31 of 2017 cases. The number of cases reported during 2017 are continued

to be higher than the number of cases reported during the similar weeks of 2016 with slight decrement

during this week.

Figure 8: Epidemic typhus cases trend by week, 2016-2017, Ethiopia.

Nationwide about eight persons per 100,000 populations were affected by epidemic typhus while in Addis

Ababa and B/Gumuz Region about 82 and 31 persons per 100,000 populations were affected respectively

during the week.

7. Severe Acute Malnutrition

During week 32 of 2017, a total of 3,900 cases were reported which showed 6.4% (268 cases) decrement as

compared to last week. There were a total of five deaths from SNNPR (2 deaths) and Addis Ababa (2

deaths) and Amhara (1 death). The severe acute malnutrition cases reported during the week 32 of 2017

was slightly lower than the number of cases reported during the same week of the last year.

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Figure 9: Severe acute malnutrition cases trend by week, 2016-2017, Ethiopia.

About 399(10.2%) of the total reported SAM cases were treated in patient during the week nationally.

The top ten severe acute manutrition leading woredas during the last one month (week 29-32) were from

Oromia, Afar and Somali Regions.

Table 3: Top ten severe acute malnutrition cases reporting woredas, week 29-32, 2017, Ethiopia.

Region Zone Woreda Cases

wk 29 wk 30 wk 31 wk 32

Oromia West Arsi Shashemene Rural 50 62 20 61

Oromia East Hararge Fedis 47 33 37 56

Oromia West Hararge Oda Bultum 31 28 53 43

Afar Zone 02 Erebti 29 42 49 42

Oromia East Hararge Haromaya Rural 47 46 50 42

Oromia East Hararge Bedeno 30 40 46 41

Oromia West Hararge Mesela 29 61 46 36

Somali Doollo Warder 120 36 36 34

Oromia West Hararge Habro 27 80 39 30

Oromia East Hararge Girawa 49 79 22 23

Grand Total 459 507 398 408


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8. Acute Flaccid Paralysis

During the week a total of 10 suspected AFP cases were reported which was 42.9% (3 cases) higher than

the last week.

Nationally, about 284 woredas have achieved both non polio AFP and stool adequacy rates above the

standard as of week 32, 2017

Note: NPAFPR = Non Polio AFP Rate, SAR = Stool Adequacy Rate

Map 3: Annualized AFP surveillance performance indicators as of week 32, 2017, Ethiopia

9. Anthrax

A total of 14 suspected anthrax cases without death were reported from Amhara and Tigray Regions during

the week.

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Table 4: Distribution of suspected anthrax cases and deaths by woredas, week 32, 2017, Ethiopia.

Region Zone Reporting site Case Death

Amhara Wag Himra Zikwala 7 0

Tigray Central Tigray Kola Temben 2 0

Amhara Wag Himra Sehale Seyemt 2 0

Amhara North Shewa Enat Hospital 1 0

Tigray Central Tigray Tanqua Abergele 1 0

Tigray North Western Tigray Tselemt 1 0

Grand Total 14 0

10. Measles

During the week 32, a total of 30 suspected measles cases without death were reported and as compared to

last week there was 25% (10 cases) decrement. The annualized proportion of woredas that reported at least

one suspected measles case as of week 32, were 59% (523 woredas) nationwide. The national non measles

febrile rash rate as of week 32 was 2.8.


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Table 5: Annualized non measles febrile rash rate and proportion of woredas reported at least one

suspected measles case by region as of week 32, 2017, Ethiopia.

Region Name Non Measles Febrile Rash

Rate

Number of Woredas Expected to Report at

least 1 Suspected Measles Case

Number of Woredas Reported at least 1

Suspected Measles Case

Proportion of Woredas Reported at least 1

Suspected Measles Case

Addis Ababa 17.4 85 85 100%

Afar 1.4 30 8 27%

Amhara 1.6 143 88 62%

B/Gumuz 10.6 16 16 100%

Dire Dawa 2.5 1 1 100%

Gambella 3.9 8 3 38%

Hareri 0.6 1 1 100%

Oromia 2.3 332 172 52%

SNNPR 2.0 152 98 64%

Somali 1.5 69 17 25%

Tigray 1.7 49 34 69%

National 2.8 886 523 59%

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Note: NMFR = Non Measles Febrile Rash Rate

Map 4: Woreda level non measles febrile rash rate as of week 32 of 2017, Ethiopia

Measles suspected outbreak threshold was surpassed in about ten woredas based on the national outbreak

threshold criteria (woreda that reported greater than five suspected cases over the last four weeks, 29-32

weeks).

11. Neonatal Tetanus

One suspected cases of NNT with death was reported from Agarfa Woreda of Oromia Region during the

week.

12. Rabies Exposure

A total of 51 exposure cases without death were reported during the week which was 12.1% (7 exposure

cases) lower than the last week exposure cases.


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Table 6: Distribution of suspected rabies exposure cases and deaths by reporting sites, week 32 of

2017, Ethiopia.

Region Zone/Subcity Reporting sites Case Death

Tigray Central Tigray Abiyi Adi Town 6 0

Tigray Central Tigray Ahiferom 2 0

Tigray Central Tigray Akisum Town 2 0

Amhara West Gojjam Finote Selam Hospital 5 0

Amhara Gonder Town Gonder Town 9 0

Tigray Western Tigray Humera Town 2 0

Oromia East Wellega Sasiga 3 0

Oromia Sebeta Town Sebeta Town 3 0

Amhara East Gojjam Shebel Berenta 4 0

Tigray Mekele Especial Zone South & North Mekele 6 0

Tigray Central Tigray Tanqua Abergele 6 0

Addis Ababa Arada Yekatit 12 Hospital 3 0

Grand Total 51 0

13. Maternal Death

During the week a total of 21 maternal deaths were reported from 19 reporting sites of Oromia Region (11

deaths), Amhara Region (6 deaths), Tigray Region (2 deaths), SNNP Region (1 death) and Gambella

Region (1 death).

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Note: MD: Maternal death

Map 5: Maternal death distribution by woreda, week 1-32, 2017, Ethiopia.

14. Influenza Sentinel Surveillance

In week 32 of 2017, a total of twelve patients complaining of ILI or SARI were reported and throat swab

samples were collected to be tested in predesignated influenza sentinel sites of which ten samples were

processed. Among the ten samples processed one sample tested positive for Influenza A (H3) during the

week.


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Figure 10: Influenza suspected samples processed and sub type, week 1-32, 2017, Sentinel

Surveillance Sites, Ethiopia.

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V. Diseases/Conditions Outbreaks 1. Acute Watery Diarrhea Outbreak

Acute watery diarrhea outbreak is ongoing in some woredas of Amhara, Tigray, Somali, Oromia and Afar

Regions. During the week a total of 316 suspected cases of AWD without death were reported.

Team composing of epidemiologists both from national and regional health bureaus, partners including

WHO, UNICEF, MSF and Save the Children are enhancing the response to the AWD outbreak. Case

management, surveillance, WASH and social mobilization are maintained and strengthened.

The Ethiopian Public Health Institute Emergency Operation Center has continued to coordinate the

response to the outbreak by revitalizing the technical committees under incident management system.

Rumor collection through toll free phone, 8335 and new PHEOC E-mail, [email protected] in addition

to daily case and death due to AWD report collection from the affected areas is maintained at the PHEOC.

Daily reports and situation updates were prepared and shared to all responsible bodies.

2. Suspected Hepatitis E Outbreak

There were 86 suspected hepatitis cases with four deaths in Warder, Danot and Korahe woredas of Dolo

Zone of Somali Region. Seven samples were collected and tested at EPHI Reference laboratory at which all

the samples tested negative for Hepatitis E, Yellow fever, Dengue fever, Chikungunya and Zika viruses.

The case management and response to the suspected outbreak is underway in collaboration with MSF

Holland.

VI. Other Activities

1. Frontline FETP Training

In order to build the capacity of public health emergency management officers at woreda level 1st

workshop of frontline FETP was conducted in Bahir Dar Town from August 15-19 training about 87

PHEM officers from different zones of Amhara Region.

mailto:[email protected]


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2. Epidemiologic Approach for Malaria Control Training

National Public Health Emergency Management (PHEM) of Ethiopian Public Health Institute has

continued to provide the training on epidemiological approach for malaria control to PHEM officers at

regional, zonal and woreda levels. The 1st round training was conducted in SNNP Region from August 16-

19 in Arba Minch Town training about 80 PHEM officers at different levels. 2nd round will be conducted

from August 28-31 in Hawassa Town.

3. One Health Approach Rabies Training

Training on rabies cell culture vaccine, surveillance and outbreak investigation was given for more than

500 participants including, woreda PHEM officers, veterinarians and health officers at health centers

delegated from city administration of Addis Ababa. The training was held for two days on five rounds from

August 8-21, 2017; which was organized by Zoonotic Disease Research Team.

4. Training on Diseases Mapping

Training on disease mapping and GIS were carried out by CDC-Atlanta experts for seven participants (4

from EPHI and 3 from MoLF) from August 14-16, 2017 at EPHI Training Center. The training was

organized by EPHI/cPHEM in collaboration with CDC.

5. MPDSR Training

First round Maternal and Perinatal Death Surveillance and Response (MPDSR) Training of Trainers (TOT)

for National and regional Surveillance and Maternal and child health officers was conducted from august

15-17, 2017 in Bishoftu Town to deliver a practical introduction to the Ethiopian MPDSR system and

support establishment of a functional, effective and action-oriented MPDSR system across the nation

training about 48 trainees.

6. A Workshop on Medical Countermeasure Guideline/Plan Development

A workshop on medical countermeasure guideline/plan development is being conducted at Adama Town

from August 21-24 aiming to enrich and finalize the MCM document at hand on which different

participants from different stakeholders like Public Procurement Agency, Pharmaceuticals Fund and

Supply Agency, Ministry of Health, EFMHACA and EPHI are attending.

7. Weekly Epidemiological Feedback

Weekly epidemiological surveillance data feedback were prepared by regional focals and communicated

to the respective regions.

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Aknowledgement

Many thanks go to all regional states health bureau for sharing to national PHEM their respective

regional weekly surveillance data, data managers of EPHI/cPHEM for compiling all regional

surveillance data and all national PHEM officers for their close follow-up and sharing updates and

National Virology Research Team for compiling and sharing the case based data of acute flaccid

paralysis and influenza.


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For Further Information:

Please Contact Us: Ethiopian Public Health Institute (EPHI), Public Health Emergency Management

(PHEM),

Early Warning and Response Unit (EWaR),

Web site: www.ephi.gov.et,

P.O Box 1242, Telephone: +251-11-27-65-340/58-896

For any rumor or information please call: Toll free telephone: 8335/8665

Send to: [email protected]

Author and Editor in Chief:

Zewdu Assefa-MPH, Field Epidemiologist

E-mail: [email protected]

Mobile: +251-919-59-97-09

Contributors:

Yohannes Dugasa and Malaku Seyoum: Malaria

Diriba Sufa, Mikias Alayu and Mengistu Biru: Measles and Acute Flaccid Paralysis

Shambel Habebe: Acute Watery Diarrhea

Adamu Tayachew: Influenza

Mikias Alayu: Suspected Hepatitis E Outbreak

Fikirte Girma: Workshop on medical counter measure guideline/plan development

Yohannes Dugasa: Epidemiological Approach for Malaria Control Training

Tesfahun Abiye and Dr. Muse Tadese: One Health Approach Rabies Training

Dr. Muse Tadese: Diseases Mapping Training

Abdulhafiz Hassen: Maternal and Perinatal Death Surveillance and Response TOT Training

Reviewers:

Mikias Mokennin (MPH, Delegate for Public Health Emergency Preparedness and Capacity

Building Team)

Emana Alemu (MPH, Delegate for Public Health Emergency Early Warning and Response

Team)

mailto:[email protected]

Ethiopian Public Health Institute Center for Public …...6 Ethiopian Public Health Institute Center for Public Health Emergency Management A total of 968 cases (3.6%) of malaria were

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