Ethiopian Public Health Institute Center for Public Health …€¦ · epidemiological approach...

Ethiopian Weekly Epidemiological Bulletin

Ethiopia Wkly Epi Bulletin/Vol. 3/No. 27 Epidemiological Week 27 July/2017

Highlights of the week

Surveillance Completeness Rate: Nationally, the proportion

of health facilities that reported surveillance data was 91.8%

which was above the minimum requirement (80%).

Surveillance Timeliness Rate: Nationwide, the proportion of

health facilities that reported the surveillance data timely was

above the minimum requirement i.e. 91.8%.

Malaria: A total of 111,428 febrile cases were suspected for

malaria and tested either by microscopy or RDT in the week.

Of these cases, 23.7% (26,436) were treated for malaria. As

compared to week 26, there was 1.5% (408 cases) decrement.

Severe Acute Malnutrition: A total of 3,934 cases with two

deaths were reported, showing 8% (341 cases) decrement as

compared to last week.

Measles: Suspected outbreak threshold was surpassed in 15

woredas and the national non measles febrile rash rate was

2.8.

Meningitis: A total of 34 suspected meningococcal meningitis

cases were reported without death. As compared to last week

there was 10.5% (4 cases) decrement. Alert threshold was

reached at Moyale Woreda of Oromia (AR= 5/100,000) during

the week.

Anthrax: A total of 10 suspected anthrax cases without death

were reported during the week.

Rabies Exposure: A total of 109 exposure cases without

death were reported which was 34.6% (28 cases) higher than

the last week.

Maternal Death: A total of 26 maternal deaths were reported

from 21 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.

Influenza Sentinel Surveillance: Eleven samples were

collected and tested during the week of which two were

positive for seasonal influenza (A H3N2).

Acute Watery Diarrhea Outbreak: Acute watery diarrhea

outbreak is ongoing in some woredas of Somali, Oromia,

Amhara, Tigray and Afar Regions and a total of 212 suspected

AWD cases with one death were reported during the week.

Dengue Fever Outbreak: There is ongoing dengue fever

outbreak in Dire Dawa City Administration.

Malaria Surveillance System Strengthening Training: In

order to build the capacity of the PHEM officers malaria

epidemiological approach training was conducted from July

20-23 training 120 PHEM officers from western part of

Oromia Region.

Frontline FETP Workshop: 1st round 2nd Frontline FETP

workshop was conducted in Adama Town from July 18-22,

2017 training about 54 PHEM officers of Addis Ababa City

Administration. The second round will be conducted from July

24-28, 2017.

Ethiopian Public Health Institute Center for Public Health Emergency Management

Ethiopian Weekly Epidemiological Bulletin Vol. 3/No. 27

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

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 27 of 2017

and daily phone communication, line list reports of outbreaks for week 28 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 26 and 27, 2017, Ethiopia. Indicators 2017

Week 26 Week 27 % Change

Percent of Health Facility reported 92.11% 91.80% -0.3

Percent of Health Facility reported timely 88.80% 91.80% 3.4

Total Malaria Confirmed and Clinical 26,844 26,436 -1.5 Typhoid fever 21,883 21,124 -3.5

Epidemic Typhus 7,514 7,222 -3.9

Dysentery 7,100 6,570 -7.5

Severe Acute Malnutrition 4275 3934 -8.0

Acute Watery Diarrhea 171 212 24.0

Rabies exposure 81 109 34.6

Measles 49 52 6.1

Meningitis 38 34 -10.5

Relapsing fever 55 32 -41.8

Maternal Death 22 26 18.2

AFP 9 10 11.1

Anthrax 14 10 -28.6

Neonatal Tetanus 4 2 -50.0

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

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Ethiopian Public Health Institute

Center for Public Health Emergency Management

III. Public Health Surveillance Reporting Completeness and Timeliness Rates

A. Public Health Surveillance Reporting Completeness Rate

The national surveillance completeness rate was 91.8% in the week which is above the minimum

requirement (80%) and all regions except Dire Dawa (0.0%), Afar Region (50.6%) and Somali Region

(74.4%) had achieved above the minimum requirement (Fig 1).

Figure 1: Surveillance data completeness rate by regions, week 24-27, 2017, Ethiopia.

B. Public Health Surveillance Reporting Timeliness Rate

During the week the national surveillance data reporting timeliness rate was 91.8% and all the rest

regions except Dire Dawa (0.0%), Afar Region (50.6%) and Somali Region (74.4%) had achieved above

the minimum requirement, 80%.

Figure 2: Surveillance data completeness rate by regions, week 24-27, 2017, Ethiopia.


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IV. Diseases/Conditions under Surveillance Updates 1. Malaria

During the week a total of 111,428 health facilities visitors were suspected and examined for malaria of

which 23.7% (26,436) cases were treated as malaria which was 1.5% (408 cases) lower than the last

week. There was one death reported from SNNP Region during the week. Plasmodium falciparum

contributes the highest portion of the cases reported during the week, 74.9% (18,878 cases) of the cases

nationally and 94.7%, 90.0% and 83.0% in Gambella, Harari and Afar Regions respectively. The

number of cases reported in 2017 is still lower than the number of cases reported in the last two years.

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 (533.6) followed by B/Gumuz

Region (328.0) during the week and it was 20.6 nationwide which showed increment as compared to last

week.

Cascading the malaria cases to regions, 19.18% (5,071 cases), 18.35% (4,853 cases) and 17.6% (4,662

cases) were reported from Amhara, SNNP and B/Gumuz Regions respectively during the week. The

malaria cases are slightly increasing in Amhara and Gambella Regions while steadily decreasing in

B/Gumuz Region over the last four weeks.

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Figure 4: Regional malaria cases distribution by week, week 24-27, 2017, Ethiopia.

A total of 1,239 cases (4.7%) of malaria were treated clinically nationwide while 45%, 8.6% and 8.1%

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

malaria during the week was below the national recommendation except in Somali, Gambella, Oromia

and Harari Regions. The malaria slide positivity rate nationwide during the week was 22.6%.

2. Meningitis

During week 27 of 2017 a total of 34 suspected meningococcal meningitis cases were reported

from SNNP (10 cases), Oromia (10 cases), Amhara (7 cases), Afar (4 cases), Addis Ababa (2 cases) and

Tigray (1 case). There was no death reported during the week. The suspected cases had decreased by

10.5% (4 cases) as compared to the last week. The alert threshold was reached at Moyale woreda of

Oromia Region (AR=5/100,000 populations) during the week. The suspected cases reported during the

week were higher than the suspected cases during the same week of the last two years.


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

Map 1: Suspected meningococcal meningitis threshold status by woreda, week 27, 2017, Ethiopia.

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3. Dysentery

During week 27, a total of 6,570 dysentery cases without death were reported showing 7.5% (530 cases)

decrement as compared to week 26 of 2017. There was no death reported during the week.

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

The national attack rate per 100,000 populations during the week was 6.82 and Tigray Region, the

second largest affected during the last week, was with highest attack rate (19.65/100,000) followed by

B/Gumuz Region (AR=15.01/100,000) and Gambella Region (AR=13.9/100,000).

4. Tyhoid Fever

During week 27, a total of 21,124 cases of typhoid fever without death were reported which was 3.5%

(759 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 though there is a tendency of

decrement.

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


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B/Gumuz Region had highest affected population (AR= 98.6/100,000) followed by Addis Ababa (AR=

85.6/100,000) during the week while nationwide 219 persons per a million populations were affected by

typhoid fever.

5. Relapsing Fever

A total of 32 cases of relapasing fever without death were reported during week 27, which were 41.8%

(23 cases) lower than the week 26 of 2017 cases. Nationally, about three persons per ten million

populations were affected while 183 and 23 persons per ten million populations were affected in

Gambella Region and Addis Ababa City Administration respectively during the week.

6. Epidemic Typhus

A total of 7,222 cases of epidemic typhus without death were reported during week 27, which were

3.9% (292 cases) lower than the week 26 of 2017 cases. The number of cases reported in 2017 are

continued to be higher than the number of cases reported during the similar weeks of 2016 though there

is a tendency to decrease.

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 67 and 30.3 persons per 100,000 populations were affected

respectively during the week.

7. Severe Acute Malnutrition

During week 27 of 2017, a total of 3,934 cases were reported which showed 8% (341 cases) decrement

as compared to last week. There were a total of two deaths from SNNPR (1 death) and Oromia Region

(1 death). The severe acute malnutrition cases reported during the week 27 of 2017 is slightly similar to

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 498 (12.7%) 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 24-27) were from

SNNP, Oromia and Somali Regions.

Table 2: Top ten severe acute malnutrition cases reporting woredas, week 24-27, 2017, Ethiopia.

Region Zone Reporting sites Cases by week

wk 24 wk 25 wk 26 wk 27

SNNPR Segen Konso 46 18 40 61

Oromia East Hararge Bedeno 21 44 39 58

Oromia West Hararge Gemechis 46 63 45 49

SNNPR Gedeo Wenago 40 50 32 37

Oromia West Arsi Siraro 55 36 31 35

Oromia East Hararge Haromaya Rural 34 32 70 32

Oromia West Arsi Shashemene Rural 57 76 64 32

Somali Shabelle Kalafo 129 86 12 19

Oromia East Hararge Girawa 58 33 33 17

Somali Jarar Dagahbur Hospital 65 66 56 0

Grand Total 551 504 422 340


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8. Acute Flaccid Paralysis

During the week a total of 10 suspected AFP cases were reported which were 11.1% (1 case) higher than

the last week suspected cases.

Table 3: Distribution of suspected acute flaccid paralysis cases and deaths by reporting sites, week

27, 2017, Ethiopia

Region Zone/Subcity Reporting sites Case Death

B/Gumuz Assosa Assosa Rural 2 0

Somali Faafan Aw-Bare 1 0

Oromia West Wellega Ayira Hospital 1 0

Amhara West Gojjam Dembecha 1 0

Amhara Dese Town Dese Town 1 0

Oromia East Hararge Kurfa Chele 1 0

Addis Ababa Lideta Lideta 1 0

SNNPR Gamo Gofa Melekoza 1 0

Oromia Horo Gudru Wellega Shambu Hospital 1 0

Grand Total 10 0

9. Anthrax

A total of 10 suspected anthrax cases without death were reported from Amhara and Tigray Regions.

Table 4: Distribution of suspected anthrax cases and deaths by woredas, week 27, 2017, Ethiopia.

Region Zone Woreda Case Death

Amhara Wag Himra Sehale Seyemt 3 0

Amhara Wag Himra Abergele 2 0

Amhara Wag Himra Zikwala 2 0

Tigray North Western Tigray Laelay Adiabo 1 0

Tigray Central Tigray Tahitay Maychew 1 0

Tigray Central Tigray Tanqua Abergele 1 0

Grand Total 10 0

10. Measles

During the week 27, a total of 52 suspected measles cases without death were reported and as compared

to last week there was 6.1% (3 cases) increment. The annualized proportion of woredas that reported at

least one suspected measles case as of week 27, were 56% (496 woredas) nationwide. The national non

measles febrile rash rate as of week 27 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 27, 2017, Ethiopia.

Region Name Non Measles Febrile Rash

Rate

# of Woredas Expected to Report at least 1

Suspected Measles Case

# of Woredas Reported at least 1 Suspected

Measles Case

Proportion of Woredas Reported at least 1

Suspected Measles Case

Addis Ababa 17.7 85 85 100%

Afar 1.5 30 7 23%

Amhara 1.5 143 82 57%

B/Gumuz 11.9 16 15 94%

Dire Dawa 2.9 1 1 100%

Gambella 1.4 8 2 25%

Hareri 0.7 1 1 100%

Oromia 2.5 332 166 50%

SNNPR 2.1 152 93 61%

Somali 1.2 69 14 20%

Tigray 1.8 49 30 61%

National 2.8 886 496 56%

Note: # = number

Suspected measles outbreak threshold was surpassed in about 15 woredas based on the national outbreak

threshold criteria (woreda that reported greater than five suspected cases over the last four weeks, 24-27

weeks).


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Note: NMFR: Non Measles Febrile Rash Rate

Map 2: Woreda level non measles febrile rash rate and outbreak status as of week 27 of 2017,

Ethiopia.

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11. Neonatal Tetanus

Two suspected cases of NNT with one death from Oromia Region were reported during the week.

Table 6: Distribution of suspected NNT cases and death by reporting sites, week 27 of 2017,

Ethiopia.

Region Zone Reporting site Case Death

Oromia West Guji Bule Hora Hospital 2 0

Oromia Arsi Digeluna Tijo 1 1

Grand Total 2 1

12. Rabies Exposure

A total of 109 exposure cases without death were reported during the week which was 34.6% (28 cases)

higher than the last week exposure cases.

Table 7: Distribution of rabies exposure cases and deaths by reporting sites, week 27 of 2017,

Ethiopia.

Region Zone Reporting sites Case Death

Amhara Waghimra Dehena 21 0

Tigray North Western Tigray Shire Enida Silase Town 19 0

Amhara Wag Himra Tefera Hailu Hospital 18 0

Amhara Gonder Town Gonder Town 15 0

Tigray Central Tigray Akisum Town 6 0

Oromia East Wellega Jimma Arjo 6 0

Tigray Mekele Especial Zone South & North Mekele 5 0

Tigray Central Tigray Tanqua Abergele 4 0

Tigray Central Tigray Abiyi Adi Town 3 0

Amhara West Gojjam Bure Zuria 3 0

Amhara Wag Himra Sehale Seyemt 3 0

Tigray Eastern Tigray Adi Girat Town 2 0

Tigray South Tigray Korem Town 2 0

Oromia west Guji Bule Hora Hospital 1 0

Tigray Central Tigray Wereilehi 1 0

Grand Total 109 0

13. Maternal Death

During the week a total of 26 maternal deaths were reported from 21 reporting sites of Oromia Region

(15 deaths), Amhara Region (7 deaths), SNNPR (2 deaths), B/Gumuz Region (1 death) and Addis

Ababa (1 death).


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Note: MD: Maternal death

Map 3: Maternal death distribution by woreda, week 1-27, 2017, Ethiopia.

14. Influenza Sentinel Surveillance

In week 27 of 2017, a total of 11 patients complaining of ILI or SARI were reported and throat swab

samples were collected to be tested in predesignated influenza sentinel sites. Among them two samples

were tested positive for Influenza A H3N2 (seasonal influenza).

N

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Figure 10: Influenza suspected samples processed and sub type, week 1-27, 2017, Sentinel

Surveillance Sites, Ethiopia.

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

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

Afar Regions. During the week a total of 212 suspected cases of AWD with one 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.

2. Dengue Fever Outbreak

There is confirmed ongoing dengue fever outbreak in Dire Dawa City administration. The response to

the outbreak is undergoing by both national and city administration health bureau team.

VI. Other Activities

1. Malaria Surveillance System Strengthning Training

In order to build the capacity of public health emergency management officers at all levels malaria

epidemiological approach training was conducted Jimma Town from 20th-23rd July 2017 capacitating

about 120 PHEM officers from western part of Oromia Region. The training will be extended to the

eastern part of Oromia Region from 24th-27th July 2017 in Adama Town.


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2. Frontline FETP Workshop

In order to capacitate the Addis Ababa City Administration PHEM officers, 1st round of 2nd frontline

FETP workshop was conducted from 18th -22nd July 2017 in Adama Town training about 54 PHEM

officers and the second round will take place from 24th-28th July 2017.

3. EDEP Activivities

In order to enhance GWD case investigation, 47 RRT members in B/Gumuz Region were trained on

GWD Eradication. Additionally, regional level quarterly review meeting was conducted and refresher

training was also provided to NTD, PHEM and EPI officers/focal persons from all woredas of the

Region.

4. Vaccine Preventable Diseases Surveillance System Strengthening Activities

In order to strengthen VPD surveillance system in collaboration with WHO AFRO midyear review of

surveillance and immunization plan was conducted in Lusaka, Zambia and training on environmental

surveillance was conducted in Abujan, Ivory Cost.

5. 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 measles, 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

Toll free telephone: 8335/8665

Author and Editor in Chief:

Zewdu Assefa-MPH, Field Epidemiologist

E-mail: [email protected]

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

Contributors:

Diriba Sufa and Mengistu Biru: Measles, Acute Flaccid Paralysis and Neonatal Tetanus

Shambel Habebe: Acute Watery Diarrhea

Abdulhafiz Hassen: Maternal Death

Getaneh Abraha: Guinea worm disease

Mesfin Mengesha: Influenza

Yohanes Dugasa: Malaria Epidemiological Approach Training

Kefyalew Amene: Addis Ababa Frontline FETP Workshop

Reviewers:

Emana Alemu (MPH, Delegate for National Early Warning and Response Team)

Abyot Bekele (MPH, Coordinator for National Early Warning and Response Team)

Ethiopian Public Health Institute Center for Public Health …€¦ · epidemiological approach...

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