Cholera in Zimbabwe Aug08-Jan09 · CTC and CTU • 231 active CTC/CTUsdistributed in the country...
Transcript of Cholera in Zimbabwe Aug08-Jan09 · CTC and CTU • 231 active CTC/CTUsdistributed in the country...
Cholera in Zimbabwe Aug08-Jan09
Epidemiology update
25–31 Jan 2009
Email: [email protected].
C4 Surveillance and lab group
Toll free number for alert by district and province is 08089001 or
08089002 or 08089000
Mobile number for alerts is 0912 104 257
Summary – week 5 (25-31 Jan 09)
Background
• Start of outbreak in August 08; Chitugwiza province
• Since beginning, 58/62 (93%) districts affected in 10 provinces
• 306 CTC actives on 358 CTC/CTU opened since start (04Feb09)
Week 5 (25-31 Jan 09)
• 8,653 new cases (7,378 prior week)
• 336 new deaths (332 prior week)
• crude CFR 3.9 % and institutional CFR 1.4 %
Total since beginning
• 61,304 suspected cases and 3,181 deaths
• 1,948 of deaths (66%) at community level
• Overall crude CFR 5.2% and institutional CFR 2.1%
CTC and CTU
• 231 active CTC/CTUs distributed in the country
• Half run only by MoHCW and half with NGOs/partners
Cholera in Zimbabwe, Aug08-Jan09
New suspected cases & deaths by week of report
0
2,000
4,000
6,000
8,000
10,000
w47 w48 w49 w50 w51 w52 w1 w2 w3 w4 w5
epidemiological weeks
number
cases
deaths
2008 2009
(61,304 cases / 3,181 death)
Weekly Attack rates by district
A) This week : 25-31 Jan 09 B) Cumulative (different scale)
54 reporting districts
21 : Decreased caseload
27 : Increased caseload
5 : No case
Attack Rate (per 100,000)
No cases/deaths
No data
1-9
10-99
100-199
>=200
Attack Rate
0
0. 1 - 9 9.9
10 0 - 499. 9
50 0.0 - 99 9.0
10 00 a nd above
Crude case-fatality ratios, by district
Cases Fatality Ratio
No data
no cases/no deaths
0
0.1 - 1.0
1.1 - 5.0
>5
A)This week: 25-31 Jan 2009 B) Last week: 18-24 Jan 09
17 (>35%) had a crude CFR>5%
Case Fatality Ratio
No data
no cases/no deaths
0
0.1-1.0
1.1-5.0
>=5
Cholera in Zimbabwe Aug08-Jan09
Cumulative suspected cases reported by province (N=61,304)
14,259
14,126
7,081
6,970
4,991
4,865
3,975
3,584
1,034
419
Mashonaland West
Harare
Manicaland
Masvingo
Matabeleland South
Mashonaland East
Mashonaland Central
Midlands
Matebeleland North
Bulawayo
(23%)
(23%)
Cholera in Zimbabwe Week 5 (25-31 Jan 09)
Cumulative suspected cases reported by province (N=8,653)
1,825
1,805
1,452
1,172
815
572
404
385
213
10
Mashonaland Central
Mashonaland West
Masvingo
Midlands
Manicaland
Harare
Mashonaland East
Matabeleland South
Matebeleland North
Bulawayo
(21%)
(21%)
(17%)
“Hot spots” this week
1/3
2/2
8/8
7/8
6/6
7/7
N° district
case
w5>w4
1.310 (0%)5385Mata South
1.723 (23%)13572Harare
2.3846 (71%)65815Manicaland
1.3316 (52%)311,172Midlands
1.4442 (68%)621,452Masvingo
0.3240 (89%)451,825Mash Central
Inst
CFR**
Crude
CFR
Com
Deaths
*
Total
Deaths
Total
Cases
Province
Increasing trend in 6 provinces, decrease in other provinces
* Community deaths
** Institutional Case Fatality Ratio
Cholera in Chitungwiza province, Zimbabwe
17 aug 08-31 Jan 09
0
50
100
150
200
250
300
17-23 Aug
24-30 Aug
31 Aug- 6 Sep
7-13 Sep
14-20 Sep
21-27 Sep
28 Sep -4 Oct
5-11 Oct
12-18 Oct
19-25 Oct
26 Oct-1 Nov
2-8 Nov
9-15 Nov
16-22 Nov
23-29 Nov
30 Nov - 6 Dec
7-13 Dec
14-20 Dec
21-27 Dec
28 Dec-3 Jan
4-10 Jan
11-17 Jan
18-24 Jan
25-31 Jan
Cases
CasesDeaths
Harare province week 5
Cholera in Harare City, Zimbabwe
17 aug 08-31 Jan 09
0
500
1000
1500
2000
2500
3000
17-23 Aug
24-30 Aug
31 Aug- 6 Sep
7-13 Sep
14-20 Sep
21-27 Sep
28 Sep -4 Oct
5-11 Oct
12-18 Oct
19-25 Oct
26 Oct-1 Nov
2-8 Nov
9-15 Nov
16-22 Nov
23-29 Nov
30 Nov - 6 Dec
7-13 Dec
14-20 Dec
21-27 Dec
28 Dec-3 Jan
4-10 Jan
11-17 Jan
18-24 Jan
25-31 Jan
Cases
Cases
Deaths
Most cases were reported from Harare city (different scales)
Cholera in Mashonaland Central province,
Zimbabwe
17 aug 08-31 Jan 09
0
500
1,000
1,500
2,000
2,500
17-23 Aug
24-30 Aug
31 Aug- 6 Sep
7-13 Sep
14-20 Sep
21-27 Sep
28 Sep -4 Oct
5-11 Oct
12-18 Oct
19-25 Oct
26 Oct-1 Nov
2-8 Nov
9-15 Nov
16-22 Nov
23-29 Nov
30 Nov - 6 Dec
7-13 Dec
14-20 Dec
21-27 Dec
28 Dec-3 Jan
4-10 Jan
11-17 Jan
18-24 Jan
25-31 Jan
Cases Cases
Deaths
Cholera in Masvingo province, Zimbabwe
17 aug 08-31 Jan 09
0
500
1000
1500
2000
17-23 Aug
24-30 Aug
31 Aug- 6 Sep
7-13 Sep
14-20 Sep
21-27 Sep
28 Sep -4 Oct
5-11 Oct
12-18 Oct
19-25 Oct
26 Oct-1 Nov
2-8 Nov
9-15 Nov
16-22 Nov
23-29 Nov
30 Nov - 6 Dec
7-13 Dec
14-20 Dec
21-27 Dec
28 Dec-3 Jan
4-10 Jan
11-17 Jan
18-24 Jan
25-31 Jan
Cases
Cases
Deaths
Cholera in Midlands province, Zimbabwe
17 aug 08-31 Jan 09
0
500
1000
1500
2000
17-23 Aug
24-30 Aug
31 Aug- 6 Sep
7-13 Sep
14-20 Sep
21-27 Sep
28 Sep -4 Oct
5-11 Oct
12-18 Oct
19-25 Oct
26 Oct-1 Nov
2-8 Nov
9-15 Nov
16-22 Nov
23-29 Nov
30 Nov - 6 Dec
7-13 Dec
14-20 Dec
21-27 Dec
28 Dec-3 Jan
4-10 Jan
11-17 Jan
18-24 Jan
25-31 Jan
Cases
Cases
Deaths
Cholera in Manicaland province, Zimbabwe
17 aug 08-31 Jan 09
0
500
1000
1500
2000
17-23 Aug
24-30 Aug
31 Aug- 6 Sep
7-13 Sep
14-20 Sep
21-27 Sep
28 Sep -4 Oct
5-11 Oct
12-18 Oct
19-25 Oct
26 Oct-1 Nov
2-8 Nov
9-15 Nov
16-22 Nov
23-29 Nov
30 Nov - 6 Dec
7-13 Dec
14-20 Dec
21-27 Dec
28 Dec-3 Jan
4-10 Jan
11-17 Jan
18-24 Jan
Cases
Cases
Deaths
Cholera in Matabeleland South province, Zimbabwe
17 aug 2008 - 31 Jan 09
0
500
1000
1500
2000
17-23 Aug
24-30 Aug
31 Aug- 6 Sep
7-13 Sep
14-20 Sep
21-27 Sep
28 Sep -4 Oct
5-11 Oct
12-18 Oct
19-25 Oct
26 Oct-1 Nov
2-8 Nov
9-15 Nov
16-22 Nov
23-29 Nov
30 Nov - 6 Dec
7-13 Dec
14-20 Dec
21-27 Dec
28 Dec-3 Jan
4-10 Jan
11-17 Jan
18-24 Jan
25-31 Jan
Cases
Cases
Deaths
Cholera in Zimbabwe from 16 nov 08 to 31 Jan 09
Weekly crude (CFR) and institutional (iCFR) case-fatality ratios
0
1
2
3
4
5
6
7
8
9
10
w47 w48 w49 w50 w51 w52 w1 w2 w3 w4 w5
Epidemiological weeks
percent
CFR
iCFR
*
*
CFR = all reported deaths/all reported cases
iCFR = institutional deaths/institutional cases
Target = 1%
Cholera in Zimbabwe, Dec08-Jan09
Weekly number of new death by location
0
100
200
300
400
500
w51 w52 w1 w2 w3 w4 w5
epidemiological weeks
numberat community level
in health facilities
Cholera in Mudzi district
Age distribution of cases – 06/10-12/12/08(on-going analysis)
5.7861,512Total
5.9681,160Pop >=15
3.78214pop 5-14
8.011138Pop < 5
CFRDeathsCasesAge group
Completeness of district reporting (week 4)
On average 47% of districts reported each day
Reporting particularly poor on Sunday (31%).
At time of reporting, reports were
• complete: 30% of districts
• missing for 1 to 2d : 40%
• missing for 3 to 6d: 15%
• missing completely: 5%
Interpretation
Weekly caseload
• Continuous increasing trend
• Relapsing increase in Harare
• Rural provinces continue reporting increasing cases
Weekly mortality
• Count of deaths stable despite increasing caseload
• Crude CFR remaining high but decreasing
• Institutional CFR stable and < 2%. Better/earlier management?
• % of community deaths decreasing. Better home care ?
Better attendance to CTCs/CTU ?
Thank you for you
attention