YEMEN: cholera outbreak Weekly epidemiology bulletin Week 24 - 2017
Highlights
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During week 24 (from 11 to 17 June 2017), 37 808 suspected cholera cases and 187 deaths were reported in Yemen. Since the beginning of this outbreak second wave (from 27 April to 18 June 2017), 166 976 suspected cholera cases, and 1 146 deaths (CFR: 0.7%) have been reported in 20 of the country 23 governorates (87%), and in 85% of the districts (283/333).
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The apparent decline of cases should be interpreted with caution given incompleteness of reporting in some districts
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Geographical distribution of cases The four most affected governorates were Amanat Al Asimah, Al Hudaydah, Amran and Hajjah with 49.3% (82 308/166 976) of the cases reported since 27 April 2017. Al Mahwit governorate had still the highest attacks rate (116.0 per 10 000), followed by Amran governorate (114.8 per 10,000) (see table 1 and figure 2).
Table 1: Number of cholera cases and attack rate by governorate, Yemen, 27 April – 18 June 2017
Governorate
Cases
Attack Rate (per 10 000)
Amanat Al Asimah
27 134
82.0
Al-Hudaydah
20 182
60.3
Amran
17 561
114.8
Hajjah
17 431
78.5
Sana'a
14 149
113.1
Taizz
13 194
43.5
Ibb
12 832
41.9
Al Mahwit
8 822
116.0
Dhamar
8 489
40.0
Al Dhale'e
6 802
90.3
Al Bayda
5 963
77.4
Aden
4 699
49.1
Abyan
3 194
52.2
Raymah
3 019
47.6
Lahj
1 900
18.1
Al_Jawf
841
13.0
Ma'areb
456
12.7
163 110 35 166 976
1.8 6.8 0.5 56.3
Sa'ada AL Mahrah Shabwah Total
Since 12 June2, 33 091 suspected cases and 175 deaths of cholera were reported in 20 governorates and 250 districts (see table 2). The highest numbers of cases were reported in Amanat Al Asimah and Al Hudaydah governorates, and in the districts of Al Hali (Al Hudaydah gov., 1 820 cases, 4 deaths), Ma'ain (Amanat Al Asimah gov., 871 cases, 2 deaths) and Bani Al Harith (Amanat Al Asimah gov., 861 cases, 2 deaths).
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Previous weekly epi bulletin was released on 11 June
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Table 2: Number of cholera cases and deaths by governorate, Yemen, 12 June – 18 June 2017
Governorate
Deaths
Al-Hudaydah
4 835
19
Amanat Al Asimah
4 521
6
Ibb
3 969
34
Amran
3 257
11
Taizz
2 923
17
Sana'a
2 699
13
Dhamar
2 251
21
Al Dhale'e
1 886
10
Hajjah
1 281
15
Al Mahwit
1 332
7
Al Bayda
780
-
Aden
866
3
Raymah
841
14
Abyan
641
-
Lahj
559
-
Al_Jawf
192
2
Ma'areb
160
2
AL Mahrah
60
1
Sa'ada
24
-
Shabwah
14
-
Total
Cases
33 091
175
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The map shows the Yemen governorates and the attack rates per district per 10 000 population
Since 27 April 85% of all districts (283/333) have been affected. Figure 3 shows the 45 most affected districts where 56.4% (93 428/165 575)3 of the cases have been reported. The highest number of cases were reported in Al Hali (Al Hudaydah gov., 7 722 cases, 15 deaths), Bani Al Harith (Amanat Al Asimah gov., 5 280 cases, 10 deaths) and Ma’ain (Amanat Al Asimah gov., 5 261 cases, 7 deaths). Zulaymat Habur (Amran gov.) and Ash Sharyah (Al Bayda gov.) had the highest attack rates (respectively 390.2 and 316.4 per 10 000).
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1 401 missing values
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Figure 4: Epidemic curves of most affected governorates and districts, Yemen, 27 April – 18 June 2017
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Hajjah is one of the main late-reporting governorates
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Case fatality ratio, and age and sex distribution
Table 3: Number of cholera cases and case fatality ratio (CFR), Yemen, 27 April – 18 June 2017
Governorate Amanat Al Asimah Al-Hudaydah Amran Hajjah Sana'a Taizz Ibb Al Mahwit Dhamar Al Dhale'e Al Bayda Aden Abyan Raymah Lahj Al_Jawf Ma'areb Sa'ada AL Mahrah Shabwah Total
Number of Proportion of Number of CFR (%) cases cases (%) deaths 27 134 16.3 51 0.2 20 182 12.1 110 0.5 17 561 10.5 120 0.7 17 431 10.4 181 1.0 14 149 8.5 83 0.6 13 194 7.9 92 0.7 12 832 7.7 163 1.3 8 822 5.3 77 0.9 8 489 5.1 81 1.0 6 802 4.1 36 0.5 5 963 3.6 18 0.3 4 699 2.8 37 0.8 3 194 1.9 21 0.7 3 019 1.8 55 1.8 1 900 1.1 8 0.4 841 0.5 9 1.1 456 0.3 3 0.7 163 0.1 - - 110 0.1 1 0.9 35 0.0 - - 166 976 100.0 1 146 0.7
From 27 April to 18 June, the overall case fatality ratio (CFR) was 0.7 % (1 146/166 976). The highest CFR were still reported in Raymah, Ibb, and Al Jawf governorates, respectively 1.8%, 1.3%, and 1.1% (see table 3 and figure 5). The Ministry of health and WHO are investigating the reasons behind the high CFR in these governorates. Since 12 June, the overall CFR was 0.5% (175/33 091) and was the highest in Raymah governorate (1.7%, 14/841) and Al Mahrah governorate (1.7%, 1/60) (see figure 6).
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The male/female sex ratio was 0.9. The highest proportion of cases was still seen in the 1529 year age group (i.e. 27.5%). Patients aged under 18 years old were 47.0% of the total. People over 60 years old were more at risk of dying (CFR: 3.1%), followed by cases in the 4560 year age group (CFR: 1.4%) (see table 4). CFR was slightly higher in male than in female cases (respectively 0.73% and 0.65%). Table 4: Distribution of cholera cases and deaths by age, Yemen, 27 April – 18 June 2017 Age Cases Deaths (y.o.) % of Male Female Total* Male Female Total** cases < 5 5 - 14 15 - 29 30 - 44 45 - 60 > 60 Total
16 859 20 086 18 893 10 906
13 794 17 730 26 751 16 181
30 653 37 816 45 644 27 087
18.5 22.8 27.5 16.3
89 88 44 67
5 545 5 232 77 521
7 679 13 224 6 227 11 459 88 362 165 883
8.0 6.9 100.0
98 177 563
*1 093 missing values
73 85 66 85
CFR (%)
162 173 110 152
0.5 0.5 0.2 0.6
83 181 183 360 575 1 138
1.4 3.1 0.7
**8 missing values
For further information:
Dr Xavier de Radiguès C: +967 738 445 522 Dr Ahmed Zouiten
[email protected] Note: This bulletin is now released once a week. A shorter update is proposed daily. You can find them on EMRO website.
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