SOMALIA DART SITUATION REPORT 9 RIFT VALLEY

UNCLAS SECTION 01 OF 04 NAIROBI 000477 SIPDIS AIDAC AID/DCHA FOR MHESS, WGARVELINK, LROGERS DCHA/OFDA FOR KLUU, GGOTTLIEB, AFERRARA, ACONVERY, CGOTTSCHALK, KCHANNELL DCHA/FFP FOR WHAMMINK, JDWORKEN AFR/AFR/EA FOR JBORNS STATE FOR AF/E AND PRM STATE/AF/E FOR NGARY STATE/F FOR ASISSON STATE/PRM FOR AWENDT, MMCKELVEY NSC FOR TSHORTLEY USUN FOR TMALY BRUSSELS FOR PLERNER GENEVA FOR NKYLOH USMISSION UN ROME FOR RNEWBERG SIPDIS E.O. 12958: N/A TAGS: EAID PREF PHUM PREL SO SUBJECT: SOMALIA DART SITUATION REPORT 9 RIFT VALLEY FEVER UPDATE REFS: A) NAIROBI 00255 NAIROBI 00000477 001.2 OF 004 SUMMARY ¶1. On January 23, the first human case of Rift Valley fever (RVF) in Somalia was confirmed. Animal sampling is currently targeting Afmadow District and Dobley near the Kenya border. To date, no animal samples have been tested or confirmed for RVF. RVF Task Force members report that local radio stations are broadcasting public health messages, some Somali medical staff have been trained in case identification and management, and protocols for sampling animal and human cases have been established. Currently, the fluid security situation limits surveillance teams' access to affected areas, hinders transport of samples, and prevents additional Kenya-based medical and veterinary staff from assisting in RVF response efforts. The USG Disaster Assistance Response Team (DART) reports that coordination between the UN Food and Agriculture Organization (FAO) and the UN World Health Organization (WHO) needs to rapidly improve to ensure timely dissemination of information, rapid sample collection and transport, adequate disease surveillance in humans and livestock, and implementation of intervention activities. End Summary. ¶2. The Somali Support Secretariat has mobilized a RVF Task Force including UN agencies and health and livestock sector non-governmental organizations (NGOs). The purpose of the WHO-chaired RVF Task Force is to share information and coordinate response plans. (REFTEL) DART members have attended the weekly Task Force meetings and are concerned that critical information tracking systems of WHO and FAO need to be improved. STATUS OF EPIDEMIC IN SOMALIA ¶3. On January 23, one of two human samples taken in the Medecins Sans Frontieres (MSF)-supported Marare Hospital in Jilib District, Middle Juba Region, tested positive for RVF in laboratory tests conducted in Nairobi. This is the first confirmed human case in Somalia. The patient traveled from Dobley, the same area where the first RVF-suspected deaths were reported in early December, to Marare. Three other samples tested the week of January 15 were negative for RVF, although the cold chain was broken during transport of the samples. From December 12 to January 17, WHO has reported a total of 84 suspected RVF cases, including 49 deaths in Somalia. ¶4. FAO reported on January 25, that more than 200 samples from small ruminants and cattle were in Afmadow and Marare awaiting transport to Nairobi for testing. To date, no animal samples have been tested or confirmed for RVF. ¶5. WHO reports that there are 13 hospitals that can provide care for RVF patients, with at least one hospital in each region. The hospitals identified for RVF care are Marare, Kismayo, Merka, Medina, Keynsey, Luug, Garbaharey, Khalil, Dinsor, Baidoa, Hudur, Jowhar, and Belet Weyne. DISEASE SURVEILLANCE EFFORTS: HUMAN AND LIVESTOCK NAIROBI 00000477 002.2 OF 004 ¶6. Human case surveillance is being conducted by WHO polio surveillance teams, non-governmental organization (NGO) health clinics, and regional hospitals. The majority of RVF cases are being reported by WHO polio teams that have 147 district officers supporting RVF surveillance in the field. However, 99 percent of the team members who are referring suspected cases to health facilities are not medical staff and do not have adequate training to collect samples from suspected RVF cases, according to members of the RVF Task Force. Health clinics, maternal and child health facilities, and NGOs have also contributed to surveillance efforts when access allows or when suspected cases are referred to their health facilities. WHO has trained some Somali medical staff in surveillance, case identification, and case management. ¶7. MSF-Holland has played a key role in the surveillance efforts at Marare health clinic, which is accessible to people in Afmadow District. MSF has a team trained in managing RVF cases, collecting samples, and MSF uses their own planes to transport the samples to the U.S. Centers for Disease Control and Prevention (CDC) laboratory in Nairobi. ¶8. FAO, the Somali Animal Health Services Program (SAHSP),Cooperazione Internazionale (COOPI),and Veterinaires Sans Frontieres (VSF)-Swiss are coordinating animal field surveillance activities. SAHSP plans to conduct an animal serological survey at the end of January and results from this survey will guide future interventions, according to FAO. ¶9. The DART notes that disease surveillance is hindered by the unpredictable security situation, limiting movement of surveillance teams. On January 23, the UN Office for the Coordination of Humanitarian Affairs (OCHA) reported that efforts to obtain written assurances of safety for a WHO-led medical mission to Kismayo to assess the health situation, including the possible presence of RVF, have so far been unsuccessful. At the first RVF Task Force meeting in Nairobi, an NGO representative commented that with the Somalia-Kenya border closed, transport of samples from Lower Juba Region to Kenya via road was impossible. SAMPLE COLLECTION ¶10. The traveling time of the human samples from Somalia to Nairobi has been increased by insecurity, lack of humanitarian flights, and the Kenya-Somalia border closure. During the transport of the first three human samples, the cold chain was broken as the sample was in transit for two days without adequate levels of refrigeration. This made the results, which were negative for RVF, inconclusive. WHO reports that insecurity has limited access, forcing health staff to focus on collecting samples from the most probable cases and not all suspected cases in the affected areas. ¶11. The approach with human cases has been to only obtain samples from probable cases rather than suspected cases (probable cases have both fever and bleeding). If RVF is confirmed in a particular area, sampling may be broadened to include all suspected NAIROBI 00000477 003.2 OF 004 cases. ¶12. FAO reports that collection of animal specimens has to take place in potentially infected areas (in contrast to the human sample collection that occurs at medical facilities). On January 23, the SAHSP reported that two teams were collecting samples near the Kenya- Somalia border and the riverine areas near Marare. FAO reports that 200 samples from small ruminants and cattle collected in Hayo and Qoqani are in the freezer at Afmadow. Other samples are in cold chain storage at Marare. SAHSP is currently processing the Government of Kenya (GOK) biological material entry permits needed to transport the samples to Nairobi for laboratory testing. ¶13. FAO also reports that it is working closely with the Somali Transitional Federal Government (TFG) Chief Veterinary Officer, sharing information and seeking TFG input into response plans. ANIMAL VACCINATION AND OTHER INTERVENTIONS ¶14. In the meetings attended by the DART, health and livestock agencies have debated on whether animal vaccination should be part of an intervention strategy in Somalia. All experts agree that vaccination in Somalia is not the control method of choice within the declared infected zone. FAO plans to vaccinate in areas that do not have RVF and are deemed to be at high risk for the disease, such as wetlands. ¶15. FAO also plans to treat livestock with insecticide to minimize contact with mosquitoes that transmit RVF. FAO will support WHO with public education messages on RVF prevention. ¶16. The UN Children's Fund (UNICEF) and WHO are distributing approximately 200,000 insecticide-treated mosquito nets to partner agencies, health facilities, and other groups in high-risk regions. The distribution is part of the ongoing flood response as well as a RVF prevention measure. SOCIAL MOBILIZATION ACTIVITIES ¶17. WHO reports that the Jowhar radio station broadcasts daily messages to the community about case definition and prevention of RVF. WHO has distributed health education and surveillance materials to Jowhar Hospital staff, the Italian NGO INTERSOS, Somali Red Cross Society (SRCS),MSF, the UN Development Program (UNDP),and UNICEF. WHO has also discussed community mobilization strategies with MSF, SRCS head nurses, and health officers in Galgadud Region. WHO plans to conduct a workshop for partners in Nairobi to increase awareness of RVF prevention in the next week and will replicate the workshops in Kismayo, Mogadishu, Wajid, Garowe, and Hargeisa in the coming weeks. ECONOMIC IMPLICATIONS ¶18. According to FAO, an outbreak of RVF in 1997 and 1998 lead to a livestock export ban imposed by important markets in the Middle East, which caused a loss of revenue for producers and traders. FAO estimates that approximately 3 to 4 million head of NAIROBI 00000477 004.2 OF 004 livestock are exported annually from Somalia to countries on the Arabian Peninsula. Somalia is expected to suffer greater economic loss than Kenya, because Somalia exports more livestock. ¶19. It is not yet clear if the United Arab Emirates will impose a ban on livestock imports from the Horn of Africa but they are reported to be testing animals to determine if any are carrying RVF. USAID RESPONSE ACTIVITIES ¶20. USAID's Office of U.S. Foreign Disaster Assistance (OFDA) has funded the purchase of animal vaccines in Kenya. OFDA is reviewing an FAO funding request for interventions in Somalia and other parts of the region. At this time, WHO has not requested USAID funding for assistance with human RVF interventions. ¶21. OFDA is deploying a livestock specialist to assist in developing a regional approach with the key stakeholders in Kenya, Somalia, and Ethiopia. ¶22. OFDA is coordinating efforts with other USG offices, such as CDC, USAID/Kenya, and USAID/East Africa to plan RVF response efforts. Additionally, OFDA is emphasizing a regional approach to RVF response and is supporting efforts in Kenya, Ethiopia, and Somalia. ¶23. The DART notes that coordination among the Somalia RVF Task Force agencies needs to be quickly improved. Improved coordination will expedite data and sample collection, as well as transport of samples to Nairobi for testing. Additionally, WHO and FAO need to disseminate accurate, timely, and comprehensive information on number of cases in human and animals (similar to the information provided on RVF in Kenya by WHO). RANNEBERGER